论文部分内容阅读
目的增加使用主动呼吸控制(ABC)系统时屏气时间,结合使用图像引导放疗(IG- RT)提高肺癌患者放疗精度。方法对31例肺癌患者行主动呼吸控制系统训练,训练屏气时接入氧,训练5 d,每日训练约30 min。训练时充分发挥患者的主观能动性,让患者熟练掌握屏气技巧,主动配合治疗。采用立体定向体架固定(SBF),用IGRT的SynergyTM系统锥形束CT(CBCT)与ABC系统配合进行治疗。结果31例中训练后最大屏气时间达40 s以上的24例,平均最大屏气时间为65.5 s,较训练前增加33.9 s。使用ABC时横膈在头脚方向运动平均为1.7 mm,而在自由呼吸时为16.0 mm。首次CBCT采集图像与计划图像比较在左右(x)、头脚(y)、前后(z)方向平均误差分别为3.3、4.8、3.1 mm,调整床后分别为1.0、1.2、1.1 mm。结论通过吸入氧气屏气的呼吸训练,能明显延长患者屏气时间。在IGRT中配合使用ABC系统,可使肺部肿瘤放疗精度控制在2 mm,为提高分次剂量和总治疗剂量,减少肺损伤提供可能。
Objective To increase the breath holding time when using an active respiratory control (ABC) system and to use radiotherapy guided imaging (IG-RT) to improve radiotherapy accuracy in patients with lung cancer. Methods Thirty-one patients with lung cancer underwent active respiratory control training. Oxygen was infused during training breath-holding. The training was performed for 5 days and trained daily for about 30 minutes. Training to give full play to the patient’s subjective initiative, so that patients master breath-hold skills, take the initiative with the treatment. Stereotaxic Stereotaxic Stent (SBF) and IGRT SynergyTM Cone Beam CT (CBCT) were used in conjunction with the ABC system. Results Of the 31 cases, the maximum breath-hold time was 40 s after 24-hour training, with an average maximum breath-hold time of 65.5 s, an increase of 33.9 s before training. The diaphragmatic motion of the diaphragms in the direction of the head and feet was 1.7 mm on average when using ABC and 16.0 mm on free breathing. The first CBCT acquisition images compared with the planned images in the left and right (x), head and foot (y), the average error before and after (z) directions were 3.3,4.8,3.1 mm, respectively, after adjustment bed 1.0,1.2,1.1 mm. Conclusions Breathing by breath-hold oxygen breathing can significantly prolong the patient’s breath-holding time. The combination of ABC system in IGRT can make lung tumor radiotherapy accuracy control at 2 mm, which may provide the possibility of improving the dose and the total therapeutic dose of lung and reducing the lung injury.