| 苏 适,陈 虹,周一帆,等.旋转和平移摆位误差对小细胞肺癌海马保护全脑放疗的剂量学影响[J].肿瘤学杂志,2025,31(3):224-230. |
| 旋转和平移摆位误差对小细胞肺癌海马保护全脑放疗的剂量学影响 |
| Dosimetric Effects of Rotational and Translational Positioning Errors on Hippocampal Protection in Whole Brain Radiotherapy |
| 投稿时间：2024-11-20 |
| DOI：10.11735/j.issn.1671-170X.2025.03.B007 |
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| 中文关键词: 摆位误差 海马保护 全脑放疗 小细胞肺癌 剂量学 |
| 英文关键词:positioning error hippocampus protection whole brain radiotherapy small cell lung cancer dosimetry |
| 基金项目:浙江省医药卫生科技计划B类（2024KY1780）；浙江省台州恩泽医疗中心（集团）科学研究基金（22EZB09） |
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| 中文摘要: |
| 摘 要：［目的］ 研究旋转和平移摆位误差对小细胞肺癌海马保护全脑放疗剂量学的影响。［方法］ 随机选择10例接受海马保护全脑放疗的小细胞肺癌患者，在Pinnacle计划系统分别模拟患者绕Z轴旋转治疗床的±3.0度摆位误差（步长为0.5度）和三维6个方向中（X为右左，Y为腹背，Z为脚头）同时在两个方向上移动3 mm或5 mm时的平移摆位误差。在保持计划参数不变的前提下，重新计算剂量分布。分析位移后和初始计划的靶区及危及器官的剂量差异，并采用配对t检验验证差异是否具有统计学意义。［结果］ 对于旋转误差，在±3.0度内对PTV D90%基本无影响，而在大于1.0~1.5度时海马Dmax和Dmean及左右晶体Dmax有较大增加，其中海马Dmean和左右晶体Dmax接近限制剂量；对视神经Dmax和视交叉Dmax剂量基本无影响；左右眼球Dmax随着旋转误差角度的绝对值增加而增加，但仍在限制范围内。对于平移误差，PTV D90%在YZ-3和YZ-5方向剂量最低，降幅为-1.56%和-3.23%，受YZ方向影响较大；海马Dmax在YZ-3和YZ-5方向剂量最高，接近和超过限制剂量16 Gy，受YZ方向影响较大；海马Dmean在XZ-3和XZ-5方向剂量最高，接近和超过限制剂量10 Gy，受XZ方向影响较大；对于其他危及器官，左右晶体均在XZ+3和YZ+5方向剂量最高，均仅在XY+3方向没有超过限制剂量，受Z方向影响较大；左视神经在XY+3和XZ+5方向剂量最高，右视神经在XZ-3和XZ-5方向剂量最高，受X方向影响较大；平移误差对视交叉Dmax基本无影响；左右眼球均在YZ+3和YZ+5方向剂量最高，受YZ方向影响较大。［结论］ 实际摆位中要重点关注达到1.0~1.5度旋转摆位误差和头脚方向3 mm平移摆位误差，以更好地保护海马等危及器官，达到更精准的治疗效果。 |
| 英文摘要: |
| Abstract：［Objective］ To investigate the dosimetric effects of rotational and translational positioning errors on the hippocampal protection in whole brain radiotherapy. ［Methods］ Ten patients with small-cell lung cancer who received hippocampal protection whole brain radiotherapy were randomly selected. In Pinnacle planning system， the ± 3.0 degree positioning error with step size of 0.5 degrees of the patient rotating the treatment bed around the Z-axis and the translational positioning error when moving 3 mm or 5 mm in two directions simultaneously in six three-dimensional directions (X-axis： right and left， Y-axis： abdomen and back， Z-axis： foot and head) were simulated. The dose distribution was recalculated while keeping the plan parameters unchanged， and the dose differences between the target area and endangered organs after displacement and the initial plan were compared. ［Results］ For rotation error， within ± 3.0 degrees， there was basically no effect on PTV D90%. However， when it was greater than 1.0~1.5 degrees， there was a significant increase in hippocampal Dmax and Dmean， as well as left and right crystal Dmax， with hippocampal Dmean and left and right crystal Dmax approaching the limit dose. There was basically no effect on the dosage of optic nerve Dmax and optic chiasm Dmax. The Dmax of the left and right eyeballs increased with the absolute value of the rotation error angle， but still within the limited range. For translation errors， PTV D90% had the lowest dose in the YZ-3 and YZ-5 directions， with a decrease of -1.56% and -3.23%， respectively， and was greatly affected by the YZ direction. Hippocampus Dmax had the highest dose in the YZ-3 and YZ-5 directions， approaching or exceeding the limit dose of 16 Gy， and was greatly affected by the YZ direction. The hippocampus Dmean had the highest dose in the XZ-3 and XZ-5 directions， approaching or exceeding the limit dose of 10 Gy， and was greatly affected by the XZ direction. For other endangered organs， both the left and right crystals had the highest dose in the XZ+3 and YZ+5 directions， with only the XY+3 direction not exceeding the limit dose， which was greatly affected by the Z direction. The left optic nerve had the highest dose in the XY+3 and XZ+5 directions， while the right optic nerve had the highest dose in the XZ-3 and XZ-5 directions， and was greatly affected by the Xdirection. The translation error had little effect on the optic chiasm Dmax. Both the left and right eyeballs had the highest dose in the YZ+3 and YZ+5 directions， and were greatly affected by the YZ direction. ［Conclusion］ For patients undergoing whole brain radiotherapy， it is important to focus on achieving a rotational positioning error of 1.0~1.5 degrees and a translational positioning error of 3 mm in the head foot direction， in order to better protect endangered organs such as the hippocampus and achieve more precise treatment effects. |
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