应用CBCT、EPID研究鼻咽癌2种体位固定方式摆位误差的比较分析  

Comparison of set-up errors detected by EPID and CBCT using two different immobilization techniques for patients with nasopharygeal carcinoma

作　　者：陆维[1] 许婷婷[1] 许青[1] 应红梅[1] 胡超苏[1] 

机构地区：[1]复旦大学附属肿瘤医院放射治疗科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2014年第7期535-539,共5页China Oncology

摘　　要：背景与目的:随着放疗技术和设备的不断发展,鼻咽癌放射治疗已经进入了精确放疗时代,摆位误差成为影响放疗效果的非常重要的因素。本研究在千伏级锥形束CT(cone beam computed tomography,CBCT)与兆伏级电子射野影像系统(electronic portal imaging device,EPID)2种影像模式引导下治疗鼻咽癌,在头枕+头颈肩面膜、真空气垫+头颈肩面膜固定2种方式下的摆位误差分析比较。方法:随机选取40例鼻咽癌患者分成2组(头枕+头颈肩面膜组,真空气垫+头颈肩面膜固定组),每组组内再分成CBCT扫描组和EPID验证组。将CBCT扫描图像与计划CT图像进行自动骨性配准、将EPID拍摄的正侧位片采用突出性骨性标志进行手动配准,分别得出x、y、z共3个线性方向上的摆位误差值,对获得的2组数据进行组内组间两两比较,采用t检验比较数据差异有无统计学意义。结果:头枕+头颈肩面膜组摆位后行CBCT扫描,在x、y、z方向上进行配准所得的平均误差分别为:x方向(0.67±2.01)mm、y方向(0.51±1.71)mm、z方向(0.57±2.04)mm;拍摄EPID验证片配准所得误差均值:x方向(0.69±2.19)mm、y方向(0.54±2.03)mm、z方向(0.61±2.11)mm。真空气垫+头颈肩面膜固定组摆位后行CBCT扫描,在x、y、z方向上进行配准所得的平均误差分别为:x方向(0.42±1.81)mm、y方向(0.33±1.55)mm、z方向(0.50±1.75)mm;拍摄EPID验证片配准误差均值:x方向(0.44±1.87)mm、y方向(0.43±1.70)mm、z方向(0.54±1.77)mm。采用头枕+头颈肩面膜组、真空气垫+头颈肩面膜固定组的误差数据差异均有统计学意义(P<0.05)。结论:2种不同的影像模式(CBCT与EPID)进行摆位误差的比对未见明显统计学差异,2种固定方式下头颈部真空气垫+头颈肩面膜固定的患者体位重复性更好。Background and purpose： With the development of therapy equipments and technology, the treatment for nasopharyngeal carcinoma（NPC） has entered into the era of precision radiotherapy, and setup errors have become a very important factor affecting treatment effects. The purpose of this study was to analyze the set-up errors detected by the kilovoltage cone beam CT（EPID） and the megavoltage electronic portal imaging device（CBCT） using 2 kinds of different immobilization techniques （pillow＋head neck shoulder mask and vacuum bag＋head neck shoulder mask） for NPC patients. Methods：A total number of 40 NPC patients were randomly assigned into 2 groups （pillow＋head neck shoulder mask group and vacuum bag＋neck shoulder mask group）. Then each group was further divided into CBCT scan group and EPID group for veriifcation before treatment delivery. We matched the EPID images with the DRRs and acquired the set-up errors in x, y, z axis. Setup errors of CBCT were calculated according to its matched and planned CT images in left-right （x）, superior-inferior （y） and anterior-posterior （z） directions. Paired t-test was used to evaluate the differences. Results：In the pillow＋head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x （0.67±2.01）mm, y （0.51±1.71）mm and z （0.57±2.04）mm, respectively. The errors of EPID were x （0.69±2.19）mm, y （0.54±2.03）mm and z （0.61±2.11）mm. In the vacuum bag＋head neck shoulder mask group, the set-up errors of CBCT in the x, y, z axis were x （0.42±1.81）mm, y （0.33±1.55）mm and z （0.50±1.75）mm, respectively. The errors of EPID were x （0.44±1.87）mm, y （0.43±1.70）mm and z （0.54±1.77）mm. The vacuum bag＋head neck shoulder mask ifxed technique was more accurate when compared to the pillow ＋ head neck shoulder mask ifxation method （P〈0.05）. Conclusion：CBCT and EPID were similar in detecting set-up errors for the NPC patients. However, the vacuum bag＋neck should

关 键 词：千伏级锥形束CT 兆伏级电子射野影像系统 头颈部肿瘤 摆位误差 

分 类 号：R739.62[医药卫生—肿瘤]