摘要
目的:探讨在肺癌患者放疗中选用不同解剖结构进行图像配准对结果的影响,为肺癌图像引导放射治疗图像配准时解剖结构的优化选择提供依据。方法:选择2021年6月至2022年8月就诊于承德市中心医院行胸部放射治疗的肺癌患者43例,所有患者均使用图像引导下的调强放射治疗。其中29例中央型肺癌患者以胸椎、胸骨、气管、气管隆突、肿瘤作为解剖结构,另外14例周围型肺癌患者以胸椎、肿瘤、患侧肋骨、肿瘤联合附近肋骨为解剖结构,均采用自动加手动配准方法将治疗前首次锥形束CT图像与定位CT图像进行离线配准,分别记录X(左右)、Y(头脚)、Z(前后)3个方向的误差值,并将肿瘤组为对照组配准得出的误差值与其余各组进行对比,分析误差产生的原因。结果:在中央型肺癌中,各个解剖结构的误差值,以肿瘤组误差最小,其次依次为气管隆突组、胸椎组、气管组,胸骨组误差值最大。单因素方差分析结果示:差异性主要体现在Y、Z轴上(F=3.329,P=0.012;F=0.033,P=0.022)。进一步统计分析发现,Y、Z轴间差异性主要体现在胸骨组与肿瘤组之间。在周围型肺癌中,误差值按照升序排列依次为:肿瘤联合附近肋骨、患侧肋骨、胸椎、肿瘤。误差值在X、Z轴上具有统计学意义(F=3.63,P=0.019;F=2.889,P=0.044)。并且,患侧肋骨组、肿瘤联合附近肋骨组的误差值与肿瘤组的误差值比较均有统计学意义。结论:肺癌图像引导放射治疗图像配准时解剖结构的选择,肿瘤联合附近肋骨作为周围型肺癌的配准结构为优先选择,气管隆突、胸椎、气管均可作为中央型肺癌的配准结构,气管隆突、胸椎为优先选择。
Objective:To explore the effect of image registration with different anatomical structures on the results of lung cancer patients in radiotherapy,and to provide a basis for the optimal selection of anatomical structures in image registration of image guided radiotherapy for lung cancer.Methods:From June 2021 to August 2022,43 lung cancer patients who received chest radiation therapy in Chengde Central Hospital were selected.All patients received image guided intensity-modulated radiation therapy.In 29 patients with central lung cancer,the thoracic vertebrae,sternum,trachea,tracheal ramus,and tumor were used as the anatomical structures,and in the other 14 patients with peripheral lung cancer,the thoracic vertebrae,tumor,affected ribs,and ribs near the tumor union were used as the anatomical structures.The error values in X(left and right),Y(head and foot)and Z(front and back)directions were recorded,and the error values obtained from the registration of the tumor group as the control group were compared with those of the other groups to analyze the causes of the errors.Results:In the central type of lung cancer,the error value of each anatomical structure is the smallest in the tumor group,followed by the trachea carina group,thoracic vertebrae group,trachea group,and the sternum group,and the sternum group had the largest error values.The results of one-way ANOVA showed that the differences were mainly reflected on the Y and Z axes(F=3.329,P=0.012;F=0.033,P=0.022).Further statistical analysis showed that the difference between Y axis and Z axis was mainly between sternum group and tumor group.In peripheral lung cancer,the error values in ascending order are:the rib near the tumor joint,the rib at the affected side,the thoracic spine,and the tumor.The error value is statistically significant on the X and Z axes(F=3.63,P=0.019;F=2.889,P=0.044).In addition,the error values of the affected rib group and the rib group near the tumor union were statistically significant compared with the error values of the tumor group.Conclusion:Anatomical structure selection during image registration of lung cancer image-guided radiotherapy:tumor combined with adjacent ribs as the registration structure of peripheral lung cancer is preferred;trachea carina,thoracic vertebra and trachea can be used as the registration structure of central lung cancer;trachea carina and thoracic vertebra are preferred.
作者
袁亚杰
崔志强
代俊利
YUAN Yajie(Chengde Medical University,Hebei Chengde 067000,China)
出处
《河北医学》
CAS
2023年第5期839-843,共5页
Hebei Medicine
基金
河北省卫生健康委科研基金项目,(编号:20211025)。
关键词
肺癌
图像引导放射治疗
图像配准
Lung cancer
Image-guided radiotherapy
Image registration
