锥形束CT临床应用中的主要问题对策研究现状

doi:10.3760/cma.j.cn113030-20201023-00509

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摘要图像引导放疗应用于临床以来,锥形束CT (CBCT)已成为应用最广泛的图像引导设备。然而,CBCT的应用中仍存在一些问题需要注意,如患者摆位误差经CBCT校正前后均存在一定误差、CBCT难以校正肿瘤动态变化误差、患者靶区外放边界能否减小受CBCT应用频率影响、CBCT摄像条件还缺乏一定灵活性、CBCT实用性受到临床价值和应用成本影响等。只有充分认识CBCT应用中的问题,才能更加合理和科学地使用CBCT。

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	张丙新
	付东山

关键词 ：体层摄影术,X线计算机,锥形束, 肿瘤/图像引导放射疗法, 问题与对策

Abstract：Since the application of image-guided radiotherapy in clinical practice, cone-beam CT (CBCT) has become the most widely employed image-guided device. However, some problems remain to be cautioned in the application of CBCT, such as certain errors in the setup errors before and after the correction of CBCT, the failure of CBCT to correct dynamic changes, whether the influence of application frequency of CBCT on patients’ boundary of clinical target volume can be reduced, imaging conditions of CBCT lack of a certain degree of flexibility, and the effect of clinical value and application cost on the practicality of CBCT. Only by fully understanding the problems in CBCT application can CBCT be applied more reasonably and scientifically.

Key words： Tomography,X-ray computed,cone-beam Neoplasm/image-guided radiotherapy Problem and solution

收稿日期: 2020-10-23

通讯作者: 付东山,Email:dfu@rayrtch.com

引用本文:

张丙新,付东山. 锥形束CT临床应用中的主要问题对策研究现状[J]. 中华放射肿瘤学杂志, 2021, 30(10): 1099-1104.

Zhang Bingxin,Fu Dongshan. Research status of solutions for main problems in clinical application of cone-beam CT[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 1099-1104.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20201023-00509 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2021/V30/I10/1099

