CAJ | 학술논문

目的比较电子射野影像仪(EPID)和锥形柬CT(CBCT)用于胸部肿瘤影像引导放疗,在工作流程和发现患者摆位误差两个方面为临床选择不同影像引导放疗工具提供依据.方法选择2007年3月至2008年1月在我院接受根治性放疗的17例胸部恶性肿瘤患者(包括肺癌、食管癌和胸腺瘤),每位患者每周分别行千伏锥形束CT(KVCBCT)和EPID影像引导分析各1次.1例患者(肺癌)在完成2次KVCBCT在线引导放疗后自动退出研究,共有16例患者进入最终研究分析.结果 16例患者共获取81对EPI和CBCT影像.采用CBCT引导放疗系统时,患者的治疗总时间较采用EPID引导放疗系统时增加1.2 min.采用EPID引导放疗技术分析胸部肿瘤患者的摆位误差,患者在左右(LR)、头脚(SI)和前后(AP)3个方向上的摆位误差分别为:(-0.1±3.2)mm、(1.3±3.7)mm 和(-0.2±3.1)mm.计算临床靶体积(CTV)到计划靶体积(PTV)的预留边界,CTV到PTV的预留边界应设定为10 mm.采用KVCBCT引导放疗技术分析这部分患者的摆位误差,LR、SI和AP3个方向上的摆位误差分别为:(0.1±4.6)mm、(0.6±4.0)mm和(-0.9±4.6)mm,CTV到PTV的预留边界应设定为12 mm.结论与EPID相比,采用CBCT引导放疗系统没有明显延长治疗时间,但增加了发现摆位误差的能力,建议有条件的单位选择CBCT进行胸部肿瘤患者的影像引导放疗或摆位误差分析.
목적 비교전자사야영상의(EPID)화추형간CT(CBCT)용우흉부종류영상인도방료,재공작류정화발현환자파위오차량개방면위림상선택불동영상인도방료공구제공의거.방법 선택2007년3월지2008년1월재아원접수근치성방료적17례흉부악성종류환자(포괄폐암、식관암화흉선류),매위환자매주분별행천복추형속CT(KVCBCT)화EPID영상인도분석각1차.1례환자(폐암)재완성2차KVCBCT재선인도방료후자동퇴출연구,공유16례환자진입최종연구분석.결과 16례환자공획취81대EPI화CBCT영상.채용CBCT인도방료계통시,환자적치료총시간교채용EPID인도방료계통시증가1.2 min.채용EPID인도방료기술분석흉부종류환자적파위오차,환자재좌우(LR)、두각(SI)화전후(AP)3개방향상적파위오차분별위:(-0.1±3.2)mm、(1.3±3.7)mm 화(-0.2±3.1)mm.계산림상파체적(CTV)도계화파체적(PTV)적예류변계,CTV도PTV적예류변계응설정위10 mm.채용KVCBCT인도방료기술분석저부분환자적파위오차,LR、SI화AP3개방향상적파위오차분별위:(0.1±4.6)mm、(0.6±4.0)mm화(-0.9±4.6)mm,CTV도PTV적예류변계응설정위12 mm.결론 여EPID상비,채용CBCT인도방료계통몰유명현연장치료시간,단증가료발현파위오차적능력,건의유조건적단위선택CBCT진행흉부종류환자적영상인도방료혹파위오차분석.
Objective To compare the set-up error detected by electronic portal imaging device (EPID) with cone-beam CT (CBCT) for patients with thoracic tumor, and to explore the impact on the workflow of different imaging-guided device. Methods From Mar 2007 to Jan 2008, 17 patients with pathologically confirmed thoracic tumor, including lung, esophagus and thymoma, were included in this study. Each patient received both EPID based-CBCT based-imaging-guided analysis once a week. Results A total of 81 pairs of EPI and CBCT scan from 16 patients except one case were obtained during treatment. Compared with EPID based-imaging guided analysis, CBCT based-imaging guided analysis did not increase the total treatment time significantly. The average set-up error of EPID was (- 0.1 ± 3.2), (1.3 ± 3.7) and (-0.2 ± 3.1) mm in the left-right (LR), superior-inferior (SI) and anterior-posterior (AP) directions, respectively ( ± SD). But the average set-up error,while that of CBCT was (0.1 ± 4.6), (0.6 ± 4.0) and ( - 0.9 ± 4.6) mm in the LR, SI and AP directions, respectively. Conclusions CBCT would be better than EPID in detecting set-up error of the thoracic tumor patients. Compared with EPID, CBCT based-imaging guided analysis could not influence the workflow of radiotherapy significantly. CBCT based-imaging guided analysis might be more efficient than EPID.