乳腺癌放療擺位誤差分析及其對心肺受量的影響
發(fā)布時間：2019-02-28 21:17
【摘要】：目的：通過模擬擺位誤差,探討乳腺癌放療中擺位誤差對心肺受量的影響。方法：通過移動射野中心,模擬三個方向(X、Y、Z軸)的線性擺位誤差,模擬的誤差值分別選取為2、3、5、7、9mm,將射野中心向患側(cè)乳腺方向移動2mm,重新計算心肺受量,并將新劑量序列記為X2,將治療中心向健側(cè)乳腺方向移動2mm,將新劑量序列記為X-2,模擬其他誤差值時新劑量序列分別記為X3、X-3、X5、X-5等。將射野中心向頭側(cè)方向移動2mm,重新計算靶區(qū)及危及器官劑量,并將新劑量序列記為Y2,將射野中心向腳側(cè)方向移動2mm,將新劑量序列記為Y-2,模擬其他誤差值時新劑量序列分別記為Y3、Y-3、Y5、Y-5等。將射野中心向前胸方向移動2mm,重新計算靶區(qū)及危及器官劑量,并將新劑量序列記為Z2,將治療中心向后背方向移動2mm,將新劑量序列記為Z-2,模擬其他誤差值時新劑量序列分別記為Z3、Z-3、Z5、 Z-5等。結(jié)果：①對于肺,Y-5、Y-7、Y-9、Z5、Z7、Z9的雙肺V20較原計劃增加；X-5、X-7、X-9、Y-5、Y-7、Y-9、Z5、Z7、Z9的患肺V20較原計劃增加,均超過限量；X-3、X-5、X-7、X-9、Y-3、Y-5Y-7、Y-9、Z5、 Z7、Z9的患肺平均劑量較原計劃增加4.39%、7.65%、11.55%、17.15%、7.5%、12.5%、17.8%、23.1%、8.0%、11.48%、10.7%。②對于心臟,X-3、X-5、X-7、X-9、Y-5、Y-7、Y-9的V30較原計劃增加,其中X-7、X-9、Y-9超過限量；X-7、X-9的V40較原計劃增加；X-5、X-7、X-9、Y-5、Y-7、Y-9的心臟平均劑量較原計劃增加；增加幅度為51cGy、79cGy、107cGy、 85cGy、125cGy、171cGy。結(jié)論：①患側(cè)方向、頭方向、后背方向大于5mm的誤差會使患肺V20超過限量；患側(cè)肺方向、頭方向大于3mm,后背方向大于5mm的誤差會使患側(cè)肺平均劑量產(chǎn)生較大增加。②患側(cè)方向、頭方向大于5mm的誤差會使心臟平均劑量產(chǎn)生較大增加。③建議當患側(cè)方向、頭方向、后背方向誤差大于5mm時,應校正誤差；當預估患者產(chǎn)生放射性肺損傷風險較大時,患側(cè)方向、頭方向校正閾值為3mm。目的：利用千伏級錐形束CT(CBCT)分析頭肩體墊固定的乳腺癌患者放療擺位中的誤差,并為臨床靶區(qū)(CTV)外擴為計劃靶區(qū)(PTV)提供依據(jù)。方法：利用CBCT分析頭肩體墊固定的乳腺癌病人放療擺位中的誤差,獲得患者左右(X)、頭腳(Y)、上下(Z)三個軸方向的線性誤差(X、Y、Z),及繞此三個軸的旋轉(zhuǎn)誤差(Xr、Yr、Zr)。統(tǒng)計誤差數(shù)據(jù),評價頭肩體墊的優(yōu)劣,并由公式MPTV=2.5Σ+0.7δ，，計算出CTV外擴為PTV的范圍(MPTV)。結(jié)果：53例患者共得到265次擺位誤差的數(shù)據(jù)。對于線性擺位誤差,三個方向總系統(tǒng)誤差為2.5mm、 2.3mm、1.9mm,總隨機誤差為2.5mm、2.2mm、2.2mm。建議外擴邊界為8.0mm,7.3mm、6.3mm。對于旋轉(zhuǎn)誤差,繞三軸方向的總系統(tǒng)誤差分別為1.03。、1.1。、0.95。,總隨機誤差為0.79。、1.15。、0.72。。結(jié)論：頭肩體墊具有較好的擺位精度。利用CBCT測量乳腺癌放療的擺位誤差,為乳腺癌放療CTV外擴為PTV提供參考依據(jù),提高了乳腺癌放療的精準性。
[Abstract]:Objective: to investigate the effect of placement error on cardio-pulmonary dose in radiotherapy of breast cancer by simulating positioning error. Methods: the linear positioning errors in three directions (X, Y, Z axis) were simulated by moving the center of the field. The error values were 2, 3, 5, 7, 9 mm, respectively. The center of the field was moved 2 mm to the affected side of the breast, and the cardio-pulmonary dose was recalculated. The new dose sequence was recorded as X2, the treatment center moved 2 mm to the contralateral mammary gland, the new dose sequence was recorded as X ~ (2), and the new dose sequence was recorded as X _ 3, X _ (3), X _ (5), X _ (5) and so on when other error values were simulated. Moving the center of the field 2 mm to the head side, recalculating the target area and endangering organ doses, recording the new dose sequence as Y 2, moving the center of the field 2 mm to the crural side, and recording the new dose sequence as Y\-2\ {# * $} 2. The new dose sequences were recorded as Y _ 3, Y _ 5, Y _ 5 and so on when other error values were simulated. Move the center of the field 2 mm to the front chest, recalculate the target and organ-endangering doses, write the new dose sequence Z2, move the treatment center 2 mm to the back, and write the new dose sequence Z-2. The new dose sequences were recorded as Z _ 3, Z _ 5, Z _ 5 and so on when other errors were simulated. Results: (1) for the lung, V20 of both lungs was higher than that of the original plan for Y5, Y7, Y9, Z5, Z7 and Z9; The lung V20 of X5, X7, X9, Y5, Y7, Y9, Z5, Z7, Z9 were increased compared with the original plan and exceeded the limit. The average lung dose for X-3, X-5, X-7, X-9, Y-3, Y-5Y-7, Y-9, Z5, Z7, Z9 increased by 4.39%, 7.65%, 11.55%, 17.15%, 7.5%, respectively. 