CN110237441A - Coordinate method positions in radiotherapy and puts the application of position - Google Patents
Coordinate method positions in radiotherapy and puts the application of position Download PDFInfo
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- CN110237441A CN110237441A CN201910464104.0A CN201910464104A CN110237441A CN 110237441 A CN110237441 A CN 110237441A CN 201910464104 A CN201910464104 A CN 201910464104A CN 110237441 A CN110237441 A CN 110237441A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1048—Monitoring, verifying, controlling systems and methods
- A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1048—Monitoring, verifying, controlling systems and methods
- A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
- A61N2005/1054—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using a portal imaging system
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1048—Monitoring, verifying, controlling systems and methods
- A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
- A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
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Abstract
The invention discloses a kind of coordinate methods to position and put the application of position in radiotherapy, is using body surface visible marking after the external coordinate record plate record of radiotherapy or mark patient simulation's positioning, with two dimensional coordinate values relationship of telltale mark point;The treatment of pendulum position is carried out by the irradiation field central point indicated when daily treatment, also periodically device can must also be verified every time by the D coordinates value pendulum position treatment of the body surface visible marking of record and therapeutic community's point using airborne imagery, carry out location verification.Therefore technical solution of the present invention, can allow tumor patient during receiving radiotherapy, and without considering that body surface does the clarity for the treatment of mark, daily life is unaffected, nor affects on normal radiotherapy.And the accuracy for guaranteeing each treatment position makes to treat Set-up errors control 95% degree of belief within the scope of defined error threshold, guarantees that radiotherapy treatment planning accurately executes, guarantee radiotherapeutic effect.
Description
Technical field
The invention belongs to radiation therapy technology fields, position and put in radiotherapy more particularly to coordinate method
The application of position.
Background technique
Tumour radiotherapy (abbreviation radiotherapy) is exactly with radiation cure cancer.Radiotherapy has been subjected to century more than one
Developing history roentgen find x-ray, Madame Curie find radium after, be respectively used to clinical treatment malignant tumour soon, directly
It is still the important local therapeutic approaches of malignant tumour to current radiotherapy.Mistake of about 70% cancer patient in treating cancer
It needs to use radiotherapy in journey, there are about 40% cancers can be eradicated with radiotherapy.Effect and ground of the radiotherapy in oncotherapy
Position becomes increasingly conspicuous.Radiotherapy has become one of the main means for the treatment of malignant tumour.Radiotherapy only has the history of decades,
But development is very fast.Due to the use of super-pressure therapy apparatus, the improvement of auxiliary tool and the accumulation of experience, therapeutic effect are obtained significantly
It improves, has become one of the most important means in treatment of cancer at present.There are about 70% or more cancers need to use radiotherapy for China,
U.S.'s statistics also has 50% or more cancer that need to use radiotherapy;Radiotherapy may be used with nearly all treatments of cancer, to many
For cancer patient, radiotherapy be uniquely must treatment method.
When radiotherapy, patient body position is fixed, the design of simulator locating, treatment plan, the verifying of position, is even put daily
Position treatment must all carry out under the same position, just can guarantee the accuracy of Patients Treated by Radiotherapy.It is most using Postural immobilization at present
It is negative-pressure vacuum pad and macromolecule polyester low-temp thermoplastic material.It can be divided by fixed position, facial mask, head-neck-shoulder mould, pleuroperitoneum etc..
