摆位误差对脑立体定向放射治疗剂量分布的影响
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摘要
目的:探讨摆位误差对脑立体定向放疗剂量分布的影响,指导改进定位方案。方法:随机选取10例脑立体定向放疗患者,借助XVI采集患者摆位后治疗前的锥形束CT(CBCT)和放疗后的CBCT,分别与计划CT配准,获得放疗前和放疗中的摆位误差。借助Xio计划系统,研究摆位误差对计划靶区(PTV)的适形度、平均剂量和最大剂量值的影响。结果:脑立体定向放疗前和放疗中的摆位误差分别为(3.40±1.14)和(0.36±0.12)mm。放疗前摆位误差使PTV的相对适形度由1.00±0.00降低为0.81±0.17(P=0.007,t=-3.494),使相对平均剂量改变了1.56%±1.15%(P=0.002,t=4.304)。放疗中摆位误差对PTV剂量分布的影响可忽略。结论:图像引导的无框架脑立体定向放射治疗在线修正摆位误差,可获得较高的几何和剂量测量精度。
Objective To investigate the effect of setup errors on dose distribution in intracranial stereotactic radiotherapy(SRT)for improving positioning scheme. Methods Ten patients receiving intracranial SRT was randomly enrolled in the study. The cone beam CT before and after radiotherapy was acquired by XVI and then was registered with planning CT to obtain the setup errors before and during radiotherapy. Moreover, Xio planning system was used to investigate the effects of setup errors on the conformity, mean dose and maximum dose of planning target areas. Results The setup errors before and during intracranial SRT were(3.40±1.14) and(0.36±0.12) mm, respectively. The relative conformity index of planning target areas was reduced from1.00±0.00 to 0.81±0.17(P=0.007, t=-3.494). The relative mean dose was increased by 1.56%±1.15 %(P=0.002, t=4.304). The effect of setup errors during radiotherapy on dose distribution was negligible. Conclusion Using image-guided frameless intracranial SRT with online correction of setup errors can achieve high geometric and dosimetric accuracies.
Objective To investigate the effect of setup errors on dose distribution in intracranial stereotactic radiotherapy(SRT)for improving positioning scheme. Methods Ten patients receiving intracranial SRT was randomly enrolled in the study. The cone beam CT before and after radiotherapy was acquired by XVI and then was registered with planning CT to obtain the setup errors before and during radiotherapy. Moreover, Xio planning system was used to investigate the effects of setup errors on the conformity, mean dose and maximum dose of planning target areas. Results The setup errors before and during intracranial SRT were(3.40±1.14) and(0.36±0.12) mm, respectively. The relative conformity index of planning target areas was reduced from1.00±0.00 to 0.81±0.17(P=0.007, t=-3.494). The relative mean dose was increased by 1.56%±1.15 %(P=0.002, t=4.304). The effect of setup errors during radiotherapy on dose distribution was negligible. Conclusion Using image-guided frameless intracranial SRT with online correction of setup errors can achieve high geometric and dosimetric accuracies.
引文
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[7]胡燕,王亮和,陈星萌,等. 2种不同固定头架在头颈部肿瘤放疗中的摆位误差研究[J].医疗卫生装备, 2017, 38(3):80-82.HU Y, WANG L H, CHEN X M, et al. Influences of two head holders on setup errors during head and neck neoplasms radiotherapy[J].Chinese Medical Equipment Journal, 2017, 38(3):80-82.
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[9]张彦新,符贵山,徐英杰,等.脑转移瘤立体定向放疗分次间和分次内摆位误差及残余误差分析[J].中华放射肿瘤学杂志, 2019, 28(6):448-451.ZHANG Y X, FU G S, XU Y J, et al. Analysis of the inter-and intrafraction setup errors and residual errors during stereotactic radiotherapy for brain metastasis[J]. Chinese Journal of Radiation Oncology, 2019, 28(6):448-451.
[10]LAURA M, FRANCO C, CATERINA P, et al. Cone beam CT image guidance for intracranial stereotactic treatments:comparison with a frame guided set-up[J]. Int J Radiat Oncol Biol phys, 2008, 71(3):926-933.
