基于kV正交图像引导的头部肿瘤伽玛刀无痛面模分次治疗的摆位误差分析研究

doi:10.3760/cma.j.cn371439-20250530-00094

摘要/Abstract

摘要：

目的分析基于kV正交图像引导的头部肿瘤伽玛刀无痛面模分次治疗患者摆位误差和综合摆位误差（OSE）。方法选取2022年7月1日至2024年5月31日西安国际医学中心医院伽玛刀治疗中心收治的58例行头部肿瘤图像引导伽玛刀无痛面模分次治疗的患者作为研究对象。通过kV级正交X射线IGPS图像引导定位系统，采集患者校正前左右（X）、前后（Y）、头脚（Z）3个平移方向和左右（P）、前后（R）、头脚（Y）3个旋转方向摆位误差，经在线校正并结合人工摆位复核验证，再次计算获得校正后摆位误差。计算平移和旋转方向校正前、后OSE。绘制校正前、后X、Y、Z、P、R、Y 6个方向的摆位误差以及平移和旋转方向OSE散点图。比较6个方向校正前、后的摆位误差以及平移和旋转方向OSE，并比较不同年龄段、性别患者平移及旋转方向的OSE。结果患者X、Y、Z、P、R、Y 6个方向上的校正前摆位误差分别为（0.45±1.54）mm、-0.96（-1.70，-0.28）mm、1.67（-0.15，3.07）mm、（0.70±1.60）°、0.65（0.30，1.19）°、（0.59±0.87）°，校正后分别为（-0.02±0.18）mm、0.15（0.10，0.21）mm、0.06（-0.04，0.16）mm、（0.20±0.79）°、0.42（0.19，0.78）°、（0.20±0.63）°，校正前、后差异均有统计学意义（t=2.30，P=0.025；Z=-5.43，P<0.001；Z=-4.10，P<0.001；t=2.56，P=0.013；Z=-3.21，P=0.001；t=3.21，P=0.002）。平移（X、Y、Z）和旋转（P、R、Y）方向校正前OSE分别为3.07（1.93，4.35）mm、1.90（1.28，2.66）°，校正后分别为0.27（0.21，0.33）mm、1.08（0.70，1.54）°，校正前、后差异均有统计学意义（Z=-6.60，P<0.001；Z=-5.52，P<0.001）。18~44岁年龄段患者平移（X、Y、Z）和旋转（P、R、Y）方向校正前、后OSE分别为3.65（1.62，3.95）、0.21（0.21，0.31）mm，3.25（2.24，3.96）°、0.92（0.59，1.45）°；45~59岁年龄段分别为3.57（2.17，5.22）、0.29（0.22，0.35）mm，1.89（1.30，2.30）°、1.08（0.62，1.51）°；60~74岁年龄段分别为2.92（1.74，4.06）、0.24（0.19，0.35）mm，2.16（1.09，2.95）°、0.98（0.78，1.75）°；75~89岁年龄段分别为3.24（2.12，4.37）、0.29（0.22，0.47）mm，1.73（1.01，1.83）°、0.60（0.47，1.51）°；4个年龄段间平移、旋转方向校正前、后OSE差异均无统计学意义（H=1.23，P=0.747；H=1.74，P=0.627；H=7.45，P=0.059；H=2.80，P=0.424）。男性患者平移（X、Y、Z）及旋转（P、R、Y）方向校正前、后OSE分别为（3.19±1.59）、0.27（0.27，0.33）mm，1.89（1.27，2.75）°、（0.84±0.59）°；女性患者分别为（3.22±1.99）、0.26（0.25，0.35）mm，1.90（1.34，2.41）°、（1.04±0.46）°；男、女性别间平移、旋转方向校正前、后OSE差异均无统计学意义（t=-0.07，P=0.949；Z=-0.48，P=0.632；Z=-0.02，P=0.161；t=-2.80，P=0.424）。结论基于kV正交X射线立体成像图像引导系统，通过“自动校准+人工复核”双重验证引导，可明显减少头部肿瘤患者伽玛刀无痛面模分次治疗间的摆位误差，提高伽玛刀的摆位精度。

关键词: 头颈部肿瘤, 放射外科手术, 伽玛刀, 无痛面模, 摆位误差

Abstract:

