体表监测系统在胸部肿瘤调强放疗中的应用

doi:10.3969/j.issn.1006-5725.2024.17.014

Abstract

Abstract:

Objective To assess the feasibility of utilizing the ExacTracDynamic surface monitoring system （ETD） for setup and body surface monitoring in patients with thoracic tumors undergoing intensity?modulated radiotherapy （IMRT）. Methods Patients receiving IMRT for thoracic tumors were included in this study. The enrolled patients were alternatively assigned to either conventional cross curve positioning （control group） or surface monitoring system?assisted positioning （experimental group）. ETD X?ray images were utilized for calibration purposes prior to radiotherapy， enabling the determination of setup errors. A region of interest （ROI） was delineated on the body surface above the sternum， and real?time body surface monitoring was performed based on this ROI during radiotherapy. Post?radiotherapy X?ray images were obtained to verify patient position. Data regarding left?right （X）， head?foot （Y）， abdomen?back （Z）， pitch， roll， and yaw directions were recorded and analyzed. Results A total of 60 patients were enrolled， with 754 fractions of radiotherapy in the control group and 718 fractions in the experimental group. The setup errors in the X and Z directions were significantly smaller in the experimental group compared to the control group （P < 0.05）. Moreover， there was a significant reduction in the number of setup errors ≤ 0.50 cm for X， Y， and Z directions， as well as ≤ 1.00° for Roll angle in the experimental group compared to the control group （P < 0.05）. Additionally， differences were observed between surface monitoring and X?ray image verification regarding position deviation along Y and Z directions （P < 0.05）， although these deviations remained within submillimeter levels on average. Conclusion Surface monitoring system?assisted positioning can enhance radiotherapy setup accuracy among thoracic tumor patients， particularly along X and Z directions. Furthermore， when setting ROI above sternum on body surface area， surface monitoring provides better reflection of target area's position deviation.

Key words: body surface monitoring system, thoracic tumors, IMRT, setup errors

CLC Number:

R811.1

Ying CHEN,Fei CHEN,Xiaoqin GONG,Jian HUANG,Wuyang YANG,Tao YOU,Chunhua DAI,Jing. HU. Application of surface monitoring system for thoracic tumors treated with intensity modulated radiotherapy[J]. The Journal of Practical Medicine, 2024, 40(17): 2435-2439.