[11]BABIC S, LEE Y, RUSCHIN M, et al. To frame or not to fram? Conebeam CT-based analysis of head immobilization devices specific to linac-based stereotactic radiosurgery and radiotherapy[J]. J Appl Clin Med Phys, 2018, 19(2):111-120.
[12]BOMAN E, KAPANEN M, LAAKSOMAA M, et al. Treatment accuracy without rotational setup corrections in intracranial SRT[J].J Appl Clin Med Phys, 2016, 17(4):86-94.
[13]BRISCOE M, VORONEY J P, PLOQUIN N. Establishing a threshold for rotational patient setup errors in linear accelerator-based stereotactic radiosurgery[J]. Biomed Phys Eng Express, 2016, 2(4):045018.
[14]张玉海,王文桥,罗凤霞,等.基于锥形束CT技术不同部位肿瘤三维适形调强放疗的摆位误差[J].广西医学, 2018, 40(15):1671-1673.ZHANG Y H, WANG W Q, LUO F X, et al. Setup errors of threedimensional conformal or intensity-modulated radiotherapy for tumors in different locations using cone-beam computed tomography[J].Guangxi Medical Journal, 2018, 40(15):1671-1673.
[15]张秀甫,刘永琴,郭瑞嵩.不同部位肿瘤患者在立体定向放射治疗中摆位误差分析与控制方法[J].中国实用医刊, 2015, 42(9):98-100.ZHANG X F, LIU Y Q, GUO R S. Setup error analysis and control methods for patients with cancer in different position in stereotactic radiotherapy[J]. Chinese Journal of Practical Medicine, 2015, 42(9):98-100.
[16]PADDICK I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note[J]. J Neurosurg, 2000,93(Suppl 3):219-222.
[17]MASI L, CASAMASSIMA F, POLLI C, et al. Cone beam CT image guidance for intracranial stereotactic treatments:comparison with a frame guided set-up[J]. Int J Radiat Oncol Biol Phys, 2008, 71(3):926-933.
[18]TRYGGESTAD E, CHRISTIAN M, FORD E, et al. Inter-and intrafraction patient positioning uncertainties for intracranial radiotherapy:a study of four frameless, thermoplastic mask based immobilization strategies using daily cone-beam CT[J]. Int J Radiat Oncol Biol Phys, 2011, 80(1):281-290.
[19]HAERTL P M, LOESCHEL R, REPP N, et al. Frameless fractionated stereotactic radiation therapy of intracranial lesions:impact of cone beam CT based setup correction on dose distribution[J]. Radiat Oncol,2013, 8(1):153.
[20]SARKAR B, RAY J, GANESH T, et al. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy[J]. Phys Med Biol, 2018, 63(7):075004.
[2] CHANG J, YENICE K M, NARAYANA A, et al. Accuracy and feasibility of cone-beam computed tomography for stereotactic radiosurgery setup[J]. Med Phys, 2007, 34(6):2077-2084.
[3] GUCKENBERGER M, ROESCH J, BAIER K, et al. Dosimetric consequences of translational and rotational errors in frame-less imageguided radiosurgery[J]. Radiat Oncol, 2012, 7:63.
[4] TAKAKURA T, MIZOWAKI T, NAKATA M, et al. The geometric accuracy of frameless stereotactic radiosurgery using a 6D robotic couch system[J]. Phys Med Biol, 2010, 55(1):1-10.
[5] WILBERT J, GUCKENBERGER M, POLAT B, et al. Semi-robotic6 degree of freedom positioning for intracranial high precision radiotherapy; first phantom and linical results[J]. Radiat Oncol, 2010,5:42.
[6] OHTAKARA K, HAYASHI S, TANAKA H, et al. Clinical comparison of positional accuracy and stability between dedicated versus conventional masks for immobilization in cranial stereotactic radiotherapy using 6-degree-of-freedom image guidance systemintegrated platform[J]. Radiother Oncol, 2012, 102(2):198-205.
