CAJ | 학술논문

目的对食道癌放疗中使用头颈肩膜固定的患者中,比较选取不同位置的CT定位点,对上、中、下段食管癌患者摆位误差的影响.比较采用头颈肩膜固定的食道癌患者选取肩胸部或者下颌部CT定位点所致摆位误差的变化情况.材料与方法选取上中下段食道癌患者段各40例,等分成A、B两组,均使用Q-Fix头颈肩膜固定,在大孔径CT定位时分别选取不同参考点定位位置(A组参考点选取在肩胸部靠近靶区的位置,B组选在下颌部的位置,两侧均平体中线),按5mm层厚扫描后传至计划系统.在加速器第一次上治疗时,激光灯对齐参考点后按计划的移床信息移动治疗床到治疗野中心,使用EPID验证系统拍摄正侧位验证片,以第一次摆位拍摄的验证片为准,与CT模拟数字重建的DRR图像进行比对,比较两组食道癌患者在X轴(左右方向)、Y轴(进出方向)、Z轴(升降方向)三个方向上的摆位误差.结果对于上段食道癌患者两组P值>0.05,均无显著性差异；中段食管癌患者只有X轴方向P<0.05,有统计学意义.A组为(0.427±0.063)cm,B组为(0.267±0.021)cm；下段食管癌患者三个方向P<0.05,均有统计学意义.A组X、Y、Z三个方向的误差分别是(0.645±0.086)cm,(0.276±0.052)cm,(0.334±0.080)cm；B组X、Y、Z三个方向的误差分别为(0.401±0.050)cm,(0.185±0.027)cm,(0.144±0.039)cm.结论对于中下段食道癌患者而言,在头颈肩面膜上选取以下颌部为参考点进行的摆位比以肩胸部作为参考点的摆位准确性更高.
목적대식도암방료중사용두경견막고정적환자중,비교선취불동위치적CT정위점,대상、중、하단식관암환자파위오차적영향.비교채용두경견막고정적식도암환자선취견흉부혹자하합부CT정위점소치파위오차적변화정황.재료여방법선취상중하단식도암환자단각40례,등분성A、B량조,균사용Q-Fix두경견막고정,재대공경CT정위시분별선취불동삼고점정위위치(A조삼고점선취재견흉부고근파구적위치,B조선재하합부적위치,량측균평체중선),안5mm층후소묘후전지계화계통.재가속기제일차상치료시,격광등대제삼고점후안계화적이상신식이동치료상도치료야중심,사용EPID험증계통박섭정측위험증편,이제일차파위박섭적험증편위준,여CT모의수자중건적DRR도상진행비대,비교량조식도암환자재X축(좌우방향)、Y축(진출방향)、Z축(승강방향)삼개방향상적파위오차.결과대우상단식도암환자량조P치>0.05,균무현저성차이；중단식관암환자지유X축방향P<0.05,유통계학의의.A조위(0.427±0.063)cm,B조위(0.267±0.021)cm；하단식관암환자삼개방향P<0.05,균유통계학의의.A조X、Y、Z삼개방향적오차분별시(0.645±0.086)cm,(0.276±0.052)cm,(0.334±0.080)cm；B조X、Y、Z삼개방향적오차분별위(0.401±0.050)cm,(0.185±0.027)cm,(0.144±0.039)cm.결론대우중하단식도암환자이언,재두경견면막상선취이하합부위삼고점진행적파위비이견흉부작위삼고점적파위준학성경고.
Objective The esophagus cancer radiotherapy was used in head and neck shoulder membrane immobilized patients, comparison of different location of CT positioning point, on, in, the lower esophageal cancer patient setup error influence. Compared with the neck shoulder film fixed in esophageal cancer patients select the shoulder and chest or the mandibular division of CT positioning point position error caused by the changes of. Methods Selection of middle and lower segment esophageal cancer patients, 40 cases, divided into A, B two group, Q-Fix is used for neck shoulder fixed film, in the large aperture CT respectively when selecting different reference point location ( group A reference point selection at the shoulder and chest near the target zone location, B group is chosen in the mandibular position both sides, flat body midline ), according to the 5mm layer thickness is scanned to plan system. In accelerator first treatment, laser lights aligned reference point by the plan after shift bed information mobile treatment bed to the treatment field centers, use EPID authentication system shooting side position verification, to the first pendulum filmed verification sheet shall prevail, and CT analog and digital reconstruction of DRR image in comparison, comparison two groups of patients with esophageal carcinoma in X axis ( left-right axis ( Y ), import and direction), Z ( vertical axis ) in a three direction on the position error. Results For upper esophageal cancer patients of two groups of P value > 0.05, have no significant difference; esophageal carcinoma patients with only X axis direction P < 0.05, there was statistical significance. Group A was ( 0.427± 0.063 ) cm, B group was (0.267 ±0.021) cm; the lower esophageal cancer patients in a three direction P < 0.05, there was statistical significance. In group A, Y X, Z three directional error were (0.645 ±0.086) cm, ( 0.276 ±0.052) cm, ( 0.334 ±0.080) cm; B X, Y, Z three directional errors were ( 0.401± 0.050 ) cm, ( 0.185 ±0.027) cm, ( 0.144 ±0.039) cm. Conclusions For middle and lower segment esophageal cancer patients, in the head and neck shoulder mask selection following jaw as reference point placement than to shoulder and chest as the reference point for the positioning accuracy of the higher.