中华放射医学与防护杂志

陈利,黄晓延,曹午飞,等.肺癌调强计划在水与介质中蒙特卡罗计算的剂量差异[J].中华放射医学与防护杂志,2015,35(9):670-673.Chen Li,Huang Xiaoyan,Cao Wufei,et al.The differences between Monte Carlo calculated dose-to-medium and dose-to-water for lung cancer IMRT[J].Chin J Radiol Med Prot,2015,35(9):670-673

肺癌调强计划在水与介质中蒙特卡罗计算的剂量差异

The differences between Monte Carlo calculated dose-to-medium and dose-to-water for lung cancer IMRT

投稿时间：2015-01-28

DOI：10.3760/cma.j.issn.0254-5098.2015.09.007

中文关键词: 肺癌调强放疗蒙特卡罗算法对介质的剂量对水的剂量

英文关键词:Lung cancer Intensity-modulated radiotherapy Monte Carlo algorithm Dose-to-medium Dose-to-water

基金项目:

作者	单位	E-mail
陈利	510060 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
黄晓延	510060 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心	huangxiaoy@sysucc.org.cn
曹午飞	510060 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
姚杏红	510060 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心
陈阿龙	510060 广州, 中山大学肿瘤防治中心放疗科华南肿瘤学国家重点实验室肿瘤医学协同创新中心

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中文摘要:

目的探讨肺癌调强放疗计划时,蒙特卡罗算法计算对水与介质的剂量差异。方法随机类型抽样法选取10例肺癌患者的5野调强计划,在质量保证模块下以患者自身图像为模体,采用蒙特卡罗算法分别计算两种计划的吸收剂量,计算对实际介质的吸收剂量(D_m)和对水的吸收剂量(D_w);通过剂量体积直方图的剂量体积参数和计划分析,比较两种剂量在患者体内的分布差异。结果靶区PTV65和PTV50的D_50%、D_98%和D_2%的D_m和D_w差异分别为:-0.3%、-0.2%、0.3%和0.1%、-0.6%、0.4%,其中PTV65的D_50%和PTV50的D_98%差异有统计学意义(t=-2.536、-3.776,P<0.05)。正常组织的D_50%中,脊髓、心脏、肺和食管的D_m与D_w的平均偏差为0.3%、1.1%、-0.2%和-0.1%,脊髓和心脏的D_m比D_w稍低(t=2.535、3.254,P<0.05);正常组织的D_2%的平均偏差为0.3%、-0.6%、-0.7%和0.6%,差异有统计学意义(t=2.311、-4.105、-3.878、6.214,P<0.05)。所有剂量的体积偏差均<2%。对于没有勾画出来的一些骨组织区域,D_m和D_w的偏差>5%。结论在临床使用过程中,在考虑骨性组织的受照剂量限制时,需要注意肺癌患者的D_m与D_w的相对偏差。

英文摘要:

Objective To investigate the differences between Monte Carlo (MC) calculated dose-to-water (D_w) and dose-to-medium (D_m) for lung cancers treated with intensity-modulated radiotherapy (IMRT). Methods A total of 10 lung carcinoma patients with 5-field IMRT treatment plans were stratified sampling randomly selected for this study, which were performed on Monaco treatment planning system (TPS) with MC algorithm. Using the patients' own CT images as quality assurance (QA) phantoms, two kinds of QA plan were calculated, one was the D_m, and another was the D_w plan. Dose volume histogram (DVH) parameters and the subtraction of two plans were used to evaluate the spatial distribution of the difference between the D_m and D_w. Results Differences between dose-volume indices computed with D_m and D_w for the PTV65 and PTV50 doses (D_50%, D_98% and D_2%) were -0.3%,-0.2%,0.3% and 0.1%,-0.6%,0.4%, respectively, of which the D_50% of PTV65 and D_98% of PTV50 had statistical difference (t=-2.536, -3.776, P<0.05). For normal tissues, spinal cord, heart, lung and esophagus, the D_50% differences between D_m and D_w were 0.3%, 1.1%, -0.2% and -0.1%, of which the D_m of spinal cord and heart were slightly lower than the D_w (t=2.535, 3.254, P<0.05). For the D_2% of the normal tissues, the differences were 0.3%, -0.6%, -0.7% and 0.6%, the differences were statistically significant (t=2.311, -4.105, -3.878, 6.214, P<0.05). All the differences were within 2%. Meanwhile planned subtraction analysis showed the differences between the D_m and D_w varied very much with the other body parts of the patient, especially for bone tissues, and the two doses were significant difference (>5%). Conclusion In the course of clinical application, the relative differences between D_m and D_w for lung cancers MC calculations should be noted when considering the dose limitations of bone tissue.

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