治疗机托架对低熔点铅挡块位置的影响及相应的质量控制措施

Effects of Gantry Position on the Accuracy of Lead Block Localization and Relative Quality Control Methods

背景与目的:目前,国内绝大多数的放射治疗机构都是以低熔点铅挡块作为实现精确的线束向适形放射治疗的主要手段。尽管低熔点铅挡块在临床使用前已通过挡块校验机或治疗机的光学验证,但由于这些验证仅是在机架为0°时进行的,因此,除非做好预防措施,否则不能保证这些挡块在机架斜角度也能通过后续的射野摄片验证(主要是相对于照射野十字中心线的挡块位置误差),而造成这些位置误差的非人为因素,都涉及到治疗机托架。本文就治疗机托架对低熔点铅挡块的影响及采取的相应的控制措施进行探讨。方法:在西门子直线加速器上设置90°的机架角度和0°的准直器角度,在托架里的挡块固定有机板上设置与照射野灯光十字投影线相重合的十字定位刻线,然后变换不同的机架角度和准直器角度,观察这些条件下固定有机板上的十字刻线与照射野灯光十字投影线相重合的程度。结果:挡块固定有机板与治疗机托架之间存在固有的安装间隙虚位,在不同准直器角度范围内倾斜机架,托架内的固定有机板(包括挡块)会因重力的缘故而程度不一地朝这些虚位移动,从而使有机板上的挡块也随之在照射野中出现位置偏移,折算到源轴距位置处有0～3.6mm的位置误差。结论:在挡块固定有机板上设置准确的十字定位线,以此作为挡块在固定有机板上的安装和位置检验的基准,同时作为挡块在托架位置处与照射野十字灯光投影线对中的标记线,可以预先了解挡块位置偏移情况进而采取控制措施;在不同机架斜角度下,准直器旋至托架开口与地面平行或斜向天空、但托架内限位角的平分角线打斜指向天空(此时托架的第一基准边斜向或正向天空)时的角度范围内时,可避免或减少挡块在托架位置处出现偏移的现象。

BACKGROUND ＆ OBJECTIVE： To date, the low-melting point lead blocks are commonly used as a beam modifier for the accurate threedimensional （3D） radiotherapy in China. However, care should be taken when using blocks even though they are verified on the specified simulator or linear accelerator before treatment. This is because that those verifications are only performed under the gantry angle of 0°. For the oblique gantry angles, the block may shift in the tray leading to the positioning error. In this study, we explored the influence of gantry position on the accuracy of lead block localization, and the relative quality control methods were also provided. METHODS： After rotating the gantry to 90° and setting the collimator angle to 0° on a Siemens linear accelerator, a crosshair was marked on the plastic base of the lead block fitted to the tray according to the crosshair of light field of the linear accelerator. Then the discrepancy between the base crosshair and the light crosshair was investigated for different gantry positions and collimator angles. RESULTS： There was clearance between the plastic base of the lead block and the block tray. As for some collimator angles at oblique gantry positions, the lead block shifted in the tray due to the gravity. This led to the position error of blocked radiation fields from 0 up to 3.6 mm at the isocenter plane. CONCLUSIONS： Accurately marking the crosshair on the plastic base of the lead block is an effective method of correctly fixing the lead block influenced by the plastic base as well as of double checking the accuracy of the localization of the lead block. The positioning error of oblique gantry positions can be minimized by limiting the collimator to some degrees which makes the block tray opening to the ceiling or parallel to the ground while the bisector of the restrictive angle points slanting to the ceiling （that is, the first baseline of the block tray points inclined or right to the ceiling）.