CAJ | 학술논문

目的用CT血管造影(CTA)技术勾画冠状动脉左前降支(LAD)并分析其空间走向,初步探讨各种左侧乳腺癌术后放疗技术对LAD的影响.方法对29例平均年龄54.71岁乳腺癌治疗后复查女性行CTA并勾画LAD,同时在T7～ T8、T8～ T9、T9～ T10胸椎间隙水平,乳头、乳腺下缘水平测量LAD至胸壁(前后向)、左内乳动脉(水平向)、室间沟(斜向)距离,分析其空间走向.取2例左侧乳腺切除术后患者(LAD起始部位分别在T3、T4胸椎间隙水平)和1例左侧保乳术后患者分别采用不同切线野、内乳野放疗技术照射并分析LAD受照情况.结果 29例患者LAD起始部位于第3肋间隙(40%)或第4肋间隙水平(60%),长度为(7.49±0.58) cm.T7～ T8、T8～ T9、T9～ T10水平LAD至前后方向距离分别为(2.99±1.11)、(1.26±0.65)、(0.68±0.39) cm,至水平方向距离分别为(2.27±0.84)、(2.81±0.65)、(3.37±1.21) cm,至斜方向距离分别为(0.47±0.25)、(0.38±0.21)、(0.42±0.19) cm;乳头、乳腺下缘水平LAD至前后方向距离分别为(2.94±1.06)、(0.79±0.46) cm,至水平方向距离分别为(2.45±0.89)、(3.32±1.22) cm,至斜方向距离分别为(0.56±0.30)、(0.57±0.24) cm.结论勾画LAD可以将室间沟作为主要参考点,切线野照射技术可能对LAD的剂量影响较高.
목적 용CT혈관조영(CTA)기술구화관상동맥좌전강지(LAD)병분석기공간주향,초보탐토각충좌측유선암술후방료기술대LAD적영향.방법 대29례평균년령54.71세유선암치료후복사녀성행CTA병구화LAD,동시재T7～ T8、T8～ T9、T9～ T10흉추간극수평,유두、유선하연수평측량LAD지흉벽(전후향)、좌내유동맥(수평향)、실간구(사향)거리,분석기공간주향.취2례좌측유선절제술후환자(LAD기시부위분별재T3、T4흉추간극수평)화1례좌측보유술후환자분별채용불동절선야、내유야방료기술조사병분석LAD수조정황.결과 29례환자LAD기시부위우제3륵간극(40%)혹제4륵간극수평(60%),장도위(7.49±0.58) cm.T7～ T8、T8～ T9、T9～ T10수평LAD지전후방향거리분별위(2.99±1.11)、(1.26±0.65)、(0.68±0.39) cm,지수평방향거리분별위(2.27±0.84)、(2.81±0.65)、(3.37±1.21) cm,지사방향거리분별위(0.47±0.25)、(0.38±0.21)、(0.42±0.19) cm;유두、유선하연수평LAD지전후방향거리분별위(2.94±1.06)、(0.79±0.46) cm,지수평방향거리분별위(2.45±0.89)、(3.32±1.22) cm,지사방향거리분별위(0.56±0.30)、(0.57±0.24) cm.결론 구화LAD가이장실간구작위주요삼고점,절선야조사기술가능대LAD적제량영향교고.
Objective To delineate and measure the left anterior descending coronary artery (LAD) on CT angiography (CTA) and evaluate the dose delivered to LAD by different radiotherapy techniques for left-sided breast cancer.Methods Twenty-nine left-side breast cancer women with mean age of 54.71 years (range:30-80 years) were included.CTA was performed, and LAD was contoured and the distances were measured between LAD and chest wall (posteroanterior diameter,PD), between LAD and internal mammary artery (horizontal diameter,HD), between LAD and interventricular groove (oblique diameter,OD) at the level of T7-T8,T8-T9,T9-T10 and at level of nipple and lower boundary of the breast.The dose delivered to LAD was calculated on three-dimensional plans for two patients with mastectomy whose chest wall and internal mammary chain (IMC) were irradiated and one patient with breast-conserving surgery who received whole breast irradiation.Results The LAD arose at the level of the third rib in 40% of patients and at the fourth rib in 60% of patients.The mean length of LAD was 7.49±0.58 cm.At the level of T7-T8,T8-T9,T9-T10,the mean PD were 2.99±1.11 cm, 1.26±0.65 cm,0.68±0.39 cm, the mean HD were 2.27±0.84 cm, 2.81±0.65 cm, 3.37±1.21 cm, and the mean OD were 0.47±0.25 cm,0.38±0.21 cm,0.42±0.19 cm respectively.At the level of the breast nipple and the lower boundary of the breast, the mean PD were 2.94±1.06 cm, 0.79±0.46 cm, the mean HD were 2.45±0.89 cm, 3.31±1.22 cm,and the mean OD were 0.56±0.30 cm,0.57±0.24 cm respectively.The mean dose to the LAD was 5 Gy and 14 Gy for patients with mastectomy whose IMC was irradiated with 9 MeV electron and whose IMC was irradiated with 6 MV photon tangential beams.The mean dose to the LAD was 26 Gy for patients with breast conserving surgery.Conclusions To contour the LAD, the interventricular groove could be the reference point.Tangential technique can be giving a higher dose of LAD when compared with other radiation techniques