The urethral position may shift due to urethral catheter placement in the treatment planning for prostate radiation therapy
The urethral position may shift due to urethral catheter placement in the treatment planning for prostate radiation therapy
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DOI：
10.1186/s13014-019-1424-8
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发表时间：
2019-12-12
影响因子：
3.6
通讯作者：
Shimizu, Shinichi
中科院分区：
文献类型：
--
作者：
Dekura, Yasuhiro;Nishioka, Kentaro;Shimizu, Shinichi
目的探讨软细导丝引导下Foley导尿管在尿路中的移位情况，以确定测量尿路计划器官危险体积(PRV)的最佳方法。方法采用两组CT图像用于放射治疗计划(RT-CT)：(1)在第一次RT-CT中放置Foley导尿管(直径4.0 mm)加一根导丝(直径0.46 mm)；(2)在第一次RT-CT后2分钟记录的第二次CT中设置单独的导丝。利用前列腺内三个基准标记物进行图像融合，计算出导尿管与导丝在前列腺尿路中的位移。在2011至2017年间连续治疗的155例患者中，对5531层RT-CT进行了评估。结果在23.2%(36/155)的RT-CT切片中，假设导尿管与导丝位置相差3.0 mm为显著移位，仅导丝导尿管的导尿管即可使导尿管从导尿管移位至导尿管的20%。前列腺上段(38/15 5)、中段(14/15 5)和下段(18/15 5)的尿管在~gt；=2 0%的CT切片上有3 mm的前移量(P<；0.0167)。结论Foley导尿管的导尿位与导丝细软的导尿位有很大比例不同。这一点应该考虑到的PRV的尿路，以确保精确的放射治疗，如在保留尿路的放射治疗。
Purpose To determine the best method to contour the planning organ at risk volume (PRV) for the urethra, this study aimed to investigate the displacement of a Foley catheter in the urethra with a soft and thin guide-wire. Methods For each patient, the study used two sets of computed tomography (CT) images for radiation treatment planning (RT-CT): (1) set with a Foley urethral catheter (4.0 mm diameter) plus a guide-wire (0.46 mm diameter) in the first RT-CT and (2) set with a guide-wire alone in the second CT recorded 2 min after the first RT-CT. Using three fiducial markers in the prostate for image fusion, the displacement between the catheter and the guide-wire in the prostatic urethra was calculated. In 155 consecutive patients treated between 2011 and 2017, 5531 slices of RT-CT were evaluated. Results Assuming that >= 3.0 mm of difference between the catheter and the guide-wire position was a significant displacement, the urethra with the catheter was displaced significantly from the urethra with the guide-wire alone in > 20% of the RT-CT slices in 23.2% (36/155) of the patients. The number of patients who showed >= 3.0 mm anterior displacement with the catheter in >= 20% RT-CT slices was significantly larger at the superior segment (38/155) than at the middle (14/155) and inferior segments (18/155) of the prostatic urethra (p < 0.0167). Conclusions The urethral position with a Foley catheter is different from the urethral position with a thin and soft guide-wire in a significant proportion of the patients. This should be taken into account for the PRV of the urethra to ensure precise radiotherapy such as in urethra-sparing radiotherapy.