A respiratory compensating system: design and performance evaluation

作者:Chuang Ho Chiao*; Huang Ding Yang; Tien Der Chi; Wu Ren Hong; Hsu Chung Hsien
来源:Journal of Applied Clinical Medical Physics, 2014, 15(3): 307-322.
DOI:10.1120/jacmp.v15i3.4710

摘要

This study proposes a respiratory compensating system which is mounted on the top of the treatment couch for reverse motion, opposite from the direction of the targets (diaphragm and hemostatic clip), in order to offset organ displacement generated by respiratory motion. Traditionally, in the treatment of cancer patients, doctors must increase the field size for radiation therapy of tumors because organs move with respiratory motion, which causes radiation-induced inflammation on the normal tissues (organ at risk (OAR)) while killing cancer cells, and thereby reducing the patient's quality of life. This study uses a strain gauge as a respiratory signal capture device to obtain abdomen respiratory signals, a proposed respiratory simulation system (RSS) and respiratory compensating system to experiment how to offset the organ displacement caused by respiratory movement and compensation effect. This study verifies the effect of the respiratory compensating system in offsetting the target displacement using two methods. The first method uses linac (medical linear accelerator) to irradiate a 300 cGy dose on the EBT film (GAFCHROMIC EBT film). The second method uses a strain gauge to capture the patients' respiratory signals, while using fluoroscopy to observe in vivo targets, such as a diaphragm, to enable the respiratory compensating system to offset the displacements of targets in superior-inferior (SI) direction. Testing results show that the RSS position error is approximately 0.45 similar to 1.42 mm, while the respiratory compensating system position error is approximately 0.48 similar to 1.42 mm. From the EBT film profiles based on different input to the RSS, the results suggest that when the input respiratory signals of RSS are sine wave signals, the average dose (%) in the target area is improved by 1.4% similar to 24.4%, and improved in the 95% isodose area by 15.3% similar to 76.9% after compensation. If the respiratory signals input into the RSS respiratory signals are actual human respiratory signals, the average dose (%) in the target area is improved by 31.8% similar to 67.7%, and improved in the 95% isodose area by 15.3% similar to 86.4% (the above rates of improvements will increase with increasing respiratory motion displacement) after compensation. The experimental results from the second method suggested that about 67.3% similar to 82.5% displacement can be offset. In addition, gamma passing rate after compensation can be improved to 100% only when the displacement of the respiratory motion is within 10 similar to 30 mm. This study proves that the proposed system can contribute to the compensation of organ displacement caused by respiratory motion, enabling physicians to use lower doses and smaller field sizes in the treatment of tumors of cancer patients.

  • 出版日期2014