대한방사선치료학회지 (The Journal of Korean Society for Radiation Therapy)

  • 제35권
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  • Pages.41-51
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  • 2023
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  • 1598-8449(pISSN)
대한방사선치료학회 (Korean Society for Radiation Therapy)
권호 표지

폐암 환자의 정위체부방사선치료 시 기준선 변화에 따른 3D-CBCT(Cone Beam Computed-Tomography)와 Gated-CBCT의 영상 품질 및 유용성 평가

Image quality and usefulness evaluaton of 3D-CBCT and Gated-CBCT according to baseline changes for SBRT of Lung Cancer

  • 한국희 (서울아산병원 방사선종양학과) ;
  • 신충훈 (서울아산병원 방사선종양학과) ;
  • 이충환 (서울아산병원 방사선종양학과) ;
  • 유순미 (서울아산병원 방사선종양학과) ;
  • 박자람 (서울아산병원 방사선종양학과) ;
  • 김진수 (서울아산병원 방사선종양학과) ;
  • 윤인하 (서울아산병원 방사선종양학과)
  • Han Kuk Hee (Department of Radiation Oncology, ASAN Medical Center) ;
  • Shin Chung Hun (Department of Radiation Oncology, ASAN Medical Center) ;
  • Lee Chung Hwan (Department of Radiation Oncology, ASAN Medical Center) ;
  • Yoo Soon Mi (Department of Radiation Oncology, ASAN Medical Center) ;
  • Park Ja Ram (Department of Radiation Oncology, ASAN Medical Center) ;
  • Kim Jin Su (Department of Radiation Oncology, ASAN Medical Center) ;
  • Yun In Ha (Department of Radiation Oncology, ASAN Medical Center)
  • 발행 : 2023.12.31
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초록

목 적: 본 연구는 폐암 환자의 정위체부방사선치료 시(Stereotactic Body Radiation Therapy, SBRT) 기준선(Baseline) 변화에 따른 3D-CBCT(Cone Beam Computed-Tomography)와 Gated-CBCT의 영상 품질(Image quality)을 비교 분석하여 호흡에 따른 움직임의 보정에 유용한 CBCT 촬영 방법을 찾고자 한다. 대상 및 방법: QUASARTM(Modus Medical Devices Inc, Canada) 팬텀에 지름이 3 cm인 고체 종양 물질(Solid Tumor)을 삽입하여 팬텀의 속도를 주기 3 sec, 최대 진폭 20 mm 로 4DCT(4-Dimentional Computed-Tomography)를 촬영하였다. 전산화 치료계획시스템 EclipseTM을 이용하여 고체 종양 물질에 육안적 종양용적(Gross Target Volume, GTV)을 윤곽 묘사하였다. Truebeam STxTM을 이용해 4DCT 촬영 시와 동일하게 설정한 후, 기준선 변화가 1 mm, 3 mm, 5 mm인 호흡 패턴을 팬텀에 입력하여 3D-CBCT(Spotlight, Full)와 Gated-CBCT(Spotlight, Full) 영상을 5회 반복하여 획득하였다. 획득된 영상을 4DCT 영상을 기준으로 신호대잡음비(Signal-to-Noise Ratio, SNR), 대조대잡음비(Contrast-to-Noise Ratio, CNR), 종양 체적 길이(Tumor Volume Length) 및 모션 블러링 비(Motion Blurring Ratio, MBR)를 측정하여 비교하였다. 결 과: Spotlight Gated-CBCT 영상이 기준선 변화에 따른 신호대잡음비가 평균 13.30±0.10%, 대조대잡음비가 평균 7.78±0.16%, 종양 체적 길이가 평균 3.55 ± 0.17%, 모션 블러링 비가 평균 1.18 ± 0.06%로 Spotlight 3D-CBCT보다 우수한 값을 보였다. 또한, Full Gated-CBCT 영상이 기준선 변화에 따른 신호대잡음비가 평균 12.80 ± 0.11%, 대조대잡음비가 평균 7.60 ± 0.11%, 종양 체적 길이가 평균 3.54 ± 0.16%, 모션 블러링 비가 평균 1.18 ± 0.05%로 Full 3D-CBCT보다 우수한 값을 보였다. 결 론: 3D-CBCT 촬영 영상과 비교하여 Gated-CBCT 촬영 영상이 기준선 변화에 따른 영상 품질이 우수한 값을 보였으며, 호흡으로 인한 모션 블러링 인공물(Motion Blurring Artifacts)의 영향이 적은 것을 확인했다. 따라서 단기간에 고선량을 전달하는 폐암의 정위체부방사선치료 시 불규칙한 호흡으로 인한 기준선 변화가 발생하는 경우 Gated-CBCT를 이용해 영상유도(Image Guide)를 하는 것이 유용하다고 판단된다.