Objective To analyze the positioning error and the overall setup errors （OSEs） of patients undergoing gamma knife pain-free face mask fractionated treatment for head tumors based on kV orthogonal image guidance. Methods A total of 58 patients who received image-guided fractionated gamma knife treatment for head tumors with a pain-free face mask at the Gamma Knife Treatment Center of Xi'an International Medical Center Hospital from July 1， 2022 to May 31， 2024 were included in the study. A kV-class orthogonal X-ray IGPS image-guided positioning system was used to collect positioning errors in three translational directions： left-right （X）， anterior-posterior （Y）， and head-foot （Z）， as well as in three rotational directions： left-right （P）， anterior-posterior （R）， and head-foot （Y） before correction. After online correction and combined with manual positioning verification， the corrected positioning errors were recalculated. The OSEs in translational and rotational directions were calculated before and after correction. The positioning errors in all six directions （X， Y， Z， P， R， Y） before and after correction were plotted. And the OSE scatter plots in translational and rotational directions were created accordingly. Errors in the six directions and OSEs in translational and rotational directions were compared. The OSEs in translational and rotational directions were analyzed across different age groups and genders. Results The pre-correction positioning errors in the X， Y， Z， P， R， Y directions for patients were （0.45±1.54） mm， -0.96 （-1.70， -0.28） mm， 1.67 （-0.15， 3.07） mm，（0.70±1.60）°， 0.65 （0.30， 1.19）°，（0.59±0.87）°， and the post-correction positioning errors were （-0.02±0.18） mm， 0.15 （0.10， 0.21） mm， 0.06 （-0.04， 0.16） mm，（0.20±0.79）°， 0.42 （0.19， 0.78）°，（0.20±0.63）°. There were statistically significant differences between before and after correction （t=2.30， P=0.025； Z=-5.43， P<0.001； Z=-4.10， P<0.001； t=2.56， P=0.013； Z=-3.21， P=0.001； t=3.21， P=0.002）. The OSEs in translational （X， Y， Z） and rotational （P， R， Y） directions before correction were 3.07 （1.93， 4.35） mm， 1.90 （1.28， 2.66）°， and the OSEs after correction were 0.27 （0.21， 0.33） mm， 1.08 （0.70， 1.54）°， with statistically significant differences （Z=-6.60， P<0.001； Z=-5.52， P<0.001）. For patients aged 18-44 years， the OSEs in translational （X， Y， Z） and rotational （P， R， Y） directions before and after correction were 3.65 （1.62， 3.95）， 0.21 （0.21， 0.31） mm， 3.25 （2.24， 3.96）°， 0.92 （0.59， 1.45）°； for patients aged 45-59 years， the OSEs were 3.57 （2.17， 5.22）， 0.29 （0.22， 0.35） mm， 1.89 （1.30， 2.30）°， 1.08 （0.62， 1.51）°； for patients aged 60-74 years， the OSEs were 2.92 （1.74， 4.06）， 0.24 （0.19， 0.35） mm， 2.16 （1.09， 2.95）°， 0.98 （0.78， 1.75）°； for patients aged 75-89 years， the OSEs were 3.24 （2.12， 4.37）， 0.29 （0.22， 0.47） mm， 1.73 （1.01， 1.83）°， 0.60 （0.47， 1.51）°. There were no statistically significant differences in OSEs of translational and rotational directions before and after correction among the four age groups （H=1.23， P=0.747； H=1.74， P=0.627； H=7.45， P=0.059； H=2.80， P=0.424）. For male patients， the OSEs before and after correction in translational （X， Y， Z） and rotational （P， R， Y） directions were （3.19±1.59）， 0.27 （0.27， 0.33） mm， 1.89 （1.27， 2.75）°，（0.84±0.59）°； for female patients， the OSEs were （3.22±1.99）， 0.26 （0.25， 0.35） mm， 1.90 （1.34， 2.41）°，（1.04±0.46）°. There were no statistically significant differences in OSEs of translational and rotational directions before and after correction between genders （t=-0.07， P=0.949； Z=-0.48， P=0.632； Z=-0.02， P=0.161； t=-2.80， P=0.424）. Conclusions The image-guided system， which is based on the kV orthogonal X-ray stereoscopic imaging， can significantly reduce the positioning errors between fractions of pain-free face mask gamma knife treatment for head tumor patients and improve the positioning accuracy of the gamma knife through the dual verification process of "automatic correction and manual review".

Key words: Head and neck neoplasms, Radiosurgery, Gamma knife, Pain-free face mask, Setup error

李鹏, 张双, 刘华锋, 纪娜, 候向坤, 席奥航, 宗建海. 基于kV正交图像引导的头部肿瘤伽玛刀无痛面模分次治疗的摆位误差分析研究[J]. 国际肿瘤学杂志, 2025, 52(9): 554-559.

Li Peng, Zhang Shuang, Liu Huafeng, Ji Na, Hou Xiangkun, Xi Aohang, Zong Jianhai. Research on positioning errors analysis of gamma knife pain-free face mask fractionated treatment for head tumors based on kV orthogonal image guidance[J]. Journal of International Oncology, 2025, 52(9): 554-559.

