中华放射医学与防护杂志

李倩,尹勇,佟颖,等.左侧乳腺癌调强放疗中心跳对左心室肌及左前降支剂量评估的影响[J].中华放射医学与防护杂志,2018,38(10):747-750.Li Qian,Yin Yong,Tong Ying,et al.The impact of heartbeat on the left ventricular myocardial and the left anterior descending coronary arterial dosimetry following intensity modulated radiotherapy for left-sided breast cancer[J].Chin J Radiol Med Prot,2018,38(10):747-750

左侧乳腺癌调强放疗中心跳对左心室肌及左前降支剂量评估的影响

The impact of heartbeat on the left ventricular myocardial and the left anterior descending coronary arterial dosimetry following intensity modulated radiotherapy for left-sided breast cancer

投稿时间：2018-04-10

DOI：10.3760/cma.j.issn.0254-5098.2018.10.005

中文关键词: 乳腺癌调强放疗左心室肌左前降支剂量评估

英文关键词:Breast carcinoma Intensity modulated radiotherapy Left ventricular myocardial Left anterior descending Dose evaluation

基金项目:国家自然科学基金（81301936）；山东省重点研发计划（2018GSF118048）

作者	单位	E-mail
李倩	421001 衡阳, 南华大学核科学技术学院
尹勇	250117 济南, 山东大学附属山东省肿瘤医院放射物理技术科
佟颖	250117 济南, 山东大学附属山东省肿瘤医院放射物理技术科
魏鸿	250117 济南, 山东大学附属山东省肿瘤医院放射物理技术科
程品晶	421001 衡阳, 南华大学核科学技术学院
巩贯忠	250117 济南, 山东大学附属山东省肿瘤医院放射物理技术科	gongguanzhong@yeah.net

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中文摘要:

目的研究左侧乳腺癌调强放射治疗（IMRT）中，心跳对左心室肌（mLV）及左前降支（LAD）剂量评估的影响。方法选取15例女性患者平静吸气屏气下的心电门控（ECG-gated）4D-CT图像，参照心动周期以5%间隔进行图像重建，重建0~95%共20个时相的图像。分别勾画mLV及LAD。基于0%时相的图像进行左侧乳腺癌IMRT计划设计。统计各时相mLV的体积并计算相似性指数（dice similarity coefficient，DSC）；计算LAD及mLV剂量-体积指标的变化范围。结果 mLV的DSC变化率最大可达472.07%，其平均变化率约为体积变化率的8倍。mLV的体积与DSC在最大、最小值之间差异均具有统计学意义（t=-6.585、-28.870，P<0.05）。mLV的平均剂量（D_mean）变化率最高可达41.95%。mLV的D_mean、V₁₀、V₂₀、V₃₀、V₄₀在最大、最小值之间差异均有统计学意义（t=-5.260、-4.084、-3.592、-3.273、-2.566，P<0.05）。LAD的D_mean平均变化率最高可达130.14%。LAD的D_mean、V₁₀、V₂₀、V₃₀、V₄₀在最大、最小值之间差异均有统计学意义（t=-9.758、-8.810、-8.682、-7.853、-6.205，P<0.05）。结论左侧乳腺癌放疗中，心跳对mLV和LAD的剂量评估影响不容忽视。

英文摘要:

Objective To study the impact of heartbeat on the left ventricular myocardial (mLV) and the left anterior descending (LAD) coronary arterial dosimetry following intensity modulated radiotherapy (IMRT) for left-sided breast carcinoma. Methods A total of 15 female patients who received electrocardiography gated 4D-CT scan in inspiratory breathing-holding were enrolled. According to cardiac cycle, 20 time-phase images were reconstructed from 0 to 95% at 5% interval. Then, the mLV and the LAD were delineated respectively and the IMRT plans of the left breast carcinoma were generated based on 0% phase CT images. The volume and dice similarity coefficient (DSC) of the mLV were calculated, and the variation range of the mLV and the LAD dose-volume indexes were compared among different phases. Results The average rate of DSC variation of mLV was eightfold of volume, which reached to 472.07%,and the average change rate of mLV (D_mean) was up to 41.95%. The difference of the mLV's volume and DSC was statistically significant between the maximum and minimum(t=-6.585, -28.870, P<0.05), as well as the D_mean, V₁₀, V₂₀, V₃₀ and V₄₀(t=-5.260, -4.084, -3.592, -3.273, -2.566, P<0.05). The average change rate of the LAD's D_mean was up to 130.14%. The difference of D_mean, V₁₀, V₂₀, V₃₀ and V₄₀ of LAD was statistically significant between the maximum and minimum(t=-9.758, -8.810, -8.682, -7.853, -6.205,P<0.05). Conclusions The dosimetry impact of heartbeat on mLV and LAD should not be ignored.

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