Clinical workflow for MR-only simulation and planning in prostate.
Clinical workflow for MR-only simulation and planning in prostate.
复制标题
DOI：
10.1186/s13014-017-0854-4
复制
发表时间：
2017-07-17
期刊：
影响因子：
--
通讯作者：
Hunt M
中科院分区：
文献类型：
--
作者：
Tyagi N;Fontenla S;Zelefsky M;Chong-Ton M;Ostergren K;Shah N;Warner L;Kadbi M;Mechalakos J;Hunt M
描述在临床中实施仅MR工作流以模拟和规划前列腺癌患者的细节和经验。2016年6月至2016年12月期间，48例接受外射束放疗的前列腺癌患者计划接受仅MR模拟。采集MR图像用于轮廓绘制（T2 w轴向、冠状、矢状）、合成CT生成（基于3D FFE）和基准识别（基于3D bFFE）。总采集时间为25 min。Syn-CT在控制台上使用称为MRCAT的商业软件生成。作为MRCAT包装验收测试的一部分，进行了外部激光定位系统QA（< 2 mm）和几何保真度QA（50 cm LR和30 cm AP内< 2 mm），并设定了基线值。我们修改了当前的CT + MR组合模拟过程，以适应基于MRCAT的仅MR模拟工作流程。创建了使用MIM™工作流程的自动化分步过程，用于在MR图像上绘制轮廓。通过将MRCAT DRR与基于基准ROI或骨骼的正交KV射线照片匹配，实现患者治疗设置。获取3-D CBCT并与MR/syn-CT进行比较，以评估与模拟条件相比的直肠和膀胱充盈。42例患者成功接受了仅MR模拟，并符合我们基于CT + MR工作流程制定的所有机构剂量测定目标。其余6名患者要么有髋关节假体，要么他们的大体型超出了几何保真度QA标准，因此他们不是仅MR模拟的候选人。与基于CT + MR的模拟相比，基于MR的模拟可节省约15分钟的总时间。由于正常结构的时间变化最小，因此与CT + MR组合图像相比，自动化和有组织的MIM工作流程使MR上的轮廓绘制更容易、更快和更准确。所有病例均成功实现了使用MRCAT参考图像基于骨骼/基准点的2D和3D治疗设置定位。在临床环境中，具有等同或上级靶勾画、规划和治疗设置定位准确性的仅MR模拟和规划是可行的。未来的工作将集中在实现一个强大的三维各向同性采集轮廓。本文的在线版本（doi：10.1186/s13014-017-0854-4）包含补充材料，可供授权用户使用。
To describe the details and experience of implementing a MR-only workflow in the clinic for simulation and planning of prostate cancer patients. Forty-eight prostate cancer patients from June 2016 - Dec 2016 receiving external beam radiotherapy were scheduled to undergo MR-only simulation. MR images were acquired for contouring (T2w axial, coronal, sagittal), synthetic-CT generation (3D FFE-based) and fiducial identification (3D bFFE-based). The total acquisition time was 25 min. Syn-CT was generated at the console using commercial software called MRCAT. As part of acceptance testing of the MRCAT package, external laser positioning system QA (< 2 mm) and geometric fidelity QA (< 2 mm within 50 cm LR and 30 cm AP) were performed and baseline values were set. Our current combined CT + MR simulation process was modified to accommodate a MRCAT-based MR-only simulation workflow. An automated step-by-step process using a MIM™ workflow was created for contouring on the MR images. Patient setup for treatment was achieved by matching the MRCAT DRRs with the orthogonal KV radiographs based on either fiducial ROIs or bones. 3-D CBCTs were acquired and compared with the MR/syn-CT to assess the rectum and bladder filling compared to simulation conditions. Forty-two patients successfully underwent MR-only simulation and met all of our institutional dosimetric objectives that were developed based on a CT + MR-based workflow. The remaining six patients either had a hip prosthesis or their large body size fell outside of the geometric fidelity QA criteria and thus they were not candidates for MR-only simulation. A total time saving of ~15 min was achieved with MR-based simulation as compared to CT + MR-based simulation. An automated and organized MIM workflow made contouring on MR much easier, quicker and more accurate compared with combined CT + MR images because the temporal variations in normal structure was minimal. 2D and 3D treatment setup localization based on bones/fiducials using a MRCAT reference image was successfully achieved for all cases. MR-only simulation and planning with equivalent or superior target delineation, planning and treatment setup localization accuracy is feasible in a clinical setting. Future work will focus on implementing a robust 3D isotropic acquisition for contouring. The online version of this article (doi:10.1186/s13014-017-0854-4) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
3.6
作者：
Nyholm, Tufve;Jonsson, Joakim;Zackrisson, Bjorn
通讯作者：
Zackrisson, Bjorn
影响因子：
5.7
作者：
Gao, Zhanrong;Wilkin, David;Gerig, Lee
通讯作者：
Gerig, Lee
影响因子：
3.5
作者：
Tyagi, Neelam;Fontenla, Sandra;Hunt, Margie
通讯作者：
Hunt, Margie
影响因子：
5.7
作者：
Pinkawa, Michael;Corral, Nuria Escobar;Eble, Michael J.
通讯作者：
Eble, Michael J.
DOI：
10.1016/j.ijrobp.2015.08.049
发表时间：
2015-12-01
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Paradis E;Cao Y;Lawrence TS;Tsien C;Feng M;Vineberg K;Balter JM
通讯作者：
Balter JM