基于kV级图像引导放疗在胸部肿瘤中的应用
|
摘要
目的分析k V级图像引导下胸部肿瘤放疗分次间、分次内的摆位误差,研究k V级图像引导对胸部肿瘤调强放疗精准性的影响。方法采用Varian Novalis Tx直线加速器机载影像系统对我院2016年3~10月收治的10例胸部肿瘤患者每日行放疗前图像扫描,若需移床则行移床后图像扫描及放疗后图像扫描,将该扫描图像经系统自动重建后与治疗计划的CT图像进行配准,获取并统计分析患者左右、上下、前后方向摆位误差。结果共获取688套图像,左右、上下、前后方向放疗前误差分别为(-0.03±2.06)、(0.16±2.69)、(0.18±2.28)mm,移床后误差分别为(0.65±0.92)、(0.65±0.93)、(0.61±0.80)mm,放疗后误差分别为(-0.08±1.12)、(0.32±1.13)、(0.16±1.08)mm。结论每日k V级图像引导放疗可显著减少胸部肿瘤放疗分次间的摆位误差,对提高胸部肿瘤调强放疗精确性具有重要意义。
Objective To analyze the inter-and intra-fractional setup errors of thoracic tumors using kilovolt-image guided radiotherapy(k V-IGRT),and to study the influence of k V image guidance on the accuracy of intensity modulated radiotherapy(IMRT) of thoracic tumors.Methods 10 patients with thoracic tumors in our hospital from March to October in 2016 were selected,and the Varian Novalis Tx Linear Accelerator with on board image(OBI) system was used for daily image scanning before radiotherapy,if the bed needs to be moved,image scanning after the moving bed and scanning after radiotherapy was carried out.After the automatic reconstruction of the scanned image,the CT image of the treatment plan was registered,and the setup error of the patient′s Vrt,Lng,Lat were obtained and analyzed statistically.Results 688 sets of images were obtained,the pre-radiotherapy setup error of Vrt,Lng,Lat were(-0.03 ±2.06),(0.16 ±2.69),(0.18±2.28)mm,respectively.The setup error after the moving bed were(0.65±0.92),(0.65±0.93),(0.61±0.80)mm,respectively.The post-radiotherapy setup error were(-0.08 ±1.12),(0.32 ±1.13),(0.16 ±1.08)mm,respectively.Conclusion Daily k V-IGRT can significantly reduce the setup error of radiotherapy for thoracic tumors,and is of great significance for improving the accuracy of IMRT for thoracic tumors.
Objective To analyze the inter-and intra-fractional setup errors of thoracic tumors using kilovolt-image guided radiotherapy(k V-IGRT),and to study the influence of k V image guidance on the accuracy of intensity modulated radiotherapy(IMRT) of thoracic tumors.Methods 10 patients with thoracic tumors in our hospital from March to October in 2016 were selected,and the Varian Novalis Tx Linear Accelerator with on board image(OBI) system was used for daily image scanning before radiotherapy,if the bed needs to be moved,image scanning after the moving bed and scanning after radiotherapy was carried out.After the automatic reconstruction of the scanned image,the CT image of the treatment plan was registered,and the setup error of the patient′s Vrt,Lng,Lat were obtained and analyzed statistically.Results 688 sets of images were obtained,the pre-radiotherapy setup error of Vrt,Lng,Lat were(-0.03 ±2.06),(0.16 ±2.69),(0.18±2.28)mm,respectively.The setup error after the moving bed were(0.65±0.92),(0.65±0.93),(0.61±0.80)mm,respectively.The post-radiotherapy setup error were(-0.08 ±1.12),(0.32 ±1.13),(0.16 ±1.08)mm,respectively.Conclusion Daily k V-IGRT can significantly reduce the setup error of radiotherapy for thoracic tumors,and is of great significance for improving the accuracy of IMRT for thoracic tumors.
引文
[1]Sun Y,Lu Y,Cheng S,et al.Interfractional variations of tumor centroid position and tumor regression during stereotactic body radiotherapy for lung tumor[J].Biomed Res Int,2014,2014:372738.
[2]Wu Z,Xie C,Hu M,et al.Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer:is the conformal radiotherapy still an alternative option?[J].J Appl Clin Med Phys,2014,15(3):4641.
[3]王义海,柔倩,张瑾熔,等.15例非小细胞肺癌IMRT计划与IGRT计划剂量学比较研究[J].新疆医科大学学报,2014,37(1):97-100.
[4]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.
[5]Kong FM,Zhao J,Wang J,et al.Radiation dose effect in locally advanced non-small cell lung cancer[J].J Thorac Dis,2014,6(4):336-347.
[6]戴建荣,胡逸民.图像引导放疗的实现方式[J]中华放射肿瘤学杂志,2006,15(2):132-135.
[7]岳丹,杨永净,赵玲,等.k V-CBCT图像引导鼻咽癌调强放疗的精确性研究[J].中华放射医学与防护杂志,2016,36(3):211-215.
[8]Sonke JJ,Belderbos J.Adaptive radiotherapy for lung cancer[J].Semin Radiat Oncol,,2010,20(2):94-106.
[9]车少敏,惠蓓娜,张晓智,等.IGRT在颈段、胸上段食管癌放疗中的应用[J].现代肿瘤医学,2013,21(1):96-100.
[10]Elsayad K,Kriz J,Reinartz G,et al.Cone-beam CT-guided radiotherapy in the management of lung cancer:Diagnostic and therapeutic value[J].Strahlenther Onkol,2016,192(2):83-91.