Purpose: This study compares and analyzes the image quality of 3D-CBCT(Cone Beam Computed-Tomography) and Gated CBCT according to baseline changes during SBRT(Stereotactic Body RadioTherapy) in lung cancer patients to find a useful CBCT method for correcting movement due to breathing Materials and methods : Insert a solid tumor material with a diameter of 3 cm into the QUASARTM phantom. 4-Dimentional Computed-Tomography(4DCT) images were taken with a speed of the phantom at period 3 sec and a maximum amplitude of 20 mm. Using the contouring menu of the computerized treatment planning system EclipseTM Gross Tumor Volume was outlined on solid tumor material. Set-up the same as when acquiring a 4DCT image using Truebeam STxTM, breathing patterns with baseline changes of 1 mm, 3 mm, and 5 mm were input into the phantom to obtain 3D-CBCT (Spotlight, Full) and Gated-CBCT (Spotlight, Full) images five times repeatedly. The acquired images were compared with the Signal-to-Noise Ratio(SNR), Contrast-to-Noise Ratio(CNR), Tumor Volume Length, and Motion Blurring Ratio(MBR) based on the 4DCT image. Results: The average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Spotlight Gated CBCT images were 13.30±0.10%, 7.78±0.16%, 3.55±0.17%, 1.18±0.06%. As a result, Spotlight Gated-CBCT images according to baseline change showed better values than Spotligtht 3D-CBCT images. Also, the average Signal-to-Noise Ratio, Contrast-to-Noise Ratio, Tumor Volume Length and Motion Blurring Ratio of Full Gated CBCT images were 12.80±0.11%, 7.60±0.11%, 3.54±0.16%, 1.18±0.05%. As a result Full GatedCBCT images according to baseline change showed better values than Full 3D-CBCT images. Conclusion : Compared to 3D-CBCT images, Gated-CBCT images had better image quality according to the baseline change, and the effect of Motion Blurring Artifacts caused by breathing was small. Therefore, it is considered useful to image guided using Gated-CBCT when a baseline change occurs due to difficulty in regular breathing during SBRT that exposes high doses in a short period of time

