X射线容积成像引导不同配准方式下胸部肿瘤放疗摆位误差分析  

Analysis of Setup Errors in Thoracic Tumors Radiotherapy under Different Registration Methods Guided by X-ray Volume Imaging

作　　者：赵文龙[1] 刘攀 朱彤[1] 刘景杰[1] ZHAO Wenlong;LIU Pan;ZHU Tong;LIU Jingjie(Department of Radiation Oncology,Ji’an Central People's Hospital,Ji’an 343000,China)

机构地区：[1]吉安市中心人民医院肿瘤科,江西吉安343000

出　　处：《中国医学创新》2024年第4期146-151,共6页Medical Innovation of China

基　　金：吉安市指导性科技计划项目(20222-026732)。

摘　　要：目的:探讨X射线容积成像(XVI)系统不同配准方式对胸部肿瘤摆位误差的影响。方法:随机选取2022年2月—2023年5月吉安市中心人民医院接受放疗的肺癌、食管癌和乳腺癌患者各15例,基于前三次患者治疗前锥形束CT(CBCT)扫描图像共135次,与计划CT图像比较,分别使用灰度值自动配准(GAR)、灰度值自动配准加手动微调(GA&MR)、骨性自动配准(BAR)和骨性自动配准加手动微调(BA&MR)四种方式进行图像配准,得到左右(X)、头脚(Y)和胸背(Z)方向摆位误差并进行统计分析。结果:肺癌患者BAR和BA&MR两种配准方式Y方向的差异有统计学意义(P=0.019),乳腺癌患者Y方向GAR和GA&MR、BAR和GA&MR间的差异均有统计学意义(P=0.022、0.015),Z方向GAR和GA&MR、GAR和BAR、GAR和BA&MR间的差异均有统计学意义(P=0.023、0.027、0.017),肺癌和乳腺癌患者GA&MR方式较其他配准方式在X、Y、Z方向上,配准误差数值落在≤2 mm误差范围区间频数数据较优,可以更大程度提高放疗精度肺癌CTV外扩PTV误差范围参考:X方向2.0 mm、Y方向4.4 mm、Z方向3.3 mm,乳腺癌CTV外扩PTV误差范围参考:X方向4.1 mm、Y方向4.7 mm、Z方向5.4 mm;食管癌患者四种配准方式计算得到的摆位误差结果在X、Y和Z方向差异均无统计学意义(P>0.05),GA&MR与BA&MR在X、Y、Z方向上,配准误差数值落在≤2 mm、>2 mm且≤4 mm误差范围区间频数数据更优,食管癌CTV外扩PTV误差范围参考:X方向2.4 mm、Y方向5.6 mm、Z方向3.0 mm。结论:肺癌和乳腺癌患者灰度值自动配准加手动微调(GA&MR),食管癌灰度值自动配准加手动微调(GA&MR)或骨性自动配准加手动微调(BA&MR),更能高效配准,提高治疗精度。Objective:To investigate the impact of different registration methods of the X-ray volume imaging(XVI)system on setup errors of thoracic tumors.Method:Fifteen patients with lung cancer,15 patients with esophageal cancer and 15 patients with breast cancer who received radiotherapy in Ji’an Central People's Hospital from February 2022 to May 2023 were randomly selected.A total of 135 pre-treatment cone beam CT(CBCT)scan images were obtained and compared with the planning CT image.Four types of image registration were performed,gray value automatic registration(GAR),gray value automatic&manual registration(GA&MR),bone automatic registration(BAR)and bone automatic&manual registration(BA&MR).The left-right(X),superior-inferior(Y),and anterior-posterior(Z)setup errors were obtained and statistically analyzed.Result:There was a statistically significant difference in the Y direction between the BAR and BA&MR methods for lung cancer patients(P=0.019).The differences between GAR and GA&MR,BAR and GA&MR in the Y direction of breast cancer patients were statistically significant(P=0.022,0.015);the differences in the Z direction between the GAR and GA&MR,GAR and BAR,GAR and BA&MR methods for breast cancer patients were statistically significant(P=0.023,0.027,0.017).The GA&MR method for lung cancer and breast cancer patients had better error values in the X,Y,and Z directions compared to other registration methods,with an absolute value of≤2 mm.The frequency data in the error interval were better,which can greatly improve the accuracy of radiotherapy.The error range of lung cancer CTV external expansion PTV were referenced as X directions 2.0 mm,Y directions 4.4 mm,Z directions 3.3 mm,and breast cancer CTV external expansion PTV were referenced as X directions 4.1 mm,Y directions 4.7 mm,Z directions 5.4 mm.The positioning error results calculated by the four registration methods for esophageal cancer patients showed no statistically significant difference in the X,Y,and Z directions(P>0.05).GA&MR and BA&MR had better erro

关 键 词：胸部肿瘤 放射治疗 图像配准 摆位误差 

分 类 号：R730.55[医药卫生—肿瘤]