肝癌伽玛刀治疗定位呼吸时相确认及靶点Z坐标修正  

The confirmation of respiratory phase in localization and the correction of Z-axis coordinates under the therapy of gamma knife for hepatic cancer patients

作　　者：高立 周宣 周龙兴 李胜元 

机构地区：[1]解放军第515医院肿瘤科,江苏江阴214400

出　　处：《临床肿瘤学杂志》2015年第7期651-653,共3页Chinese Clinical Oncology

摘　　要：目的探讨肝癌伽玛刀治疗定位呼吸时相判断和靶点Z坐标修正的必要性。方法模拟机下观察平静呼吸状态下右膈顶的上下移动范围和中间点位置,CT定位时将后者用Φ2 mm钢珠在体表做出标记,扫描层厚5 mm,根据膈顶与标记点钢珠是否在同一层面显示对呼吸时相做出判断和Z坐标的向量修正。结果 122例中膈顶与标记点钢珠同层显示者38例(31%),非同层显示者84例(69%),其中膈顶与钢珠相差1层者48例(39%)、2层者18例(15%)、3层者12例(10%)及3层以上者6例(5%)。结论肝癌伽玛刀治疗在Z坐标上除参照呼吸运动幅度确定计划靶区体积(PTV)外,还需根据呼吸时相做相应修正。Objective To explore the necessity for the judgement of respiratory phase in localization and the correction of Z- axis coordinates under the therapy of gamma knife for hepatic cancer patients. Methods The motion range of right diaphramatic dome in eupnea and the position of middle point were observed. The position of middle point was marked in body surface using a steel ball with a diameter of 2 mm during CT scan of 5 mm slice thickness. Whether the position of diaphramatic dome and the middle point is in the same slice helped to ascertain the respiratory phase and correct the Z-axis coordinates. Results In the entire 122 patients, there were 38 （31%） cases with the position of diaphramatic dome and the middle point in the same slice, 84 cases （69%） not in the same shce,48 cases（39%） with difference of one slice, 18 cases（15%） with difference of two slices, 12 cases（10%） with difference of three slices and 6 cases （5%） with difference of more than three slices. Conclusion The correction of Z-axis and the determination of PTV coordinates should not only refer to the range of respiratory range, but also to the respiratory phase.

关 键 词：肝癌 伽玛刀 呼吸时相 

分 类 号：R735.7[医药卫生—肿瘤]