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1
題名:評估頭頸部模型使用的TIMO枕與壓克力枕在放射治療中的再現性與舒適度     (24點)
COMPARISON OF REPOSITIONING ACCURACY AND COMFORT SURVEY IN TWO HEAD SUPPORTS USED INSIDE THE SAME AVAILABLE IMMOBILIZATION SYSTEMS FOR TREATMENT OF HEAD-AND-NECK TARGET
著者:高菁苓(Ching-Ling Kao) ;林信吟(Shinn-Yn Lin) ;劉煥彰(Huan-Chang Liu) ;林倩伃(Chien-Yu Lin) ;范綱行(Kang-Hsing Fan) ;劉義誠(Yi-Cheng Liu) ;陳柏元(Po-Yuan-Chen)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:影像導引放射治療 ; 頭頸部腫瘤 ; 枕墊舒適度 ; 再現性 ; Image-guided radiation therapy (IGRT) ; Head-and-neck tumor ; Comfort level ; Reproducibility
刊名:放射治療與腫瘤學
頁碼:115-126
語言:繁體中文
摘要: 中文摘要PDF ; 英文摘要PDF

目的:本試驗試圖以兩種不同軟硬程度的枕墊,來為即將接受頭頸部放射治療的病患製作模型,使用影像導引技術來測量並比較兩種枕墊在治療定位中的再現性,並試圖比較受試病患感受兩種不同枕墊主觀舒適度及軟硬程度。另外,本試驗將會探討定位再現性與枕墊舒適度或軟硬程度之間的相關性。
材料與方法:自2011年三月開始,至2012年二月底止,總共有35位受試者進入本試驗。每位受試者皆會接受兩組模型的製作及分別的模擬電腦斷層掃描,其中一組模型的枕墊使用TIMO枕,另一組模型的枕墊使用壓克力枕。在療程一開始的三天內、療程中每隔三至五天、及療程結束的那一天利用影像導引放射治療技術來分別取得當日治療前的定位影像,藉此測量並計算出擺位再現性的相關參數,包括在中心點上的垂直角度面上的三軸位移。再者,在療程進行中的取像日當天以問卷方式調查受試者對於兩種枕墊的主觀感受舒適程度、軟硬程度、及偏好選擇。最後,定位再現性與枕墊舒適度或軟硬程度互相之間的相關性亦會被分析。
結果:總共有351筆由即時影像導影所得的取像資料,可供我們做位移誤差的分析。一、兩枕墊之位移誤差分析:由結果可知雖然各項位移絕對差異相當小,但於前後軸(p=0.011,成對t檢定)與左右軸(p=0.004,成對t檢定)的位移差異,確實已達統計顯著意義,亦即壓克力枕的再現性較TIMO枕佳。在評估頸椎彎曲位移與下頷骨仰角變化,可得知不論是頸椎彎曲或下頷骨仰角的變動都可觀察到當治療到中後期後,兩枕墊的再現性呈現變差的趨勢。二、兩枕墊之舒適度問卷分析:從Spearman's相關係數得知不論是壓克力枕或TIMO枕,受試者主觀感受枕墊愈軟,則給予該枕墊舒適度的評分有顯著愈高之趨勢(Spearman's相關係數=0.387, p<0.001)。三、兩枕墊軟硬度評等及舒適度分數與位移誤差之間的關係:雖然兩種枕墊的軟硬程度與位移誤差之間毫無相關性,但若評估枕墊舒適度與定位誤差之間的相關性,只有壓克力枕在空間向量位移(Pearson's相關係數=0.153, p=0.006)和中軸旋轉上(Pearson's相關係數=0.213, p<0.001)的定位誤差與病患感受舒適度之間存在著統計顯著的正相關性。
結論:不論是在再現性或舒適度上,壓克力枕墊與TIMO枕墊差異皆不大。在未來,如何設計兼顧病患舒適性與準確性的模型,且在不影響治療準確度與再現性的狀況下,讓病患可採取舒適且不易變動的姿勢來做治療,是我們未來期許的重要目標。
Objectives/Hypothesis: To compare setup reproducibility, comfort level and hardness perceived by the patients between two head suports employed in the same immobilization system in head-and neck radiotherapy. Additionally, the relationship between setup accuracy and patient comfort survey was also investigated.
Methods: Between March 2011 and February 2012, there were 35 patients undergoing head-and-neck radiotherapy (RT) being recruited and all studied patients received the same immobilization device (a standard thermoplastic head-and-shoulder mask, Type S mask) twice, in which two different head supports were employed. Both a TIMO support and a Silverman support were used to compare setup accuracy/precision with several types of measurement respectively in each studied patient. All patients underwent planning computed tomography (CT). A series of on-board images (OBIs) were taken at the start, during, and by the end of the radiotherapy course in each studied patient. The OBI images were subsequently co-registered and repositioning accuracy was examined by recording displacement including three axes at the isocenter and orthogonal planes. Furthermore, the patients' subjective perception of comfort level, hardness, and preference for selecting between the two head supports were analyzed and compared. Last but not least, we attempted to explore the association between repositioning accuracy represented by several indicators and the patients' subjective perception in terms of comfort level and hardness.
Results: A total of 351 OBI data sets were analyzed. Although the absolute difference was quite small between the two head supports (TIMO support vs. Silverman support) with regard to three displacement errors, total vector displacement errors, spine curve, and mandible angle, it was noted that Silverman support was associated with more limited repositioning displacement in the antero-posterior (AP) and medio-lateral (ML) directions (paired t-test, p=0.011, 0.004, respectively). As the RT course was proceeding, a trend was noted toward a greater variation in both spinal curve and mandible angle, suggesting that reproducibility should be paid more attention when the RT course moves forward. In the comfort survey, perception of hardness was positively correlated with comfort level in both head supports with weak but significant significance (Spearman's correlation coefficient=0.387, p<0.001). As for the association between repositioning accuracy and comfort survey, although there was no any correlation between hardness of head supports and repositioning accuracy, comfort level was positively correlated with repositioning displacement in rotation (Pearson's correlation coefficient=0.213, p<0.001) and total vector displacement error (Pearson's correlation coefficient=0.153, p=0.006) in Silverman head support only.
Conclusions: The results of the current study have demonstrated that the available immobilization system equipped with either TIMO head support or a Silverman head support provides satisfactory and nearly equivalent repositioning-related outcomes. More limited repositioning displacement is positively associated with more satisfactory perception of comfort level exclusively in the immobilization system equipped with Silverman head support. In the future, we might consider leaving the choice between the two different head supports to the individual patient according to subjective perception of comfort level.


