Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer
Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer
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DOI：
10.1016/s0360-3016(00)00747-1
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发表时间：
2000-11-01
影响因子：
7
通讯作者：
Mageras, G
中科院分区：
文献类型：
--
作者：
Mah, D;Hanley, J;Mageras, G
目的：本文的目的是描述我们的初步经验与深吸气屏气（DIBH）技术在非小细胞肺癌的适形治疗，特别强调所需的技术方面的implementation.Methods和Materials：在DIBH技术，病人是口头教练通过修改后的缓慢肺活量机动，并带来了可重复的深吸气屏气水平。目标是使肿瘤缩小，并将正常肺从高剂量区域扩大。物理学家或治疗师使用具有自定义计算机界面的肺活量计在模拟、验证和治疗期间监测和记录患者呼吸。在多次屏气的荧光透视期间检查内部解剖结构确定了每例患者DIBH动作的再现性。获得参考自由呼吸CT扫描和DIBH计划扫描。为了提供正常潮气呼吸期间肿瘤运动的估计，在吸气末和呼气末获得额外的扫描集。这些也用于设置肺量计的治疗作用水平。在治疗过程中，通过比较从DIBH数字重建X线片测量的等中心点到横膈膜的距离与在射野片上测量的距离，独立验证患者肺充气。在治疗过程中获得的患者呼吸痕迹仅仅回顾性地检查，以评估重现性的technology.Results：数据从第一个7例，涵盖超过250治疗，进行了分析。根据超过350次屏气中的肺活量计记录计算得出的大体肿瘤体积质心相对于其在计划扫描中的位置的推断位移为0.02 +/- 0.14 cm（平均值和标准差）。这些数据与（92）射野片上测量的横膈膜相对于等中心点的位移（-0.1 +/- 0.4 cm;范围，从-1.2至1.1 cm）一致。后一种测量包括患者摆位误差。患者平均位移的肿瘤在自由呼吸，确定从吸气末和呼气末之间的肿瘤位移，是0.8 +/- 0.5厘米，在上下和前后方向和0.1厘米（+/- 0.1厘米）medial-lateral.Conclusion：治疗患者的DIBH技术是可行的，在临床环境。使用这种技术，在患者中实现一致的肺充气水平。这是通过肺活量测定法和验证胶片来判断的。与自由呼吸相比，使用DIBH显著减少了呼吸诱导的肿瘤运动，从而实现了更好的目标覆盖。(C)2000 Elsevier Science Inc.
Purpose: The goal of this paper is to describe our initial experience with the deep inspiration breath-hold (DIBH) technique in conformal treatment of non-small-cell lung cancer with particular emphasis on the technical aspects required for implementation.Methods and Materials: In the DIBH technique, the patient is verbally coached through a modified slow vital capacity maneuver and brought to a reproducible deep inspiration breath-hold level. The goal is to immobilize the tumor and to expand normal lung out of the high-dose region. A physicist or therapist monitors and records patient breathing during simulation, verification, and treatment using a spirometer with a custom computer interface. Examination of internal anatomy during fluoroscopy over multiple breath holds establishes the reproducibility of the DIBH maneuver for each patient. A reference free-breathing CT scan and DIBH planning scan are obtained. To provide an estimate of tumor motion during normal tidal breathing, additional scan sets are obtained at end inspiration and end expiration. These are also used to set the spirometer action levels for treatment. Patient lung inflation is independently verified over the course of treatment by comparing the distance from the isocenter to the diaphragm measured from the DIBH digitally reconstructed radiographs to the distance measured on the portal films. Patient breathing traces obtained during treatment mere examined retrospectively to assess the reproducibility of the technique.Results: Data from the first 7 patients, encompassing over 250 treatments, were analyzed. The inferred displacement of the centroid of gross tumor volume from its position in the planning scan, as calculated from the spirometer records in over 350 breath holds was 0.02 +/- 0.14 cm (mean and standard deviation). These data are consistent with the displacements of the diaphragm (-0.1 +/- 0.4 cm; range, from -1.2 to 1.1 cm) relative to the isocenter, as measured on the (92) portal films. The latter measurements include the patient setup error. The patient averaged displacement of the tumor during free breathing, determined from the tumor displacement between end inspiration and end expiration, was 0.8 +/- 0.5 cm in both the superior-inferior and anterior-posterior directions and 0.1 cm (+/- 0.1 cm) medial-laterally.Conclusion: Treatment of patients with the DIBH technique is feasible in a clinical setting. With this technique, consistent lung inflation levels are achieved in patients. as judged by both spirometry and verification films. Breathing-induced tumor motion is significantly reduced using DIBH compared to free breathing, enabling better target coverage. (C) 2000 Elsevier Science Inc.