本文選題：脊椎腫瘤　切入點(diǎn)：放射療法　出處：《北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版)》2015年06期

【摘要】：目的:探討頸椎、胸椎及腰椎腫瘤在錐形束CT(cone beam CT,CBCT)影像引導(dǎo)下的調(diào)強(qiáng)放射治療(image guided radiation therapy,IGRT)六自由度擺位誤差分析。方法:收集2013年5月至2014年6月在北京大學(xué)第三醫(yī)院行脊柱惡性腫瘤放療的患者30例,其中頸椎腫瘤10例,胸椎腫瘤10例,腰椎腫瘤10例。采用瑞典醫(yī)科達(dá)(ELEKTA)公司AXESSE直線加速器CBCT引導(dǎo),用Hexa PODTMevoRT床從平移和旋轉(zhuǎn)六自由度方向在線校正擺位誤差,CT模擬定位獲取治療計(jì)劃參考圖像(層厚3 mm,120 k V,200 m As)。每次治療前行千伏級(jí)(k V級(jí))CBCT掃描(100 k V,36.6 m As,s20射野準(zhǔn)直器),CBCT圖像采用骨窗模式與計(jì)劃參考圖像自動(dòng)匹配,并經(jīng)高資質(zhì)醫(yī)師和物理師共同確認(rèn),誤差校正后再次行CBCT掃描,將兩次圖像與計(jì)劃參考圖像分別進(jìn)行匹配驗(yàn)證。本研究共收集838次擺位校正前、后匹配結(jié)果,分別記錄患者平移擺位誤差左右方向X(lateral)、進(jìn)出方向Y(lngitudinal)、升降方向Z(vertical)、旋轉(zhuǎn)誤差俯仰方向RX(pitch)、滾動(dòng)方向RY(roll)及左右旋轉(zhuǎn)方向RZ(yaw)匹配結(jié)果。應(yīng)用SPSS13.0統(tǒng)計(jì)軟件,對(duì)Hexa PODTMevoRT床校正前后位移誤差數(shù)據(jù)行配對(duì)t檢驗(yàn)。結(jié)果:椎體腫瘤擺位誤差(絕對(duì)值)中,3個(gè)平移X、Y和Z方向擺位誤差結(jié)果分別為頸椎(1.71±0.10)mm、(1.81±0.11)mm和(1.94±0.09)mm;胸椎(3.17±0.19)mm、(4.26±0.28)mm和(2.18±0.12)mm;腰椎(2.69±0.24)mm、(3.33±0.26)mm和(2.86±0.21)mm�；颊邤[位后首次CBCT獲得擺位誤差數(shù)據(jù)與誤差糾正后(動(dòng)床后)再次CBCT驗(yàn)證后獲得殘余誤差數(shù)據(jù)3個(gè)平移X、Y和Z方向分別為頸椎(0.5±2.4)mm、(0.01±2.4)mm和(2.4±1.4)mm,胸椎(1.17±0.11)mm、(0.26±0.30)mm和(0.08±0.12)mm,腰椎(1.09±0.24)mm、(2.03±1.26)mm和(0.06±0.51)mm。進(jìn)行配對(duì)t檢驗(yàn)結(jié)果:頸椎及胸椎平移3個(gè)方向誤差糾正前后差異均有統(tǒng)計(jì)學(xué)意義;腰椎僅是升降Z方向平移誤差糾正前后差異統(tǒng)計(jì)學(xué)有意義(t=-3.518,P0.001)。3個(gè)旋轉(zhuǎn)RX、RY和RZ方向擺位誤差分別為頸椎腫瘤0.67°±0.04°、1.06°±0.06°和0.78°±0.05°,胸椎0.62°±0.05°、0.75°±0.06°和0.84°±0.06°,腰椎0.59°±0.06°、0.80°±0.07°和0.73°±0.06°;誤差糾正后(動(dòng)床后)再次CBCT驗(yàn)證后獲得殘余誤差數(shù)據(jù)3個(gè)旋轉(zhuǎn)方向RX、RY和RZ方向分別為頸椎腫瘤0.27°±0.14°、1.20°±0.04°和0.28°±0.05°,胸椎0.02°±0.20°、0.05°±0.26°和0.64°±0.16°,腰椎0.09°±0.26°、0.50°±0.05°和0.03°±0.16°,誤差糾正前后頸椎和腰椎旋轉(zhuǎn)3個(gè)方向差異均具有統(tǒng)計(jì)學(xué)意義,胸椎僅是滾動(dòng)方向RY方向差異有統(tǒng)計(jì)學(xué)意義(t=7.106,P0.001)。30例患者疼痛均有緩解,未發(fā)現(xiàn)放療副反應(yīng)。結(jié)論:IGRT下Hexa PODTMevoRT床對(duì)脊柱腫瘤放射治療的擺位誤差糾正有明顯作用,建議采用在線校正脊柱腫瘤放射治療擺位誤差。
[Abstract]:Objective: to study the cervical vertebrae, The 6-DOF positioning error analysis of intensity-modulated radiotherapy for thoracic and lumbar spine tumors under the guidance of cone-beam CT(cone beam CT imaging. Methods: from May 2013 to June 2014, spinal malignancy was performed in the third Hospital of Peking University. 30 patients with tumor radiotherapy, 10 cases of cervical spine tumors, 10 cases of thoracic tumors and 10 cases of lumbar vertebrae tumors were guided by AXESSE linear accelerator (CBCT) of Swedish medical company ELEKTAA. The Hexa PODTMevoRT bed is used for on-line correction of the pendulum error from translation and rotation in six degrees of freedom direction. Ct simulation location is used to obtain the treatment plan reference image (3 mm thickness of 120kV / 200m ASL). Before each treatment, the KV / V level of Hexa PODTMevoRT is scanned with 100kV / 36.6 m / s / s 20 beam field. The CBCT image of collimator is automatically matched by bone window mode and plan reference image. After