CAJ | 학술논문

目的千伏特平片引导测定自主呼吸控制(ABC)辅助适度深吸气呼吸控制(mDIBH)状态下术腔中银夹位移以探讨保乳术后ABC辅助三维适形部分乳腺外照射(EB-PBI)临床靶区(CTV)外扩到计划靶区(PTV)的边界.方法 ABC辅助行CT模拟定位扫描,获取mDIBH状态CT图像,分别勾画和标记术腔中4个选定银夹及所有银夹构成的术腔作为肉眼靶区(GTV).每次治疗前获取ABC辅助mDIBH状态下2次正交平片,每次获取平片先与计划数字重建影像片进行自动匹配,在此基础上进行手动匹配,获得选定银夹在左右(LAT)、上下(LNG)、前后(VRT)各个方向位移数据,并依数据计算各个选定银夹在LAT、LNG、VRT各个方向上由CTV外扩到PTV所需边界大小.结果最上层银夹LAT、LNG、VRT三个方向由CTV到PTV的外扩边界分别为5.00、7.78、9.30 mm,最近胸壁层银夹为4.40、6.43、6.73 mm,最外侧银夹为5.04、8.63、10.54 mm,最下层银夹为5.40、8.59、10.81 mm.结论术腔中银夹可清晰显示在千伏特平片上,ABC辅助mDIBH状态下平片与计划数字重建影像片自动加手动配准可准确显示银夹的位移,为EB-PBI的PTV边界确定提供了依据.
목적 천복특평편인도측정자주호흡공제(ABC)보조괄도심흡기호흡공제(mDIBH)상태하술강중은협위이이탐토보유술후ABC보조삼유괄형부분유선외조사(EB-PBI)림상파구(CTV)외확도계화파구(PTV)적변계.방법 ABC보조행CT모의정위소묘,획취mDIBH상태CT도상,분별구화화표기술강중4개선정은협급소유은협구성적술강작위육안파구(GTV).매차치료전획취ABC보조mDIBH상태하2차정교평편,매차획취평편선여계화수자중건영상편진행자동필배,재차기출상진행수동필배,획득선정은협재좌우(LAT)、상하(LNG)、전후(VRT)각개방향위이수거,병의수거계산각개선정은협재LAT、LNG、VRT각개방향상유CTV외확도PTV소수변계대소.결과 최상층은협LAT、LNG、VRT삼개방향유CTV도PTV적외확변계분별위5.00、7.78、9.30 mm,최근흉벽층은협위4.40、6.43、6.73 mm,최외측은협위5.04、8.63、10.54 mm,최하층은협위5.40、8.59、10.81 mm.결론 술강중은협가청석현시재천복특평편상,ABC보조mDIBH상태하평편여계화수자중건영상편자동가수동배준가준학현시은협적위이,위EB-PBI적PTV변계학정제공료의거.
Objective To measure the displacement of the silver clips guided by kV-plain film at state of moderate deep inspiration hold(mDIBH) assisted by active breathing control(ABC) and to explore the margin of clinical target volume(CTV) to planning target volume(PTV) for breast cancer patients treated with three-dimensional conformal external-beam partial breast irradiation (EB-PBI) assisted by ABC. Methods The patients undertook CT simulation assisted by ABC to get the CT images on the respiratory condition of mDIBH. Four selected silver clips in breast cavity were delineated and the cavity based on all of the clips were delineated as gross tumor volume (GTV). Before each irradiation, two orthogonal kV-plain films were taken for the patients in the respiratory condition of mDIBH assisted by ABC device. 2D-2D auto-matie registration was performed based on pixel between the kV-plain films and the digital reconstructed radi-ographs(DRR). Then manual registration was undertook to get the shifts of the four clips separately at LAT, LNG,and VRT directions. Based on the shift data,the margins of CTV to PTV at LAT,LNG and VRT direc-tions were calculated. Results The margins from CTV to PTV were 5.00 mm,7.78 mm and 9.30 mm at LAT,LNG and VRT directions based on the clip at cephal border of the cavity. The corresponding margins were 4.40 mm,6.43 mm and 6.73 mm based on the clip at bottom of the cavity;5.04 mm,8.63 mm and 10.54 mm based on the clip at lateral border of the cavity;5.40 mm,8.59 ram and 10.81 mm based on the clip at pedal border of the cavity. Conclusions The silver clips in breast cavity can be clearly showed on the kV-plain film. The displacement of the clips can be exactly measured by registration of kV-plain film and planning DRR in condition of mDIBH assisted by ABC. The margins from CTV to PTV for EB-PBI can be calculated based on the displacement of the clips.