光学体表监测系统在乳腺癌改良根治术后放疗中的应用研究  

Application of optical surface monitoring system during postmastectomy radiotherapy for patients with breast cancer

作　　者：冯鑫 郇福奎 陈欢 芦凤玉 李朝辉 李伟 王淑莲 张彦新 Feng Xin;Huan Fukui;Chen Huan;Lu Fengyu;Li Zhaohui;Li Wei;Wang Shulian;Zhang Yanxin(Department of Radiation Oncology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《实用肿瘤杂志》2023年第1期59-65,共7页Journal of Practical Oncology

基　　金：中国癌症基金会北京希望马拉松课题基金(LC2019L02)。

摘　　要：目的利用光学体表监测系统(optical surface monitoring system,OSMS)对颈胸一体架固定下乳腺癌改良根治术后放疗患者进行辅助摆位,研究其对锁骨上下区摆位误差及肩锁关节摆位重复性的影响。方法选取2021年5月至8月于中国医学科学院北京协和医学院肿瘤医院接受乳腺癌改良根治术后放疗的患者32例,通过OSMS辅助摆位,应用“Treatment”功能校正患者手臂等部位位置和身体角度以提高摆位精准性。治疗过程中使用OSMS辅助摆位(OSMS辅助摆位组)和仅使用体表标记线常规摆位(常规摆位组)依次交替进行,将加速器机载锥形束CT(cone-beam CT,CBCT)扫描获取的图像与模拟定位CT图像进行配准,记录患者X(左右方向)、Y(头脚方向)和Z(腹背方向)轴以及3个绕轴旋转方向Rx、Ry和Rz的摆位误差,并分别测量肩锁关节的移动幅度和三维空间位移,对误差值进行分析计算。统计学分析采用配对样本t检验与秩和检验。结果入组32例病例,共行142次CBCT扫描和142次OSMS+CBCT扫描。OSMS辅助摆位组和常规摆位组在X、Y以及Z轴方向上的平移摆位误差分别为(0.17±0.12)cm和(0.21±0.15)cm(P=0.394)、(0.14±0.13)cm和(0.24±0.19)cm(P=0.026)以及(0.13±0.12)cm和(0.19±0.21)cm(P=0.591),在Rx、Ry和Rz方向上的旋转摆位误差分别为(0.60±0.52)°和(0.51±0.52)°(P=0.344),(0.61±0.60)°和(0.75±0.71)°(P=0.195),(0.65±0.62)°和(0.85±0.65)°(P=0.025)。两组肩锁关节的动度ΔX、ΔY以及ΔZ分别为(0.12±0.10)cm和(0.13±0.10)cm(P=0.546)、(0.10±0.13)cm和(0.10±0.12)cm(P=0.565)以及(0.11±0.12)cm和(0.12±0.13)cm(P=0.009);肩锁关节的空间位移分别为(0.16±0.14)cm和(0.17±0.13)cm(P=0.066)。结论应用OSMS光学体表摆位可以减小头脚方向的平移摆位误差,减小肩锁关节在腹背方向的动度和空间位移。Objective To analyze the setup error of postmastectomy radiotherapy(PMRT)by additional optical surface monitoring system(OSMS)to cone-beam computed tomograph(CBCT)for patients with breast cancer,immobilized with integral cervicothoracic fixation device after modified radical mastectomy,and to investigate its effect on the setup error of supra/infraclavicular nodal region and the repetition of acromioclavicular joint.Methods A total of 32 patients with breast cancer who received PMRT in Cancer Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,from May to August 2021 were included.With OSMS assisted positioning,the"Treatment"function was used to correct the position of the patient’s arm and other parts of the body and the body angle to improve positioning accuracy.During the treatment,the OSMS assisted positioning(the OSMS assisted group)and the conventional positioning using only the body surface marker line(the conventional group)were used alternately.The images acquired by the CBCT were compared with the simulated positioning CT images.The translational(X,Y and Z)and rotational(Rx,Ry and Rz)setup errors,and the movement amplitude and three-dimensional space displacement of the acromioclavicular joint,were compared between the conventional group and the OSMS assisted group.Paired sample t test and rank sum test were used for statistical analyses.Results Thirty-two patients were included.The CBCT only were performed in 142 fractions,and the OSMS plus CBCT were used in 142 fractions.The translational setup errors of the OSMS assisted group and the conventional group were(0.17±0.12)cm and(0.21±0.15)cm in X direction(P=0.394),(0.14±0.13)cm and(0.24±0.19)cm in Y direction(P=0.026),and(0.13±0.12)cm and(0.19±0.21)cm in Z direction(P=0.591),respectively.The corresponding rotational errors were(0.60±0.52)°and(0.51±0.52)°in Rx direction(P=0.344),(0.61±0.60)°and(0.75±0.71)°in Ry direction(P=0.195),and(0.65±0.62)°and(0.85±0.65)°in Rz direction(P=0.025),respectively.The movement amp

关 键 词：乳腺癌 改良根治术 放疗 摆位误差 光学体表监测系统 

分 类 号：R737.9[医药卫生—肿瘤]