全脑全脊髓螺旋断层放疗体位固定技术的优化及应用研究
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摘要
目的对用于全脑全脊髓螺旋断层放疗的固定装置进行优化设计。方法收集18例行螺旋断层放射治疗的全脑全脊髓患者资料,靶区外放边界值脑段为3 mm,脊髓段为5 mm。对用于全脑全脊髓治疗的固定装置进行分析,并结合螺旋断层放疗装置的结构进行优化设计,采用热塑头颈肩模加发泡垫加"I"形块真空垫的固定装置,分析优化前、后各9例患者每次治疗行兆伏CT(megavoltage CT,MVCT)图像引导的6个自由度方向上共计287组摆位误差。结果优化后的固定装置表现出良好的重复性,二次摆位次数10次,摆位误差在左右(X)、头脚(Y)和腹背(Z)平移方向以及矢状面(Pitch)、冠状面(Yaw)和横断面(Roll)旋转方向上分别为(0. 23±0. 31) mm、(0. 36±1. 52) mm、(0. 91±0. 72) mm和(0. 76±0. 21)°、(0. 44±0. 19)°、(0. 06±0. 78)°,优化前的二次摆位次数17次,各方向上的摆位误差分别为(1. 63±1. 5) mm、(0. 36±3. 16) mm、(1. 60±1. 17) mm和(0. 98±0. 22)°、(0. 78±0. 35)°、(0. 77±1. 24)°。优化后较优化前整体的误差绝对值有所减小,且X方向的偏差比较,差异具有统计学意义(P <0. 05)。进一步计算靶区PTV外放边界值在X、Y和Z方向优化后和优化前分别为0. 36 mm、1. 96mm、2. 78 mm和3. 03 mm、3. 11 mm、4. 82 mm。结论热塑头颈肩模加发泡垫加"I"形块真空垫的固定装置可减小摆位误差并具有良好的摆位重复性,建议将全脑全脊髓靶区(脑段和脊髓段)的PTV外放边界值改为脑段CTV外扩3 mm和脊髓段CTV外扩3 mm,为临床靶区的精准勾画提供可靠依据。
Objective To optimize the fixing device in craniospinal irradiation with helical tomotherapy. Methods Eighteen patients undergoing craniospinal irradiation with helical tomotherapy were enrolled. The PTV margin in the target area of the craniospinal irradiation was 3 mm of CTV-brain section and 5 mm of CTV-spinal section. The fixing device for craniospinal irradiation with tomotherapy was analyzed. The device was redesigned with the structure of tomotherapy,the fixing device with thermoplastic film of neck and shoulder,styrofoam,and vacuum mold with " I" shape block. Finally,the287 setup errors of 9 patients before and after optimization were analyzed. Results Optimized fixture showed good repeatability,and the setup errors and the number of second positions were reduced compared with those of before optimization.The setup errors in left-right( X),cranial-caudal( Y),anterior-posterior( Z),Pitch,Roll,and Yaw after optimization and before optimization were( 0. 23 ± 0. 31) mm,( 0. 36 ± 1. 52) mm,( 0. 91 ± 0. 72) mm,( 0. 76 ± 0. 21) °,( 0. 44 ±0. 19) °,( 0. 06 ± 0. 78) °,and( 1. 63 ± 1. 5) mm,( 0. 36 ± 3. 16) mm,( 1. 60 ± 1. 17) mm,( 0. 98 ± 0. 22) °,( 0. 78 ±0. 35) °,( 0. 77 ± 1. 24) °,respectively. The deviation in the X direction was statistically significant( P < 0. 05). The value of PTV margin on X,Y,and Z directions after optimization and before optimization were 0. 36 mm,1. 96 mm,2. 78 mm,and 3. 03 mm,3. 11 mm and 4. 82 mm,respectively. Conclusion The fixing device with thermoplastic film of neck and shoulder,styrofoam,and vacuum mold with " I" shape block can reduce the setup errors and have good setup repeatability. It is recommended to use the PTV margin in the target area of the craniospinal irradiation at 3 mm of CTV-brain section and 3 mm of CTV-spinal section,which will provide reliable basis for accurate delineation of clinical PTV.
