技术说明:对一款新推出的表面导引放射治疗系统在左乳腺放射治疗中的深吸气保护评估。
Technical note: Clinical evaluation of a newly released surface-guided radiation therapy system on DIBH for left breast radiation therapy.
发表日期:2023 Sep 08
作者:
Hui Zhao, Vikren Sarkar, Adam Paxton, Y Jessica Huang, Christine Haacke, Ryan G Price, Fan-Chi Frances Su, Martin Szegedi, Prema Rassiah, Bill Salter
来源:
HEART & LUNG
摘要:
已经证明,通过使用深呼吸靶区放疗技术(DIBH)可以显著减少左乳癌放射治疗中的平均心脏剂量和左前降支(LAD)剂量。表面引导的深呼吸靶区放疗技术(Surface-guided DIBH)在过去十年中被广泛采用,目前主要有三种商用的三维复原技术(SGRT)系统。目前,有关新发布的SGRT系统在DIBH应用方面的性能报告非常有限。本研究旨在评估新发布的SGRT系统在左乳癌深呼吸靶区放疗中的临床表现。本研究纳入了25名采用Varian Identify系统进行DIBH治疗的左侧乳腺癌患者(共计493次治疗)。评估了临床表现的四个方面:深呼吸前患者准备期间自由呼吸Identify偏移、深呼吸期间的Identify偏移、深呼吸期间Identify与放射照射口的一致性以及深呼吸参考表面在患者移动后的重新获取。计算了每个患者自由呼吸Identify偏移和深呼吸Identify偏移的系统误差和随机误差。当患者深呼吸位于(± 0.3 cm,± 30°)的临床容忍度范围内时,进行放射照射口的摄影。然后将其与治疗区域的设计射线图(DRRs)进行比较。如果照射口显示患者对不符合DRRs在3mm内的调整,会进行患者移位,并重新捕获参考表面,然后进行验证照射口。对于自由呼吸阶段的人体表面Identify偏移,所有患者的系统误差和随机误差均在(0.4 cm,1.50°)范围内。最大的患者系统误差和随机误差分别为(1.1 cm,6.20°)和(0.9 cm,20°),而最大振幅的Identify偏移为(2.59 cm,90°)。 Identify SGRT系统成功地指导了所有493次深呼吸治疗。对于深呼吸阶段的Identify偏移,系统误差和随机误差均在(0.2 cm,2.30°)范围内。其中7名患者由于表面变异或位置偏移而需要重新捕获表面参考。所有由Identify引导的深呼吸验证照射口均获得了主治医生的批准。本评估结果表明Identify系统在表面引导的患者定位和表面引导的深呼吸成像和治疗递送方面的效果显著。彩色编码的实时患者表面匹配反馈功能有助于评估患者对准精度并调整患者的位置以匹配参考位置。© 2023年美国医学物理师协会。
It has been shown that a significant reduction of mean heart dose and left anterior descending artery (LAD) dose can be achieved through the use of DIBH for left breast radiation therapy. Surface-guided DIBH has been widely adopted during the last decade, and there are mainly three commercially available SGRT systems. The reports of the performance of a newly released SGRT system for DIBH application are currently very limited.To evaluate the clinical performance of a newly released SGRT system on DIBH for left breast radiation therapy.Twenty-five left breast cancer patients treated with DIBH utilizing Varian's Identify system were included (total 493-fraction treatments). Four aspects of the clinical performance were evaluated: Identify offsets of free breathing post patient setup from tattoos, Identify offsets during DIBH, Identify agreement with radiographic ports during DIBH, and DIBH reference surface re-capture post patient shifts. The systematic and random errors of free breathing Identify offsets post patient setup were calculated for each patient, as well as for offsets during DIBH. Radiographic ports were taken when the patient's DIBH position was within the clinical tolerance of (± 0.3 cm, ± 30 ), and these were then compared with treatment field DRRs. If the ports showed that the patient alignment did not agree with the DRRs within 3 mm, a patient shift was performed. A new reference surface was captured and verification ports were taken.The all-patient average systematic and random errors of Identify offsets for free breathing were within (0.4 cm, 1.50 ) post tattoo setup. The maximum per-patient systematic and random errors were (1.1 cm, 6.20 ) and (0.9 cm, 20 ), and the maximum amplitude of Identify offsets were (2.59 cm, 90 ). All 493-fraction DIBH treatments were delivered and successfully guided by the Identify SGRT system. The systematic and random errors of Identify offsets for DIBH were within (0.2 cm, 2.30 ). Seven patients needed re-captured surface references due to surface variation or position shifts based on the ports. All patient DIBH verification ports guided by Identify were approved by attending physicians.This evaluation showed that the Identify system performed effectively for surface-guided patient setup and surface-guided DIBH imaging and treatment delivery. The feature of color-coded real-time patient surface matching feedback facilitated the evaluation of the patient alignment accuracy and the adjustment of the patient position to match the reference.© 2023 American Association of Physicists in Medicine.