基于EPID三维剂量重建在肿瘤患者中应用

doi:10.3760/cma.j.issn.1004-4221.2018.11.007

摘要
图/表
参考文献()
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (0 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS) 背景资料

摘要

目的基于EPID利用Edose软件重建三维剂量分布,帮助放疗工作人员更好地了解治疗期间患者相关危及器官和靶区的剂量变化情况。方法对头颈部肿瘤和胸部肿瘤患者治疗前行1 次/周总共6次CBCT扫描,将CBCT图像与计划CT图像进行刚性配准后传入到Edose剂量分析软件中,利用Edose软件根据摆位误差基于EPID对其进行三维剂量重建,最后分析不同危及器官剂量并比较γ通过率。结果与原计划剂量相比,鼻咽癌患者脊髓Dmax分次间受量波动较大且高于患者原计划剂量,脑干Dmax分次间受量变化较小,左右腮腺V30所受剂量变化较大,单次增加幅度最高可达28.69%;胸部肿瘤患者脊髓Dmax差异较小,肺与心脏实际受量都高于计划剂量,尤其肺V5与原计划平均偏差达16.99%(P<0.05)。通过对γ通过率分析可看出危及器官受量与原计划受量存在较大变化的节点为头颈部肿瘤第16次左右和胸部肿瘤第24次左右。结论通过在单次治疗中利用Edose剂量验证系统基于EPID重建患者体内三维剂量的分布,可以了解相关靶区与危及器官的剂量变化,能够更好地保护危及器官以及提高靶区剂量的覆盖率,为下一步的剂量引导放射治疗和自适应放射治疗提供一定的参考。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	李玉成
	程品晶
	蒋璐
	王健
	李剑龙
	邵凯南
	陈维军

关键词 ：电子射野影像装置, 剂量重建, 剂量验证, γ通过率

Abstract：

Objective To perform 3D dose reconstruction based on electronic portal imaging device (EPID) of linear accelerator for the static intensity-modulated using Edose,a dose verification system, Aiming to assist the radiotherapy professionals to better understand the radiotherapy organs at risk and target dose changes. Methods CBCT image was acquired for patients with head and neck cancer and thoracic cancer once a week for a total of six times. Subsequently,CBCT images and planning CT images were subject to rigid registration and exported to the Edose software. According to the setup error,EPID-based three-dimensional dose reconstruction was performed by using Edose software. The gamma passing rate and dose of different organs at risk (OARs) were analyzed and statistically compared. Results For patients with nasopharyngeal carcinoma,the intra-fractional Dmax of the spinal cord was more significantly fluctuated and higher compared with the planning dose,whereas the intra-fractional Dmax of the brainstem did not significantly fluctuate. The V30 of the parotid gland significantly changed with a maximum increase of 28.69% per fraction. For patients with thoracic tumors,the Dmax of the spinal cord was slightly changed,and the actual doses in the lung and heart were higher than the planning doses. The average deviation of the pulmonary V5 was up to 16.99% between the actual and planning doses with statistical significance (P<0.05).According to the analysis of gamma passing rate,significant dose changes occurring in the OARs were detected in the 16^th fraction for the head and neck cancer and the 24^th fraction for the thoracic neoplasms. Conclusions The dose changes in the OARs can be obtained by reconstructing the EPID-based 3D dose distribution using the Edose software for each fraction,which can better protect the OAR,enhance the coverage of target dose and provide certain reference for dose-guided and self-adaptive radiotherapy.

Key words： Electronic Portal Imaging Device Dose reconstruction Dose verification Gamma passing rate

收稿日期: 2017-06-13

基金资助:

浙江省医药卫生科技计划(2017PY014)

通讯作者: 陈维军,Email:chenvj@163.com

引用本文:

李玉成,程品晶,蒋璐等. 基于EPID三维剂量重建在肿瘤患者中应用[J]. 中华放射肿瘤学杂志, 2018, 27(11): 984-988.

Li Yucheng,Cheng Pinjing,Jiang Lu et al. Application of EPID-based 3D dose reconstruction in cancer patients[J]. Chinese Journal of Radiation Oncology, 2018, 27(11): 984-988.

