超声图像与CBCT图像引导宫颈癌放疗摆位误差的对比分析

发布时间：2018-03-30 06:18

本文选题：宫颈癌　切入点：放射治疗　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的:通过比较超声图像与CBCT图像引导宫颈癌放疗中的摆位误差,验证超声图像引导放疗在宫颈癌中治疗中的实用性和可行性。方法:选取10例宫颈癌初治患者,行图像引导放疗(IGRT),分别予以模拟定位、增强扫描,并由同一放疗医师在增强CT图像上行各靶区勾画及危及器官的勾画,由放疗物理师制定放疗计划,计算各靶区剂量大小,PTV的处方剂量50.4 Gy/28f,1.8 Gy/f.在放疗前10例患者分别行B超图像引导和CBCT图像引导验证,并分别记录每次三维方向(前后、左右和头脚方向)上移位的偏差。得出误差值,比较两种方法在的三维方向误差值,计算其统计学差异;并得出靶区和危及器官的剂量学指标、危及器官剂量分布,收集相关数据进行统计分析。结果:1.左右方向B超验证后移位误差值为(2.49±3.65)mm、CBCT验证后为(2.55±3.09)mm,比较两种方法摆位误差,差异无统计学意义(P=0.84,t=-2.10);前后方向B超验证后移位误差值为(2.86±4.30)mm,CBCT验证后移位为(2.68±3.80)mm,前后方向两种方法比较,差异无统计学意义(P=0.34,t=1.03);头脚方向上B超验证后移位误差值为(3.05±4.47),CBCT验证后移位为(3.57±4.61)mm,两种方法比,差异无统计学意义(P=0.16,t=-1.60)。2.在宫颈癌放疗的摆位移动度上,超声图像引导系统在左右及头脚方向上的系统误差比CBCT引导的系统误差要低,前后方向超声图像引导较CBCT大。3.各靶区计划均能够满足剂量学要求,危及器官的计划上均未超出正常组织器官的耐受剂量结论:1.CBCT图像引导宫颈癌放疗摆位误差广泛应用于临床,超声图像引导与CBCT图像引导宫颈癌放疗摆位误差比较,无明显统计学差异,且其操作简便,无电离辐射、系统误差小、可实时纠正,亦可应用于临床。2.本计划在直肠、膀胱及股骨头的保护上,均满足所有危及器官的剂量学要求。IGRT计划在危及器官的剂量分布上具有优势,能够较好地保护宫颈癌患者靶区周围的正常组织器官。
[Abstract]:Objective: to verify the practicability and feasibility of ultrasound guided radiotherapy in cervical cancer by comparing the positioning error between ultrasound image and CBCT image guided radiotherapy for cervical cancer. Methods: ten patients with cervical cancer were selected. Image guided radiotherapy was performed to simulate the location, enhance the scanning, and the same radiotherapeutic physician was used to draw up each target area of the enhanced CT image and to draw up the dangerous organs. The radiotherapy plan was drawn up by the radiation physicist. The prescription dose of 50. 4 Gy / 28 f / 1. 8 Gy / f was calculated for each target area. Before radiotherapy, 10 patients were guided by B ultrasound and CBCT respectively, and the three dimensional directions were recorded respectively (before and after radiotherapy). The deviation of displacement on the left and right and the direction of the head and foot. Get the error value, compare the three dimensional error of the two methods, calculate the statistical difference, and get the dosimetry index of the target area and the endangering organ, endanger the organ dose distribution, The results showed that the displacement error of the two methods was 2.49 卤3.65 mm and 2.55 卤3.09 mm after CBCT verification. The difference was not statistically significant (P < 0. 84) ~ 2. 10%, the difference of displacement error was 2. 86 卤4. 30 mm after CBCT, and 2. 68 卤3. 80 mm after CBCT, and the difference between the two methods was compared with that in front and rear direction, the difference between the two methods was 2.86 卤4. 30 mm after CBCT, and the difference was 2. 68 卤3. 80 mm. There was no significant difference between the two methods (P < 0.05 卤4.47). There was no significant difference between the two methods. There was no significant difference between the two methods, and there was no significant difference between the two methods. The displacement error was 3.05 卤4.47 卤4.61mm. there was no significant difference between the two methods, and there was no significant difference between the two methods. The system error of ultrasonic image guidance system is lower than that of CBCT guidance system in left and right direction and head and foot direction, and the front and rear direction ultrasonic image guidance is larger than that of CBCT. Each target plan can meet the requirements of dosimetry. Conclusion: 1. CBCT-guided radiotherapy errors of cervical cancer are widely used in clinical practice. Ultrasound image guidance is compared with CBCT image-guided cervical cancer radiotherapy alignment error. There is no significant statistical difference, and its operation is simple, no ionizing radiation, system error is small, can be corrected in real time, can also be used in clinical .2.This program can be used in the protection of rectum, bladder and femoral head. IGRT program has advantages in dose distribution of endangered organs and can protect normal tissues and organs around the target area of cervical cancer patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55;R445.1

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