多平面重组图像引导定位参考点标记法在宫颈癌放射治疗定位中的应用.pdf
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7、microcystic,elongated and fragmented(MELF)pattern invasion inendometrial carcinomas might be associated with poor survival inChinese women J.Gynecol Oncol,2020,159(1):36-42.(编校:巩森淼)放射治疗【RadiationTherapy】多平面重组图像引导定位参考点标记法在宫颈癌放射治疗定位中的应用成肇杰,刘光明,韦婷,梁卫学,苏婷,王占宇广西医科大学第四附属医院/柳州市工人医院肿瘤科,广西柳州5450 0 5【摘要】目的:探讨
8、多平面重组(multiplanarreformation,M PR)图像引导定位参考点标记法在宫颈癌放射治疗定位中的应用价值。方法:选取2 0 2 2 年0 5月至12 月在我院肿瘤放射治疗中心进行容积旋转调强放射治疗(volumetric-modulated arc therapy,VM A T)的40 例宫颈癌患者,采用随机数表法将其分为观察组和对照组,每组2 0 例。观察组使用MPR图像引导定位参考点标记法进行定位;对照组使用常规参考点标记法进行定位。物理师进行VMAT放疗计划设计时,根据国际辐射单位及测量委员会(international commis-sion onradiation
9、units andmeasurements,I C RU)参考点的选择原则,选出靶区剂量归一的规定点并作为治疗中心点,比较两组患者治疗中心点与定位参考点位移的例数,并用位移率(%)进行描述。所有患者首次治疗及以后每周均进行一次锥形束CT(CBCT)扫描位置验证(共5次),分别采集两组患者分次间的左右X、头脚Y、腹背Z方向上的摆位误差数据及复位完成的时间,采用独立样本t检验,P0.05为差异有统计学意义。计划靶区外放边界(Mprv)公式:Mprv=2.5Z+0.7计算不同定位方式下的靶区外扩边界。结果:观察组中定位参考点与治疗中心点在三维方向上产生位移例数均为0 例,而对照组在Y方向、Z方向产生
10、位移例数分别是11例和19 例,位移率分别55%和9 5%。观察组的平均摆位误差分别为X(-0.16 1.99)mm、Y(1.0 44.13)m m、Z(0.7 7 2.30)m m;对照组的平均摆位误差分别为X(0.18 2.59)m m、Y(-2.0 95.0 2)m m、Z(1.442.39)m m。两组Y、Z方向上的摆位误差有统计学意义(P0.05)。观察组复位平均时间(9.7 6 2.35)min,对照组复位平均时间(13.2 53.6 6)min,观察组较对照组复位效率更高。观察组靶区外扩边界(Mprv)分别为3.8 2 mm、7.2 8 m m、4.55m m,较对照组减少了18
11、.2 0%、2 2.0 6%、6.38%。结论:在宫颈癌放射治疗定位中使用多平面重组图像引导定位参考点标记法可实现定位参考点与治疗中心点同中心,同时提高摆位效率,减少摆位误差及缩小靶区外扩边界,值得推广。【收稿日期】2023 03-30【基金项目】)广西壮族自治区卫生健康委员会科研课题(编号:Z-B20221401,Z20200503);广西重点研发计划(编号:桂科AB22035026);广西柳州市科技重大专项(编号:2 0 19AF10601)【作者简介】成肇杰(1990),男,广西藤县人,主管技师,从事肿瘤放射治疗技术研究工作。Ema i l 30 6 9517 50 q q.c o m【
12、通信作者】王占宇(197 4一),男,湖南株洲人,高级工程师,主要从事肿瘤放射治疗物理方面的研究工作。E-mail:【修回日期】2 0 2 3-0 6-0 1现代肿瘤医学2 0 2 3年10 月第31卷第19期【关键词】宫颈癌;摆位误差;放疗定位;参考点标记法【中图分类号】R737.33【文章编号】16 7 2-4992(2 0 2 3)19-36 34-0 6Application of reference point labeling guided and localized by multiplanar reformationimage in the localization of ce
13、rvical cancer radiotherapyCHENG Zhaojie,LIU Guangming,WEI Ting,LIANG Weixue,SU Ting,WANG ZhanyuDepartment of Oncology,the Fourth Affliated Hospital of Guangxi Medical University/Liuzhou Workers Hospital,Guangxi Liuzhou545005,China.AbstractObjective:To investigate the application value of reference p
14、oint labeling guided and localized by mul-tiplanar reformation(MPR)image in the localization of cervical cancer radiotherapy.Methods:A total of 40 patientswith cervical cancer who underwent volumetric modulated arc therapy(VMAT)in the tumor radiotherapy center of ourhospital from May to December 202
15、2 were selected and divided into observation group and control group by randomnumber table method,with 20 cases in each group.The patients in the observation group used the reference point labe-ling guided and localized by MPR image to locate,and those in the control group used conventional referenc
