| 基于射波刀Xsight spine prone tracking模式治疗脊柱肿瘤患者的摆位准确性分析 |
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| 引用本文： | 李君,孔祥慧,杨瑞杰,程程,王工,庄洪卿. 基于射波刀Xsight spine prone tracking模式治疗脊柱肿瘤患者的摆位准确性分析[J]. 中国肿瘤临床, 2022, 49(13): 670-674. DOI: 10.12354/j.issn.1000-8179.2022.20211797 |
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| 作者姓名： | 李君 孔祥慧 杨瑞杰 程程 王工 庄洪卿 |
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| 作者单位： | 1.北京大学第三医院肿瘤放疗科 （北京市100191） |
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| 基金项目： | 国家自然科学基金（编号：81372420）；;北京市科学自然基金项目（编号：7202223）资助~~； |
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| 摘 要： | ![]()
目的 射波刀脊柱肿瘤治疗提供了两种追踪模式，即脊柱追踪系统（Xsight spine tracking，XST）和俯卧位脊柱追踪系统（Xsight spine prone tracking，XSPT）。本研究通过比较两种脊柱追踪模式的摆位误差，评估射波刀采用XSPT模式治疗脊柱肿瘤患者的摆位准确性。 方法 回顾性分析2020年7月至2021年6月在北京大学第三医院行射波刀治疗的腰骶脊柱肿瘤患者18例，分别采用仰卧位（真空垫固定）和俯卧位（热塑体网与俯卧板固定）进行CT模拟定位。按照XST与XSPT两种追踪方式设计治疗计划，治疗中分别记录两种体位脊柱追踪的摆位修正误差，平移修正为进出、左右、升降方向，角度修正为顺时针-逆时针旋转、仰俯、倾斜。同时采集俯卧位治疗模式下同步呼吸追踪的相关误差。两种追踪模式的摆位修正误差参数通过配对t检验方法进行分析，比较两组修正误差的差异。同时分析俯卧位同步呼吸相关误差，评估呼吸模型的预测准确性。 结果 升降方向仰卧位修正误差为（0.18±0.16）mm，俯卧位为（0.31±0.26）mm，差异具有统计学意义（P<0.05）；进出方向仰卧位修正误差为（0.27±0.24）mm，俯卧位为（0.50±0.40）mm，差异具有统计学意义（P<0.05）。俯卧位呼吸模型相关误差左右、进出和升降的平均值分别为（0.21±0.11）mm、（0.41±0.38）mm和（0.68±0.42）mm。 结论 治疗中受呼吸运动的影响，相比于仰卧位定位方式，俯卧位在升降与进出方向摆位误差相对较大，但俯卧位治疗方式具有同步呼吸追踪系统，且该系统可以实现治疗过程中呼吸动度的实时修正。俯卧位脊柱追踪模式的一致性与准确性同样能够满足临床治疗需求。
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| 关 键 词： | 射波刀 脊柱追踪 俯卧位 立体定向放疗 |
| 收稿时间： | 2021-11-30 |
Positioning accuracy of patients with spinal tumors treated with Cyberknife Xsight spine prone tracking mode |
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| Affiliation: | 1.Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China2.School of Radiation Medicine and Protection, Soochow University, Suzhou 215123, China3.Collaborative Innovation Center of Radiological Medicine of Jiangsu Higher Education Institutions, Suzhou 215123, China |
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| Abstract: | ![]()
Objective Two tracking modes are provided for treating spinal tumors with Cyberknife: Xsight spine tracking (XST) and Xsight spine prone tracking (XSPT). In this study, the positioning errors of the two spinal tracking modes were compared to evaluate the accuracy of the XSPT mode in treating patients with spinal tumors. Methods Eighteen patients with lumbosacral spinal tumors were retrospectively selected at Peking University Third Hospital from July 2020 to June 2021. CT-simulated localization was performed in the supine (fixed with vacuum pad) and prone (fixed with thermoplastic mask and prone plate) positions. The treatment plans for the supine position were designed using the XST methods, and those for the prone position were designed using the XSPT method. During treatment, the spinal tracking correction errors of the two postures were recorded. The movement-corrected errors included the following three directions: inferior-superior (I-S), left-right (L-R), and anterior-posterior (A-P). The angle-corrected errors included clockwise-anticlockwise, pitch, and tilt. Furthermore, correlation errors of synchrony respiratory tracking in the prone position were recorded. Parameters of corrected error for the two tracking modes were analyzed using the paired t-test statistical method to compare the differences in the positioning accuracy between the two groups. In addition, correlation errors of the synchrony respiratory model in the prone position were analyzed to evaluate the prediction accuracy of the respiratory model. Results The correction error of the supine position in the A-P direction was (0.18±0.16) mm, and that of the prone position was (0.31 ± 0.26) mm (P<0.05). The correction error of the supine position in the I-S direction was (0.27±0.24) mm, and that of the prone position was (0.5±0.4) mm (P <0.05). The average correlation errors of the synchrony model for the L-R, I-S and A-P directions of the prone position were (0.21±0.11) mm, (0.41±0.38) mm, and (0.68±0.42) mm, respectively. Conclusions Because of the effect of respiratory movement during treatment, compared with the positioning error of the supine position, that of the prone position in the A-P and I-S directions is relatively large. However, the prone position mode has a synchronous tracking system that can correct the error of respiratory motility in real time to realize accurate target irradiation. Therefore, the consistency and accuracy of the XSPT mode meets the clinical treatment requirements. |
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