Cone-Beam CT Images as an Indicator of QACT During Adaptive Proton Therapy of Extremity Sarcomas.

IF 2.1 Q3 ONCOLOGY International Journal of Particle Therapy Pub Date : 2024-04-26 eCollection Date: 2024-06-01 DOI:10.1016/j.ijpt.2024.100017
Nrusingh C Biswal, Baoshe Zhang, Elizabeth Nichols, Matthew E Witek, William F Regine, ByongYong Yi
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Abstract

Purpose: Periodic quality assurance CTs (QACTs) are routine in proton beam therapy. In this study, we tested whether the necessity for a QACT could be determined by evaluating the change in beam path length (BPL) on daily cone-beam CT (CBCT).

Patients and methods: In this Institutional Review Board-approved study, we retrospectively analyzed 959 CBCT images from 78 patients with sarcomas treated with proton pencil-beam scanning. Plans on 17 QACTs out of a total of 243 were clinically determined to be replanned for various reasons. Daily CBCTs were retrospectively analyzed by automatic ray-tracing of each beam from the isocenter to the skin surface along the central axis. A script was developed for this purpose. Patterns of change in BPL on CBCT images were compared to those from adaptive planning using weekly QACTs.

Results: Sixteen of the 17 adaptive replans showed BPL changes ≥4 mm for at least 1 of the beams on 3 consecutive CBCT sessions. Similarly, 43 of 63 nonadaptively planned patients had BPL changes <4 mm for all of the beams. A new QACT criterium of a BPL change of any beam ≥4 mm on 3 consecutive CBCT sessions resulted in a sensitivity of 94.1% and a specificity of 68.3%. Had the BPL change been used as the QACT predictor, a total of 37 QACTs would have been performed rather than 243 QACTs in clinical practice.

Conclusion: The use of BPL changes on CBCT images represented a significant reduction (85%) in total QACT burden while maintaining treatment quality and accuracy. QACT can be performed only when it is needed, but not in a periodic manner. The benefits of reducing QACT frequency include reducing imaging dose and optimizing patient time and staff resources.

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锥形束 CT 图像作为四肢肉瘤自适应质子治疗过程中 QACT 的指标。
目的:定期质量保证 CT(QACT)是质子束治疗的常规方法。在这项研究中,我们测试了是否有必要通过评估每日锥束 CT(CBCT)上束路径长度(BPL)的变化来确定是否需要进行 QACT:在这项经机构审查委员会批准的研究中,我们回顾性分析了 78 名接受质子铅笔束扫描治疗的肉瘤患者的 959 张 CBCT 图像。在总共 243 个 QACT 中,有 17 个 QACT 的计划因各种原因被临床确定为需要重新计划。通过对每束射线从等中心到皮肤表面沿中心轴进行自动射线追踪,对每天的 CBCT 进行回顾性分析。为此开发了一个脚本。将 CBCT 图像上 BPL 的变化模式与使用每周 QACTs 进行自适应规划的模式进行比较:结果:在 17 个自适应重扫描中,有 16 个在连续 3 次 CBCT 扫描中至少有 1 个光束的 BPL 变化≥4 mm。同样,63 名非适应性计划患者中有 43 人的 BPL 发生了变化:使用 CBCT 图像上的 BPL 变化可显著减少(85%)QACT 的总负担,同时保持治疗质量和准确性。只有在需要时才能进行 QACT,而不是定期进行。减少 QACT 频率的好处包括降低成像剂量、优化患者时间和人力资源。
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来源期刊
International Journal of Particle Therapy
International Journal of Particle Therapy Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
3.70
自引率
5.90%
发文量
23
审稿时长
20 weeks
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