本文選題：肺癌 + 射波刀��； 參考：《清華大學(xué)》2015年碩士論文

【摘要】：呼吸運(yùn)動(dòng)是影響肺部腫瘤立體定向放射治療過(guò)程中的重要因素,因?yàn)槟[瘤的內(nèi)靶區(qū)(ITV)的確定較為困難。同步動(dòng)態(tài)追蹤技術(shù)(Synchrony)是射波刀治療肺部腫瘤最大的優(yōu)勢(shì),它是通過(guò)B超或CT引導(dǎo)下穿刺,將圓柱形金標(biāo)(Fiducials)植入到在患者病灶附近或周邊,在治療開始時(shí),患者穿著同步呼吸追蹤背心,獲取患者在整個(gè)呼吸周期的波形,同時(shí)拍攝一系列X射線肺部影像片,獲得不同呼吸時(shí)刻金標(biāo)的位置,建立金標(biāo)位置和呼吸波形二者的相互關(guān)系,指導(dǎo)機(jī)械手臂控制射線束隨患者的呼吸節(jié)奏運(yùn)動(dòng),這樣就實(shí)現(xiàn)了射線實(shí)時(shí)追蹤腫瘤。這項(xiàng)技術(shù)使放療醫(yī)生在勾畫靶區(qū)的過(guò)程不必考慮腫瘤隨呼吸運(yùn)動(dòng)的影響,減少勾畫靶區(qū)的范圍,一定程度上縮小了腫瘤周邊正常組織的受照范圍。但是在臨床實(shí)踐中,總有部分患者自身原因不能接受金標(biāo)植入手術(shù),對(duì)于這部分患者,最好用4D-CT定位掃描方法確定腫瘤在呼吸過(guò)程中的運(yùn)動(dòng)范圍,找到腫瘤內(nèi)靶區(qū)(ITV)的邊界,治療時(shí)通常采取脊柱追蹤(Xsight-Spine)技術(shù)。但4D-CT掃描技術(shù)機(jī)器配置相對(duì)較高,掃描過(guò)程較普通定位CT掃描較為復(fù)雜,且患者在接受4D-CT掃描時(shí)受照劑量較普通CT掃描劑量大。鑒于此,本研究選取射波刀治療的37例肺部腫瘤患者,通過(guò)瓦里安呼吸門控實(shí)時(shí)位置管理系統(tǒng)(RPM)獲得患者實(shí)時(shí)的監(jiān)測(cè)呼吸時(shí)相,觀察其呼吸波形來(lái)訓(xùn)練其呼氣、吸氣末屏氣,并掃描其呼氣、吸氣末屏氣狀態(tài)的CT圖像序列,分別找到兩個(gè)圖像序列中腫瘤中心的三維坐標(biāo),分別與同一患者4D-CT掃描得到的呼氣、吸氣末圖像序列中的腫瘤中心三維坐標(biāo)作比較,分析得出每位患者每個(gè)病灶的三維坐標(biāo)差異,為臨床工作提供依據(jù)。研究結(jié)果證明,通過(guò)使用瓦里安RPM系統(tǒng)監(jiān)測(cè)呼吸波形采集到的呼氣、吸氣末CT圖像序列中的病灶三維坐標(biāo)值與4D-CT采集的呼氣、吸氣末CT圖像序列中的病灶三維坐標(biāo)值基本一致,存在差異受以下因素影響,坐標(biāo)差值隨年齡增大有增大趨勢(shì),同一患者肺下部腫瘤差別最大、肺中部次之、肺上部最小。
[Abstract]:Respiratory movement is an important factor affecting the stereotactic radiotherapy of lung tumors, because the internal target area of the tumor (ITV) is difficult to determine. Synchronous dynamic tracking (Synchrony) is the greatest advantage of the radio wave knife in the treatment of lung cancer. It is inserted through a B-mode or CT guided puncture, and the cylindrical gold mark (Fiducials) is implanted in the patient. Near or around the lesion, at the beginning of the treatment, the patient wore a synchronous breathing tracking vest, acquired the patient's waveform of the entire respiratory cycle, and photographed a series of X ray radiographic images to obtain the position of the gold mark at different breaths, and set up the relationship between the position of the gold mark and the two of the respiratory waves, guiding the mechanical arm to control the ray beam. The technique enables the doctor to trace the target area without considering the effect of the tumor with the respiratory movement, reducing the scope of the target area and reducing the scope of the normal tissue around the tumor to a certain extent. However, in clinical practice, there are always some patients in clinical practice. In this part of the patients, it is best to use the 4D-CT location scanning method to determine the range of the movement of the tumor in the breathing process, to find the boundary of the target area (ITV) in the tumor, and to use the spinal tracking (Xsight-Spine) technique in the treatment. But the 4D-CT scanning technique is relatively high in the machine configuration and the scanning process is more common. The location of CT scan is more complex, and the dose of the patient in the 4D-CT scan is larger than that of the ordinary CT scan. In view of this, this study selects 37 cases of lung cancer patients treated with radio wave knife, through the real time position management system (RPM) of the Varian respiratory gated control system (RPM), to obtain the real-time monitoring of the respiratory phase of the patient, and observe its respiratory waveform to train its call Gas is breathed and breathed at the end of breath, and the CT image sequence of its expiration and breath holding state is scanned. The three-dimensional coordinates of the tumor center in the two image sequences are found respectively. The three-dimensional coordinates of the tumor centers in the exhaled and inhaled image sequences obtained by the same patient 4D-CT scan are compared respectively, and the three-dimensional coordinates of each focus of each patient are analyzed. The difference is the basis for clinical work. The results show that the three-dimensional coordinate values of the focus in the CT image sequence of the terminal RPM are basically consistent with the three-dimensional coordinates of the focus in the exhale and the end of the aspirated CT image sequence, and the differences are influenced by the following factors. The difference increased with the age increasing, the same is the biggest difference in patients with lung tumor, lung in the middle, upper lung is minimal.
【學(xué)位授予單位】：清華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R734.2
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本文編號(hào)：2039401