[1] 王为,聂生东,吴国华. 锥形束CT在放射治疗中的应用[J]. 中国医学影像技术,2011, 27(5):1074-1077. DOI:0.13929/j.1003-3289.2011.05.019.
Wang W, Nie SD, Wu GH. Application of cone beam CT in radiotherapy[J]. Chin Med Imag Technol, 2011, 27(5):1074-1077. DOI:0.13929/j.1003-3289.2011.05.019.
[2] 刘轶群,王文玲. 锥形束CT在肿瘤精确放疗中的应用[J]. 肿瘤学杂志,2013, 19(12):991-994. DOI:10.11735/j.issn.1671-170X.2013.12. B018.
Liu YQ, Wang WL. Application of cone beam CT in tumor precise radiotherapy[J]. J Oncol, 2013, 19(12):991-994. DOI:10.11735/j.issn.1671-170X.2013.12. B018.
[3] 王巍,刘冉生,张爱旭,等. 锥形束CT在癌症放疗中的应用进展[J]. 山东医药,2016, 56(21):92-94. DOI:10.3969/j.issn.1002-266X.2016.21.038.
Wang W, Liu RS, Zhang AX, et al. Application progress of cone beam CT in tumor radiotherapy[J]. Shandong Med J, 2016, 56(21):92-94. DOI:10.3969/j.issn.1002-266X.2016.21.038.
[4] 李文杰,林承光,陈立新. CT扫描/重建参数对三维治疗计划系统影像的影响[J]. 肿瘤学杂志,2005, 11(5):323-326. DOI:10.3969/j.issn.1671-170X.2005.05.002.
Li WJ, Lin CG, Chen LX. Influence of CT scanning/reconstruction parameters on 3D treatment planning system[J]. J Oncol, 2005, 11(5):323-326. DOI:10.3969/j.issn.1671-170X.2005.05.002.
[5] Morin O, Gillis A, Chen J, et al. Megavoltage cone-beam CT:system description and clinical applications[J]. Med Dosim, 2006, 31(1):51-61. DOI:10.1016/j.meddos.2005.12.009.
[6] 黄伯天,张丹丹,彭应林,等. 图像配准条件对头颈部CBCT引导放疗精度影响[J]. 中华放射肿瘤学杂志,2016, 25(4):391-394. DOI:10.3760/cma.j.issn.1004-4221.2016.04.019.
Huang BT, Zhang DD, Peng YL, et al. Impacts of registration parameters on accuracy of cone-beam computed tomography image-guided head and neck radiotherapy[J]. Chin J Radiat Oncol, 2016, 25(4):391-394. DOI:10.3760/cma.j.issn.1004-4221.2016.04.019.
[7] 王艳阳,傅小龙,夏冰. 不同标记点对肺癌图像引导放疗图像配准结果的影响[J]. 中华放射肿瘤学杂志,2010, 19(6):517-519. DOI:10.3760/cma.j.issn.1004-4221.2010.06.011.
Wang YY, Fu XL, Xia B. Impact of different anatomical landmarks on registration in imaging-guided radiation for lung cancer[J]. Chin J Radiat Oncol, 2010, 19(6):517-519. DOI:10.3760/cma.j.issn.1004-4221.2010.06.011.
[8] 傅万凯,邹钦凤,刘利彬,等. 应用千伏级锥形束CT研究鼻咽癌调强放疗中不同配准区域的摆位误差[J]. 福建医药杂志,2016, 38(6):134-136.
Fu WK, Zou QF, Liu LB, et al. Study of setup errors of different registration regions in intensity modulated radiotherapy for nasopharyngeal carcinoma using kilovolt cone beam CT[J]. Fujian Med J, 2016, 38(6):134-136.
[9] 马广栋,李承军,付敬国,等. 不同解剖区域配准方法对鼻咽癌体位误差的影响[J]. 医疗卫生装备,2011, 32(7):63-64. DOI:10.3969/j.issn.1003-8868.2011.07.027.
Ma GD, Li CJ, Fu JG, et al. Effect of different anatomical region registration methods on posture error of nasopharyngeal carcinoma[J]. Med Heal Equip, 2011, 32(7):63-64. DOI:10.3969/j.issn.1003-8868.2011.07.027.
[10] 黄伯天,邓小武,罗广文,等图像引导放疗锥束CT与计划CT不同配准方法精度研究[J]. 中华放射肿瘤学杂志,2014, 23(2):156-160. DOI:10.3760/cma.j.issn.1004-4221.2014.02.020.
