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IGRT: Bildgesteuerte Strahlentherapie

Eine Übersicht von der planaren röntgenbasierten Positionierung zum Cone-Beam-CT

IGRT: image guidance in radiation oncology

A review from planar x-ray based positioning to cone beam CT

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Zusammenfassung

Das Ziel in der modernen Strahlentherapie ist die Verabreichung von hohen Bestrahlungsdosen im Zielvolumen bei gleichzeitiger Schonung der umgebenden gesunden Organe. Voraussetzung für diese meist fraktioniert durchgeführte Therapie ist eine präzise Immobilisierung des Patienten bzw. des Tumors und Positionierung des Isozentrums vor jeder Behandlung. Besonders problematisch sind diese Vorgänge in extrakraniellen Regionen, wo sich der Tumor wegen Atembewegung oder Organfüllung bewegt und damit seine Position in Bezug auf einen knöchernen Referenzpunkt stetig ändert. Bei Hochpräzisionstechniken wie z. B. IMRT mit steilen Dosisgradienten führt diese Ungenauigkeit zu bedeutenden Unsicherheiten in der Bestrahlungsplanung.

Diese Übersicht beschreibt neue Möglichkeiten zur Optimierung der Patientenimmobilisierung (Atemsteuerung, Gating) und fasst dann die bildgestützen Ansätze zur Zielvolumen-Positionierung (bildgestützte Strahlentherapie; IGRT) zusammen. Dabei werden 2D-Methoden (Röntgenfilme, EPID), 2D–3D-Methoden (bidirektionale EPID-Lokalisation unter Verwendung implantierter Marker, ggf. unterstützt durch Infrarot-Positionierung) und echte 3D-Positionierungssysteme (In-Room-CT und ultraschallbasierte Positionierung) beschrieben.

Abstract

In most clinical situations, the purpose of radiotherapy is to apply high doses to the target volume as well as the protection of organs at risk from the side effects of radiation. For biological reasons, radiation is usually administered as a fractionated therapy, which requires reproducibly precise immobilisation of the patient and positioning of the radiation isocenter in the correct location in relation to tumor geometry before each treatment. This allows a maximum reduction in the “safety margin” around the target volume. Positioning for extracranial regions is problematic because of the movement of the tumor in relation to bony structures, e.g. due to breathing or organ filling. This uncertainty leads to difficulties in establishing high precision techniques such as intensity modulated radiation therapy in the extracranial regions.

This overview discusses image guided radiotherapy (IGRT) techniques. Immobilisation strategies (breath holding, gating) and position verification techniques based on 2D image-guidance (port films, EPID), 2D–3D guidance (bidirectional EPID localization in combination with implanted fiducial markers and optional supplementary infrared positioning) as well true 3D image guidance possibilities such as ultrasound-based positioning systems and in-room CTs are discussed.

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Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim

    J. Boda-Heggemann, C. Walter, S. Mai, B. Küpper, H. Wertz, A. Rahn, B. Dobler, F. Wenz & F. Lohr

  2. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim

    J. Boda-Heggemann

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  1. J. Boda-Heggemann
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  2. C. Walter
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  3. S. Mai
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  4. B. Küpper
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  5. H. Wertz
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  6. A. Rahn
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  7. B. Dobler
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  8. F. Wenz
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  9. F. Lohr
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Correspondence to J. Boda-Heggemann.

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Boda-Heggemann, J., Walter, C., Mai, S. et al. IGRT: Bildgesteuerte Strahlentherapie. Onkologe 12, 365–372 (2006). https://doi.org/10.1007/s00761-005-1000-8

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  • DOI: https://doi.org/10.1007/s00761-005-1000-8

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