| 徐飞,郭福新,彭冉,范京红,李卫燕,张喜乐,王巍,程程,赵田地,王俊杰.CT引导3D打印共面模板辅助植入金标射波刀放射治疗利用率统计与弃用原因分析[J].中华放射医学与防护杂志,2018,38(3):187-191 |
| CT引导3D打印共面模板辅助植入金标射波刀放射治疗利用率统计与弃用原因分析 |
| Analysis of the qualified rate of the fiducial markers and the cause of unqualified ones by the means of 3D-printing co-planar template assisted CT-guided implantation in stereotactic body radiation therapy of CyberKnife |
| 投稿时间：2018-01-22 |
| DOI：10.3760/cma.j.issn.0254-5098.2018.03.005 |
| 中文关键词: 肿瘤 射波刀 金标植入 利用率 3D打印共面模板 |
| 英文关键词:Tumor CyberKnife Fiducial markers Qualified rate 3D-printing co-planar template |
| 基金项目:福建省自然科学基金项目（2015J01366）；福建省卫生计生委创新课题（2014-CXB-5） |
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| 中文摘要: |
| 目的 统计射波刀治疗中CT引导3D打印共面模板辅助植入金标的利用率，并分析金标弃用的原因，为射波刀治疗金标植入、放射治疗计划设计和放射治疗操作提供参考数据。方法 2017年3月至12月，在北京大学第三医院CT引导3D打印共面模板辅助植入金标52例，其中肺22例、肝12例、纵隔淋巴结5例、腹膜后淋巴结8例、胰腺3例、腹腔淋巴结1例、盆腔淋巴结1例。射波刀共治疗45例肿瘤患者，42例使用金标联合呼吸追踪进行治疗，3例因不能使用金标改为脊柱追踪。植入金标52例中，有7例未行射波刀放疗。统计患者在射波刀治疗时使用金标和弃用金标的数量，得到金标利用率和弃用率。对弃用金标的原因进行了分析。结果 42例使用金标联合呼吸追踪患者植入131颗金标有85颗使用，利用率为64.89%；弃用46颗，弃用率为35.11%。造成金标弃用的主要因素有刚性误差大12颗（26.08%），植入金标不符合要求有19颗（41.31%），其中45°共线的有2颗（4.35%）、金标间距小于阈值的有4颗（8.70%）、连线角度<15°的有5颗（10.87%），其他因素有15颗（32.61%），其中无法正确识别的5颗（10.87%）、物体遮挡的有4颗（8.70%）、移位的有6颗（13.04%）。植入后患者出现并发症的有气胸4例，血胸1例，疼痛2例，未出现感染等其他并发症。结论 与既往单纯CT引导徒手植入和超声引导下金标植入文献比较，CT引导3D打印共面模板辅助金标植入，可减少穿刺针数目，降低患者穿刺造成的风险和创伤，降低金标植入手术术后并发症的发生率，但植入的金标会因各种原因造成弃用。因此，在金标植入等环节中需考虑此情况。 |
| 英文摘要: |
| Objective To analyze the qualified rate of the fiducial markers during 3D-printing co-planar template assisted CT-guided implantation in stereotactic body radiation therapy by CyberKnife,and to explore the cause of the unavailable markers in order to provide the reference for the fiducial implantation, treatment planning and radiotherapy delivery. Methods From March to December 2017, a total of 52 cases were planned to stereotactic body radiation therapy(SBRT) using CyberKnife by fiducial tracking, and the fiducial markers were implanted based on CT-guided 3D-printing co-planar template, including 22 in lung, 12 in liver, 5 in mediastinal lymph node, 8 in retroperitoneal lymph node, 3 in pancreas, each in celiac and pelvic lymph nodes, respectively. Except 7 cases not fit for CyberKnife treatment, 45 cases finished the treatment of CyberKnife, but there were 3 cases changed to spine tracking due to unqualified fiducial markers. The number of fiducial markers used and the qualified rate of fiducial markers were analyzed,and the cause of unqualified fiducial markers was studied.Results A total of 131 fiducial markers were impanted into 42 cases who finally received the treatment of CyberKnife by fiducial tracking,including 85 fiducial markers qualified(64.89%) and 46 fiducial markers unqualified (35.11%). The main causes of the unqualified fiducial markers varied, including outrange of rigidity error(26.08%), fiducial markers unavailable(41.31%), and other (32.61%).Conclusions The 3D-printing co-planar template assisted CT-guided implantation could reduce the number of puncture needles used,help to decrease the risk of puncture and trauma and the incidence of complications after the fiducial markers implantation. However, the fiducial markers implanted by this way would be abandoned by a variety of causes and should be taken into account before the fiducial markers implantation. |
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