Figures/Tables 6

Fig.1

Fig.2

Tab.1

Tab.2

Tab.3

Tab.4

References 20

1	WU F， WANG L， ZHOU C. Lung cancer in China： current and prospect［J］. Curr Opin Oncol， 2021， 33（1）： 40-46. doi:10.1097/cco.0000000000000703 doi: 10.1097/cco.0000000000000703
2	高山，季坤，赵丽，等. 食管鳞状上皮内瘤变的研究进展［J］. 实用医学杂志， 2024， 40（3）： 432-438.
3	ZHU H， MA X， YE T， et al. Esophageal cancer in China： Practice and research in the new era［J］. Int J Cancer， 2023， 152（9）： 1741-1751. doi:10.1002/ijc.34301 doi: 10.1002/ijc.34301
4	SONG W， LU H， LIU J， et al. Fixed-jaw technique to improve IMRT plan quality for the treatment of cervical and upper thoracic esophageal cancer［J］. J Appl Clin Med Phys， 2019， 20（10）： 24-32. doi:10.1002/acm2.12704 doi: 10.1002/acm2.12704
5	FLECKENSTEIN J， ESCHLER A， KREMP K， et al. Dose distribution and tumor control probability in out-of-field lymph node stations in intensity modulated radiotherapy （IMRT） vs 3D-conformal radiotherapy （3D-CRT） of non-small-cell lung cancer： an in silico analysis［J］. Radiat Oncol， 2015， 10： 178. doi:10.1186/s13014-015-0485-6 doi: 10.1186/s13014-015-0485-6
6	CHUN S G， HU C， CHOY H， et al. Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer： A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial［J］. J Clin Oncol， 2017， 1： 56-62. doi:10.1200/jco.2016.69.1378 doi: 10.1200/jco.2016.69.1378
7	CHEN Q S， ZHAO Y H， CHEN X， et al. Setup error of electronic portal image device in IMRT for thoracic tumors and its influence［J］. Eur Rev Med Pharmacol Sci， 2023， 24： 12012-12020.
8	肖亮杰，方涌文，王宇留，等. 基于锥形束CT分析食管癌和肺癌患者摆位误差［J］. 中国医学物理学杂志， 2022， 39（10）： 1189-1193.
9	CAILLET V， BOOTH J T， KEALL P. IGRT and motion management during lung SBRT delivery［J］. Phys Med， 2017， 44： 113-122. doi:10.1016/j.ejmp.2017.06.006 doi: 10.1016/j.ejmp.2017.06.006
10	LI G. Advances and potential of optical surface imaging in radiotherapy［J］. Phys Med Biol， 2022， doi：10.1088/1361-6560/ac838f doi: 10.1088/1361-6560/ac838f
11	NAUMANN P， BATISTA V， FARNIA B， et al. Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold［J］. Front Oncol， 2020， 10： 573279. doi:10.3389/fonc.2020.573279 doi: 10.3389/fonc.2020.573279
12	BEDDOK A， BLANCHARD P. Image-guided radiotherapy for head and neck carcinoma［J］. Cancer Radiother， 2018， 22（6/7）： 617-621. doi:10.1016/j.canrad.2018.06.015 doi: 10.1016/j.canrad.2018.06.015
13	DE CREVOISIER R， LAFOND C， MERVOYER A， et al. Image-guided radiotherapy［J］. Cancer Radiother， 2022， 26（1/2）： 34-49. doi:10.1016/j.canrad.2021.08.002 doi: 10.1016/j.canrad.2021.08.002
14	SONG Y， ZHANG W， ZHANG H， et al. Low-dose cone-beam CT （LD-CBCT） reconstruction for image-guided radiation therapy （IGRT） by three-dimensional dual-dictionary learning［J］. Radiat Oncol， 2020， 15（1）： 192. doi:10.1186/s13014-020-01630-3 doi: 10.1186/s13014-020-01630-3
15	方键蓝，方涌文，刘镖水，等. Catalyst HD 调强放疗摆位精度的研究光学体表引导发泡胶固定乳腺癌［J］. 实用医学杂志， 2022， 38（5）： 547-551.
16	LIU H， SCHAAL D， CURRY H， et al. Review of cone beam computed tomography based online adaptive radiotherapy： current trend and future direction［J］. Radiat Oncol， 2023， 18（1）： 144. doi:10.1186/s13014-023-02340-2 doi: 10.1186/s13014-023-02340-2
17	SARKAR B， GANESH T， MUNSHI A， et al. Rotational positional error-corrected linear set-up margin calculation technique for lung stereotactic body radiotherapy in a dual imaging environment of 4-D cone beam CT and ExacTrac stereoscopic imaging［J］. Radiol Med， 2021， 126（7）： 979-988. doi:10.1007/s11547-021-01355-7 doi: 10.1007/s11547-021-01355-7
18	DUAN J， GUO R， WEI W， et al. Demonstration of quasi-real-time intrafractional motion in esophageal cancer radiotherapy provided by ExacTrac X-ray snap verification［J］. J Xray Sci Technol， 2022， 30（4）： 677-687. doi:10.3233/xst-221165 doi: 10.3233/xst-221165
19	LI J， SHI W， ANDREWS D， et al. Comparison of Online 6 Degree-of-Freedom Image Registration of Varian TrueBeam Cone-Beam CT and BrainLab ExacTrac X-Ray for Intracranial Radiosurgery［J］. Technol Cancer Res Treat， 2017， 16（3）： 339-343. doi:10.1177/1533034616683069 doi: 10.1177/1533034616683069
20	HATTEL S H， ANDERSEN P A， WAHLSTEDT I H， et al. Evaluation of setup and intrafraction motion for surface guided whole-breast cancer radiotherapy［J］. J Appl Clin Med Phys， 2019， 20（6）： 39-44. doi:10.1002/acm2.12599 doi: 10.1002/acm2.12599