Objective To optimize the fixing device in craniospinal irradiation with helical tomotherapy. Methods Eighteen patients undergoing craniospinal irradiation with helical tomotherapy were enrolled. The PTV margin in the target area of the craniospinal irradiation was 3 mm of CTV-brain section and 5 mm of CTV-spinal section. The fixing device for craniospinal irradiation with tomotherapy was analyzed. The device was redesigned with the structure of tomotherapy,the fixing device with thermoplastic film of neck and shoulder,styrofoam,and vacuum mold with " I" shape block. Finally,the287 setup errors of 9 patients before and after optimization were analyzed. Results Optimized fixture showed good repeatability,and the setup errors and the number of second positions were reduced compared with those of before optimization.The setup errors in left-right( X),cranial-caudal( Y),anterior-posterior( Z),Pitch,Roll,and Yaw after optimization and before optimization were( 0. 23 ± 0. 31) mm,( 0. 36 ± 1. 52) mm,( 0. 91 ± 0. 72) mm,( 0. 76 ± 0. 21) °,( 0. 44 ±0. 19) °,( 0. 06 ± 0. 78) °,and( 1. 63 ± 1. 5) mm,( 0. 36 ± 3. 16) mm,( 1. 60 ± 1. 17) mm,( 0. 98 ± 0. 22) °,( 0. 78 ±0. 35) °,( 0. 77 ± 1. 24) °,respectively. The deviation in the X direction was statistically significant( P < 0. 05). The value of PTV margin on X,Y,and Z directions after optimization and before optimization were 0. 36 mm,1. 96 mm,2. 78 mm,and 3. 03 mm,3. 11 mm and 4. 82 mm,respectively. Conclusion The fixing device with thermoplastic film of neck and shoulder,styrofoam,and vacuum mold with " I" shape block can reduce the setup errors and have good setup repeatability. It is recommended to use the PTV margin in the target area of the craniospinal irradiation at 3 mm of CTV-brain section and 3 mm of CTV-spinal section,which will provide reliable basis for accurate delineation of clinical PTV.
引文
[1]祝敏,蒋帅君,蒋马伟.螺旋断层放疗系统MVCT分析儿童髓母细胞瘤中不同定位方式的摆位误差[J].实用肿瘤杂志,2018,33(1):73-77.
[2]胡永,张振宁,张树民.超长靶区食管癌螺旋断层放疗时不同体位固定方式效果比较[J].实用肿瘤杂志,2016,31(6):546-552.
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[7]李珠明,崔玉琴.全脑全脊髓照射仰卧位CT模拟定位技术[J].中国医学物理杂志,2006,23(1):16-20.
[8]顾松.全脑全脊髓多等中心仰卧位整体放疗技术在临床应用中的可行性研究[D].江苏:苏州大学放射医学与防护学院,2014.
[9]文婷,李志强,张晋建,等.改进全脑全脊髓螺旋断层放射治疗计划的研究[J].中国医学物理学杂志,2012,29(6):3737-3741.
[10] Van HM,Remeijer P,Rasch C,et al. The probability of correct target dosage:dose population histograms for deriving treatment margins in radiotherapy[J]. Int J Radiat Oncol Biol Phys,2000,47(4):1121-1135.
[11] Van HM. Errors and margins in radiotherapy[J]. Semin Radiat Oncol,2004,14(1):52-64.
[12]朱夫海,吴伟章,王勇,等.胰腺癌患者螺旋断层放疗摆位误差分析[J].中国医学物理学杂志,2013,30(6):4480-4483.
[13]张寅,张连胜,肖建平,等.用图像引导技术提高胸腹部肿瘤大分割放疗的治疗精度[J].中华放射肿瘤学杂志,2008,17(6):441-444.
[2]胡永,张振宁,张树民.超长靶区食管癌螺旋断层放疗时不同体位固定方式效果比较[J].实用肿瘤杂志,2016,31(6):546-552.
[3]徐英杰,胡志辉,黄鹏,等. Tomo Direct技术在全脑全脊髓放疗中的应用[J].中华放射医学与防护杂志,2015,35(6):445-448.
[4] Qu BL,Du L,Huang Y,et al. Clinical analysis of intracranial germinoma's craniospinal irradiation using helical tomotherapy[J]. Chin J Cancer Res,2014,26(3):247-254.
[5] Schiopu SR,Habl G,Hfner M,et al. Craniospinal irradiation using helical tomotherapy for central nervous system tumors[J]. J Radiat Res,2017,58(2):238-246.
[6] Tsang SWS,Collins M,Wong JTL,et al. A dosimetric comparison of craniospinal irradiation using Tomo Direct radiotherapy,Tomo Helical radiotherapy and 3D conventional radiotherapy[J]. J Radiother Pract,2017,16(4):12-19.
[7]李珠明,崔玉琴.全脑全脊髓照射仰卧位CT模拟定位技术[J].中国医学物理杂志,2006,23(1):16-20.
[8]顾松.全脑全脊髓多等中心仰卧位整体放疗技术在临床应用中的可行性研究[D].江苏:苏州大学放射医学与防护学院,2014.
[9]文婷,李志强,张晋建,等.改进全脑全脊髓螺旋断层放射治疗计划的研究[J].中国医学物理学杂志,2012,29(6):3737-3741.
[10] Van HM,Remeijer P,Rasch C,et al. The probability of correct target dosage:dose population histograms for deriving treatment margins in radiotherapy[J]. Int J Radiat Oncol Biol Phys,2000,47(4):1121-1135.
[11] Van HM. Errors and margins in radiotherapy[J]. Semin Radiat Oncol,2004,14(1):52-64.
[12]朱夫海,吴伟章,王勇,等.胰腺癌患者螺旋断层放疗摆位误差分析[J].中国医学物理学杂志,2013,30(6):4480-4483.
[13]张寅,张连胜,肖建平,等.用图像引导技术提高胸腹部肿瘤大分割放疗的治疗精度[J].中华放射肿瘤学杂志,2008,17(6):441-444.
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