CN101120871A - Precise radiotherapy planning system - Google Patents
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Abstract
The present invention discloses an accurate radiation treatment planning system, which mainly comprises a three-dimensional medical image reconstruction module for reconstruction of human organs and the tumor target area, a three-dimensional dose calculation module of high accuracy photon beam, a three-dimensional dose calculation module of high accuracy electron beam, a conventional radiation plan designing module of the photon beam and the electron beam, a conformal radiation designing module of the photon beam and the electron beam, a reverse plan scheme designing module focused on the photon beam treatment. The present invention independently resolves the main and key technology of the radiation treatment planning system. The present invention develops a highly accurate algorithm and a fast precise optimal method of the three-dimensional dose distribution in photon beam and the electron beam, which distributes in non-uniform human medium. The present invention greatly improves accuracy of the embarking dose in tumor target area in patient body. Because the dose calculation speed has been improved dramatically, the advanced conformal radiation treatment planning system and the treatment planning system focused on radiation are feasible for clinical application. The present invention brings important benefits for improving the radiation treatment effect and improving life quality of the patient.
Description
Technical Field
The invention relates to a radiation therapy technology for tumors, in particular to an accurate radiation therapy planning system for treating tumor diseases, which comprises airborne functional modules required by conformal and intensity modulated radiation therapy technology.
Background
Radiotherapy technology is one of three main means (surgery, radiotherapy and chemotherapy) for treating cancer, and has great significance for improving human health and prolonging human life. After a large number of investigation and research studies, the international radiation unit and the measurement committee (ICRU) provide statistical results of the curative effect of radiotherapy, which show that the cure rate of radiotherapy is 12%, the cure rate of radiotherapy and surgery is 6%, the surgery is 22%, and the chemotherapy and others are only 5%. Therefore, radiotherapy is an important technique for treating cancer patients. Radiotherapy is highly appreciated in developed countries and China, and 60% -70% of cancer patients receive radiotherapy. Radiation therapy has created a tremendous social need because of its significant effects in curing tumors. The developed countries invest in huge capital to establish medical equipment industry closely related to radiotherapy, develop related medical equipment and develop research work closely related to radiotherapy, so that the industry for developing and producing radiotherapy equipment and related products becomes one of the most concentrated industries of modern high and new technologies. The development of radiotherapy devices and related products has become a new growth point for socio-economic development. Internationally recognized that the implementation of precision radiotherapy techniques is the most effective way to improve the efficacy of radiotherapy. However, due to the limitations of conventional irradiation techniques (limited to rectangular fields or circular fields), conventional radiotherapy has the following disadvantages: or failure to administer a sufficient dose of radiation to the tumor to avoid serious complications, incomplete eradication of the tumor resulting in recurrence, or severe damage to critical organs of the body due to the administration of excessive doses of radiation. Therefore, solving the problems of the traditional irradiation technology becomes a main way for improving the curative effect of radiotherapy. Currently, the international radiotherapy community is developing a new generation of radiotherapy technology featuring precise control of radiation dose. The core technology has three main points:
a) High precision dose control:
radiation therapy techniques are very demanding in terms of the accuracy of the delivered dose. In 1976 the requirements of ICRU for dose accuracy of radiotherapy were significantly suggested: the accuracy of absorbed dose in the target region (tumor) needs to be up to 5% (see ICRU24 report). The proposal of ICRU has actually become a compendium for the development of the radiomedical science and technology. Therefore, the development and solution of accurate measurement and algorithm of the dose distribution of photon beam and electron beam in the treatment energy region in the human body are required for the high-quality radiation medical technology.
b) Development of Conformal irradiation technique (Conformal Radiation Therapy):
conformal radiotherapy requires that the cross-section of the beam match the projection of the target in the direction of the beam, so that high doses of the radiation beam are delivered to the target while healthy tissue outside the target receives as low a dose as possible to avoid damage.
c) Development of Intensity Modulated Radiation Therapy (IMRT) or Inverse treatment Planning (Inverse Planning):
the desired dose distribution is achieved by adjusting the beam intensity distribution, known as the intensity modulation technique, also known as inverse treatment planning. The intensity modulation technology is one of the most important development directions of the modern radiotherapy technology, is the core of the new generation radiotherapy technology, and is expected to improve the cure rate of tumors and the life quality of patients in the international radiophysical world. Since the intensity modulation technique requires the calculation of the dose distribution of a large number of pencil beam photons in the human body, the difficulty of the beam dose algorithm in calculating speed and accuracy requirements is further increased. The development of a rapid and reliable inverse planning algorithm for intensity modulated radiation therapy is the most critical and pressing task of intensity modulation techniques.
It is known that since it is not possible to implant a detector in a patient for dose measurement in radiotherapy, the dose distribution in the patient can only be determined by complicated theoretical calculations. Therefore, in the development of accurate radiation therapy techniques, the study of dose algorithms is of particular importance in achieving technical goals. The study of accurate and rapid dose algorithms and intensity modulated technology algorithms has become a key element in the main content and success of conformal and intensity modulated radiation therapy techniques. At present, china is still weak in the aspect of high-end medical equipment such as a radiotherapy planning system, and is basically monopolized by foreign companies such as Varian, siemens, elekta and the like. Foreign manufacturers never published their core technical material for political and commercial interest. In order to develop the system, the applicant has made many years of effort to independently and creatively address the major and critical technologies involved in precision radiation therapy techniques. The core content of the invention comprises: the invention discloses a technology for reproducing three-dimensional medical images of human organs and tumor target areas by CT data of a patient, develops a high-precision algorithm and a rapid and precise intensity modulation optimization method for dose distribution of photon beams and electron beams in a three-dimensional uneven human body, realizes a new technology of conformal and intensity modulation radiotherapy of the ray beams by adjusting a multi-She Zhunzhi device (MLC) or a photon beam intensity Compensator (Compensator), enables the ray beams to be accurately delivered to the tumor at high dose, and effectively protects vital organs and surrounding tissues while killing cancer cells.
Disclosure of Invention
The invention aims to: provides an accurate radiation treatment planning system which can meet the urgent need of clinical radiation treatment of tumor diseases. The system mainly comprises a module system which can satisfactorily complete accurate radiotherapy irradiation design according to a radiotherapy plan flow (figure I): the device comprises a three-dimensional medical image reconstruction module for reproducing human organs and a tumor target area, a high-precision photon beam three-dimensional dose calculation module, a high-precision electron beam three-dimensional dose calculation module, a photon beam and electron beam conventional irradiation scheme design module, a photon beam and electron beam conformal irradiation scheme design module, a photon beam intensity modulation treatment reverse planning scheme design module and a machine parameter and radiotherapy plan output module. Wherein:
the three-dimensional medical image reconstruction module for reproducing the target areas of the organs and the tumors of the human body comprises the following processing steps:
(1) inputting CT human body density information of a patient into a computer through a scanner video signal or DICOM 3.0 and DICOM.RT international standard input system, and automatically correcting, positioning and preprocessing a CT image;
(2) converting the human body electron density of the CT into pixel density;
(3) carrying out sectional image segmentation on the CT scanning image, and delineating a tumor target area and parts, sizes and shapes of adjacent vital organs on the sectional image by using a software tool;
(4) generating a reconstructed three-dimensional medical image of a tumor target area and an essential organ by a surface three-dimensional reconstruction technology based on a slice level;
(5) and determining the surface and projection contour line of the tumor target area in the reconstructed three-dimensional medical image.
The present invention is (3): the method for segmenting the tomography image of the CT scanning image comprises the following six steps:
firstly, determining the resolution of a reference tomographic image according to the length actually represented by a scale and corresponding pixel coordinates of two end points on a CT scanning image;
secondly, selecting a tomogram to be segmented by using a rectangular frame on a reference tomogram;
thirdly, using the end point of the scale on the reference tomographic image as a reference point, and locking the relative position relation between the rectangular frame and the scale reference point;
fourthly, determining the resolution of other tomographic images according to the method of the first step, dividing the resolution of the reference tomographic image by the resolution of the other tomographic images to obtain a scaling ratio, and scaling the other tomographic images according to the scaling ratio to keep the scaling ratio of the other tomographic images consistent with the scaling ratio of the reference tomographic image;
and fifthly, determining the position of the rectangular frame on other tomograms by taking the scale end points on other tomograms corresponding to the reference point on the reference tomogram as the reference points according to the relative position relation between the locked rectangular frame and the scale reference points determined in the third step, wherein the region surrounded by the rectangular frame is a tomogram needing to be segmented.
