[논문]호흡이 불규칙한 환자의 치료를 위한 Beam on/off Interface를 이용한 종양 추적 치료 방법의 성능 평가

이민식

doi:10.7742/jksr.2018.12.3.343

호흡이 불규칙한 환자의 치료를 위한 Beam on/off Interface를 이용한 종양 추적 치료 방법의 성능 평가
Performance Evaluation of the Tumor Tracking Method Using Beam on/off Interface for the Treatment of Irregular Breathing 원문보기

한국방사선학회 논문지 = Journal of the Korean Society of Radiology, v.12 no.3, 2018년, pp.343 - 349

초록
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선량률을 조절하면서 종양을 추적하는 방법은 호흡이 불규칙한 환자를 치료할 때 방사선을 적응적으로 전달하는 효율적인 방법으로 알려져 있다. 이 연구에서는 빔 켜기/끄기 스위칭을 제공하는 모션 관리 인터페이스 (MMI, Varian Medical System, CA)를 이용한 불규칙 호흡에 대해 적응성 종양 추적을 시행 할 수 있는지 확인하였다. 폐암 환자로부터 획득한 55개의 호흡 정보를 사용하였다. 첫날 환자의 RPM 흔적을 사용하여 사전 프로그래밍 된 추적 MLC 패턴을 디자인하는데, 치료 기간 중 환자의 호흡 불규칙성의 변화를 따라 잡기 위해 기간을 의도적으로 20% 줄였다. 이 기술의 적정성 기준은 진폭 및 주기의 20 % 미만의 표준편차이다. 사전 프로그래밍 된 MLC 위치와 현재 호흡 위치를 고려하여 100 ms마다 빔 켜기 / 끄기를 결정하는 알고리즘이 개발되었다. 추적 오류 및 전달 효율성은 RPM 추적에서 빔 스위칭 적응형 추적을 시뮬레이션하여 계산되었다. 38 명의 환자(70%)의 호흡 양상이 적합 기준을 충족 시켰습니다. 기준을 충족하는 모든 사례의 추적 오류는 2 mm 미만 (평균 1.4 mm)이며 평균 전달 효능은 71 % 였다. 기준을 충족하지 못한, 나머지 경우의 추적오류와 전달 효율은 1.9 mm와 48% 였다. 본 연구를 통해, 환자 선택이 적격 기준을 기반으로 하는 경우 빔 스위칭을 통한 적응형 추적 치료가 가능한 것을 확인하였다.

Abstract ▼ AI-Helper

Dose rate regulated tracking is known to be an efficient method which adaptively delivers tracking treatments when patient breathing is irregular. The Motion Management Interface (MMI, Varian Medical System, CA), which provides beam on/off switching during treatment is available for clinic. Study is to test if delivering the adaptive tumor tracking is feasible for irregular breathing using beam switching with MMI. 55 free breathing RPM traces acquired from lung cancer patients are used. The first day RPM traces of the patients are utilized to design preprogrammed tracking MLC patterns, of which periods are intentionally reduced by 20% in order to catch up the variation of patient breathing irregularity in the treatment day. Eligibility criteria for this technique are the variation of amplitude and period less than 20%. An algorithm which determines beam on/off every 100 ms by considering the preprogrammed (MLC) positions and current breathing positions is developed. Tracking error and delivery efficacy are calculated by simulating the beam-switching adaptive tracking from the RPM traces. Breathing patterns of 38 patients (70%) met the eligibility criteria. Tracking errors of all of the cases who meet the criteria are less than 2 mm (average 1.4 mm) and the average delivery efficacy was 71%. Those of rest of the cases are 1.9 mm and 48%. Adaptive tracking with beam switching is feasible if patient selection is based on the eligibility criteria.

주제어

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문제 정의

In this paper, we presented the practical imple mentation of the adaptive tumor tracking using beam switching interface used for DRRT to compensate for the breathing irregularities. The results showed that the patients with satisfying the eligible criteria can get 71% average delivery efficacy and 1.
This paper is focused on the practical implementation of the adaptive tumor tracking using beam switching. The beam switching can be achieved from gating interface or from the motion management interface (MMI, Varian Medical System, CA).

제안 방법

We set up the expected phase and displacement values (P_{Exp_RPM} and A_{Exp_RPM}) based on the incoming current RPM signals. If the difference between the current RPM displacement and the current MLC displacement is less than the tolerance, the algorithm conducts the adaptive tumor tracking on the phase mode; otherwise it works based on the displacement mode.
In the amplitude tracking mode, we implemented the algorithm by comparing the displacement difference between the expected tumor displacement (A_{Exp_RPM}) and the current MLC displacement (A_MLC) (or the next MLC displacement (A_{Next_MLC}) after 100ms). If the displacement differences satisfy the following condition, i.
In the phase tracking mode, we implemented the algorithm by comparing the phase difference between the expected tumor phase (P_{Exp_RPM}) and the current MLC phase (P_MLC) (or the next MLC phase (P_{Next_MLC}) after 100ms). If the phase difference between the expected tumor phase (P_{Exp_RPM}) and the current MLC phase (P_MLC) is greater than the phase difference between the expected tumor phase (P_{Exp_RPM}) and the next MLC phase (P_{Next_MLC}), the radiation beam is on and the MLC sequence follows tumor motion as planned.
Fifty-five free breathing RPM traces acquired from lung cancer patients are used for the feasibility test of MMI to implement DRRT. The first day RPM traces of the patients are utilized to design tracking MLC patterns, of which periods are intentionally reduced by 20% in order to catch up the variation of patient breathing periods in the treatment day. Eligibility criteria for this technique are the variation of amplitude and period less than 20%.
The first day RPM traces of the patients are utilized to design tracking MLC patterns, which periods are intentionally reduced by 20% in order to catch up the variation of patient breathing periods in the treatment day. All the breathing traces are categorized into two groups based on eligibility criteria, i.
This study is to test if delivering the adaptive tumor tracking is feasible for irregular breathing using beam switching with MMI.

성능/효과

In this paper, we presented the practical imple mentation of the adaptive tumor tracking using beam switching interface used for DRRT to compensate for the breathing irregularities. The results showed that the patients with satisfying the eligible criteria can get 71% average delivery efficacy and 1.4 mm average displacement error.
The study revealed that the adaptive tumor tracking was feasible using beam switching interface. The average delivery efficacy defined as the ratio of beam-on time to the total treatment time was 64% and the maximum delivery efficacy was 86%.

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상세보기
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