Vpliv ocene slikovne verifikacije na stranske učinke pri obsevanju raka prostate : magistrsko delo

Gomzi, Katarina (avtor), Žager Marciuš, Valerija (mentor), Petrun, Tamara (komentor), Grošelj, Blaž (recenzent)

Uvod: Slikovno vodena radioterapija je pomemben del obsevanja raka prostate, saj omogoča natančno preverjanje dejanskega položaja tarčnih volumnov in kritičnih organov. Sliko računalniške tomografije s konusnim snopom (angl. Cone beam computer tomography – CBCT) vedno oceni radiološki inženir po t. i. ''protokolu semaforja'' in ji dodeli barvo (zelena, rumena, oranžna ali rdeča). Namen: Namen magistrskega dela je ugotoviti, ali obstaja povezava med stranskimi učinki glede na oceno slikovne verifikacije pri obsevanju bolnikov z rakom prostate. Zanima nas tudi, ali premikanje danke v ali iz planiranega tarčnega volumna in vključenost medeničnih bezgavk v obsevalni načrt doprineseta k pogostejšim stranskim učinkom. S pridobljenimi rezultati želimo izboljšati vlogo radioloških inženirjev pri ocenjevanju CBCT slik ter posodobiti protokol semaforja. Metode dela: Pri izdelavi magistrskega dela smo najprej pregledali domačo in tujo strokovno literaturo. Izvedena je bila retrospektivna klinična raziskava na Onkološkem oddelku na Enoti za radioterapijo v Univerzitetnem kliničnem centru Maribor. V raziskavo je bilo vključenih 88 bolnikov z rakom prostate, ki so bili zdravljeni s pooperativnim obsevanjem. Polovica bolnikov je obsevala le ležišče prostate, druga polovica je imela v obsevalno polje vključene še medenične bezgavke. Analizirane podatke smo izpisali iz programa Mosaiq. Uporabili smo tabele za oceno CBCT slik in tabele kontrolnih ambulant, iz katerih smo beležili stranske učinke. Rezultati: Najpogostejši stranski učinek je bil pogostejše in/ali mehkejše odvajanje blata, takoj zatem je nočno odvajanje urina. Ugotovili smo statistično značilno razliko (p = 0,004) v pojavnosti stranskih učinkov glede na ocenjeno barvo CBCT slik (zelena, oranžna). Mehkejše in/ali pogostejše odvajanje blata se pri 61,5 % bolnikov pojavi, kadar je danka v tarčni volumen pomaknjena v več kot devetih frakcijah. Razlike v pojavnosti stranskih učinkov glede na pomaknjenost danke ter glede na prisotnost medeničnih bezgavk niso bile statistično značilne (p = 0,322; p = 0,309). Razprava in zaključek: Barvne ocene CBCT slik so uporaben in praktičen pokazatelj kakovosti pozicioniranja bolnika ter potencialni napovednik pojava stranskih učinkov. Vpeljava protokola za ukrepanje ter jasen in dosleden protokol semaforja pripomoreta k večji učinkovitosti dela, boljšemu sodelovanju v timu in manj stranskih učinkov, povezanih z obsevanjem.

• Jezik: Slovenski jezik
• Ključne besede: magistrska dela, radiološka tehnologija, radioterapija, rak prostate, stranski učinki, protokol semaforja, slikovno vodena radioterapija
• Vrsta gradiva: Magistrsko delo/naloga
• Tipologija: 2.09 - Magistrsko delo
• Organizacija: ZF - Zdravstvena fakulteta
• Kraj izida: Ljubljana
• Založnik: [K. Gomzi]
• Leto izida: 2025
• Št. strani: 50 str., [6] str. pril.
• PID: 20.500.12556/RUL-175123
• UDK: 616-07
• COBISS.SI-ID: 253589251
• Datum objave v RUL: 17.10.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: The impact of image verification evaluations on side effects in prostate cancer radiation therapy : master thesis

Izvleček

Introduction: In prostate cancer radiotherapy, image-guided radiotherapy ensures precise verification of target volumes and critical organs. Cone-beam computed tomography (CBCT) is routinely performed, with radiologic technologists applying the traffic light protocol to evaluate patient positioning. Purpose: The purpose of this master’s thesis is to determine if there is a relationship between side effects and CBCT-based image verification assessments in prostate cancer patients. We also investigate whether displacement of the rectum into or out of the planning targer volume and irradiation of pelvic lymph nodes contribute to more frequent side effects. The results aim to improve the role of radiologic technologists in the evaluation of CBCT images and to update the traffic light protocol. Methods: A retrospective clinical study was conducted at the Oncology Department, Department of Radiotherapy, University Medical Centre Maribor, including 88 postoperative patients. In half of the patients only the prostate bed was irradiated, while in the other half the pelvic lymph nodes were also included. The data was extracted from the Mosaiq system. CBCT image assessments and outpatient follow-up forms documenting side effects were analyzed. Results: The most common side effect was softer and/or more frequent bowel movements, followed by nocturia. A statistically significant difference (p = 0.004) was found in the occurrence of side effects based on the traffic light color category (green, orange) assigned to the CBCT images. Softer and/or more frequent bowel movements associated with rectal displacement into the target volume in more than nine fractions occurred in 61.5% of patients. However, the differences in the occurrence of side effects associated with rectal displacement and the presence of pelvic lymph nodes were not statistically significant (p = 0.322; p = 0.309). Discussion and conclusion: Color-coded CBCT image assessments provide a useful and practical indicator of the quality of patient positioning and serve as potential predictors of side effects. The implementation of a clear and consistent response protocol, together with an updated traffic light protocol, contributes to increased work efficiency, improved team collaboration, and a reduction in radiation-related side effects.

• Ključne besede: master's theses, radiologic technology, radiotherapy, prostate cancer, side effects, traffic light protocol, image guided radiotherapy