12.5%, 17.8%, 23.1%, 8.0%, 11.48%, 10.7% for the heart, X3, X5, X7, X9, Y5, Y7, Y9, V30 is higher than originally planned. Among them, X7, X9, Y9 exceeded the limit; The V40 of X-7, X-9, X-5, X-7, X-9, Y-5, Y-7, Y-9 and Y-9 were increased by 51 cGy, 79 cGy, 107 cGy, 85 cGy, 125 cGy, 171 cGY, and 51 cGy, 79 cGy, 107 cGy, 85 cGy, 125 cGy, 171 cGY, respectively. Conclusion: 1the error of the affected side direction, the head direction and the back direction greater than the 5mm will cause the lung V20 to exceed the limit; The mean lung dose of the affected side increased greatly when the direction of the affected side was greater than 3 mm in the head direction, and the error of the back direction was greater than that of 5mm. (2) in the affected side, The error of head direction greater than 5mm will increase the average dose of heart. 3 it is suggested that when the error of head direction, head direction and back direction is greater than that of 5mm, the error should be corrected. When the risk of radiation-induced lung injury was high, the correction threshold of the affected side and head direction was 3 mm. Aim: to analyze the error of radiotherapy placement in patients with breast cancer fixed with head and shoulder pad by using kVA cone bundle CT (CBCT), and to provide the basis for the expansion of clinical target area (CTV) as the planned target area (PTV). Methods: CBCT was used to analyze the error of radiotherapy placement in patients with breast cancer fixed with head and shoulder pad. The linear errors (X, Y, Z) of the upper and lower (Z) axes of left and right (X), head and foot (Y), were obtained. And the rotation error (Xr,Yr,Zr) around the three axes. Statistical error data are used to evaluate the advantages and disadvantages of the head shoulder pad. Based on the formula MPTV=2.5 危 0.7 未, the range (MPTV). Of the expansion from CTV to PTV is calculated. Results: data of 265 placement errors were obtained in 53 patients. For the linear positioning error, the total system error in three directions is 2.5 mm, 2.3 mm, 1.9 mm, and the total random error is 2.5 mm, 2.2 mm. It is suggested that the outer boundary be 8.0mm, 7.3mm, 6.3mm. For the rotation error, the total system error around the triaxial direction is 1.03,1.1,0.95.The total random error is 0.79,1.15.0.72. Conclusion: the head-shoulder pad has good positioning accuracy. Using CBCT to measure the positioning error of breast cancer radiotherapy can provide reference for the external expansion of breast cancer radiotherapy CTV for PTV, and improve the precision of breast cancer radiotherapy.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9
本文編號：2432177
[Abstract]:Objective: to investigate the effect of placement error on cardio-pulmonary dose in radiotherapy of breast cancer by simulating positioning error. Methods: the linear positioning errors in three directions (X, Y, Z axis) were simulated by moving the center of the field. The error values were 2, 3, 5, 7, 9 mm, respectively. The center of the field was moved 2 mm to the affected side of the breast, and the cardio-pulmonary dose was recalculated. The new dose sequence was recorded as X2, the treatment center moved 2 mm to the contralateral mammary gland, the new dose sequence was recorded as X ~ (2), and the new dose sequence was recorded as X _ 3, X _ (3), X _ (5), X _ (5) and so on when other error values were simulated. Moving the center of the field 2 mm to the head side, recalculating the target area and endangering organ doses, recording the new dose sequence as Y 2, moving the center of the field 2 mm to the crural side, and recording the new dose sequence as Y\-2\ {# * $} 2. The new dose sequences