不同图像引导方式下宫颈癌近距离治疗的工作流程与时效分析

Workflow and time efficiency analysis of different image guided brachytherapy for cervical cancer

目的探讨不同图像引导方式下宫颈癌患者近距离治疗计划辐射剂量及其临床工作流程中每个部分的时间效率特征,为临床近距离治疗的统筹安排提供参考。方法回顾性分析223人次近距离治疗患者的工作流程,将整个工作流程分为5个部分:施源器置入、图像采集、靶区和危及器官勾画、计划设计及审核、治疗实施。根据图像引导方式将近距离治疗分为X射线平片引导的二维治疗、CT和MRI引导的三维治疗,统计3种引导方式下治疗计划的辐射剂量差异和5个部分用时,计划辐射剂量使用总参考空气比释动能(TRAK)评价。采用SPSS 20软件非参数检验分析方法进行差异性检验。结果X射线平片引导的二维计划TRAK 4.2(4.4,3.9)cGy显著高于CT引导[3.5(3.9,2.7)cGy,H=90.73,P<0.01]和MRI引导[2.7(2.9,2.4)cGy,H=90.73,P<0.01]的三维计划。X射线平片引导组工作流程总用时最短55.0(67.0,50.0)min,其次为CT引导组80.0(91.0,72.0)min,MRI引导组总用时最长[119.0(143.0,105.5)min,H=106.39,P<0.01]。5个部分用时中,MRI引导组的图像采集时间明显高于X射线平片引导组和CT引导组(H=44.80,P<0.01);MRI引导组靶区勾画时间明显高于CT引导组(Z=-5.10,P<0.01);计划设计时间MRI引导组最长,其次为CT引导组,X射线平片引导组用时最短(H=57.93,P<0.01)。结论X射线平片引导的二维近距离治疗模式用时最短但TRAK较高,MR引导的三维近距离治疗模式用时最长,计划TRAK结果与CT引导相当。多位患者同时进行近距离治疗时,通过不同环节穿插进行,可提高单位时间内的工作效率,避免顺序进行的等待耗时。

Objective To explore the radiation dose of brachytherapy plan for cervical cancer patients under different image-guided method and the time efficiency characteristics of each part of the clinical workflow,so as to provide reference for the overall arrangement of clinical brachytherapy.Methods The workflow of 223 patients with brachytherapy was retrospectively analyzed.The whole workflow was divided into 5 parts:applicator placement,image acquisition,delineation of target and organs at risk,plan design and review,and treatment implementation.The image-guided brachytherapy was divided into X-ray guided 2D treatment groups,and computed tomography(CT)and magnetic resonance imaging(MRI)guided 3D treatment groups.The radiation dose and the time spent in each part of the three image-guided brachytherapy workflow were calculated.The radiation dose was evaluated using total reference air kerma(TRAK).The results were analyzed using the nonparametric test of SPSS 20 software.Results TRAK 4.2(4.4,3.9)cGy was significantly higher in X-ray guided 2D treatment group than in the CT guided 3D treatment group[3.5(3.9,2.7)cGy,H=90.73,P<0.01]and the MRI guided 3D treatment group[2.7(2.9,2.4)cGy,H=90.73,P<0.01].The total workflow time of the X-Ray film guidance group was the shortest[55.0(67.0,50.0)min],followed by the CT guidance group[80.0(91.0,72.0)min],and the total workflow time of the MRI image guidance group was the longest[119.0(143.0,105.5)min,H=106.39,P<0.01].The image acquisition time of the MRI-guided group was significantly higher than that of the X-ray film guidance group and the CT-guided group(H=44.80,P<0.01).The time of target delineation in the MRI-guided group was significantly longer than that in the CT-guided group(Z=-5.10,P<0.01).The MRI-guided group took the longest time for planning,followed by the CT-guided group,and the X-ray guided group took the shortest time(H=57.93,P<0.01).Conclusions The 2D brachytherapy mode guided by X-ray film had the shortest process time but higher TRAK,while the 3D brachytherapy mode guided by MR had the longest process time,and the planned TRAK result were comparable to those guided by CT.When multiple patients are treated with brachytherapy at the same time,the work efficiency can be improved by interspersing different phases and the waiting time can be avoided.