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Dose deformation and accumulation for adaptive radiotherapy in nasopharyngeal carcinoma

机译:鼻咽癌自适应放射治疗剂量变形与积累

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To realize dose deformation and accumulation using image registration technology, and evaluate the anatomic changes and corresponding dosimetric variations for patients with nasopharyngeal carcinoma (NPC). 15 patients with NPC treated with IMRT were selected in this study, the original treatment plan(Plan1(CT1)) based on the first CT scan(CT1) and the second plan(Plan2(CT2)) based on the repeated CT scan(CT2) were calculated using the planning system Raystation Version 4.5 (RaySearch Laboratories AB, Stockholm, Sweden). Plan1(CT2) was acquired by deforming the dose of Plan1(CT1) to CT2 using the hybrid deformation image registration method, which express to perform the original plan without re-planning. Assessing the dose distribution and deciding whether to modify the plan, if need it, Plan2(CT2) was planned based on CT2 images, Plan1+2(CT2) that expressing the actual exposure dose after modification was generated by accumulating the dose of Plan1(CT2) and Plan2(CT2). The dose distribution was compared among Plan1(CT1), Plan2(CT2) and Plan1+2(CT2). Compared with CT1, the volume of GTVnx, GTVnd and CTV2 in CT2 decreased by 36.3%, 36.3% and 49.8% respectively, and the left and right parotid gland decreased in volume by 34.6% and 34.6%. Compared with Plan1(CT1), due to the changes of organ size and location, the dose to target organ were significantly decreased in Plan1(CT2) (the dose received by 95% of the target (D95) to GTVnx, GTVnd and CTV2 were decreased by 2.9%, 6.2% and 3.3%, respectively), and the dose to normal tissue were increased (the dose to right parotid gland, brain stem and spinal cord were increased by 5.5%, 1.4% and 8.9%, respectively). With repeated CT and re-planning after 20 times as shown in Plan1+2(CT2), the dose delivered to target were significantly increased (Compared with Plan1(CT2), the dose in Plan1+2(CT2) received by 95% of the target (D95) to GTVnx, GTVnd and CTV2 were increased by 2.9%, 3.3% and 3.7%, respectively), and at the same tim- the dose to normal tissue were decreased as much as possible (the mean dose to the left and right parotid gland were decreased by 3.0% and 7.4%, and the max dose to the brain stem and spinal cord were decreased by 14.1% and 7.7%). During the course of adaptive radiotherapy, the volume of parotid gland and target significantly decreased. Re-planning after 20 times could ensure adequate dose to target and safe dose to the normal tissues.
机译:使用图像配准技术实现剂量变形和积累,评价鼻咽癌(NPC)患者的解剖学变化和相应的剂量变化。在该研究中选择的15例NPC与IMRT治疗,基于所述第一CT扫描(CT1),以及基于所述重复CT扫描的第二方案(计划2(CT2))的原治疗计划(计划1(CT1))(CT2 )使用规划系统射线版本4.5(Raysearch Laboratories Ab,Stockholm,Sweden)计算。通过使用混合变形图像配准法使Plan1(CT1)的剂量变形为CT2来获取Fla1(CT2),该方法在没有重新规划的情况下表达以执行原始计划。评估剂量分布和决定是否需要修改计划,如果需要,基于CT2图像计划计划2(CT2),通过积累Plan1的剂量产生修饰后的实际曝光剂量的Plan1 + 2(CT2)( CT2)和Plan2(CT2)。在Plan1(CT1),Plan2(CT2)和Plan1 + 2(CT2)中比较剂量分布。与CT1相比,CT2中GTVNX,GTVND和CTV2的体积分别降低了36.3%,36.3%和49.8%,左右腮腺的体积减少了34.6%和34.6%。与Plan1(CT1)相比,由于器官尺寸和位置的变化,Plan1(CT2)中的剂量显着降低(通过95%的靶(D95)给GTVNX,GTVND和CTV2接收的剂量。分别下降2.9%,6.2%和3.3%,较正常组织的剂量增加(右腮腺,脑干和脊髓的剂量分别增加了5.5%,1.4%和8.9%)。随着Plan1 + 2(CT2)所示的20倍后重复的CT和重新计划,递送给靶的剂量显着增加(与Plan1(CT2)相比,Plan1 + 2(CT2)的剂量由95%获得靶(D95)至GTVNX,GTVND和CTV2分别增加了2.9%,3.3%和3.7%),并且在相同的时间 - 正常组织的剂量尽可能地降低(左侧的平均剂量右腮腺均下降3.0%和7.4%,最大剂量为脑干和脊髓的数量减少14.1%和7.7%)。在适应放疗过程中,腮腺和靶的体积显着降低。重新计划20次后可以确保足够的剂量靶向和安全剂量至正常组织。

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