[7]胡燕,王亮和,陈星萌,等. 2种不同固定头架在头颈部肿瘤放疗中的摆位误差研究[J].医疗卫生装备, 2017, 38(3):80-82.HU Y, WANG L H, CHEN X M, et al. Influences of two head holders on setup errors during head and neck neoplasms radiotherapy[J].Chinese Medical Equipment Journal, 2017, 38(3):80-82.
[8]张淑慧,杨敬贤,崔广余,等.放疗定位膜制作及体位固定质量控制[J].中国医学物理学杂志, 2015, 32(4):554-558.ZHANG S H, YANG J X, CUI G Y, et al. Quality control of positioning membrane production and posture fixation in radiotherapy[J]. Chinese Journal of Medical Physics, 2015, 32(4):554-558.
[9]张彦新,符贵山,徐英杰,等.脑转移瘤立体定向放疗分次间和分次内摆位误差及残余误差分析[J].中华放射肿瘤学杂志, 2019, 28(6):448-451.ZHANG Y X, FU G S, XU Y J, et al. Analysis of the inter-and intrafraction setup errors and residual errors during stereotactic radiotherapy for brain metastasis[J]. Chinese Journal of Radiation Oncology, 2019, 28(6):448-451.
[10]LAURA M, FRANCO C, CATERINA P, et al. Cone beam CT image guidance for intracranial stereotactic treatments:comparison with a frame guided set-up[J]. Int J Radiat Oncol Biol phys, 2008, 71(3):926-933.
[11]BABIC S, LEE Y, RUSCHIN M, et al. To frame or not to fram? Conebeam CT-based analysis of head immobilization devices specific to linac-based stereotactic radiosurgery and radiotherapy[J]. J Appl Clin Med Phys, 2018, 19(2):111-120.
[12]BOMAN E, KAPANEN M, LAAKSOMAA M, et al. Treatment accuracy without rotational setup corrections in intracranial SRT[J].J Appl Clin Med Phys, 2016, 17(4):86-94.
[13]BRISCOE M, VORONEY J P, PLOQUIN N. Establishing a threshold for rotational patient setup errors in linear accelerator-based stereotactic radiosurgery[J]. Biomed Phys Eng Express, 2016, 2(4):045018.
[14]张玉海,王文桥,罗凤霞,等.基于锥形束CT技术不同部位肿瘤三维适形调强放疗的摆位误差[J].广西医学, 2018, 40(15):1671-1673.ZHANG Y H, WANG W Q, LUO F X, et al. Setup errors of threedimensional conformal or intensity-modulated radiotherapy for tumors in different locations using cone-beam computed tomography[J].Guangxi Medical Journal, 2018, 40(15):1671-1673.
[15]张秀甫,刘永琴,郭瑞嵩.不同部位肿瘤患者在立体定向放射治疗中摆位误差分析与控制方法[J].中国实用医刊, 2015, 42(9):98-100.ZHANG X F, LIU Y Q, GUO R S. Setup error analysis and control methods for patients with cancer in different position in stereotactic radiotherapy[J]. Chinese Journal of Practical Medicine, 2015, 42(9):98-100.
[16]PADDICK I. A simple scoring ratio to index the conformity of radiosurgical treatment plans. Technical note[J]. J Neurosurg, 2000,93(Suppl 3):219-222.
[17]MASI L, CASAMASSIMA F, POLLI C, et al. Cone beam CT image guidance for intracranial stereotactic treatments:comparison with a frame guided set-up[J]. Int J Radiat Oncol Biol Phys, 2008, 71(3):926-933.
[18]TRYGGESTAD E, CHRISTIAN M, FORD E, et al. Inter-and intrafraction patient positioning uncertainties for intracranial radiotherapy:a study of four frameless, thermoplastic mask based immobilization strategies using daily cone-beam CT[J]. Int J Radiat Oncol Biol Phys, 2011, 80(1):281-290.
[19]HAERTL P M, LOESCHEL R, REPP N, et al. Frameless fractionated stereotactic radiation therapy of intracranial lesions:impact of cone beam CT based setup correction on dose distribution[J]. Radiat Oncol,2013, 8(1):153.
[20]SARKAR B, RAY J, GANESH T, et al. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy[J]. Phys Med Biol, 2018, 63(7):075004.
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