3D打印技术在胸部调强放疗计划中的应用研究

Analysis and application of IMRT plan based on 3D printing individualized phantom

  • 摘要:
    目的 比较患者图像和模体图像的放射治疗计划中的剂量学参数,分析3D打印个体化模体在治疗计划系统(TPS)和加速器下的放射治疗剂量分布。
    方法 选取2023年10月徐州市肿瘤医院收治的1例食管癌患者(女性,78岁)的定位CT扫描医学数字成像及通信(DICOM)格式图像进行回顾性研究。分别以患者图像(对照组)和3D打印模体图像(实验组)为基础,制定放射治疗计划,并比较靶区和危及器官的剂量学参数。分别在靶区(高密度区)和参考点(低密度区)插入电离室,将模体放在加速器下实际投照,分析靶区和参考点的TPS计算值与测量值的误差。两处数据分别采用单样本t检验。
    结果 在放疗计划剂量学参数评估方面,剂量体积直方图(DVH)显示,对照组和实验组计划中靶区和危及器官剂量分布曲线基本重合。在椎体放疗计划中,实验组的靶区平均剂量高于对照组。在肺内参考点,实验组的平均剂量明显低于对照组。在剂量验证测量方面,靶区内测量均值(211.0±0.5 cGy)与靶区内计算平均值(210.4 cGy)的绝对误差为0.6 cGy(95% 置信区间:−0.08,1.28),对应误差百分比为0.29%(置信区间:−0.04%,0.61%)。单侧检验表明该误差显著低于3%(t=2.449,p=0.035)。靶区旁(参考点)测量值为(49.4±0.6)cGy,计算值为49.1 cGy,即参考点的百分剂量偏差为0.68%。靶区旁测量均值与靶区旁计算平均值的绝对误差为0.6 cGy(95%置信区间:−0.14,1.42),对应误差百分比为1.22% 95%CI:−0.29%,2.91%。单侧样本检验表明该误差显著低于3%(t=2.268,p=0.043)。两处剂量偏差均在3%内,满足《医用电子直线加速器质量控制检测规范》要求。
    结论 电离室探测器联合3D打印个体化模体可以用来验证调强放射治疗计划,实验结果为射线在不同组织间的能量沉积分布规律研究、放射治疗质量保证研究提供基础和参考。

     

    Abstract:
    Objective The dosimetry parameters in the radiotherapy plan of the patient image and the phantom image were compared, and the radiotherapy dose distribution in 3D printing individualized phantom under the treatment planning system (TPS) and accelerator was analyzed.
    Methods CT localization images in digital imaging and communications in medicine (DICOM) format were selected from a patient (female, 78 years old) with esophageal cancer who were treated at the Xuzhou Cancer Hospital in October 2023. On the experimental basis of the 3D printing individualized phantom, the radiotherapy plans of the patient and phantom were designed, and the dosimetry parameters of the target volume and the organ at risk were compared. The ionization chamber was inserted into the target volume (high density area) and the reference point (low density area) respectively before the phantom was exposed to radiation under the accelerator. The errors between the calculated from TPS and measured values in the target volume and the reference point were analyzed.
    Results In the dose volume histogram (DVH) of the radiotherapy plan of the patient image and the phantom image, the curves of the target volume and the organ at risk basically coincide. The average dose of the target volume was higher in the phantom group than in the patient group. The average dose of reference point was lower in the phantom group than in the patient group and the difference was significant. The calculated and measured values of the target volume are 210.4 cGy and 211.0±0.6 cGy respectively, the percentage dose deviation is 0.3%. The calculated and measured values of the reference point are 49.1 cGy and 49.4±0.6 cGy respectively, the percentage dose deviation is 0.68%. The dose deviation of the two places is within 3%, which meets the requirements of the "Specification for testing of quality control in medical linear accelerato".
    Conclusions The combination of chamber detector and 3D printing individualized phantom can be used to verify the intensity modulated radiotherapy plan, and the experimental results provide a foundation and reference for the study of the energy deposition distribution between different tissues and the research on the quality assurance of radiotherapy.

     

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