[1]李壮玲,钟鹤立,高艳,等.光学体表监测系统引导VMAT技术在全身放射性治疗的应用[J].中国医学物理学杂志,2024,41(9):1070-1077.[doi:DOI:10.3969/j.issn.1005-202X.2024.09.003]
　LI Zhuangling,ZHONG Heli,GAO Yan,et al.Application of optical surface monitoring system guided volumetric modulated arc therapy in total body irradiation[J].Chinese Journal of Medical Physics,2024,41(9):1070-1077.[doi:DOI:10.3969/j.issn.1005-202X.2024.09.003]
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光学体表监测系统引导VMAT技术在全身放射性治疗的应用()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第9期
页码:
1070-1077
栏目:
医学放射物理
出版日期:
2024-10-25

文章信息/Info

Title:
Application of optical surface monitoring system guided volumetric modulated arc therapy in total body irradiation
文章编号:
1005-202X（2024）09-1070-08
作者:
李壮玲; 钟鹤立; 高艳; 李隆兴; 史亚滨; 邓小年; 付鑫; 张定; 郑芳; 陈洪涛; 陈伟思
深圳市人民医院（南方科技大学第一附属医院，暨南大学第二临床医学院）肿瘤放疗科， 广东 深圳 518020
Author(s):
LI Zhuangling;  ZHONG Heli;  GAO Yan;  LI Longxing;  SHI Yabin;  DENG Xiaonian;  FU Xin;  ZHANG Ding;  ZHENG Fang;  CHEN Hongtao;  CHEN Weisi
Department of Radiation Oncology, Shenzhen Peoples Hospital (First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University), Shenzhen 518020, China
关键词:
光学体表监测系统; 容积旋转调强技术; 全身放射治疗; 摆位误差; 分次内运动
Keywords:
Keywords: optical surface monitoring system volumetric modulated arc therapy total body irradiation positioning error intra-fractional motion
分类号:
R318；R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2024.09.003
文献标志码:
A
摘要:
目的：建立光学体表监测系统（OSMS）引导容积旋转调强（VMAT）技术应用于全身放射性治疗（TBI）的基本流程，评价OSMS在放疗前分次间辅助摆位和放疗中分次内实时监测位置误差的精确性和有效性。方法：回顾分析造血干细胞移植前清髓接受OSMS引导VMAT-TBI的白血病患者15例，CT模拟定位，分别在头先进仰卧位（HFS）和脚先进仰卧位（FFS）采集全身图像数据，传输至治疗计划系统进行图像融合、多中心VMAT放疗计划设计及剂量验证，处方剂量为800 cGy/4F，一天两次。放疗前采用OSMS辅助摆位，CBCT进行位置验证，治疗中应用OSMS监控，通过分析离线日志文件获得OSMS实时监测的分次内误差。结果：HFS模式计划靶区的平均剂量和覆盖率分别为（905.4±19.0） cGy和（93.0±2.8）%；危及器官肺和肾脏平均剂量分别为（603.7±55.7） cGy和（600.4±49.6） cGy；晶体最大受照剂量为（393.9±58.9） cGy。FFS模式计划靶区的平均剂量和覆盖率分别为（888.5±58.9） cGy和（94.0±3.2）%；衔接处的最大剂量为（1 148.9±72.9） cGy。单次放疗实施时间为（75.1±15.1） min。放疗前OSMS辅助摆位，CBCT三维矢量总偏差在平移方向和旋转方向分别为（2.71±1.96） mm和（0.91±0.90）°。在放疗中OSMS监测的分次内运动幅度平移方向三维矢量偏差为（1.95±1.88） mm，其中偏差在1 mm以内的在LNG、LAT和VRT方向上占比分别为57.5%、79.7%和62.1%；旋转方向三维矢量偏差为（0.76±0.72）°，其中偏差在1°以内在Rtn、Pitch和Roll方向上占比分别为93.1%、85.7%和94.3%。结论：VMAT简化TBI流程，同时提高靶区的覆盖率并较好地保护危及器官；采用OSMS可减少位移误差特别是旋转误差，为保障TBI精确实施和患者的安全性，有必要联合OSMS进行辅助摆位和分次内位置监测。
Abstract:
Abstract: Objective To establish a novel clinical application process of the optical surface monitoring system (OSMS) guided volumetric modulated arc therapy (VMAT) for total body irradiation (TBI), and to assess the accuracy and effectiveness of OSMS in inter-fractional auxiliary positioning before radiotherapy and real-time monitoring of intra-fractional motion during radiotherapy. Methods A retrospective analysis was conducted on 15 leukemia patients who underwent OSMS-guided VMAT-TBI before hematopoietic stem cell transplantation. CT simulation