摘要
目的:提出一种新的放射治疗标记方法--“井”字法,旨在提升放射治疗摆位的精准度和重复性。方法:设计一种“十”字印章,由手持方形底座和十字形凸起组成。通过该印章,可在患者体表正上方及左右两侧的激光指示区域,分别标记呼气末和吸气末的极限位置,各位置均印制一个“十”字,最终形成“井”字形标记,代表患者的呼吸运动范围。本研究包括两部分:①通过三维运动平台模拟呼吸引起的体表位移,进行仿真人模体实验;②随机选取2024年1至6月中国医学科学院肿瘤医院放射治疗科收治的乳腺肿瘤(裸露胸部外轮廓定位)和胸部肿瘤(热塑膜固定定位)患者各20例,分为“井”字法和传统“十”字法进行分组对照研究。通过治疗前的CBCT图像,比较两种标记方法对乳腺和胸部肿瘤患者摆位误差的影响,并进行统计学分析,以评估摆位精准度。结果:仿真人模体实验结果显示,“井”字法在不同呼吸运动参数下的摆位误差均显著优于“十”字法。在3种不同呼吸周期(3、4和5 s)和幅度(8、12和15 mm)下,“井”字法的摆位误差分别为(0.15±0.04)、(0.19±0.05)和(0.35±0.14)cm,而“十”字法分别为(0.42±0.16)、(0.64±0.28)和(0.88±0.37)cm,两者比较差异具有统计学意义(t=8.347、3.416、2.901,P<0.05)。实际患者研究结果表明,对于乳腺肿瘤患者(裸露胸部外轮廓定位),“井”字法的摆位误差(0.97±0.32)cm显著低于“十”字法(1.62±0.47)cm,差异有统计学意义(t=3.615,P<0.05);对于胸部肿瘤患者(热塑膜固定定位),“井”字法的摆位误差(0.69±0.24)cm同样显著低于“十”字法(0.97±0.39)cm,差异有统计学意义(t=1.934,P<0.05)。结论:与传统“十”字法相比,“井”字法在放射治疗摆位过程中展现出更高的精准度和重复性,尤其适用于需精确控制呼吸运动影响的乳腺和胸部肿瘤治疗。
Objective:To propose a novel radiotherapy marking method-the"#"-character method,which aimed at improving the accuracy and repeatability of positioning during radiotherapy.Methods:A specially"cross-shaped"stamp was designed by this study,which consisted of a handheld square base with a"cross-shaped"protrusion.Using this stamp,the extreme positions of endexpiration and end-inspiration were marked respectively at the laser-guided regions on the directly above and bilateral sides of the patient’s body,and each position was printed a"+"character.Finally,a"#-shaped"signal was formed,which represented the full range of respiratory motion of patients.The study included two parts:surface displacement caused by respiration was simulated through a three-dimensional(3D)motion platform,which was used to conduct a phantom experiment for anthropomorphic dummy,A randomized controlled study involving 40 patients,who were treated between January and June 2024 at the Department of Radiotherapy,Cancer Hospital,Chinese Academy of Medical Sciences,were conducted.The cohort included 20 patients with breast tumor(Positioning the outer contour by exposing the chest)and 20 patients with thoracic tumor(fixed position of using thermoplastic film).These patients were divided into two groups for comparison,which received respectively the"#-shaped"method and the conventional"+-shaped"method.The cone-beam computed tomography(CBCT)images before treatment were used to compare the influences of the two kinds of marking methods on the positioning errors of patients with breast tumor and patients with thoracic tumor.Then,the statistical analysis was used to assess precision and accuracy of positioning.Results:The result of phantom experiment indicated that the positioning error of the"#-shaped"method was significantly better than that of the"+-shaped"method under various parameters of respiratory movement.Under three kinds of different respiratory cycles(3,4,and 5 seconds)and amplitudes(8,12,and 15 mm),the positioning errors of the"#-shaped"method were respectively(0.15±0.04)cm,(0.19±0.05)cm and(0.35±0.14)cm,while the"+-shaped"method were respectively(0.42±0.16)cm,(0.64±0.28)cm and(0.88±0.37)cm,and the differences were statistically significant(t=8.347,3.416,2.901,P<0.05).The results of actual patients indicated the positioning error[(0.97±0.32)cm]of the"#-shaped"method was significantly lower than[(1.62±0.47)cm]of the"+-shaped"method for patients with breast tumor(Positioning the outer contour by exposing the chest),and the difference was significant(t=3.615,P<0.05).On the other hand,the positioning error[(0.69±0.24)cm]of the"#-shaped"method was significantly lower than[(0.97±0.39)cm]of the"+-shaped"method for patients with thoracic tumor(fixed position of using thermoplastic film),and the difference also was significant(t=1.934,P<0.05).Conclusion:Compared to the conventional"+-shaped"method,the"#-shaped"method appears higher accuracy and repeatability during the positioning process of radiotherapy,which especially is suitable to the treatment for breast tumor and thoracic tumor that need accurately control the influences of respiratory motion.
作者
郭晨雷
曹莹
冯鑫
张凯旋
王振
孙铭鉴
宋勇利
刘星
刘文扬
戴建荣
Guo Chenlei;Cao Ying;Feng Xin;Zhang Kaixuan;Wang Zhen;Sun Mingjian;Song Yongli;Liu Xing;Liu Wenyang;Dai Jianrong(Department of Radiotherapy,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中国医学装备》
2025年第8期52-56,共5页
China Medical Equipment
关键词
呼吸运动
放疗标记
胸部肿瘤
乳腺放疗
Respiratory motion
Radiotherapy marking
Thoracic tumor
Radiotherapy on breast
作者简介
共同第一作者:曹莹;通信作者:戴建荣,Email:dai_jianrong@cicams.ac.cn。
