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中华放射肿瘤学杂志
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中华放射肿瘤学杂志  2021, Vol. 30 Issue (10): 1059-1064    DOI: 10.3760/cma.j.cn113030-20210317-00111
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体表铅点标记辅助iSCOUT图像引导定位系统在乳腺癌术后调强放疗应用研究
董芳芬1,2, 戴立言3, 黄妙云1,2, 翁星2, 江柳清2, 徐本华1,2, 李小波1,2,4
1福建医科大学医学技术与工程学院 福建医科大学临床医学部 福建医科大学肿瘤中心,福州 350122;
2福建医科大学附属协和医院放疗科,福州 350001;
3上海交通大学医学院附属仁济医院放疗科 200025;
4清华大学工程物理系,北京 100084
Study of setup error and dosimetry of postoperative intensity-modulated radiotherapy for breast cancer using skin lead marker and iSCOUT image-guided positioning system
Dong Fangfen1,2, Dai Liyan3, Huang Miaoyun1,2, Weng Xing2, Jiang Liuqing2, Xu Benhua1,2, Li Xiaobo1,2,4
1College of Medical Technology and Engineering, School of Clinical Medicine, Cancer Center, Fujian Medical University, Fuzhou 350122, China;
2Department of Radiotherapy, Fujian Medical University Union Hospital, Fuzhou 350001, China;
3Department of Radiotherapy, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, Shanghai 200025, China;
4Department of Engineering Physics, Tsinghua University, Beijing 100084, China
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摘要 目的 探究体表铅点标记辅助iSCOUT图像引导定位系统在乳腺癌调强放疗摆位误差监测及校正的应用价值,并计算PTV外放边界为临床提供参考。方法 选取2019年间福建医科大学附属协和医院行乳腺癌改良根治术后调强放疗的 25例患者,利用体表铅点标记辅助iSCOUT系统基于金标配准算法进行图像引导定位,分别记录3个平移方向左右(x)、头脚(y)和腹背(z)的初始摆位误差以及图像引导校正后的残余误差统计分析,进一步比较图像引导校正前后误差对计划剂量的影响,最后计算合理的计划靶体积(PTV)外放边界。结果 25例患者在体表铅点标记辅助iSCOUT图像引导定位下进行150次摆位验证,x、y、z轴向残余摆位误差绝对值分别为(1.53±0.96)、(1.30±0.99)、(1.34±0.92)mm,均小于初始误差值的(2.63±2.12)、(2.41±2.45)、(3.07±2.77)mm (P<0.001)。残余误差导致的剂量偏差百分比也比初始误差的小,在PTV的D98%、D2%、Dmax,心脏 Dmax、健侧乳腺 Dmax、患侧肺及双肺 Dmean等具有显著差异,与原计划偏差百分比分别由2.18%、3.19%、10.66%、8.75%、48.21%、10.50%、3.66%降低到0.38%、0.23%、2.31%、0.04%、13.78%、6.35%、0.41%(P<0.05)。图像引导后PTV外放边界估算得x、y、z轴向外放边界分别为1.87、1.75、1.69mm。结论 体表铅点标记辅助iSCOUT图像引导定位系统在乳腺癌放疗体位验证及校正中的应用具有可行性和应用价值,且为临床PTV外放边界提供新的参考。
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董芳芬
戴立言
黄妙云
翁星
江柳清
徐本华
李小波
关键词 体表铅点标记iSCOUT系统乳腺肿瘤/放射疗法摆位误差外放边界    
AbstractObjective To explore the application value of skin lead marker combined with iSCOUT image-guided positioning system in monitoring and correcting the setup error of intensity-modulated radiotherapy (IMRT) for breast cancer and calculate the PTV margin, aiming to provide reference for clinical practice. Methods 25 breast cancer patients treated with IMRT after modified radical mastectomy in Fujian Medical University Union Hospital from April to August 2019 were enrolled in this study. The skin lead marker combined with iSCOUT image-guided positioning system was employed for image-guided positioning based on the gold standard registration algorithm. Initial setup errors on the x (lateral), y (craniocaudal) and z (anteroposterior) axis and residual errors after the position correction were recorded and analyzed. The effect of the errors before and after image-guided correction upon the plan dose was compared and the reasonable PTV margin was calculated. Results 25 patients received 150 times of positioning verification using skin lead marker combined with iSCOUT image-guided positioning system. The absolute residual errors on the x-, y-and z-axis were (1.53±0.96),(1.30±0.99) and (1.34±0.92)mm, significantly smaller than the initial setup errors of (2.63±2.12),(2.41±2.45) and (3.07±2.77)mm (all P<0.001). The percentage of dose deviation due to residual errors was also smaller than that of the initial errors. Significant differences were observed in D98%, D2%, Dmax of PTV, Dmax of the heart, Dmax of the healthy breast, and Dmean of the affected lung and both lungs. The percentage deviation from the original plan was decreased from 2.18%, 3.19%, 10.66%, 8.75%, 48.21%, 10.50%, and 3.66% to 0.38%, 0.23%, 2.31%, 0.04%, 13.78%, 6.35% and 0.41%, respectively (all P<0.05). PTV margins on the x-, y-and z-axis after correction were calculated as 1.87, 1.75 and 1.69mm, respectively. Conclusion It is feasible and valuable to apply the skin lead marker combined with iSCOUT image-guided positioning system in the positioning verification and correction of breast cancer radiotherapy position, providing novel reference for clinical PTV margin.
Key wordsSkin lead marker    iSCOUT system    Breast neoplasm/radiotherapy    Setup error    Margin   
收稿日期: 2021-03-17     
基金资助:福建省科技厅高校产学研项目(2020Y4010);福建医科大学启航基金一般项目(2020QH1078)
通讯作者: 李小波,Email:lixiaobo2004@126.com;徐本华,Email:benhuaxu@163.com   
引用本文:   
董芳芬,戴立言,黄妙云等. 体表铅点标记辅助iSCOUT图像引导定位系统在乳腺癌术后调强放疗应用研究[J]. 中华放射肿瘤学杂志, 2021, 30(10): 1059-1064.
Dong Fangfen,Dai Liyan,Huang Miaoyun et al. Study of setup error and dosimetry of postoperative intensity-modulated radiotherapy for breast cancer using skin lead marker and iSCOUT image-guided positioning system[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 1059-1064.
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