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臨床磁振導航聚焦超音波系統的位置穩定性分析:一年的經驗

POSITION STABILITY ANALYSIS OF A CLINICAL MRI-GUIDED FOCUSED ULTRASOUND SYSTEM: ONE-YEAR EXPERIENCE

摘要


目的:本研究的目的在介紹超音波熱治療儀,應用於骨轉移疼痛所需之相關設備,分享超音波聚焦位置校正程序等經驗,並根據目前已執行之案例,提供校正數據的標準與建議容許值。盼能藉此經驗建立驗證超音波聚焦位置準確性之作業程序,以提供病患更具品質的治療。材料與方法:本篇研究使用於臺北醫學大學附設醫院所收集的31個案例之每日品質保證(Daily Quality Assurance, DQA)資料,並比較其在每日品質保證前後,超音波聚焦點與正確升溫點間的差距。磁振導航超音波熱治療,是利用核磁共振影像定位轉移性骨腫瘤位置,搭配超音波聚焦加熱技術,使超音波將能量傳達到骨頭疼痛區域,加熱至60℃以上,以熱消融破壞骨頭痛楚表面之感覺神經,達到疼痛控制的目的。此一治療方式的主要優點為非侵入性、非輻射線的單次療程即可達成持久性的疼痛緩解。結果:研究顯示經過每日品質保證程序,可以有效的減少聚焦點與正確溫度點之差距,其p-value皆<0.01,達到統計上的顯著差異,且95%信賴區間由1.73±0.43 mm降為0.43±0.12 mm。結論:總結上述經驗可知進行每日品質保證,可保證治療的準確性與安全性,且聚焦點與正確升溫點的誤差可以明顯的減少。故在執行磁振導航聚焦超音波熱治療的每日品質保證程序時,建議要做到使聚焦點與正確溫度點的差距小於1 mm,可大幅提高治療時的精確度。

並列摘要


Purpose : We developed a quality assurance protocol for treating painful bone metastasis with a Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) system. The system delivers ultrasonic energy to heat the MR-delineated metastatic bone target up to 60 degrees Celsius and ablate periosteal nerve fibers for sustained pain control. In this protocol, equipments, calibration procedures, and recommended tolerance are reported. Materials and Methods : In this research, we measured sonication-induced temperature change in a homogenous phantom before and after Daily Quality Assurance (DQA) procedure performed in thirty-one treatment sessions in a single institute. Distances between ultrasonic focus and the spot with highest temperature (Focusing Error, FE) in the phantom were measured with magnetic resonance thermography. Result : DQA procedure effectively decrease FE (Pre-DQA group: 1.73±0.43 mm, DQA group: 0.43±0.12 mm, p-value<0.01). Discussion : A comprehensive DQA procedure decreases focusing error and therefore guarantees treatment accuracy. It may translate into better patient safety and avoid unplanned heating of adjacent critical structures. We recommend that a FE of less than 1 mm should be achieved with DQA procedure before starting a MRgFUS treatment session.

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