基于CBCT的头颈部被动散射质子治疗中的剂量监测与自适应计划触发
CBCT-Based Dose Monitoring and Adaptive Planning Triggers in Head and Neck PBS Proton Therapy.
作者信息
Reiners Keaton, Dagan Roi, Holtzman Adam, Bryant Curtis, Andersson Sebastian, Nilsson Rasmus, Hong Liu, Johnson Perry, Zhang Yawei
机构信息
University of Florida Health Proton Therapy Institute, Jacksonville, FL 32206, USA.
Medical Physics Graduate Program, University of Florida College of Medicine, Gainesville, FL 32610, USA.
出版信息
Cancers (Basel). 2023 Jul 30;15(15):3881. doi: 10.3390/cancers15153881.
PURPOSE
To investigate the feasibility of using cone-beam computed tomography (CBCT)-derived synthetic CTs to monitor the daily dose and trigger a plan review for adaptive proton therapy (APT) in head and neck cancer (HNC) patients.
METHODS
For 84 HNC patients treated with proton pencil-beam scanning (PBS), same-day CBCT and verification CT (vfCT) pairs were retrospectively collected. The ground truth CT (gtCT) was created by deforming the vfCT to the same-day CBCT, and it was then used as a dosimetric baseline and for establishing plan review trigger recommendations. Two different synthetic CT algorithms were tested; the corrected CBCT (corrCBCT) was created using an iterative image correction method and the virtual CT (virtCT) was created by deforming the planning CT to the CBCT, followed by a low-density masking process. Clinical treatment plans were recalculated on the image sets for evaluation.
RESULTS
Plan review trigger criteria for adaptive therapy were established after closely reviewing the cohort data. Compared to the vfCT, the corrCBCT and virtCT reliably produced dosimetric data more similar to the gtCT. The average discrepancy in D99 for high-risk clinical target volumes (CTV) was 1.1%, 0.7%, and 0.4% and for standard-risk CTVs was 1.8%, 0.5%, and 0.5% for the vfCT, corrCBCT, and virtCT, respectively.
CONCLUSION
Streamlined APT has been achieved with the proposed plan review criteria and CBCT-based synthetic CT workflow.
目的
探讨使用锥形束计算机断层扫描（CBCT）衍生的合成CT来监测头颈部癌（HNC）患者自适应质子治疗（APT）的每日剂量并触发计划复查的可行性。
方法
回顾性收集了84例接受质子笔形束扫描（PBS）治疗的HNC患者同日的CBCT和验证CT（vfCT）图像对。通过将vfCT变形至同日的CBCT创建了真实CT（gtCT），然后将其用作剂量学基线并用于建立计划复查触发建议。测试了两种不同的合成CT算法；校正后的CBCT（corrCBCT）使用迭代图像校正方法创建，虚拟CT（virtCT）通过将计划CT变形至CBCT，随后进行低密度掩蔽处理来创建。在这些图像集上重新计算临床治疗计划以进行评估。
结果
在仔细审查队列数据后建立了自适应治疗的计划复查触发标准。与vfCT相比，corrCBCT和virtCT可靠地产生了与gtCT更相似的剂量学数据。对于高风险临床靶区（CTV），vfCT、corrCBCT和virtCT的D99平均差异分别为1.1%、0.7%和0.4%，对于标准风险CTV分别为1.8%、0.5%和0.5%。
结论
通过所提出的计划复查标准和基于CBCT的合成CT工作流程实现了简化的APT。
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