Schneider Sergej, Stefanowicz Sarah, Jentsch Christina, Lohaus Fabian, Thiele Julia, Haak Danilo, Valentini Chiara, Platzek Ivan, G C Troost Esther, Hoffmann Aswin L
Technische Universität Dresden, Faculty of Medicine Carl Gustav Carus, Dresden, Germany.
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.
Clin Transl Radiat Oncol. 2022 Nov 9;38:111-116. doi: 10.1016/j.ctro.2022.11.006. eCollection 2023 Jan.
Motion mitigation is of crucial importance in particle therapy (PT) of patients with abdominal tumors to ensure high-precision irradiation. Magnetic resonance imaging (MRI) is an excellent modality for target volume delineation and motion estimation of mobile soft-tissue tumors. Thus, the aims of this study were to develop an MRI- and PT-compatible abdominal compression device, to investigate its effect on pancreas motion reduction, and to evaluate patient tolerability and acceptance.
In a prospective clinical study, 16 patients with abdominal tumors received an individualized polyethylene-based abdominal corset. Pancreas motion was analyzed using time- and phase resolved MRI scans (orthogonal 2D-cine and 4D MRI) with and without compression by the corset. The pancreas was manually segmented in each MRI data set and the population-averaged center-of-mass motion in inferior-superior (IS), anterior-posterior (AP) and left-right (LR) directions was determined. A questionnaire was developed to investigate the level of patient acceptance of the corset, which the patients completed after acquisition of the planning computed tomography (CT) and MRI scans.
The corset was found to reduce pancreas motion predominantly in IS direction by on average 47 % - 51 % as found in the 2D-cine and 4D MRI data, respectively, while motion in the AP and LR direction was not significantly reduced. Most patients reported no discomfort when wearing the corset.
An MRI- and PT-compatible individualized abdominal corset was presented, which substantially reduced breathing-induced pancreas motion and can be safely applied with no additional discomfort for the patients. The corset has been successfully integrated into our in-house clinical workflow for PT of tumors of the upper abdomen.
在腹部肿瘤患者的粒子治疗（PT）中，减轻运动对于确保高精度照射至关重要。磁共振成像（MRI）是用于移动软组织肿瘤靶区勾画和运动估计的极佳方式。因此，本研究的目的是开发一种与MRI和PT兼容的腹部压迫装置，研究其对胰腺运动减少的效果，并评估患者的耐受性和接受度。
在一项前瞻性临床研究中，16例腹部肿瘤患者接受了个体化的基于聚乙烯的腹部束腹带。使用有和没有束腹带压迫的时间分辨和相位分辨MRI扫描（正交二维电影成像和四维MRI）分析胰腺运动。在每个MRI数据集中手动分割胰腺，并确定其在上下（IS）、前后（AP）和左右（LR）方向上的总体平均质心运动。设计了一份问卷来调查患者对束腹带的接受程度，患者在完成计划计算机断层扫描（CT）和MRI扫描后填写该问卷。
发现束腹带主要在IS方向上减少胰腺运动，在二维电影成像和四维MRI数据中分别平均减少47%-51%，而AP和LR方向上的运动没有显著减少。大多数患者表示佩戴束腹带时没有不适。
提出了一种与MRI和PT兼容的个体化腹部束腹带，其显著减少了呼吸引起的胰腺运动，并且可以安全应用，不会给患者带来额外不适。该束腹带已成功整合到我们用于上腹部肿瘤PT的内部临床工作流程中。