Huang BT, Deng XW, Luo GW, et al. Accuracy of different registration methods between cone beam CT and planned CT in image-guided radiotherapy[J]. Chin J Radiat Oncol, 2014, 23(2):156-160. DOI:10.3760/cma.j.issn.1004-4221.2014.02.020.
[11] 李晓玉,周继丹,钟仁明,等. 千伏级CBCT引导鼻咽癌IMRT中不同图像配准方式比较[J]. 中华放射肿瘤学杂志,2014, 23(4):340-343. DOI:10.3760/cma.j.issn.1004-4221.2014.04.016.
Li XY, Zhou JD, Zhong RM, et al. Compare the registration results with different registration methods in cone beam CT guided radiotherapy for nasopharyngeal carcinoma[J]. Chin J Radiat Oncol, 2014, 23(4):340-343. DOI:10.3760/cma.j.issn.1004-4221.2014.04.016.
[12] 彭应林,刘松然,黄伯天,等. 图像配准方法对肺癌放疗图像引导摆位精度的影响[J]. 中华放射肿瘤学杂志,2015, 24(2):184-188. DOI:10.3760/cma.j.issn.1004-4221.2015.02.019.
Peng YL, Liu SR, Huang BT, et al. The accuracy of image registration methods for image-guided positioning in lung cancer radiotherapy[J]. Chin J Radiat Oncol, 2015, 24(2):184-188. DOI:10.3760/cma.j.issn.1004-4221.2015.02.019.
[13] 李庆瑞,陈吉祥,丁大庆,等. 不同人员对肺癌CBCT图像配准误差分析[J]. 实用癌症杂志,2018, 33(8):1245-1248. DOI:10.3969/j.issn.1001-5930.2018.08.009.
Li QR, Chen JX, Ding DQ, et al. Analysis of registration error of CBCT image of lung cancer by different personnel[J]. J Pract Cancer, 2018, 33(8):1245-1248. DOI:10.3969/j.issn.1001-5930.2018.08.009.
[14] 甄鑫. 自适应放射治疗中的图像变形配准关键技术研究[D]. 广州:南方医科大学,2013:1-105.
Zhen X. Research on key technology of image deformation registration in adaptive radiotherapy[D]. Guangzhou:Southern Med Univ, 2013:1-105.
[15] 王琳婧,张书旭,张海南,等. GPU框架下基于改进Demons算法的CT-CBCT图像变形配准研究[J]. 中国医学物理学杂志,2013, 30(3):4130-4133. DOI:10.3969/j.issn.1005-202X.2013.03.011.
Wang LJ, Zhang SX, Zhang HN, et al. A GPU based improved demons algorithm for CT to CBCT deformable image registration[J]. Chin J Med Phys, 2013, 30(3):4130-4133. DOI:10.3969/j.issn.1005-202X.2013.03.011.
[16] 申红峰,王小深,欧光明,等. 基于图像引导下头颈部肿瘤放射治疗患者摆位误差的相关性分析[J]. 中国医学装备,2016, 13(10):22-24. DOI:10.3969/J. ISSN.1672-8270.2016.10.007.
Shen HF, Wang XS, Ou GM, et al. Research on the correlation of setup errors for head and neck cancer patients with radiotherapy based on image guiding[J]. Chin Med Equip, 2016, 13(10):22-24. DOI:10.3969/J. ISSN.1672-8270.2016.10.007.
[17] 黄家文,张梅芳,刘利彬,等. 鼻咽癌放疗旋转与平移误差的相关性[J]. 中国医学物理学杂志,2018, 35(12):1365-1370. DOI:10.3969/j.issn.1005-202X.2018.12.001.
Huang JW, Zhang MF, Liu LB, et al. Correlation between rotational errors and translational errors in intensity-modulated radiotherapy for nasopharyngeal carcinoma[J]. Chin J Med Phys, 2018, 35(12):1365-1370. DOI:10.3969/j.issn.1005-202X.2018.12.001.
[18] Den RB, Doemer A, Kubicek G, et al.Daily image guidance with cone beam computed tomography for head and neck cancer intensity modulated radiotherapy:a prospective study[J]. Int J Radiat Oncol Biol Phys, 2010, 76(5):1353-1359. DOI:10.1016/j.ijrobp.2009.03.059.
[19] 刘婷婷. 图像引导调强放疗在头颈部肿瘤治疗中的应用[D]. 乌鲁木齐:新疆医科大学,2013:1-39.
