[1]冯鑫,陈欢,郑黎明,等.膀胱充盈不足对前列腺癌放疗摆位和剂量精度的影响[J].中国医学物理学杂志,2026,43(9):1209-1214.[doi:DOI:10.3969/j.issn.1005-202X.2026.09.008]
　FENG Xin,CHEN Huan,ZHENG Liming,et al.Effects of insufficient bladder filling on setup and dosimetric accuracy in prostate cancer radiotherapy[J].Chinese Journal of Medical Physics,2026,43(9):1209-1214.[doi:DOI:10.3969/j.issn.1005-202X.2026.09.008]
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膀胱充盈不足对前列腺癌放疗摆位和剂量精度的影响()

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
43卷
期数:
2026年第9期
页码:
1209-1214
栏目:
医学放射物理
出版日期:
2026-09-30

文章信息/Info

Title:
Effects of insufficient bladder filling on setup and dosimetric accuracy in prostate cancer radiotherapy
文章编号:
1005-202X（2026）09-1209-06
作者:
冯鑫1; 陈欢1; 郑黎明2; 韩娜娜3; 郇福奎1; 张文文1; 门阔1
1.国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放射治疗科， 北京 100021；2.监利市人民医院肿瘤科， 湖北 监利 433300；3.临汾市中心医院消化肿瘤一科， 山西 临汾 041000
Author(s):
FENG Xin1;  CHEN Huan1;  ZHENG Liming2;  HAN Nana3;  HUAN Fukui1;  ZHANG Wenwen1;  MEN Kuo1
1. Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China 2. Department of Oncology, Jianli Peoples Hospital, Jianli 433300, China 3. Department of Gastrointestinal Oncology I, Linfen Central Hospital, Linfen 041000, China
关键词:
前列腺癌; 膀胱体积; 摆位误差; 剂量分布
Keywords:
Keywords: prostate cancer bladder volume setup error dose distribution
分类号:
R318；R811.1
DOI:
DOI:10.3969/j.issn.1005-202X.2026.09.008
文献标志码:
A
摘要:
目的：分析膀胱充盈不足对放疗过程中摆位误差的影响，并初步探索充盈不足对剂量分布的影响。方法：回顾性选取2023年1月至2024年1月在中国医学科学院肿瘤医院进行旋转调强放疗的11例前列腺癌患者，患者在CT定位及治疗前均按统一要求憋尿后进行定位扫描或执行放疗，每次放疗前均行锥形束CT（CBCT）扫描，与计划CT对比调整后获得六维方向摆位误差。使用深度学习方法将CBCT影像生成高质量的合成CT（sCT），用于后续的轮廓勾画。使用自动勾画+人工审核的模式完成所有分次膀胱轮廓的勾画。在MIM软件上统计计划CT和sCT上膀胱轮廓体积，根据sCT影像上膀胱体积进行分组，≤80%计划CT膀胱体积定义为膀胱充盈不足组、>80%计划CT膀胱体积定义为膀胱充盈组，分析膀胱体积与放疗过程中摆位误差之间的关系。在不足组中随机选取6个分次，由医生在sCT上勾画靶区和危及器官后，将原始计划参数复制到sCT图像上，评估原始计划在当前解剖状态下患者实际接受的剂量，分析膀胱充盈不足对剂量学方面的影响。结果：11例患者共获得220组CBCT影像，其中充盈组92组，不足组128组。不足组在X（左右）、Y（头脚）、Z（腹背）方向摆位误差均高于充盈组，在Z方向差异明显，差异有统计学意义（P<0.05）。两组在Rx（矢状面）、Ry（横断面）、Rz（冠状面）轴的误差均无统计学意义（P>0.05）。在剂量学方面，6个分次的靶区覆盖率均低于95%。分次计划在膀胱Dmean、膀胱Dmax、直肠Dmax、结肠Dmean、小肠Dmean剂量上均优于原始计划，差异有统计学意义（P<0.05）。结论：膀胱体积过小会影响实际照射剂量分布，治疗时要尽可能使膀胱体积保持在80%以上以减少摆位误差、提升放疗的准确性。
Abstract:
Abstract: Objective To analyze the effects of insufficient bladder filling on setup errors during radiotherapy for prostate cancer, and to preliminarily explore its dosimetric consequences. Methods Eleven prostate cancer patients who underwent volumetric modulated arc therapy at the Cancer Hospital, Chinese Academy of Medical Sciences between January 2023 and January 2024 were retrospectively enrolled. All patients followed a consistent bladder?illing protocol before CT simulation and each treatment session. Prior to each fraction, cone?eam CT (CBCT) imaging was performed, and six?imensional setup errors were obtained after rigid registration with the planning CT. A deep learning?ased method was used to generate high?uality synthetic CT (sCT) images from the CBCT images for subsequent contouring. Bladder contours on all fractions were delineated using an approach combining auto?egmentation and manual verification. Bladder volumes on both the planning CT and sCT images were recorded using MIM software. Fractions were stratified based on the sCT?erived bladder volume: the insufficient-bladder group (≤80% of the bladder volume on the planning CT) and the full-bladder group (>80% of the bladder volume on the planning CT). The relationship between bladder volume and setup errors was analyzed. Furthermore, 6 fractions were randomly selected from the insufficient-bladder group. After the physician contoured the target and organs-at-risk on the sCT images, the original treatment plan was recalculated on the corresponding sCT images to assess the actual delivered dose in the current anatomical condition, thereby evaluating the dosimetric effects of insufficient bladder filling. Results A total of 220 sets of CBCT scans were obtained from the 11 patients, with 92 in the full-bladder group and 128 in the insufficient-bladder group. The setup errors in the X (lateral), Y (craniocaudal), and Z (anteroposterior) directions were higher in the insufficient-bladder group than in the full-bladder group, with a significant difference observed in the Z direction. No statistically significant inter-group differences were found in Rx (sagittal), Ry (transverse), and Rz (coronal) rotation errors (all P>0.05). In terms of dosimetry, target coverage was below 95% in all 6 evaluated fractions. The fractionated plan (insufficient bladder filling) was superior to the original plan in the terms of bladder-Dmean, bladder-Dmax, rectal-Dmax, colon-Dmean, and small bowel-Dmean, with all differences statistically significant (P<0.05). Conclusion Insufficient bladder volume will compromise the actual delivered dose distribution. During treatment, bladder volume should be maintained at > 80% of the planning volume whenever possible to minimize setup errors and enhance radiotherapy accuracy.

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备注/Memo

备注/Memo:
【收稿日期】2026-06-16 【基金项目】国家自然科学基金（12375320）；中国医学科学院医学与健康科技创新工程（2025-I2M-XHJC-012） 【作者简介】冯鑫，主管技师，研究方向：图像引导放疗，E-mail: 1158923096@qq.com 【通信作者】门阔，副研究员，研究方向：自适应放疗，E-mail: menkuo126@126.com
更新日期/Last Update: 2026-09-30