调强放射治疗电子射野成像设备和锥形束CT模式下不同部位肿瘤位置验证方案的研究  

Verification plan of tumor position of different parts under EPID and CBCT modes of IMRT

作　　者：苏王辉 何普 李毅[1] 何赟[1] 李芳[1] 李宇星 许琨[1] Su Wanghui;He Pu;Li Yi;He Yun;Li Fang;Li Yuxing;Xu Kun(Department of Radiotherapy,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院放疗科,西安710004

出　　处：《中国医学装备》2024年第12期39-43,共5页China Medical Equipment

基　　金：陕西省重点研发计划(2024SF-YBXM-123)。

摘　　要：目的:分析Trilogy瓦里安直线加速器系统对肿瘤调强放射治疗(IMRT)电子射野成影像设备(EPID)及锥形束CT(CBCT)两种模式下的头颈、胸部及腹部的肿瘤位置验证,以确定肿瘤位置验证方案最适宜的肿瘤部位。方法:择取2022年10月至2023年10月在西安交通大学第二附属医院行肿瘤IMRT的48例肿瘤患者的病例资料,患者中头颈肿瘤、胸部肿瘤及腹部肿瘤各16例,每周IMRT干预5次,每周接受3次EPID和CBCT模式验证。评定病例摆位在x(左右)、y(上下)、z(头脚)三维轴位的偏差情况。CBCT模式验证借助机载成像仪(OBI)影像系统对应的配准分析软件对于接受剂量照射区域(靶区)予以灰度配准法自动配准,靶区以及邻近区域为配准区,以放疗计划设计中获取的诊断CT图像为参考图像,统计计算参考图像与采集图像的x、y、z三维轴位的摆位偏差。对比EPID和CBCT两种模式肿瘤位置验证方案的应用价值。结果:IMRT中CBCT模式与EPID模式在头颈肿瘤患者的位置验证效果差异无统计学意义(P>0.05);CBCT模式x轴的摆位误差小于EPID模式,但差异无统计学意义(P>0.05)。IMRT中CBCT模式在胸部肿瘤患者的位置验证中x、y和z轴的摆位误差小于EPID模式,差异有统计学意义(t=4.546、15.445、15.961,P<0.05);IMRT中CBCT模式在腹部肿瘤x、y和z轴的摆位误差小于EPID模式,差异有统计学意义(t=30.402、11.766、12.047,P<0.05)。结论:EPID和CBCT模式在头颈肿瘤IMRT中位置验证的摆位误差相差无几,胸部肿瘤和腹部肿瘤时应优先选择CBCT验证。Objective:To analyze the verification of Trilogy Varian linear accelerator system on tumor position of head and neck,chest and abdomen under electronic portal imaging device(EPID)mode and cone beam computed tomography(CBCT)mode of intensity modulated radiotherapy(IMRT),so as to confirm the most suitable body parts of verification plan of tumor position.Methods:The case data of 48 patients with tumor who underwent IMRT treatment on tumor at the Second Affiliated Hospital of Xi'an Jiaotong University from October 2022 to October 2023 were selected,which could be divided into tumor at head and neck(16 cases),tumor at chest(16 cases)and tumor at abdomen(16 cases),and all of them were intervened 5 times per week by IMRT.They received 3 times of verification of EPID and CBCT modes per week.The positioning deviation on three dimensional(3D)axis position included x(left and right),y(up and down)and z(head and foot)was evaluated.The verification of CBCT mode conducted automatic registration of grayscale registration method for receiving irradiation area(target area)with dose through the corresponding registration software of OBI system,and the target area and the adjacent area were registration area,and the diagnostic CT image obtained from the design of radiotherapy plan was used as reference image.The positioning deviations on 3D axis positions(x direction,y direction and z direction)of referred image and collected image were calculated by using statistic method.The application values of two verification plans of EPID and CBCT modes on tumor positions were compared.Results:There was no statistically significant in the verification effect of the position of patients with tumor on head and neck between CBCT and EPID of IMRT(P>0.05).Compared with positioning error of EPID mode,that of CBCT mode on x axis was smaller,but the difference was not statistically significant(P>0.05).In the position verification of patients with tumor on chest,the positioning errors of x,y and z axis of CBCT mode of IMRT were respectively less tha

关 键 词：调强放射治疗(IMRT) 电子射野成影像设备(EPID) 锥形束CT(CBCT) 肿瘤位置验证 

分 类 号：R816[医药卫生—放射医学]