Uporabnost ultrazvoka in mehkotkivne geometrične verifikacije pri obsevanju raka materničnega vratu : diplomsko delo

Pušnik, Nina (author), Ugovšek, Aleksandra (author), Žager Marciuš, Valerija (mentor), Salmič, Klemen (comentor), Medič, Mojca (reviewer)

Uvod: Rak materničnega vratu je v preteklosti veljal za najpogostejši rak med ženskami v razvitem svetu, in še danes prevladuje v manj razvitih državah. Glavni dejavnik tveganja za razvoj raka materničnega vratu je okužba s humani papiloma virusom (HPV). Pri zdravljenju z obsevanjem je gibanje obsevalnega volumna pogost pojav. Možni razlogi so sprememba položaja maternice, sečnega mehurja oziroma rektuma med obsevanjem. Med posameznimi obsevanji so prisotna odstopanja v polnjenosti volumna sečnega mehurja, kar posledično vpliva na položaj obsevalnega volumna. Namen: Ugotoviti dejansko potrebo po uporabi ultrazvoka pred vsakim obsevanjem in pogostost uporabe dodatne slikovne verifikacije z računalniško tomografijo s stožčastim snopom (CBCT) pri obsevanju bolnic z rakom materničnega vratu. Metode dela: V retrospektivno raziskavo s sekundarno analizo podatkov smo vključili 17 izbranih bolnic z rakom materničnega vratu, ki so bile radikalno obsevane z volumetrično modulirano ločno terapijo (VMAT) na Oddelku za teleradioterapijo Onkološkega inštituta v Ljubljani. Izbrano časovno obdobje je bilo med 10. 6. 2020 in 31. 12. 2021. Podatke smo analizirali s pomočjo računalniškega programa Microsoft Excel 2016 in IBM SPSS Statistics 26. Rezultati: V rezultatih smo ugotovili, da med številom opravljenih UZ in številom dodatnih CBCT slikovnih metod ni statistično značilne povezave. Pri translacijskih premikih v vertikalni in longitudinalni smeri ni bilo statistično značilnih razlik, v lateralnem premiku (levo / desno) pa je obstajala statistično značilna razlika. Večji premiki so bili zaznani v anteriorni, inferiorni ter levi smeri. Pri rotacijskih premikih v naklonu in nagibu ni bilo statistično značilnih razlik, le te so se pojavile v odklonu. Prav tako ni statistično značilnih razlik med nagibi v smeri in nasprotni smeri urinega kazalca. Razprava in zaključek: Na podlagi analize podatkov smo ugotovili, da ima polnjenost sečnega mehurja vpliv na natančnost položaja obsevalnega volumna, kot tudi, da neuporaba UZ pred vsakim obsevanjem ne poveča potrebe po dodatni uporabi slikovne verifikacije s CBCT. Prav tako na ustrezno polnjenost mehurja vpliva upoštevanje navodil bolnice glede pitja tekočine pred obsevanjem, ledvična funkcija ter vpliv radioterapije na izločanje urina.

• Language: Slovenian
• Keywords: diplomska dela, radiološka tehnologija, rak materničnega vratu, radioterapija, ultrazvok
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [N. Pušnik; A. Ugovšek]
• Year: 2022
• Number of pages: 21 str., [3] str. pril.
• PID: 20.500.12556/RUL-139544
• UDC: 616-07
• COBISS.SI-ID: 120371971
• Publication date in RUL: 04.09.2022

Secondary language

• Language: English
• Title: The use of ultrasound and soft tissue geometric verification in cervical cancer irradiation : diploma work

Abstract

Introduction: Cervical cancer has historically been considered the most common cancer among women in the developed world and is still prevalent in less developed countries. The main risk factor for the development of cervical cancer is infection with the human papillomavirus (HPV). For radiation therapy is movement of the irradiation volume a common occurrence. Possible reasons for that are a change in the position of the uterus, bladder, or rectum during irradiation. Variations in bladder volume fill occur between individual irradiations, which in turn affect the position of the irradiation volume. Purpose: To determine the actual need for an ultrasound before each irradiation and the frequency of additional Cone Beam Computed Tomography (CBCT) imaging verification in the irradiation of patients with cervical cancer. Methods: 17 selected patients with cervical cancer who underwent radical irradiation with the Volumetric Modulated Arc Therapy (VMAT) irradiation technique at the Department of Teleradiotherapy of the Institute of Oncology Ljubljana were included in a retrospective study with secondary data analysis. The selected period was between 10 June 2020 and 31 December 2021. The data were analysed using Microsoft Excel 2016 and IBM SPSS Statistics 26. Results: There were no statistically significant differences in the vertical and longitudinal directions, but there was a statistically significant difference between the lateral shifts (left / right). Larger shifts were detected in the anterior, inferior and left directions. There were no statistically significant differences in pitch and roll, only in yaw. There were also no statistically significant differences between clockwise and counterclockwise directions. Discussion and conclusion: We observed that not using ultrasound before each irradiation treatment does not increase the need for additional CBCT imaging verification. Renal function, the effect of radiotherapy on urine output and how the patient follows the instructions about drinking before irradiation also have an influence on adequate bladder filling.

• Keywords: diploma theses, radiologic technology, cervical cancer, radiotherapy, ultrasound