And sixthly, repeating the fourth step and the fifth step until all other sectional images are segmented one by one.
The invention relates to a method for segmenting a tomographic image in a CT scanning image, which associates a rectangular frame with an end point of a ruler as a reference point, and can realize the rapid positioning of the tomographic image only by lightly clicking a mouse button in the actual operation. Because the automatic identification technology is applied to the end point of the scale, the positioning accuracy is improved. In the method, the concept of scale reference points is introduced, so that the split fault image is ensured to have good consistency in proportion and direction.
The present invention is (4): a method for generating medical images of a tumor target and reconstructed three-dimensional morphology of critical organs based on a slice-level surface three-dimensional reconstruction technique, comprising the steps of:
firstly, extracting contour lines of human organs and tumor target regions distributed on each tomographic image of the CT;
then, matching contour points of contour lines extracted from all faults to construct triangular plates;
then, fitting the three-square as a unit to the outer surfaces of the corresponding organs and the tumor entity so as to obtain a reconstructed three-dimensional morphological entity of the human organ and the tumor target area.
The radiotherapy planning system divides the human anatomy structure into three types: the outer contour of the human body surface, the target area of the tumor and vital organs, hereinafter collectively referred to as organs. The two-dimensional description of the organ is the contour of the corresponding region of the organ on each tomographic image of the CT, and the basic data of the organ is the boundary surrounding a certain organ region on the tomographic image. In order to obtain the anatomical details of the inside of the human body, the reconstructed three-dimensional entity can be cut from any direction, and then a corresponding section image pasted on a cutting plane in a texture mode is obtained by using a section recombination algorithm. Because the distance between CT image slices is much larger than the pixel size of the slice image, and the slice recombination algorithm requires volume data with equal resolution, image interpolation is needed in the slice recombination process.
In the radiation therapy planning system, in addition to various display modes including translucency, opacity and wire frame, medical images of sagittal plane, coronal plane, transverse plane and arbitrary section are provided, and reconstructed Digital radiography (DRR), beam Eye View (BEV) and space View (REV) are provided for three-dimensional stereo Reconstruction images of body surfaces, organs and tumor target areas.
(II) a high-precision photon beam three-dimensional dose calculation module:
the photon beam dose estimation method of conventional radiotherapy techniques is a table look-up method based on measurement data. The dose distribution of the square field, rectangular field or circular field photon beam with different energy and different size in the water tank is measured and then made into a table or an empirical formula, and various corrections are made when the formula is used. This approach is clearly not applicable to new techniques for conformal and intensity modulated treatment of photon beams. To implement new techniques for conformal and intensity modulated therapy, a pencil beam model of the photon beam must be developed. The so-called pencil beam model of a photon beam is simply a very fine dose distribution of a photon beam in the human body. Internationally, the Monte Carlo method is commonly used to calculate the dose distribution of a very fine photon beam in a water tank and to store it as a database in a computer. In use, the dose distribution in the human body is called out and obtained by superposition of the dose distributions of different photon beamlets (which we will call photon microbeams in the following) and various corrections. Due to the large pen beam dose database, calculating the dose distribution of the photon beam in the human body is rather time consuming. In order to develop a fast and accurate photon beam three-dimensional dose calculation module. The advanced algorithm of a photon pen beam model based on a characteristic line algorithm is invented and developed into a photon beam three-dimensional dose calculation module. Because the photon pen beam model of the characteristic line algorithm is basically a few uncomplicated formulas (see below), the calculation efficiency is high, and the contradiction between speed and accuracy in photon beam dose calculation is well solved. The invention relates to a high-precision photon beam three-dimensional dose calculation module, which solves the problem of how to determine the three-dimensional dose of a photon beam generated in a human body with high precision and high speed, and comprises the following contents and steps:
the first step is as follows: dispersing the photon beam into a series of microbeam photons with side lengths of a and b tiny rectangular cross sections;
the second step is that: for each microbeam photon, applying a photon pencil beam model based on a characteristic line algorithm to calculate the dose generated by the photon pencil beam model at each spatial point P (z, x, y) in the human body:
wherein: SSD is the source-skin distance, μ E (E) Is the linear energy absorption coefficient, mu, of a photon a (E) Is the linear absorption coefficient of the photon, z is the photon penetration depth, erf is the error function, where ω = (0.5R) 2 . And R (E) is the average range of the secondary electrons generated by the incident photons, B d (z, E) represents the dose accumulation factor of the broad beam photon, calculated by the photon transport characteristic line algorithm, and
wherein: n is a radical of 0 (1) (z, E) is the first scattered photon fluence, N 0 (m) (z, E) is the multiple scattered photon fluence, N 1 (1) (z, E) is the primary scattered photon flux, N 1 (m) (z, E) is the multiple scattered photon flux;
the third step: correcting the influence of the energy spectrum on the dose distribution; for a photon beam of a medical accelerator, the energy is not uniform but has a certain distribution. Therefore, the effect of its spectrum on dose distribution must be taken into account, and with respect to determining the effective spectrum of a particular accelerator photon beam, functional modules are already available which can be embedded in the system of the invention, and which can be invoked from the system when applied, to obtain the photon spectrum W (E) i ) Thus, taking into account the spectral effects of the photon beam, the dose of the microbeam photons generated at each spatial point P (z, x, y) in the body is:
the fourth step: correcting the influence of the human body density on the dose distribution; and (3) correcting the density of the micro-beam photon along the track by interpolating a density matrix to determine the density distribution on the photon track, and then determining the total equivalent water penetration depth, wherein the difference between the equivalent water penetration depth and the actual penetration depth is the corrected value of the penetration depth. From the correction of the penetration depth, the density correction factor eta (z, x, y, E) is calculated and the density correction of the dose at the point of calculation is determined.
The fifth step: correcting the surface flexibility of the skin; due to the influence of the flexibility of the skin surface, the distance between each micro beam photon incidence point on the skin surface and the photon source is not equal to the source-skin distance, so when each micro beam photon is used for correcting the human body density along the track, the influence of the factor on the dose distribution needs to be considered, and the correction method can be summarized as the human body density correction. FIG. 10 is a schematic illustration of the effect of skin surface flexibility.
And a sixth step: the three-dimensional dose distribution of the photon beam in the human body is obtained by adding the doses generated by all the micro-beam photons of the photon beam at the same point in the human body, and is represented by a three-dimensional dose matrix, so that after the energy spectrum of the photon beam, the surface curvature of the human body medium and the intensity matrix of the photon beam (irregular field conformal irradiation) are considered, the three-dimensional dose distribution of the photon beam in the irradiated human body is represented as follows:
in the formula: d (n) (z, x, y) denotes the dose produced by the nth microbeam photon at point p (z, x, y), i and j are the numbers of microbeam photons in the x and y directions in the cross-section of the photon beam, k denotes the number of nodes of the energy spectrum of the incident photon beam, and W (E) k ) Is the energy spectrum of the photon beam, i.e. the energy is E k Weight of photon intensity of a ij Is the intensity of the microbeam photon numbered ij, D p (n) (z, x, y, i, j, k) is the energy E in the microbeam photon energy spectrum numbered ij k The dose of photons generated at point p (z, x, y) in the body。
The seventh step: in the case of multi-photon conformal irradiation, the dose generated by all photon beams is summed to obtain the dose generated by the multi-photon conformal irradiation in the human body:
the dose precision obtained by applying the photon pen beam model based on the characteristic line algorithm is compared with domestic and foreign large-scale measurement data, the error is less than 3%, and the qualified requirement is higher if the error is far less than 5% of the photon beam dose calculation error of a general commercial radiotherapy planning system, so that the photon beam dose calculation precision of the radiotherapy planning system disclosed by the invention is shown to be in top international. The calculation module can complete the dose calculation of one conformal irradiation for only 2-3 minutes, which is much higher than the calculation speed of many foreign famous photon beam dose algorithms.
