四种不同配准方式对食管癌 IGRT 摆位误差的影响

摘要

Objective:To investigate four different image registrations for esophageal tumor in image guided radia-tion therapy.Methods:All 100 esophageal tumor patients were treated by the Elekta Synergy IGRT system,compare the difference between CBCT images and planning CT images in Automatic grey -value registration,Automatic grey -value +Manual registration,Automatic bone registration,Automatic bone +Manual registration.Results:Total of 400 CBCT images were registrated for 100 esophageal tumor patients.The set -up errors on X -axis ofAutomatic grey -val-ue registration,Automatic grey -value +Manual registration,Automatic bone registration,Automatic bone +Manual registration were (2.70 ±2.20)mm,(3.04 ±2.36)mm,(2.76 ±2.24)mm,(3.04 ±2.45)mm respectively.The set -up errors on Y -axis were (2.82 ±2.15)mm,(2.95 ±2.31)mm,(2.74 ±1.78)mm,(2.66 ±1.82)mm re-spectively.The set -up errors on Z -axis were (2.42 ±1.91)mm,(2.49 ±2.02)mm,(3.07 ±2.16)mm,(2.67 ± 2.02)mm respectively.There was significant difference between Automatic grey -value registration and Automatic grey -value +Manual registration in X -axis,Z -axis(P <0.05),there was significant difference between Automatic bone registration and Automatic bone +Manual registration in X -axis(P <0.05),there was no significant difference between Automatic grey -value registration and Automatic bone registration,Automatic grey -value +Manual regis-tration and Automatic bone +Manual registration in X,Y,Z -axis(P >0.05).Conclusion:It is suggested that Auto-matic bone +Manual registration may be the best solution to reduce the set -up errors for esophageal tumor in IGRT.%目的：研究四种不同配准方法对食管癌图像引导放射治疗（IGRT）摆位误差的影响。方法：应用瑞典医科达 Synergy 直线加速器治疗食管癌患者100例，每位患者治疗前用锥形束 CT（CBCT）扫描。将获得的CBCT 图像与计划 CT 图像配准，分析左右（X）、头脚（Y）、上下（Z）方向上的平移误差，比较自动灰度配准、自动灰度＋手动配准、自动骨性配准、自动骨性＋手动配准四种配准间的差异。结果：100例食管癌患者共进行400次配准。自动灰度配准、自动灰度＋手动配准、自动骨性配准、自动骨性＋手动配准在左右（X）方向的平移误差分别为（2．70±2．20）mm、（3．04±2．36）mm、（2．76±2．24）mm、（3．04±2．45）mm，在头脚（Y）方向的平移误差分别为（2．82±2．15）mm、（2．95±2．31）mm、（2．74±1．78）mm、（2．66±1．82）mm，在上下（Z）方向的平移误差分别为（2．42±1．91）mm、（2．49±2．02）mm、（3．07±2．16）mm、（2．67±2．02）mm。其中自动灰度与自动灰度＋手动配准在 X、Z 方向差异有统计学意义（P ＜0．05），自动骨性与自动骨性＋手动配准在 X方向差异有统计学意义（P ＜0．05），自动灰度与自动骨性、自动灰度＋手动配准与自动骨性＋手动配准在 X、Y、Z 方向上均差异无统计学意义（P ＞0．05）。结论：对于食管癌肿瘤的图像配准，加上手动配准是有必要的，骨性配准＋手动配准精度和稳定性效果更好。