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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images.
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A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images.

机译：使用平均和最大强度投影图像研究肺癌立体定向放射治疗计划的剂量学准确性。

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PURPOSE: To assess the accuracy of current stereotactic body radiation therapy (SBRT) lung treatment planning methodologies on irregular breathing patterns, we have performed a systematic dosimetric evaluation in phantoms by utilizing maximum intensity projection (MIP) and average (AVG) images generated from four dimensional computed tomography (4DCT). METHODS: A custom built programmable lung phantom was used to simulate tumor motions due to various breathing patterns of patients. 4DCT scans were obtained in helical mode, and reconstructed AVG and MIP datasets were imported into the Pinnacle 8.0 h treatment planning system. SBRT plans were generated and executed, and delivered doses were measured by radiochromic film for analysis. RESULTS: For targets moving regularly or irregularly within a small range (7.0+/-1.8 mm, n=6), we observed good agreement between the measured and computed dose distributions. However, for targets moving irregularly with a larger range (20.8+/-2.6 mm, n=4), the measured isodose lines were found to be shifted relative to the planned distribution, resulting in an under-dosing (over 10%) in a portion of the PTV. We further observed that the discrepancy between planned and measured dose distribution is due to the inaccurate representation of irregular target motion in the MIP images generated from 4DCT. CONCLUSIONS: Caution should be used when planning from 4DCT images in the presence of large and irregular target motion. The inaccuracy inherent in 4DCT MIP and AVG images can be mitigated through the application of methodologies to reduce respiratory motion, such as abdominal compression, and through the use of volumetric image guidance (e.g., cone beam CT-CBCT) to assure precise targeting with minimal shifts.
机译：目的：为了评估当前的立体定向放射治疗（SBRT）肺治疗计划方法在不规则呼吸模式上的准确性，我们通过利用最大强度投影（MIP）和平均（AVG）图像生成的幻影对幻影进行了系统的剂量学评估三维计算机断层扫描（4DCT）。方法：使用定制的可编程肺部体模来模拟由于患者各种呼吸模式而引起的肿瘤运动。以螺旋模式获得4DCT扫描，并将重建的AVG和MIP数据集导入Pinnacle 8.0 h治疗计划系统。生成并执行SBRT计划，并通过放射致变色膜测量递送剂量以进行分析。结果：对于目标在较小范围（7.0 +/- 1.8毫米，n = 6）内有规律或无规律地移动的目标，我们观察到实测剂量分布与计算剂量分布之间的一致性很好。但是，对于较大范围（20.8 +/- 2.6 mm，n = 4）不规则移动的目标，发现测得的等剂量线相对于计划的分布发生了偏移，导致剂量不足（超过10％）。 PTV的一部分。我们进一步观察到，计划剂量分布与测量剂量分布之间的差异是由于4DCT生成的MIP图像中不规则目标运动的不准确表示。结论：在目标运动较大且不规则的情况下，从4DCT图像进行计划时应谨慎。可以通过应用减少呼吸运动（例如腹部压缩）的方法来缓解4DCT MIP和AVG图像固有的不准确性，并通过使用体积图像引导（例如锥束CT-CBCT）来确保以最小的精确瞄准转移。

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