中华放射医学与防护杂志

刘成新,巩贯忠,刘玉忠,等.基于千伏级锥形束CT进行心脏受量评估的研究[J].中华放射医学与防护杂志,2013,33(5):489-492.LIU Cheng-xin,GONG Guan-zhong,LIU Yu-zhong,et al.To evaluate the irradiation dose of heart based on kV-CBCT and planning CT in the stereotactic body radiotherapy of early stage non-small cell lung cancer (NSCLC)[J].Chin J Radiol Med Prot,2013,33(5):489-492

基于千伏级锥形束CT进行心脏受量评估的研究

To evaluate the irradiation dose of heart based on kV-CBCT and planning CT in the stereotactic body radiotherapy of early stage non-small cell lung cancer (NSCLC)

投稿时间：2013-01-17

DOI：10.3760/cma.j.issn.0254-5098.2013.05.008

中文关键词: 立体定向放射治疗剂量学千伏级锥形束CT 心脏

英文关键词:Stereotactic body radiotherapy Dosimetry Kilovoltage-cone beam computed tomography Heart

基金项目:国家自然科学基金(81272699);山东省自然科学基金(ZR2009CL032,ZR2011HL060)

作者	单位	E-mail
刘成新	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科
巩贯忠	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科
刘玉忠	济南军区空军机关医院放疗科
卢洁	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科
刘同海	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科
董玮	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科
赵木昆	河北大学
尹勇	250117 济南大学医学与生命科学学院山东省肿瘤医院放疗科	yongyinsd@163.com

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中文摘要:

目的研究早期非小细胞肺癌(NSCLC)患者行立体定向放射治疗(SBRT)时,基于千伏级锥形束CT(kV-CBCT)和定位CT制定放疗计划的心脏受量的差异。方法选取在本院接受放射治疗的早期NSCLC患者15例,每次治疗前均拍摄CBCT进行摆位误差纠正。利用每位患者前10次的CBCT进行研究,处方剂量定义为5 Gy×10次。应用首次kV-CBCT与定位CT进行心脏范围勾画,比较两种勾画方式下心脏剂量学参数的差异。结果基于第1次治疗时的kV-CBCT图像勾画的心脏体积(717±103)cm³大于基于定位CT勾画的(588±90)cm³,差异具有统计学意义(t=13.8,P<0.05);基于kV-CBCT获得的心脏相对剂量-体积(V_x _Gy-R)指标中除V₅ _Gy-R外,V₁₀ _Gy-R、V₁₅ _Gy-R、V₂₀ _Gy-R、V₂₅ _Gy-R、V₃₀ _Gy-R、V₃₅ _Gy-R大于基于定位CT,差异有统计学意义(t=2.3~3.9,P<0.05);基于kV-CBCT所获得的绝对剂量-体积(V_x _Gy-A)指标V₅ _Gy-A、V₁₀ _Gy-A、V₁₅ _Gy-A、V₂₀ _Gy-A、V₂₅ _Gy-A、V₃₀ _Gy-A、V₃₅ _Gy-A大于基于定位CT,差异有统计学意义(t=4.8~7.9,P<0.05);基于CBCT所获得的心脏固定体积内的剂量指标D₅₀ _cm³、D₁₀₀ _cm³、D₁₅₀ _cm³、D₂₀₀ _cm³、D₂₅₀ _cm³及D_mean、D_max大于基于定位CT,差异有统计学意义(t=2.9~6.5,P<0.05)。结论根据kV-CBCT的特性及其心脏受量统计分析,应用kV-CBCT进行心脏受量评价可弥补心跳和呼吸的影响,得到更真实、客观的剂量-体积参数。

英文摘要:

Objective To compare the difference in evaluating the heart irradiation dose based on different heart range contoured on kilovoltage-cone beam computed tomography (kV-CBCT) and planning CT images in stereotactic body radiotherapy (SBRT) of non-small cell lung cancer (NSCLC) at early stage. Methods Fifteen early NSCLC patients who underwent radiotherapy were selected. For every case, kV-CBCT scan was achieved before every fraction treatment to correct the setup error, and the first 10 serious kV-CBCT images were adopted. The heart range on kV-CBCT and planning CT images was contoured and the differences between volume and dose-volume indices were analyzed. Results The heart volume on first kV-CBCT [(717±103)cm³] was larger than that on planning CT [(588±90)cm³] with statistical difference(t=13.8,P<0.05). The relative dose-volume indices: V_10Gy-R,V_15Gy-R,V_20Gy-R,V_25Gy-R,V_30Gy-R,V_35Gy-R obtained on CBCT images were larger than those on planning CT with statistical difference (t=2.3-3.9,P<0.05) expect for V_5Gy-R. The absolute dose-volume indices:V_5Gy-A,V_10Gy-A,V_15Gy-A,V_20Gy-A,V_25Gy-A,V_30Gy-A,V_35Gy-A obtained on CBCT images were larger than those on planning CT, and all differences were statistically significant(t=4.8-7.9,P<0.05). The dose of certain heart volume D_mean,D_max,D_50cm³,D_100cm³,D_150cm³,D_200cm³,D_250cm³,based on CBCT images were larger than CT images with statistical difference(t=2.9-6.5,P<0.05). Conclusions Based on the characteristics of kV-CBCT and the dose-volume indices of heart, the more accurate and objective dose-volume indices could be obtained through applying kV-CBCT in SBRT of NSCLC.

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