腹部肿瘤患者放疗行图像引导对剂量误差纠正的有效性研究
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摘要
目的:探讨腹部肿瘤通过锥形束CT扫描纠正摆位误差后对治疗剂量实施的准确性影响,以对临床放疗提供指导。方法:采用双盲法选取6例腹部肿瘤患者,每次治疗时利用电子射野影像装置(electronical portal imaging device,EPID)采集剂量学信息,利用EDOSE工具进行三维剂量重建,对患者的治疗计划完成实时三维剂量验证。每例患者行图像引导与未行图像引导各采集5组数据,共60组数据,比较图像引导后再治疗与直接治疗2种情况下实时三维剂量验证的结果。结果:治疗前锥形束CT图像引导能够在一定程度上纠正摆位误差,但总体γ通过率与未行图像引导相比并未体现出优势,患者靶区的覆盖率亦没有提高,正常组织受量方面也没有明显优势。结论:对于腹部肿瘤患者,现行的按照骨性标记来配准的图像引导纠正摆位误差后,患者治疗过程中三维剂量验证结果没有得到明显改善,治疗剂量实施准确性没有得到明显提高。
Objective To investigate the effect of the correction of the position error of the abdominal tumor by cone beam scanning. Methods Six patients with abdominal tumor were selected with double-blind method, and electronical portal imaing device was used to collect the information of the patient dosimetry during radiotherapy. EDOSE tool was applied to 3 D dose reconstruction so as to execute real-time 3 D dose verification of the treatment plan. Each patient had 5 sets of data acquired when image guidance existed and another 5 sets when image guidance was absent. The treatment effects with or without image guidance were compared. Results The overall γ passing rate with cone beam CT image guidance gained no advantages over that without image guidance, though the setup error was corrected to some extent. Image guidance contributed nothing to increasing target area coverage while decreasing exposure dose to normal tissue. Conclusion Setup error correction by the image guidance based on bone marker has no significant effect on improving 3 D dose verification and dose accuracy during the radiotherapy of the abdominal tumor patient.
Objective To investigate the effect of the correction of the position error of the abdominal tumor by cone beam scanning. Methods Six patients with abdominal tumor were selected with double-blind method, and electronical portal imaing device was used to collect the information of the patient dosimetry during radiotherapy. EDOSE tool was applied to 3 D dose reconstruction so as to execute real-time 3 D dose verification of the treatment plan. Each patient had 5 sets of data acquired when image guidance existed and another 5 sets when image guidance was absent. The treatment effects with or without image guidance were compared. Results The overall γ passing rate with cone beam CT image guidance gained no advantages over that without image guidance, though the setup error was corrected to some extent. Image guidance contributed nothing to increasing target area coverage while decreasing exposure dose to normal tissue. Conclusion Setup error correction by the image guidance based on bone marker has no significant effect on improving 3 D dose verification and dose accuracy during the radiotherapy of the abdominal tumor patient.
引文
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[11]黄妙云,陈明秋,陈远贵,等.基于EPID三维剂量验证系统的物理模型测试及临床应用的初步研究[J].中华放射肿瘤学杂志,2016,25(12):1 335-1 340.
[12]陈明伟,邓小武,黄劭敏,等.非晶硅平板电子射野影像用于放射治疗剂量学质量控制检验的应用[J].癌症,2007,26(11):1 272-1 275.
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[15]ALSHANQITY M,DUANE S,NISBET A.A simple approach for EPID dosimetric calibration to overcome the effect of image-lag and g hosting[J].Appl Radiat Isot,2012,70(7):1 154-1 157.
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[17]LIN M H,LI J,WANG L,et al.4D patient dose reconstruction usingonline measured EPID cine images for lung SBRT treatment validation[J].Med Phys,2012,39(10):5 949-5 958.
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[19]LOO M V H,WELLEWEERD J.PO-0837:3D dose verification of VMAT lung SBRT using Mobius3D[J].Radiother Oncol,2015,115:S423-S424.
[20]花威,张西志,汪步海,等.用COMPASS验证鼻咽癌调强放射治疗计划[J].生物医学工程与临床,2015(2):4.
[21]褚薛刚,邢晓汾,崔桐,等.Compass R在宫颈癌调强放疗三维剂量验证中的应用研究[J].中华放射医学与防护杂志,2015,35(7):548-549.
[22]INFUSINO E,MAMELI A,CONTI R,et al.Initial experience of Arc CHECK and 3DVH software for Rapid Arc treatment plan verification[J].Med Dosim,2014,39(3):276-281.
[23]JARRY G,MARTIN D,LEMIRE M,et al.SU-E-T-405:evaluation of IMRT QA using 3DVH,a 3D patient dose and verification analysis software[J].Med Phys,2011,38(6 part 16):3 581.
[24]ELENA V.EPID-based dosimetry using a commercial software:gamma analysis and DVH metrics for VMAT pretreatment and in vivo QA[J].Phys Medica,2016,32:262.
