Abstract：
BACKGROUND: Implementation of daily cone-beam CT (CBCT) into clinical practice in paediatric image-guided radiotherapy (IGRT) lags behind compared to adults. Surveys report wide variation in practice for paediatric IGRT and technical information remains unreported. In this study we report on technical settings from applied paediatric CBCT protocols and review the literature for paediatric CBCT protocols.
METHODS: From September to October 2022, a survey was conducted among 246 SIOPE-affiliated centres across 35 countries. The survey consisted of 3 parts: 1) baseline information; technical CBCT exposure settings and patient set-up procedure for 2) brain/head, and 3) abdomen. Descriptive statistics was used to summarise current practice. The literature was reviewed systematically with two reviewers obtaining consensus RESULTS: The literature search revealed 22 papers concerning paediatric CBCT protocols. Seven papers focused on dose-optimisation. Responses from 50/246 centres in 25/35 countries were collected: 44/50 treated with photons and 10/50 with protons. In total, 48 brain/head and 53 abdominal protocols were reported. 42/50 centres used kV-CBCT for brain/head and 35/50 for abdomen; daily CBCT was used for brain/head = 28/48 (58%) and abdomen = 33/53 62%. Greater consistency was seen in brain/head protocols (dose range 0.32 - 67.7 mGy) compared to abdominal (dose range 0.27 - 119.7 mGy).
CONCLUSIONS: Although daily CBCT is now widely used in paediatric IGRT, our survey demonstrates a wide range of technical settings, suggesting an unmet need to optimise paediatric IGRT protocols. This is in accordance with the literature. However, there are only few paediatric optimisation studies suggesting that dose reduction is possible while maintaining image quality.
METHODS: From September to October 2022, a survey was conducted among 246 SIOPE-affiliated centres across 35 countries. The survey consisted of 3 parts: 1) baseline information; technical CBCT exposure settings and patient set-up procedure for 2) brain/head, and 3) abdomen. Descriptive statistics was used to summarise current practice. The literature was reviewed systematically with two reviewers obtaining consensus RESULTS: The literature search revealed 22 papers concerning paediatric CBCT protocols. Seven papers focused on dose-optimisation. Responses from 50/246 centres in 25/35 countries were collected: 44/50 treated with photons and 10/50 with protons. In total, 48 brain/head and 53 abdominal protocols were reported. 42/50 centres used kV-CBCT for brain/head and 35/50 for abdomen; daily CBCT was used for brain/head = 28/48 (58%) and abdomen = 33/53 62%. Greater consistency was seen in brain/head protocols (dose range 0.32 - 67.7 mGy) compared to abdominal (dose range 0.27 - 119.7 mGy).
CONCLUSIONS: Although daily CBCT is now widely used in paediatric IGRT, our survey demonstrates a wide range of technical settings, suggesting an unmet need to optimise paediatric IGRT protocols. This is in accordance with the literature. However, there are only few paediatric optimisation studies suggesting that dose reduction is possible while maintaining image quality.
摘要：
背景：与成人相比，在儿科影像引导放射治疗（IGRT）的临床实践中，每日锥束CT（CBCT）的实施滞后。调查报告表明，儿科IGRT的实践差异很大，技术信息仍未报告。在这项研究中，我们报告了应用儿科CBCT协议的技术设置，并回顾了儿科CBCT协议的文献。
方法：从2022年9月到10月，对35个国家的246个SIOPE附属中心进行了调查。调查包括3个部分：1）基线信息；CBCT暴露技术设置和患者设置程序2）大脑/头部，和3）腹部。描述性统计用于总结当前的实践。对文献进行了系统的审查，两名审阅者获得了共识结果：文献检索显示了22篇有关儿科CBCT方案的论文。七篇论文专注于剂量优化。收集了来自25/35个国家的50/246个中心的响应：44/50用光子处理，10/50用质子处理。总的来说,报告了48个脑/头和53个腹部方案。42/50中心使用kV-CBCT用于大脑/头部，35/50用于腹部；每日CBCT用于大脑/头部=28/48（58％），腹部=33/5362％。与腹部(剂量范围0.27-119.7mGy)相比,在脑/头部方案(剂量范围0.32-67.7mGy)中观察到更高的一致性。
结论：尽管现在每天CBCT广泛用于儿科IGRT，我们的调查展示了广泛的技术设置，提示优化儿科IGRT方案的需求尚未满足。这与文献一致。然而,只有少数儿科优化研究表明,在保持图像质量的同时减少剂量是可能的.
方法：从2022年9月到10月，对35个国家的246个SIOPE附属中心进行了调查。调查包括3个部分：1）基线信息；CBCT暴露技术设置和患者设置程序2）大脑/头部，和3）腹部。描述性统计用于总结当前的实践。对文献进行了系统的审查，两名审阅者获得了共识结果：文献检索显示了22篇有关儿科CBCT方案的论文。七篇论文专注于剂量优化。收集了来自25/35个国家的50/246个中心的响应：44/50用光子处理，10/50用质子处理。总的来说,报告了48个脑/头和53个腹部方案。42/50中心使用kV-CBCT用于大脑/头部，35/50用于腹部；每日CBCT用于大脑/头部=28/48（58％），腹部=33/5362％。与腹部(剂量范围0.27-119.7mGy)相比,在脑/头部方案(剂量范围0.32-67.7mGy)中观察到更高的一致性。
结论：尽管现在每天CBCT广泛用于儿科IGRT，我们的调查展示了广泛的技术设置，提示优化儿科IGRT方案的需求尚未满足。这与文献一致。然而,只有少数儿科优化研究表明,在保持图像质量的同时减少剂量是可能的.
