PDF(Pubmed)
Abstract：
This report covers clinical implementation of a low kV intraoperative radiation therapy (IORT) program with the INTRABEAM® System (Carl Zeiss Meditec AG, Jena, Germany). Based on collective user experience from eight institutions, we discuss best methods of INTRABEAM quality assurance (QA) tests, commissioning measurements, clinical workflow, treatment planning, and potential avenues for research. The guide provides pertinent background information and clinical justification for IORT. It describes the INTRABEAM system and commissioning measurements along with a TG100 risk management analysis to ensure safety and accuracy of the IORT program. Following safety checks, dosimetry measurements are performed for verification of field flatness and symmetry, x-ray output, and depth dose. Also discussed are dose linearity checks, beam isotropy, ion chamber measurements, calibration protocols, and in-vivo dosimetry with optically stimulated luminescence dosimeters OSLDs, and radiochromic film. Emphasis is placed on the importance of routine QA procedures (daily, monthly, and annual) performed at regular intervals for a successful IORT program. For safe and accurate dose delivery, tests of important components of IORT clinical workflow are emphasized, such as, dose prescription, pre-treatment QA, treatment setup, safety checks, radiation surveys, and independent checks of delivered dose. Challenges associated with in-vivo dose measurements are discussed, along with special treatment procedures and shielding requirements. The importance of treatment planning in IORT is reviewed with reference to a Monte Carlo-based commercial treatment planning system highlighting its main features and limitations. The report concludes with suggested topics for research including CT-based image-guided treatment planning and improved prescription dose accuracy. We hope that this multi-institutional report will serve as a guidance document on the clinical implementation and use of INTRABEAM IORT.
摘要：
本报告涵盖了使用INTRABEAM®系统（CarlZeissMeditecAG，Jena,德国)。基于八家机构的集体用户体验，我们讨论了INTRABEAM质量保证（QA）测试的最佳方法，调试测量，临床工作流程，治疗计划,和潜在的研究途径。该指南为IORT提供了相关的背景信息和临床依据。它描述了INTRABEAM系统和调试测量以及TG100风险管理分析，以确保IORT计划的安全性和准确性。安全检查后，进行剂量测量以验证场平坦度和对称性，x射线输出，和深度剂量。还讨论了剂量线性检查，光束各向同性，离子室测量，校准协议，以及使用光学刺激发光剂量计OSLD进行体内剂量测定，和放射变色胶片。强调常规质量保证程序的重要性(每日，每月,和年度)为成功的IORT计划定期执行。安全和准确的剂量输送，强调了IORT临床工作流程的重要组成部分的测试，例如,剂量处方，预处理QA,治疗设置，安全检查,辐射调查,和输送剂量的独立检查。讨论了与体内剂量测量相关的挑战，随着特殊的处理程序和屏蔽要求。参考基于蒙特卡洛的商业治疗计划系统，重点介绍了其主要特征和局限性，审查了IORT中治疗计划的重要性。该报告最后提出了研究的建议主题，包括基于CT的图像引导治疗计划和改进的处方剂量准确性。我们希望这份多机构报告将作为INTRABEAMIORT临床实施和使用的指导文件。
