CN112933428B - Insertion guide plate design method and insertion guide plate - Google Patents
Insertion guide plate design method and insertion guide plate Download PDFInfo
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Abstract
The invention provides an insertion guide plate design method and an insertion guide plate, wherein the insertion guide plate design method comprises the following steps: s1: determining a feasible solution space based on the patient image information; s2: based on the needle path optimization factors, screening out multiple groups of needle path designs from the feasible solution space determined in the step S1; s3: the multiple sets of needle track designs selected in step S2 are dose optimized to select a set of needle track designs with the optimal dose volume. The design method of the insertion guide plate adopts objective evaluation indexes to replace manual experience, optimizes the needle path design of the insertion guide plate, and accordingly obtains the personalized insertion guide plate.
Description
Technical Field
The invention relates to an insertion guide plate for brachytherapy, in particular to an insertion guide plate design method and an insertion guide plate.
Background
Brachytherapy, also known as internal irradiation, corresponds to external irradiation (teleirradiation) in which an encapsulated radiation source is implanted directly into the tumor site of a patient through an applicator or delivery catheter for irradiation. The radioactive source used for brachytherapy has a low intensity, a short effective treatment distance of radiation, and most of its energy is absorbed by tumor tissue. The dose distribution around the source drops as the square of the distance from the source-the inverse square law. Brachytherapy is rarely used alone, and generally used as an auxiliary treatment means for external irradiation, higher dose can be given to a specific part, so that the local control rate of tumor is improved, and the life quality of a patient is improved.
Brachytherapy is generally divided into intracavitary afterloading therapy and interstitial interpolation radiotherapy, and the combination of the intracavitary afterloading therapy and the interstitial interpolation radiotherapy; the tissue transplantation radiotherapy is characterized in that a radioactive source is directly inserted into the tumor through a plurality of metal insertion needles to perform high-dose irradiation according to the size and the shape of the tumor, has obvious curative effect, and is recommended to be used for patients who have local recurrence, residual focus, parauterine diseases and vaginal invasion and can not perform intra-cavity afterloading treatment.
In order to ensure the accuracy of inserting the inserting needle abroad, the inserting is mostly carried out through a perineum template under the general anesthesia condition of a patient, such as an MUPIT template, a Syed-Neblett template and a Venezia inserting mode of intracavity combined inserting, while the inserting is carried out by free hand under the local anesthesia condition without using the template at home. In recent years, the 3D printing technology enables needle path positioning in brachytherapy to have good repeatability, and printing materials and biocompatible materials can be matched for use to manufacture individualized brachytherapy molds.
The global insertion mode is still in the development and exploration stage, and how to reasonably utilize the inter-tissue insertion technology is closely related to the skill level of a radiotherapy doctor, the facility condition of each unit, the medical environment and the like.
1. The perineum template can guide the needle inserting direction of an inserting needle and plays a certain protection role on normal tissues around a pelvic cavity, but researchers in China think that the vagina template occupies the vagina volume and influences the operation visual field, and in addition, the template is single in type, poor in conformality and large in fixed injury, so the needle distribution operation is carried out by mostly adopting a bare-handed mode.
2. The operation is relatively convenient and flexible, and the method is convenient to develop and popularize because the manual insertion is adopted in China under the local anesthesia, but the insertion template is not guided, the pain sense reaction of a patient is recovered quickly during the local anesthesia, the interference on the insertion operation is very large, the insertion needles are often unevenly distributed, the pain of the patient is increased if the insertion is repeatedly performed, the peripheral tissue damage is caused, and the bleeding is increased, so that the manual insertion operation needs abundant experience and skilled skills of a clinician.
3. In recent years, the 3D printing technology enables needle track positioning in brachytherapy to have good repeatability, but needle track selection still depends on individual experience of clinicians, individual differences are obvious, the space for optimizing time of subsequent residence points is limited, and optimal target irradiation dose and organ-endangerment protection cannot be achieved.
Disclosure of Invention
In order to solve the technical problems, the invention discloses an insertion guide plate design method and an insertion guide plate, which are used for optimizing the needle path design of the insertion guide plate by adopting objective evaluation indexes to replace artificial experience so as to obtain a personalized insertion guide plate.
