nucВестник НЯЦ РКNNC RK Bulletin1729-75161729-7885Национальный ядерный центр Республики Казахстан10.52676/1729-7885-2026-1-160-168nuc-997Research ArticleСтатьиФИЗИКО-ДОЗИМЕТРИЧЕСКИЙ АНАЛИЗ 2D И 3D ПЛАНИРОВАНИЯ В КЛИНИЧЕСКОЙ БРАХИТЕРАПИИ: ОПЫТ ЦЕНТРА ЯДЕРНОЙ МЕДИЦИНЫ И ОНКОЛОГИИ (Г. СЕМЕЙ)PHYSICO-DOSIMETRIC ANALYSIS OF 2D AND 3D TREATMENT PLANNING IN CLINICAL BRACHYTHERAPY: EXPERIENCE OF THE CENTER FOR NUCLEAR MEDICINE AND ONCOLOGY (SEMEY, KAZAKHSTAN)https://orcid.org/0009-0009-3782-2693ТусуповаА. Д.TussupovaA. D.

Медицинский физик; магистрант

Семей

 

Semey

tusupova.83@mail.ruhttps://orcid.org/0009-0009-4069-889XАйткалиевС. М.AitkaliyevS. M.

Заведующий отделением медицинских физиков

Семей

Semey

seka_asm@mail.ruhttps://orcid.org/0009-0009-6769-2551АйткалиевЖ. Қ.AitkaliyevZh. K.

Медицинский физик

Семей

Semey

zh.aitkaliev@mail.ruhttps://orcid.org/0009-0009-4893-9264ИдиновМ. Т.IdinovM. T.

Главный инженер

Семей

Semey

idinov_medet@list.ruhttps://orcid.org/0000-0003-0379-5315ТанатаровС. З.TanatarovS. Z.

Директор

Семей

Semey

sayat68@mail.ruhttps://orcid.org/0000-0002-4553-356XКенжинаЛ. Б.KenzhinaL. B.

Советник по науке

Семей

Semey

laurakenzhina@yandex.kzhttps://orcid.org/0009-0009-2911-4427СтепановаО. А.StepanovaO. A.

Заведующая кафедрой технической физики и теплоэнергетики

Семей

Semey

o.stepanova@shakarim.kzhttps://orcid.org/0009-0008-2171-9037ЕлемесоваН. А.ElemessovaN. A.

Медицинский физик

Семей

Semey

elemesovanazgul1996@mail.ruhttps://orcid.org/0009-0005-3700-9812МергенбаеваА. Д.MergenbayevaA. D.

Медицинский физик

Семей

Semey

ainur.mergenbayeva@mail.ruhttps://orcid.org/0009-0000-6284-8806ЕсенгариА. К.EssengariA. K.

Врач-лучевой терапевт

Семей

Semey

azalia939393@gmail.comКГП «Центр ядерной медицины и онкологии» УЗ области Абай; НАО «Шәкәрім университет»Казахстан“Center of Nuclear Medicine and Oncology” of Abay Regional Health Department; NP JSC “Shakarim University”KazakhstanКГП «Центр ядерной медицины и онкологии» УЗ области АбайКазахстан“Center of Nuclear Medicine and Oncology” of Abay Regional Health DepartmentKazakhstanНАО «Шәкәрім университет»КазахстанNP JSC “Shakarim University”Kazakhstan20262504202601160168Copyright © Тусупова А.Д., Айткалиев С.М., Айткалиев Ж.Қ., Идинов М.Т., Танатаров С.З., Кенжина Л.Б., Степанова О.А., Елемесова Н.А., Мергенбаева А.Д., Есенгари А.К., 20262026Тусупова А.Д., Айткалиев С.М., Айткалиев Ж.Қ., Идинов М.Т., Танатаров С.З., Кенжина Л.Б., Степанова О.А., Елемесова Н.А., Мергенбаева А.Д., Есенгари А.К.Tussupova A.D., Aitkaliyev S.M., Aitkaliyev Z.K., Idinov M.T., Tanatarov S.Z., Kenzhina L.B., Stepanova O.A., Elemessova N.A., Mergenbayeva A.D., Essengari A.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journals.nnc.kz/jour/article/view/997

В статье представлен ретроспективный физико-дозиметрический анализ различий между двумерным (2D) и трёхмерным (3D) планированием высокодозной брахитерапии у 20 пациенток с местно-распространённым раком шейки матки. Исследование проведено на базе Центра ядерной медицины и онкологии (ЦЯМиО) области Абай в 2023–2025 гг. и включало две независимые когорты по 10 планов каждая, выполненных с использованием системы GammaMed Plus iX с источником иридий-192 и программного комплекса BrachyVision. Ключевой особенностью методологии явилось применение специализированного стола-провайдера для компьютерно-томографической топометрии, обеспечивающего технологию индексированного позиционирования и исключающего геометрические погрешности при подготовке к 3D-планированию. Целью исследования была количественная оценка различий дозового охвата клинического целевого объёма и дозовых нагрузок на органы риска при переходе к 3D-планированию. Для обеспечения методологической сопоставимости, в соответствии с рекомендациями GEC- ESTRO и ICRU Report 89, для 10 планов 2D-группы выполнено ретроспективное контурирование HR-CTV и OAR на архивных КТ-изображениях, с последующим перерасчётом объёмных дозиметрических параметров. Основными критериями анализа были HR-CTV D90 и OAR D2cc (для мочевого пузыря, прямой и сигмовидной кишки). Статистический анализ независимых выборок показал, что 3D-планирование, подкрепленное прецизионной фиксацией мишени, ассоциируется со снижением вариабельности HR-CTV D90, повышением конформности дозового распределения и возможностью корректной оценки объёмных дозовых нагрузок на органы риска. Полученные результаты соответствуют международным рекомендациям и подчёркивают преимущества трёхмерного планирования, направленные на повышение точности, качества и безопасности брахитерапии в онкологической практике Казахстана.

This study presents a retrospective physico-dosimetric analysis of differences between two-dimensional (2D) and three-dimensional (3D) treatment planning approaches in high-dose-rate (HDR) brachytherapy for 20 patients with locally advanced cervical cancer. The research was conducted at the Center for Nuclear Medicine and Oncology of the Abai Region between 2023 and 2025 and included two independent cohorts of 10 treatment plans each, generated using the GammaMed Plus iX after loading system and the BrachyVision treatment planning software. A key methodological feature of the study was the use of a dedicated CT topometric provider table, enabling indexed patient positioning and eliminating geometric uncertainties during preparation for 3D treatment planning. The aim of the study was to quantitatively assess differences in clinical target volume coverage and dose exposure to organs at risk during the transition to 3D planning. To ensure methodological comparability, in accordance with GEC-ESTRO recommendations and ICRU Report 89, retrospective contouring of the high-risk clinical target volume (HR-CTV) and organs at risk (OARs) was performed on archived CT images for the 10 plans in the 2D cohort, followed by recalculation of volumetric dosimetric parameters. The primary dosimetric endpoints included HR-CTV D90 and OAR D2cc for the bladder, rectum, and sigmoid colon. Statistical analysis of independent samples demonstrated that 3D planning, supported by precise target fixation, is associated with reduced variability of HR-CTV D90, improved dose distribution conformity, and the ability to accurately assess volumetric dose exposure to organs at risk. The obtained results are consistent with international guidelines and highlight the advantages of three-dimensional planning in improving the accuracy, quality, and safety of brachytherapy in oncological practice in Kazakhstan.

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The authors declare that there are no conflicts of interest present.