| 李建彬,王巾帼,卢洁,于金明,马志芳,孙涛,郭守芳.乳腺癌保乳术后自主呼吸控制全乳腺调强放疗靶区勾画与靶区位移[J].中华放射医学与防护杂志,2009,29(1):58-60 |
| 乳腺癌保乳术后自主呼吸控制全乳腺调强放疗靶区勾画与靶区位移 |
| The study of target delineation and target movement of whole breast assisted by active breathing control in intensity modulated radiotherapy after breast conservative surgery |
| 投稿时间：2008-06-07 |
| DOI：10.3760/cma.j.issn.0254-5098.2009.01.018 |
| 中文关键词: 自主呼吸控制 乳房 调强放射疗法 靶区勾画 靶区位移 |
| 英文关键词:Active breathing control Breast Intensity-modulated radiotherapy Target delineation Target displacement |
| 基金项目:国家自然科学基金资助项目(30870742);山东省科技攻关资助项目(01213014) |
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| 中文摘要: |
| 目的 探讨自主呼吸控制(ABC)辅助适度深吸气呼吸控制(mDIBH)状态下勾画者和勾画时间对乳腺癌保乳术后全乳靶区的影响及放疗分次内和放疗分次间全乳靶区的位移。方法 20例保乳术后拟行全乳调强放疗患者,ABC辅助CT模拟定位获得3个呼吸状态的5套CT图像[自由呼吸(FB)1套、适度深吸气呼吸控制(mDIBH) 2套、深呼气呼吸控制(DEBH)2套]。放疗10~15次再获5套CT图像。5位放疗医师和同一放疗医师不同时间分别在初次定位获得的第1套mDIBH图像上勾画全乳靶区,比较勾画者和勾画时间对全乳靶区影响。分别标记初次定位2套mDIBH图像上术腔中全部银夹,比较全部银夹所构成几何体在分次内位移。分别勾画初次定位2套和重复定位第1套mDIBH图像上近乳腺靶区等中心平面的2条肋骨,通过比较所勾画肋骨感兴趣点(POI)空间位置位移,获得分次内和分次间胸廓扩张差异。结果 同一医师不同时间勾画4次分别所得全乳靶区体积间差异无统计学意义,5位医师分别勾画全乳靶区体积差异有统计学意义(F=19.681,P=0.000);同一mDIBH状态下,分次内全部银夹所构成几何体POI各方向位移差异无统计学意义,分次内肋骨POI各方向位移差异无统计学意义;同一mDIBH状态下,分次间肋骨POI各方向位移差异无统计学意义。结论 不同勾画者所勾画全乳靶区差异是明显的。ABC辅助mDIBH状态下分次内及分次间全乳靶区位移在各个方向上的差异不明显。 |
| 英文摘要: |
| Objective To explore the influence of different delineators and different delineating time on target determination of the whole breast and to explore intrafraction and interfraction target displacements of the breast on moderate deep inspiration breathing hold (mDIBH) assisted by active breathing control (ABC) after breast conservative surgery. Methods Twenty patients received primary CT-simulation assisted by ABC to get five sets of CT image on the three breathing condition which included one set from free breath (FB),two sets from mDIBH and two sets from deep expiration breathing control (DEBH). After radiotherapy with ten to fifteen fractions, the repeat CT-simulation was carried out to get the same five sets of CT image as the primary CT-simulation. The whole breast target were delineated at different time by the same delineator and delineated respectively by five delineators on the first set of CT images got with mDIBH from the primary CT-simulation,and to compare the influence of delineator and delineating time on the whole breast target. The total silver clips in the cavity were marked respectively on the two sets of CT images got with mDIBH from the primary CT-simulation, and to compare the intrafraction displacement of geometric body structured by the total of silver clips. The two ribs near the isocentric plane of the breast target were delineated respectively on two sets of the mDIBH CT image from the primary CT-simulation and on one set of the mDIBH CT image from the repeat CT-simulation, and comparing the movement of the point of interest (POI) of the ribs delineated to get the value of intrafraction and interfraction thoracic expansion. Results There was not statistically significant between the four volumes of whole breast targets delineated by the same delineator at different time, but with statistics significant between the volumes of whole breast target delineated by the different delineators(F=19.681,P=0.000). There was not statistically significant between the intrafraction displacements of the POI of the geometric body at each direction, and with no statistically significant between intrafraction displacements of the POI of the ribs delineated on the same mDIBH condition. There was not statistically significant between the interfraction displacements of the POI of the ribs delineated.Conclusion The influence of different delineators on the whole breast target is statistically significant. The difference of displacement of the breast target with the same mDIBH condition assisted by ABC at the different direction is not statistically significant. |
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