The Journal of Korean Society for Radiation Therapy (대한방사선치료학회지)

Korean Society for Radiation Therapy (대한방사선치료학회)
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A Study on Usefulness of Clinical Application of Metal Artifact Reduction Algorithm in Radiotherapy

방사선치료 시 Metal artifact reduction Algorithm의 임상적용 유용성평가

  • Park, Ja Ram (Department of Radiation Oncology, ASAN Medical Center) ;
  • Kim, Min Su (Department of Radiation Oncology, ASAN Medical Center) ;
  • Kim, Jeong Mi (Department of Radiation Oncology, ASAN Medical Center) ;
  • Chung, Hyeon Suk (Department of Radiation Oncology, ASAN Medical Center) ;
  • Lee, Chung Hwan (Department of Radiation Oncology, ASAN Medical Center) ;
  • Back, Geum Mun (Department of Radiation Oncology, ASAN Medical Center)
  • 박자람 (서울아산병원 방사선종양학과) ;
  • 김민수 (서울아산병원 방사선종양학과) ;
  • 김정미 (서울아산병원 방사선종양학과) ;
  • 정현숙 (서울아산병원 방사선종양학과) ;
  • 이충환 (서울아산병원 방사선종양학과) ;
  • 백금문 (서울아산병원 방사선종양학과)
  • Published : 2017.12.29
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Abstract

Purpose: The tissue description and electron density indicated by the Computed Tomography(CT) number (also known as Hounsfield Unit) in radiotherapy are important in ensuring the accuracy of CT-based computerized radiotherapy planning. The internal metal implants, however, not only reduce the accuracy of CT number but also introduce uncertainty into tissue description, leading to development of many clinical algorithms for reducing metal artifacts. The purpose of this study was, therefore, to investigate the accuracy and the clinical applicability by analyzing date from SMART MAR (GE) used in our institution. Methode: and material: For assessment of images, the original images were obtained after forming ROIs with identical volumes by using CIRS ED phantom and inserting rods of six tissues and then non-SMART MAR and SMART MAR images were obtained and compared in terms of CT number and SD value. For determination of the difference in dose by the changes in CT number due to metal artifacts, the original images were obtained by forming PTV at two sites of CIRS ED phantom CT images with Computerized Treatment Planning (CTP system), the identical treatment plans were established for non-SMART MAR and SMART MAR images by obtaining unilateral and bilateral titanium insertion images, and mean doses, Homogeneity Index(HI), and Conformity Index(CI) for both PTVs were compared. The absorbed doses at both sites were measured by calculating the dose conversion constant (cCy/nC) from ylinder acrylic phantom, 0.125cc ionchamber, and electrometer and obtaining non-SMART MAR and SMART MAR images from images resulting from insertions of unilateral and bilateral titanium rods, and compared with point doses from CTP. Result: The results of image assessment showed that the CT number of SMART MAR images compared to those of non-SMART MAR images were more close to those of original images, and the SD decreased more in SMART compared to non-SMART ones. The results of dose determinations showed that the mean doses, HI and CI of non-SMART MAR images compared to those of SMART MAR images were more close to those of original images, however the differences did not reach statistical significance. The results of absorbed dose measurement showed that the difference between actual absorbed dose and point dose on CTP in absorbed dose were 2.69 and 3.63 % in non-SMRT MAR images, however decreased to 0.56 and 0.68 %, respectively in SMART MAR images. Conclusion: The application of SMART MAR in CT images from patients with metal implants improved quality of images, being demonstrated by improvement in accuracy of CT number and decrease in SD, therefore it is considered that this method is useful in dose calculation and forming contour between tumor and normal tissues.

목 적: 방사선치료에서 CT number에 의해 나타나는 조직의 묘사 및 전자밀도는 CT(Computed Tomography)기반의 전산화치료계획 정확성을 보장하는데 중요한 역할을 한다. 하지만 체내의 금속 이식물은 CT number의 정확성을 감소시킬 뿐 아니라 조직 묘사에 대한 불확실성을 나타내기 때문에 임상에서는 metal artifact를 감소시킬 수 있는 알고리즘이 개발되었다. 이에 본 연구에서는 본원에서 사용하고 있는 GE사의 SMART MAR의 CT number 정확도를 평가하고 방사선치료에서의 유용성에 대해 평가하고자 한다. 대상 및 방법: 영상평가를 위해 CIRS ED phantom을 이용하여 6개 조직의 rod를 삽입하여 동일한 체적의 ROI를 형성 후 original 영상을 획득하고 의료용 티타늄 rod를 삽입하여 non-SMART MAR 영상과 SMART MAR영상을 획득하여 CT number와 SD값을 비교하였다. Metal artifact로 인해 CT number 변화에 따른 선량변화 확인을 위해 전산화계획시스템 Epclipse를 사용하여 CIRS ED phantom CT 영상에 PTV를 형성하여 original 영상을 획득하고 편측 티타늄 삽입, 양측 티타늄 삽입 영상을 획득하여 non-SMART MAR와 SMART MAR영상에 동일한 치료계획을 수립하여 PTV가 받는 평균처방선량, HI(Homogeneity Index), CI(Conformity Index)를 비교, 분석하였다. 흡수선량 측정은 원통형 아크릴 팬텀과 0.125 cc ionchamber, electrometer를 이용하여 선량변환상수(cCy/nC)를 계산하고 CIRS phantom을 이용하여 편측, 양측 티타늄 rod를 삽입한 영상으로 non-SMART MAR와 SMART MAR 영상을 획득하여 동일한 지점에서의 흡수선량을 측정하여 전산화치료계획상의 point dose와 비교하였다. 결 과: 영상평가 결과 CT number는 non-SMART MAR영상보다 SMART MAR 영상이 original영상에 더 유사한 값이 나왔고 SD값은 SMART MAR영상에서 더 감소되었다. 선량평가 결과 평균처방선량과 HI 및 CI 값은 SMART MAR 영상보다 non-SMART MAR 영상이 original 영상에 더 근접한 결과가 나왔지만 통계적으로 유의하지 않았다. 흡수선량 측정결과 치료계획상의 point dose와 실제 흡수선량과의 차이가 non-SMART MAR의 영상에서는 각각 2.69, 3.63 %의 차이가 있었지만 SMART MAR영상에서는 0.56, 0.68 %로 감소하였다. 결 론: 금속 이식물을 삽입한 환자의 CT 영상에 SMART MAR를 적용했을 때 CT number 정확성 상승 및 SD 감소로 영상의 질이 향상되므로 종양과 정상조직의 윤곽도 생성 및 선량계산 시 유용할 것으로 사료된다.

Keywords

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