Evaluation on the Accuracy of Targeting Error Correction Through the Application of Target Locating System in Robotic CyberKnife

로봇 사이버나이프에서 위치인식시스템을 이용한 Targeting Error값 보정의 정확성 평가

Purpose: The purpose is to evaluate the accuracy of correcting the targeting error through the Target Location System (TLS) for the location change error of the reference point which arises from the movement or motion of patient during the treatment using the CyberKnife. Materials and Methods: In this test, Gafchromic MD-55 film was inserted into the head and neck phantom to analyze the accuracy of the targeting, and then the 6 MV X-ray of CyberKnife (CyberKnife Robotic Radiosurgery System G4, Accuray, US) was irradiated. End to End (E2E) program was used to analyze the accuracy of targeting, which is provided by Accuray Corporation. To compute the error of the targeting, the test was carried out with the films that were irradiated 12 times by maintaining the distance within the rage of $0{\pm}0.2\;mm$ toward x, y, z from the reference point and maintaining the angle within the rage of $0{\pm}0.2^{\circ}$ toward roll, pitch, yaw, and then with the films which were irradiated 6 times by applying intentional movement. And the correlation in the average value of the reference film and the test film were analyzed through independent samples t-test. In addition, the consistency of dose distribution through gamma-index method (dose difference: 3%) was quantified, compared, and analyzed by varying the distance to agreement (DTA) to 1 mm, 1.5 mm, 2 mm, respectively. Results: E2E test result indicated that the average error of the reference film was 0.405 mm and the standard deviation was 0.069 mm. The average error of the test film was 0.413 mm with the standard deviation of 0.121 mm. The result of independent sampling t-test for both averages showed that the significant probability was P=0.836 (confidence level: 95%). Besides, by comparing the consistency of dose distribution of DTA through 1 mm, 1.5 mm, 2 mm, it was found that the average dose distribution of axial film was 95.04%, 97.56%, 98.13%, respectively in 3,314 locations of the reference film, consistent with the average dose distribution of sagittal film that was 95.47%, 97.68%, 98.47%, respectively. By comparing with the test film, it was found that the average dose distribution of axial film was 96.38%, 97.57%, 98.04%, respectively, at 3,323 locations, consistent with the average dose distribution of sagittal film which was 95.50%, 97.87%, 98.36%, respectively. Conclusion: Robotic CyberKnife traces and complements in real time the error in the location change of the reference point caused by the motion or movement of patient during the treatment and provides the accuracy with the consistency of over 95% dose distribution and the targeting error below 1 mm.

목 적: 로봇 사이버나이프에서 환자의 움직임에 의한 기준점의 위치변화 오차가 위치인식시스템(target location system, TLS) 을 통하여 targeting error값이 정확히 보정(correction)되는지 평가하고자 한다. 대상 및 방법: 본 실험은 targeting의 정확성을 분석하기 위해 head and neck팬텀에 Gafchromic 필름(MD-55)을 삽입한 후, 사이버나이프(CyberKnife Robotic Radiosurgery System G4, Accuray, US)의 6 MV X선을 조사하였다. 필름 분석은 Accuray사에서 제공하는 End to End (E2E) 프로그램을 이용하였다. 기준점의 위치에서 x, y, z방향으로 $0{\pm}0.2\;mm$, roll, pitch, yaw방향으로 $0{\pm}0.2^{\circ}$ 이내로 유지하여 12회 조사한 대조군과 인위적으로 움직임을 주어 실험을 시행한 6회의 실험군의 targeting 오차를 구하고, 대조군과 실험군의 평균값에 대한 유의성을 t-검정을 통해 분석하였다. 또한, gamma-index method (dose difference: 3%)를 통해 2차원적 선량분포의 일치성을 distance to agreement (DTA)를 각각 1 mm, 1.5 mm, 2 mm로 달리하여 정량화하고, 비교 분석하였다. 결 과: E2E test 시행 결과, 기준 필름의 targeting 평균오차 0.405 mm, 표준편차 0.069 mm, 실험 필름의 평균오차 0.413 mm, 표준편차 0.121 mm으로 나왔으며, t-검정 결과 유의확률 P=0.836 (신뢰구간 95%)으로 두 집단에서 유의한 차이를 볼 수 없었다. 또한, DTA를 각각 1 mm, 1.5 mm, 2 mm로 선량분포의 일치성을 비교한 결과 기준필름 3,314개 위치에서 axial필름 평균은 각각 95.04%, 97.56%, 98.13%, sagittal필름 평균은 각각 95.47%, 97.68%, 98.47% 일치하였다. 실험필름과 비교한 결과 3,323개 위치에서 axial필름 평균은 각각 96.38%, 97.57%, 98.04%, sagittal필름 평균은 각각 95.50%, 97.87%, 98.36% 일치하는 것을 확인할 수 있었다. 결 론: 로봇 사이버나이프는 치료 시 환자의 움직임에 의해 발생하는 기준점의 위치변화 오차를 실시간 추적하여 보정하며, targeting 오차를 1 mm 이내, 선량분포는 95% 이상 일치하는 정확성을 확인할 수 있었다.