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目的利用电子射野影像系统(EPID)分析摆位过程中误差的各个来源,有针对地减少分次治疗过程中由于误差导致的放射治疗效果的不佳,同时提出治疗过程中质量保证措施。方法选择2014年10月至2015年10月南京军区南京总医院收治的50例头部肿瘤和50例体部肿瘤患者,其中男性68例,女性32例,年龄35~76岁,平均年龄53岁。所有患者行医科达静态调强治疗,且所有患者进行常规方法定位,每周定位1次,分别测其在头脚方向(Z轴)、左右方向(X轴)和上下方向(Y轴)的摆位误差。每次行EPID验证时,头部患者其偏差超过5 mm,体部患者其偏差超过10 mm时,由放射治疗医师及物理师共同分析其原因。结果每例患者在放射治疗全过程中大概有5~8次行EPID验证。50例头部肿瘤患者摆位误差<5 mm的占98.2%;50例体部肿瘤患者摆位误差<10 mm的占90.0%。头部肿瘤患者在X轴、Y轴、Z轴摆位误差都<5 mm,差异无统计学意义(t=1.65,P>0.05)。体部肿瘤患者在X轴、Y轴摆位误差也都<5 mm,差异无统计学意义(t=1.43,P>0.05);由于呼吸运动等因素影响,体部Z轴摆位误差差异有统计学意义(P<0.05)。可以得出头部肿瘤患者在治疗的过程中摆位有很好的稳定性。结论在放射治疗的实际操作过程中,误差来源很复杂,通过EPID的摆位验证,有效地减少了患者的靶区误差,提高了肿瘤治疗的靶区的局部控制率及治疗的安全性。但在整个过程中,EPID的摆位分析,显得尤为重要。
Objective To analyze the sources of errors during setup using the Electronic Radiographic Imaging System (EPID), and to reduce the poor effect of radiotherapy caused by error during the fractional treatment and to propose the quality assurance measures during the treatment. Methods Fifty patients with head and throat cancer and 50 patients with solid tumors admitted to Nanjing General Hospital of Nanjing Military Region from October 2014 to October 2015 were selected, 68 males and 32 females, aged from 35 to 76 years with a mean age of 53 years . All patients underwent static intensity modulation therapy, and all patients were routinely positioned once a week and measured in the direction of head and foot (Z axis), left and right direction (X axis) and up and down direction (Y axis) Setting error. For each EPID verification, the head patient has a deviation of more than 5 mm and the patient in the body has a deviation of more than 10 mm. The radiologist and the physician jointly analyze the cause. Results Each patient in the whole process of radiotherapy about 5 to 8 times EPID validation. In 50 cases of head and neck cancer patients, the error was <5 mm, accounting for 98.2%; and 50 cases of body tumors were 90.0% and <10 mm. There was no significant difference in the positioning errors between the head and neck tumor in X axis, Y axis and Z axis (t = 1.65, P> 0.05). There was no significant difference in the positioning errors between the X-axis and Y-axis of patients with body tumors (t = 1.43, P> 0.05). Because of respiratory motion and other factors, there were Statistical significance (P <0.05). It can be concluded that patients with head tumors have a good stability during treatment. Conclusion In the actual operation of radiotherapy, the source of error is very complicated. The validation of EPID can effectively reduce the target area error and improve the local control rate and the safety of the treatment. But throughout the process, EPID positioning analysis, it is particularly important.