心脏 SABR:精确治疗的图像匹配技术。

IF 2.5 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
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引用次数: 0

摘要

背景:室性心动过速是一种心律不齐的疾病,传统的治疗方法是采用侵入性心脏导管消融术和药物治疗。然而,在用尽标准治疗方法后,心脏 SABR 为这种死亡率极高的疾病提供了最后的治疗选择。复杂的诊断绘图和规划扫描可为 25Gy 单次分次治疗划定多学科靶点。然而,靶点附近的高危器官(OAR)使这种治疗方法的计划和实施具有挑战性。心脏病专家发表的文章报告了心脏 SABR 的疗效,但有关这种复杂手术的治疗实施和图像匹配的数据却很有限:方法:四名在心脏 SABR 方面经验丰富的专业治疗放射技师对在英国接受治疗的 10 名患者的 40 张 CBCT 进行了审查。每位治疗放射技师进行了五次图像匹配:手动匹配(manual)、自动匹配心脏结构(auto)和自动匹配后手动调整 PTV(PTV),所有匹配均仅使用三个自由度(DoF)。自动匹配和 PTV 匹配也使用 6 自由度重复进行。使用改良的布兰-阿尔特曼分析法得出的 95% 的一致性限值对观察者间的变异性进行量化:结果:自动匹配的一致性极限最小,表明该算法是可靠的。从自动匹配到 PTV 的手动调整在临床上适合优化目标覆盖范围。6DoF PTV匹配1.06毫米、1.24毫米、1.68毫米(横向、纵向、纵向)的一致性极限小于3DoF PTV匹配1.57毫米、2.06毫米、2.11毫米(横向、纵向、纵向):结论:6DoF CBCT 图像匹配的变异性较小,因此建议使用 6DoF 床进行治疗:实践意义:心脏 SABR CBCT 图像匹配在治疗过程中非常复杂,因此在实施之前,必须优化 CBCT 采集参数并对放射治疗技师进行培训。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cardiac SABR: Image matching techniques for accurate treatment delivery

Background

Ventricular tachycardia is an irregular heartbeat conventionally treated using invasive cardiac catheter ablation and medication. However, when standard treatments have been exhausted, cardiac SABR provides a final treatment option to this high-mortality condition. Complex diagnostic mapping and planning scans enable multi-disciplinary target delineation for a 25Gy single fraction. However, organs at risk (OAR) near the target make this treatment challenging to plan and deliver. Publications from cardiologists report the efficacy of cardiac SABR, however there is limited data on the treatment delivery and image matching of this complex procedure.

Methods

Four specialist therapeutic radiographers experienced in cardiac SABR reviewed 40 CBCTs from 10 patients treated in the UK. Each therapeutic radiographer conducted five image matches: a manual match (manual), an automatic match to the heart structure (auto) and the auto match followed by manual adjustment to the PTV (PTV), all using three degrees of freedom (DoF) only. The auto and PTV matches were also repeated using 6DoF. Inter-observer variability was quantified using 95% limits of agreement from a modified Bland-Altman analysis.

Results

The limits of agreement were smallest in the automatic matches suggesting the algorithm is reliable. A manual adjustment from the auto match to the PTV is clinically appropriate to optimise target coverage. The limits of agreement were smaller in the 6DoF PTV match 1.06 mm, 1.24 mm, 1.68 mm than the 3DoF PTV match 1.57 mm, 2.06 mm, 2.11 mm (lateral, vertical, longitudinal).

Conclusion

The 6DoF CBCT image match has less variability and therefore suggest using a 6DoF couch for treatment delivery.

Implications for practice

Cardiac SABR CBCT image matching at treatment delivery is complex, optimisation of CBCT acquisition parameters and therapeutic radiographer training is essential prior to implementation.
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来源期刊
Radiography
Radiography RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.70
自引率
34.60%
发文量
169
审稿时长
63 days
期刊介绍: Radiography is an International, English language, peer-reviewed journal of diagnostic imaging and radiation therapy. Radiography is the official professional journal of the College of Radiographers and is published quarterly. Radiography aims to publish the highest quality material, both clinical and scientific, on all aspects of diagnostic imaging and radiation therapy and oncology.
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