| 李清山,宋伟,符天晓.不同部分皮肤标记点相对盆腔位置变化的模拟研究[J].中华放射医学与防护杂志,2023,43(12):969-973 |
| 不同部分皮肤标记点相对盆腔位置变化的模拟研究 |
| A simulation study on the position variations of skin markers at different parts relative to the pelvic cavity |
| 投稿时间：2023-08-08 |
| DOI：10.3760/cma.j.cn112271-20230808-00036 |
| 中文关键词: 放疗 盆腔 定位 皮肤标记点 位置变化 |
| 英文关键词:Radiotherapy Pelvic cavity Localization Skin marker Position variation |
| 基金项目: |
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| 中文摘要: |
| 目的 分析常规腹盆部放疗体表不同部分皮肤标记点活动度,位移偏差值与盆腔充盈程度的相关性。方法 回顾分析苏州大学附属第一医院2020年1月至2022年1月期间15例腹盆部放疗患者,每例行4次腹盆腔CT扫描。所有影像自L3上缘至耻骨联合上缘,利用"九分法"分为右上、中、下,中上、中、下,左上、中、下9个部分,依次编号为1~9。同一患者分次间同一部分均选择同一个紧贴皮肤的血管或筋膜交叉点作为模拟放疗皮肤定位"标记点"。选取L5椎体后下缘同一点为坐标原点,测定每个标记点相对坐标。每例患者4次CT扫描两两比较,获取每个标记点三维方向的位移偏差值和活动度。9个部分标记点间分别在左右、头脚、腹背方向活动度差异的比较,采用非参数Kruskal-Wallis检验和描述性分析;各标记点三维方向位移偏差值分别与"5"的标记点腹背方向位移偏差值的相关性,采用Pearson相关性分析。结果 9个部分标记点间分别在左右、头脚、腹背方向活动度存在差异(H=36.66、66.20、92.15,P＜0.05);其中"3、9"的标记点三维方向总体活动度较其他各点小,中位数为2.40~3.75 mm;"5"的标记点腹背方向活动度最大,中位数为9.20 mm。"1、2、3、7、8、9"的标记点左右方向位移偏差值分别与"5"的标记点腹背方向位移偏差值相关(r=-0.36~0.49,P＜0.05);"4、5、6、9"的头脚方向与其相关(r=-0.34~-0.24,P＜0.05);"1、2、3、4、6、7、8、9"的腹背方向均与其相关(r=0.33~0.91,P＜0.05)。结论 以双侧髋臼区域描记皮肤标记点,对于盆腔放疗体位重复性最佳;常用的"正中"部分描记皮肤标记点易受腹盆腔充盈程度影响而发生头脚方向偏差。 |
| 英文摘要: |
| Objective To analyze the activity of skin markers at different parts of the body surface and the correlations between their displacement deviations and pelvic filling volumes during conventional abdominal and pelvic radiotherapy.Methods A retrospective analysis was conducted on 15 patients receiving abdominal and pelvic radiotherapy with four times of computed tomography (CT) in the First Affiliated Hospital of Soochow University from January 2020 to January 2022. All CT images were divided into nine parts from the upper edge of L3 to the upper edge of the pubic symphysis: upper, middle, and lower parts in the right portion; upper, middle, and lower parts in the central portion; and upper, middle, and lower parts in the left part portions, No. 1-9 in sequence. The same blood-vessel or fascia intersection points near the same skin parts receiving the same dose fraction were used as the markers for skin positioning during simulated radiotherapy. The relative coordinates of the markers were measured, with the same point at the lower edge behind the L5 vertebral body set as the coordinate origin. Through pairwise comparison of each patient's four CT images, the three-dimensional displacement deviations and activity were calculated for all markers. In the left-right (L-R), superior-inferior (S-I), and anterior-posterior (A-P) directions, the differences in the displacement activity of the markers in the nine parts were compared using both the non-parametric Kruskal-Wallis test and the Descriptives. The correlations between the three-dimensional displacement deviations of all markers and the A-P displacement deviations of the No. 5 marker were analyzed using the Pearson correlation analysis.Results Differences existed in the displacement activity of the nine-part markers in the L-R, S-I, and A-P directions (H=36.66, 66.20, 92.15, P<0.05). No. 3 and 9 markers exhibited lower overall three-dimensional displacement activity (median: 2.40-3.75 mm) than other markers. The No. 5 marker manifested the highest A-P displacement activity, with a median of 9.20 mm. The A-P displacement deviation of No. 5 marker was correlated using the L-R displacement deviations of the No. 1, 2, 3, 7, 8 and 9 markers (r=-0.36 to 0.49, P<0.05), the S-I displacement deviations of the No. 4, 5, 6, and 9 markers (r=-0.34 to -0.24, P<0.05), and the A-P displacement deviations of the No. 1, 2, 3, 4, 6, 7, 8 and 9 markers (r=0.33-0.91, P<0.05).Conclusions Skin markers drawn in bilateral acetabular regions serve as the best choices for reposition in pelvic radiotherapy. Conventional skin markers made at the central parts are prone to suffer deviations in the S-I direction due to the influence of the abdominal and pelvic filling volumes. |
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