(III) the high-precision electron beam three-dimensional dose calculation module solves the problem of determining the three-dimensional dose distribution generated by the electron beam in the human body with high precision, and comprises the following steps:
as with conventional photon beam dose estimation methods, conventional electron beam dose calculation is also a table look-up method based on similar measurement data. This method cannot of course be used for new techniques of conformal treatment of electron beams. In order to realize new techniques for conformal irradiation of electron beams, a pencil-beam model of electron beams must also be developed. The internationally commonly applied pencil beam model construction method is to multiply the lateral electron intensity distribution calculated by Fermi-Eyges theory by the measurement data of the electron beam central axis dose to obtain the three-dimensional dose distribution of the electron microbeam. Since the central beam dose is measured in a uniform water tank, application to non-uniform humans can produce large errors. Other methods, such as the Monte Carlo method, are too slow. In order to develop a rapid and accurate three-dimensional electron beam dose calculation module, an advanced algorithm of an electronic mixed pencil beam model based on a double-group model is invented and developed into the three-dimensional electron beam dose calculation module. Because the double-group model can be used for non-uniform correction of the human body density, the spear of speed and accuracy in the electron beam dose calculation is well solved. The hybrid electronic pencil beam model of the system of the invention comprises the following calculation steps:
the first step is as follows: dispersing the electron beam into a series of micro-beam electrons with side lengths of a and b micro rectangular sections;
the second step is that: calculating the dose distribution of the micro-beam electrons generated at the point P (z, x, y) of the human body by applying a mixed electron pencil beam model:
wherein E is the energy of the single-energy microbeam electrons; it is incident on the surface of human body, and its cross-section size is 2a × 2b; the positive direction of the z axis is the incident direction of the micro-beam electrons, and the incident point is the origin of coordinates; d p (z, x, y, E) represents a single-energy microbeam electron of energy E, the energy deposited at point p (z, x, y) in space, i.e., the dose absorbed by the organ at that point; d bm (z, E) represents the energy deposited by a wide beam of electrons with energy E at the depth z of the human body, which is calculated by a binomial model (bipartition model electron transport); a and b are the beam half-widths of the microbeam electrons; a. The 2 2 (z, E) represents the lateral distribution parameter at depth z of the microbeam electrons with energy E:
is an electron transport section corresponding to the average energy of the microbeam electrons at the depth t;
is the average energy of an electron at depth t when the energy of the incident electron is E;
after the electron beam passes through the accelerator head, the moving direction and energy of a part of electrons are changed, so that the electron beam has a certain initial energy spectrum and angular distribution before entering a human body. This initial energy spectrum and angular distribution also affect the spatial dose distribution of electrons in the human body. Considering the influence of the factor, in the calculation of the application mixed pencil beam model, the calculation of the lateral distribution parameters of the electrons is corrected, and the corrected lateral distribution parameters are as follows:
wherein A is 2 (z) is a modified lateral distribution parameter of the electronic pen beam at depth z; a. The 2 0 The initial lateral distribution parameters of the electronic pen beams are obtained by calculating the flatness curve of the electronic beams on the surface of the water model; a. The 2 2 (z) is a lateral distribution parameter at depth z of the pencil beam electrons in the hybrid pencil beam model.
The third step: correction of the effect of the electron beam energy spectrum on the dose distribution was performed: for an electron beam of a medical accelerator, like a photon beam, its energy has a certain distribution. Therefore, it is necessary to consider the influence of its energy spectrum on the dose distribution, how to determine the energy spectrum of the accelerator electron beam, a new and effective technique has been developed and related functional modules have been formed, which are embedded in the system of the present invention and called from the system when applied, so as to obtain the electron energy spectrum W E (E i ) Thus, taking into account the spectral effects of the electron beam, the dose of the microbeam electrons generated at each spatial point P (z, x, y) in the human body is:
the fourth step: considering the human body surface bendability effect: due to the flexibility of the human body surface, the distance from the source to the incident point of each microbeam electron is different. Thus, the electron beam is discretizedThe dose distribution of each microbeam electron needs to be corrected by SSD 2 /(SSD+d) 2 。
The fifth step: after considering the influence of the electron beam energy spectrum, the human body surface curvature and the intensity matrix (non-regular radiation field) of the electron beam, the three-dimensional dose distribution of the n-th electron beam in the irradiated human body is calculated as follows:
in the formula: d (n) (z, x, y) represents the dose produced by the nth electron beam at point p (z, x, y); i and j are position numbers of the discrete micro-beam electrons on the beam section; k represents the number of the energy spectrum node of the incident electron beam; w E (E k ) Is the energy E in the electron beam spectrum k The spectral components of (a); d ij Is the surface correction distance of the microbeam electrons numbered ij; a is ij Is the intensity of the microbeam electron numbered ij; d p (n) (z, x, y, i, j, k) is the energy E in the microbeam electron spectrum numbered ij k The dose produced by a unit number of electrons at a point (z, x, y) in the body.
And a sixth step: in the presence of multiple beams of electron conformal irradiation, the dose generated by all electron beams at a point p (z, x, y) in the human body is added up to obtain the dose generated by the multiple beams of electron conformal irradiation in the human body:
the electron dose of the radiotherapy energy region is calculated by applying the mixed pencil beam model, the outstanding advantage of the radiotherapy is that the calculation speed is high, the treatment design scheme is convenient to select, and the quality is one of the key factors for the clinical application of a dose algorithm. After comparing the calculation efficiency of internationally different electron dose algorithms, it is believed that the mixed pencil beam model of the present invention is most efficient in calculating electron dose. The conditions and results of the comparison are as follows: the electron beam has a nominal energy of 20MeV (21 MeV for the case of Phase Space Evolution (PSE)). The computation time is normalized to the same computation condition: CPU working frequency 133MHz, radiation field 15cm × 15cm, voxel size 0.5cm × 0.5cm. Except for the example of the discretized pencil beam model (PBRA), a heterogeneous medium is used. The calculation accuracy of each example was approximately the same. The VMC algorithm (simplified Monte card Luo Fangfa) requires 100 points (see literature: phys. Med. Biol.42 (3), 1997, P501); PSE algorithms (phase space evolution algorithms) require 76 points (see document: med. Phys.22, 1995, P948); the PBRA algorithm (discretized pencil beam model) requires 20 points (see document: med. Phys.25 (11), 1998, P2176); the HPBM algorithm (mixed pencil-beam model based on two-cluster model) is only 1.3 points (see the literature: med. Phys.30 (3), 2003, P415)
(IV) photon beam and electron beam conventional radiotherapy planning design module:
although the system is designed for precise radiotherapy techniques, the functional modules corresponding to conventional radiotherapy techniques are also included in the arrangement of functional modules. The photon beam and electron beam conventional radiotherapy plan design module comprises:
1. and a photon beam square field and rectangular field source-skin distance (SSD) irradiation module.
2. And an isocentric (SAD) irradiation module for a photon beam square field and a rectangular field.
3. And the photon beam rotating irradiation module is used for irradiating a round field.
4. And a Source Skin Distance (SSD) irradiation module of the square field and the rectangular field of the electron beam.
5. And a rotating irradiation module of the electron beam circular field.
Since conventional radiotherapy techniques using photon beams and electron beams have already been referred to, they are not described in detail here.
(V) photon beam and electron beam conformal radiotherapy plan design module:
the conformal radiation therapy planning module provided by the system comprises the following execution steps:
the first step is as follows: acquiring the human body density matrix information of an irradiated patient, which comprises the following specific steps:
1. establishing a mapping table of the CT value and the electron density so as to determine a conversion relation from the CT value to the electron density;
2. establishing three-dimensional CT data according to the CT image sequence;
3. establishing a three-dimensional data area of a density matrix, wherein the three-dimensional coordinate of each node of the density matrix corresponds to the dose matrix;
4. obtaining CT values of positions of all nodes in the density matrix from the three-dimensional CT data;
5. converting a CT value-electron density mapping table to obtain the electron density corresponding to the CT value;
6. and repeating the step 4 in sequence until the electron density of the positions of all the nodes in the density matrix is obtained.
