基于桌面级3D打印机的放射性粒子肺癌植入导板的剂量学验证

Dosimetric verification of radioactive particle implantation guide-plate printed by desktop-grade 3D printer in treating lung cancers

目的采用桌面级3D打印机设计打印聚乳酸(PLA)肺癌放射性粒子植入导板,比较该植入导板引导放射性粒子植入术后验证剂量与术前计划剂量的差异、验证剂量的准确性,探讨其临床应用的可行性。方法 2018年1月至2018年12月于安徽医科大学第一附属医院老年呼吸与危重症学科确诊的实施放射性粒子植入的10例肺癌患者,按照标准流程进行放射性粒子植入手术,采用桌面级3D打印机打印的PLA导板做引导,观察手术前后90%靶体积的最小吸收剂量(D90)、90%处方剂量覆盖的体积占靶体积的百分比(V90、V100、V150)及粒子数量有无差异。结果 10例肺癌患者术中复位良好,PLA手术导板有效地指导了肺癌放射性粒子植入手术;术前计划D90、V90、V100、V150及粒子数量分别为(12 598±1 084) cGy、(92.9±1.5)%、(89.5±1.0)%、(58.6±1.6)%、(94±53)颗,术后验证D90、V90、V100、V150及粒子数量分别为(12 629±1 538) cGy、(93.6±1.3)%、(88.9±1.7)%、(59.8±2.0)%、(94±54)颗,各指标手术前后比较差异均无统计学意义(P>0.05)。结论基于桌面级3D打印机打印的PLA肺癌放射性粒子植入导板能够有效地指导肺癌放射性粒子植入手术,较好地实现术前TPS治疗计划,满足临床肺癌放射性粒子导板引导植入手术需求。

Objective To design and print polylactic acid(PLA) lung cancer radioactive particle implantation guide-plate by using desktop-grade 3 D printer, to compare the difference in radiation dose between the postoperative verified dose and the preoperative planned dose after the implantation of radioactive particles under the guidance of the implantation guide-plate, to verify the accuracy of the dose, and to discuss its feasibility in clinical practice. Methods A total of 10 patients with proved lung cancer, who underwent implantation of radioactive particles during the period from January 2018 to December 2018 at the Department of Geriatric Respiratory and Critical Diseases, First Affiliated Hospital of Anhui Medical University of China, were enrolled in this study. According to the standard procedure, the radioactive particle implantation was performed under the guidance of PLA guide-plate that was printed by the desktop-grade 3D printer. The preoperative and postoperative minimum absorbed dose of 90% target volume(D90), the percentage of 90% prescription dose covered volume to target volume(V90, V100 and V150), and the number of used particles were recorded and analyzed. Results The PLA guide-plate was well reset during the operation and effectively guided the procedure of radioactive particles implantation. The preoperative planned D90, V90, V100, V150 and the number of particles were(12 598±1 084) cGy,(92.9±1.5)%,(89.5±1.0)%,(58.6±1.6)% and(94±53) particles respectively, and the postoperative verified D90, V90, V100, V150 and the number of particles were(12 629±1 538) cGy,(93.6±1.3)%,(88.9±1.7)%,(59.8±2.0)% and(94±54) particles respectively. No statistically significant differences in the above indicators existed between preoperative values and postoperative ones(P>0.05 in all indicators). Conclusion The PLA lung cancer radioactive particle implantation guide-plate printed by desktop-grade 3 D printer can effectively guide the implantation of radioactive particles for lung cancer and well realize the preoperative TPS treatment plan. This technique can meet the clinical requirements for guiding and implanting the radioactive particles in treating lung cancers.