Specifically, the invention discloses a design method of an insertion guide plate, which comprises the following steps: s1: determining a feasible solution space based on the patient image information; s2: based on the needle path optimization factors, screening out multiple groups of needle path designs from the feasible solution space determined in the step S1; s3: the multiple sets of needle track designs selected in step S2 are dose optimized to select a set of needle track designs with the optimal dose volume.
Further, the method comprises the steps of: s4: the optimal set of needle track designs selected in step S3 is further fine tuned to achieve a better dose volume distribution, wherein the fine tuning range does not exceed 5 mm.
Further, the method comprises the following steps: s5: and obtaining the design information of the insertion needle channel, and performing 3D printing insertion guide plate design based on the design information of the insertion needle channel so as to print and manufacture the insertion guide plate by a 3D printer.
Further, in step S1, a feasible solution space is determined by delineating the tumor area to determine a needle placement incidence plane that enables needle placement, and delineating the organs-at-risk to avoid the organs-at-risk while needle placement.
Further, in step S1, a feasible solution space is determined according to the following steps:
calculating the central point S on the incidence surface of the cloth needle 0 Calculating the tumor center point E 0 Wherein S is 0 And E 0 The connecting line of (A) is a central axis K;
carrying out projection transformation on the cloth needle incidence surface along the central axis K, dividing the projection surface into N circles with similar areas, wherein N is an integer larger than 1 (the specific size depends on the area of the projection surface of the cloth needle incidence surface), and recording all circle centers as C i Mixing C with i Back-projected to the incident surface of the cloth needle and marked as S i If S is i If the points belong to the distributable needle points, adding the points into the initial point set;
carrying out projection transformation on the contour of the tumor region along the central axis K, dividing a projection plane into N circles with similar areas, and recording the centers of all circles as O i Introducing O i Back-projected back into the tumor region, recording the point farther from the plane of incidence as E i D, E is to i Adding the mixture into the termination point set;
respectively selecting S from the starting point set and the end point set i And E j Then remember (S) i ,E j ) Is a needle track, if (S) i ,E j ) When the needle passage passes through the endangered organ to be protected, the needle passage is not considered to be a feasible needle passage, and the needle passage is deleted.
Further, the needle track optimization factors in step S2 include: the insertion path is short, the distance from the surrounding normal tissues is long, and the needle channels are uniformly distributed in the target area.
Further, in step S2, a needle track optimization objective function is set based on the needle track optimization factors:
F(Ap)＝α·f C (Ap)+β·f D (Ap)+γ·f V (Ap)
wherein the content of the first and second substances,
f C (Ap)＝∑C(Ap i ) Representing the contribution of the interpolation paths of all needle tracks to the objective function;
f D (Ap)＝∑D(Ap i ) All needle tracks represent distance contributions from surrounding normal tissue;
f V (Ap)＝∑V(Ap i ) The contribution of the uniform distribution degree of all needle tracks in the target area is expressed;
Ap i ＝(S i ,E i ) For the ith needle track, S i ＝(sx i ,sy i ,sz i ) Is the three-dimensional coordinate of the incident point of the ith needle track, E i ＝(ex i ,ey i ,ez i ) Is the three-dimensional coordinate of the ith needle track end point, alpha, beta and gamma are weights, C (Ap) i ) The contribution of the interpolation path representing the ith needle track to the objective function, D (Ap) i ) Represents the distance contribution, V (Ap), of the ith track from the surrounding normal tissue i ) Representing the contribution of the even distribution of the ith needle track within the target volume,
and selecting a better plurality of groups of needle track designs from the feasible solution space determined in the step S1 through the needle track optimization objective function.
Further, in step S3, a set of needle track designs with optimal dose volume is selected by setting a dose optimization objective function to perform dwell time optimization for each set of needle track designs in step S2, where the dose optimization objective function is:
Fobj(Ap(t))＝α·F OAR (Ap(t))+β·F PTV (Ap(t))
wherein the content of the first and second substances,
Further, in step S4, based on the dose optimization objective function, the optimal set of needle track designs selected in step S3 is further fine-tuned to obtain a better dose volume distribution.