[25]MOHAMMADI M,BEZAK E.Two-dimensional transmitted dose measurements using a scanning liquid ionization chamber EPID[J].Phys Med Biol,2006,51(11):2 971-2 986.
[2]陈娜,胡彩容,吴君心,等.腹盆部肿瘤在放疗分次内的摆位误差分析[J].中国肿瘤,2010,19(8):503-506.
[3]王京.电子射野影像系统(EPID)在头颈部肿瘤放射治疗中的摆位误差分析及质量控制[J].科技视界,2015(17):277.
[4]孟慧鹏,董化江,丁红军,等.基于EPID的容积旋转调强放疗绝对剂量验证探讨[J].医疗卫生装备,2016,37(8):98-100,108.
[5]张健,岳海阵,张艺宝,等.CT与CBCT图像配准范围选择的对比研究[J].中国医学物理学杂志,2015,32(1):21-24.
[6]高升.基于DICOM RT的医学图像信息显示及配准[D].南京:南京大学,2011.
[7]傅万凯,林友金,刘利彬,等.应用IGRT机载KV-CBCT校正胸腹部肿瘤调强适形放疗摆位误差的研究[J].实用癌症杂志,2010,25(5):511-513.
[8]孙丽,李建中.胸腹部肿瘤放疗体位固定和无固定的比较[J].实用肿瘤杂志,2003,18(2):145-146.
[9]徐寿平,王石,吴朝霞,等.基于非晶硅电子射野影像装置的剂量响应研究[J].中国医学物理学杂志,2012,29(3):3 380-3 385.
[10]黎桂华,覃文,张大伟,等.EPID在调强验证中的应用[J].广西医科大学学报,2014,31(4):611-612.
[11]黄妙云,陈明秋,陈远贵,等.基于EPID三维剂量验证系统的物理模型测试及临床应用的初步研究[J].中华放射肿瘤学杂志,2016,25(12):1 335-1 340.
[12]陈明伟,邓小武,黄劭敏,等.非晶硅平板电子射野影像用于放射治疗剂量学质量控制检验的应用[J].癌症,2007,26(11):1 272-1 275.
[13]FIDANZIO A,MAMELI A,PLACIDI E,et al.Epid cine acquisition mode for in vivo dosimetry in dynamic are radiation therapy[J].Nucl Instrum Meth B,2008,266(4):658-666.
[14]SABET M,ROWSHANFARZAD P,VIAL P,et al.Transit dosimetry in IMRT with an a-Si EPID in direct detection configuration[J].Phys Med Biol,2012,57(15):N295-N306.
[15]ALSHANQITY M,DUANE S,NISBET A.A simple approach for EPID dosimetric calibration to overcome the effect of image-lag and g hosting[J].Appl Radiat Isot,2012,70(7):1 154-1 157.
[16]HEIJMEN B J,PASMA K L,KROONWIJK M,et al.Portal dose measurement in radiotherapy using an electronic portal imaging device(EPID)[J].Phys Med Biol,1995,40(11):1 943-1 955.
[17]LIN M H,LI J,WANG L,et al.4D patient dose reconstruction usingonline measured EPID cine images for lung SBRT treatment validation[J].Med Phys,2012,39(10):5 949-5 958.
[18]MAJITHIA L,DICOSTANZO D,WELDON M,et al.SU-ET-564:validation of photon dose calculation using Mobius3D system compared to AAA and acuros XB systems[J].Med Phys,2013,40(6 part 19):335.
[19]LOO M V H,WELLEWEERD J.PO-0837:3D dose verification of VMAT lung SBRT using Mobius3D[J].Radiother Oncol,2015,115:S423-S424.
[20]花威,张西志,汪步海,等.用COMPASS验证鼻咽癌调强放射治疗计划[J].生物医学工程与临床,2015(2):4.
[21]褚薛刚,邢晓汾,崔桐,等.Compass R在宫颈癌调强放疗三维剂量验证中的应用研究[J].中华放射医学与防护杂志,2015,35(7):548-549.
[22]INFUSINO E,MAMELI A,CONTI R,et al.Initial experience of Arc CHECK and 3DVH software for Rapid Arc treatment plan verification[J].Med Dosim,2014,39(3):276-281.
[23]JARRY G,MARTIN D,LEMIRE M,et al.SU-E-T-405:evaluation of IMRT QA using 3DVH,a 3D patient dose and verification analysis software[J].Med Phys,2011,38(6 part 16):3 581.
[24]ELENA V.EPID-based dosimetry using a commercial software:gamma analysis and DVH metrics for VMAT pretreatment and in vivo QA[J].Phys Medica,2016,32:262.
[25]MOHAMMADI M,BEZAK E.Two-dimensional transmitted dose measurements using a scanning liquid ionization chamber EPID[J].Phys Med Biol,2006,51(11):2 971-2 986.