Author: Ku, Ki Man
Title: Clinical evaluation of fiducial marker pre-planning for virtual bronchoscopic navigation implantation in lung tumour patients treated with cyberknife
Advisors: Cai, Jing (HTI)
Wu, W. C. Vincent (HTI)
Degree: DHSc
Year: 2022
Subject: Lungs -- Tumors -- Treatment
Cancer -- Radiotherapy
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xiv, 67 pages : color illustrations
Language: English
Abstract: Purpose: For the treatment of invisible lung tumours with CyberKnife (CK), fiducial markers (FMs) were implanted as an internal surrogate under Virtual Bronchoscopic Navigation (VBN). This research aims to evaluate the clinical benefits of introducing an additional pre-procedure planning system in assigning the optimal FM positions. The objectives are 1) To improve the FMs implantation process by reducing the duration of implantation and radiation exposure to patients, and increasing the number of FMs implanted; 2) to improve FMs stabilities by increasing the FMs usage rate in RT planning and the retention rate at first treatment; reducing the relative migration of the FMs configuration.
Methods and Materials: 32 patients were recruited and divided into two groups. 18 patients of Group 1 underwent VBN FMs implantation without pre-procedure planning, 14 patients of Group 2 underwent additional pre-procedure planning. The steps of pre-procedure planning include 1) importing CT images into the treatment planning system (Eclipse, Varian Medical System, Inc.) and delineating five to six FMs in their ideal virtual positions. 2) copy the FM configuration into VBN planning software (LungPoint Bronchus Medical, Inc.) for verification and simulation. Finally, the verified FMs were deployed through VBN with the guidance of the LungPoint planning software.
Results: 162 FMs were implanted among 35 lesions in 32 patients aged from 37 to 92 (Median=66). 16 males, and 16 females. Results showed that for objective one, the average FM implantation duration was reduced from 41 (SD=2.05) to 23 minutes (SD=1.25), p=0.00; the average radiation exposure in Dose Area Product (DAP) to patients was reduced from 67.4 (SD=14.48) to 25.3 cGy*cm^2 (SD=3.82), p=0.01 (1 tail); and the average number of FMs implanted around the tumour was increased from 4.7 (SD=0.84) to 5.6 (SD=0.76) and the difference was significant. For objective two, the average FMs usage rate in RT planning was increased from 70 (SD=8) to 92% (SD=4), p=0.02 (1 tail); the average retention rate was increased from 41 (SD=6) to 50% (SD=5), but the difference was insignificant with p=0.12, and the relative migration of FMs configuration was reduced from 5.2 to 2.5%, but the difference was also insignificant.
Conclusion: The pre-procedure planning improves the FMs implantation efficiency by reducing the implantation duration and radiation exposure to patients, and increasing the number of FMs implanted. It also improves the qualities of FMs stability by increasing the FMs usage rate for planning, but no significant improvement in increasing the FMs retention rate and reducing the relative migration of FMs configuration.
Rights: All rights reserved
Access: restricted access

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