IMRT或3DCRT计划评估——适形指数(CI)

doi:10.3760/cma.j.issn.1004-4221.2017.10.015

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摘要目的推荐一组适形指数用于判断IMRT或3DCRT计划中靶区和OAR受量是否满足临床剂量处方的要求。方法从已治NSCLC的IMRT或3DCRT计划中随机抽取30例计划,按文中定义的新适形指数进行评估分析,根据评估结果选出其中待改进的计划并对其制定2个改进方案,评估改进前后计划组参数值以及靶区和OAR剂量学参数的差异并配对t检验差异。结果 30例计划中处方剂量线(面)包裹的体积比PTV体积大25%,即处方剂量线(面)包裹的体积中只有75%体积是靶区,而大约有25%PTV的正常肺组织会受到和靶区一样的剂量,30例计划中95%靶区都受到了处方剂量,虽然有5%靶区受量低于处方剂量,但仍然能保证几乎100%靶区受到了90%处方剂量;两改进组与原计划组相比,方案(1)与原临床计划组在CI₂、CI₄、CI₅、CI₆和HI中都相近(P=0.240~0.780),CI₁和CI₃不同(P=0.002、0);PTV的D_max、D_min、D_mean和正常肺组织V₅、V₂₀,心脏V₃₀、V₄₀及脊髓D_max都近似(P=0.211~0.964);方案(2)与原临床组在CI₂、CI₄和CI₅中都相近(P=0.308、0.308、0.106),在CI₁、CI₃、CI₆和HI不同(P=0.001~0.014);PTV的D_max、D_min、D_mean和正常肺组织V₅、V₂₀及脊髓D_max都不同(P=0.008~0.036),心脏V₃₀、V₄₀近似(P=0.083、0.080)。结论文中推荐的适形指数方法定量评估了计划中靶区适形度及OAR中接受处方剂量情况,有利于设计出更高水平的个性化计划。

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	赵漫
	胡逸民

关键词 ：调强放射疗法, 三维适形放射疗法, 适形指数, 计划评估

Abstract： Objective To propose a new set of conformity indices (CIs) that may be useful for evaluating whether the prescribed doses to target volume and organs at risk (OAR) in intensity-modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3DCRT) plans meet clinical requirements. Methods A total of 30 patients’ plans were randomly selected from the IMRT or 3DCRT plans for non-small cell lung cancer and analyzed with the newly defined CIs described in this article. The plans to be improved were selected according to the evaluating results, and two schemes were developed to improve these plans. Then, the differences in CI, D_max, D_min, and D_meanof the planning target volume (PTV), V₅ and V₂₀ of the normal lung, V₃₀ and V₄₀ of the heart, and D_max of the spinal cord were investigated with the paired t-test.Results Among the 30 plans, the average volume covered by the prescribed isodose line (V_RI) was 25% larger than the PTV, so the normal lung tissue with a volume approximately 25% of PTVwas given the same dose as the target volume, and the volume covered by the prescribed isodose line in the target V (C) R was only 75% of the volume VR. Ninety-five percent of the target volume received a full prescribed dose;only 5% of the target volume received less than the prescribed dose, but which was still within 90% of the prescribed dose. In the comparison between the original plans and the plans improved using the first scheme, CI₂, CI₄, CI₅, CI₆, and homogeneity index (HI) were not significantly different (P=0.240-0.780), and CI₁ and CI₃ showed significant differences (P=0.002 and 0);D_max, D_min, and D_mean of the PTV, V₅ and V₂₀ of the normal lung, V₃₀ and V₄₀ of the heart, and D_max of the spinal cord were not significantly different (P=0.211-0.964). In the comparison between the original plans and the plans improved using the second scheme, CI₂, CI₄, and CI₅ were not significantly different (P=0.308, 0.308, and 0.106), CI₁, CI₃, CI₆, and HI showed significant differences (P=0.001-0.014);D_max, D_min, and D_mean of the PTV, V₅ and V₂₀ of the normal lung, and D_max of the spinal cord showed significant differences (P=0.008-0.036), and V₃₀ and V₄₀ of the heart were not significantly different (P=0.083 and 0.080). Conclusions The new set of CIs proposed in this paper may be a good tool for evaluating the conformity of the target and the prescribed dose to OAR and thus developing better individualized treatment plans.

Key words： Intensity modulated radiotherapy Three-dimensional conformity radiotherapy Conformity index Plan evaluation

收稿日期: 2017-03-02

通讯作者: 胡逸民,Email:yiminhu888@163.com

引用本文:

赵漫,胡逸民. IMRT或3DCRT计划评估——适形指数(CI)[J]. 中华放射肿瘤学杂志, 2017, 26(10): 1177-1181.

Zhao Man,Hu Yimin. A new set of conformity indices for evaluating intensity-modulated radiotherapy or three-dimensional conformal radiotherapy plans[J]. Chinese Journal of Radiation Oncology, 2017, 26(10): 1177-1181.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2017.10.015 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2017/V26/I10/1177

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