[11]吴钦宏,李高峰,王婵,等.基于锥形束CT体部肿瘤图像引导放疗的摆位误差分析[J].中华放射肿瘤学杂志,2012,21(1):68-71.
[12]曹晓辉,刘明,翟福山,等.CBCT图像引导下胸部肿瘤放疗摆位误差及其外放边界[J].中华放射肿瘤学杂志,2014,23(1):53-55.
[13]Alaei P,Spezi E.Imaging dose from cone beam computed tomography in radiation therapy[J].Phys Med,2015,31(7):647-658.
[14]Kan MW,Leung LH,Wong W,et al.Radiation dose from cone beam computed tomography for image-guided radiation therapy[J].Int J Radiat Oncol Biol Phys,2008,70(1):272-279.
[15]李娜,张旭,尹策,等.兆伏级锥形束CT所致剂量与体重指数的关系[J].中华放射肿瘤学杂志,2013,22(4):324-325.
[16]Ciardo D,Alterio D,Jereczek-Fossa BA,et al.Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy:quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images[J].Phys Med,2015,31(8):1015-1021.
[17]尹勇,朱健,李建彬,等.锥形束CT图像拼接技术的实现及其临床应用研究[J].中华放射肿瘤学杂志,2008,17(5):391-394.
[18]Yan H,Wang X,Shi F,et al.Towards the clinical implementation of iterative low-dose cone-beam CT reconstruction in image-guided radiation therapy:cone/ring artifact correction and multiple GPU implementation[J].Med Phys,2014,41(11):111912.
[19]Van Herk M.Different styles of image-guided radiotherapy[J].Semin Radiat Oncol,2007,17(4):258-267.
[20]Sejpal SV,Amos RA,Bluett JB,et al.Dosimetric changes resulting from patient rotational setup errors in proton therapy prostate plans[J].Int J Radiat Oncol Biol Phys,2009,75(1):40-48.
[2]Wu Z,Xie C,Hu M,et al.Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer:is the conformal radiotherapy still an alternative option?[J].J Appl Clin Med Phys,2014,15(3):4641.
[3]王义海,柔倩,张瑾熔,等.15例非小细胞肺癌IMRT计划与IGRT计划剂量学比较研究[J].新疆医科大学学报,2014,37(1):97-100.
[4]尚凯,迟子峰,王军,等.胸段食管癌IGRT中摆位误差分析[J].中华放射肿瘤学杂志,2015,24(1):70-73.
[5]Kong FM,Zhao J,Wang J,et al.Radiation dose effect in locally advanced non-small cell lung cancer[J].J Thorac Dis,2014,6(4):336-347.
[6]戴建荣,胡逸民.图像引导放疗的实现方式[J]中华放射肿瘤学杂志,2006,15(2):132-135.
[7]岳丹,杨永净,赵玲,等.k V-CBCT图像引导鼻咽癌调强放疗的精确性研究[J].中华放射医学与防护杂志,2016,36(3):211-215.
[8]Sonke JJ,Belderbos J.Adaptive radiotherapy for lung cancer[J].Semin Radiat Oncol,,2010,20(2):94-106.
[9]车少敏,惠蓓娜,张晓智,等.IGRT在颈段、胸上段食管癌放疗中的应用[J].现代肿瘤医学,2013,21(1):96-100.
[10]Elsayad K,Kriz J,Reinartz G,et al.Cone-beam CT-guided radiotherapy in the management of lung cancer:Diagnostic and therapeutic value[J].Strahlenther Onkol,2016,192(2):83-91.
[11]吴钦宏,李高峰,王婵,等.基于锥形束CT体部肿瘤图像引导放疗的摆位误差分析[J].中华放射肿瘤学杂志,2012,21(1):68-71.
[12]曹晓辉,刘明,翟福山,等.CBCT图像引导下胸部肿瘤放疗摆位误差及其外放边界[J].中华放射肿瘤学杂志,2014,23(1):53-55.
[13]Alaei P,Spezi E.Imaging dose from cone beam computed tomography in radiation therapy[J].Phys Med,2015,31(7):647-658.
[14]Kan MW,Leung LH,Wong W,et al.Radiation dose from cone beam computed tomography for image-guided radiation therapy[J].Int J Radiat Oncol Biol Phys,2008,70(1):272-279.
[15]李娜,张旭,尹策,等.兆伏级锥形束CT所致剂量与体重指数的关系[J].中华放射肿瘤学杂志,2013,22(4):324-325.
[16]Ciardo D,Alterio D,Jereczek-Fossa BA,et al.Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy:quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images[J].Phys Med,2015,31(8):1015-1021.
[17]尹勇,朱健,李建彬,等.锥形束CT图像拼接技术的实现及其临床应用研究[J].中华放射肿瘤学杂志,2008,17(5):391-394.
[18]Yan H,Wang X,Shi F,et al.Towards the clinical implementation of iterative low-dose cone-beam CT reconstruction in image-guided radiation therapy:cone/ring artifact correction and multiple GPU implementation[J].Med Phys,2014,41(11):111912.
[19]Van Herk M.Different styles of image-guided radiotherapy[J].Semin Radiat Oncol,2007,17(4):258-267.
[20]Sejpal SV,Amos RA,Bluett JB,et al.Dosimetric changes resulting from patient rotational setup errors in proton therapy prostate plans[J].Int J Radiat Oncol Biol Phys,2009,75(1):40-48.