CN104524697A - Image-guided nasopharyngeal carcinoma intensity modulated radiation therapy position error method - Google Patents
Image-guided nasopharyngeal carcinoma intensity modulated radiation therapy position error method Download PDFInfo
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Abstract
The invention aims at providing an image-guided nasopharyngeal carcinoma intensity modulated radiation therapy position error method. Kilovolt cone beam CT (KVCBCT) is used for guiding the intensity modulated radiation therapy of a patient receiving initial treatment of nasopharyngeal carcinoma, and a position difference obtained through the KVCBCT is deduced to obtain a target region and sketch the boundary of the KVCBCT. A CT model is used for inspecting CBCT image quality and isocenter deviation, and a matrix ionization chamber is used for conducting dosage verification on an intensity modulation plan. According to the image-guided nasopharyngeal carcinoma intensity modulated radiation therapy, setup errors caused by setup can be reduced, target region dosage accuracy can be improved through online correction, the boundary of CTV-PTV can also be reduced, and therefore the dosage of a normal organ is reduced. A guarantee of imaging quality and mechanical precision of an image-guided part is the key to image-guided radiation therapy. Verification of the planned dosage is the basis of all therapies.
Description
Technical field
The invention belongs to field of medical technology, relate to a kind of image and guide nasopharyngeal carcinoma to emphasize radiotherapy site error method.
Background technology
In recent years, conformal modulating radiotherapy (IMRT) application clinically increases gradually, and object is herein that some hot issues when it being applied to treatment of nasopharyngeal carcinoma are summarized, to causing the concern of colleague.
Delineating of nasopharyngeal carcinoma IMRT target area: conformal modulating radiotherapy is a kind of high-precision radiotherapy, only have after the shape of illuminated object is precisely determined on three-dimensional, conform irradiation is just meaningful.In the U.S.'s the 43rd tumor and radiotherapy annual meeting, the IMRT group of research tumor of head and neck reaches an agreement with delineating to the selection of nasopharyngeal carcinoma target area.Before new reference standard is put into effect, this suggestion has important guiding value, is now described below: what tumor targets was long-pending delineate tumor targets long-pending (GTV) comprises nasopharynx part primary tumo(u)r and lymphnode metastatic.The GTV of primary tumo(u)r relies on clinical and radiologic evaluation to determine.The diagnostic criteria of lymph node GTV is: the lymph node of diameter >1cm (if küttner ganglion, diameter >1.2 ~ 1.5cm); Spherical instead of oval small lymph node; Inner in inhomogeneity, there is downright bad lymph node at prompting center; The critical lymph node of more than three clusters.Delineating of clinical target volume: clinical target volume (CTV) comprise may there is mirror under or the surrounding tissue of subclinical infringement.Should consider when determining the scope of nasopharyngeal carcinoma CTV the position of tumor, size, by stages, the factor such as differentiation degree and Morphologic type.Nasopharyngeal carcinoma CTV routine should comprise basis cranii, wing plate, nasopharynx anterior diastema (inner side is pharynx, and outside is alary muscle and the dark leaf of the parotid gland), and tumor comparatively early also will comprise alary muscle.The sphenoid sinus of basis cranii and cavernous sinus should be included in CTV.CTV width is at least 7 ~ 8cm, to comprise oval foramen, carotid foramen, spinous foramen, because these positions are all the main paties that tumor spreads to cavernous sinus.CTV also will comprise parapharyngeal space, retropharyngeal space, slope, rear 1/3, the posterior ethmoid sinus of maxillary sinus and rear 1/3 of nasal cavity.Lower bound should reach level in the middle part of tonsil.The case that basis cranii is invaded, also will comprise hypophysis, optic nerve and optic chiasma, and by the dose limitation of said structure at 45 ~ 55Gy (fractionated dose≤2Gy every day).The selection of lymphatic drainage district CTV with delineate: the CTV in the cervical lymph drain district of nasopharyngeal carcinoma should comprise bilateral 2 ~ 5 grades of lymph nodes, and bilateral 2 grades of lymph nodes all should be delineated from basis cranii.2 grades of lymph nodes are if any transfer, and homonymy 1B level lymph node also will be included.The postoperative CTV of cervical lymph node delineates: if the cut biopsy of the cervical lymph node of Nasopharyngeal Carcinoma Patients, the CTV of IMRT will comprise whole field of operation.Invade if lymph node has outside tunicle under mirror, then this region should be considered to high-risk danger zone, give higher dosage.Once CTV delineates complete, GTV and CTV just unified extending out obtains PTV.Consider Set-up errors, PTV extends out 3 ~ 5mm usually.MRI, PET effect in nasopharyngeal carcinoma IMRT Target delineations.The determination of nasopharyngeal carcinoma target area is very large to the dependency of iconography, with regard to IMRT, this dependency is stronger, because IMRT has very precipitous dosage to fall between target area and normal structure, this potential trap makes delineating of its target area seem most important, only have fully and accurately Target delineations, could effectively avoid the leakage of target volume to shine.The iconography instruments such as CT, MRI and PET have very consequence in nasopharyngeal carcinoma Target delineations, but in recent years, along with the progress of Medical Imaging, the effect of MRI and PET in nasopharyngeal carcinoma IMRT Target delineations is outstanding day by day.MRI has and higher than CT organizes resolution, tumor can be made a distinction from Surrounding muscles and blood vessel, thus can sketch out tumor with by the boundary line of invading adjacent tissue or cerebral tissue.Such as: MRI, has a clear superiority in during the infringement of especially centering, Posterior fossa to the infiltration of medullary cavity to the infringement of pterygopalatine fossa in display nasopharyngeal carcinoma.The discoveries such as Chung, compared with CT, MRI can provide more detailed information to Gross tumor volume (GTV), is carried out Target delineations better.The impact that Emami etc. adopt CT+MRI image fusion technology observation MRI to plan the Target delineations of nasopharyngeal carcinoma and IMRT, found that: the dosage adopting this technology can improve target area significantly covers, and reduces being measured of normal structure.The research of Nishioka, Heron etc. also draws same conclusions.