This plastic net diaphragm plate material has excellent plasticity, only need to indicate irradiation field central point on film, not need in patient's skin
It is scribbled on skin surface with red ink, to alleviate the psychological burden of patient.Tumor-localizing at present mainly have analog machine position and
CT simulator locating, analog machine positioning is to mark launched field center with special marking pen in patient skin surface by radiotherapy simulative generator
Point and irradiation field shape;And CT simulator locating is to paste the positioning ball of 3-5 high desnity metal material in patient body-surface, according to wanting
Carry out Postural immobilization is sought, row CT scan pastes the position of metal positioning ball with special token pen in patient body-surface after the completion of to be scanned
It sets and marks point or tattoo, plan to be treated complete, planning system can provide skin-marker and doctor determines treatment meter
Draw center corresponding coordinate value, by coordinate relationship Mobile treatment table determine patient therapeutic community respectively coronal-plane, cross section and
The corresponding position of sagittal plane is determined for compliance with what treatment required through the verifying of airborne imagery system, with special token pen in patient body-surface
Or thermoplastic film surface does treatment mark, carries out the position treatment for the treatment of pendulum by the irradiation field central point indicated when daily treatment;This
Class body surface mark will keep clear in the entire course for the treatment of, make troubles to patient's daily life, need again if mark disappears
It positions and determines treatment position, is i.e. increase patient economy burden aggravates medical worker's workload again.
With the development of Medical Imaging Technology and computer technology, X-ray digital imaging technology is gradually in radiotherapy
Using electronic portal imaging device EPID (electronic portal imaging device, EPID) and taper are beam computerized
Tomoscan (Cone-beam computed tomography, CBCT) keeps radiotherapy location verification increasingly convenient, and CBCT has
In treatment position progress x line perspective, the multi-functional that piece and volume are imaged is taken the photograph, it is very valuable to online reset.With accurately putting
The extensive use for the treatment of technology is penetrated, usually in entire treatment course, repeatedly CBCT scanning is carried out before treatment, verify treatment position
Precision.Generally taken in tumour radiotherapy for the first time, in treatment, last or five treatments to first week be continuously shot verifying
Piece and the DRR piece for the treatment of plan compare, and determine the error for the treatment of position to annotate the repeatability and standard of entire course of therapy position
True property.However EPID film making, the similar diagnosis CT scan of CBCT scanning, it is all to be imaged using the principle that penetrates of X-ray, therefore
CBCT scanning in the treatment can generate certain ionizing radiation dose and certain sweep time, and it is certain to will increase tumor patient
Dose of radiation, it is opposite to extend in the residence time of therapeutic room, it should give consideration when making treatment plan.
Summary of the invention
It is an object of the invention to overcome the deficiencies in the prior art, and provide one kind and receiving radiation for convenience of tumor patient
During treatment, without considering that body surface does the clarity for the treatment of mark, daily life is unaffected, nor affects on normal radiation
Treatment;And the accuracy for guaranteeing each treatment position makes to treat Set-up errors control within the scope of defined error threshold, protects
Card radiotherapy treatment planning accurately executes, and guarantees that the coordinate method of radiotherapeutic effect positions in radiotherapy and put the application of position.
For achieving the above object, the present invention adopts the following technical scheme that realization: coordinate method is fixed in radiotherapy
The application of position and pendulum position, it is characterised in that: use body surface after the external coordinate record plate record of radiotherapy or mark patient simulation's positioning
Visible marking, with two dimensional coordinate values relationship of telltale mark point;Treatment plan completes be verified after, patient press simulator locating
Position lie in therapeutic bed, find telltale mark point by the body surface visible marking and two dimensional coordinate values of telltale mark point of record
It sets consistent with the central point of therapy apparatus;System provides the D coordinates value of skin-marker Yu treatment plan center according to plan, moves
Dynamic therapeutic bed determines patient therapeutic community respectively in the corresponding position of coronal-plane, cross section and sagittal plane, through airborne imagery system
Verifying is determined for compliance with what treatment required, does treatment mark in patient body-surface or thermoplastic film surface with special token pen, and record body
The D coordinates value of table visible marking and therapeutic community's point;Pendulum position is carried out by the irradiation field central point indicated when daily treatment to control
It treats, must also can also be used weekly every time by the D coordinates value pendulum position treatment of the body surface visible marking of record and therapeutic community's point
Airborne imagery verifies device, carries out location verification.