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참고문헌

  1. Yali Shen, Hong Zhang, Jin Wang et al: Hypofractionated radiotherapy for lung tumors with online cone beam CT guidance and active breathing control. Radiation Oncology voulme 5, Article number: 19(2010)
  2. Winnie Li, Thomas G Purdie, Mojgan Taremi et al:. Effect of immobilization and performance status on intrafraction motion for stereotactic lung radiotherapy: analysis of 133 patients. Int. J. Radiation Oncology Biol. Phys., Vol. 81, No. 5(2011)
  3. Chirag Shah, Inga S Grills, Larry L Kestin et al.: Intrafraction variation of mean tumor position during image-guided hypofractionated stereotactic body radiotherapy for lung cancer. Int. J. Radiation Oncology Biol. Phys., Vol 82, No. 5(2012)
  4. Matthias Guckenbergera, Katrin Heilmana, Joern Wulf et. al. :Pulmonary Injury and Tumor Response after Stereotactic Body Radiotherapy (SBRT): Results of a Serial Follow-up CT Study. Radiotherapy and Oncology, 85, 435-442, 2007 https://doi.org/10.1016/j.radonc.2007.10.044
  5. T Li, E Schreibmann, Y Yang et al. :Motion correction for improved target localization with on-board cone-beam computed tomography. Phys Med Biol, Vol. 51 2006;51(2):253-67. https://doi.org/10.1088/0031-9155/51/2/005
  6. Yu Wang, Tao Liu, Huiqin Chen et al :Comparison of internal target volumes defined by three-dimensional, four-dimensional, and cone-beam computed tomography images of a motion phantom. Ann Transl Med. 2020 Nov; 8(22) : 1488.
  7. Russell E, .Kincaid Jr, Ellen D. Yorke et al :Investigation of gated cone-beam CT to reduce respiratory motion blurring. Medical Physics. Vol 40, Issue 4(2013)
  8. Sweeney RA, Seubert B, Stark S et al. :Accuracy and inter-observer variability of 3D versus 4D conebeam CT based image-guidance in SBRT for lung tumors. Radiat Oncol 2012;7:81.
  9. Seppenwoolde Y, Shirato H, Kitamura K et al.. :Precise and real-time measurement of 3D tumor motion in lung due to breathing and heartbeat, measured during radiotherapy. Int J Radiat Oncol Biol Phys., 2002;53:822-34. https://doi.org/10.1016/S0360-3016(02)02803-1
  10. Dietrich L, Jetter S, Tucking T et al. :Linac-integrated 4D cone beam CT: first experimental results., Phys Med Biol. 2006;51(11):2939-52. https://doi.org/10.1088/0031-9155/51/11/017
  11. Sonke JJ, Zijp L, Remeijer P et al. :Respiratory correlated cone beam CT. Med Phys. 2005;32(4):1176-86. https://doi.org/10.1118/1.1869074
  12. Bissonnette JP, Franks KN, Purdie TG, et al. :Quantifying interfraction and intrafraction tumor motion in lung stereotactic body radiotherapy using respiration-correlated cone beam computed tomography. Int J Radiat Oncol Biol Phys. 2009;75(3):688-95. https://doi.org/10.1016/j.ijrobp.2008.11.066
  13. Sonke JJ, Rossi M, Herk MV et al :Frameless stereotactic body radiotherapy for lung cancer using fourdimensional cone beam CT guidance. Int J Radiat Oncol Biol Phys. 2009;74(2):567-74. https://doi.org/10.1016/j.ijrobp.2008.08.004
  14. Li T, Xing L. :Optimizing 4D cone-beam CT acquisition protocol for external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2007;67(4):1211-19 https://doi.org/10.1016/j.ijrobp.2006.10.024
  15. Pascal Hauri, Roger A. Halg, Uwe Schneider. :No increase in effective dose from half compared to full rotation pelvis cone beam CT. Med Phys. 02 August 2017
  16. Marc A. Russo, Danielle M. Santarelli, Dean O'Rourke. :The physiological effects of slow breathing in the healthy human. Breathe(Sheff). 2017;13(4):298-309. https://doi.org/10.1183/20734735.009817
  17. Sara M Elkhateeb, Gerald R Torgersen, Eman A Arnout. :Image quality assessment of clinically-applied CBCT protocols using a QAT phantom. Dentomaxillofacial Radiology Vol. 45, No. 5 4 May 2016
  18. Kim Ki-Won, Min Jung-Whan, Lyu, Kwang-Yeul et al. :Comparison Study on CNR and SNR of Thoracic Spine Lateral Radiography. Journal of radiological science and technology Volume 36 Issue 4°31 December 2013
  19. Lee Soyoung, Yan Guanghua, Bo Lu et al :Impact of scanning parameters and breathing patternson image quality and accuracy of tumor motionreconstruction in 4D CBCT: a phantom study. Med Phys. Vol16, 6, 2015