Treatment efficiency and quality improvement via double imaging modality (DIM) versus single imaging modality (SIM) image-guided radiotherapy for prostate cancer

Q1 Nursing

Technical Innovations and Patient Support in Radiation Oncology Pub Date : 2025-02-21 DOI:10.1016/j.tipsro.2025.100307

Milad Mirzaei , Suki Gill , Mahsheed Sabet , Martin A. Ebert , Pejman Rowshanfarzad , Jake Kendrick , Angela Jacques , Clare Herbert , Jeremy Croker , Sean Bydder , Joshua Dass , Edward Bailey , Rohen White , Catherine Moffat , Colin Tang , Adriano Polpo , Nicholas Bucknell

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引用次数: 0

Abstract

Purpose

Daily image-guided radiotherapy (IGRT) for prostate cancer reduces treatment-related toxicity. However, positional and anatomical variations can result in patient re-setup, increased treatment time, and additional imaging dose. A simple technique of two distinct imaging modalities was investigated: initially, an anteroposterior kilovoltage (AP-kV) planar image was acquired, followed by cone beam computed tomography (CBCT). To determine whether this dual imaging modality (DIM) can reduce repeat CBCTs with an AP-kV screening image compared to CBCT alone, i.e. a single imaging modality (SIM).

Methods

Patients were enrolled sequentially before and after the new departmental protocol for IGRT. Initially, all patients had a CBCT prior to treatment (SIM group) as usual. For the DIM group, AP-kV imaging was added to the first three fractions, and subsequent AP-kV imaging (on demand) for patients unable to maintain adequate bladder and bowel compliance. Sixty intact prostate or post-prostatectomy patients were included: 30 before the change in protocol (SIM group) and 30 after (DIM group). Bladder volume, rectal filling, and positioning errors were evaluated.

Results

In the SIM group, 30 patients underwent a total of 1116 CBCTs. In the DIM group, 30 patients had 156 AP-kV images and 1077 CBCTs. In the SIM group, 166 were repeat CBCTs with a median of 4 repeat CBCTs per patient. In DIM group, 132 were repeat CBCTs with a median of 3 repeat CBCTs per patient. We found a significant difference in incidence of repeat CBCTs due to suboptimal bladder filling (p = 0.028) and rectal gas (p = 0.045), indicating the number of repeat CBCTs was significantly lower in patients imaged with DIM.

Conclusion

The DIM technique was found to be superior to the SIM technique, as it allowed the desired bladder volume, rectal condition, and patient positioning to be achieved prior to CBCT, reducing the need for repeat CBCTs.

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双成像模式（DIM）与单成像模式（SIM）影像引导放射治疗前列腺癌的疗效和质量提高

目的摄护腺癌每日影像引导放射治疗（IGRT）可降低治疗相关毒性。然而，位置和解剖结构的变化可能导致患者重新安置，增加治疗时间和额外的成像剂量。研究了一种简单的两种不同成像方式的技术：首先，获得正面千电压（AP-kV）平面图像，然后进行锥束计算机断层扫描（CBCT）。为了确定与单独CBCT相比，这种双重成像模式（DIM）是否可以减少AP-kV筛查图像的重复CBCT，即单一成像模式（SIM）。方法在IGRT新科室方案前后依次入组患者。最初，所有患者在治疗前进行CBCT检查（SIM组）。对于DIM组，在前三个部分添加AP-kV成像，对于无法维持足够的膀胱和肠道顺应性的患者，随后添加AP-kV成像（按需）。纳入60例完整前列腺或前列腺切除术后患者：方案改变前30例（SIM组），方案改变后30例（DIM组）。评估膀胱体积、直肠充盈和定位误差。结果SIM组30例患者共进行了1116次cbct。在DIM组中，30例患者有156张AP-kV图像和1077张cbct。在SIM组中，166例为重复cbct，每位患者中位数为4例重复cbct。DIM组132例为重复cbct，平均每位患者3例重复cbct。我们发现，由于膀胱填充不理想（p = 0.028）和直肠气体（p = 0.045），重复CBCT的发生率有显著差异，这表明使用DIM成像的患者重复CBCT的次数明显减少。结论DIM技术优于SIM技术，因为它可以在CBCT之前获得所需的膀胱体积、直肠状况和患者体位，减少了重复CBCT的需要。

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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