Kendall Kiser, Eric Laugeman, Robbie Beckert, Minji Kwon, Allen Mo, Eric Morris, Justin Barnes, Geoffrey Hugo, Clifford Robinson, Pamela Samson, Hyun Kim
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引用次数: 0
摘要
背景：腹部计算机断层扫描（CT）引导的在线自适应立体定向消融放疗（SABR）治疗可能会因肠道气体伪影而复杂化。我们调查了延长病人仰卧位是否会减少肠气伪影。方法：三名放射肿瘤学家、一名物理学家和一名高级实践放射治疗师使用Halcyon/Ethos在线自适应SABR平台对26名胰腺腺癌患者从104个CBCT数据集中获得的52个部分的1644张图像进行肠气体假影评分。肠气伪影评分遵循从1（最好）到4（最差）的顺序。10例患者采用HyperSight CBCT， 16例采用早期CBCT成象机Halcyon v3.0。结果：444张CBCT图像（27%）有肠道气体伪影，至少在最小程度上模糊了器官危险（OAR）边界。初始cbct中的伪像比后续验证cbct更差（平均得分2.26 vs. 2.15, p = 0.006）。与验证cbct相比，Halcyon初始cbct中得分为4的图像比例（0.25）显著高于验证cbct (0.16；P < 0.001)。对于HyperSight，该比例在初始cbct中较低（0.03），在验证cbct中较低(0.01； = 0.09页)。结论：在线自适应SABR CBCT数据集中临床有效的肠道气体伪影在验证CBCT中优于初始CBCT，可能是由于长时间仰卧位时肠道沉降。
Minimizing Bowel Gas Artifact in Computed Tomography Guided Online Adaptive Radiation Therapy With Prolonged Supine Positioning.
Purpose: Abdominal computed tomography guided online adaptive SABR treatments can be complicated by bowel gas artifact. We investigated whether prolonged patient supine positioning decreases bowel gas artifact.
Methods and materials: Three radiation oncologists, a physicist, and an advanced practice radiation therapist scored bowel gas artifact in 1644 images from 104 cone beam computed tomography (CBCT) data sets acquired in 52 fractions delivered to 26 pancreatic adenocarcinoma patients with a Halcyon/Ethos online adaptive SABR platform. Bowel gas artifact scoring followed an ordinal rubric from 1 (best) to 4 (worst). Ten patients were imaged with HyperSight CBCTs and 16 with an earlier CBCT imager, Halcyon v3.0.
Results: Four-hundred forty-four CBCT images (27%) had bowel gas artifact that at least minimally obscured organ-at-risk borders. Artifact was worse in initial CBCTs than subsequent verification CBCTs (mean scores 2.26 vs 2.15, P = .006). The proportion of images scored 4 was significantly greater in Halcyon initial CBCTs (0.25) compared to verification CBCTs (0.16; P < .001). For HyperSight, this proportion was low in initial CBCTs (0.03) and lower in verification CBCTs (0.01; P = .09).
Conclusions: Clinically impactful bowel gas artifact in online adaptive SABR CBCT data sets was better in verification CBCTs than in initial CBCTs, potentially due to bowel settling during prolonged supine positioning.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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