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目的:比较自主呼吸控制(active breathing control,ABC)辅助三维CT(three dimensional CT,3DCT)平静吸气末和呼气末与四维CT(four dimensional CT,4DCT)终末时相间膈顶、肺脏和心脏位置和(或)体积差异。方法:选取2011-08-03-2011-12-12在山东省肿瘤医院行放疗的15例周围型肺癌患者,依次完成胸部4DCT扫描及ABC辅助平静吸气末(CTEIH)和呼气末(CTEEH)3DCT扫描。将每个呼吸周期的4DCT图像平均分为10个呼吸时相,0时相定义为吸气末时相(CT0),50%时相定义为呼气末时相(CT50),分别在CT0、CT50、CTEIH和CTEEH上勾画双肺、心脏及双膈肌顶。结果:CTEIH和CTEEH间(Z=-1.21,P=0.228)与CT0和CT50间(Z=-1.62,P=0.106)左右膈肌顶头脚方向位移的平均差值均≤1.5mm,且差异均无统计学意义;CTEIH和CT0间、CTEEH和CT50间左右肺及心脏中心点位置的差异,在头脚方向上差异均有统计学意义(Z=-3.27~-1.93,P=0.001~0.047),在径向方向上差异均无统计学意义,Z=-1.58~-0.26,P=0.128~0.798;CTEIH和CTEEH左右肺体积均大于CT0和CT50左右肺体积,差异均有统计学意义(t=-5.07~-2.25,P=0.000~0.041),而心脏体积CT0和CT50(t=2.10,P=0.054)均大于CTEIH和CTEEH(t=1.85,P=0.085),但差异均无统计学意义。结论:从保护肺和心脏的角度看,在其他条件相同时,基于ABC辅助平静吸气末门控放疗优于基于4DCT吸气末门控放疗。
OBJECTIVE: To compare the effects of active breathing control (ABC) three-dimensional CT (3DCT) on the end-inspiratory end-diastolic and end-expiratory end diaphragms, lung and Heart position and / or volume difference. Methods: Totally 15 patients with peripheral lung cancer undergoing radiotherapy at Tumor Hospital of Shandong Province from 2011-08-03 to 2011-12-12 were enrolled in this study. The chest CT scan, CTEIH and CTEEH 3DCT scan. The 4DCT images of each respiratory cycle were divided equally into 10 respiration phases, the 0 phase was defined as end-inspiration phase (CT0) and the 50% phase was defined as end-expiratory phase (CT50) CT50, CTEIH and CTEEH sketching the lungs, heart and diaphragm top. Results: The average difference of displacement between the CTEIH and CTEEH in the direction of the top of the diaphragm was less than or equal to 1.5 mm (Z = -1.21, P = 0.228) and between CT0 and CT50 (Z = -1.62, P = 0.106) Statistical differences between the CTEIH and CT0 and between the CTEEH and the CT50 were statistically significant in the head and foot directions (Z = -3.27 ~ -1.93, P = 0.001 ~ 0.047) There was no significant difference in the radial direction between the two groups (Z = -1.58-0.26, P = 0.128-0.798). The lung volumes of both CTEIH and CTEEH were significantly larger than those of CT0 and CT50 (t = -5.07 ~ -2.25, P = 0.000 ~ 0.041), while CT0 and CT50 of cardiac volume were significantly higher than those of CTEIH and CTEEH (t = 1.85, P = 0.085) . CONCLUSIONS: From the perspective of lung and heart protection, ABC-assisted, quiescent end-point gated radiotherapy is superior to 4GCT end-gated radiotherapy at the other conditions being the same.