本文選題：宮頸癌　切入點：放射治療　出處：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過比較超聲圖像與CBCT圖像引導宮頸癌放療中的擺位誤差,驗證超聲圖像引導放療在宮頸癌中治療中的實用性和可行性。方法:選取10例宮頸癌初治患者,行圖像引導放療(IGRT),分別予以模擬定位、增強掃描,并由同一放療醫(yī)師在增強CT圖像上行各靶區(qū)勾畫及危及器官的勾畫,由放療物理師制定放療計劃,計算各靶區(qū)劑量大小,PTV的處方劑量50.4 Gy/28f,1.8 Gy/f.在放療前10例患者分別行B超圖像引導和CBCT圖像引導驗證,并分別記錄每次三維方向(前后、左右和頭腳方向)上移位的偏差。得出誤差值,比較兩種方法在的三維方向誤差值,計算其統(tǒng)計學差異;并得出靶區(qū)和危及器官的劑量學指標、危及器官劑量分布,收集相關數(shù)據進行統(tǒng)計分析。結果:1.左右方向B超驗證后移位誤差值為(2.49±3.65)mm、CBCT驗證后為(2.55±3.09)mm,比較兩種方法擺位誤差,差異無統(tǒng)計學意義(P=0.84,t=-2.10);前后方向B超驗證后移位誤差值為(2.86±4.30)mm,CBCT驗證后移位為(2.68±3.80)mm,前后方向兩種方法比較,差異無統(tǒng)計學意義(P=0.34,t=1.03);頭腳方向上B超驗證后移位誤差值為(3.05±4.47),CBCT驗證后移位為(3.57±4.61)mm,兩種方法比,差異無統(tǒng)計學意義(P=0.16,t=-1.60)。2.在宮頸癌放療的擺位移動度上,超聲圖像引導系統(tǒng)在左右及頭腳方向上的系統(tǒng)誤差比CBCT引導的系統(tǒng)誤差要低,前后方向超聲圖像引導較CBCT大。3.各靶區(qū)計劃均能夠滿足劑量學要求,危及器官的計劃上均未超出正常組織器官的耐受劑量結論:1.CBCT圖像引導宮頸癌放療擺位誤差廣泛應用于臨床,超聲圖像引導與CBCT圖像引導宮頸癌放療擺位誤差比較,無明顯統(tǒng)計學差異,且其操作簡便,無電離輻射、系統(tǒng)誤差小、可實時糾正,亦可應用于臨床。2.本計劃在直腸、膀胱及股骨頭的保護上,均滿足所有危及器官的劑量學要求。IGRT計劃在危及器官的劑量分布上具有優(yōu)勢,能夠較好地保護宮頸癌患者靶區(qū)周圍的正常組織器官。
[Abstract]:Objective: to verify the practicability and feasibility of ultrasound guided radiotherapy in cervical cancer by comparing the positioning error between ultrasound image and CBCT image guided radiotherapy for cervical cancer. Methods: ten patients with cervical cancer were selected. Image guided radiotherapy was performed to simulate the location, enhance the scanning, and the same radiotherapeutic physician was used to draw up each target area of the enhanced CT image and to draw up the dangerous organs. The radiotherapy plan was drawn up by the radiation physicist. The prescription dose of 50. 4 Gy / 28 f / 1. 8 Gy / f was calculated for each target area. Before radiotherapy, 10 patients were guided by B ultrasound and CBCT respectively, and the three dimensional directions were recorded respectively (before and after radiotherapy). The deviation of displacement on the left and right and the direction of the head and foot. Get the error value, compare the three dimensional error of the two methods, calculate the statistical difference, and get the dosimetry index of the target area and the endangering organ, endanger the organ dose distribution, The results showed that the displacement error of the two methods was 2.49 鹵3.65 mm and 2.55 鹵3.09 mm after CBCT verification. The difference was not statistically significant (P < 0. 84) ~ 2. 10%, the difference of displacement error was 2. 86 鹵4. 30 mm after CBCT, and 2. 68 鹵3. 80 mm after CBCT, and the difference between the two methods was compared with that in front and rear direction, the difference between the two methods was 2.86 鹵4. 30 mm after CBCT, and the difference was 2. 68 鹵3. 80 mm. There was no significant difference between the two methods (P < 0.05 鹵4.47). There was no significant difference between the two methods. There was no significant difference between the two methods, and there was no significant difference between the two methods. The displacement error was 3.05 鹵4.47 鹵4.61mm. there was no significant difference between the two methods, and there was no significant difference between the two methods. The system error of ultrasonic image guidance system is lower than that of CBCT guidance system in left and right direction and head and foot direction, and the front and rear direction ultrasonic image guidance is larger than that of CBCT. Each target plan can meet the requirements of dosimetry. Conclusion: 1. CBCT-guided radiotherapy errors of cervical cancer are widely used in clinical practice. Ultrasound image guidance is compared with CBCT image-guided cervical cancer radiotherapy alignment error. There is no significant statistical difference, and its operation is simple, no ionizing radiation, system error is small, can be corrected in real time, can also be used in clinical .2.This program can be used in the protection of rectum, bladder and femoral head. IGRT program has advantages in dose distribution of endangered organs and can protect normal tissues and organs around the target area of cervical cancer patients.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R730.55;R445.1

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