In recent years, MRI has had again new progress in nasopharyngeal carcinoma radiotherapy field, mainly comprise: the application etc. of the appearance of MRI spectroscopy (MRI spectroscopy), fuzzy logic method (fuzzy logicmethod) and partitioning algorithm (segmentation algorithm), these progress will improve the importance of MRI in nasopharyngeal carcinoma IMRT Target delineations, reliability and accuracy.
Except MRI, PET (Positron emission computed tomography) owing to can observe the biological properties such as the distinctive biochemical metabolism of tumor tissues from molecular level, thus plays a role in nasopharyngeal carcinoma Target delineations.Paulino etc. compare difference when alone CT image and alone PET image delineate tumor of head and neck GTV, result shows: the patient CT GTV of 75% (30/40) is greater than PET GTV, when carrying out IMRT planned based on CT GTV, the dosage of the PET GTV of about 1/4th patients covers can not be satisfactory, fully shows the importance of PET on Target delineations.The technique study that Ciernik etc. merge with the same machine application of PET/CT image on Target Area of Conformal Radiation Therapy is delineated, found by research: with same machine PET/CT fusion image drawing target outline, improve the accuracy of target area, reduce target area and leak the danger of photograph, the exposure dose that non-target area is subject to is reduced to minimum.
Known CT, MRI and PET have respective pluses and minuses, such as: PET, MRI are not so good as CT when showing the external margin of various structure clear; PET is to lymphnode metastatic, be obviously better than MRI and CT etc. to the diagnosis of residual/recurrence pathological changes.Accurately delineating the tumor target of IMRT by the fusion image of CT+MRI+PET, will be the direction of effort from now on.Daisne etc. have studied the image co-registration problem of CT, MRI and PET, result proves, when Postural immobilization is suitable, the Precise fusion of three can realize completely, and utilization fusion image, different doctor reduces the obvious difference that same target volume is familiar with, and this is conducive to the standardization of Target delineations.
The feature of conical beam CT (CBCT) guided radiation treatment obtains CBCT image before the treatment, and with treatment plan CT image registration, obtain Real-time Error value and also undertaken correcting to reduce Set-up errors by Mobile treatment table.Report display uses CBCT obviously can reduce Set-up errors, reduces plan field (PTV) border.It should be noted that in incidence, use different matching areas can obtain different error amounts.
Summary of the invention
A kind of image is the object of the present invention is to provide to guide nasopharyngeal carcinoma to emphasize radiotherapy site error method, the invention has the beneficial effects as follows that image guides intensity modulated radiation therapy in nasopharyngeal carcinoma, the Set-up errors that pendulum position causes can be reduced, and the accurate of target dose can be improved by online correction, also can reduce the border of CTV-PTV, thus reduce the dosage of normal organ.
The technical solution adopted in the present invention utilizes kilovolt conical beam CT (KVCBCT) to guide just to control Nasopharyngeal Carcinoma Patients Intensity Modulation Radiated Therapy (IMRT), the position difference obtained by KVCBCT, derives and obtain the border of Target delineations CTVPTV.
Further, check CBCT picture quality with CT die body and wait centre deviation, exchanging strong plan with matrix ionization chamber and carry out dosage verifying.
Detailed description of the invention
Below in conjunction with detailed description of the invention, the present invention is described in detail.
The present invention utilizes KV level conical beam CT image to the 21 routine nasopharyngeal carcinoma pushing volume intensity modulated radiation therapy Set-up errors online tracings omnidistance same period, and utilize its deviate to carry out quantitative analysis that off-line position deviation adds up to plan is to illustrate that Set-up errors causes doses change situation.