error correction, CBCT scanning was performed again, and the two images and the planned reference images were matched and verified respectively. In this study, a total of 838 pendulum correction results were collected before and after pendulum correction. The matching results were recorded respectively in the right and left directions of the swinging error, in the direction of entry and exit, in the direction of entrance and exit, in the direction of lifting and descending, in the direction of pitching of rotation error, in the direction of pitching, in the direction of rolling, and in the direction of left and right rotation, respectively. SPSS13.0 statistical software was used. The displacement error data before and after correction of Hexa PODTMevoRT bed were tested by paired t test. Results: of the three lateral displacement errors (absolute values) of vertebral body tumor, the results were 1.71 鹵0.10mm 鹵1.81 鹵0.11)mm and 1.94 鹵0.09mm for the cervical vertebrae, 3.17 鹵0.19mm and 2.18 鹵0.12mm for the thoracic vertebrae, 2.69 鹵0.24mm and 3.33 鹵0.26)mm for the lumbar vertebrae respectively, and 2.69 鹵0.24mm and 3.33 鹵0.26)mm for the lumbar vertebrae, respectively. After the first CBCT was obtained and the error corrected (after the moving bed) was again verified by CBCT, the remaining error data were obtained. The three translational error data were obtained in the cervical spine (0.5 鹵2.4 mm) and Z direction (0.01 鹵2.4 鹵1.4 mm), the thoracic vertebrae (1.17 鹵0.11 mm) were 0.26 鹵0.30)mm and 0.08 鹵0.12 mm, the lumbar vertebrae were 1.09 鹵0.24 mm, 2.03 鹵1.26)mm and 0.06 鹵0.51 mm respectively. The results of paired t test showed that there were significant differences between the three direction errors of cervical vertebra and thoracic vertebrae before and after correction. There were significant differences between the lumbar vertebrae before and after correction of the Z direction translation error. The three rotation RXRY and RZ positioning errors were 0.67 擄鹵0.04 擄1.06 擄鹵0.06 擄and 0.78 擄鹵0.05 擄respectively, thoracic vertebrae 0.62 擄鹵0.05 擄0.75 擄鹵0.06 擄and 0.84 擄鹵0.06 擄, lumbar vertebrae 0.59 擄鹵0.06 擄0.80 擄鹵0.07 擄and 0.73 擄鹵0.06 擄respectively. The residual error data obtained by CBCT were: cervical spine tumor 0.27 擄鹵0.14 擄1.20 擄鹵0.04 擄and RZ direction 0.28 擄鹵0.04 擄, thoracic vertebra 0.02 擄鹵0.20 擄0.05 擄鹵0.26 擄and 0.64 擄鹵0.16 擄, lumbar spine 0.09 擄鹵0.26 擄0.50 擄鹵0.05 擄and 0.03 擄鹵0.16 擄respectively. There was significant difference in the direction RY of thoracic vertebrae in rolling direction. The pain was alleviated in all 30 patients, but no side effects of radiotherapy were found. Conclusion the Hexa PODTMevoRT bed has a significant effect on correction of positioning error in radiotherapy of spinal tumors under the condition of 1: IGRT.Conclusion\\\; It is suggested that the alignment error of radiotherapy for spinal tumors should be corrected on line.
【作者單位】： 北京大學(xué)第三醫(yī)院腫瘤放射治療科;
【分類(lèi)號(hào)】：R730.55;R738.1

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