国产和进口鼻咽癌精确放疗设备的临床剂量学比较研究  

Comparison of clinical dosimetry between domestic and imported equipment for accurate radiotherapy of nasopharyngeal carcinoma

作　　者：冀天楠 赵志飞[1] 丛小虎[1] 葛瑞刚[1] 李建雄[1] JI Tian-nan;ZHAO Zhi-fei;CONG Xiao-hu;GE Rui-gang;LI Jian-xiong(Department of Radiotherapy,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院放疗科,北京100853

出　　处：《医疗卫生装备》2018年第12期41-45,共5页Chinese Medical Equipment Journal

基　　金：国家重点研发计划(2016YFC0105700)

摘　　要：目的:比较国产和进口鼻咽癌精确放疗设备的临床剂量学差异。方法:从解放军总医院(A组,进口加速器及计划系统)既往治疗患者中随机选取鼻咽癌患者20例。将病例传给原解放军404医院(B组,国产加速器及计划系统)、原解放军148医院(C组,国产加速器及进口计划系统)分别进行计划设计,然后用OCTAVIUS Detector 729二维矩阵进行相对剂量验证,测出验证计划的剂量分布,并通过验证软件与计划设计时计算的剂量分布作比较,得出剂量分布误差。平面相对剂量验证误差分析采用Gamma分析方法,设置距离误差标准和剂量误差标准为2 mm/2%、3 mm/3%、4 mm/4%来比较平面相对剂量验证通过率,通过平均值来比较3组危及器官的受量异同及计划大体肿瘤靶区(PGTVnx)、计划靶区(高危淋巴引流区PTV1、低危淋巴引流区PTV2)的均匀性指数(homogeneity index,HI)及适形性指数(conformity index,CI)。采用SPSS 17.0软件进行统计学分析。结果:平面剂量分布的计算值和测量值之间总体具有良好的一致性,Gamma分析的3 mm/3%通过率均值均在90%以上;B组Gamma通过率低,与A、C 2组比较具有统计学差异(P<0.05)。几乎所有的危及器官剂量A组表现最好,但B组视神经和晶体的平均受量比较小。A组的D5(5%体积接受的剂量)、D95(95%体积接受的剂量)、D98(98%体积接受的剂量,可近似为最小剂量)、Dmean(剂量均值)比较小。每2组HI之间差异不明显,各组CI差异明显,但均在临床可接受范围内。结论:国产与进口精确放疗设备在鼻咽癌根治性放疗方面其通过率及剂量学、均匀性、适形性均能达到临床要求,基本可以满足鼻咽癌根治性放疗的需要,结合国产设备的价格优势,推荐用于市县级医院。Objective To compare the China-made and imported radiotherapy equipment on clinical dosimetry when used for treating nasopharyngeal carcinoma(NPC).Methods A total of 20 cases of nasopharyngeal carcinoma were randomly selected from the previous patients treated by Chinese PLA General Hospital(group A=imported accelerator and planning system).The cases were sent to the former 404th Hospital(group B=domestic accelerator and planning system)and the former 148th Hospital of the PLA(group C=imported accelerator and planning system)for planning design,and the dose distribution of verification plan was measured by relative dose verification with OCTAVIUS Detector 729 2D matrix.The dose distribution error was obtained through comparison between the verification software and the calculated dose distribution.Plane relative dose verification error analysis was executed by using Gamma analysis method,and distance and dose error criteria were set as 2 mm/2%,3 mm/3%and 4 mm/4%to compare the passing rates of the plane relative dose verification.Mean value method was used to contrast the received doses of the organs at risk(OAR)as well as the homogeneity index(HI)and conformity index(CI)of the planning gross tumor volume(PGTVnx)and planning target volumes including high-risk(PTV1)and low-risk(PTV2)lymphatic drainage areas.SPSS 17.0 software was applied to statistical analysis.Results There was a high consistency between the calculated value and measured value of the plane dose distribution,and the mean passing rate of 3 mm/3%in Gamma analysis was above 90%;group B had a low passing rate of individual nasopharyngeal carcinoma,and had statistically significant differences from group A and C(P<0.05);group A behaved the best in the dose of OAR,while group B had a low dose to the optic nerve and crystal;the values of D5(doses accepted by 5%volume),D95(doses accepted by 95%volume),D98(doses accepted by 98%volume,which can be approximately considered as the minimum dose)and Dmean(dose mean value)proved low in group A;there were no signi

关 键 词：鼻咽癌 精确放疗 国产设备 进口设备 剂量验证 

分 类 号：R318.6[医药卫生—生物医学工程] TH774[医药卫生—基础医学]