乳腺癌调强放射治疗影像引导锥形束CT匹配区域选择对靶区精度的影响及临床应用

陈国泉; 房建南; 杨瑾; 李欢; 王玺先; 郭再仁; 马玉家; 石俊田; 黄晓波

doi:10.11889/j.1000-3436.2023-0035

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乳腺癌调强放射治疗影像引导锥形束CT匹配区域选择对靶区精度的影响及临床应用

辐射生物学与医学 | 更新时间：2023-12-18

- 乳腺癌调强放射治疗影像引导锥形束CT匹配区域选择对靶区精度的影响及临床应用
- Effects of automatic registration range settings of cone-beam computed tomography (CBCT) on target volume accuracy and clinical applications for breast cancer
- 辐射研究与辐射工艺学报 2023年41卷第6期页码：60301
- 作者机构：
  
  1.中山大学孙逸仙纪念医院肿瘤放疗科广州 510120
- 作者简介：
  
  陈国泉，男，1995年1月出生，2017年6月于中山大学新华学院获学士学位，从事肿瘤放射物理学研究，放射治疗师
  黄晓波，博士，副主任医师，E-mail: huangxbo@mail.sysu.edu.cn
- 基金信息：
  
  “2023年度广州市基础研究计划市校（院）联合资助项目”(2022A03J01189)
- DOI：10.11889/j.1000-3436.2023-0035
  中图分类号：
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陈国泉, 房建南, 杨瑾, 等. 乳腺癌调强放射治疗影像引导锥形束CT匹配区域选择对靶区精度的影响及临床应用[J]. 辐射研究与辐射工艺学报, 2023, 41(06): 060301.

CHEN Guoquan, FANG Jiannan, YANG Jin, et al. Effects of automatic registration range settings of cone-beam computed tomography (CBCT) on target volume accuracy and clinical applications for breast cancer[J]. Journal of Radiation Research and Radiation Processing, 2023, 41(6): 060301.
陈国泉, 房建南, 杨瑾, 等. 乳腺癌调强放射治疗影像引导锥形束CT匹配区域选择对靶区精度的影响及临床应用[J]. 辐射研究与辐射工艺学报, 2023, 41(06): 060301. DOI： 10.11889/j.1000-3436.2023-0035.

CHEN Guoquan, FANG Jiannan, YANG Jin, et al. Effects of automatic registration range settings of cone-beam computed tomography (CBCT) on target volume accuracy and clinical applications for breast cancer[J]. Journal of Radiation Research and Radiation Processing, 2023, 41(6): 060301. DOI： 10.11889/j.1000-3436.2023-0035.

摘要

探究乳腺癌调强放射治疗影像引导锥形束CT（Cone-beam CT， CBCT）匹配区域的选择对靶区精度的影响，为临床应用提供参考。回顾性分析2020年1月至10月乳腺癌保乳术后行放疗患者22名，比较入组病例不同匹配框对靶区匹配精度的影响，设置胸骨组（对照组1）、胸椎组（对照组2）与胸骨胸椎+靶区组（研究组）3种不同匹配区域进行配准，每组测量记录匹配误差、CBCT与定位CT靶区术腔边界金属夹位移数据。共获得匹配误差与靶区金属夹位移数据各528组，对所得数据采用独立样本非参数检验分析并计算3组金属夹的3D矢量距离。胸骨组与研究组匹配误差除旋转误差,X,轴方向差异有统计学意义，其余方向差异均无统计学意义（,p,>,0.05），胸椎组与研究组的匹配误差均无统计学意义（,p,>,0.05）。胸骨组与研究组靶区金属夹在,X、Y、Z,三个方向位移分别为：（1.59±1.61） mm与（1.23±1.19） mm （,p,=0.045）、（1.65±1.44） mm与（1.89±1.52） mm（,p, =0.006）、（1.13±1.18） mm与（1.37±1.31） mm （,p,=0.999）；胸椎组与研究组靶区金属夹在,X、Y、Z,三个方向的位移分别为：（1.51±1.83） mm与（1.23±1.19） mm （,p, =0.002）、（1.69±1.84） mm与（1.89±1.52） mm （,p,<,0.001）、（0.91±1.28） mm与（1.37±1.31） mm （,p,=0.003）。三组靶区金属夹3D矢量距离分别为：（3.16±1.92） mm、（3.62±1.92） mm、（2.52±1.53） mm。乳腺癌调强放疗CBCT自动配准最佳匹配区域应包括胸骨、胸椎与患侧靶区，术腔放置金属夹能提高乳腺癌放疗靶区匹配精准度。

Abstract

To explore the influence of cone-beam computed tomography (CBCT) matching reference point selection on target accuracy in intensity-modulated radiotherapy (IMRT) for breast cancer and aimed to provide a reference for clinical application. We conducted a retrospective analysis on breast cancer patients who underwent postoperative radiotherapy between January 2020 and October 2020. CBCT images for image-guided radiotherapy, different matching reference points, and the location of computed tomography (CT) image registration were used to divide patients into the sternum (control group 1), thoracic (control group 2), and sternum-thoracic + target (team) groups. CBCT alignment was confirmed by three different registration methods. After matching, the matching error and spatial displacement of the metal clip at the boundary of the operative cavity in CBCT and target CT were measured and recorded. A total of 528 sets of matching errors and spatial displacement data of metal clips in the target area were obtained for 22 enrolled patients. Independent sample nonparametric tests were used to analyze the significant differences in the three groups of data, and the distance of metal clips in the three groups was calculated. The matching errors of the sternum and study groups were statistically significant, except for the rotation error in the direction of the ,X,-axis (,p,>,0.05). There were no statistically significant differences in the matching error between the thoracic vertebra and the study groups (,p,>,0.05). After the sternum group was matched with the study group, the displacements of the metal clips in the target area of CBCT and CT in the ,X,Y, and ,Z, directions were as follows: (1.59±1.61) mm and (1.23±1.19) mm (,p,=0.045), (1.65±1.44) mm and (1.89±1.52) mm (,p,=0.006), and (1.13±1.18) mm and (1.37±1.31) mm (,p,=0.999), respectively. The thoracic vertebra group was matched with the study group, and the displacements of the metal clips in the target area of CBCT and CT in the ,X, Y, and ,Z, directions were as follows: (1.51±1.83) mm and (1.23±1.19) mm (,p,=0.002), (1.69±1.84) mm and (1.89±1.52) mm (,p,<,0.001), and (0.91±1.28) mm and (1.37±1.31) mm (,p,=0.003), respectively. Moreover, the 3D vector distances of metal clips in the three groups were (3.16±1.92) mm, (3.62±1.92) mm, and (2.52±1.53) mm, respectively. The selection of optimal reference points for IMRT CBCT automatic registration of breast cancer should simultaneously include the sternum, thoracic vertebra, and target area of the affected side. Placement of a metal silver clip in the intraoperative cavity can improve the matching accuracy of the target area of breast cancer radiotherapy.

关键词

乳腺肿瘤/调强放射疗法摆位误差CBCT匹配区域自动配准

Keywords

Breast tumor/intensity modulated radiotherapyPosition errorMatching reference pointsAutomatic registration

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