16、e point la-beling to locate.In the design of VMAT radiotherapy plan,according to the selection principle of ICRU referencepoint,the prescribed point of dose normalization in the target area was selected as the central point of treatment.Thenumber of patients in which the displacement between the tre
17、atment center point and the positioning reference pointwas compared between the two groups,and the displacement rate(%)was described.Conical beam CT(CBCT)scan-ning position verification was performed at the first treatment and once a week after the first treatment for all patients(a total of 5 times
18、).The positioning error data of left and right X,head and foot Y,abdominal and dorsal Z directionsbetween the two groups and the time to complete reset were collected respectively,and independent sample t testwas used.P0.05 was considered statistically significant.The formula to calculate margin pla
19、nning target volume(Mprv),Mprv=2.52+0.7o,was used to calculate the extermal boundary of the target under different positioningmethods.Results:In the observation group,O case of positioning reference point and treatment center point had dis-placement in the three-dimensional direction,while in the co
20、ntrol group,11 cases and 19 cases had displacement inthe Y direction and Z direction,with displacement rates of 55%and 95%,respectively.The average positioning errorsof the observation group were X(-0.16 1.99)mm,Y(1.04 4.13)mm and Z(0.77 2.30)mm,respectively.The average errors of the control group w
21、ere X(0.18 2.59)mm,Y(-2.09 5.02)mm and Z(1.44 2.39)mm,respectively.The positioning errors in Y and Z directions were statistically significant between the two groups(P0.05).The average reset time of the observation group was(9.76 2.35)min and that of the control group was(13.25 3.66)min.The reset ef
22、ficiency of the observation group was higher than that of the control group.The Mprvvalues of the observation group were 3.82 mm,7.28 mm and 4.55 mm,respectively,which were reduced by 18.20%,22.06%and 6.38%compared with the control group.Conclusion:The use of reference point labeling guided and lo-c
23、alized by MPR image in the localization of cervical cancer radiotherapy can realize the same center of the located ref-erence point and treatment center point,improve the efficiency of positioning,reduce positioning errors and narrow theMprv,and thus is worth popularizing.Key words cervical cancer,p
24、ositioning error,radiotherapy localization,reference point marking method宫颈癌是全球常见的女性生殖系统肿瘤之一,也是女性面临的主要健康问题1-2 1。手术和放射治疗是宫颈瘤治疗的两大主要手段,而容积旋转调强放射治疗(volumetricmodulated arctherapy,VM A T)具有照射野形状与靶区高度适形的优点,能更好的保护正常器官和组织,已经成为宫颈癌常用的放射治疗方法3-4。VMAT的治疗中心点通常为VMAT计划设计时选定的国际辐射单位及测量委员会(inter-national commission o
25、n radiation units and measurements,ICRU)参考点,而长期以来ICRU都建议将某个明确点的吸收剂量Drer作为ICRU参考点,该点位置应位于肿瘤区域中心或位于临床靶区(CTV)范围内5。但在放射治疗定位中,根据常规MODERN ONCOLOGY,Oct.2023,VOL.31,No.19【文献标识码】AD0I:10.3969/j.issn.1672-4992.2023.19.019经验设置体表标记点时,并不能精确的使定位参考点位于上述位置,通常在VMAT计划设计时需要重新选择ICRU参考点以精确确定吸收剂量Dref。并且在复位时,需要进行定位参考点与治疗中心
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