표면유도방사선치료 시 광학표면영상을 활용한 머리 회전교정장치의 유용성 = Usefulness of a Head Rotational Correction Device Utilizing Optical Surface Imaging in Surface Guided Radiation Therapy

국문 초록 (Abstract)

본 연구의 목적은 토모테라피 수행 시 위치설정(set–up) 오차를 최소화하고, 오차 교정 과정의 시간과 횟수를 단축하여 효율적인 방사선치료가 가능하게 하기 위함이다. 본 연구를 위해 광학표면영상(optical surface imaging: OSI)에서 제공하는 위치설정 오차 정보를 이용해 피치(Pitch)와 요(Yaw) 위치설정 오차를 교정하는 회전교정장치(rotational correction device: RCD)를 자체 제작했다. 메가볼트 전산화단층촬영(mega–voltage computed tomography: MVCT)과 OSI의 위치설정 오차 값 일치성 검증은 QUASAR 팬텀을 무작위로 조정하며 각 시스템의 오차를 측정하였다. MVCT와 RCD 시스템의 위치설정 오차에 대해 교정의 정확성과 시간 유용성 분석을 위해 머리 모형 팬텀을 사용하여 오차가 ±1 mm 및 ±0.5° 미만이 될 때까지 교정하고, MVCT 교정횟수, 최종 오차 값, 위치설정에 필요한 평균 소요시간을 측정하였다. 선량 검증은 총 3개의 임상표적체적(clinical target volume: CTV)를 설정하고 선량부피그림표(dose–volume histogram: DVH)를 이용하여 D99% (radiation doses received by 99% volume of the CTV)의 차이를 분석했다. 본 연구의 결과로 첫 번째, MVCT와 OSI의 오차 값 일치성 평가에서 ∆MVCT-OSI 값은 축(X, Y, Z) 방향에서 각각 0.37 ± 0.28 mm, -0.44 ± 0.28 mm, 0.64 ± 0.16 mm이며, 회전 방향(Roll, Pitch, Yaw)은 - 0.19 ± 0.03°, 0.31 ± 0.15°, 0.17 ± 0.05°였다(p>0.05). 두 번째, MVCT와 RCD 시스템의 유용성 분석을 실험에서 MVCT 평균 촬영횟수는 각각 3.6회와 1.3회였다. MVCT와 RCD 시스템에서 얻은 최종 결과 값에 대한 축 방향에 대한 벡터 값(MAGtrans)은 각각 0.84 ± 0.28 mm, 0.65 ± 0.25 mm로 통계적 차이는 없었다(p>0.05). 회전 방향에 대한 벡터 값(MAGrot)은 MVCT와 RCD 시스템에서 각각 평균 0.49 ± 0.14°와 0.24 ± 0.16°로 통계적으로 유의미한 차이가 있었다(p=0.001). MVCT와 RCD 시스템의 위치설정에 소요된 시간은 각각 평균 19분 37초와 7분 48초였다(p<0.001). 마지막으로 선량 검증에서 Yaw 위치설정 오차(3°)를 적용한 경우, CTV1, CTV2 및 CTV3의 D99%는 기준 치료계획 대비 각각 0.12%, 3.88%, 3.44%로 감소했다. RCD로 위치설정을 교정한 경우, CTV1, CTV2의 D99%는 각각 0.44%, 0.56%로 감소했고, CTV3의 선량분포는 기준 치료계획과 동일했다. 본 연구는 토모테라피에서 Pitch와 Yaw방향의 위치설정 오차를 교정하는 RCD를 개발함으로써 IGRT에 소요되는 시간과 횟수를 줄이는 효율적인 방안을 제시하였다. 특히 머리부위의 다중표적 종양의 치료 시 회전 방향 위치설정 오차에 대한 정확도를 향상할 수 있었다. 본 연구는 환자의 위치와 자세의 정확도가 중요한 방사선치료에 있어서 정밀한 치료를 제공하는데 기여할 것이다.

목차 (Table of Contents)

• 국 문 초 록 - ⅰ
• 목차 - ⅲ
• List of tables - ⅴ
• List of figures - ⅵ
• Ⅰ. 서 론 - 1
• Ⅱ. 이론적 배경 - 6
• 1. 표면유도방사선치료 - 6
• 2. 토모테라피의 메가볼트 전산화단층촬영 - 8
• 3. 축 방향과 회전 방향의 오차 교정 - 9
• Ⅲ. 대상 및 방법 - 11
• 1. 회전교정장치 - 11
• 2. MVCT와 OSI 오차 값 일치성 - 13
• 3. MVCT와 RCD 시스템 유용성 - 15
• 1) 치료계획 설계 - 15
• 2) 위치설정 교정 및 시간 유용성 - 17
• 4. 치료계획 설계 및 평가 - 22
• Ⅲ. 결 과 - 24
• 1. MVCT와 OSI 오차 값 일치성 - 24
• 2. MVCT와 RCD 시스템 유용성 - 26
• 1) 위치설정 교정 유용성 - 26
• 2) 위치설정 시간 유용성 - 30
• 3. 치료계획 검증 - 33
• Ⅳ. 고 찰 - 38
• Ⅴ. 결 론 - 49
• 참고문헌 - 51
• ABSTRACT - 60

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