平卧位与直立位在放疗中肝呼吸运动管理中的比较

IF 3.2 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Medical physics Pub Date : 2025-09-10 DOI:10.1002/mp.18111
Yusuke Nomura, Taku Inaniwa, Yoshitake Yamada, Minoru Yamada, Yoichi Yokoyama, Sodai Tanaka, Shunsuke Yonai, Hideyuki Mizuno, Yoshiyuki Iwata, Atsuya Takeda, Hitoshi Ishikawa, Masahiro Jinzaki
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引用次数: 0

摘要

背景了解肝脏及其替代器官的呼吸运动是肝癌放疗中精确给药的关键。虽然这些运动已经被研究用于平卧姿势的呼吸运动管理,但很少有研究对它们进行量化并评估它们在直立姿势中的相关性。目的本研究量化了平卧位和直立位呼吸运动监测中肝脏和替代器官的呼吸运动,并评价了肝脏运动与替代器官信号的相关性。方法对13名无症状志愿者进行仰卧位和直立位自由呼吸时的4D动态体积计算机断层扫描。通过可变形图像配准计算肝脏的四维运动。随后,在4D CT图像上获得右膈顶点的上下运动(SI)和腹部皮肤表面的前后运动(AP)作为替代信号。比较两种体位之间肝脏运动和替代信号的平均位移和最大幅度。此外,基于相关模型评估肝脏运动与代理信号之间的相关性。结果仰卧位呼气末沿左、左、右方向的平均肝脏位移分别为- 6.1、2.1和- 0.4 mm,直立位为- 4.6、2.5和0.1 mm。沿SI方向的最大运动范围从仰卧位的16.3±6.6 mm显著减小到直立位的11.0±2.7 mm。与仰卧位相似,相关模型也以较高的拟合精度再现了直立姿势下的肝脏运动。结论与传统仰卧位相比,直立体位的肝脏SI运动较小,但与替代信号保持明显的相关性,表明直立体位可以精确给药,减少内靶间隙。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Comparison of supine and upright postures for liver respiratory motion management in radiotherapy

Comparison of supine and upright postures for liver respiratory motion management in radiotherapy

Comparison of supine and upright postures for liver respiratory motion management in radiotherapy

Background

Understanding respiratory motions of liver and its surrogate organs is crucial for precise dose delivery in liver cancer radiotherapy. Although these motions have been studied for respiratory motion management in the supine posture, few studies have quantified them and evaluated their correlations in the upright posture.

Purpose

This study quantified the respiratory motions of liver and surrogate organs and evaluated the correlations between the liver motions and surrogate signals for respiratory motion monitoring in both the supine and upright postures.

Methods

4D dynamic volume computed tomography (CT) images were acquired from 13 asymptomatic volunteers in both supine and upright postures while free breathing. The 4D liver motions were calculated by performing deformable image registration. Subsequently, superior–inferior (SI) motion at the right diaphragm apex and anterior–posterior (AP) motion at the abdominal skin surface were obtained as surrogate signals from the 4D CT images. The average displacements and maximum magnitudes of liver motions and surrogate signals were compared between the postures. Moreover, the correlations between the liver motions and surrogate signals were evaluated based on correlation models.

Results

The average liver displacements from the end-exhalation along the SI, AP, and left-right directions were −6.1, 2.1, and −0.4 mm in the supine posture and −4.6, 2.5, and 0.1 mm in the upright posture, respectively. The maximum motion range along the SI direction significantly decreased from 16.3 ± 6.6 mm in the supine posture to 11.0 ± 2.7 mm in the upright posture. Similar to the supine posture, the correlation models also reproduced the liver motions with high fitting accuracy in the upright posture.

Conclusions

Compared to the conventional supine posture, the liver SI motion became smaller in the upright posture while keeping evident correlations with the surrogate signals, which suggests the upright posture will allow precise dose delivery with reduced internal target margins.

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来源期刊
Medical physics
Medical physics 医学-核医学
CiteScore
6.80
自引率
15.80%
发文量
660
审稿时长
1.7 months
期刊介绍: Medical Physics publishes original, high impact physics, imaging science, and engineering research that advances patient diagnosis and therapy through contributions in 1) Basic science developments with high potential for clinical translation 2) Clinical applications of cutting edge engineering and physics innovations 3) Broadly applicable and innovative clinical physics developments Medical Physics is a journal of global scope and reach. By publishing in Medical Physics your research will reach an international, multidisciplinary audience including practicing medical physicists as well as physics- and engineering based translational scientists. We work closely with authors of promising articles to improve their quality.
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