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摘要:
目的 探讨在有限条件下完成分次双侧位大野全身照射治疗时多点实时剂量监测技术用于质控的必要性。 方法 使用Varian 2300 C/D加速器6 MV射线对25例准备进行骨髓移植的患者进行全身照射治疗。治疗同时使用半导体剂量计进行多点实时剂量监测, 记录监测结果并与计划计算结果进行比对分析, 在治疗的同时进行剂量的修正, 以确保患者受照剂量误差控制在±5%以内。 结果 25例患者的12通道首次实时剂量监测结果与理论计划剂量有显著偏差。头部、胸部、腹部、盆腔、大腿、膝关节和踝关节剂量偏差中位数分别为6.10%、-1.30%、5.90%、5.05%、-4.00%、3.05%和3.30%。通过对实时监测数据的分析及时修正偏差, 所有患者的受照剂量偏差均在±5%以内, 上述部位的剂量偏差中位数分别降为0.35%、-1.05%、0.60%、0.20%、-2.55%、1.20%和0.85%。 结论 实时剂量监测是实施全身照射的必要质控手段。 Abstract:Objective To explore the necessity of multi-point real-time dose monitoring for total body irradiation. Methods Varian 2300 C/D accelerator 6 MV rays were applied on 25 cases ready for bone marrow transplant patients with total body irradiation. Treatment was conducted while using semiconductor dosimeters for multi-point real-time dose monitoring, and the results were monitored and recorded, during which the doses were adjusted to ensure that the radiation dose error was controlled within ±5%. Results The measured dose and calculated dose showed large deviations in the first multi-point real-time dose monitoring of all these 25 patients. The median deviations of the head, chest, abdomen, pelvic, thigh, knee, and ankle were 6.10%, -1.30%, 5.90%, 5.05%, -4.00%, 3.05% and 3.30%, respectively. After timely bias adjustment based on the monitoring results, the dose deviations were within ±5% in all patients, and the median deviations of above mentioned points decreased to 0.35%, -1.05%, 0.60%, 0.20%, -2.55%, 1.20% and 0.85%, respectively. Conclusions Multi-point real-time dose monitoring is necessary for the quality control of total body irradiation. -
表 1 各部位参数测量结果及器官受照剂量计算值(x±s)
部位 宽度测量结果
(cm)厚度测量结果
(cm)处方剂量
12 Gy(Gy)处方剂量
10 Gy(Gy)头部 16.26±0.77 16.70±1.40 11.90±0.09 9.94±0.03 颈部 11.40±1.36 10.80±1.62 12.00±0.10 10.10±0.09 肩部 42.34±2.78 13.10±1.73 - - 上臂 8.04±1.17 8.48±1.29 - - 胸部 31.56±2.01 19.24±2.20 - - 左肺 7.68±1.09 13.79±2.92 6.00±0.11 5.91±0.02 右肺 8.52±0.98 肚脐 29.76±2.76 18.44±2.33 12.07±0.15 9.99±0.08 髋关节 32.94±2.63 16.90±1.54 12.00±0.06 9.99±0.01 大腿 15.74±1.60 14.24±2.04 11.91±0.16 9.96±0.56 膝关节 11.50±0.96 11.30±0.99 11.93±0.08 10.01±0.01 踝关节 7.08±0.54 8.40±0.78 11.97±0.07 9.98±0.04 
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[1] 张绍刚.全身照射技术的临床应用(之一)——白血病等病症患者在造血干细胞移植前的全身放射治疗[J].医疗装备, 2010, 23:1-13. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ylzb201001001 [2] 卢杰, 陈立新, 梁健, 等.全身照射治疗中的半导体剂量监测[J].肿瘤学杂志, 2005, 11:334-336. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zlxzz200505005 [3] 胡逸民.肿瘤放射物理学[M].北京:原子能出版社, 1999. [4] Ravichandran R, Binukumar JP, Davis CA, et al.Beam configuration and physical parameters of clinical high energy photon beam for total body irradiation (TBI)[J].Phys Med, 2011, 27:163-168. doi: 10.1016/j.ejmp.2010.10.003 [5] Kawa-Iwanicka A, Dybek M, Iwanicki T, et al. The technique of total body irradiation applied at the Leszczyński Memorial Hospital[J]. Rep Pract Oncol Radiother, 2002, 7:53-60. doi: 10.1016/S1507-1367(02)70979-6 -
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