Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance.
Considerations for Upright Particle Therapy Patient Positioning and Associated Image Guidance.
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DOI：
10.3389/fonc.2022.930850
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发表时间：
2022
影响因子：
4.7
通讯作者：
Graeff, Christian
中科院分区：
文献类型：
--
作者：
Volz, Lennart;Sheng, Yinxiangzi;Durante, Marco;Graeff, Christian
粒子治疗是癌症治疗中快速发展的领域。在全球范围内，有100多个中心正在运营，目前还有更多的中心处于建设阶段。粒子治疗的兴趣在于通过粒子的反向深度剂量分布可实现的上级目标剂量一致性和健康组织保护。然而，这种物理优势与粒子治疗设施的复杂性和成本增加相反。粒子治疗，特别是使用较重的离子，需要大型且昂贵的设备来将粒子加速到所需的治疗能量并将射束引导到患者。治疗设施的成本的很大一部分归因于机架，其用于在患者周围实现不同的射束角度，以实现最佳的健康组织保护。代替台架，与固定水平光束线配对的旋转椅定位系统提供了合适的具有成本效益的替代方案。椅子系统已经在粒子治疗出现时使用，但由于缺乏专用的图像引导系统而导致与直立位置相关的设置不确定性增加，因此很快被淘汰。最近，由于射束输送的改进、垂直患者CT成像的商业可用性和改进的图像引导系统以减轻坐式治疗中的解剖运动问题，治疗椅获得了新的兴趣。在这篇综述中，讨论了直立患者定位系统的经济和临床原因。现有的设计有针对性的粒子治疗进行审查，并得出结论的椅子系统和相关的图像引导的设计和建设。最后，从文献的不同方面被引导到潜在的直立治疗布局的建议，无论是改造和新的设施。
Particle therapy is a rapidly growing field in cancer therapy. Worldwide, over 100 centers are in operation, and more are currently in construction phase. The interest in particle therapy is founded in the superior target dose conformity and healthy tissue sparing achievable through the particles’ inverse depth dose profile. This physical advantage is, however, opposed by increased complexity and cost of particle therapy facilities. Particle therapy, especially with heavier ions, requires large and costly equipment to accelerate the particles to the desired treatment energy and steer the beam to the patient. A significant portion of the cost for a treatment facility is attributed to the gantry, used to enable different beam angles around the patient for optimal healthy tissue sparing. Instead of a gantry, a rotating chair positioning system paired with a fixed horizontal beam line presents a suitable cost-efficient alternative. Chair systems have been used already at the advent of particle therapy, but were soon dismissed due to increased setup uncertainty associated with the upright position stemming from the lack of dedicated image guidance systems. Recently, treatment chairs gained renewed interest due to the improvement in beam delivery, commercial availability of vertical patient CT imaging and improved image guidance systems to mitigate the problem of anatomical motion in seated treatments. In this review, economical and clinical reasons for an upright patient positioning system are discussed. Existing designs targeted for particle therapy are reviewed, and conclusions are drawn on the design and construction of chair systems and associated image guidance. Finally, the different aspects from literature are channeled into recommendations for potential upright treatment layouts, both for retrofitting and new facilities.
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