链接本文:

http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2018.11.007 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2018/V27/I11/984

[1] Webb S.The physics of three dimensional radiation therapy:conformal radiotherapy, radiosurgery and treatment planning (Series in medical Physics and Biomedical Engineering)[C].Bristol:IOP Publishing,1993.DOI:10.1118/1.596941.
[2] 黄妙云,陈明秋,陈远贵等.基于EPID三维剂量验证系统的物理模型测试及临床应用的初步研究[J].中华放射肿瘤学杂志,2016,25(12):1335-1340.DOI:10.3760/cma.j.issn.1004-4221.2016.12.014.
Huang MY, Chen MQ, Chen GY, et al. A preliminary study of test and clinical application of a physical model based on the three-dimensional dose verification system using electronic portal imaging device.[J].Chin J Radiat Oncol,2016,25(12):1335-1340.DOI:10.3760/cma.j.issn.1004-4221.2016.12.014.
[3] 黎旦,宾石珍,程品晶,单冬勇,成树林,张俊俊.非晶硅电子射野影像装置在宫颈癌剂量验证中的应用[J].中国医学物理学杂志,2017(3):230-234.DOI:10.3969/j.issn.1005-202X.2017.03.003.
Li D,Bin SZ,Cheng PJ,et al. Dose verification of cervical cancer using a-Si EPID[J]. Chin J Med Phys,2017(3):230-234.DOI:10.3969/j.issn.1005-202X.2017.03.003.
[4] Tyner E,McClean B,McCavana P,et al. Experimental investigation of the response of an a-Si EPID to an unflattened photon beam from an Elekta Precise linear accelerator[J].Med Phys,2009,36(4):1318-29.DOI:10.1118/1.3089424.
[5] Liebich J,Licher J,Scherf C,et al. Simple proposal for dosimetry with an elekta iviewgttm electronic portal imaging device (EPID) using commercial software modules[J].Strahlenther Onkol,2011,187(5):316-321.DOI:10.1007/s00066-011-2176-z.
[6] Mans A,Remeijer PRI,Wendling M,et al.3D dosimetric verification of volumetric-modulated arc therapy by portal dosimetry[J].Radiother Oncol,2010,94(94):181-187.DOI:10.1016/j.radonc.2009.12.020.
[7] Chen J,Morin O,Aubin M,et al. Dose-guided radiation therapy with megavoltage cone-beam CT[J].Br J Radiol,2006,79(1):S87-98.DOI:10.1259/bjr/60612178.
[8] Ansbacher W.Three-dimensional portal image-based dose reconstruction in a virtual phantom for rapid evaluation of IMRT plans[J].Med Phys,2006,33(9):3369-3382.DOI:10.1118/1.2241997.
[9] Van EW,Petit SRD,Lambin P,et al.3D dose delivery verification using repeated cone-beam imaging and EPID dosimetry for stereotactic body radiotherapy of non-small cell lung cancer[J].Radiother Oncol,2010,94(2):188-194.DOI:10.1016/j.radonc.2009.12.024.
[10] Van ZM,Dirkx ML,de Boer HC,et al.3D dose reconstruction for clinical evaluation of IMRT pretreatment verification with an EPID[J].Radiother Oncol,2007,82(2):201-207.DOI:10.1016/j.radonc.2006.12.010.
[11] Cilla S,Meluccio D,Fidanzio A,et al. Initial clinical experience with Epid-based in-vivo dosimetry for VMAT treatments of head-and-neck tumors[J].Phys Med,2016,32(1):52-58.DOI:10.1016/j.ejmp.2015.09.007.
[12] Castadot P,Geets X,Lee JA,et al. Assessment by a deformable registration method of the volumetric and positional changes of target volumes and organs at risk in pharyngo-laryngeal tumors treated with concomitant chemo-radiation[J].Radiother Oncol,2010,95(2):209-217.DOI:10.1016/j.radonc.2010.03.007.
