The first clinical implementation of real-time image-guided adaptive radiotherapy using a standard linear accelerator

被引：55
|
作者：
Keall, Paul J. [1 ]
Doan Trang Nguyen [1 ]
O'Brien, Ricky [1 ]
Caillet, Vincent [1 ,2 ]
Hewson, Emily [1 ]
Poulsen, Per Rugaard [3 ]
Bromley, Regina [2 ]
Bell, Linda [2 ]
Eade, Thomas [1 ,2 ]
Kneebone, Andrew [1 ,2 ]
Martin, Jarad [4 ]
Booth, Jeremy T. [1 ,2 ]
机构：
[1] Univ Sydney, Sydney, NSW, Australia
[2] Royal North Shore Hosp, Sydney, NSW, Australia
[3] Aarhus Univ Hosp, Aarhus, Denmark
[4] Calvary Mater Newcastle Hosp, Waratah, NSW, Australia
来源：
RADIOTHERAPY AND ONCOLOGY | 2018年 / 127卷 / 01期
基金：
澳大利亚国家健康与医学研究理事会;
关键词：
Kilovoltage Intrafraction Monitoring (KIM); Multileaf collimator tracking; Real-time image-guided adaptive radiotherapy; Geometric accuracy; Dose reconstruction; TREATMENT-COUCH TRACKING; RADIATION-THERAPY; SYSTEM; LOCALIZATION; VALIDATION;
D O I：
10.1016/j.radonc.2018.01.001
中图分类号：
R73 [肿瘤学];
学科分类号：
100214 ;
摘要：
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.
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页码：6 / 11
页数：6
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