李宏奇 王颖杰 刘承利 夏廷毅

[摘要] 立体定向消融治疗是代表性的精确放疗技术，具有精准定位、精准照射、高效微创等特点，已在脑转移瘤、早期非小细胞肺癌治疗中取得与手术相当的效果。其中影像引导技术在精确放疗过程管理中发挥关键作用，分为单一成像系统和组合成像系统。前者有超声引导、电子射野成像引导、锥形束和扇形束CT引导、核磁引导以及电磁追踪等技术，后者有ExacTrac X射线六维立体定向引导系统等。本文将回顾当前应用的影像引导技术，分析成像原理以及如何改善治疗准确性和缩小肿瘤周围正常组织受照射体积，探索未来融合发展前景。

[关键词] 放射治疗；影像引导；成像原理；应用

[中图分类号] R815.6 [文献标识码] A [文章编号] 1673-7210（2018）07（a）-0030-04

Imaging principle and application of image-guided technology in the precise radiotherapy

LI Hongqi1 WANG Yingjie1 LIU Chengli2 XIA Tingyi1

1.Department of Radiation Oncology， Airforce General Hospital， Beijing 100142， China； 2.Department of Hepatic Surgery， Airforce General Hospital， Beijing 100142， China

[Abstract] Stereotactic ablative radiation therapy is one of representative precise radiotherapy technology and has characteristics of precise simulation， accurate delivery， good performance and minimal adverse effect， which has acquired similar results with surgery in the treatment of brain metastasis and early stage non-small cell lung cancer. During the precise delivery management， the image-guided technologies play an important role， which include single imaging system and the combination of imaging system. The former are guided by ultrasound， electron beam， cone beam computer tomography （CT）， fan beam CT， nuclear magnetic image and electromagnetic tracking technology； the latter are guided by ExacTrac X-ray six dimensional directional guidance system， etc. This article will review current application of image-guided technology and analyze imaging principle and how to improve the accuracy and shrink surrounding normal tissues irradiated volume， explore the future development.

[Key words] Radiotherapy； Image-guided； Imaging principle； Application

放射治療是重要的肿瘤治疗手段，目前已经进入精确放射治疗时代。精确放疗的最大优势体现在精确打击肿瘤，正常组织损伤轻微，但实现这一目标需具备准确发现肿瘤、精准定位肿瘤和精细控制肿瘤动度等条件，这些前提条件都需要通过影像引导技术来实现。因此，影像引导技术是精确放疗发展的必要条件和质量保证，它的成像质量、速度和模式很大程度上影响了放疗的结果。目前临床上采用了很多不同模式的影像引导技术，种类繁杂，各有优缺点，深入了解各种影像引导技术的成像原理、技术参数和应用环境，对临床医生正确选择恰当的影像引导方式，最大程度改善精确放疗效果有重要意义。……