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目的:评价在全盲模式下,食道癌根治性放疗时,心脏勾画图谱统一学习前后不同研究者勾画心脏的差异,及其对全心和各瓣膜受照剂量分布的影响。方法:对10名未行手术的食道癌患者,在全盲模式下,由5名医生在统一学习心脏图谱前后行两次心脏靶区勾画,比较学习前后全心勾画的差异以及全心和各个瓣膜受照射剂量的变化。结果:与无指南相比,引入指南后,心脏勾画的体积明显增大从635.3 cm3增加到647.6 cm3,Soensen-Dice相似指数从0.84~0.87增加至0.92~0.94;Jaccard相似指数从0.91~0.93增加至0.96~0.97,I_Tot/U_Tot从0.75±0.02提高到0.84±0.03。除全心和肺动脉瓣外,主动脉瓣、二尖瓣和三尖瓣的平均照射剂量(Dmean)和最大照射剂量(Dmax)较引入指南前均明显提高,全心及所有瓣膜的Dmean和Dmax的变异系数均有明显提高。结论:心脏勾画指南的引入明显缩小了不同研究者对心脏勾画的差异,这种差异的改变对全心和肺动脉瓣膜受照剂量没有明显影响,导致了主动脉瓣、二尖瓣及三尖瓣Dmean和Dmax的不同,而心脏勾画指南的引入减小了上述所有结构的受照射剂量差异。
PURPOSE: To evaluate the differences in heart size profiled by different investigators before and after learning from the topographic radiotherapy of esophageal cancer in full blinded mode, and their effects on the dose distribution of whole heart and each valve. Methods: Ten patients with esophageal cancer who had undergone surgery under full blinded mode were examined by five doctors before and after the study of cardiac spectrum, and the difference between the heart and heart was compared before and after learning, Irradiated dose changes. Results: Compared with no guidelines, the volume of cardioplegia increased significantly from 635.3 cm to 647.6 cm3, and the similarity index of Soensen-Dice increased from 0.84 to 0.87 to 0.92 to 0.94. Jaccard similarity index increased from 0.91 to 0.93 To 0.96 ~ 0.97, I_Tot / U_Tot increased from 0.75 ± 0.02 to 0.84 ± 0.03. In addition to whole heart and pulmonary valve, aortic valve, mitral valve and tricuspid valve average dose (Dmean) and the maximum dose (Dmax) were significantly higher than before the introduction of guidelines, whole heart and all valves Dmean and Dmax The coefficient of variation were significantly improved. CONCLUSIONS: The introduction of a cardiac contouring guide significantly reduces the difference in heart profiling among different investigators. This difference in change has no significant effect on the whole-heart and pulmonary valve exposure dose, resulting in aortic, mitral, and tricuspid valve Dmean and Dmax, and the introduction of a cardiac mapping guide reduces the difference in irradiated dose across all of the above structures.