鼻咽癌調(diào)強(qiáng)放療計(jì)劃十分復(fù)雜, 計(jì)劃質(zhì)量通常與治療劑量師的經(jīng)驗(yàn)密切相關(guān)。本研究納入了10例不同分期的鼻咽癌患者, 基于Pinnacle3 9.2治療計(jì)劃系統(tǒng)腳本, 運(yùn)用計(jì)算機(jī)程序設(shè)置計(jì)劃的基本參數(shù)、目標(biāo)參數(shù)等, 最終自動(dòng)完成鼻咽癌調(diào)強(qiáng)放療計(jì)劃。然后, 對(duì)自動(dòng)和手動(dòng)調(diào)強(qiáng)放療計(jì)劃進(jìn)行統(tǒng)計(jì)學(xué)比較和臨床評(píng)估。結(jié)果顯示兩種計(jì)劃中大多數(shù)靶區(qū)和危及器官劑量學(xué)參數(shù)的差異無(wú)統(tǒng)計(jì)學(xué)意義。本文所述的鼻咽癌自動(dòng)調(diào)強(qiáng)放療計(jì)劃能夠滿足臨床放療要求, 顯著減少計(jì)劃時(shí)間, 同時(shí)避免因?yàn)榻?jīng)驗(yàn)不足等人為因素對(duì)計(jì)劃質(zhì)量造成的影響。
目的 分析比較錐形束CT(CBCT)與MOSAIQ兩系統(tǒng)用于測(cè)量胸部放射治療(放療)擺位誤差情況。 方法 2011年2月－9月,隨機(jī)選擇21例用熱塑模固定的胸部調(diào)強(qiáng)治療患者，進(jìn)行同次擺位的CBCT圖像采集和電子射野影像(EPID)正側(cè)位圖像采集。將CBCT圖像與定位CT圖像進(jìn)行匹配，圖像經(jīng)iViewGT系統(tǒng)傳輸至MOSAIQ系統(tǒng)圖像處理模塊中與計(jì)劃生成的數(shù)字重建圖像(DRR)正側(cè)位片進(jìn)行匹配，分別記錄兩套系統(tǒng)圖像匹配結(jié)果在X(左右)方向、Y(頭腳)方向、Z(前后)方向的平移誤差及CBCT的旋轉(zhuǎn)誤差值，計(jì)算其均值、標(biāo)準(zhǔn)差，進(jìn)行統(tǒng)計(jì)學(xué)處理。 結(jié)果 本研究共獲取圖像106組，每組內(nèi)包含一次CBCT圖像和EPID圖像。CBCT和MOSAIQ系統(tǒng)下EPID匹配結(jié)果平移誤差在X、Y、Z方向分別為(?0.103 ± 0.240)cm、(?0.086 ± 0.342)cm、(0.017 ± 0184)cm和(0.005 ± 0.214)cm、(?0.004 ± 0.0.315)cm、(?0.113 ± 0.239)cm；旋轉(zhuǎn)誤差在X、Y、Z方向分別為(0.792 ± 1.173)°、(?0.130 ± 1.407)°、(0.793 ± 0.960)°，其中≤3°的概率分別為98.2%、97.2%、99.1%，最大絕對(duì)值分別為5°、3.4°、3.3°。兩套系統(tǒng)在X、Y、Z三個(gè)方向的平移誤差經(jīng)配對(duì)樣本檢驗(yàn)，在Y方向P＞0.05，在X和Z方向上P值均＜0.05， 兩系統(tǒng)的測(cè)量差值有直線負(fù)相關(guān)關(guān)系。 結(jié)論 CBCT和EPID在測(cè)量胸部放療靶區(qū)中心的平移誤差中差異有統(tǒng)計(jì)學(xué)意義，因此建議在做胸部放療時(shí)有CBCT的情況下應(yīng)優(yōu)先使用。
【摘要】 目的 利用不同匹配區(qū)域?qū)﹀F形束CT（CBCT）與定位CT（FBCT）分別配準(zhǔn)，測(cè)量出鼻咽癌放射治療中頸部的變形誤差?！》椒ā》治?007年4月-2008年12月收治鼻咽癌患者23例，調(diào)整治療床前198次CBCT掃描。將鼻咽部掃描CBCT圖像匹配區(qū)域分為上下兩個(gè)區(qū)域進(jìn)行對(duì)比分析。其中上匹配區(qū)域?yàn)?上界為蝶竇上緣，下界為頸4下緣，側(cè)界包括下頜骨外輪廓，前界為上頜竇1/2，后界為平棘突后緣；下匹配區(qū)域?yàn)?上界約頸4下緣，下界約胸2-3下緣，側(cè)界包括椎體外輪廓，前界包括皮膚，后界平棘突后緣。匹配方式選擇骨，比較匹配結(jié)果差異?！〗Y(jié)果 選擇上與下匹配區(qū)域結(jié)果除Y（頭腳）方向旋轉(zhuǎn)誤差無(wú)統(tǒng)計(jì)學(xué)差異外，余均有統(tǒng)計(jì)學(xué)差異（Plt;0.05） 。差值在X（左右）、Z（前后）、Y（頭腳）方向平移分別為（1.14±2.80）、（0.47±1.41）、（0.58±3.88） mm，旋轉(zhuǎn)誤差X、Y、Z方向分別為（0.90±1.98）、（0.80±2.03）、（0.68±1.90）°。 結(jié)論 鼻咽癌放射治療中頸部區(qū)域存在一定變形誤差，通過(guò)CBCT引導(dǎo)發(fā)現(xiàn)變形誤差并進(jìn)行正確糾正是必須的，結(jié)合臨床實(shí)際及靶區(qū)與危及器官的變化為重新計(jì)劃提供依據(jù)。【Abstract】 Objective To investigate the rotation errors due to neck deformation in nasopharyngeal cancer (NPC) radiotherapy with different match areas to register conebeam CT(CBCT) from image guiding and fanbeam (FBCT) from simulation. Methods A total of 198 pre-correction CBCT data sets from 23 NPC patients from April 2007 to December 2008 were retrospectively analyzed. The matching areas in CBCT images were divided into up and down region of interest (ROI). For the up ROI, the superior, inferior, left and right, anterior, and posterior boundary were set parallel with sphenoid sinus up side, C4 down side, mandible outside, and 1/2 of maxillary air sinus and acanthi. For the down ROI, the lines were set parallel with C4 down side, T2-3 down side, neck outside, skin surface and acanthi respectively in all directions. All registrations were performed automatically by bony anatomy and the results were compared. Results The registration results by the up and the down ROI showed significant difference except Y direction for rotation. The translation error was (1.14±2.80),(0.47±1.41),and (0.58±3.88) mm, respectively; and the rotation error was (0.90±1.98),(0.80±2.03),and (0.68±1.90) ° in X, Y, and Z direction, respectively. 〖WTHZ〗Conclusions〖WTBZ〗There are some significant deformation errors at neck areas in NPC radiotherapy. It is important to find out the deformation and correct it with CBCT image guiding. This kind of error information may provide clues for re-planning in addition to clinical practice and the changes of clinical targets and involved organs.