本文選題：乳腺癌 + 四維CT��； 參考：《清華大學(xué)》2015年碩士論文

【摘要】：容積旋轉(zhuǎn)調(diào)強(VMAT)技術(shù)具有治療時間短,靶區(qū)劑量適形度好,危及器官受照量小等優(yōu)點,隨著VMAT技術(shù)在乳腺癌中的應(yīng)用,由于呼吸動度的原因,存在著腫瘤靶區(qū)漏照的問題。4D-CT可以采集患者各呼吸時相的圖像,經(jīng)過軟件分析得出胸廓的動度閾值。將該閾值作為VMAT治療計劃中MLC外放的范圍值,從而解決乳腺癌VMAT照射技術(shù)中所存在的靶區(qū)漏照問題。對左側(cè)乳腺癌保乳術(shù)后患者三種照射技術(shù)進(jìn)行劑量學(xué)比較。4D-CT定位掃描,獲得10個呼吸時相的影像信息,分析后獲得胸廓呼吸動度閾值。取呼氣末影像勾畫靶區(qū)和危及器官,在同一患者的影像中分別制作3D-CRT、4F-HIMRT、VMAT 3種治療計劃。PTV劑量50Gy。比較各計劃之間靶區(qū)和危及器官的各項參數(shù)。同時比較3種計劃平均治療時間的差異。其中VMAT計劃中,對MLC進(jìn)行一定外放,解決呼吸運動引起的靶區(qū)漏照問題。利用4D-CT獲得的呼吸時相數(shù)據(jù),經(jīng)過分析后得出呼吸動度閾值,做為外放的參考值。與切線野和調(diào)強計劃相比,VMAT組明顯提高了腫瘤靶區(qū)適形度和均勻性(P0.05)。VMAT組肺臟V20低于3D-CRT與IMRT組,V10、V5高于3D-CRT與IMRT組。VMAT組心臟V30,V40均低于3D-CRT與IMRT組。VMAT組對側(cè)乳腺Dmax與Dmean高于3D-CRT與4F-HIMRT組。3D-CRT、4F-HIMRT、VMAT三種計劃的治療時間分別(110±5s)、(145±6s)、(105±6s)。與其它兩種照射技術(shù)比較,VMAT改善了靶區(qū)的適形度和均勻性,降低了危及器官的受照劑量,減少了治療時間。與此同時,危及器官的低劑量區(qū)域有所增加。
[Abstract]:Volume rotation intensity modulation (VMT) has the advantages of short treatment time, good dose conformability of target area, low exposure to organs, and so on. With the application of VMAT technique in breast cancer, respiratory motility is the reason. There is the problem of tumor target leakage. 4D-CT can collect the images of each breath phase of the patients, and get the threshold of thoracic motility by software analysis. The threshold is used as the range of MLC release in the VMAT treatment plan, so as to solve the problem of target leakage in VMAT irradiation for breast cancer. Dosimetric comparison of three irradiation techniques for patients with left breast cancer after breast conserving surgery was performed. The imaging information of 10 breathing phases was obtained and the threshold of thoracic respiratory motility was obtained. The target area and the dangerous organ were drawn from the end-expiratory image and the 3D-CRTX 4F-HIMRTT VMAT was made in the same patient. The dose of PTV was 50Gy. Compare the parameters of target area and organ hazard between plans. At the same time, the differences of average treatment time among the three plans were compared. In the VMAT program, MLC is given out to solve the problem of target area leakage caused by respiratory movement. Based on the respiratory phase data obtained by 4D-CT, the threshold of respiratory motility is obtained, which can be used as the reference value. Compared with tangent field and intensity modulation plan, VMAT group significantly increased the conformability and homogeneity of tumor target area. The lung V20 level in VMAT group was lower than that in 3D-CRT and IMRT group. V10 V5 was higher than that in 3D-CRT and IMRT group. V30 V40 in VMAT group was lower than that in 3D-CRT and IMRT group. VMAT group was higher than that in 3D-CRT and IMRT group. VMAT group in contralateral breast Dmax and Dmean was higher than that in 3D-CRT and IMRT group. The treatment time of 3D-CRT group and 4F-HIMRT group. 3D-CRT 4F-HIMRTT VMAT was 110 鹵5s, 145 鹵6s, 105 鹵6s, respectively. Compared with the other two irradiation techniques, VMAT improved the conformability and uniformity of the target area, reduced the radiation dose of the endangered organs, and reduced the treatment time. At the same time, low-dose areas that endanger organs have increased.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R737.9

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