Zhao Hui, Paxton Adam, Sarkar Vikren, Price Ryan G, Huang Jessica, Su Fan-Chi Frances, Li Xing, Rassiah Prema, Szegedi Martin, Salter Bill
Radiation Oncology, University of Utah - Huntsman Cancer Institute, Salt Lake City, USA.
Cureus. 2022 Aug 31;14(8):e28644. doi: 10.7759/cureus.28644. eCollection 2022 Aug.
In this study, patient setup accuracy was compared between surface guidance and tattoo markers for radiation therapy treatment sites of the thorax, abdomen and pelvis.
A total of 608 setups performed on 59 patients using both surface-guided and tattoo-based patient setups were analyzed. During treatment setup, patients were aligned to room lasers using their tattoos, and then the six-degree-of-freedom (6DOF) surface-guided offsets were calculated and recorded using AlignRT system. While the patient remained in the same post-tattoo setup position, target localization imaging (radiographic or ultrasound) was performed and these image-guided shifts were recorded. Finally, surface-guided vs tattoo-based offsets were compared to the final treatment position (based on radiographic or ultrasound imaging) to evaluate the accuracy of the two setup methods.
The overall average offsets of tattoo-based and surface-guidance-based patient setups were comparable within 3.2 mm in three principal directions, with offsets from tattoo-based setups being slightly less. The maximum offset for tattoo setups was 2.2 cm vs. 4.3 cm for surface-guidance setups. Larger offsets (ranging from 2.0 to 4.3 cm) were observed for surface-guided setups in 14/608 setups (2.3%). For these same cases, the maximum observed tattoo-based offset was 0.7 cm. Of the cases with larger surface-guided offsets, 13/14 were for abdominal/pelvic treatment sites. Additionally, larger rotations (>3°) were recorded in 18.6% of surface-guided setups. The majority of these larger rotations were observed for abdominal and pelvic sites (~84%).
The small average differences observed between tattoo-based and surface-guidance-based patient setups confirm the general equivalence of the two potential methods, and the feasibility of tattoo-less patient setup. However, a significant number of larger surface-guided offsets (translational and rotational) were observed, especially in the abdominal and pelvic regions. These cases should be anticipated and contingency setup methods planned for.
在本研究中，比较了胸部、腹部和骨盆放疗治疗部位使用体表引导和纹身标记进行患者摆位的准确性。
分析了59例患者使用体表引导和纹身标记两种患者摆位方式进行的总共608次摆位。在治疗摆位期间，患者通过纹身与室内激光对齐，然后使用AlignRT系统计算并记录六自由度（6DOF）体表引导偏移量。当患者保持在纹身后置摆位位置时，进行靶区定位成像（射线照相或超声）并记录这些图像引导移位。最后，将体表引导与纹身标记偏移量与最终治疗位置（基于射线照相或超声成像）进行比较，以评估两种摆位方法的准确性。
基于纹身和基于体表引导的患者摆位在三个主要方向上的总体平均偏移量在3.2毫米以内具有可比性，基于纹身的摆位偏移量略小。纹身摆位的最大偏移量为2.2厘米，而体表引导摆位为4.3厘米。在608次摆位中有14次（2.3%）体表引导摆位观察到较大偏移量（范围为2.0至4.3厘米）。对于这些相同的病例，观察到的基于纹身的最大偏移量为0.7厘米。在体表引导偏移量较大的病例中，14例中有13例是腹部/骨盆治疗部位。此外，在18.6%的体表引导摆位中记录到较大旋转（>3°）。这些较大旋转中的大多数在腹部和骨盆部位观察到（约84%）。
基于纹身和基于体表引导的患者摆位之间观察到的平均差异较小，证实了这两种潜在方法的总体等效性以及无纹身患者摆位的可行性。然而，观察到大量较大的体表引导偏移量（平移和旋转），尤其是在腹部和骨盆区域。应预期到这些情况并规划应急摆位方法。
