新型3D打印组织补偿物的放疗应用研究  

Application of new three-dimensional printed tissue compensators in radiotherapy

作　　者：张敏[1] 赵波[1] 尹金鹏[1] 刘思伟[1] 高献书[1] 秦尚彬[1] 王庆国[1] 赵勍[1] 刘凌[1] 李晓梅[1] 李洪振[1] 李晓颖[1] 马茗微 

机构地区：[1]北京大学第一医院放疗科,北京100034

出　　处：《中华放射肿瘤学杂志》2017年第2期210-214,共5页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金青年科学基金（81502651）;北京市科技计划课题“首都特色”专项（Z14110700251160、Z161100000516041）

摘　　要：目的研制一种能适用于不规则体表的3D打印组织补偿物。方法对无组织补偿物、市售等效组织补偿膜及3D打印组织补偿物通过假人模体进行临床前评估。采集上述3套假人模体会阴部的CT图像，相同靶区给予同样处方剂量（D95%=100cGy）。采用同一TPS设计IMRT计划,比较三者PTV剂量学参数。评估该3D打印组织补偿物应用于10例患者后的剂量学参数指标。结果选定材料的电子密度为1．00～1．01。无组织补偿物、市售等效组织补偿膜、3D打印组织补偿物的靶区Dmax分别为182．9、118．9、114．8cGy，Dmean分别为146．2、107．7、104．1cGy，H1分别为0．565、0．15、0．11。10例患者的3D打印组织补偿物个体化程度高、剂量均匀性好（HI为0．03～0．15，中位数0．06）。共5例阴茎阴囊佩吉特氏病患者受益于3D打印组织补偿物的支撑固定作用。结论该3D打印组织补偿物个体化程度高，可起到摆位支撑作用，能有效提高皮肤剂量。Objective To develop three-dimensional （3D） printed tissue compensators for irregular body surface in radiotherapy. Methods Pre-clinical evaluation was made among human phantoms with no tissue compensators, commercially available tissue equivalent bolus, and 3D printed tissue compensators. Perineal computed tomography （CT） images were acquired from the above three human phantoms with the same prescription close to the same target volume （ D95% = 100 cGy）. Intensity-modulated radiotherapy plans for the three human phantoms were designed using the same treatment planning system. The dosimetric parameters of planning target volume （PTV） were compared between the three plans. The dosimetrie parameters were evaluated among 10 patients who were treated with 3D printed tissue compensators. Results The electron density of the selected material was 1.00-1.01. The phantoms with no tissue compensators, commercially available tissue equivalent bolus, and 3D printed tissue compensators had Dmax of 182.9, 118.9, and 114. 8 cGy, Dmean of 146. 2, 107.7, and 104. 1 cGy, and homogeneity index （HI） of 0.565, 0. 15, and 0. 11 for PTV, respectively. All the 10 patients had highly personalized 3D printed tissue compensators with satisfactory dose homogeneity （HI = 0. 03-0. 15 with a median of 0. 06）. Five patients with Paget＇s disease of penis and scrotum benefited from the support and fixation by 3D printed tissue compensators. Conclusions The highly personalized 3D printed tissue compensators can provide a positioning support for patients and effectively increase the dose to the skin.

关 键 词：浅表性病变/放射疗法 三维打印组织补偿物 均匀性指数 

分 类 号：R730.55[医药卫生—肿瘤] TP391.73[医药卫生—临床医学]