The second step is that: acquiring machine parameter data of the medical accelerator related to the beam (photon beam or electron beam);
the invention divides the machine parameters into three categories: namely machine characteristic parameters, machine equipment parameters and machine dosimetry parameters.
(1) Machine characteristic parameters: the parameters reflect the ray characteristics of the treatment machine, including ray types, energy gear number, energy size, motion control of the machine and the like, such as the limited control range of the rotation of the frame, the handpiece and the treatment bed;
(2) machine equipment parameters: the parameters reflect the technical parameters of the treatment machine and the accessory equipment connected with the treatment machine, such as the technical parameters of a multi-blade collimator, the technical parameters of a wedge-shaped plate, the technical parameters of a lead stopper and the like;
(3) machine dosimetry parameters: the parameters reflect the output dose performance of the treatment machine, such as the percentage depth dose, off-axis dose and field output factor of the machine under each standard field.
The third step: the conformal irradiation design of the irradiation field of the finished beam (photon beam or electron beam) comprises the following contents and steps:
(1) determining the projection area of the section of the beam (photon beam or electron beam) at the exit of the accelerator to the tumor;
(2) determining the shape and size of the conformal irradiation field according to the projection region;
(3) arranging tungsten sheets or lead baffles of the multi-leaf collimator to shield areas outside the conformal irradiation field;
(4) the dose distribution of the conformal irradiation field in the patient (including the tumor region) is accurately calculated:
calling a high-precision photon beam three-dimensional dose calculation module for the irradiation of the photon beam, calculating the three-dimensional dose distribution of the photon beam in the human body, calling the high-precision electron beam three-dimensional dose calculation module for the irradiation of the electron beam, and calculating the three-dimensional dose distribution of the electron beam in the human body;
(5) based on the calculated precise dose, the accelerator is adjusted and controlled to irradiate the total amount of the beam emitted from the accelerator or the irradiation time of the beam in the tumor region as required.
The so-called conformal irradiation design of modern radiology is the conformal design of an irradiation field, and the shape and the size of the irradiation field of rays are determined according to the irregular shape of a tumor on a projection plane, so that normal tissues outside a tumor area are protected from being damaged. This requires that before irradiation, the located tumor must be projected along the beam direction onto the reference cross section at the exit of the accelerator beam (photon beam or electron beam) to determine the projection area of the tumor on the surface, the shape and size of the irradiation field is determined according to the projection area, and the tungsten plate or lead block of the multi-leaf collimator is arranged to block the area outside the irradiation field from the beam; then, according to the accurately calculated beam dosage required for killing the tumor, the accelerator is adjusted and controlled, so that the total amount of the emitted beams or the irradiation time of the beams is accurately thrown to the tumor area according to the calculated dosage, and the cancer cells are effectively killed. Therefore, determining the projection area of the tumor on the beam cross section at the exit of the accelerator is a key link of the conformal irradiation technology, and becomes one of the core technologies for realizing the field conformal irradiation design. How is the projection area of the beam cross section of the tumor at the accelerator exit determined? The invention provides a method for determining projection contour lines of field conformal irradiation, which has important practical value.
The method for determining the projection contour line of the field conformal irradiation comprises the following main steps:
1) Calling a three-dimensional medical image reconstruction module for reproducing the human organ and the tumor target area, and constructing a three-dimensional structure of the human organ and the tumor target area which are formed by taking a triangular plate as a unit;
2) Establishing an orthogonal projection coordinate system by taking a connecting line of an isocenter point and a beam origin of the medical accelerator as a Z axis and taking a plane passing through the isocenter and perpendicular to the Z axis as a projection plane;
3) Projecting the solid envelope of the target region of the three-dimensional tumor constructed by taking a triangular plate as a unit on an XOY plane of a projection coordinate system by using a photon beam or an electron beam at the outlet of an accelerator to obtain a rectangular region with the maximum enclosure, establishing a marking image with the size corresponding to the rectangular region, and conventionally selecting the original point of the marking image in the upper left corner of the rectangular region (as shown in FIG. 2);
4) The projection line segments of each side of the triangular plate for constructing the three-dimensional tumor target area entity are drawn on the marked image, and the flow of drawing the projection line segments is shown in fig. 3. Two end points of the projection line segment can be obtained by projecting two vertexes of each side of the triangular plate to the XOY plane. The two end points are mapped to the marked image and drawn to obtain a two-dimensional marked image of the tumor target area (as a specific implementation scheme, the marked image after drawing is shown in fig. 4), the area formed by the pixels of the marked image is a projection area corresponding to the three-dimensional anatomical structure of the tumor target area, and the outermost edge of the area is the projection contour line of the tumor target area. The projected outline surrounding area of the tumor target area is the irradiation area of the beam at the exit of the accelerator to the tumor.
In practical applications, the present invention employs a contour tracing algorithm that can adapt to any shape region, i.e. for any pixel point P, its neighboring 8 pixels are represented by eight basic directions of the directional chain code (as shown in fig. 5). Defining the right neighborhood pixel point of the P point to be marked as 0, defining other 7 neighborhood pixel points of the P point in the anticlockwise direction, and respectively marking the other 7 neighborhood pixel points by 1,2, 3, 4, 5, 6 and 7; let R be a connected region in the binary image, and the boundary point with the gray value of 1,R in the region is defined as the pixel point in R: at least one of its 4 neighbourhoods is a pixel not in R, the totality of the boundary points having this feature, i.e. the contour constituting the region R.
Defining: the direction is the current direction in the search process, and the implementation of the search process is shown in fig. 6, which specifically includes the following steps:
(1) scanning each pixel point from top to bottom and from left to right on the binary image until a contour point is found; taking the contour Point as the starting Point of the tracking process, marking as Start Point, and marking 5 by direction;
(2) then, taking the direction of the mark 5 as an initial direction, and testing 8 neighborhood points of the current point one by one in a counterclockwise direction until a target area point is found; stopping the tracking process for the case that all 8 neighborhood points are not target region points;
(3) then testing whether the neighborhood Point is the starting Point Start Point or not, if so, ending the tracking process; if not, automatically taking the mark 5 from the current search direction as the initial direction for searching the next contour point, and repeating the step (2);
(4) a certain contour point P obtained just after searching is processed n When searching the next contour point as the current contour point, the starting direction is according to the step (2), the direction takes the mark 5, this is to ensure the searched neighborhood point is the boundary point of the target area, when P is n And P n-1 When the two adjacent points are positioned on the same row or the same column, the direction mark 6 and the direction mark 7 are searched; for P n And P n-1 In other direction situations, the neighborhood point of the direction taking mark 6 direction is also alreadyAfter the search. Therefore, in order to improve the efficiency of the algorithm, the respective skips are performed. Fig. 7 is a projected contour line obtained after contour tracing. The projection contour line is the projection contour line of the target area on the projection plane.
5) Projecting the contour line on the obtained projection plane onto a reference plane at the beam outlet of the accelerator to obtain the contour line on the reference plane, setting the positions of multiple She Zhunzhi device blades and completing the design of a lead block according to the shape of the contour line on the reference plane, and enabling the shape of the cross section of the photon or electron beam passing through the multi-blade collimator or the lead block to be exactly matched with the projection contour line of the beam direction on the tumor target area to complete the conformal irradiation plan design. Thereby greatly improving the accuracy of the dose delivered to the target area of the tumor in the body of the patient.
In a radiation treatment planning system, the method for obtaining the projection contour line of the three-dimensional tumor and other anatomical structures uses line drawing and contour tracking processing to replace the operations of intersection, sequencing, selection and rejection and the like among projection line segments, and has high applicability and important application value.
