CAJ | 학술논문

目的：探讨胸部肿瘤 IGRT 治疗中不同图像配准方法对摆位误差的影响。方法：医科达 Synergy IG-RT 直线加速器分别治疗胸部肿瘤患者20例，每次治疗前均行 CBCT 扫描，重建获得的 CBCT 图像与原计划CT 图像进行配准，分析 X、Y、Z 轴方向的平移误差及旋转误差，比较骨性配准、灰度值配准及手动配准间的差异。结果：20例胸部肿瘤患者治疗前共行384次 CBCT 扫描。手动配准、骨性配准、灰度值配准在 X 轴的平移误差分别为（0.01±0.29）cm、（0.04±0.31）cm、（-0.02±0.28）cm，在 Y 轴的平移误差分别为（0.11±0.41） cm、（0.12±0.45）cm、（0.09±0.41）cm，在 Z 轴的平移误差分别为（-0.11±0.23）cm、（-0.05±0.22）cm、（-0.08±0.23）cm；X 轴的旋转误差分别为（0.61±1.09）°、（0.34±1.44）°、（0.66±1.28）°，在 Y 轴的旋转误差分别为（0.06±0.83）°、（0.04±1.89）°、（0.16±1.6）°，在 Z 轴的旋转误差分别为（-0.17±1.45）°、（-0.19±1.53）°、（-0.13±1.45）°。结果显示手动配准、骨性配准和灰度值配准三种方式之间存在明显的差异。结论：胸部肿瘤患者行 IGRT 时，需要根据病变具体部位选择配准方式，建议自动配准后必要时结合手动微调，直到配准结果符合要求。
목적：탐토흉부종류 IGRT 치료중불동도상배준방법대파위오차적영향。방법：의과체 Synergy IG-RT 직선가속기분별치료흉부종류환자20례，매차치료전균행 CBCT 소묘，중건획득적 CBCT 도상여원계화CT 도상진행배준，분석 X、Y、Z 축방향적평이오차급선전오차，비교골성배준、회도치배준급수동배준간적차이。결과：20례흉부종류환자치료전공행384차 CBCT 소묘。수동배준、골성배준、회도치배준재 X 축적평이오차분별위（0.01±0.29）cm、（0.04±0.31）cm、（-0.02±0.28）cm，재 Y 축적평이오차분별위（0.11±0.41） cm、（0.12±0.45）cm、（0.09±0.41）cm，재 Z 축적평이오차분별위（-0.11±0.23）cm、（-0.05±0.22）cm、（-0.08±0.23）cm；X 축적선전오차분별위（0.61±1.09）°、（0.34±1.44）°、（0.66±1.28）°，재 Y 축적선전오차분별위（0.06±0.83）°、（0.04±1.89）°、（0.16±1.6）°，재 Z 축적선전오차분별위（-0.17±1.45）°、（-0.19±1.53）°、（-0.13±1.45）°。결과현시수동배준、골성배준화회도치배준삼충방식지간존재명현적차이。결론：흉부종류환자행 IGRT 시，수요근거병변구체부위선택배준방식，건의자동배준후필요시결합수동미조，직도배준결과부합요구。
To investigate the optimal alignment methods for the treatment of thoracic tumor in IGRT. Methods:All 20 thoracic tumor patients were treated with the Elekta Synergy IGRT system. KV - CBCT images re-ceived before every treatment fraction. The difference in bone alignment,grey value alignment and manual alignment was compared. Results:Total of 384 sets of CBCT images were analyzed for 20 thoracic tumor patients. The mean ± standard deviation in the X,Y and Z axis directions were(0. 01 ± 0. 29)cm,(0. 04 ± 0. 31)cm,( - 0. 02 ± 0. 28) cm;(0. 11 ± 0. 41)cm,(0. 12 ± 0. 45)cm,(0. 09 ± 0. 41)cm;( - 0. 11 ± 0. 23)cm,( - 0. 05 ± 0. 22)cm,( - 0. 08 ± 0. 23)cm in thoracic tumor with bone alignment,grey value alignment and manual alignment respectively. The mean ± standard deviation in the X,Y and Z rotation directions were(0. 61 ± 1. 09)°,(0. 34 ± 1. 44)°,(0. 66 ± 1. 28)°;(0. 06 ± 0. 83)°,(0. 04 ± 1. 89)°,(0. 16 ± 1. 6)°;( - 0. 17 ± 1. 45)°,( - 0. 19 ± 1. 53)°,( - 0. 13 ± 1. 45)° in thoracic tumor with bone alignment,grey value alignment and manual alignment respectively. There was significant difference among the three alignments. Conclusion:There exists some extent of setup error in 3DCRT or IMRT of tho-racic tumor patients. Alignment can be choiced based on the disease region. It is suggested that manul adjustment after automatic alignment is necessary.