| 王玮,李建彬,王素贞,张英杰,李奉祥,徐敏,尚东平.基于4D-CT测定的保乳术后全乳调强放疗靶区位移的相关性研究[J].中华放射医学与防护杂志,2011,31(6):664-667 |
| 基于4D-CT测定的保乳术后全乳调强放疗靶区位移的相关性研究 |
| A correlation study on the displacement of the whole breast target after breast-conserving surgery based on four-dimensional computed tomography |
| 投稿时间：2011-04-21 |
| DOI：10.3760/cma.j.issn.0254-5098.2011.06.011 |
| 中文关键词: 保乳术,放疗 靶区位移 四维CT 体表标记 术腔中银夹 |
| 英文关键词:Breast-conserving treatment, radiotherapy Target displacement Four-dimensional computed tomography Skin-marker Silver clip in cavity |
| 基金项目:国家自然科学基金(30870742);山东省科技发展计划(2009GG10002019) |
| 作者 | 单位 | | 王玮 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 李建彬 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 王素贞 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 张英杰 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 李奉祥 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 徐敏 | 250117 济南,山东省放射肿瘤学重点实验室,山东省肿瘤医院放疗三病区 | | 尚东平 | 大孔径CT定位室 |
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| 中文摘要: |
| 目的 探讨基于4D-CT的乳腺癌保乳术后全乳靶区在自由呼吸状态下随呼吸运动位移变化及与术腔中选定银夹、乳头及体表金属标记位移的相关性。方法 13例保乳术后拟行全乳调强放疗的患者,在自由呼吸状态下行大孔径CT模拟定位并获4D-CT图像。在瓦里安Eclipse治疗计划系统中,由同一放疗医师在每例患者10个呼吸时相CT图像上分别行全乳靶区、乳头、最上层银夹、体中线体表标记勾画,获各中心点在三维方向上的位移,分析靶区位移及与银夹、乳头和体表标记相关性。分析各呼吸时相CT图像上肺体积变化及与靶区位移的相关性。结果 全乳靶区x、y、z轴最大位移分别为0.71、0.76、1.29 mm (F=5.755,P<0.05);全乳靶区中心点三维方向位移与靶体积及同侧肺体积变化均不存在相关性;吸气末2个连续时相与呼气末3个连续时相靶区x、y、z轴平均位移相似,全乳靶体积大小相似;在x、z轴上全乳靶区位移与乳头、体中线体表标记、最上层银夹位移均无相关性,在y轴上全乳靶区位移则与乳头、正中体表标记针、最上层银夹位移有相关性的比例分别为8/13、7/11、9/13,但群体性分析显示全乳靶区位移仅与最上层银夹有相关性(r=0.657,P<0.05)。结论 乳腺体积大小和肺体积改变对全乳靶区位移无明显影响;术腔中选定银夹可用以监测靶区活动度,其用以靶区位移测量和校正可靠性优于乳头及体中线处体表标记。 |
| 英文摘要: |
| Objective To investigate the correlations of the whole breast displacement in different respiratory cycle during free breathing (FB) following breast-conserving surgery to the displacement of selected skin marker, nipple, and selected surgical clip based on four-dimensional computed tomography (4D-CT). Methods Thirteen breast cancer patients who had undergone breast-conserving surgery received whole breast intensity-modulated radiotherapy (IMRT). Respiration-synchronized 4D-CT image data were gathered during FB and were exported to the Varian Eclipse treatment planning system, and the whole breast target, nipple, superior clip, and metal marker on the skin at the anterior body midline were delineated on the CT images of ten phases of the respiratory cycle by the same radiotherapist based on the same delineating criteria. The displacement distances of the delineated target in the mediolateral (x), anteroposterior (y), and superoinferior (z) axles were achieved, and the correlations of the whole breast target displacement to the displacement of the clip, nipple, and skin marker were analyzed. The ipsilateral lung was delineated on the CT images of every phase of the respiratory cycle, and the changes in ipsilateral lung volume were analyzed during the respiratory cycle relative to the displacement of the breast. Results The maximal displacement distances of the whole breast target in the x, y, and z axles during FB were 0.71,0.76 and 1.29 mm, respectively (F=5.755,P<0.05). There was no relationship between the three-dimensional (3D) displacement of the whole breast and the volume of the whole breast (r=-0.264, P<0.05), and there was no relationship between the displacement of the whole breast and the volume change of the ipsilateral lung (r=0.346, P<0.05). There was no significant difference among the mean target displacement distances in 3 axles, and among 2 selected successive end-inspiration (EI) phases and 3 selected successive end-expiration (EE) phases. There was no significant difference between the volumes of the whole breast targets at the selected EI and EE phases. There was no relationship between the displacement of the whole breast target and the displacement of the nipple, skin marker or superior clip in the cavity along the x-and z-axles. Along the y-axle, 8/13, 7/11 and 9/13 of the patients showed displacement of the whole breast target relative to the displacement of the nipple, skin marker and superior clip respectively. However, according to a population-based analysis, the displacement of the whole breast target was only significantly associated with the displacement of the superior clip (r=0.657, P<0.05). Conclusions The clip registration is more credible and sensitive than a skin marker or the nipple for measuring and correcting the displacement of the whole breast target during radiotherapy. |
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