Method of the present invention just controls Nasopharyngeal Carcinoma Patients Intensity Modulation Radiated Therapy (IMRT), the position difference obtained by KVCBCT for utilizing kilovolt conical beam CT (KVCBCT) to guide, and derives and obtains the border of Target delineations CTVPTV; Check CBCT picture quality with CT die body and wait centre deviation; Exchange strong plan with matrix ionization chamber and carry out dosage verifying.
Result: in 15 routine nasopharyngeal carcinoma, 280 CBCT scanning, 3 deviations of directivity, X-direction: 0.55 ± 1.03mm, Y-direction: 0.72 ± 2.25mm, Z-direction: 0.42 ± 1.14mm, the deviation ratio that 3 directions are less than 2mm is respectively 86.3%, 76.7%, 83.8%; Be greater than 3mm deviation and be respectively 5.9%, 9.4%, 6.3%.To central authentication such as KV-MV, three directions are merged difference and are respectively 0.2 ± 0.3mm, 0.4 ± 0.3mm ,-0.2 ± 0.5mm; Adjust with the checking of matrix ionization chamber and plan relative dosage by force, being 93.2%-97.2% for Dan Ye, Gamma value, is 95.0%-97.7% for whole plan Gamma value.Absolute dosages verifies that mainly isocenter point, dose uniformity district, high dose area, comparatively cold spot area, high gradient regions select 5 points to detect, and percentage deviation scope is-3.7%-4%.Conclusion: image guides intensity modulated radiation therapy in nasopharyngeal carcinoma, can reduce the Set-up errors that pendulum position causes, and can improve the accurate of target dose by online correction, also can reduce the border of CTV-PTV, thus reduce the dosage of normal organ.The image quality of guarantee image leader and mechanical precision are the keys of termed image-guided radiotherapy; And the checking of intended dose is the basis of all treatments.
Experimental result:
1. put systematic error and random error, after 21 routine patients are put, treatment moves ahead 376 CBCT, 376 times that obtain in three-dimensional top offset deviation respectively with 1,2,3mm and >3mm statistical analysis in left and right, up and down, fore-and-aft direction deviation frequency, result table 1.
Table 1
2. cumulative planned compares with program of standards development dose difference; The program of standards development of carrying out cumulative planned and corresponding number of times to 10,15 inferior centre deviations has been carried out clinical dosage and has been compared, and table 2 shows 10,15 accumulative plan tumor region dosage and CI value situation of change.
Table 2
When increasing Set-up errors number of times, all can there is significant change in target area and CI value, table 3 shows the percentage deviation situation based on 15 cumulative planned and 15 program of standards development;
Table 3
In dose volume histogram is analyzed, when target area after the more Set-up errors of introducing is to worse future development, and armour can not determine that dosage must be increase, and can there is dosage and reduce situation.
The above is only to better embodiment of the present invention, not any pro forma restriction is done to the present invention, every any simple modification done above embodiment according to technical spirit of the present invention, equivalent variations and modification, all belong in the scope of technical solution of the present invention.
Claims (2)
1. an image guides nasopharyngeal carcinoma to emphasize radiotherapy site error method, it is characterized in that: utilize kilovolt conical beam CT (KVCBCT) to guide and just control Nasopharyngeal Carcinoma Patients Intensity Modulation Radiated Therapy (IMRT), the position difference obtained by KVCBCT, derives and obtains the border of Target delineations CTVPTV.
2. guide nasopharyngeal carcinoma to emphasize radiotherapy site error method according to image a kind of described in claim 1, it is characterized in that: check CBCT picture quality with CT die body and wait centre deviation, exchange strong plan with matrix ionization chamber and carry out dosage verifying.
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| CN108564576A (en) * | 2018-04-11 | 2018-09-21 | 福建省肿瘤医院（福建省肿瘤研究所、福建省癌症防治中心） | A kind of nasopharyngeal carcinoma Set-up errors monitoring method of image block number identification |
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| CN111862021A (en) * | 2020-07-13 | 2020-10-30 | 中山大学 | Deep learning-based automatic head and neck lymph node and drainage area delineation method |
| RU2774857C1 (en) * | 2021-03-01 | 2022-06-23 | Федеральное государственное бюджетное учреждение "Российский научный центр рентгенорадиологии" Министерства здравоохранения Российской Федерации (ФГБУ "РНЦРР" Министерства здравоохранения Российской Федерации) | Selective contouring of soft tissues of the anterior chest wall in patients with breast cancer after mastectomy and reconstructive plastic surgery with endoprosthetics before radiotherapy following a hypofractionated regimen |
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| RU2774857C1 (en) * | 2021-03-01 | 2022-06-23 | Федеральное государственное бюджетное учреждение "Российский научный центр рентгенорадиологии" Министерства здравоохранения Российской Федерации (ФГБУ "РНЦРР" Министерства здравоохранения Российской Федерации) | Selective contouring of soft tissues of the anterior chest wall in patients with breast cancer after mastectomy and reconstructive plastic surgery with endoprosthetics before radiotherapy following a hypofractionated regimen |
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Application publication date: 20150422 |