電腦斷層模擬攝影應用於全腦脊椎照射照野之設計與評估

目的：對於全腦脊椎照射病患而言，電腦斷層模擬攝影機的使用，不僅縮短病患相對於模擬攝影所需要的時間，更重要的是提供精確的工具讓醫師更能有信心去決定照野位置。材料與方法：林口長庚醫學中心放射腫瘤科自民國89年引進PQ5000電腦斷層模擬攝影機以來，利用VOXEL Q治療計畫系統及ACQ sim虛擬模擬攝影系統對取得自病患的斷面影像進行處理。重組成三度空間影像得知腫瘤的深部位置、大小，而後能決定出治療的照野大小、範圓、角度、阻擋物等治療參數。結果：傳統上全腦脊椎照射的模擬攝影須耗時較久，所有的作業流程約需要30~50分鐘，且病患採用以下巴和鼻樑來支撐頭部重量的俯臥姿勢進行模擬攝影。電腦斷層模擬攝影時採用仰臥的方式進行全腦脊椎照射模擬攝影，使病患得到舒服的治療姿勢，縮短模擬攝影作業的時間，只需要10~15分鍾的時間而且可以提供較準確的照野設定。結論：使用電腦斷層模擬攝影機在全腦脊椎照射模擬攝影作業方面的助益，在使病患模擬攝影所需花費的時間只需傳統模擬攝影的三分之一。對醫師而言射束與照野的設定更準確。更重要的是病患因為模擬攝影所需花費的時間減少，降低了模擬攝影期間因病患移動所造成的誤差，提高了模擬攝影及治療的準確性。

關鍵字

放射治療；全腦脊椎照射；電腦斷層模擬攝影

並列摘要

Purpose: An important issue for cancer patients, who are destined to receive craniospinal irradiation (CSI), is how to reduce the overall time needed for simulation. Furthermore, it is necessary that more accurate tools are designed and adapted so that there is increased accuracy in the determination of the optimal irradiation position and field. This will increase the level of confidence of radiation oncologists with respect to these factors. In this study, we investigated and evaluated simulation techniques that utilize computed tomography (CT) for simulation of craniospinal irradiation. Material and Methods: A PQ5000 computed tomography simulator (CT-sim) has been available since 2000 at the Department of Radiation Oncology of Linkou Chang-Gung Memorial Hospital. The VOXEL Q treatment planning system and the ACQ-sim virtual simulation software were employed to access images for processing to allow the reconstruction of three-dimensional images and the accurate identification of the location and size of the tumor. Subsequently, the treatment-related parameters such as field size, the angles of gantry and collimator, and the customized block could be decided. Result: Conventional CSI simulation, which is similar to traditional X-ray simulation, is rather time consuming, requiring thirty to fifty minutes to accomplish all the processes. In addition, the patient must assume an uncomfortable prone position during which the chin and nose inevitably has to bear the weight of the head. In CT-sim, the patient adopts a supine position for CSI. With this simulation technique and position, not only does the patient feels much more comfortable as well as the simulation time needed being reduced to ten to fifteen minutes, but it also seems to be a more accurate method for determining the treatment parameters. Discussion: The benefits of CT-sim, when utilized for CSI, include a reduction in the simulation time to only one third of that needed for conventional X-ray simulation, an increased level of confidence for the radiation oncologist with respect to the determination of the radiation beam and field size and, most important of all, a decrease in treatment errors caused by patient motion during the simulation.

並列關鍵字

Radiotherapy ； Craniospinal irradiation ； Computed tomography simulation

國際替代計量

電腦斷層模擬攝影應用於全腦脊椎照射照野之設計與評估

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