基于光学表面引导技术优化离子束治疗床旁骨盆、四肢及胸部/脊柱肿瘤患者的体位摆放流程
Optimizing the Patient Positioning Workflow of Patients with Pelvis, Limb, and Chest/Spine Tumors at an Ion-Beam Gantry based on Optical Surface Guidance.
作者信息
Qubala Abdallah, Schwahofer Andrea, Jersemann Stefan, Eskandarian Saleh, Harrabi Semi, Naumann Patrick, Winter Marcus, Ellerbrock Malte, Shafee Jehad, Abtehi Samira, Herfarth Klaus, Debus Jürgen, Jäkel Oliver
机构信息
Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany.
Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.
出版信息
Adv Radiat Oncol. 2022 Dec 5;8(2):101105. doi: 10.1016/j.adro.2022.101105. eCollection 2023 Mar-Apr.
PURPOSE
Surface-guided radiation therapy (SGRT) has been investigated intensively to ensure correct patient positioning during a radiation therapy course. Although the implementation is well defined for photon-beam facilities, only a few analyses have been published for ion-beam therapy centers. To investigate the accuracy, reliability, and efficiency of SGRT used in ion-beam treatments against the conventional skin marks, a retrospective study of a unique SGRT installation in an ion gantry treatment room was conducted, where the environment is quite different to conventional radiation therapy.
METHODS AND MATERIALS
There were 32 patients, divided into 3 cohorts-pelvis, limb, and chest/spine tumors-and treated with ion-beams. Two patient positioning workflows based on 300 fractions were compared: workflow with skin marks and workflow with SGRT. Position verification was followed by planar kilo voltage imaging. After image matching, 6 degrees of freedom corrections were recorded to assess interfraction positioning errors. In addition, the time required for patient positioning, image matching, and the number of repeated kilo voltage imaging also were gathered.
RESULTS
SGRT decreased the translational magnitude shifts significantly ( < .05) by 0.5 ± 1.4 mm for pelvis and 1.9 ± 0.5 mm for limb, whereas for chest/spine, it increased by 0.7 ± 0.3 mm. Rotational corrections were predominantly lowered with SGRT for all cohorts with significant differences in pitch for pelvis ( = .002) and chest/spine ( = .009). The patient positioning time decreased by 18%, 9%, and 15% for pelvis, limb, and chest/spine, respectively, compared with skin marks. By using SGRT, 53% of all studied patients had faster positioning time, and 87.5% had faster matching time. Repositioning and consequent reimaging decreased from about 7% to 2% with a statistically significant difference of .042.
CONCLUSIONS
The quality of patient positioning before ion-beam treatments has been optimized by using SGRT without additional imaging dose. SGRT clearly reduced inefficiencies in the patient positioning workflow.
目的
表面引导放射治疗（SGRT）已得到深入研究，以确保在放射治疗过程中患者体位正确。虽然光子束设备的实施已明确界定，但关于离子束治疗中心的分析仅有少数发表。为了研究离子束治疗中使用的SGRT相对于传统皮肤标记的准确性、可靠性和效率，我们对离子龙门治疗室中独特的SGRT装置进行了一项回顾性研究，该治疗室的环境与传统放射治疗有很大不同。
方法和材料
共有32例患者，分为3组——骨盆、肢体和胸部/脊柱肿瘤——接受离子束治疗。比较了基于300分次的两种患者体位设置工作流程：使用皮肤标记的工作流程和使用SGRT的工作流程。体位验证后进行平面千伏成像。图像匹配后，记录6个自由度的校正值，以评估分次间体位误差。此外，还收集了患者体位设置、图像匹配所需的时间以及千伏成像的重复次数。
结果
SGRT显著降低了平移幅度偏移（P <.05），骨盆偏移量为0.5±1.4 mm，肢体偏移量为1.9±0.5 mm，而胸部/脊柱则增加了0.7±0.3 mm。对于所有组，SGRT主要降低了旋转校正，骨盆（P = 0.002）和胸部/脊柱（P = 0.009）的俯仰角有显著差异。与皮肤标记相比，骨盆、肢体和胸部/脊柱的患者体位设置时间分别减少了18%、9%和15%。使用SGRT后，所有研究患者中有53%的体位设置时间更快，87.5%的匹配时间更快。重新定位及随之而来的重新成像从约7%降至2%，差异有统计学意义（P = 0.042）。
结论
通过使用SGRT，在不增加额外成像剂量的情况下优化了离子束治疗前患者体位设置的质量。SGRT明显减少了患者体位设置工作流程中的低效率情况。
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