Liu TT. Application of image-guided intensity-modulated radiotherapy in the treatment of head and neck tumors[D]. Wulumuqi:Xinjiang Med Univ, 2013:1-39.
[20] 张大伟,覃文,苏世达,等. 锥形束CT在头颈部和腹盆部肿瘤放疗摆位误差中的应用[J]. 广西医科大学学报,2017, 34(12):1731-1734. DOI:10.16190/j.cnki.45-1211/r.2017.12.014.
Zhang DW, Qin W, Su SD, et al. Analysis of setup error for head and neck tumors and for abdominal and pelvic tumors in radiotherapy with cone-beam computed tomography[J]. J Guangxi Med Univ, 2017, 34(12):1731-1734. DOI:10.16190/j.cnki.45-1211/r.2017.12.014
[21] 杨志勇,王继平,袁红,等. 锥型束CT对鼻咽癌调强放射治疗患者摆位精度的影响[J]. 医疗装备,2018, 31(21):49-51. DOI:10.3969/j.issn.1002-2376.2018.21.033.
Yang ZY, Wang JP, Yuan H, et al. The influence of the cone beam ct on positioning accuracy of intensity modulated radiotherapy for nasopharyngeal carcinoma[J]. Med Equip, 2018, 31(21):49-51. DOI:10.3969/j.issn.1002-2376.2018.21.033.
[22] 吴伟伟,李韶今,尹慧,等. 局部晚期鼻咽癌调强放疗中解剖结构改变及剂量分布变化研究[J]. 中华放射医学与防护杂志,2017, 37(11):826-831. DOI:10.3760/cma.j.issn.0254-5098.2017.11.005.
Wu WW, Li SJ, Yin H, et al. Anatomical changes and dose distribution deviations of locally advanced nasopharyngeal carcinoma patients during IMRT[J]. Chin J Radiol Med Protect, 2017, 37(11):826-831. DOI:10.3760/cma.j.issn.0254-5098.2017.11.005.
[23] 刘小慧. 非小细胞肺癌调强放疗后肿瘤体积变化规律及预后因素研究[D]. 福州:福建医科大学,2017:1-56.
Liu XH. The study on the change of tumor volume and prognosis factors after intensity modulated radiotherapy of NSCLC[D]. Fuzhou:Fujian Med Univ, 2017:1-56.
[24] 李奕彤,王雅棣,张富利,等. 宫颈癌调强放疗中靶区变化与剂量分析[J]. 中华放射医学与防护杂志,2015, 35(10):751-755. DOI:10.3760/cma.j.issn.0254-5098.2015.10.007.
Li YT, Wang YD, Zhang FL, et al. Variation of organ position and dose for cervical cancer patients treated with helical tomotherapy[J]. Chin J Radiol Med Protect, 2015, 35(10):751-755. DOI:10.3760/cma.j.issn.0254-5098.2015.10.007.
[25] 吴瑞花,宋勇春,袁智勇,等. 肺肿瘤运动规律及其影响因素的研究[J]. 中华放射肿瘤学杂志,2011, 20(3):193-196. DOI:10.3760/cma.j.issn.1004-4221.2011.03.006.
Wu RH, Song YC, Yuan ZY, et al. The study in the mobility of lung tumors and impact factors[J]. Chin J Radiat Oncol, 2011, 20(3):193-196. DOI:10.3760/cma.j.issn.1004-4221.2011.03.006.
[26] 朱六玲,蔡陈枫,孟岩. X射线模拟机和射波刀同步呼吸追踪下肺肿瘤的运动规律分析[J]. 中国医学装备,2018, 15(12):53-56. DOI:10.3969/J. ISSN.1672-8270.2018.12.013.
Zhu LL, Cai CF, Meng Y. Analysis on the motion law of lower lung tumor of X-ray simulator and synchronous breathing tracking by Cyberknife[J]. Chin Med Equip, 2018, 15(12):53-56. DOI:10.3969/J. ISSN.1672-8270.2018.12.013.
[27] 庞皓文,邱杰,孙帅,等. 宫颈癌调强放疗中直肠体积与位置变化及对吸收剂量影响[J]. 中华放射肿瘤学杂志, 2012, 21(3):258-261.
Pang HW, Qiu J, Sun S, et al. Rectal volume, location change and effect on absorption dose in cervical cancer intensive modulation radiotherapy[J]. Chin J Radiat Oncol, 2012, 21(3):258-261.
