Minimal mask immobilization with optical surface guidance for head and neck radiotherapy.
Minimal mask immobilization with optical surface guidance for head and neck radiotherapy.
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DOI：
10.1002/acm2.12211
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发表时间：
2018-01
影响因子：
2.1
通讯作者：
Schwartz DL
中科院分区：
文献类型：
--
作者：
Zhao B;Maquilan G;Jiang S;Schwartz DL
全脸和颈部热塑性口罩为接受H&N IMRT的患者提供标准护理固定。然而，这些口罩是不舒服的，并增加皮肤剂量。本试验的目的是研究光学表面引导下最小面部和颈部面罩固定的可行性和设置精度。20例患者入组本IRB批准的方案。患者被固定在面罩上，仅固定前额和下巴。肩关节的运动受到可塑形垫或手持带牵开器的限制。位置信息，包括等中心点位置和CT皮肤轮廓，导入到商业表面图像引导系统。患者通常接受标准治疗IMRT，剂量为60-70戈伊，分30-33次。患者首先在光学图像引导下设置表面标记，参考模拟CT图像上的感兴趣区域（ROI）。通过室内CBCT确认定位。在六维机器人治疗床校正后，采集新的光学真实的时间表面图像，以跟踪分次内运动，并作为下一次治疗分次设置的参考表面。治疗师手动记录总治疗时间以及基于kV成像的治疗床移位。分次内ROI运动跟踪由光学图像引导系统自动记录。通过自我调查评估患者舒适度。设置误差测量为六维位移（垂直/纵向/横向/旋转/俯仰/滚动）。平均误差值分别为−0.51 ± 2.42 mm、−0.49 ± 3.30 mm、0.23 ± 2.58 mm、−0.15 ± 1.01 o、−0.02 ± 1.19 o和0.06 ± 1.08 o。平均治疗时间为21.6 ± 8.4分钟。表面引导治疗期间的主观舒适度在患者调查中得到证实。这些试验结果证实了与市售光学图像引导相结合的最小掩模固定的可行性。患者接受最低限度的面罩固定是令人鼓舞的。与标准面罩固定直接比较的后续确认似乎是必要的。
Full face and neck thermoplastic masks provide standard‐of‐care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. Twenty patients enrolled onto this IRB‐approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard‐of‐care IMRT to 60–70 Gy in 30–33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in‐room CBCT. Following six‐dimensional robotic couch correction, a new optical real‐time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self‐administered surveys. Setup error was measured as six‐dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were −0.51 ± 2.42 mm, −0.49 ± 3.30 mm, 0.23 ± 2.58 mm, −0.15 ± 1.01o, −0.02 ± 1.19o, and 0.06 ± 1.08o, respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface‐guided treatment was confirmed on patient surveys. These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow‐up validation, with direct comparison to standard mask immobilization, appears warranted.
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