were recorded as Y _ 3, Y _ 5, Y _ 5 and so on when other error values were simulated. Move the center of the field 2 mm to the front chest, recalculate the target and organ-endangering doses, write the new dose sequence Z2, move the treatment center 2 mm to the back, and write the new dose sequence Z-2. The new dose sequences were recorded as Z _ 3, Z _ 5, Z _ 5 and so on when other errors were simulated. Results: (1) for the lung, V20 of both lungs was higher than that of the original plan for Y5, Y7, Y9, Z5, Z7 and Z9; The lung V20 of X5, X7, X9, Y5, Y7, Y9, Z5, Z7, Z9 were increased compared with the original plan and exceeded the limit. The average lung dose for X-3, X-5, X-7, X-9, Y-3, Y-5Y-7, Y-9, Z5, Z7, Z9 increased by 4.39%, 7.65%, 11.55%, 17.15%, 7.5%, respectively. 12.5%, 17.8%, 23.1%, 8.0%, 11.48%, 10.7% for the heart, X3, X5, X7, X9, Y5, Y7, Y9, V30 is higher than originally planned. Among them, X7, X9, Y9 exceeded the limit; The V40 of X-7, X-9, X-5, X-7, X-9, Y-5, Y-7, Y-9 and Y-9 were increased by 51 cGy, 79 cGy, 107 cGy, 85 cGy, 125 cGy, 171 cGY, and 51 cGy, 79 cGy, 107 cGy, 85 cGy, 125 cGy, 171 cGY, respectively. Conclusion: 1the error of the affected side direction, the head direction and the back direction greater than the 5mm will cause the lung V20 to exceed the limit; The mean lung dose of the affected side increased greatly when the direction of the affected side was greater than 3 mm in the head direction, and the error of the back direction was greater than that of 5mm. (2) in the affected side, The error of head direction greater than 5mm will increase the average dose of heart. 3 it is suggested that when the error of head direction, head direction and back direction is greater than that of 5mm, the error should be corrected. When the risk of radiation-induced lung injury was high, the correction threshold of the affected side and head direction was 3 mm. Aim: to analyze the error of radiotherapy placement in patients with breast cancer fixed with head and shoulder pad by using kVA cone bundle CT (CBCT), and to provide the basis for the expansion of clinical target area (CTV) as the planned target area (PTV). Methods: CBCT was used to analyze the error of radiotherapy placement in patients with breast cancer fixed with head and shoulder pad. The linear errors (X, Y, Z) of the upper and lower (Z) axes of left and right (X), head and foot (Y), were obtained. And the rotation error (Xr,Yr,Zr) around the three axes. Statistical error data are used to evaluate the advantages and disadvantages of the head shoulder pad. Based on the formula MPTV=2.5 危 0.7 未, the range (MPTV). Of the expansion from CTV to PTV is calculated. Results: data of 265 placement errors were obtained in 53 patients. For the linear positioning error, the total system error in three directions is 2.5 mm, 2.3 mm, 1.9 mm, and the total random error is 2.5 mm, 2.2 mm. It is suggested that the outer boundary be 8.0mm, 7.3mm, 6.3mm. For the rotation error, the total system error around the triaxial direction is 1.03,1.1,0.95.The total random error is 0.79,1.15.0.72. Conclusion: the head-shoulder pad has good positioning accuracy. Using CBCT to measure the positioning error of breast cancer radiotherapy can provide reference for the external expansion of breast cancer radiotherapy CTV for PTV, and improve the precision of breast cancer radiotherapy.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9
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本文編號：2432177
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