中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
CHINESE JOURNAL OF RADIATION ONCOLOGY
2014年
3期
239-243
,共5页
钱建军%邢鹏飞%陆雪官%田野
錢建軍%邢鵬飛%陸雪官%田野
전건군%형붕비%륙설관%전야
危及器官勾画%剂量学%鼻咽肿瘤/调强放射疗法
危及器官勾畫%劑量學%鼻嚥腫瘤/調彊放射療法
위급기관구화%제량학%비인종류/조강방사요법
Organs at risk delineation%Dosimetry%Nasopharynx neoplasms/intensity modulated radiotherapy
目的 观察鼻咽癌IMRT中低年资与高年资医师勾画OAR的差异和剂量学差异,评估针对性的培训对改善差异的作用.方法 选择初治鼻咽癌患者16例,组织低年资和高年资医师各3位分别勾画患者OAR并与参考OAR比较几何差异和剂量学差异.针对差异最大的2个OAR,组织两组医师培训后重新勾画并再次比较差异.差异比较行配对t检验.结果 低年资、高年资医师勾画OAR的Dmax差异分别为(2.33±12.06)％(-48.06％～137.82％)、(0.09±4.72)％(-49.54％～42.96％)(P=0.039),其中视交叉的差异最大[(5.85±19.63)％∶(1.36±4.64)％,P=0.042];Dmwan差异分别为(3.10±8.07)％(-46.76％～59.76％)、(-0.93±2.03)％(-45.54％～35.69％)(P =0.021),其中腮腺的差异最大[(13.23±13.39)％∶ (3.20±6.71)％,P=0.002].培训并重新勾画后低年资、高年资医师勾画视交叉的Dmax差异分别为(1.68±3.34)％、(1.50±1.87)％(P=0.841),其中低年资医师的差异较培训前明显减少[(1.68±3.34)％∶(5.85±19.63)％,P=0.048];腮腺的Dmean差异分别为(2.46±3.06)％、(1.35±3.00)％ (P=0.274),分别较培训前的差异明显减少[(2.46±3.06)％∶ (13.23±13.39)％,P=0.002;(1.35±3.00)％∶ (3.20±6.71)％,P=0.033].结论 鼻咽癌IMRT中OAR的勾画差异可引起明显的剂量不确定性,针对性的培训可提高勾画精准性.
目的 觀察鼻嚥癌IMRT中低年資與高年資醫師勾畫OAR的差異和劑量學差異,評估針對性的培訓對改善差異的作用.方法 選擇初治鼻嚥癌患者16例,組織低年資和高年資醫師各3位分彆勾畫患者OAR併與參攷OAR比較幾何差異和劑量學差異.針對差異最大的2箇OAR,組織兩組醫師培訓後重新勾畫併再次比較差異.差異比較行配對t檢驗.結果 低年資、高年資醫師勾畫OAR的Dmax差異分彆為(2.33±12.06)％(-48.06％～137.82％)、(0.09±4.72)％(-49.54％～42.96％)(P=0.039),其中視交扠的差異最大[(5.85±19.63)％∶(1.36±4.64)％,P=0.042];Dmwan差異分彆為(3.10±8.07)％(-46.76％～59.76％)、(-0.93±2.03)％(-45.54％～35.69％)(P =0.021),其中腮腺的差異最大[(13.23±13.39)％∶ (3.20±6.71)％,P=0.002].培訓併重新勾畫後低年資、高年資醫師勾畫視交扠的Dmax差異分彆為(1.68±3.34)％、(1.50±1.87)％(P=0.841),其中低年資醫師的差異較培訓前明顯減少[(1.68±3.34)％∶(5.85±19.63)％,P=0.048];腮腺的Dmean差異分彆為(2.46±3.06)％、(1.35±3.00)％ (P=0.274),分彆較培訓前的差異明顯減少[(2.46±3.06)％∶ (13.23±13.39)％,P=0.002;(1.35±3.00)％∶ (3.20±6.71)％,P=0.033].結論 鼻嚥癌IMRT中OAR的勾畫差異可引起明顯的劑量不確定性,針對性的培訓可提高勾畫精準性.
