乳腺癌术后放疗正交图像引导频率对摆位误差校正及外放边界的影响  

Impacts of the frequency of orthogonal image guided⁃verification on set⁃up error correction and PTV margins in postoperative radiotherapy for breast cancer

作　　者：董芳芬 吴冰[2] 王志新 黎嘉明 黄妙云[1,2] 杨勇 徐本华 李小波[1,2,3,4] Dong Fangfen;Wu Bing;Wang Zhixin;Li Jiaming;Huang Miaoyun;Yang Yong;Xu Benhua;Li Xiaobo(Department of Radiation Oncology,Fujian Medical University Union Hospital,Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors,Clinical Research Center for Radiology and Radiotherapy of Fujian Province(Digestive,Hematological and Breast Malignancies),Fuzhou 350001,China;School of Medical Imaging,Fujian Medical University,Fuzhou 350122,China;Department of Engineering Physics,Tsinghua University,Beijing 100084,China;Department of Radiation Oncology,Zhangpu County Hospital,Zhangpu 363299,China)

机构地区：[1]福建医科大学附属协和医院放疗科,福建省肿瘤智能影像与精准放疗重点实验室福建省消化、血液系统与乳腺恶性肿瘤放射与治疗临床医学研究中心,福州350001 [2]福建医科大学医学影像学院,福州350122 [3]清华大学工程物理系,北京100084 [4]福建省漳浦县医院放疗科,漳浦363299

出　　处：《中华放射医学与防护杂志》2025年第1期37-42,共6页Chinese Journal of Radiological Medicine and Protection

基　　金：福建省卫生健康青年科研课题(2022QNA018);福建医科大学启航基金项目资助(2022QH1029)。

摘　　要：目的探讨乳腺癌术后放疗不同正交图像引导频率对摆位误差校正及计划靶体积(PTV)外放边界计算参考的影响,为实际临床工作中乳腺癌术后放疗患者提供正交图像引导频率建议参考。方法选取2021年1月至2022年1月福建医科大学附属协和医院收治的乳腺癌术后调强放疗患者80例,每次放疗前进行正交图像引导验证,获取初始及残余摆位误差,对误差数据按假设不同图像引导验证频率(每1、2、3、4、5 d、不校正)分A、B、C、D、E、F组进行统计学分析,计算不同图像引导验证频率分组下获取的摆位误差大小、分布及差异情况,并根据参考公式计算PTV外放边界。结果收集的80例患者的初始摆位误差在x、y、z方向上分别为(3.49±3.43)、(2.87±2.88)、(2.75±2.35)mm,随着验证频率的增加,残余摆位误差逐渐减小,若每日进行图像引导验证,则残余摆位误差在x、y、z方向分别为(1.63±0.90)、(1.63±0.93)、(1.55±0.90)mm。进一步根据不同验证频率下摆位误差计算参考PTV外放大小,同样随着验证频率的增加而减小,其中每日验证下摆位误差计算PTV外放参考值由初始摆位误差(不校正)的6.60、6.29、4.22 mm降低到1.27、1.37、1.28 mm。其余每3、4、5 d验证之间相差在0.81 mm以内。结论每天进行图像引导体位验证(包括校正)能有效减少乳腺癌术后图像引导放疗摆位误差,不同验证频率之间各有差异,频率越高对误差的修正效果越好,PTV外放需求越小。Objective To explore the impacts of different frequencies of orthogonal image⁃guided verification on set⁃up error correction and the reference values of planning target volume(PTV)margins in postoperative radiotherapy for breast cancer,in order to provide recommendations of the verification frequency in clinical practice.Methods A total of 80 breast cancer patients who received postoperative intensity⁃modulated radiotherapy for breast cancer at the Affiliated Union Hospital of Fujian Medical University from January 2021 to January 2022 were enrolled.Orthogonal image⁃guided verification was conducted before each radiation treatment to determine initial and residual set⁃up errors.The error data were statistically analyzed by categorizing patients into groups A,B,C,D,E,and F,based on assumed verification frequencies(daily,every 2,3,4,and 5 d,and no correction).The magnitude,distribution,and differences of set⁃up errors of various groups were analyzed,and the PTV margins were calculated using a reference formula.Results The collected initial set⁃up errors of the 80 patients were(3.49±3.43),(2.87±2.88),and(2.75±2.35)mm,in x,y,and z directions,respectively.The residual set⁃up errors decreased gradually with increasing verification frequency.In the case of daily image⁃guided verification,the residual set⁃up errors in x,y,and z directions decreased to(1.63±0.90),(1.63±0.93),and(1.55±0.90)mm,respectively.The reference values of PTV margins calculated under different verification frequencies decreased with an increase in the verification frequency.Under daily verification,the reference values of PTV margins calculated based on set-up errors decreased from initial 6.60,6.29,and 4.22 mm(without correction)to 1.27,1.37,and 1.28 mm,respectively.Differences in the reference values under verification frequencies every 3,4,and 5 d were less than 0.81 mm.Conclusions Daily image-guided verification(including correction)can effectively reduce set-up errors in imageguided radiotherapy for breast cancer.The s

关 键 词：乳腺癌 图像引导频率 摆位误差 计划靶体积外放边界 

分 类 号：R737.9[医药卫生—肿瘤]