The fourth step: dose calculation for photon beam or electron beam conformal radiation therapy:
after the conformal irradiation field is determined, the main task is to calculate the dose distribution of the conformal irradiation field in the patient. Since the conformal irradiation field is an irregular field, it needs to be discretized into a series of micro-beams, and the cross section of each micro-beam is rectangular or triangular (fig. 8), so that a high-precision photon beam or electron beam three-dimensional dose calculation module can be invoked to calculate the dose distribution of the beam in the human body. Fig. 9 is a hatched portion showing a constructed photon beam intensity matrix, the intensity of the photon microbeam at the central portion is 1, and the intensity of the photon microbeam at the edge portion is a value between 0 and 1, which is determined according to the area of the photon microbeam at the edge portion. Outside the illuminated area, the intensity of the photon microbeam is 0. As an illustration in the lower part of fig. 9, the intensity of each photon microbeam formed after the field is discretized is listed, forming an intensity matrix of photon beams, wherein the unit with intensity 0 is not listed.
(VI) an inverse planning scheme design module of the photon beam intensity modulation treatment:
conventional radiotherapy is based on the experience of a doctor to set the number of beams, the energy of the beams, and the direction of the beams and then calculate the dose distribution of the photon beams with uniform intensity in the human body. Since the uniform beam emerging from the accelerator exit is influenced by density after passing through the medium, in particular the human body, and is no longer a beam of uniform intensity after reaching the tumor volume, the dose distribution obtained in the tumor volume is not ideal. Repeated adjustments of the irradiation conditions are required to find an acceptable dose distribution. An acceptable dose distribution may not be found for complex situations. This is a very significant disadvantage. The process of photon beam intensity modulated treatment is the opposite of conventional radiation treatment. The physician first designs an ideal dose prescription for the tumor target and critical organs, then selects the number of photon beams, the energy of the photon beams, and the direction of the photon beams, and performs a reverse treatment planning calculation of the beam intensity distribution to obtain the photon beam intensity distribution required for realizing the ideal dose distribution. Then, according to the photon beam intensity distribution data, a control instruction for driving the intensity modulated radiation therapy hardware equipment (a multi-leaf collimator or a photon beam intensity compensator) to act is obtained, and final evaluation is given to the intensity modulated radiation therapy plan, wherein the final evaluation comprises the steps of giving a dose volume histogram, an isodose line and a dose verification result. This planning is called inverse planning because the flow of the plan is inverse to that of a conventional radiation treatment plan. Because the technology needs to change the intensity distribution of photon beams to realize ideal dose distribution, the technology is called intensity modulation treatment; the intensity modulated radiation therapy technique is far superior to the traditional radiation therapy technique because it has a new regulation and control means-changing the intensity distribution of the photon beam in the beam cross section, thus it is easy to realize the ideal dose distribution to the tumor target area and the vital organs. Which is difficult to achieve with conventional radiation therapy. The biggest bottleneck of photon beam intensity modulated radiotherapy is the difficulty and inefficiency of clinical application due to the large amount of calculation. For example, the international famous brand calmlan requires hours or even one or two days for a patient to perform a reverse program of a boost treatment. Therefore, the development of an intensity modulated radiation therapy algorithm with high computational efficiency is naturally the most urgent problem of the intensity modulated therapy technology. The invention creatively provides a K space projection operator algorithm to develop a high-efficiency and accurate intensity modulation algorithm, the time required by the reverse planning design of one-time intensity modulation treatment for a patient is only a few minutes, and the practical basis is provided for clinical practical application. The design of the reverse plan scheme of the photon beam intensity modulated treatment comprises the following steps:
first, setting a photon beam: includes setting the number of photon beam as M, defining a beam direction for each photon beam, dividing the field of reference cross section into many micro-beam photons, called photon beam elements, for example, dividing the field of any k-th beam photon into N x k ×N y k Individual beam elements, total M-beam photons being co-divided(ii) beam microbeam photons; simultaneously dividing the tumor target area and the nearby critical organs into a plurality of volume elements, determining the total number N of all spatial points in which the dose is to be calculated T And their bitsCoordinates are set, for convenience it is generally assumed that N = N M ＝N T . This condition is always satisfied, but it can facilitate the problem solution.
Secondly, calling a high-precision photon beam three-dimensional dose calculation module, applying a photon pen beam model based on a characteristic line algorithm, calculating a photon beam element with unit intensity and a dose d (i, j) generated at a calculation point with a mark j on a target area or an essential organ; calculating the dose of all photon beam elements with unit intensity of all photon beams on each calculation point to form a matrix of n × n order:
wherein D i，j = d (i, j) i =1,2, · n, j =1,2, · n, called photon beam element dose matrix;
third, when the intensity of the photon beam element labeled I is I (I), the dose produced at the calculated point labeled j should be d (I, j) xI (I). This process is repeated to calculate all beam elements of the total photon beam, and the total dose produced at the calculated point marked j on the tumor target or critical organ is
Then, the total dose of all beam elements of all photon beams at each calculation point is calculated for all calculation points of the tumor target area and critical organs one by one.
The fourth step, according to the prescribed dose determined by the doctor for the target area and the tolerance dose on the critical organs, requires designing the intensities of all photon beam elements so that the total dose they deliver on all calculated points of the tumor target area and critical organs is exactly the prescribed dose p (j) that the doctor wants to assign, i.e. requires:
or written in matrix form:
wherein D is a photon beam element dose matrix; the matrix element d (i, j) is the photon beam element of the ith unit intensity, and the dose is generated at the jth calculation point on the target area or the critical organ; 
is a photonAn intensity vector of the beam element; 
is the prescribed dose vector that the physician determines for the target area and critical organs. In general, a system of linear equations
Is pathological in order to solve a system of pathological linear equations
First, a special set of substrates is constructed
(Vector)
The definition of (A) is:
.......
.......
wherein D (i) Representing pairs of photon beam element dose matrices D
Act i times, we call the substrate
Is K (n) A substrate; by means of k (n) Base, approximately solvedThe method comprises the following steps:
(1) The photon beam element intensity vector solved in advance is required to satisfy an accuracy condition: 
representing a vector
Is the precision index given by the doctor.
(2) First, a first basis vector is selectedWill be provided with
Is projected toOpened K (1) In space, get
At K (1) Projection vector in space
Then calculating the error
If it is not
If the accuracy requirement of the problem cannot be met, a second basis vector may be added
Let a
And
form a two-dimensional space K (2) And will be
Is projected to
And
opened K (2) In space, get
At K (2) Projection vector in space
If it is used
The accuracy requirements of the problem cannot yet be met and we will repeat this process until the m-th time. By adding the m-th basis vector
Let
Form an m-dimensional space K (m) Then will beIs projected to
Opened K (m) In space, getAt K (m) Projection vector in space
Here, the first and second liquid crystal display panels are,
W T is the transposed matrix of W. Then calculating the error
If the precision is required to be delta when dimension is extended to m m If < epsilon is established for the first time, the dimension expansion process is completed. Thus, an available intensity vector of photon beam elements is obtained
Lower partThe accuracy condition of the photon beam element intensity vector is given in detail in the following. By definition, the precision condition is expressed in the form of:
wherein:
is the beam element photon intensity vector, whose vector element I i (m) Is the photon intensity of the ith beam elementThere are n beam elements; d (i, j) is the dose produced by the ith beam element at the jth target zone calculation point when the photon intensity of the ith beam element is one unit; p is a radical of j Is the prescribed dose at the jth target calculation point; w is a j Is the dose weight of the jth target volume calculation point.
In the planning of the inverse radiotherapy proposed by the present invention, the following two constraints are also considered:
(a) Non-negative constraints: i.e. the intensity of any one beam element cannot be smaller than zero, i.e.: i is j ≥0；
(b) Hard constraint conditions: it is meant that for a critical organ, the absorbed dose in any volume element of the organ cannot exceed a predetermined tolerance dose value.
And fifthly, converting the obtained photon beam intensity distribution data, namely the most important technical parameters for implementing intensity modulated irradiation into the operation action of the intensity modulated machine. Aiming at a multi-Leaf Collimator (MLC) and a photon beam intensity Compensator (Compensator) which are implemented to adjust the intensity at present, the photon beam intensity adjusting treatment reverse planning scheme design module of the system has the characteristics of being used for both the multi-Leaf Collimator and the Compensator.