The visible marking includes: that xiphoid-process, navel, male patient's nipple, the apparent wart of patient body-surface, mole etc are transported
Dynamic, skin drawing factor influences small mark.
The patient's usage record coordinate information 152 times of origin 116 of the invention determines therapeutic community using external template
Verified through airborne imagery system position, coincidence loss limit value left and right directions, head foot direction, abdomen back direction be respectively 2mm, 5mm,
38.8%, the coincidence loss limit value that accounts for of 2mm requirement accounts for 58.6% for what 5mm, 8mm, 5mm were required;Its error amount is for the first time than the patient
Set-up errors value is small, and coincidence pendulum position error limit desired ratio is relaxed with limit value condition and increased.
The application can allow tumor patient during receiving radiotherapy, without considering that body surface does the clear for the treatment of mark
Degree, daily life is unaffected, nor affects on normal radiotherapy.And the accuracy for guaranteeing each treatment position makes to control
Set-up errors control is treated within the scope of defined error threshold, guarantees that radiotherapy treatment planning accurately executes, guarantees radiotherapeutic effect
The advantages of.
Detailed description of the invention
The external reference point coordinate record plate of Fig. 1 uses exemplary view.
External reference point coordinate record plate uses figure after Fig. 2 simulator locating.
External reference point coordinate record plate uses figure after Fig. 3 CT positioning.
The external reference point coordinate record plate of the daily treatment of Fig. 4 uses figure.
Specific embodiment
Explanation and specific embodiment with reference to the accompanying drawing, the present invention is further elaborated.
Coordinate method positions in radiotherapy and puts the application of position, it is characterised in that: in the external coordinate record plate note of radiotherapy
Body surface visible marking after record or mark patient simulation's positioning, with two dimensional coordinate values relationship of telltale mark point;Treatment plan has made
After being verified, patient is lain in therapeutic bed by the position of simulator locating, by the body surface visible marking of record and telltale mark
It is consistent with the central point of therapy apparatus that two dimensional coordinate values of point find telltale mark point position;According to plan system provide skin-marker with
The D coordinates value at treatment plan center, Mobile treatment table determine patient therapeutic community respectively in coronal-plane, cross section and sagittal
The corresponding position in face is determined for compliance with what treatment required through the verifying of airborne imagery system, with special token pen in patient body-surface or heat
Treatment mark is done on plastic film surface, and records the D coordinates value of body surface visible marking Yu therapeutic community's point;By mark when daily treatment
Bright irradiation field central point carries out the treatment of pendulum position, can also sit every time by the body surface visible marking of record and the three-dimensional of therapeutic community's point
Scale value puts position treatment, must also verify device using airborne imagery weekly, carry out location verification.
Coordinate value -20~+20cm of range, minimum unit 0.5cm of the external coordinate record plate.
The visible marking includes: that xiphoid-process, navel, male patient's nipple, the apparent wart of patient body-surface, mole etc are transported
Dynamic, skin drawing factor influences small mark.
Coordinate method positions in radiotherapy and puts the application of position, it is characterised in that: and its applying step is,
1. determining zero reference point:
1) chest: using xiphoid-process as zero point, method is determined: to touch slight amount, after finger removes skin, to occur pressing impression
The center of mark is its mark point, and it is spare to mark " cross " with marking pen;The pressing trace is round or oval;
2) abdomen: using navel as zero point, the center " cross " of round or ellipse is marked with marking pen, is that its mark point is standby
With;
3) labeling method of body middle line: to mark center " cross " line of xiphoid-process and navel as body middle line.Two sides midaxillary line water
It is flat consistent;
4) incidence: using two endocanthions, two line and body middle line intersection point as origin;Nose and tragus line are perpendicular to treatment bed surface;
5) prone position: using neck band and body middle line intersection point or anal cleft as zero point, both hands are placed under jaw or body two sides;
6) coordinate value: patient head Xiang Weizheng, to being negative, left side is positive foot, and right side is negative, and veutro is positive, and back side is negative.
