Progress in Medical Physics (한국의학물리학회지:의학물리)

Korean Society of Medical Physics (한국의학물리학회)
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Impact of Respiratory Motion on Breast Cancer Intensity-modulated Radiation Therapy

유방암 세기조절방사선치료에서의 호흡운동 영향

  • Chung, Weon Kuu (Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong) ;
  • Chung, Mijoo (Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong) ;
  • Shin, Dong Oh (Department of Radiation Oncology, Kyung Hee University Hospital) ;
  • Kim, Dong Wook (Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong)
  • 정원규 (강동경희대학교병원 방사선종양학과) ;
  • 정미주 (강동경희대학교병원 방사선종양학과) ;
  • 신동오 (경희대학교병원 방사선종양학과) ;
  • 김동욱 (강동경희대학교병원 방사선종양학과)
  • Received : 2016.06.18
  • Accepted : 2016.06.22
  • Published : 2016.06.30
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Abstract

In this study, we evaluate the effect of respiration on the dose distribution in patient target volume (PTV) during intensity-modulated radiation therapy (IMRT) and research methods to reduce this impact. The dose distributions, homogeneity index (HI), coverage index (CVI), and conformity index of the PTV, which is calculated from the dose-volume histogram (DVH), are compared between the maximum intensity projection (MIP) image-based plan and other images at respiration phases of 30%, 60% and 90%. In addition, the reducing effect of complication caused by patient respiration is estimated in the case of a bolus and the expended PTV on the skin. The HI is increased by approximately twice, and the CVI is relatively decreased without the bolus at other respiration phases. With the bolus and expended PTV, the change in the dose distribution of the PTV is relatively small with patient respiration. Therefore, the usage of the bolus and expended PTV can be considered as one of the methods to improve the accuracy of IMRT in the treatment of breast cancer patients with respiratory motion.

유방암 환자에 대한 세기조절방사선치료(IMRT)를 수행함에 있어서 환자의 호흡이 계획표적부피(PTV) 내의 선량분포에 미치는 영향을 평가하고 그 영향을 감소시킬 수 있는 방안에 대해 연구를 수행하였다. 이에 따라 호흡위상별 전산화단층 촬영술(4DCT) 영상을 획득하여 IMRT 치료계획에 적용하고 호흡위상 30%와 60%, 90%에서 PTV에 조사된 선량분포와 선량균질지수(HI), 덮힘율지수(CVI), 처방선량지수(CI)를 선량-부피히스토그램(DVH)을 이용하여 비교하였다. 또한 치료 부위의 피부에 조직보상체와 가상계획표적부피 설정을 통하여 유방암 IMRT중에 발생할 수 있는 호흡운동에 의한 부작용 감소 효과를 평가해 보았다. 조직보상체를 사용하지 않는 경우에 HI가 2배 증가하고 CVI는 상대적으로 감소하였으나 조직 보상체와 가상계획표적부피를 사용한 경우에는 환자의 호흡에 따른 표적부피 선량 변화가 상대적으로 크지 않게 평가되었다. 따라서 유방암 환자의 대한 IMRT 치료에서의 정밀도 향상을 위하여 조직보상체 및 가상계획표적부피 사용이 한가지 방안이 될 수 있을 것으로 사료된다.

Keywords

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