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目的探讨降低头颈部调强放射治疗摆位误差的措施,提高调强放疗的质量。方法选择头颈部调强放射治疗患者26例,利用头颈肩底板和头颈肩面膜进行体位的精确固定,通过技术员细心规范的摆位,以及首次治疗前对患者进行机载锥形束CT(CBCT)扫描,治疗过程中每周至少1次CBCT扫描,取得左右、头脚、腹背3个方向的误差数值,进行判断和在线纠正摆位误差。结果26例患者进行122例次CBCT扫描位置验证,其中首次摆位26例次,治疗过程中96例次,治疗过程中摆位误差数值减小,治疗体位重复率高。所有患者能顺利完成放疗计划,肿瘤局控率97.2%,完全缓解81.4%,不良反应明显下降。结论通过质量控制,技术改进,可以保证治疗体位的重复性,使摆位误差降到最小,达到调强放疗的目的。
Objective To discuss the measures to reduce the setting error of intensity modulated radiation therapy in head and neck and to improve the quality of intensity modulated radiotherapy. Methods Twenty-six patients with head-and-neck IMRT were selected, and their positions were precisely fixed by using the head, neck and floor, head and neck shoulder mask. The technicians carefully placed their positions and performed the CBCT ) Scan, CBCT scan at least once a week during the treatment, to obtain the left and right, head and foot, abdomen and back three directions of the error value, to judge and correct the setup error online. Results Totally 26 cases underwent CBCT scan of 122 cases for the first time, of which 26 cases were placed for the first time, and 96 cases were treated during the course of treatment. The setting error value decreased and the repetition rate of the treatment position was high. All patients can successfully complete the radiotherapy plan, the local control rate of 97.2%, complete remission 81.4%, adverse reaction decreased significantly. Conclusion Through the quality control and technical improvement, the repeatability of the position can be guaranteed and the setup error can be minimized so as to achieve the purpose of intensity modulated radiotherapy.