2. application method:
2-1. patient lies low in therapeutic bed by positioning requirements, and external reference point coordinate record plate is lain in a horizontal plane in patient's body
The Y-axis of table, template is consistent with body middle line, and two sides midaxillary line is horizontal consistent.Chest patient suggests with xiphoid-process, abdomen patient with tripe
Navel is 0 point, and patient body-surface visible marking can also be used as at 0 point.
2-2. Conventional patient through radiotherapy simulative generator determines irradiation field and after body surface marking irradiation field shape, by external ginseng
The requirement of examination point coordinate record plate is put;In positioning minute book record with xx point for 0 point, launched field center and irradiation field shape are sat
Mark: center (x, y), the upper bound (x, y, x, y), lower bound (x, y, x, y), interior boundary (x, y, x, y), extraneous (x, y, x, y), if according to
Launched field it is in irregular shape can in irregular boundary line more record coordinates for example in (x, y, x, y, x, y, x, y) record sequence is served as reasons on boundary
Top to bottm, from the inside to the outside.
After 2-3.CT analog machine positions patient's completion CT scan, put by the requirement of external reference point coordinate record plate;?
CT positions minute book and records with xx point as 0 point, external reference point coordinate: upper point (x, y), midpoint (x, y), lower point (x, y), side point
(x, y).
Patient 2-4. puts position for the first time, compares and meets the requirements with treatment plan DRR piece through image verifying device bat verifying piece,
After doctor, physics teacher, technician confirm jointly after therapeutic community, puts, treating by the requirement of external reference point coordinate record plate
It is recorded on record: therapeutic community (x, y), the number of SSD numerical value or therapeutic bed bed surface to lesion centre distance when 0 ° of rack angle
Value guarantees constant using assistant product thickness under patient body.
Position is put in the daily treatment of 2-5., carries out the treatment of pendulum position by the therapeutic community's label indicated when daily treatment;It need to be by treatment
The numerical value of the therapeutic community's coordinate value and therapeutic bed bed surface recorded on record to lesion centre distance puts position, must use airborne shadow
As verifying device carries out location verification.
If patient body-surface mark line is unintelligible during 2-6. is treated, or when can not determine, the technology can be used and give for change
The relative position of therapeutic community shoots the DRR of radiotherapy location verification piece and treatment plan using airborne imagery location verification system
Piece carries out review error limit, meets, and is marked, treats;Offset correction is then carried out beyond limit value, position is clapped again and tests
Card piece is compared with DRR piece, until meeting the requirements.
The requirement met are as follows: 1, National Cancer Center and national tumour diagnosis and treatment Quality Control center were issued on November 11st, 2017
" radiotherapy quality control basic guide " i.e. NCC/T-RT 001-2017;
2, " Radiation Oncology " that in the May, 2018 of Li Yexiong chief editor publishes, periodical number: ISBN978-7-5679-1001-
0。
Embodiment:
According to above-mentioned requirements, using technical solution of the present invention, coordinate value shown in Fig. 2 is measured: with xiphoid-process for 0 point, center (0 ,+
11), the upper bound (- 1 ,+16.5 ,+2.5 ,+16.5), lower bound (- 1 ,+5.5 ,+4 ,+6.5), interior boundary (- 3.5 ,+10, -4 ,+13),
Extraneous (+6 ,+13);
Coordinate value shown in Fig. 3: with xiphoid-process for 0 point, upper point (- 0.5 ,+10), midpoint (- 1 ,+12), and lower point (- 1.5 ,+14), side point
(+3.5 ,+12);
Coordinate value shown in Fig. 4: with xiphoid-process for 0 point, therapeutic community (0 ,+16), reference point (+4 ,+9).
