CT-scan based localization of the internal mammary chain and supra clavicular nodes for breast cancer radiation therapy planning
CT-scan based localization of the internal mammary chain and supra clavicular nodes for breast cancer radiation therapy planning
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DOI：
10.1016/j.radonc.2006.05.014
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发表时间：
2006-06-01
影响因子：
5.7
通讯作者：
Fourquet, Alain
中科院分区：
文献类型：
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作者：
Kirova, Youlia M.;Servois, Vincent;Fourquet, Alain
背景与目的：评估锁骨上淋巴结（SCN）和内乳链（IMC）的位置和精确定位及其变异性对患者的影响，以改善乳腺癌（BC）患者的治疗计划。患者和方法：总共检查了46张胸部CT扫描。所有患者均为接受保乳手术和放射治疗的女性。该研究分为两个阶段。第一项包括 20 次诊断性 CT 扫描的测量，这些扫描是在仰卧位、双臂举过头顶进行的。所有患者均接受造影剂治疗。第一阶段是作为放射科医生和放射肿瘤学家的培训计划进行的，为研究的第二阶段做准备：在有角度的板上进行 26 次 CT 扫描，无需注射。对于第二组，患者将一只手臂举过头顶（治疗侧），另一只手臂放在一侧（对侧）。对两侧进行测量以评估手臂位置的影响。在五个点测量 IM 和 SC 血管的深度：(1) 乳内动脉的起点，(2) 胸锁关节，(3-5) 第一、第二和第三肋骨间隙 (RI)。在PACS工作站上使用电子卡尺测量内乳血管与胸骨中轴之间的深度和距离。结果：SCN深度存在重要的个体差异，如下：20-84毫米（诊断）和19-64（治疗位置）。在 I、II 和 III 肋骨间隙区域，治疗侧和对侧之间未发现 IMC 深度存在差异。 IMC 的侧缘距离胸骨中轴（I、II、III 肋骨间隙）绝不超过 40 毫米。治疗侧和对侧两侧的 IMC 侧向界限（IM 血管与胸骨中轴之间的距离）没有差异。结论：这项研究显示了患者个体解剖结构、位置以及 SCN 深度的巨大变异性的重要性。重要的是可视化这些区域以允许个体剂量测定优化。 (c) 2006 Elsevier Ireland Ltd. 保留所有权利。
Background and purpose: To evaluate the influence of the position and the exact localizations of supra clavicular nodes (SCN) and internal mammary chain (IMC) and their variability among patients in order to improve treatment planning in breast cancer (BC) patients.Patients and methods: A total of 46 CT scans of the chest were examined. All patients were female treated with breast conserving surgery and radiotherapy. The study was divided into two phases. The first consisted of measurements on 20 diagnostic CT scans, performed in the supine position with both arms over the head. All patients received contrast. This first phase was performed as a training program for radiologist and radiation oncologist to prepare for the second phase of the study: 26 CT scans in treatment position on angled board without injection. For this second group, patients had one arm raised above the head (treated side) and the other kept by the side (contralateral side). Measurements were performed on both sides to evaluate the influence of the arm position. The depths of IM- and SC vessels were measured at five points: (1) the origin of the internal mammary artery, (2) the sterno-clavicular articulation, (3-5) the first, second and third rib interspaces (RI). Measurements of the depth and of the distance between the internal mammary vessels and the middle axis of the sternum were obtained using electronic calipers on a PACS workstation.Results: There were important individual variations of the depth of SCN, as follows: 20-84 mm (diagnostic) and 19-64 (treatment position). No differences in the depth of the IMC were found between treated and contralateral side at the region of the I, II, and III rib interspaces. The lateral margin of the IMC was never more than 40 mm from the middle axis of the sternum (I, II, III rib interspaces). There was no difference in the lateral limits of IMC (the distance between the IM vessels and the middle axis of the sternum) between the two sides: treated and contralateral.Conclusions: This study shows the importance of the patients' individual anatomy, their position and the large variability in the depth of SCN. It is important to visualize these regions to permit individual dosimetric optimization. (c) 2006 Elsevier Ireland Ltd. All rights reserved.