[1]王勇,蔡育欣,张玲玲,等.影像增强剂对食管癌边缘靶区剂量的影响[J].中国医学物理学杂志,2019,36(11):1267-1271.[doi:DOI:10.3969/j.issn.1005-202X.2019.11.005]
　WANG Yong,CAI Yuxin,ZHANG Lingling,et al.Effects of image enhancer on the dose to marginal target areas of esophageal cancer[J].Chinese Journal of Medical Physics,2019,36(11):1267-1271.[doi:DOI:10.3969/j.issn.1005-202X.2019.11.005]
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影像增强剂对食管癌边缘靶区剂量的影响()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
36卷
期数:
2019年第11期
页码:
1267-1271
栏目:
医学放射物理
出版日期:
2019-11-25

文章信息/Info

Title:
Effects of image enhancer on the dose to marginal target areas of esophageal cancer
文章编号:
1005-202X（2019）11-1267-05
作者:
王勇; 蔡育欣; 张玲玲; 李俊萍; 黄陆茂
福建医科大学附属泉州第一医院放疗科， 福建 泉州 362000
Author(s):
WANG Yong;  CAI Yuxin;  ZHANG Lingling;  LI Junping;  HUANG Lumao
Department of Radiotherapy, Quanzhou First Hospital of Fujian Medical University, Quanzhou 362000, China
关键词:
食管癌; 边缘靶区; 剂量; 影像增强剂
Keywords:
esophageal cancer;  marginal target area;  dose;  image enhancer
分类号:
R811
DOI:
DOI:10.3969/j.issn.1005-202X.2019.11.005
文献标志码:
A
摘要:
目的：研究调强放射治疗中使用影像增强剂后靠近心脏及胸主动脉等血流丰富组织的食管癌边缘靶区的剂量是否会降低，是否会出现欠量照射的情况。方法：选取20例食管癌患者病例，在相同体位下进行平扫及增强CT扫描，在增强CT上完成靶区勾画及调强治疗计划设计。使用两种方法进行对比，方法（1）：在增强及平扫CT上确定PTV & 5 mm Aorta和PTV & 5 mm Heart两个边缘靶区，然后进行图像配准并将治疗计划移植到平扫CT上计算剂量，对比上述两个边缘靶区在增强及平扫CT中剂量的变化。方法（2）：因为增强和平扫CT是在不同时间点扫描的，配准时两幅图像之间会存在一定差异，为了避免体位偏差的影响，使用合成CT与增强CT对比。所谓合成CT，即在复制的增强CT中将心脏、胸主动脉等血流丰富组织的CT值人工修改为平扫CT的平均CT值，操作过程与方法（1）相同，仍然观察上述两个边缘靶区的剂量变化。实验中也对比了其它组织器官在平扫与增强CT中剂量的变化。结果：方法（1）和方法（2）均显示PTV & 5 mm Aorta和PTV & 5 mm Heart两个边缘靶区剂量有所增加，其中方法（1）中两个边缘靶区的剂量分别增加1.28%（P<0.01）和1.64%（P<0.01），方法（2）中分别增加0.41%（P<0.01）和0.83%（P<0.01）；正常组织器官（心脏、肺、脊髓等）剂量也有所增加，但均在临床可接受范围以内。结论：使用影像增强剂后靠近心脏及胸主动脉等血流丰富组织的食管癌边缘靶区剂量有所增加，不会出现欠量照射情况。
Abstract:
Objective To study whether the dose to marginal target areas of esophageal cancer near the heart, thoracic aorta and other tissues with abundant blood flow will be decreased after the use of image enhancer in intensity-modulated radiotherapy, and whether there will be insufficient exposure. Methods Twenty cases of esophageal cancer were selected. After plain scan and enhanced CT scan were performed in the same position, target areas were delineated in enhanced CT image and intensity-modulated radiotherapy plan was designed. Two methods were used for comparison. In method (1), two marginal target areas of PTV & 5 mm Aorta and PTV & 5 mm Heart were delineated in enhanced and plain CT, and then image registration was performed and the treatment plan was transplanted to plain CT for dose calculation. The dose changes of two marginal target areas in enhanced and plain CT were compared. In method (2), since enhanced and plain CT scans were carried out at different time points, there were certain differences between the two images during registration. In order to avoid the effects caused by body position deviation, synthetic CT was compared with enhanced CT. The synthetic CT means that in the replicated enhanced CT, the CT values of the heart, thoracic aorta and other tissues with abundant blood flow were artificially modified to the average CT value of plain CT. The operation process was the same as method (1), and the dose changes of two marginal target areas were observed. The dose changes of other tissues and organs in plain and enhanced CT were also compared. Results Both methods (1) and (2) showed an increase in the dose to two marginal target areas, PTV & 5 mm Aorta and PTV & 5 mm Heart. In method (1), the doses to the two marginal target areas were increased by 1.28% (P<0.01) and 1.64% (P<0.01), respectively, while in method (2), the dose were increased by 0.41% (P<0.01) and 0.83% (P<0.01), respectively. The doses to normal tissues (heart, lungs, spinal cord, etc.) which were also increased were still within the clinically acceptable range. Conclusion After the use of image enhancer, the doses to marginal target areas of esophageal cancer near the heart, thoracic aorta and other tissues with abundant blood flow, are increased, and there is no insufficient exposure.

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备注/Memo

备注/Memo:
【收稿日期】2019-10-10 【基金项目】泉州市科技局科技计划资助项目（2016Z035）；泉州市第一医院青年科研课题资助项目（2014-QN-21） 【作者简介】王勇，高级工程师，物理师，研究方向：放射物理，E-mail: wyong2009@126.com
更新日期/Last Update: 2019-11-28