胸部肿瘤使用手臂支撑架和不同配准方式的误差分析

The error analysis of thoracic tumors using arm braces and different registration methods

目的为了提高摆位精度、提升患者摆位舒适性、加快摆位时间、减少摆位误差,比较手臂支撑托架与普通摆位在放疗中引起的摆位误差,分析手臂支撑托架的固定效果和使用的必要性;分析不同配准方式对摆位误差的影响。方法回顾性分析于2021年8月—2022年12月在眉山市中医医院接受放射治疗的40例胸部肿瘤患者作为分析样本。将这些患者随机分为两组,即A组和B组,各20例患者。A组为支撑架摆位,B组为普通摆位。A组:(1)头颈胸腹一体式固定框架;(2)固定头枕;(3)胸腹部长条热塑膜;(4)体表标记线;(5)手臂支撑托架。B组:(1)头颈胸腹一体式固定框架;(2)固定头枕;(3)胸腹部长条热塑膜;(4)体表标记线;(5)双手报肘置于额头辅助摆位。两组患者开始治疗第一周实行5次CBCT扫描,往后每周扫描一次记录其摆位误差数据;采用的配准方式为:(1)骨配准;(2)灰度配准;(3)靶区配准,A组和B组都采用以上三种方式进行配准并对Z(升降)Y(头脚)X(左右)等各项数据进行分析。结果两组相比手臂支撑托架组在骨、软组织、靶区配准方式中Z(升降)Y(头脚)X(左右)方向的统计学意义分别是骨Z(P>0.05),Y(P<0.05),X(P<0.05);软组织Z(P>0.05),Y(P<0.05),X(P<0.05);靶区Z(P>0.05),Y(P<0.05),X(P<0.05);AB两组分别使用同组不同配准方式对比在Z、Y、X方向的误差进行对比,B组仅在骨与靶区Y方向上(P>0.05),其余均P<0.05。结论因此在治疗胸部肿瘤时手臂支撑托架摆位误差小于普通摆位,在配准方式方面应首选为软组织配准。

Objective In order to improve the positioning accuracy,improve the positioning comfort of patients,speed up the positioning time,reduce the positioning error,compare the positioning error caused by the arm support bracket and the ordinary positioning in radiotherapy,analyze the fixed effect and the necessity of use,and analyze the influence of different registration methods on the positioning error.Methods It is divided into two AB groups,Group A is the support frame,Group B is the ordinary placement,20 patients were randomly assigned to the two AB groups.Group A:①head,neck,chest and abdomen integrated fixed frame,②fixed head rest,③chest and abdomen long strip thermoplastic film,④body surface marking line,⑤arm support bracket.Group B:①head,neck,chest and abdomen integrated fixed frame,②fixed head rest,③chest and abdomen long strip thermoplastic membrane,④body surface marking line,⑤hands reported elbow in the forehead auxiliary position.5 CBCT scans in the first week of treatment,Scan later once a week to record its position error data.The registration methods are as follows:①Bone registration,②Gray registration 3.Both group A and Group B were registered in the above three methods and analyzed the data of Z(lifting),Y(head and foot),X(left and right).Results The statistical significance of Z(lift)Y(head and foot)X(left and right)in the registration methods of bone,soft tissue and target area between the two groups was bone Z(P>0.05),Y(P<0.05),X(P<0.05).Soft tissue Z(P>0.05),Y(P<0.05),X(P<0.05).Target area Z(P>0.05),Y(P<0.05),X(P<0.05).The errors in the Z,Y and X directions of the two groups AB were compared by different registration methods in the same group,and the errors in the Y direction of the bone and the target area in group B were only compared(P>0.05),and the rest were all P<0.05.Conclusion Therefore,in the treatment of the arm support bracket is less than that of the chest tumor,In terms of registration mode,soft tissue registration should be preferred.