ศึกษาเปรียบเทียบความแตกต่างค่าความคลาดเคลื่อนของก้อนมะเร็งปอดระหว่างภาพเอกซเรย์คอมพิวเตอร์ในห้องฉายรังสีแบบสามมิติ(3D-CBCT)และสี่มิติ(4D-CBCT)

Nattawan Muangmai; Supanida Ngamdee; ๋Jiraporn Settakornnukul; ๊Utumporn Puangrangsa; Chanida Sathitwattanavirot; Pailin phalipho

Authors

Nattawan Muangmai Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university
Supanida Ngamdee Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university
๋Jiraporn Settakornnukul Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university
๊Utumporn Puangrangsa Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university
Chanida Sathitwattanavirot Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university
Pailin phalipho Division of radiation oncology, Department of radiology, Faculty of medicine, Siriraj hospital, Mahidol university

Keywords:

Cone beam computed tomography, 3-dimensional Cone beam computed tomography, 4-dimensional Cone beam computed tomography, Image-Guided Radiation Therapy

Abstract

Backgrounds: Stereotactic Body Radiotherapy (SBRT) for lung cancer requires high precision because lung tumors move with respiration. Treatment planning using four-dimensional computed tomography (4D-CT) has therefore been employed. During treatment, image-guided radiation therapy (IGRT) is essential to verify tumor positioning. Both three-dimensional cone-beam CT (3D-CBCT) and four-dimensional cone-beam CT (4D-CBCT) are available, but their accuracy remains debatable. This study aims to compare matching error between these two techniques relative to average intensity projection (AIP) from 4D-CT.

Objectives: To evaluate the matching error of lung tumor positioning using 3D-CBCT and 4D-CBCT compared with 4D-CT. And to assess the feasibility of using 3D-CBCT as an alternative to 4D-CBCT.

Materials and Methods: This was a retrospective study of nine patients with lung cancer who underwent stereotactic body radiotherapy (SBRT). Tumor positioning was verified prior to each treatment fraction using image-guided radiotherapy with both three-dimensional cone-beam computed tomography (3D-CBCT) and four-dimensional cone-beam computed tomography (4D-CBCT), respectively, on a Varian TrueBeam system between 2018 and 2021. The data consisted of average intensity projection (AIP) images from 4D-CT (9 datasets) and a total of 61 sets each of 3D-CBCT and 4D-CBCT images. Matching error in the anterior–posterior(AP), superior–inferior(SI), and left–right(LR) directions were compared using an auto-matching method. Statistical analysis was performed using a paired t-test, with statistical significance defined as p < 0.05.

Results: Mean matching errors relative to AIP from 4D-CT : 3D-CBCT: AP -0.31 ± 1.75 mm, SI -1.13 ± 1.57 mm, LR -0.33 ± 0.69 mm ,4D-CBCT: AP -0.28 ± 1.92 mm, SI -0.80 ± 2.00 mm, LR -0.31 ± 0.67 mm The largest mean matching errors between the two techniques was in the SI direction -0.34 mm(p=0.26), followed by AP -0.03 mm(p=0.85) and LR -0.02 mm(p=0.82). No statistically significant differences were found (p> 0.05), and all values were within the 5 mm planning target volume (PTV) margin.

Conclusion: Both 3D-CBCT and 4D-CBCT demonstrated comparable accuracy when referenced to AIP from 4D-CT, with no statistically significant differences. These findings suggest that in institutions without 4D-CBCT, 3D-CBCT can be used as a clinically acceptable alternative for lung SBRT positioning verification.

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