A. For the case of intensity modulated illumination with a multileaf collimator:
the intensity modulated irradiation is carried out by a multi-leaf collimator, and the irradiation process of the photon beam needs to be decomposed into a plurality of times of sub-field irradiation. Multi-leaf collimators are adjustable active beam collimation systems consisting of pairs of collapsible tungsten plates. When the vanes are closed, the beam is absorbed through the tungsten sheet and does not form a radiation on the human body. However, when some of the blades leave the folding line at a certain position, the beam irradiates the human body through the air layer, and the beam passing through the surrounding tungsten plate is absorbed to form an irregular field, as shown in fig. 13. In order to realize intensity modulated irradiation, the positions of the tungsten sheets are different in each irradiation, so that irregular fields with different shapes are formed. Each such irregular portal is referred to as a subfield. According to the method provided by the invention, the effect of the sequential irradiation of a plurality of subfields is similar to the effect of the irradiation of the reversely designed photon beam intensity distribution. The method comprises the following steps:
the intensity distribution of the photon beam, obtained by the inverse design of intensity modulated illumination, is a binary function of the coordinate points on the reference cross-section of the beam, as shown in fig. 11. When intensity modulated irradiation is carried out by using a multi-leaf collimator, the intensity distribution of photon beams is decomposed into isointensity plane curves of different shapes by applying a contour line principle. The method comprises the steps of obtaining the intensity distribution of each beam of photons according to the maximum photon intensity I max For reference, it is divided into N intensity levels. The intersection of the equal-intensity plane corresponding to any one of the intensity levels and the two-dimensional curved surface of the photon beam intensity distribution forms an equal-intensity curve in the equal-intensity plane. Projecting the full iso-intensity profile onto the beam reference cross-section results in N iso-intensity profiles as shown in figure 12. In FIG. 12, the intensity difference between every two adjacent equal intensity lines is Δ, and the maximum photon intensity I max = N Δ. In this way, a continuous distribution of photon beam intensities is converted into a series of equal intensity profile distributions within the reference cross-section of the beam. Each equal intensity curve corresponds to a sub-field, and the blades on two sides of the multi-leaf collimator are adjusted and controlled to enable the shape of the irregular radiation field formed by each sub-field to approach the equal intensity curve to the maximum extent. Then, the human body was irradiated N times in the order of time, each time with an irradiation amount of Δ. The desired therapeutic dose required at the tumor site is obtained. FIG. 13 is a schematic view of the subfields formed by adjusting the tungsten plates on both sides of the multi-leaf collimator.
B. For the case of intensity modulated illumination with a photon beam intensity Compensator (Compensator):
1. after the inverse radiation treatment plan for each patient is made, a set of compensators appropriate for the patient is designed and manufactured for the patient. The set of compensators is machined from a set of lead alloy plates. The processing steps are as follows: for each photon, e.g. the k-th beam, according to the photon intensity distribution of that beam
The thickness of the lead alloy plate compensator can be obtained:
where μ is the absorption coefficient of photons in the lead alloy plate, T (x) i ，y j ) I.e. the thickness distribution, T, of the lead alloy plate compensator 0 Is an adjustable reference thickness which guarantees T min ＝Min[T(x i ，y j )]＞d 0 ，T min Is the thickness of the thinnest part of the compensator. In order to ensure proper strength of the compensator, it should be greater than or equal to a very thin thickness d 0 . When the beam of photons of uniform intensity passes through the plate compensator, its intensity distribution becomes a beam of photons that meets the intensity modulation requirements.
2. Applying a precision milling machine to lead alloy plates according to T (x) i ，y j ) Milling the lead alloy plate to a thickness distribution satisfying the formula T (x) i ，y i ) The compensator is required. In the case of multiple photon irradiation, one such beam compensator is designed and processed as described above for each photon.
(seventh) machine parameters and radiation treatment plan output module:
the machine parameter module of the invention refers to a data interface module established by various medical linear accelerators, cobalt-60 machine related parameters and the radiation therapy planning system. So as to ensure the efficient and rapid design, dose calculation and process control of the radiation treatment plan. The radiation therapy planning output module comprises seven modules of patient data, isodose curve display on any section, semitransparent isodose surface envelope, beam setting and dose prescription, dose volume histogram, optimal intensity modulation scheme for providing inverse planning, preset dose and optimal dose distribution and the like. They are the end product of a radiation treatment plan that physicians and dosimeters use to evaluate and guide them through the radiation treatment plan.
The outstanding contribution of the invention lies in that:
the main and key technologies related to an accurate radiotherapy planning system are independently solved for China: the method comprises conformal radiation therapy and intensity modulated radiation therapy technologies, solves the technical problems of low accuracy and slow calculation speed of traditional photon beam and electron beam dose calculation, develops a high-accuracy algorithm and a fast and accurate intensity modulated optimization method for three-dimensional dose distribution of photon beams and electron beams in non-uniform human body media, and greatly improves the accuracy of dose delivery to a tumor target area in a patient. Meanwhile, the technology of converting the photon beam intensity distribution data into the motion parameters of the leaves of the multi-leaf collimator and the technology of determining the thickness of the lead alloy plate compensator meeting the intensity modulation requirement are solved, so that the advanced technology of conformal and intensity modulation radiotherapy in clinic becomes a reality, and the contribution is made to the improvement of the curative effect of the radiotherapy and the improvement of the life quality of patients.
Drawings
FIG. 1 is a flow chart of a radiation design for precision radiation therapy.
Fig. 2 is a projection coordinate system and a marker image.
FIG. 3 is a flow chart for drawing a projected line segment.
Fig. 4 shows a marked image after drawing a line.
FIG. 5 is a diagram of directional chain codes.
Fig. 6 is a schematic diagram of a process of tracking a search contour.
Fig. 7 is a projection profile.
FIG. 8 is a schematic diagram of irregular field discretization.
Fig. 9 is an intensity matrix formed after discretization of an irregular field.
Fig. 10 is a schematic view of a skin having a curved surface.
Fig. 11 is a schematic view of the intensity distribution of a photon beam.
Fig. 12 is a schematic illustration of an iso-intensity curve of the intensity distribution of a photon beam made in a reference cross-section.
FIG. 13 is a schematic view of the subfields formed by a multi-leaf collimator.
FIG. 14 shows CT data of nasopharyngeal carcinoma patients displayed on a computer interface.
FIG. 15 is a perspective view of a patient's head for reconstruction of nasopharyngeal carcinoma in the patient's head using the three-dimensional reconstruction technique of the present invention.
FIG. 16 is a graph showing the orientation of 7 photons when they are used to perform intensity modulated treatment on a patient.
Fig. 17, 18 and 19 are schematic diagrams of 3 sub-fields formed by the multi-leaf collimator.
FIG. 20 is a photon fluence distribution map of a beam synthesized from the photon fluences of the 3 sub-fields of FIGS. 17, 18, 19.
Fig. 21 is a graph showing a Dose Volume Histogram (DVH) obtained by the intensity modulated treatment plan.
FIG. 22 is a CT image of a patient with superficial cancer.
FIG. 23 illustrates the shape and location of a superficial tumor region using the three-dimensional reconstruction technique of the present invention.
Fig. 24 shows a conformal irradiation of a superficial tumor with 3 18MeV electron beams.
Fig. 25 is a graph showing the isodose line distribution given by an electron beam conformal radiation therapy plan.
FIG. 26 is a comparison of the computational efficiency of several international electron beam advanced algorithms and a hybrid pencil beam model algorithm based on a double-cluster model.
In these figures:
fig. 8 illustrates that since the conformal illumination field is an irregular field, it needs to be discretized into a series of photon beamlets that are all rectangular or triangular in cross-section.
Fig. 14 is a diagram showing the anatomical structure of the head formed after DICOM 3.0 is inputted into the computer; using this technique, medical personnel can delineate on a computer interface tumor areas (GTV, purple), clinical target areas (CTV, blue), and vital organs such as parotid (orange and yellow lines), brainstem (green), eyes (pale green and yellow). The right diagram of fig. 14 shows the function of processing multiple CT slices simultaneously.
