Garbacz Magdalena, Skóra Tomasz, Cepiga Anna, Foltyńska Gabriela, Gajewski Jan, Góra Eleonora, Kędzierska-Pardel Dominika, Komenda Wiktor, Krzempek Dawid, Krzywonos Emilia, Mikołajski Tomasz, Ruciński Antoni, Sobkowicz Karolina, Sowa Urszula, Wochnik Agnieszka, Kisielewicz Kamil, Kopeć Renata
Cyclotron Centre Bronowice, The Henryk Niewodniczański Institute of Nuclear Physics Polish Academy of Sciences, ul. Radzikowskiego 152, 31-342 Krakow, Poland.
Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch, ul. Garncarska 11, 31-115 Krakow, Poland.
Cancers (Basel). 2025 Jun 14;17(12):1985. doi: 10.3390/cancers17121985.
This work presents the procedures and application of the deep inspiration breath-hold (DIBH) technique for mediastinal lymphoma patients at a proton therapy (PT) center. It also discusses the implementation and validation of the surface-guided radiotherapy (SGRT) protocol in terms of positioning accuracy. This study included six lymphoma patients. Dedicated computed tomography (CT) protocols and a treatment workflow based on international guidelines were developed. Clinical data from the treatment planning system (TPS) were used to assess the difference between DIBH and free-breathing irradiation. Additionally, data from an optical patient positioning system and kilovoltage (kV) imaging system were used to estimate positioning shifts. The new CT protocol reduced the volume CT dose index by over six times compared with the standard protocol. : The DIBH method decreased the mean dose to the heart and lungs by up to 7.02 Gy(RBE) and 0.83 Gy(RBE), respectively. The median magnitude of patient setup errors and repeatability in DIBH positioning was 0.4 cm and 0.18 cm (mean for males and females) for the SGRT protocol. The kV imaging showed a setup error of over 0.3 cm for both groups. : Despite the small size of the patient cohort, the relatively large number of individual positioning sessions enabled the detection of statistically significant differences ( < 0.05) in certain areas between male and female patients; however, no significant difference in the displacement vector magnitude was observed. DIBH treatment with SGRT offers high reproducibility for patient positioning.
这项工作展示了质子治疗（PT）中心针对纵隔淋巴瘤患者的深吸气屏气（DIBH）技术的程序及应用。它还从定位准确性方面讨论了表面引导放疗（SGRT）方案的实施与验证。本研究纳入了6名淋巴瘤患者。制定了专用计算机断层扫描（CT）方案及基于国际指南的治疗工作流程。利用治疗计划系统（TPS）的临床数据评估DIBH与自由呼吸照射之间的差异。此外，还利用光学患者定位系统和千伏（kV）成像系统的数据来估计定位偏移。新的CT方案与标准方案相比，将容积CT剂量指数降低了6倍多。：DIBH方法使心脏和肺部的平均剂量分别降低了高达7.02 Gy（相对生物效应）和0.83 Gy（相对生物效应）。对于SGRT方案，DIBH定位中患者摆位误差的中位数大小及重复性，男性和女性的均值分别为0.4 cm和0.18 cm。kV成像显示两组的摆位误差均超过0.3 cm。：尽管患者队列规模较小，但相对较多的个体定位 sessions 使得能够检测到男性和女性患者在某些区域存在统计学显著差异（<0.05）；然而，未观察到位移向量大小存在显著差异。采用SGRT的DIBH治疗为患者定位提供了高重现性。