参数	对照组	观察组	t值	P值
X/cm	0.28 ± 0.22	0.18 ± 0.21	8.685	< 0.001
Y/cm	0.38 ± 0.29	0.35 ± 0.44	1.155	0.248
Z/cm	0.31 ± 0.27	0.25 ± 0.25	4.530	< 0.001
Pitch/°	0.85 ± 0.72	0.92 ± 0.74	-1.928	0.054
Roll/°	0.95 ± 0.83	0.94 ± 1.00	0.147	0.883
Yaw/°	0.74 ± 0.65	0.70 ± 0.69	1.096	0.273

参数	对照组	观察组	χ²值	P值
X			28.817	< 0.001
≤ 0.50 cm	640（84.88）	672（93.59）
> 0.50 cm	114（15.12）	46（6.40）
Y			16.111	< 0.001
≤ 0.50 cm	530（70.29）	570（79.39）
> 0.50 cm	224（29.71）	148（20.61）
Z			25.872	< 0.001
≤ 0.50 cm	610（80.90）	648（90.25）
> 0.50 cm	144（19.10）	70（9.75）
Pitch			0.760	0.383
≤ 1.00 °	518（68.70）	478（66.57）
> 1.00 °	236（31.30）	240（33.43）
Roll			8.381	0.004
≤ 1.00 °	480（63.66）	508（70.75）
> 1.00 °	274（36.34）	210（29.25）
Yaw			1.667	0.197
≤ 1.00 °	560（74.27）	554（77.16）
> 1.00 °	194（25.73）	164（22.84）

参数	体表监测	拍片验证	t值	P1值	r值	P2值
X/cm	0.06 ± 0.07	0.07 ± 0.07	-1.912	0.056	0.548	< 0.001
Y/cm	0.10 ± 0.09	0.09 ± 0.08	2.126	0.034	0.462	< 0.001
Z/cm	0.07 ± 0.07	0.06 ± 0.06	3.628	< 0.001	0.393	< 0.001
Pitch/°	0.37 ± 0.43	0.38 ± 0.35	-1.201	0.230	0.460	< 0.001
Roll/°	0.35 ± 0.43	0.37 ± 0.34	-1.735	0.083	0.502	< 0.001
Yaw/°	0.25 ± 0.29	0.26 ± 0.27	-0.968	0.333	0.461	< 0.001

参数	对照组	观察组	t值	P值
X/cm	0.07 ± 0.07	0.07 ± 0.06	-0.417	0.677
Y/cm	0.09 ± 0.08	0.08 ± 0.07	1.528	0.127
Z/cm	0.06 ± 0.05	0.06 ± 0.06	-0.156	0.876
Pitch/°	0.40 ± 0.36	0.37 ± 0.34	1.168	0.243
Roll/°	0.36 ± 0.33	0.38 ± 0.35	-1.009	0.313
Yaw/°	0.26 ± 0.26	0.26 ± 0.28	-0.053	0.958

[1]	Kai LIAO,Yunhong TIAN,Ronghui ZHENG,Caixian HE,Jiyong PENG,Huijun LI. Reduction of head and neck lymphedema by placing dose limiting rings in the anterior and posterior regions of the neck for treating early nasopharyngeal carcinoma using intensity-modulated radiotherapy： A dosimetric perspective [J]. The Journal of Practical Medicine, 2024, 40(12): 1659-1664.
[2]	FANG Jianlan, FANG Yongwen, LIU Biaoshui, XIAO Liangjie, WANG Yuliu, GUO Xuan, HE Zhenyu, LIN Chengguang, YAO Wenyan.. Accuracy of immobilization with polyurethane in breast cancer radiotherapy fixed on Catalyst HD optical surface imaging [J]. The Journal of Practical Medicine, 2022, 38(5): 547-551.

Application of surface monitoring system for thoracic tumors treated with intensity modulated radiotherapy

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References 20

Related Articles 2

Recommended Articles

Metrics

Comments