肺追踪优化对射波刀Synchrony建模的价值
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摘要
目的:探讨射波刀肺部追踪肿瘤直径的范围并分析利用肺追踪优化措施对降低Synchrony重建次数的价值。方法:选取152例肺部肿瘤患者执行肺追踪放疗,按肿瘤直径大小分为10 mm≤d<15 mm、15 mm≤d<20 mm、≥20 mm3组。对肿瘤跟踪算法失败的目标分别采用偏移模式、调整跟踪范围、调整不确定性、二次脊柱追踪辅助定位和启用建议影像/主要参考影像进行优化处理,统计优化前后3组能通过Synchrony建模的患者,比较优化前后射波刀治疗过程中Synchrony模型重建的频率。结果:优化前后治疗执行系统能够正确识别肿瘤并通过建模的病例数由10 mm≤d<15 mm组3例(7.5%)、15 mm≤d<20 mm组24例(36.9%)、≥20 mm组43例(91.5%)改变为10 mm≤d<15 mm组8例(20%)、15 mm≤d<20 mm组53例(81.5%)、≥20 mm组45例(95.7%),差异有统计学意义(P=0.047);治疗过程中不优化模型重建频率分别为3.67、1.48和0.47,优化后治疗模型重建频率分别为1.67、0.71和0.33。结论:综合采用肺追踪优化措施,能够降低Synchrony重建次数,对于肿瘤直径在15 mm≤d<20 mm左右的患者有助于治疗的顺利进行;对于肿瘤小于15 mm的患者不建议执行肺部追踪放射治疗。
Objective To discuss the applicability of CyberKnife lung tumor tracking for the tumor diameter, and to explore the value of lung tracking optimization for decreasing the times of Synchrony reconstruction. Methods Totally 152 lung tumor patients undergoing tracking radiotherapy were divided into three groups respectively with the tumor diameters not less than 10 mm while less than 15 mm, not less than 15 mm while less than 20 mm as well as not less than 20 mm. Optimization was executed for the patients with failed tumor tracking, involving in selecting deviation mode, modulating tracking scope,regulating uncertainty, secondary spine tracking aided positioning and adopting preferred projection. The data of the three groups completing Synchrony modeling were summarized before and after optimization, and the frequencies of Synchrony reconstruction before and after optimization were compared during CyberKnife therapy. Results Optimization made the numbers of the cases increased from 3(7.5%) in the group with the diameter not less than 10 mm while less than 15 mm, 24(36.9%) in the group with the diameter not less than 15 mm while less than 20 mm and 43(91.5%) in the group with the diameter not less than 20 mm to 8(20%), 53(81.5%) and 45(95.7%) respectively, and there were significant differences between the results before and after optimization. The frequencies of the models with no optimization were 3.67, 1.48 and0.47 respectively in the three groups, while the ones after optimization were 1.67, 0.71 and 0.33 respectively. Conclusion Comprehensive lung tracking optimization measures contribute to decreasing the times of Synchrony reconstruction, which facilitate the treatment for the patient with the tumor diameter not less than 15 mm and less than 20 mm while are not applicable for the one with the tumor diameter less than 15 mm.
Objective To discuss the applicability of CyberKnife lung tumor tracking for the tumor diameter, and to explore the value of lung tracking optimization for decreasing the times of Synchrony reconstruction. Methods Totally 152 lung tumor patients undergoing tracking radiotherapy were divided into three groups respectively with the tumor diameters not less than 10 mm while less than 15 mm, not less than 15 mm while less than 20 mm as well as not less than 20 mm. Optimization was executed for the patients with failed tumor tracking, involving in selecting deviation mode, modulating tracking scope,regulating uncertainty, secondary spine tracking aided positioning and adopting preferred projection. The data of the three groups completing Synchrony modeling were summarized before and after optimization, and the frequencies of Synchrony reconstruction before and after optimization were compared during CyberKnife therapy. Results Optimization made the numbers of the cases increased from 3(7.5%) in the group with the diameter not less than 10 mm while less than 15 mm, 24(36.9%) in the group with the diameter not less than 15 mm while less than 20 mm and 43(91.5%) in the group with the diameter not less than 20 mm to 8(20%), 53(81.5%) and 45(95.7%) respectively, and there were significant differences between the results before and after optimization. The frequencies of the models with no optimization were 3.67, 1.48 and0.47 respectively in the three groups, while the ones after optimization were 1.67, 0.71 and 0.33 respectively. Conclusion Comprehensive lung tracking optimization measures contribute to decreasing the times of Synchrony reconstruction, which facilitate the treatment for the patient with the tumor diameter not less than 15 mm and less than 20 mm while are not applicable for the one with the tumor diameter less than 15 mm.
引文
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[7]MONGEON M,THIBAULT F,CHARTRAND-LEFEBVRE C,et al. Safety and efficacy of endovascular fiducial marker insertion for CyberKnife stereotactic radiation therapy planning in early-stage lung cancer[J]. J Vasc Interv Radiol,2017,28(8):1 090-1 097.
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[10]朴俊杰,徐寿平,巩汉顺,等. CyberKnife系统技术评估和临床应用评价[J].医疗卫生装备,2016,37(3):114-117.
[11]TRUMM C G,HUSSLER S M,MUACEVIC A,et al. CT fluoroscopy-guided percutaneous fiducial marker placement for CyberKnife stereotactic radiosurgery:technical results and complications in 222 consecutive procedures[J]. J Vasc Interv Radiol,2014,25(5):760-768.
[2]胡斌,程军平,彭振军,等.全身肿瘤立体定向放射外科系统——第5代射波刀[J].医疗装备,2016,29(3):50-51.
[3]蔡陈枫,朱六玲,徐胜,等.射波刀治疗系统的精确度评价[J].医疗卫生装备,2017,38(6):121-123.
[4]景生华,李兵,周正东,等.射波刀Synchrony同步追踪系统三维方向质量保证分析[J].医疗卫生装备,2018,39(1):58-61.
[5]胡斌,彭振军.射波刀追踪系技术研究进展[J].中国医疗设备,2017,32(2):100-103.
[6]LIN Y W,LIN K H,HO H W,et al. Treatment plan comparison between stereotactic body radiation therapy techniques for prostate cancer:non-isocentric CyberKnife versus isocentric RapidArc[J]. Phys Med,2014,30(6):654-661.
[7]MONGEON M,THIBAULT F,CHARTRAND-LEFEBVRE C,et al. Safety and efficacy of endovascular fiducial marker insertion for CyberKnife stereotactic radiation therapy planning in early-stage lung cancer[J]. J Vasc Interv Radiol,2017,28(8):1 090-1 097.
[8]BALACHANDRAN R,FRITZ M A,DIETRICH M S,et al.Clinical testing of an alternate method of inserting bone-implanted fiducial markers[J]. Int J Comput Assist Radiol Surg,2014,9(5):913-920.
[9]JUNG J,SONG S Y,YOON S M,et al. Verification of accuracy of CyberKnife tumor-tracking radiation therapy using patientspecific lung phantoms[J]. Int J Radiat Oncol Biol Phys,2015,92(4):745-753.
[10]朴俊杰,徐寿平,巩汉顺,等. CyberKnife系统技术评估和临床应用评价[J].医疗卫生装备,2016,37(3):114-117.
[11]TRUMM C G,HUSSLER S M,MUACEVIC A,et al. CT fluoroscopy-guided percutaneous fiducial marker placement for CyberKnife stereotactic radiosurgery:technical results and complications in 222 consecutive procedures[J]. J Vasc Interv Radiol,2014,25(5):760-768.
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