Contrast verification result: it 21 thorax abdomen patients is randomly selected is gilded using current common body surface and mark and mark mark
Method, for the first time Set-up errors data analysis result are as follows: left and right directions is minimum, maximum value 1mm, 17mm, meets accounting for for 5mm threshold value
28.6%;Head foot direction minimum, maximum value 0mm, 19mm, meet 5mm threshold value accounts for 52.4%;Abdomen carries on the back direction minimum, maximum value
0mm, 21mm, meet 5mm threshold value accounts for 14.3%, and all patients are both needed to carry out position correction.
And the patient of 21 positioning and pendulum position method by coordinate method in radiotherapy, Set-up errors data are analyzed for the first time
As a result are as follows: left and right directions minimum, maximum value 0mm, 10mm, meet 5mm threshold value accounts for 66.7%;Head foot direction minimum, maximum value
0mm, 11mm, meet 5mm threshold value accounts for 76.2%;Abdomen carries on the back direction minimum, maximum value 0mm, 15mm, meets accounting for for 5mm threshold value
61.9%.Wherein 7 patient position error amounts meet 5mm error threshold requirement, without carrying out position to correct accounting being 33.4%.
Therefore technical solution of the present invention, can allow tumor patient during receiving radiotherapy, without considering body surface institute
The clarity for the treatment of mark is done, daily life is unaffected, nor affects on normal radiotherapy.And guarantee treatment position every time
The accuracy set makes to treat Set-up errors control within the scope of defined error threshold (95% degree of belief), guarantees radiotherapy meter
The advantages of drawing and accurately execute, guaranteeing radiotherapeutic effect.
Claims (4)
1. the application that coordinate method positioned in radiotherapy and put position, it is characterised in that: in the external coordinate record plate record of radiotherapy
Or body surface visible marking after mark patient simulation's positioning, with two dimensional coordinate values relationship of telltale mark point;Treatment plan completes
After being verified, patient is lain in therapeutic bed by the position of simulator locating, body surface visible marking and telltale mark point by record
It is consistent with the central point of therapy apparatus that two dimensional coordinate values find telltale mark point position;System provides skin-marker and controls according to plan
The D coordinates value of Project Central is treated, Mobile treatment table determines patient therapeutic community respectively in coronal-plane, cross section and sagittal plane
Corresponding position, through airborne imagery system verifying be determined for compliance with treatment require, with special token pen in patient body-surface or thermoplastic
Film surface does treatment mark, and records the D coordinates value of body surface visible marking Yu therapeutic community's point;By indicating when daily treatment
Irradiation field central point carry out pendulum position treatment, also can every time by record body surface visible marking and therapeutic community's point three-dimensional coordinate
The position treatment of value pendulum, must also verify device using airborne imagery weekly, carry out location verification.
2. the application that coordinate method according to claim 1 positioned in radiotherapy and put position, it is characterised in that: described
Coordinate value -20~+20cm of range, minimum unit 0.5cm of external coordinate record plate.
3. the application that coordinate method according to claim 1 positioned in radiotherapy and put position, it is characterised in that: described
Visible marking include: xiphoid-process, navel, male patient's nipple, the apparent wart of patient body-surface, mole etc moved, skin drawing because
Element influences small mark.
