CAJ | 학술논문

目的：比较红外线标记自动摆位＋ExacTrac （ A）和人工摆位＋CBCT IGRT技术（ B）在肺癌IMRT中的摆位误差和摆位与误差修正时间。方法选择20例肺癌患者随机分为A、B两组。 A组自动摆位后再用KV级X射线获取一組交叉X线射野片，与DRR匹配得到修正前误差；B组采用人工摆位后运用CBCT引导技术获取图像，与定位CT图像匹配得到修正前误差。分别记录A、B两组摆位与误差修正时间，误差修正后再以各自IGRT技术得到修正后误差。组间比较采用配对t检验。结果 A组和B组修正后左右、上下、前后、绕前后方向误差均小于修正前的（1．8±1?3∶0．4±0?1、2．7±1?9∶0．5±0?1、2．8±1?7∶0．4±0?1、1．6±1?0∶0．3±0?9，P＝0?000、0?000、0?000、0?000和2．6±1?9∶0．5±0?5、3．1±2?5∶0．6±0?6、2．1±1?8∶0．5±0?5、0．9±0?7∶0．3±0?1，P＝0?000、0?000、0?000、0?000），A组修正后误差与B组修正后误差相近（0．4±0?1∶0．5±0?5、0．5±0?1∶0．6±0?6、0．4±0?1∶0．5±0?5、0．3±0?9∶0．3±0?1，P＝0?204、0?257、0?518、0?755），A组摆位与误差修正时间明显小于B组（199．1±16?2∶315．2±13?7，P＝0?000）。结论 ExacTrac和CBCTIGRT系统在调强放疗的应用能明显减小摆位误差，提高摆位精度，ExacTrac系统的应用可明显缩短摆位与误差修正时间。
목적：비교홍외선표기자동파위＋ExacTrac （ A）화인공파위＋CBCT IGRT기술（ B）재폐암IMRT중적파위오차화파위여오차수정시간。방법선택20례폐암환자수궤분위A、B량조。 A조자동파위후재용KV급X사선획취일조교차X선사야편，여DRR필배득도수정전오차；B조채용인공파위후운용CBCT인도기술획취도상，여정위CT도상필배득도수정전오차。분별기록A、B량조파위여오차수정시간，오차수정후재이각자IGRT기술득도수정후오차。조간비교채용배대t검험。결과 A조화B조수정후좌우、상하、전후、요전후방향오차균소우수정전적（1．8±1?3∶0．4±0?1、2．7±1?9∶0．5±0?1、2．8±1?7∶0．4±0?1、1．6±1?0∶0．3±0?9，P＝0?000、0?000、0?000、0?000화2．6±1?9∶0．5±0?5、3．1±2?5∶0．6±0?6、2．1±1?8∶0．5±0?5、0．9±0?7∶0．3±0?1，P＝0?000、0?000、0?000、0?000），A조수정후오차여B조수정후오차상근（0．4±0?1∶0．5±0?5、0．5±0?1∶0．6±0?6、0．4±0?1∶0．5±0?5、0．3±0?9∶0．3±0?1，P＝0?204、0?257、0?518、0?755），A조파위여오차수정시간명현소우B조（199．1±16?2∶315．2±13?7，P＝0?000）。결론 ExacTrac화CBCTIGRT계통재조강방료적응용능명현감소파위오차，제고파위정도，ExacTrac계통적응용가명현축단파위여오차수정시간。
Objective To compare set?up error and the positioning and error correction time between the infrared markers automatic positioning+ ExacTrac ( A) and the manual positioning+ cone?beam computed tomography ( CBCT) image?guided radiotherapy ( IGRT) ( B) in intensity?modulated radiotherapy ( IMRT) for lung cancer. Methods A total of 20 patients with lung cancer were randomly divided into Group A and Group B. In Group A, after automatic positioning, a group of orthogonal X?rays images were taken using kV X?rays, which matched digitally reconstructed radiographs to obtain errors before correction. In group B, after manual positioning, images were taken using CBCT, which matched reference computed tomography images to obtain errors before correction. The positioning and error correction time was recorded in both groups. After error correction, errors after correction were obtained in each group using IGRT. Between?group comparison was made using the paired t test. Results The errors in lateral, longitudinal, vertical, and spinning vertical directions were significantly reduced after correction in both Group A and B (A:1.8±1?3 vs. 0.4±0?1, P=0?000;2.7±1?9 vs. 0.5±0?1, P=0?000;2.8±1?7 vs. 0.4±0?1, P=0?000;1.6±1?0 vs. 0.3±0?9, P=0?000;B:2.6±1?9 vs. 0.5±0?5, P=0?000;3.1±2?5 vs. 0.6±0?6, P=0?000;2.1±1?8 vs. 0.5±0?5, P=0?000;0.9±0?7 vs. 0.3±0?1, P=0?000). There were no significant differences in errors after correction between Group A and Group B (0.4±0?1 vs. 0.5±0?5, P=0?204;0.5±0?1 vs. 0.6± 0?6, P=0?257;0.4± 0?1 vs. 0.5± 0?5, P=0?518;0.3± 0?9 vs. 0.3± 0?1, P=0?755 ) . However, the positioning and error correction time in Group A was significantly shorter than that in Group B (199.1±16?2 vs. 315.2±13?7, P=0?000). Conclusions The application of ExacTrac or CBCT IGRT can substantially reduce set?up errors and improve set?up accuracy in IMRT. In addition, the application of the ExacTrac system can substantially shorten the positioning and error correction time.