發(fā)布時間：2018-03-04 15:13

  本文選題：機載影像系統(tǒng)OBI　切入點：錐形束CT　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用瓦里安直線加速器的機載影像系統(tǒng)(on board imager,OBI)的二維正側(cè)位拍片模式和三維錐形束CT(cone beam computed tomography,CBCT)模式分別分析頭頸部、體部及盆腔腫瘤在精確放射治療中的擺位誤差,對比這兩種模式驗證在首次驗證時人體各部位的定位精度,探討人體不同部位腫瘤擺位驗證工作中,兩者的優(yōu)缺點,為指導(dǎo)臨床工作中不同部位選取哪種模式獲益最大提供可靠依據(jù)。方法:應(yīng)用VarianClinaciX醫(yī)用直線加速器的機載影像驗證系統(tǒng),對我科精確放射治療的60例病人做對比研究,頭頸部、體部、盆腔部各20例。全部病人均采用熱塑料體(面、頭頸肩)模固定,行CT模擬定位,貼金屬標(biāo)記點、掃描CT圖像傳至計劃系統(tǒng),經(jīng)醫(yī)生勾畫腫瘤靶區(qū),物理師進(jìn)行個體化計劃設(shè)計,每個計劃包含OBI正側(cè)位平片擺位野和CBCT擺位野,首次治療前復(fù)位移至等中心點,分別采集DR正側(cè)位片和CBCT圖像,分別與計劃系統(tǒng)所生成的DRR圖像和定位時CT圖像進(jìn)行2D/2D match和3Dmatch,采用自動匹配分析對比兩組擺位誤差,病人左右方向位移記為X,頭腳方向記為Y,前后方向記為Z,分別記錄三維方向線性位移大小。結(jié)果:用誤差總體的均數(shù)描述擺位誤差的平均值,記為系統(tǒng)誤差,用誤差總體的標(biāo)準(zhǔn)差描述所有分次的擺位誤差的標(biāo)準(zhǔn)差,記為隨機誤差,X軸(左右)、Y軸(頭腳)、Z軸(前后)的誤差最終用系統(tǒng)誤差±隨機誤差表示,即用x±s表示。首次治療前二維OBI模式拍片驗證所得頭頸部腫瘤擺位誤差為X:0.14±0.06cm、Y:0.27±0.09cm、Z:0.16±0.05cm,體部擺位誤差為 X:0.31±0.09cm、Y:0.59±0.19cm、Z:0.27±0.08cm;盆腔擺位誤差X:0.31±0.09cm、Y:0.53±0.15cm、Z:0.26±0.09cm;三維CBCT模式驗證所得頭頸部擺位誤差X:0.13±0.05cm、Y:0.25±0.09cm、Z:0.15±0.06cm,體部擺位誤差為 X:0.240±0.05cm、Y:0.44±0.16cm、Z:0.21±0.06cm,盆腔病人擺位誤差 X:0.20±0.07cm、Y:0.38±0.12cm、Z:0.18±0.08cm;所有數(shù)據(jù)均采用Microsoft Excel進(jìn)行錄入并做簡單作圖分析,用SPSS21.0統(tǒng)計軟件進(jìn)行統(tǒng)計分析,對兩種模式分別在X、Y、Z軸上進(jìn)行定量資料獨立t檢驗,頭頸部在三個方向的差異無統(tǒng)計學(xué)意義(p0.05),體部和盆腔病人在三個方向的差異均有統(tǒng)計學(xué)意義(p0.05)。結(jié)論:可以看出兩種模式驗證在頭頸部擺位驗證時差異沒有統(tǒng)計學(xué)意義,均能滿足精確放射治療對擺位驗證的要求,具有相同的趨勢,最大誤差均出現(xiàn)在頭腳方向Y軸,這可能與CT掃描造成的系統(tǒng)誤差有關(guān);而在體部盆腔患者,兩種模式驗證差異有統(tǒng)計學(xué)意義,表明在人體受呼吸運動、腸蠕動及膀胱充盈大小等影響較大的部位CBCT驗證優(yōu)勢明顯,更能實時驗證腫瘤靶區(qū)大小及形狀的變化以及周圍危及器官的位移大小,防止靶區(qū)漏照或者正常組織接受高劑量照射,在臨床上更具指導(dǎo)意義。
[Abstract]:Objective: to analyze the positioning errors of head and neck, body and pelvic tumors in accurate radiotherapy by using the two dimensional positive and lateral mode and the three dimensional conical beam CT(cone beam computed tomographyCBCT mode of Varian linear accelerator's airborne imaging system (OBI). Comparing the positioning accuracy of each part of human body during the first verification, and discussing the advantages and disadvantages of the two modes in the verification of tumor pendulum in different parts of human body. In order to guide the clinical work to choose which mode to benefit the most in clinical work. Methods: using the airborne image verification system of VarianClinaciX medical linear accelerator, 60 patients who received accurate radiotherapy in our department were studied, head and neck, head, neck, head, neck, head, neck, head, neck, head, neck, head, neck, head and neck, All the patients were fixed with thermoplastic body (face, head, neck and shoulder), were imitated by CT, attached metal marks, scanned CT images were transmitted to the planning system, and the tumor target area was drawn by doctors. The physicist designed the individual plan. Each plan consisted of the OBI positive and lateral plain film pendulum field and the CBCT pendulum field. Before the first treatment, the reposition moved to the isocentric point, and the Dr positive and lateral images and CBCT images were collected, respectively. 2D / 2D match and 3D matchup were performed with the DRR images generated by the planning system and CT images respectively, and the two groups of pendulum errors were compared by automatic matching analysis. The patient's left and right direction displacement is recorded as X, head and foot direction as Y, front and rear direction as Z, three dimensional direction linear displacement is recorded separately. Results: the mean of the total error is used to describe the mean value of the pendulum error, and the system error is recorded. The standard deviation of the error population is used to describe the standard deviation of the pendulum error of all grades, which is recorded as the random error and the error of the X axis (left and right / right / right / Y axis) is finally expressed as the system error 鹵random error. The error of head and neck pendulum was: X: 0.14 鹵0.06 cm Y: 0.27 鹵0.09 cm Z: 0.16 鹵0.05 cm, X: 0.31 鹵0.09 cm Y: 0.59 鹵0.19 cm Z: 0.27 鹵0.19 cm Z: 0.27 鹵0.08 cm; pelvic position error X: 0.31 鹵0.09 cm Y: 0.53 鹵0.15 cm ~ (-1) Z: 0.26 鹵0.09 cm; error of head and neck pendulum: X: 0.13 鹵0.05 cm ~ (0.05) cm Y: 0.25 鹵0.09 cm, body position error: X: 0.31 鹵0.09 cm: YW: 0.26 鹵0.09 cm; error of head and neck pendulum: X = 0.13 鹵0.05 cm ~ 0. 05 cm Y: 0.25 鹵0.09 cm. The error is: X: 0.240 鹵0.05cm, Y: 0.44 鹵0.16cm, Z: 0.21 鹵0.06cm, X: 0.20 鹵0.07cm, Y: 0.38 鹵0.12cm / Z: 0.18 鹵0.08cm; all data are recorded and analyzed by Microsoft Excel. The statistical analysis was carried out with SPSS21.0 software, and the independent t test of quantitative data was carried out on the XG YZ axis of the two models, respectively. There was no significant difference between head and neck in three directions, but there was no significant difference between body and pelvic patients in the three directions. Conclusion: it can be seen that there is no significant difference between the two modes in head and neck pendulum. All of them can meet the requirements of accurate radiotherapy for pendulum verification and have the same trend. The maximum errors appear in the Y axis of the head and foot direction, which may be related to the systematic errors caused by CT scan, while in patients with pelvic cavity in the body, The difference between the two models was statistically significant. The results showed that CBCT had obvious advantages in the parts of human body affected by respiratory movement, intestinal peristalsis and bladder filling size, etc. It can be used to verify the changes of tumor target size and shape and the displacement of the surrounding organs in real time, and to prevent the target area from leaking or the normal tissue to receive high dose irradiation, which is more instructive in clinical practice.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R730.55