The invention also provides an insertion guide plate which is designed and manufactured through the insertion guide plate design method.
Drawings
FIG. 1 is a flow chart of an insertion guide design method of the present invention;
FIG. 2 is a flow chart of the design of the 3D printing insertion guide plate of the present invention;
FIG. 3 is a schematic diagram of a 3D printing interpolation guide of the present invention.
Detailed Description
The technical solutions of the present invention will be further described with reference to specific examples, but the present invention is not limited to these examples.
Different from intracavity afterloading treatment adopting a standard applicator, the interstitial insertion treatment is to insert an insertion needle with a pipeline into a human body, and a radioactive source moves in the pipeline to carry out radiotherapy, so that an insertion guide plate is often adopted to provide an insertion needle channel to guide the needle insertion direction of the insertion needle when the insertion treatment is carried out, and therefore, the design of how to carry out the insertion guide plate is crucial.
Referring to fig. 1, the design method of the insertion guide plate of the present invention comprises the steps of:
s1: determining a feasible solution space based on the patient image information;
s2: based on the needle path optimization factors, screening out multiple groups of needle path designs from the feasible solution space determined in the step S1;
s3: the multiple sets of needle track designs selected in step S2 are dose optimized to select a set of needle track designs with the optimal dose volume.
Further, the method may further include step S4: the optimal set of needle track designs selected in step S3 are further fine-tuned (e.g., needle track start point location, needle track tilt angle, etc.) to achieve a better dose volume distribution, wherein the fine-tuned range does not exceed 5 mm.
Further, the method further includes step S5: and obtaining the design information of the insertion needle channel, and performing 3D printing on the design of the insertion guide plate based on the design information of the insertion needle channel so as to print, manufacture and insert the insertion guide plate by a 3D printer.
As shown in fig. 2, the step S5 may specifically include:
automatically generating the shape and size of the guide plate based on the body surface contour information of the patient and the physiological structure characteristics of the treatment part;
automatically synthesizing needle passage positioning columns with puncture holes on a guide plate based on the distribution or design information of the inserted needle passages and generating corresponding needle passage sequence marks;
and marking the depth of the contact pin of each needle channel beside the corresponding positioning hole based on the distribution or design information of the contact pin channel.
After the design of the interpolation guide plate is completed, the guide plate design information can be output to be a standard model file which can be printed by a 3D printer, and the personalized insertion guide plate can be printed and manufactured. The 3D inserting guide plate printing material can be PLA or resin material.
In a particular embodiment, in step S1, a feasible solution space is determined by delineating the tumor region to determine a needle incidence plane where insertion can occur, and delineating the organ at risk to avoid the organ at risk while the needle is being deployed.
Specifically, in step S1, the feasible solution space may be determined according to the following steps:
calculating the central point S on the incidence surface of the cloth needle 0 Calculating the tumor center point E 0 Wherein S is 0 And E 0 The connecting line of (A) is a central axis K;
carrying out projection transformation on the cloth needle incidence surface along the central axis K, dividing the projection surface into N circles with similar areas, wherein N is an integer larger than 1 (the specific size depends on the area of the projection surface of the cloth needle incidence surface), and recording all circle centers as C i Mixing C with i Back-projected to the incident surface of the cloth needle and marked as S i If S is i If the points belong to the distributable needle points, adding the points into the initial point set;
carrying out projection transformation on the contour of the tumor region along the central axis K, dividing a projection plane into N circles with similar areas, and recording the centers of all circles as O i Introducing O i Back-projected back into the tumor region, recording the point farther from the plane of incidence as E i A 1 is mixing E i Adding the mixture into a termination point set;
from the starting point set and the end respectivelySelecting S from the dead point set i And E j Then remember (S) i ,E j ) Is a needle track, if (S) i ,E j ) When the needle passage passes through the endangered organ to be protected, the needle passage is not considered to be a feasible needle passage, and the needle passage is deleted.
In step S2, when optimizing the needle track distribution of the interpolation guide, the following three factors are often considered: all the insertion paths are shorter, the needle channels are far away from the surrounding normal tissues, and all the needle channels are distributed more uniformly in the target area.