    

本卷期目次
放射治療與腫瘤學
THE IMPACT OF PRONE POSITION WITH BELLY-BOARD DEVICE ON THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY OF PROSTATE CANCER: DECREASING THE RECTUM COMPLICATION PROBABILITY/ Yu-Ming LiuLiang-Hsiao ChaoChun-Wei WangSang-Hue YenMei-Ling LeeChuen-Mei HsiehYuh-Lin LeePin-I HuangLing-Wei WangCheng-Ying Shiau
評估頭頸部模型使用的TIMO枕與壓克力枕在放射治療中的再現性與舒適度/ 高菁苓林信吟劉煥彰林倩伃范綱行劉義誠陳柏元
癌症多專科團隊會議運作模式與未來展望許維中/ 廖宏恩鍾娜娜王博民詹淑卿
研究overshoot effect對於執行強度調控放射治療之影響及劑量修正/ 王思文游浚彥周文采朱俊男賴姿云翁益強楊世能梁基安
TOMOTHERAPY FOR CERVICAL CANCER WITH BILATERAL TOTAL HIP REPLACEMENT/ Hsin-Hua LeeShi-Long LianChih-Jen Huang
利用放射線治療默克細胞癌淋巴腺轉移的病患--病例報告/ 葉啓源劉芳慧賴鵬安
PROGNOSTIC FACTORS AFTER ADJUVANT RADIOTHERAPY IN CERVICAL CANCERS: A RETROSPECTIVE STUDY/ Po-Chun ChenWen-Shan LiuChien-Hsun ChenChing-Hsiung ChangPei-Ling TangChung-Man LeungYu-Chang HuKuo-Chen Chang
螺旋刀放射治療儀低分次放射治療第四期非小細胞肺癌肺內病灶--單一中心經驗分享/ 李政彥張恆睿楊凱琳柯卉玲黃素禎溫嘉綺季匡華
 
   
 
   

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