[13] Rozendaal RA,Mijnheer BJ,Hamming-Vrieze O,et al. Impact of daily anatomical changes on EPID-based in vivo,dosimetry of VMAT treatments of head-and-neck cancer[J].Radiother Oncol,2015,116(1):70-74.DOI:10.1016/j.radonc.2015.05.020.
[14] 张淑慧,杨敬贤.肿瘤放射治疗摆位技术质量控制的探讨[J].中国医学物理学杂志,2013,11(15):56-58.DOI:10.3969/j.issn.1005-202X.2013.06.010.
Zhang SH,Yang JX. Quantity Control Discussion in Tumor Radiotherapy Positioning Technology[J].Chin J Med Phys,2013,11(15):56-58.DOI:10.3969/j.issn.1005-202X.2013.06.010.
[15] 王小深,鞠忠建,徐伟,等.EDOSE进行调强剂量验证结果的评估[J].中国医疗器械杂志,2016,40(2):147-149.DOI:10.3969/j.issn.1671-7104.2016.02.022.
Wang XS,Ju ZJ,Xu W,et al. Evaluation of the EDOSE for IMRT Delivery Quality Assurance[J].China Med Devices 2016,40(2):147-149.DOI:10.3969/j.issn.1671-7104.2016.02.022.
[16] 魏双,郝俊芳,杨新华,等.鼻咽癌调强放疗每周腮腺动态变化的临床分析[J].中国癌症杂志,2013(3):211-217.DOI:10.3969/j.issn.1007-3969.2013.03.010.
Wei S, Hao JF, Yang XH, et al. Clinical analysis for weekly changes of parotid glands during intensity-modulated radiotherapy for nasopharyngeal carcinoma patients[J].Chin J Oncol,2013(3):211-217.DOI:10.3969/j.issn.1007-3969.2013.03.010.
[17] Lee C,Langen K M,Lu W,et al. Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration[J].Int J Radiat Oncol Biol Phys,2008,71(5):1563-1571.DOI:10.1016/j.ijrobp.2008.04.013.
[18] Jenkins P,D′Amico K,Benstead K,et al. Radiation pneumonitis following treatment of non-small-cell lung cancer with continuous hyperfractionated accelerated radiotherapy (CHART)[J].Int J Radiat Oncol Biol Phys,2003,56(2):360. DOI:10.1016/S0360-3016(02)04491-7.
[19] Wang S,Liao Z,Wei X,et al. Analysis of clinical and dosimetric factors associated with treatment-related pneumonitis (TRP) in patients with non-small-cell lung cancer (NSCLC) treated with concurrent chemotherapy and three-dimensional conformal radiotherapy (3D-CRT)[J].Int J Radiat Oncol Biol Phys,2006,66(5):1399-1407.DOI:10.1016/j.ijrobp.2006.07.1337.
[20] Fung WW,Wu VW,Teo PM.Dosimetric evaluation of a three-phase adaptive radiotherapy for nasopharyngeal carcinoma using helical tomotherapy[J].Med Dosim,2012,37(1):92-97.DOI:10.1016/j.meddos.2011.01.006.
[21] 曹建忠,罗京伟,徐国镇,等.鼻咽癌调强放疗中解剖及剂量学改变再次计划必要性研究[J].中华放射肿瘤学杂志,2008,17(3):161-164.DOI:10.3321/j.issn:1004-4221.2008.03.001.
Cao JZ,Luo JW,Xu GZ,et al. Study on the necessity of re-planning of anatomic and dosimetry changes in nasopharyngeal carcinoma with intensity-modulated radiotherapy[J].Chin J Radiat Oncol,2008,17(3):161-164.DOI:10.3321/j.issn:1004-4221.2008.03.001.
[22] 卢洁,马一栋,尹勇,等.基于形变配准的鼻咽癌调强放射治疗计划剂量学研究[J].中华放射医学与防护杂志,2011,31(5):575-578.DOI:10.3760/cma.j.issn.0254-5098.2011.05.018.
Lu J,Ma YD,Yin Y,et al. Dosimetric study of planning of intensity-modulated radiotherapy based on deformable registration for patients with nasopharyngeal carcinoma during the course[J].Chin J Radiol Med Protect,2011,31(5):575-578.DOI:10.3760/cma.j.issn.0254-5098.2011.05.018.