positioning was performed, and the whole-body image data which were collected in head-first supine position (HFS) and feet-first supine position (FFS) were transmitted to the treatment planning system for image registration, multicenter VMAT planning and dose verification. The prescription dose was 800 cGy in 4 fractions twice daily. OSMS was used to assist positioning before delivery, and CBCT was used for position verification. During treatment, OSMS was used for monitoring. The intra-fractional error monitored by OSMS in real time was obtained by analyzing the offline log files. Results The mean dose and coverage of the target area in HFS plan were (905.4±19.0) cGy and 93.0%±2.8%. The mean doses to lung and kidney were (603.7±55.7) cGy and (600.4±49.6) cGy, respectively, and the maximum dose to the lens was (393.9±58.9) cGy. The mean dose and coverage of the target area in FFS plan were (888.5±58.9) cGy and 94.0%±3.2% and the maximum dose at the junction was (1 148.9±72.9) cGy. Fractional treatment delivery time was (75.1±15.1) min. OSMS-assisted positioning was carried out before delivery, and the total deviations of CBCT three-dimensional vector in translational and rotation directions were (2.71±1.96) mm and 0.91°±0.90°, respectively. The three-dimensional vector deviation of the intra-fractional motion amplitude in translational direction monitored by OSMS during the treatment was (1.95±1.88) mm, of which the deviation within 1 mm accounted for 57.5%, 79.7% and 62.1% in longitudinal, lateral and vertical directions, respectively. The three-dimensional vector deviation in rotation direction was 0.76°±0.72°, of which the deviation within 1° accounted for 93.1%, 85.7% and 94.3% in rotation, pitch and roll directions, respectively. Conclusion VMAT simplifies TBI process, while improving target coverage and organs-at-risk sparing. The use of OSMS can reduce positioning errors, especially rotation errors. In order to ensure the accurate implementation of TBI and the safety of patients, it is necessary to use OSMS for auxiliary positioning and intra-fractional position monitoring.

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　[J].Chinese Journal of Medical Physics,2016,33(9):898.[doi:10.3969/j.issn.1005-202X.2016.09.006]
[2]邓官华,黄爱花,陈丽霞,等.准直器角度误差对脑转移瘤VMAT计划Gamma通过率的影响[J].中国医学物理学杂志,2019,36(12):1411.[doi:DOI:10.3969/j.issn.1005-202X.2019.12.009]
　DENG Guanhua,HUANG Aihua,CHEN Lixia,et al.Effects of collimator angle error on Gamma passing rates for volumetric modulated arc therapy plan for intracranial metastases[J].Chinese Journal of Medical Physics,2019,36(9):1411.[doi:DOI:10.3969/j.issn.1005-202X.2019.12.009]

备注/Memo

备注/Memo:
【收稿日期】2024-03-15 【基金项目】广东省医学科研基金（A2023242） 【作者简介】李壮玲，硕士，副主任技师，研究方向：放射治疗新技术的应用与研究，E-mail: lizhuangling@163.com 【通信作者】钟鹤立，E-mail: zhongheli@tom.com
更新日期/Last Update: 2024-09-26