Hunt M A, Shank B, McCormick B, Yahalom J, Graham M, Kutcher G J
Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
Int J Radiat Oncol Biol Phys. 1989 Sep;17(3):597-606. doi: 10.1016/0360-3016(89)90112-0.
A technique is described for the use of lymphoscintigraphy in treatment planning of primary breast patients. During simulation of the treatment fields, the positions of the internal mammary nodes are projected back toward the source onto the patient skin surface and are marked by radio-opaque markers for visualization on films. Exact solutions for the coordinates of these surface projection points are derived. Approximate solutions are also given which are independent of the isocenter location and primarily dependent on the treatment field gantry angle. If a typical couch angle and field size are assumed, the projection points can be calculated for various gantry angles prior to simulation. Generally, a decision can then be made beforehand whether it would be better to use deep tangents or a separate field to treat the internal mammary nodes. During simulation, the surface projection points serve as visual and fluoroscopic guides to field design and optimization. A method is also presented for projecting the internal mammary node positions onto a single transverse patient contour for conventional 2-dimensional treatment planning. By accurately showing the projected location of the node with respect to the field edge, adequate treatment margin can be assured.
本文描述了一种在原发性乳腺癌患者治疗计划中使用淋巴闪烁显像的技术。在模拟治疗野时，内乳淋巴结的位置朝着源反方向投射到患者皮肤表面，并用不透射线的标记物标记，以便在胶片上显影。推导了这些表面投影点坐标的精确解。还给出了近似解，这些解与等中心位置无关，主要取决于治疗野的机架角度。如果假定典型的治疗床角度和野大小，则可在模拟前针对各种机架角度计算投影点。通常，然后可以预先决定使用深部切线野还是单独的野来治疗内乳淋巴结更好。在模拟过程中，表面投影点作为野设计和优化的视觉和荧光镜引导。还提出了一种将内乳淋巴结位置投影到单个横向患者轮廓上的方法，用于传统的二维治疗计划。通过准确显示淋巴结相对于野边缘的投影位置，可以确保足够的治疗边界。