For this reason, in step S2, a needle track optimization objective function may be set based on the above three needle track optimization factors:
F(Ap)＝α·f C (Ap)+β·f D (Ap)+γ·f V (Ap)
wherein the content of the first and second substances,
f C (Ap)＝∑C(Ap i ) Representing the contribution of the interpolation paths of all needle tracks to the objective function;
f D (Ap)＝∑D(Ap i ) All needle tracks represent the distance contribution from surrounding normal tissue;
f V (Ap)＝∑V(Ap i ) The contribution of the uniform distribution degree of all needle tracks in the target area is expressed;
Ap i ＝(S i ,E i ) For the ith needle track, S i ＝(sx i ,sy i ,sz i ) Is the three-dimensional coordinate of the incident point of the ith needle track, E i ＝(ex i ,ey i ,ez i ) Is the three-dimensional coordinate of the ith needle track end point, alpha, beta and gamma are weights, C (Ap) i ) The contribution of the interpolation path representing the ith needle track to the objective function, D (Ap) i ) Represents the distance contribution, V (Ap), of the ith track from the surrounding normal tissue i ) Representing the contribution of the even distribution of the ith needle track within the target volume,
and selecting a better plurality of groups of needle track designs from the feasible solution space determined in the step S1 through the needle track optimization objective function.
In step S3, when optimizing the dose distribution of the needle tracks, the dose distribution optimization (dwell time optimization) is performed for each group of interpolation needle tracks, respectively, to select an optimal group of interpolation needle tracks. In performing dose distribution optimization, dose contributions to the target and the crisis organ generally need to be considered, i.e., based on the dose contributions to the target and the crisis organ. Specifically, residence point time optimization may be performed on each set of needle track designs in step S2 by setting a dose optimization objective function to select a set of needle track designs with the optimal dose volume, where the dose optimization objective function is:
Fobj(Ap(t))＝α·F OAR (Ap(t))+β·F PTV (Ap(t))
wherein, the first and the second end of the pipe are connected with each other,
For example, when five groups of needle insertion path designs are selected in step S2, dwell point time optimization is performed for each group of needle insertion paths by the above dose optimization objective function, so that a group of needle insertion paths with the maximum dose optimization objective function is selected as the optimal needle insertion path design.
Further, in step S4, the optimal set of needle track designs selected in step S3 may be further fine-tuned based on the dose optimization objective function to obtain a better dose volume distribution.
In the method for designing the insertion guide plate, the feasible solution space is determined through the image information of the patient, and the needle path optimization and the dose distribution optimization of the insertion guide plate are performed respectively based on the needle path optimization factor and the dose distribution optimization factor, so that compared with a method based on manual experience, when the obtained personalized insertion guide plate is applied to an internal irradiation plan, the irradiation dose of a target region can be improved, and the irradiated dose of a endangered organ can be reduced to the maximum degree.
In other embodiments of the present invention, there is also provided an insertion guide designed by the insertion guide design method as described above. Referring to fig. 3, there is shown a schematic diagram of an insertion guide designed and manufactured according to the insertion guide design method of the present invention, wherein the insertion guide is provided with needle track positioning holes 401, needle track serial numbers 402 and needle track depth marks 403, and further, the insertion guide is provided with guide positioning holes 404 matching with the marks on the skin of the patient for positioning the guide conveniently at each treatment, and further, the insertion guide is further provided with guide fixing connection posts 405 for externally connecting a fixing device for fixing the guide position to prevent movement.
The foregoing is only a preferred embodiment of the present invention, and it should be noted that, for those skilled in the art, various changes and modifications can be made without departing from the inventive concept of the present invention, and these changes and modifications are all within the scope of the present invention.
