The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator
The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator
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DOI：
10.1016/j.radonc.2018.01.001
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发表时间：
2018-04-01
影响因子：
5.7
通讯作者：
Booth, Jeremy T.
中科院分区：
文献类型：
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作者：
Keall, Paul J.;Doan Trang Nguyen;Booth, Jeremy T.
目的：到目前为止，实时图像引导自适应放射治疗（IGART）一直是专用癌症放射治疗系统的领域。本研究的目的是在临床上实施和调查实时IGART使用一个标准的直线加速器。材料/方法：我们开发和实施了两个实时技术的标准直线加速器：（1）千伏级内监测（KIM），发现目标和（2）多叶准直器（MLC）的跟踪，对准放射束的目标。8例前列腺SABR患者接受了这种实时IGART技术治疗。结果：实时IGART的40个分次中有39个是成功的（95%置信区间87-100%）。在LR、SI和AP方向上，KIM系统的几何精度分别为-0.1 +/- 0.4、0.2 +/- 0.2和-0.1 +/- 0.6 mm。剂量重建表明，实时IGART更接近再现计划剂量比没有IGART。对于最大的运动分数，与实时IGART 100%的CTV收到了规定的剂量，没有实时IGART只有95%的CTV会收到规定的dose.Conclusion：实时图像引导的自适应放射治疗的标准直线加速器使用KIM和MLC跟踪的临床实施是可行的。这一成就为实时IGART成为主流治疗选择铺平了道路。(C)2018爱思唯尔B. V.保留所有权利。
Purpose: Until now, real-time image guided adaptive radiation therapy (IGART) has been the domain of dedicated cancer radiotherapy systems. The purpose of this study was to clinically implement and investigate real-time IGART using a standard linear accelerator.Materials/methods: We developed and implemented two real-time technologies for standard linear accelerators: (1) Kilovoltage Intrafraction Monitoring (KIM) that finds the target and (2) multileaf collimator (MLC) tracking that aligns the radiation beam to the target. Eight prostate SABR patients were treated with this real-time IGART technology. The feasibility, geometric accuracy and the dosimetric fidelity were measured.Results: Thirty-nine out of forty fractions with real-time IGART were successful (95% confidence interval 87-100%). The geometric accuracy of the KIM system was -0.1 +/- 0.4, 0.2 +/- 0.2 and -0.1 +/- 0.6 mm in the LR, SI and AP directions, respectively. The dose reconstruction showed that real-time IGART more closely reproduced the planned dose than that without IGART. For the largest motion fraction, with real-time IGART 100% of the CTV received the prescribed dose; without real-time IGART only 95% of the CTV would have received the prescribed dose.Conclusion: The clinical implementation of real-time image-guided adaptive radiotherapy on a standard linear accelerator using KIM and MLC tracking is feasible. This achievement paves the way for real-time IGART to be a mainstream treatment option. (C) 2018 Elsevier B.V. All rights reserved.