Prospective Evaluation of the Clinical Benefits of a Novel Tattoo-less Workflow for Non-Spine Bone Stereotactic Body Radiation Therapy (SBRT): Integrating surface-guidance with triggered imaging reduces treatment time and eliminates the need for tattoos,Practical Radiation Oncology

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Prospective Evaluation of the Clinical Benefits of a Novel Tattoo-less Workflow for Non-Spine Bone Stereotactic Body Radiation Therapy (SBRT): Integrating surface-guidance with triggered imaging reduces treatment time and eliminates the need for tattoos
Practical Radiation Oncology ( IF 3.3 ) Pub Date : 2023-11-08 , DOI: 10.1016/j.prro.2023.10.010
Andrew Z Zhou ₁ , Lauren Conway ₂ , Sarah Bartlett ₂ , Alexander Marques ₂ , Michelle Physic ₂ , Maria Czerminska ₂ , Alexander Spektor ₁ , Joseph H Killoran ₂ , Scott Friesen ₂ , Jeremy Bredfeldt ₂ , Mai Anh Huynh ₁

Affiliation

Objective

Oligometastatic disease has expanded the indications for non-spine bone stereotactic body radiation therapy (NSB SBRT). We investigated whether optical surface monitoring systems (OSMS) could enable tattoo-less set up and substitute for 2D-3D or cone beam computed tomography (CBCT)-based mid-imaging in NSB SBRT.

Materials/Methods

OSMS was incorporated in parallel with an existing workflow using pre-treatment CBCT and mid 2D-3D kV/kV imaging beginning 11/2019. The ability of OSMS to detect out-of-tolerance (>2mm/>2°) and commanded couch shifts was analyzed. A workflow incorporating OSMS reference captures, CBCT for pre-treatment verification and OSMS/triggered imaging (TI) for intrafraction monitoring was developed for rib/sternum SBRT beginning 11/2021 and all NSB SBRT beginning 2/2022. Treatment time and CBCT-related radiation dose between the OSMS and the non-OSMS intrafraction monitoring group was analyzed pre and post-OSMS/TI workflow adoption. All fractions were analyzed through statistical process control (SPC) with use of an XmR chart of treatment time per quarter from 2/2019 to 2/2023. Special cause rules were based on Institute for Healthcare Improvement criteria.

Results

From 2/2019 to 2/2023, 1993 NSB SBRT fractions were delivered, including 234 rib, 109 sternum, 214 ilium, and 682 multi-site. Over 20 commanded shifts, OSMS could detect 2mm shifts to within 0.4mm 67% of the time and 0.8mm 95% of time. All NSB SBRT sites showed significant reductions in treatment time, including the greatest improvement in rib total treatment (21.6 to 13.4 minutes, p=1.16*10⁻¹⁷) and beam time (7.9 to 3.2 minutes, p= 7.32*10⁻²⁷). Significant reductions in CBCT-related radiation were also observed for several NSB sites. These process improvements were associated with OSMS adoption.

Conclusion

Adoption of a novel NSB SBRT workflow incorporating OSMS/TI for bone intrafraction motion monitoring reduced treatment time and CBCT-related radiation exposure while also allowing for more continuous intrafraction motion monitoring for NSB SBRT. OSMS/TI enabled the transition to a tattoo-less workflow.

中文翻译：

非脊柱骨立体定向放射治疗 (SBRT) 新型无纹身工作流程的临床效益的前瞻性评估：将表面引导与触发成像相结合，减少治疗时间并消除纹身的需要

客观的

少转移性疾病扩大了非脊柱骨立体定向放射治疗（NSB SBRT）的适应症。我们研究了光学表面监测系统 (OSMS) 是否可以实现无纹身设置并替代 NSB SBRT 中基于 2D-3D 或锥形束计算机断层扫描 (CBCT) 的中期成像。

材料/方法

从 2019 年 11 月开始，OSMS 与使用预处理 CBCT 和中期 2D-3D kV/kV 成像的现有工作流程并行合并。分析了 OSMS 检测超差 (>2mm/>2°) 和命令治疗床移位的能力。为 2021 年 11 月开始的肋骨/胸骨 SBRT 和 2022 年 2 月开始的所有 NSB SBRT 开发了包含 OSMS 参考捕获、用于治疗前验证的 CBCT 和用于分次内监测的 OSMS/触发成像 (TI) 的工作流程。在采用 OSMS/TI 工作流程之前和之后，对 OSMS 和非 OSMS 分次内监测组之间的治疗时间和 CBCT 相关辐射剂量进行了分析。所有分数均通过统计过程控制 (SPC) 进行分析，并使用 2/2019 至 2/2023 期间每季度治疗时间的 XMR 图表。特殊原因规则基于医疗保健改进研究所的标准。

结果

从2/2019至2/2023，交付了1993个NSB SBRT部分，包括234个肋骨、109个胸骨、214个髂骨和682个多部位。在 20 多个命令的班次中，OSMS 可以检测到 2 毫米的班次，67% 的时间在 0.4 毫米以内，95% 的时间在 0.8 毫米以内。所有 NSB SBRT 部位均显示治疗时间显着减少，包括肋骨总治疗（21.6 至 13.4 分钟， p = 1.16*10 ^-17）和射束时间（7.9 至 3.2 分钟，p = 7.32*10 ^-27）的最大改善。在几个 NSB 站点还观察到 CBCT 相关辐射显着减少。这些流程改进与 OSMS 的采用相关。