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 朱晟超;王遠(yuǎn)軍;;錐形束CT對非小細(xì)胞肺癌放療擺位誤差及放療射線劑量的影響[J];中國醫(yī)學(xué)物理學(xué)雜志;2017年02期

2 姜斐;于浪;孫顯松;王欣海;胡克;邱杰;張福泉;;圖像引導(dǎo)放射治療在653例宮頸癌擺位誤差的分析[J];中國醫(yī)學(xué)裝備;2017年01期

3 杜德成;劉芬;;圖像引導(dǎo)放射治療技術(shù)腹部腫瘤放射治療精度提升的臨床分析[J];結(jié)直腸肛門外科;2016年S2期

4 高吉福;汪智勇;;胸腹部腫瘤調(diào)強放療首次擺位誤差的分析[J];醫(yī)療裝備;2016年06期

5 石祥禮;劉冉生;張丙新;;胸段食管癌圖像引導(dǎo)調(diào)強放射治療的擺位誤差分析[J];中國現(xiàn)代醫(yī)學(xué)雜志;2016年05期

6 李克新;鞠永健;王高仁;曹麗媛;;4種圖像配對方式對胸腹部腫瘤放射治療擺位誤差比較研究[J];生物醫(yī)學(xué)工程與臨床;2016年02期

7 王恩陽;徐飛;賈明軒;;應(yīng)用千伏級錐形束CT對非小細(xì)胞肺癌立體定向放療PTV外放邊界研究[J];中國CT和MRI雜志;2016年02期

8 王健;李文浩;葛云;;錐形束CT引導(dǎo)擺位與光學(xué)引導(dǎo)擺位比較[J];中國醫(yī)學(xué)物理學(xué)雜志;2016年01期

9 吳承駿;管巒;張偉;秦頌兵;;利用錐形束CT研究不同部位食管癌放射治療首周的擺位誤差[J];中華臨床醫(yī)師雜志(電子版);2016年02期

10 屈超;梁廣立;;熱塑體膜固定裝置在宮頸癌調(diào)強放療中的臨床應(yīng)用價值[J];醫(yī)療衛(wèi)生裝備;2015年12期

，

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