新冠肺炎爆發期間頭頸癌病患配戴外科口罩於質子治療之分析－利用二維影像導引與三維錐狀射束電腦斷層影像進行分析

An Analysis of Head and Neck Cancer Patient Wearing Surgical Masks during Proton Therapy in COVID-19 Pandemic-An Experience of 2D Image Guided Therapy and 3D Cone Beam Computed Tomography Images

洪佳伶(Chia-Ling Hung) ； 王友明(Yu-Ming Wang) ； 楊鈞為(Chun-Wei Yang) ； 阮國榮(Kuo-Jung Juan) ； 宋國強(Kuo-Chiang Sung)

《中華放射線技術學雜誌》 46卷2期 (2022/06) Pp. 108-113

摘要

目的：為了評估頭頸癌病患於質子治療過程中攜帶外科口罩之可行性，本研究統計有無攜帶外科口罩之鼻咽癌患者擺位誤差與治療相關因素進行評估。材料與方法：本研究為回溯性資料收集台灣南部質子暨放射治療中心，從2020年4月至2021年1月接受頭頸部質子治療，總共14位病患，分為配戴口罩治療患者與未配戴口罩治療患者各7位，共收集病患於質子治療期間各分次治療449組二維影像導引治療與三維錐狀射束電腦斷層影像，分別為無攜帶外科口罩220組與攜帶外科口罩229組。結果：在2D影像對位中，配戴口罩治療患者在X、Y、Z三軸的平均數與標準差分別為0.17±0.17 cm、0.15±0.14cm、0.21±0.23 cm。無配戴口罩治療患者的X、Y、Z三軸的平均數與標準差分別為0.11±0.08 cm、0.09±0.13 cm、0.12±0.17 cm，三軸p-value ＜ 0.05均為顯著差異。在CBCT中配戴口罩治療患者的X、Y、Z、pitch、roll、yaw六軸的平均數與標準差分別為0.12±0.11 cm、0.08±0.11 cm、0.16±0.19 cm、0.31±0.29度、0.65±0.67度、0.34±0.32度。無配戴口罩治療患者的X、Y、Z、pitch、roll、yaw六軸的平均數與標準差分別為0.13±0.12 cm、0.12±0.13 cm、0.17±0.18 cm、0.26±0.26度、0.44±0.53度、0.30±0.34度，除了Y軸為顯著外（p-value ＜ 0.05），其餘軸向均為不顯著差異。結論：如今全球COVID-19疫情大流行，建議病患以攜帶口罩之方式進行治療，不僅可以降低第一線醫護人員也可以減少病患受感染之機率，於質子治療時為了提高治療之精準性，建議放射師於2D-IGRT後再進行CBCT之影像校正。在新冠肺炎疫苗尚未普及之前，除了給予病患更好的治療品質外，大家仍須持續團結努力，堅守每一道防疫防線，並與政府合作，共同打贏這場全球疫情。

關鍵字

質子治療 ； 鼻咽癌 ； 擺位誤差

並列摘要

Introduction: In order to evaluate the feasibility of wearing surgical masks during proton therapy for head and neck cancer patients, this study was analyzed the set-up error and treatment-related factors of patients with nasopharyngeal cancer with or without surgical masks. Materials and methods: In this study, retrospective data were collected from a total of 14 patients who received head and neck proton therapy from April 2020 to January 2021 at the Southern Taiwan Proton and Radiation Therapy Center, divided into 7 patients with and 7 patients without masks. A total of 449 sets of 2D image guided therapy and 3D cone beam computed tomography images were collected for each treatment session during proton therapy, 220 sets without surgical masks and 229 sets with surgical masks. Results: In 2D image alignment, the mean and standard deviation of the three axes of X, Y, Z were 0.17±0.17 cm、0.15±0.14cm cm and 0.21±0.23 cm for patients treated with masks. The mean and standard deviation of the three axes of X, Y, Z for patients treated without a mask were 0.11±0.08 cm、0.09±0.13 cm and 0.12±0.17 cm (p-value ＜ 0.05). The mean and standard deviation of the six axes of X, Y, Z, pitch, roll, and yaw in patients treated with a mask in CBCT were0.12±0.11 cm、0.08±0.11 cm、0.16±0.19 cm、0.3°±0.29°、0.65°±0.67°and 0.34±0.32°. The mean and standard deviation of the six axes of X, Y, Z, pitch, roll, and yaw for patients treated without masks were 0.13±0.12 cm、0.12±0.13 cm (p-value ＜ 0.05)、0.17±0.18 cm、0.26±0.26°、0.44±0.53°and 0.30±0.34°. Discussion: In order to improve the accuracy of the treatment, radiologists are recommended to perform CBCT image correction after 2D-IGRT. Before the new crown pneumonia vaccine is widely available, in addition to providing better quality of treatment to patients, we must continue to work together to guard every line of prevention and cooperate with the government to win this global epidemic.

並列關鍵字

Proton therapy ； head and neck cancer ； set-up error