Radiotherapy Department, Bristol Haematology and Oncology Centre, Bristol, UK.
Br J Radiol. 2013 Mar;86(1023):20120428. doi: 10.1259/bjr.20120428.
This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies.
The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series.
Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps >2 mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson χ(2) test=46.19; p<0.0001).
The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps >2 mm.
For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre.
本质量保证研究评估了 CT 图像引导验证与之前的研究相比是否在技术上有所改进。
对 2010 年 105 例接受阴道穹窿辅助近距离治疗的子宫内膜癌患者的 CT 图像进行了研究。首次插入时拍摄图像，检查气隙并进行治疗。随后将图像传输到计划系统，并测量阴道黏膜与阴道筒之间的气隙。与该中心 2008 年的结果和文献系列进行了比较。
由于髋关节置换术的伪影，两名患者的图像无法评估。103 例患者中有 11 例存在>2mm 的气隙。重新定位或使用更大的圆筒可将气隙减少到 103 例中的 7 例。总共有 96/103 例（超过 93%）患者能够在整个治疗体积中实现良好的阴道接触。这表明自 2008 年以来，我们中心的施源器定位有了显著改善，并且也明显优于 2010 年公布的全部数据（Pearson χ(2)检验=46.19;p<0.0001）。
CT 成像引导的阴道筒技术对 96/103 例患者有效。有必要考虑对于那些存在>2mm 气隙的少数患者是否有更好的技术。
对于绝大多数患者来说，这种技术耐受性良好，无需使用镇痛药，并且将继续成为该中心的首选技术。