图/表 7

图1

表1

图2

表2

图3

表3

表4

参考文献 19

[1]	Nguyen T, Hsu W, Lim M, et al. Delivery of stereotactic radiosurgery: a cross-platform comparison[J]. Neurol Res, 2011, 33(8): 787-791. DOI: 10.1179/016164111X13123658647409. pmid: 22004701
[2]	Agrawal M, Mishra S, Garg K, et al. Trends in stereotactic radiosurgery for intracranial and spinal pathologies: analysis of the top 100 most cited articles[J]. Neurol India, 2023, 71 (Supplement): S39-S48. DOI: 10.4103/0028-3886.373651.
[3]	Tripathi M, Jani P, Bhatta R, et al. Development, validation, and impact of patient information booklet for gamma knife radiosurgery[J]. Neurol India, 2023, 71 (Supplement): S224-S229. DOI: 10.4103/0028-3886.373624.
[4]	Inserra F, Barone F, Palmisciano P, et al. Hypofractionated gamma knife radiosurgery: institutional experience on benign and malignant intracranial tumors[J]. Anticancer Res, 2022, 42(4): 1851-1858. DOI: 10.21873/anticanres.15661. pmid: 35347003
[5]	Tripathi M, Chauhan R, Luthra A, et al. Anesthetic concerns during gamma-knife radiosurgery[J]. Neurol India, 2023, 71(Supplement): S74-S81. DOI: 10.4103/0028-3886.373626.
[6]	Yamaguchi H. Gamma knife radiosurgery with mask fixation under general anesthesia for pediatric patients[J]. Cureus, 2022, 14(1): 20905. DOI: 10.7759/cureus.20905.
[7]	Grimm MA, Köppen U, Stieler F, et al. Prospective assessment of mask versus frame fixation during gamma knife treatment for brain metastases[J]. Radiother Oncol, 2020, 147: 195-199. DOI: 10.1016/j.radonc.2020.05.011. pmid: 32416280
[8]	Claps L, Mathew D, Dusenbery K, et al. Utilization of CBCT to improve the delivery accuracy of gamma knife radiosurgery with G-frame[J]. J Appl Clin Med Phys, 2021, 22(8): 120-128. DOI: 10.1002/acm2.13332. pmid: 34196098
[9]	Caudell JJ, Gillison ML, Maghami E, et al. NCCN guidelines^® insights: head and neck cancers, version 1.2022[J]. J Natl Compr Canc Netw, 2022, 20(3): 224-234. DOI: 10.6004/jnccn.2022.0016.
[10]	Chew JJ, Sneed PK, Chang EF. Recurrent radiation-induced cavernous malformation after gamma knife stereotactic radiosurgery for brain metastasis[J]. Cureus, 2022, 14(3): e22815. DOI: 10.7759/cureus.22815.
[11]	Moon HC, Park SJ, Kim YD, et al. Navigation of frameless fixation for gamma knife radiosurgery using fixed augmented reality[J]. Sci Rep, 2022, 12(1): 4486. DOI: 10.1038/s41598-022-08390-y.
[12]	Li Z, Cheng Y, Dong J, et al. The impact of setup errors on dose distribution in cervical cancer radiotherapy and the margin from CTV to PTV[J]. J Cancer Res Clin Oncol, 2024, 150(12): 516. DOI: 10.1007/s00432-024-06032-6.
[13]	Luo G, Neimat JS, Cmelak A, et al. Margin of error for a frameless image guided radiosurgery system: direct confirmation based on posttreatment MRI scans[J]. Pract Radiat Oncol, 2017, 7(3): e223-e231. DOI: 10.1016/j.prro.2016.08.006.
[14]	张彦新, 符贵山, 徐英杰, 等. 脑转移瘤立体定向放疗分次间和分次内摆位误差及残余误差分析[J]. 中华放射肿瘤学杂志, 2019, 28(6): 448-451. DOI: 10.3760/cma.j.issn.1004-4221.2019.06.012.
[15]	张平, 罗龙辉, 戴鹏, 等. ExacTrac 6D影像精确引导系统在脑转移瘤SRS中的应用[J]. 中国医疗设备, 2017, 32(5): 40-43. DOI: 10.3969/j.issn.1674-1633.2017.05.010.
[16]	Tanaka Y, Oita M, Inomata S, et al. Impact of patient positioning uncertainty in noncoplanar intracranial stereotactic radiotherapy[J]. J Appl Clin Med Phys, 2020, 21(2): 89-97. DOI: 10.1002/acm2.12820. pmid: 31957975
[17]	Faraj MK, Alazawy NM, Madlool SK, et al. Navigating precision: anatomical insights into the efficacy of masks versus stereotactic frames in icon gamma knife treatment for trigeminal neuralgia[J]. Surg Neurol Int, 2025, 16: 3. DOI: 10.25259/SNI_757_2024. pmid: 39926454
[18]	Gill M, Sharma M, Ratan R. Frameless gamma knife radiosurgery with leksell ICON: initial experience[J]. Neurol India, 2023, 71 (Supplement): S68-S73. DOI: 10.4103/0028-3886.373646.
[19]	Faraj MK, Al-Musawi MS, Ali Abdulameer T. Design and manufacturing of a head mask for fixation in stereotactic radiosurgery by the gamma knife icon[J]. Surg Neurol Int, 2023, 14: 188. DOI: 10.25259/SNI_1053_2022.