FIG. 15 is a three-dimensional reconstruction technique using the system of the present invention to reconstruct a three-dimensional representation of the nasopharyngeal carcinoma of the head of a patient. The clinical target area (CTV) is shown in line boxes and the tumor area (GTV) is shown as a purple-red solid. Spatial containment of the CTV with the GTV can be observed. The shape and location of the eyeball, parotid gland and brainstem are also shown.
FIG. 16 is an illustration of the application of 7 beams of photons to a patient for intensity modulated treatment, showing the orientation of the illumination of the 7 beams of photons as a pale yellow color, with the patient's head in the middle.
FIG. 20 is a graph of a beam of photon fluence distribution formed by the photon fluence of 3 sub-fields; the top layer region in the figure represents the high fluence region, the middle layer region represents the medium fluence region, and the bottom layer represents the low fluence region.
As can be seen in fig. 21, the intensity modulated treatment plan ensured that the dose in 95% of the tumor volume was greater than the 95% of the prescribed dose, while the eye, parotid gland, and brainstem received considerably lower doses.
FIG. 22 shows a CT image of a superficial cancer patient, the red region is the tumor region delineated by the doctor, and FIG. 22 shows a set of CT images of a superficial cancer patient.
FIG. 23 shows the shape and position of a superficial tumor region with a red tumor site using the three-dimensional reconstruction technique of the present system.
Fig. 24 is a schematic representation of 3 18MeV electron beams arranged for conformal irradiation of a superficial tumor, with the outer yellowish portion being the beam.
In fig. 25, the red coil region is a 95% electron beam prescription dose region, the green coil region is an 80% electron beam prescription dose region, the blue coil region is a 50% electron beam prescription dose region, and the yellow coil region is a 20% electron beam prescription dose region. It can be seen from the figure that the 80% electron beam prescribed dose area better encloses the tumor area.
The partial graph (1) of fig. 26 gives a comparison of the calculation times of the algorithms for calculating the three-dimensional dose distribution of the electron beam using the algorithms PBRA, VMC, HPBM, PSE. The electron beam has a nominal energy of 20MeV (21 MeV for the case of Phase Space Evolution (PSE)). The computation time is normalized to: CPU working frequency is 133MHz, radiation field is 15cm multiplied by 15cm, and voxel size is 0.5cm multiplied by 0.5cm. Except for the example of the discretized pencil beam model (PBRA), this is a non-homogeneous medium. The calculation accuracy of each example is approximately the same, and the equal dose distribution on the central plane is shown in the partial graph (2) and the partial graph (3) of fig. 26.
The left diagram of the partial diagram (2) of fig. 26 is a calculation result of an algorithm PBRA (discretized pencil beam model algorithm); the right diagram of the partial diagram (2) of fig. 26 is a calculation result of the algorithm VMC (simplified monte carlo method); the left diagram of the partial diagram (3) of fig. 26 is a calculation result of the algorithm HPBM (a mixed pencil beam model algorithm based on the two-cluster model); the right diagram of the partial diagram (3) of fig. 26 is the calculation result of the algorithm PSE (phase space evolution algorithm).
Detailed Description
An example of performing precise radiation therapy of a tumor.
The apparatus required to deliver conformal and intensity modulated radiation therapy includes: the system comprises a CT machine, a medical accelerator (outputting an electron beam or an electron beam) or a cobalt 60 machine (outputting an electron beam), a three-dimensional radiotherapy planning system, a multi-blade collimator, a three-dimensional automatic water model containing a support capable of flexibly moving in water, a scanner, a small ionization chamber with a waterproof function, a simulator, a human body positioning bed or a human head positioning support, wherein the small ionization chamber is arranged on the water model moving support.
Example 1: a process for intensity modulated radiation therapy planning of a patient using a photon beam.
The first step is as follows: CT data of the patient is input. After correcting a plurality of CT films, an automatic and semi-automatic delineation method is used to rapidly construct the three-dimensional display of human body and organs, and doctors delineate the range of tumor and vital organs by using the software tool of the system. Fig. 14 shows a CT image and a range of a target region outlined by a doctor. Figure 15 is a perspective view of a patient's head reconstructed in three dimensions.
The second step is that: the beam is set. The energy and number of photon beams, and the direction of incidence of each photon beam (determined by the gantry angle, the handpiece angle) are first selected from the computer interface. For intensity modulated therapy, a larger number of photon beams is usually chosen in order to achieve a better dose distribution. In this case the physician has selected seven photons and the orientation of these 7 photons is shown in FIG. 16.
The third step: and making a photon beam reverse treatment plan. After the physician gives the prescribed dose to the target and nearby organs, the inverse planning method invented in the present system can be applied to obtain the photon intensity distribution map (i.e. photon fluence map) of each beam of photons on the reference plane, and fig. 17, 18 and 19 are schematic diagrams of 3 subfields formed by the leaves of the multi-leaf collimator, respectively.
The fourth step: according to the photon fluence map, obtaining instruction information such as the number of sub-fields of the multi-She Zhunzhi device and the position parameter of each sub-field blade required by each beam of photons when realizing the reverse plan, wherein fig. 20 is a schematic diagram of the distribution of a beam of photons synthesized by the photon intensities of 3 sub-fields; this also indicates that the intensity distribution of a beam of photons can be decomposed into intensity distributions of several sub-fields.
The fifth step: and verifying the correctness and the precision of the reverse plan. The three-dimensional phantom (or water model) is placed at a corresponding position of a medical accelerator treatment bed (for example, the center of a detector of the phantom or the water model is required to be coincident with the isocenter of the medical accelerator). And calling a three-dimensional photon beam dose calculation module by using the obtained subfield number and subfield blade position parameter instruction information of each photon beam, calculating the dose distribution of the photon beam generated in the phantom (or water model), comparing the dose distribution with the actually measured dose data of corresponding points in the phantom (or water model) under the same irradiation condition, and if the dose distribution accords with the actually measured dose data in the phantom (or water model) within the given accuracy, confirming that the intensity modulated treatment plan is correct, further implementing intensity modulated radiation treatment on the patient, otherwise, failing to implement the intensity modulated radiation treatment on the patient.
And a sixth step: for cases where an intensity modulated radiation treatment plan can be implemented, the necessary parameters for the treatment plan and the primary results of the evaluation plan are output. The method comprises the steps of beam energy, the number and the direction of beams, a photon intensity graph of the beams, the number of sub-fields of a multi-leaf collimator corresponding to each photon beam, the position parameter of each leaf in the sub-fields, the irradiation time (or the hop count) of each sub-field, the dose distribution, the isodose line distribution, the Dose Volume Histogram (DVH) and the like of all the photon beams in a patient body, and then a medical accelerator is applied to carry out intensity modulated radiation treatment according to a reverse treatment plan after the patient is well positioned on a treatment couch. Fig. 21 is a DVH histogram of the dose distribution of the present intensity modulated illumination scheme.
Example 2: a process for conformal radiation therapy of a patient using an electron beam. The method comprises the following steps:
the first step is as follows: CT data of the patient is input. After the multiple CT films are corrected, the three-dimensional display of human body and organs can be quickly constructed by using automatic and semi-automatic sketching methods. The physician uses the software tools of the system to delineate the tumor and the critical organs. FIG. 22 is a display of a CT slice and a range of target areas delineated by a physician. Fig. 23 is a perspective display of a three-dimensional reconstruction.
The second step is that: the beam is set. The energy and number of the electron beams and the direction of incidence are selected. In this case the physician has selected three electron beams. Fig. 24 shows the direction of incidence of 3 18MeV electron beams for conformal irradiation of a superficial tumor.
The third step: and calling an electron beam dose calculation module to calculate the dose distribution of each electron beam in the patient. The irradiation time (hop count) ratio of different electron beams is adjusted to obtain a satisfactory electron beam conformal irradiation plan. Fig. 25 shows the isodose line distribution given by an electron beam conformal radiation therapy plan. It can be seen that the 95% electron beam prescribed dose area better encloses the tumor area.
The fourth step: the patient is placed in the appropriate position on the simulator, and the electron beam irradiation plan is examined and verified.
The fifth step: and outputting the electron beam conformal irradiation treatment plan. Including beam energy, number and direction of beams, collimator shape for each beam, irradiation time (or hop count) for each beam, and dose distribution of all beams in the patient, isodose line distribution, dose Volume Histogram (DVH), etc.
