대한방사선치료학회지 (The Journal of Korean Society for Radiation Therapy)

  • 제33권
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  • Pages.99-108
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  • 2021
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  • 1598-8449(pISSN)
대한방사선치료학회 (Korean Society for Radiation Therapy)
권호 표지

표면위치표지자를 적용한 정위적 부분유방방사선치료의 유용성 평가

Evaluation of usefulness for Stereotactic Partial Breast Irradiation(S-PBI) by using Surface Fiducial Marker

  • 김종열 (연세암병원 방사선종양학과) ;
  • 정동민 (연세암병원 방사선종양학과) ;
  • 김세영 (연세암병원 방사선종양학과) ;
  • 유현종 (연세암병원 방사선종양학과) ;
  • 최정환 (연세암병원 방사선종양학과) ;
  • 박효국 (연세암병원 방사선종양학과) ;
  • 백종걸 (연세암병원 방사선종양학과) ;
  • 이상규 (연세암병원 방사선종양학과) ;
  • 조정희 (연세암병원 방사선종양학과)
  • Kim, JongYeol (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Jung, DongMin (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Kim, SeYoung (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Yoo, HyunJong (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Choi, JungHoan (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Park, HyoKuk (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Baek, JongGeol (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Lee, SangKyu (Department of Radiation Oncology, Yonsei Cancer Center) ;
  • Cho, JeongHee (Department of Radiation Oncology, Yonsei Cancer Center)
  • 발행 : 2021.12.31
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초록

목 적: 사이버나이프를 이용한 정위적 부분유방방사선치료(Stereotactic Partial Breast Irradiation) 시 기존의 침습적인 위치표지자(Fiducial Marker) 삽입 방식이 아닌 비침습방식에 대한 유용성을 평가 하고자 한다. 대상 및 방법: 본 연구를 위한 영상 중심(Imaging Center)의 일치도는 2D모의치료기와 사이버나이프의 양사방향(Both oblique, 45 °, 315 °) 영상 획득 후 다이스 유사 계수를 통해 정량적으로 평가하였다. 표면위치표지자의 위치 재현성은 본원 프로토콜을 기반으로 ATOM Phantom 표면에 금 재질의 위치표지자 8개를 부착하고 2D모의치료와 치료계획, 사이버나이프 영상을 분석하여 평가 하였다. 결 과: 영상 중심의 일치도 평가결과는 양사방향(45 °, 315 °)에서 각각 0.87, 0.9 였다. 표면위치표지자의 재현성 평가 결과 좌측 유방은 수평수직방향 Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, 회전 방향 Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 ° 로 나타났다. 우측 유방은 수평수직방향 Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm 회전 방향 Roll 0.2 °, Pitch 0.1 °, Yaw 0.1 ° 로 나타났다. 결 론: 사이버나이프를 이용한 정위적 부분유방암방사선치료 시 표면위치표지자의 비침습 트로토콜을 기반으로 통증 및 감염 등의 예방과 전처치 시간을 줄이고 환자의 경제적 부담을 경감 할 수 있었으며, 영상 중심의 높은 일치도 및 위치표지자의 재현성을 바탕으로 치료에 유용할 것으로 사료된다.

Purpose: The goal of this study is to evaluate usefulness of noninvasive method instead of previous inserting Fiducial Marker Method when performing Stereotactic Partial Breast Irradiation in CyberKnife. Material and methods: For consistency of Imaging Center, we evaluated both oblique images at angle 45 and 315 acquired from 2D Simulator and CyberKnife quantitatively through dice similarity coefficient. Also, location reproducibility of Surface Fiducial Marker was analyzed from 2D Simulator, treatment plans and CyberKinfe images by using 8 Fiducial Markers made of gold attached to ATOM Phantom based on our institution's protocols. Results: The results of the estimated consistency were 0.87 and 0.9 at the oblique angle 45 and 315, respectively. For location consistency of Surface Fiducial Markers, values of horizontal vertical direction of left breast were Superior/Inferior 0.3 mm, Left/Right -0.3 mm, Anterior/Posterior 0.4 mm, and the values of rotational direction were Roll 0.3 °, Pitch 0.2 °, Yaw 0.4 °. The values of horizontal vertical direction of right breast were Superior/Inferior -0.1 mm, Left/Right -0.1 mm, Anterior/Posterior -0.1 mm, and the values of rotational direction were Roll 0.2°, Pitch 0.1°, Yaw 0.1°. Conclusions: We expect that the protocols used by Surface Fiducial Markers when performing Stereotactic Partial Breast Irradiation in CyberKnife will provide protection from pain and cut expenses for treatment and reduce treatment errors and make treatment more accurate by suggesting treatment protocols based on high consistency of Imaging Center and reproducibility of Fiducial Markers.

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