[28] 陈文娟,柏朋刚,李江山,等. 宫颈癌图像引导下调强放射治疗靶区及危及器官变化研究[J]. 中国肿瘤,2014, 23(12):1044-1048. DOI:10.11735/j.issn.1004-0242.2014.12. A018.
Chen WJ, Bai PG, Li JS, et al. Study on the changes of volume and spatial location in target and organ at risk for cervical cancer during image-guided IMRT[J]. Chin J Oncol, 2014, 23(12):1044-1048. DOI:10.11735/j.issn.1004-0242.2014.12. A018.
[29] 闵蒙真,丘敏敏,钟嘉健,等. 宫颈癌调强放疗中膀胱体积改变及其剂量学变化测量[J]. 中国医学物理学杂志,2019, 36(04):402-407. DOI:10.3969/j.issn.1005-202X.2019.04.007.
Min MZ, Qiu MM, Zhong JJ, et al. Measurement of changes in bladder volume and dosimetric variations in intensity-modulated radiotherapy for cervical cancer[J]. Chin J Med Phys, 2019, 36(04):402-407. DOI:10.3969/j.issn.1005-202X.2019.04.007.
[30] 张玮婷,童远和,李樟,等.4D-CBCT应用于肺癌SBRT的摆位误差研究[J]. 医学理论与实践,2019, 32(9):1346-1348. DOI:10.19381/j.issn.1001-7585.2019.09.032.
Zhang WT, Tong YH, Li Z, et al. The study of the positioning error of 4D CBCT in SBRT of lung cancer[J]. Med Theor Pract, 2019, 32(9):1346-1348. DOI:10.19381/j.issn.1001-7585.2019.09.032.
[31] 杨旭,梁军. 四维锥形束CT在肺癌放疗中的应用[J]. 中华放射肿瘤学杂志,2019, 28(8):621-624. DOI:10.3760/cma.j.issn.1004-4221.2019.08.015
Yang X, Liang J. The application of four-dimensional cone-beam CT in radiotherapy for lung cancer[J]. Chin J Radiati Oncol, 2019, 28(8):621-624. DOI:10.3760/cma.j.issn.1004-4221.2019.08.015.
[32] Zeidan OA, Langen KM, Meeks SL, et al. Evaluation of image-guidance protocols in the treatment of head and neck cancers[J]. Int J Radiat Oncol Biol Phys, 2007, 67(3):670-677. DOI:10.1016/j.ijrobp.2006.09.040.
[33] Kupelian PA, Lee C, Langen KM, et al. Evaluation of image-guidance strategies in the treatment of localized prostate cancer[J]. Int J Radiat Oncol Biol Phys, 2008, 70(4):1151-1157. DOI:10.1016/j.ijrobp.2007.07.2371.
[34] Han CH, Schiffner DC, Schultheiss TE, et al. Residual setup errors and dose variations with less-than-daily image guided patient setup in external beam radiotherapy for esophageal cancer[J]. Radiother Oncol, 2012, 102(2):309-314. DOI:10.1016/j.radonc.2011.07.027.
[35] Zhou L, Bai S, Zhang YB, et al. Imaging dose, cancer risk and cost analysis in image-guided radiotherapy of cancers[J]. Sci Rep, 2018, 8(1):10076-10083. DOI:10.1038/s41598-018-28431-9.
[36] Chen AM, Farwell DG, Luu Q, et al. Evaluation of the planning target volume in the treatment of head and neck cancer with intensity-modulated radiotherapy:what is the appropriate expansion margin in the setting of daily image guidance?[J]. Int J Radiat Oncol Biol Phys, 2011, 81(4):943-949. DOI:10.1016/j.ijrobp.2010.07.017.
[37] Navran AN, Heemsbergen W, Janssen T, et al. The impact of margin reduction on outcome and toxicity in head and neck cancer patients treated with image-guided volumetric modulated arc therapy (VMAT)[J]. Radiother Oncol, 2019, 130(1):25-31. DOI:10.1016/j.radonc.2018.06.032.