Claims (9)
1. A design method of an insertion guide plate is characterized by comprising the following steps:
s1: determining a feasible solution space based on the patient image information;
s2: based on the needle path optimization factors, screening out multiple groups of needle path designs from the feasible solution space determined in the step S1;
s3: dose optimization is performed on the plurality of sets of needle track designs screened in step S2 to select a set of needle track designs with the optimal dose volume; wherein the content of the first and second substances,
in step S3, a group of needle track designs with optimal dose volume is selected by setting a dose optimization objective function to perform dwell point time optimization for each group of needle track designs in step S2, the dose optimization objective function being:
Fobj(Ap(t))＝α·F OAR (Ap(t))+β·F PTV (Ap(t))
wherein the content of the first and second substances,
2. The method according to claim 1, characterized in that the method further comprises the step of:
s4: the optimal set of needle track designs selected in step S3 is further fine tuned to achieve a better dose volume distribution, wherein the fine tuning range does not exceed 5 mm.
3. The method according to claim 2, characterized in that the method further comprises the steps of:
s5: and obtaining the design information of the insertion needle channel, and performing 3D printing insertion guide plate design based on the design information of the insertion needle channel so as to print and manufacture the insertion guide plate by a 3D printer.
4. The method of claim 3, wherein in step S1, the feasible solution space is determined by delineating a tumor region to determine a needle placement incidence plane where insertion can be performed, and delineating the organ-at-risk to avoid the organ-at-risk while placing the needle.
5. The method of claim 4, wherein in step S1, the feasible solution space is determined according to the following steps:
calculating the central point S on the incidence surface of the cloth needle 0 Calculating the tumor center point E 0 Wherein S is 0 And E 0 The connecting line of (A) is a central axis K;
carrying out projection transformation on the cloth needle incidence surface along the central axis K, dividing the projection surface into N circles with similar areas, wherein N is an integer greater than 1, and recording all circle centers as C i Mixing C with i Back-projected to the incident surface of the cloth needle and marked as S i If S is i If the points belong to the distributable needle points, adding the points into the initial point set;
carrying out projection transformation on the contour of the tumor region along the central axis K, dividing a projection plane into N circles with similar areas, and recording the centers of all circles as O i Introducing O i Back-projected back into the tumor region, recording the point farther from the plane of incidence as E i D, E is to i Adding the mixture into the termination point set;
respectively selecting S from the starting point set and the end point set i And E j Then remember (S) i ,E j ) Is a needle track, if (S) i ,E j ) When the needle passage passes through the endangered organ to be protected, the needle passage is not considered to be a feasible needle passage, and the needle passage is deleted.
6. The method according to claim 5, wherein the needle track optimization factors in step S2 include: the insertion path is short, the distance from the surrounding normal tissues is long, and the needle channels are uniformly distributed in the target area.
7. The method according to claim 6, wherein in step S2, a needle track optimization objective function is set based on the needle track optimization factors:
F(Ap)＝α·f C (Ap)+β·f D (Ap)+γ·f V (Ap)
wherein the content of the first and second substances,
f C (Ap)＝∑C(Ap i ) Representing the contribution of the interpolation paths of all needle tracks to the objective function;
f D (Ap)＝∑D(Ap i ) All needle tracks represent distance contributions from surrounding normal tissue;
f V (Ap)＝∑V(Ap i ) The contribution of the uniform distribution degree of all needle tracks in the target area is expressed;
Ap i ＝(S i ,E i ) For the ith needle track, S i ＝(sx i ,sy i ,sz i ) Is the three-dimensional coordinate of the incident point of the ith needle track, E i ＝(ex i ,ey i ,ez i ) Is the three-dimensional coordinate of the ith needle track end point, alpha, beta and gamma are weights, C (Ap) i ) The contribution of the interpolated path representing the ith needle trace to the objective function, D (Ap) i ) Represents the distance contribution, V (Ap), of the ith track from the surrounding normal tissue i ) Representing the contribution of the even distribution of the ith needle track within the target volume,
and selecting a better plurality of groups of needle track designs from the feasible solution space determined in the step S1 through the needle track optimization objective function.
8. The method of claim 7, wherein in step S4, the optimal set of needle track designs selected in step S3 is further fine-tuned based on the dose optimization objective function to obtain a better dose volume distribution.
9. An insertion guide plate, characterized in that insertion needle track design is performed by the insertion guide plate design method according to any one of claims 1 to 8 to obtain insertion needle track design information, and 3D printing insertion guide plate design is performed based on the insertion needle track design information to be printed and manufactured by a 3D printer.
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