Pomen slikovne verifikacije z računalniško tomografijo s konusnim snopom pri obsevanju raka pljuč : magistrsko delo

Štrljič, Karmen (avtor), But-Hadžić, Jasna (mentor), Žager Marciuš, Valerija (komentor), Marinko, Tanja (recenzent)

Uvod: Rak pljuč ima izmed vseh rakavih obolenj najvišjo stopnjo umrljivosti na svetu. Ena izmed vrst zdravljenja je tudi radioterapija. Večjo natančnost zdravljenja z obsevanjem zagotovimo z dnevno slikovno verifikacijo lege bolnika. Računalniška tomografija s konusnim snopom je način slikovne verifikacije, pri kateri pridobljeno tri-dimenzionalno sliko bolnika primerjamo s tridimenzionalno sliko pridobljeno na računalniško tomografskem simulatorju. Pri procesu registracije se lahko orientiramo na kostne strukture oziroma mehka tkiva. Namen: Namen magistrskega dela je ugotoviti ali obstajajo razlike v registraciji slike na hrbtenico in registraciji na razcepišče sapnika glede na registracijo na tumor ter v kateri smeri je razlika največja. Poleg tega želimo ugotoviti ali ima lega tumorja in število prizadetih bezgavčnih regij vpliv na razlike v registraciji. Metode dela: V raziskavo smo vključili 40 bolnikov z rakom pljuč, katerih lega je bila pred radikalnim obsevanjem verificirana s računalniško tomografijo s konusnim snopom. Uporabili smo 4 verifikacijske slike vsakega bolnika pred 1., 10., 15. in 20. obsevanjem ter izvedli registracijo na tumor, hrbtenico in razcepišče sapnika. Razlike smo beležili v vertikalni, longitudinalni in lateralni smeri. Rezultati: Razlike med registracijo na tumor oz. hrbtenico in tumor oz. razcepišče sapnika so največje v longitudinalni smeri. Med registracijo na tumor oz. hrbtenico je povprečna razlika v longitudinalni smeri 2,5 mm, med registracijo na tumor oz. razcepišče sapnika pa 1,7 mm. Registracija na razcepišče sapnika je bolj natančna kot registracija na hrbtenico pri centralno ležečih tumorjih v vseh treh smereh. Enako opazimo pri perifernih tumorjih, razen v vertikalni smeri. Prav tako je registracija na razcepišče sapnika boljša od registracije na hrbtenico vse dni merjenja in v vse smeri pri N3 stadiju bolezni. Zaradi pojava večjih anatomskih sprememb med terapijo so 3 bolniki potrebovali ponovno pripravo na obsevanje. Razprava in zaključek: Ugotovili smo, da se registracija na razcepišče sapnika bolj ujema z registracijo na tumor kot registracija na hrbtenico. Ker je poravnava na razcepišče sapnika možna le s tridimenzionalno verifikacijo, je računalniška tomografija s konusnim snopom metoda izbora slikovne verifikacije v radioterapiji pljučnega raka. Poleg tega, da nam zagotovi večjo natančnost, nam omogoča tudi sledenje anatomskim spremembam, ki se lahko pojavijo med obsevanjem.

• Jezik: Slovenski jezik
• Ključne besede: magistrska dela, radiološka tehnologija, radikalno obsevanje, slikovna verifikacija, registracija na tumor, razcepišče sapnika, adaptivna radioterapija
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [K. Štrljič]
• Leto izida: 2021
• Št. strani: 35 str., [2] str. pril.
• PID: 20.500.12556/RUL-124585
• UDK: 616-07
• COBISS.SI-ID: 50271491
• Datum objave v RUL: 05.02.2021

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: The importance of cone-beam computed tomography imaging verification in lung cancer radiotherapy : master thesis

Izvleček

Introduction: Lung cancer has the highest mortality rate of any cancer in the world. One type of treatment for lung cancer is radiotherapy. Greater accuracy of radiotherapy treatment is ensured by daily image verification of the patient's position before treatment. Cone beam computed tomography is a method of image verification in which a three-dimensional image of a patient is compared to a three-dimensional image obtained on a computed tomography Simulator. Cone beam computed tomography allows the registration process to focus on bone tissues or on soft tissues. Purpose: The purpose of the master's thesis is to determine if there are any differences between the spine registration or the registration on the carina of the trachea in respect to tumour registration. And in which direction it differs the most. In addition, we want to determine, whether the location of the tumour and the number of affected lymph node regions have an impact on registration differences. Methods: The study included 40 patients with lung cancer, whose position was verified with cone beam computed tomography prior to radical radiotherapy. We used 4 verification images of each patient before the 1st, 10th, 15th and 20th radiotherapy fraction and performed registration on the tumour, on the spine and on the carina of the trachea. Differences were recorded in the vertical, longitudinal, and lateral directions. Results: Differences between tumour-spine registration and tumour-carina of the trachea registration are the greatest in the longitudinal direction. Between the tumour registration and the spine registration there is an average difference of 2.5 mm in longitudinal direction and between the tumour registration and the registration on the carina of the trachea the average difference is 1.7 mm. Registration on the carina of the trachea is more accurate than spine registration for centrally located tumours in all directions. The same is observed in peripheral tumours, except in the vertical direction. Additionally, registration on the carina of the trachea is better on all days of measurement and in all directions at the N3 stage of the disease. Due to the appearance of major anatomical changes during therapy, 3 patients required re-preparation for irradiation. Discussion and Conclusion: The results show that registration on the carina of the trachea is more reminiscent of tumour registration than spinal registration. Because image registration on the carina of the trachea is only possible with three-dimensional verification, cone-beam computed tomography is preferred method for image verification in lung cancer radiotherapy. In addition to providing with greater accuracy, it also allows to track anatomical changes that may occur during irradiation.

• Ključne besede: master's theses, radiologic technology, radical radiation therapy, image verification, tumour registration, carina of the trachea, adaptive radiotherapy