4. the application that coordinate method according to claim 1 positioned in radiotherapy and put position, it is characterised in that: it is applied
Step and method be,
Determine zero reference point:
1.1) chest: using xiphoid-process as zero point, method is determined: to touch slight amount, after finger removes skin, to press
The center of trace is its mark point, and it is spare to mark " cross " with marking pen;The pressing trace is round or oval;
1.2) abdomen: using navel as zero point, the center " cross " of round or ellipse is marked with marking pen, is that its mark point is standby
With;
1.3) labeling method of body middle line: to mark center " cross " line of xiphoid-process and navel as body middle line;Two sides midaxillary line
It is horizontal consistent;
1.4) incidence: using two endocanthions, two line and body middle line intersection point as origin;Nose and tragus line are perpendicular to treatment bed surface;
1.5) prone position: using neck band and body middle line intersection point or anal cleft as zero point, both hands are placed under jaw or body two sides;
1.6) coordinate value: patient head Xiang Weizheng, to being negative, left side is positive foot, and right side is negative, and veutro is positive, and back side is negative;
2. application method:
2.1) patient lies low in therapeutic bed by positioning requirements, and external reference point coordinate record plate is lain in a horizontal plane in patient's body
The Y-axis of table, template is consistent with body middle line, and two sides midaxillary line is horizontal consistent;
Chest patient suggests with xiphoid-process, abdomen patient that with navel, patient body-surface visible marking can also be used as at 0 point for 0 point;
2.2) Conventional patient through radiotherapy simulative generator determines irradiation field and after body surface marking irradiation field shape, by external reference point
The requirement of coordinate record plate is put;In positioning minute book record with xx point for 0 point, launched field center and irradiation field shape coordinate: in
The heart (x, y), the upper bound (x, y, x, y), lower bound (x, y, x, y), interior boundary (x, y, x, y), extraneous (x, y, x, y), if irradiation field
It is in irregular shape can in irregular boundary line more record coordinates for example in (x, y, x, y, x, y, x, y) record sequence is to be arrived from above on boundary
Under, from the inside to the outside;
2.3) it after CT analog machine positioning patient completes CT scan, is put by the requirement of external reference point coordinate record plate;It is fixed in CT
Position minute book is recorded with xx point as 0 point, external reference point coordinate: upper point (x, y), midpoint (x, y), lower point (x, y), side point (x,
Y);
2.4) patient puts position for the first time, compares and meets the requirements with treatment plan DRR piece through image verifying device bat verifying piece, doctor,
It after physics teacher, technician confirm jointly after therapeutic community, is put by the requirement of external reference point coordinate record plate, in treatment record
Upper record: therapeutic community (x, y), SSD numerical value or therapeutic bed bed surface guarantee to the numerical value of lesion centre distance when 0 ° of rack angle
It is constant using assistant product thickness under patient body;
2.5) position is put in daily treatment, need to be by the therapeutic community's coordinate value and therapeutic bed bed surface recorded on treatment record into lesion
The numerical value of heart distance puts position, and airborne imagery verifying device must be used to carry out location verification;
2.6) if patient body-surface mark line is unintelligible during treating, or when can not determine, the technology can be used and give treatment for change
The relative position at center, using airborne imagery location verification system, shoot the DRR piece of radiotherapy location verification piece and treatment plan into
Row review error limit, meets, is marked, treats;Offset correction is then carried out beyond limit value, claps location verification piece again
It is compared with DRR piece, until meeting the requirements.
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CN112089991A (en) * | 2020-09-30 | 2020-12-18 | 中国科学院近代物理研究所 | System and method for real-time monitoring and correcting patient-guided positioning and target area displacement |
CN112089991B (en) * | 2020-09-30 | 2021-04-27 | 中国科学院近代物理研究所 | System and method for real-time monitoring and correcting patient-guided positioning and target area displacement |
CN112263786A (en) * | 2020-10-26 | 2021-01-26 | 中国人民解放军空军军医大学 | Positioning device for treating esophageal cancer |
CN112604184A (en) * | 2020-12-26 | 2021-04-06 | 广州中医药大学第一附属医院 | Method and system for evaluating position of isocenter in radiotherapy plan |
CN112604184B (en) * | 2020-12-26 | 2022-11-11 | 广州中医药大学第一附属医院 | Method and system for evaluating position of isocenter of radiotherapy plan |
CN116370848A (en) * | 2023-06-07 | 2023-07-04 | 浙江省肿瘤医院 | Positioning method and system for radiotherapy |
CN116370848B (en) * | 2023-06-07 | 2023-09-01 | 浙江省肿瘤医院 | Positioning method and system for radiotherapy |
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