The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method
The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method
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DOI：
10.1118/1.4904023
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发表时间：
2015-01-01
期刊：
影响因子：
3.8
通讯作者：
Booth, Jeremy T.
中科院分区：
文献类型：
--
作者：
Keall, Paul J.;Ng, Jin Aun;Booth, Jeremy T.
目的：千伏分数次监测 (KIM) 是一种实时图像引导方法，采用广泛使用的放射治疗技术，即龙门式 X 射线成像仪。作者报告了 2014 年 9 月 16 日使用 KIM 进行的第一例患者治疗的几何和剂量测定结果。方法：KIM 使用当前和之前的 2D X 射线图像来估计癌症放射治疗期间的 3D 靶位置。 KIM 软件用于处理从带有龙门安装的 kV X 射线成像系统的标准 C 形臂直线加速器传输的千伏 (kV) 图像。获取 120 度治疗前 kV 成像弧以建立患者特定的 2D 到 3D 运动相关性。在兆伏 (MV) 治疗（双弧 VMAT 前列腺治疗）期间激活 kV 成像仪，以实时估计 3D 前列腺位置。本临床研究满足所有必要的道德、法律和监管要求。质量保证流程已完成并经过同行评审。结果：在治疗期间，使用 KIM 观察到前列腺位置向后偏移近 3 毫米。该位置偏移没有触发门控事件。治疗后，使用 kV/MV 三角测量独立测量前列腺运动，每个方向的平均差异小于 0.6 mm，标准偏差小于 0.6 mm。在治疗期间和治疗后对标记分割的准确性进行了目视评估，发现效果良好。治疗过程中，没有因KIM软件的性能而造成中断。结论：KIM首次用于癌症放射治疗期间的实时图像引导。第一次治疗部分的测量准确度和精确度均为亚毫米。这一临床转化研究里程碑为广泛实施实时图像引导铺平了道路，以促进癌症放射治疗中几何和剂量误差的检测和校正，从而改善临床结果。 (c) 2015 年美国医学物理学家协会。
Purpose: Kilovoltage intrafraction monitoring (KIM) is a real-time image guidance method that uses widely available radiotherapy technology, i.e., a gantry-mounted x-ray imager. The authors report on the geometric and dosimetric results of the first patient treatment using KIM which occurred on September 16, 2014.Methods: KIM uses current and prior 2D x-ray images to estimate the 3D target position during cancer radiotherapy treatment delivery. KIM software was written to process kilovoltage (kV) images streamed from a standard C-arm linear accelerator with a gantry-mounted kV x-ray imaging system. A 120 degrees pretreatment kV imaging arc was acquired to build the patient-specific 2D to 3D motion correlation. The kV imager was activated during the megavoltage (MV) treatment, a dual arc VMAT prostate treatment, to estimate the 3D prostate position in real-time. All necessary ethics, legal, and regulatory requirements were met for this clinical study. The quality assurance processes were completed and peer reviewed.Results: During treatment, a prostate position offset of nearly 3 mm in the posterior direction was observed with KIM. This position offset did not trigger a gating event. After the treatment, the prostate motion was independently measured using kV/MV triangulation, resulting in a mean difference of less than 0.6 mm and standard deviation of less than 0.6 mm in each direction. The accuracy of the marker segmentation was visually assessed during and after treatment and found to be performing well. During treatment, there were no interruptions due to performance of the KIM software.Conclusions: For the first time, KIM has been used for real-time image guidance during cancer radiotherapy. The measured accuracy and precision were both submillimeter for the first treatment fraction. This clinical translational research milestone paves the way for the broad implementation of real-time image guidance to facilitate the detection and correction of geometric and dosimetric errors, and resultant improved clinical outcomes, in cancer radiotherapy. (c) 2015 American Association of Physicists in Medicine.