New findings on clinical experience on surface-guided radiotherapy for frameless non-coplanar stereotactic radiosurgery treatments

IF 2 4区医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Journal of Applied Clinical Medical Physics Pub Date : 2024-09-17 DOI:10.1002/acm2.14510

Patricia Sánchez-Rubio, Ruth Rodríguez-Romero, María Pinto-Monedero, Luis Alejo-Luque, Jaime Martínez-Ortega

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Abstract

Purpose

The aim of this study was to assess the accuracy of a surface-guided radiotherapy (SGRT) system for setup and intra-fraction motion control in frameless non-coplanar stereotactic radiosurgery (fSRS) using actual patient data immobilized with two different types of open-faced masks and employing a novel SGRT systems settings.

Methods and materials

Forty-four SRS patients were immobilized with two types of open-faced masks. Sixty lesions were treated, involving the analysis of 68 cone-beam scans (CBCT), 157 megavoltage (MV) images, and 521 SGRT monitoring sessions. The average SGRT translations/rotations and 3D vectors (MAG-Trasl and MAG-Rot) were compared with CBCT or antero-posterior MV images for 0° table or non-coplanar beams, respectively. The intrafraction control was evaluated based on the average shifts obtained from each monitoring session. To assess the association between the SGRT system and the CBCT, the two types of masks and the 3D vectors, a generalized estimating equations (GEE) regression analysis was performed. The Wilcoxon singed-rank test for paired samples was performed to detect differences in couch rotation with longitudinal (LNG) and lateral (LAT) translations and/or yaw.

Results

The average SGRT corrections were smaller than those detected by CBCT (≤0.5 mm and 0.1°), with largest differences in LNG and yaw. The GEE analysis indicated that the average MAG-Trasl, obtained by the SGRT system, was not statistically different (p = 0.09) for both mask types, while, the MAG-Rot was different (p = 0.01). For non-coplanar beams, the Wilcoxon singed-rank test demonstrated no significantly differences for the corrections (LNG, LAT, and yaw) for any table rotation except for LNG corrections at 65° (p = 0.04) and 75° (p = 0.03) table angle position; LAT shifts at 65° (p = 0.03) and 270° (p < 0.001) table angle position, and yaw rotation at 30° (p = 0.02) table angle position. The average intrafraction motion was < 0.1 mm and 0.1° for any table angle.

Conclusion

The SGRT system used, along with the novel workflow performed, can achieve the setup and intra-fraction motion control accuracy required to perform non-coplanar fSRS treatments. Both masks ensure the accuracy required for fSRS while providing a suitable surface for monitoring.

Abstract Image

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无框架非共面立体定向放射外科治疗的表面引导放射治疗临床经验新发现

本研究的目的是评估表面引导放射治疗（SGRT）系统在无框架非共面立体定向放射外科手术（fSRS）中进行设置和分段内运动控制的准确性，评估时使用了两种不同类型的开口面罩固定患者的实际数据，并采用了新型 SGRT 系统设置。对 60 个病灶进行了治疗，分析了 68 次锥形束扫描（CBCT）、157 幅巨电压（MV）图像和 521 次 SGRT 监测。将 SGRT 的平均平移/旋转和三维矢量（MAG-Trasl 和 MAG-Rot）分别与 CBCT 图像或 0° 锥形束或非锥形束的前后 MV 图像进行了比较。根据每次监测获得的平均移位来评估分束内控制。为了评估 SGRT 系统与 CBCT、两种掩膜和三维向量之间的关联，进行了广义估计方程 (GEE) 回归分析。对配对样本进行了 Wilcoxon 单秩检验，以检测沙发旋转与纵向（LNG）和侧向（LAT）平移和/或偏航的差异。结果SGRT 的平均修正量小于 CBCT 检测到的修正量（≤0.5 mm 和 0.1°），其中 LNG 和偏航的差异最大。GEE 分析表明，SGRT 系统获得的平均 MAG-Trasl 在两种掩膜类型中没有统计学差异（p = 0.09），而 MAG-Rot 则有差异（p = 0.01）。对于非共面光束，Wilcoxon 单秩检验表明，除 65° (p = 0.04) 和 75° (p = 0.03) 角位置的 LNG 校正、65° (p = 0.03) 和 270° (p < 0.001) 角位置的 LAT 移位以及 30° (p = 0.02) 角位置的偏航旋转外，任何台面旋转时的校正（LNG、LAT 和偏航）均无显著差异。结论所使用的 SGRT 系统以及所执行的新工作流程可以达到进行非共面 fSRS 治疗所需的设置和分层内运动控制精度。两种掩膜都能确保 fSRS 所需的精确度，同时提供合适的监测表面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Applied Clinical Medical Physics 医学-核医学

CiteScore

3.60

自引率

19.00%

发文量

331

审稿时长

3 months

期刊介绍： Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission. JACMP will publish: -Original Contributions: Peer-reviewed, investigations that represent new and significant contributions to the field. Recommended word count: up to 7500. -Review Articles: Reviews of major areas or sub-areas in the field of clinical medical physics. These articles may be of any length and are peer reviewed. -Technical Notes: These should be no longer than 3000 words, including key references. -Letters to the Editor: Comments on papers published in JACMP or on any other matters of interest to clinical medical physics. These should not be more than 1250 (including the literature) and their publication is only based on the decision of the editor, who occasionally asks experts on the merit of the contents. -Book Reviews: The editorial office solicits Book Reviews. -Announcements of Forthcoming Meetings: The Editor may provide notice of forthcoming meetings, course offerings, and other events relevant to clinical medical physics. -Parallel Opposed Editorial: We welcome topics relevant to clinical practice and medical physics profession. The contents can be controversial debate or opposed aspects of an issue. One author argues for the position and the other against. Each side of the debate contains an opening statement up to 800 words, followed by a rebuttal up to 500 words. Readers interested in participating in this series should contact the moderator with a proposed title and a short description of the topic