목적 관찰비인암IMRT중저년자여고년자의사구화OAR적차이화제량학차이,평고침대성적배훈대개선차이적작용.방법 선택초치비인암환자16례,조직저년자화고년자의사각3위분별구화환자OAR병여삼고OAR비교궤하차이화제량학차이.침대차이최대적2개OAR,조직량조의사배훈후중신구화병재차비교차이.차이비교행배대t검험.결과 저년자、고년자의사구화OAR적Dmax차이분별위(2.33±12.06)％(-48.06％～137.82％)、(0.09±4.72)％(-49.54％～42.96％)(P=0.039),기중시교차적차이최대[(5.85±19.63)％∶(1.36±4.64)％,P=0.042];Dmwan차이분별위(3.10±8.07)％(-46.76％～59.76％)、(-0.93±2.03)％(-45.54％～35.69％)(P =0.021),기중시선적차이최대[(13.23±13.39)％∶ (3.20±6.71)％,P=0.002].배훈병중신구화후저년자、고년자의사구화시교차적Dmax차이분별위(1.68±3.34)％、(1.50±1.87)％(P=0.841),기중저년자의사적차이교배훈전명현감소[(1.68±3.34)％∶(5.85±19.63)％,P=0.048];시선적Dmean차이분별위(2.46±3.06)％、(1.35±3.00)％ (P=0.274),분별교배훈전적차이명현감소[(2.46±3.06)％∶ (13.23±13.39)％,P=0.002;(1.35±3.00)％∶ (3.20±6.71)％,P=0.033].결론 비인암IMRT중OAR적구화차이가인기명현적제량불학정성,침대성적배훈가제고구화정준성.
Objective To assess the differences in delineation of organs at risk (OAR) and dosimetry between junior and senior physicians during intensity-modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to evaluate the role of specific training in reducing the differences.Methods Sixteen patients newly diagnosed with NPC were selected in the study.The OAR was delineated separately by three junior physicians and three senior physicians,and the geometric and dosimetric differences were assessed relative to the reference OAR.Delineation was performed again for the two OARs with the biggest difference after specific training in the two groups of physicians,and the differences were evaluated again.The difference was determined by paired t test.Results The maximum dose differences (Dmax) of OAR in the junior and senior physicians were (2.33 ± 12.06) ％ (-48.06％-137.82％) and (0.09 ± 4.72) ％ (-49.54％-42.96％),respectively (P =0.039),and the difference in the optic chiasm was the greatest ((5.85 ± 19.63) ％ ∶ (1.36 ± 4.64) ％,P =0.042).The mean dose differences (Dmean) of OAR in the junior and senior physicians were (3.10 ± 8.07)％ (-46.76％-59.76％) and (-0.93 ± 2.03) ％ (-45.54％-35.69％),respectively (P =0.021),and the difference in the parotid gland was the greatest ((13.23 ± 13.39) ％ ∶ (3.20 ± 6.71) ％,P =0.002).In the secondary delineation after training,the Dmax of the optic chiasm in the junior and senior physicians was (1.68 ± 3.34)％ and (1.50 ± 1.87) ％,respectively (P =0.841),and the difference in junior physicians was reduced significantly compared with before training ((1.68 ± 3.34) ％ ∶ (5.85 ± 19.63) ％,P =0.048) ; the Dmean of the parotid gland in the junior and senior physicians was (2.46 ± 3.06) ％ and (1.35 ± 3.00) ％,respectively (P =0.2 7 4),significantly reduced compared with before training ((2.46 ± 3.0 6) ％ ∶ (13.23 ± 13.39)％,P=0.002; (1.35 ± 3.00)％ ∶ (3.20 ± 6.71) ％,P =0.033).Conclusions The differences in delineation of OAR lead to dose uncertainties during IMRT for NPC,and specific training can improve the accuracy of delineation.