And a sixth step: the medical accelerator is used to receive the electron beam adaptive irradiation plan to implement the electron beam radiation therapy after the patient is well positioned on the treatment couch.
The invention has the prominent effects that: the applicant has developed the first three-dimensional conformal and intensity modulated radiation therapy planning system (i.e., FONICS system or phoenix system) with proprietary intellectual property rights in our country according to the present invention, which is a large software consisting of 2668 documents, 2 thousand 5 million bytes and 80 ten thousand lines of source programs. Through strict test and clinical verification of the system, the system achieves the following indexes:
1) The photon beam dose calculation accuracy was compared to standard measurements published by the American Association of Physics in Medicine (AAPM):
a. the test conditions used were:
the accelerator energies are: 4MV, 18MV;
medium: water molds, heterogeneous media, such as bones, cavities;
field shape: rectangular portal, irregular portal;
ray direction: vertical incidence and oblique incidence;
wedge filter, dog.
b. Maximum error of comparison results: the central axis dosage is less than 2.4 percent, the beam internal dosage is less than 2.9 percent, the beam external dosage is less than 2.2 percent, and the radiation field width is less than 0.58cm. The photon beam dose calculation error of the general commercial radiotherapy planning system is less than 5 percent, and the product is qualified. The above comparison results show that the photon beam dose calculation accuracy of the radiation therapy planning system of the present invention is international.
2) Comparison of the electron beam dose calculation accuracy with internationally recognized standard measurements from the U.S. ECWG (a highly qualified medical physicist expert Group of America specializing in examining the electron beam dose calculation accuracy of radiation therapy):
a. the test conditions used were:
the accelerator energies are: 9MeV, 20MeV;
medium: water-jet, non-uniform (bone, cavity);
the field shape: rectangular and irregular fields;
ray direction: normal incidence, oblique incidence.
b. Maximum error of comparison result: the central shaft dosage is less than 3.7%, the internal beam dosage is less than 2.5%, the external beam dosage is less than 3.4%, and the radiation field width is less than 0.62cm. The electron beam dose calculation error of the general commercial radiotherapy planning system is less than 5 percent, and the electron beam dose calculation error is qualified. The above comparison results show that the electron beam dose calculation accuracy of the radiation therapy planning system of the present invention is highly relevant to the country.
3) Compared to international famous products PINNACEL, CADPLAN, PLATO and THERAPLAN: the accuracy indexes of 76 different photon doses are used for comparison, and the accuracy indexes of FONICS of the invention are in the front of the country.
4) The system has a comparison conclusion with an actual measurement value under the clinical conditions of the Beijing hospital of the Ministry of health:
test conditions A: accelerator Varian 23EX, energy 6mv, x-ray; 30 cases: of these, 15 are conformal plans and the other 15 are intensity modulated plans.
B, comparison result: the maximum error of the calculated accelerator output jump number (MU) is less than 3% compared with the CADPLAN product of the international name brand, the maximum error of the target spot dosage calculation is less than 2.6% compared with the measured value, the average dosage deviation is less than 1.5%, and the calculated accelerator output jump number is in the international front.
The above findings were also supported by the results of clinical validation in the tumor hospital of Sichuan province, the people hospital of Shanxi province and the liberated military 107 hospital.
5) In the Beijing hospital clinical test, the strength-regulating technology of the invention is compared with a CADPLAN planning system of VARIAN (International famous product) company to make a strength-regulating reverse plan to show that: the intensity modulation technology of the invention has the precision equivalent to CADPLAN, but the efficiency is improved by about 10 times compared with the latter.
6) CT image information input is accurate, and three-dimensional image reconstruction, display and other functional performances are good:
a) The positioning precision of the target point is less than 1.5mm;
b) The image reconstruction precision is less than 1.5mm;
c) The deviation between the calculated target point dose value and the test value is less than 3 percent.
FIG. 26 shows the comparison of the calculation efficiency of several advanced electron beam algorithms in the world with the mixed pencil beam model algorithm based on the double-cluster model of the present invention:
wherein: the efficiency of the PBRA algorithm to calculate the electron beam dose was 19.6 minutes;
the efficiency of VMC algorithm to calculate electron beam dose is 100 minutes;
the efficiency of PSE algorithm to calculate electron beam dose is 76.14 minutes;
the efficiency of the HPBM (mixed beam model) algorithm to calculate the electron beam dose was 1.28 minutes.
Therefore, the successful development of the accurate radiation therapy planning system (the phoenix system) is a breakthrough development of the advanced medical equipment industry in China. The method is combined with the existing domestic medical accelerator industry, so that a complete industrial chain of the precise radiotherapy equipment in China can be formed, and the replacement of the radiotherapy industry in China from the conventional industry to the precise radiotherapy industry is realized.
Claims (6)
1. An accurate radiation therapy planning system, comprising: the device comprises a three-dimensional medical image reconstruction module for reproducing human organs and tumor target areas, a high-precision photon beam three-dimensional dose calculation module, a high-precision electron beam three-dimensional dose calculation module, a photon beam and electron beam conventional irradiation scheme design module, a photon beam and electron beam conformal irradiation scheme design module, a photon beam intensity modulation treatment reverse planning scheme design module and a machine parameter and radiotherapy plan output module, and is characterized in that:
a) The three-dimensional medical image reconstruction module for reproducing the human organ and the tumor target area mainly comprises the steps of carrying out sectional image segmentation on a CT scanning image; generating a reconstructed three-dimensional medical image of the tumor target region and the critical organ by three-dimensional reconstruction based on the slice-level surface;
b) The high-precision photon beam three-dimensional dose calculation module mainly comprises the following steps of determining the dose of a photon beam at each point in a human body with high precision:
the first step is as follows: discretizing the photon beam into a series of micro-beam photons with micro-rectangular cross sections;
the second step is that: for each micro-beam photon, applying a photon pencil beam model based on a characteristic line algorithm to calculate the dose generated by the photon pencil beam model at each space point in the human body;
the third step: the influence of the photon beam energy spectrum of the medical accelerator on the calculation of the point microbeam photon dose is taken into account, and the point dose is corrected;
the fourth step: calculating the influence of the density of the human body on the photon dose of the computed point microbeam, and correcting the dose of the point;
the fifth step: the influence of the skin surface curvature on the calculation of the point microbeam photon dose is taken into account, and the point dose is corrected;
and a sixth step: determining the dose of all micro-beam photons in a photon beam at the calculation point;
the seventh step: determining the dose of all photon beams generated at the calculation point;
c) The high-precision electron beam three-dimensional dose calculation module is used for determining the three-dimensional dose distribution generated by an electron beam in a human body with high precision, and comprises the following steps:
the first step is as follows: discretizing the electron beam into a series of micro-beam electrons with micro-rectangular cross sections;
the second step is that: calculating the dose of the micro-beam electrons generated at each point of the human body by applying a mixed electron beam model;
the third step: correcting the dosage of the calculation point by using an electron beam energy spectrum of a medical accelerator;
the fourth step: correcting the microbeam electron dose of the calculation point by taking the skin surface flexibility into account;
the fifth step: calculating the three-dimensional dose distribution of the electron beams in the irradiated human body after accounting for the influence of an electron beam energy spectrum, the human body surface curvature and an intensity matrix (non-regular radiation field) of the electron beams;
and a sixth step: under the condition of multi-beam electronic conformal irradiation, calculating the dose of all electron beams generated at each space point in the human body to obtain the dose distribution generated in the human body by the multi-beam electronic conformal irradiation:
d) A photon beam and electron beam conformal irradiation scheme design module, comprising the steps of:
the first step is as follows: acquiring the human body density matrix information of the irradiated patient;
the second step is that: acquiring machine parameter data of the medical accelerator related to the photon beam or the electron beam;
the third step: completing a conformal irradiation design of a photon beam or electron beam irradiation field, comprising:
(1) determining a projection area of a section of the photon beam or the electron beam at the outlet of the accelerator to the tumor;
(2) determining the shape and size of the conformal irradiation field according to the projection area;
(3) arranging tungsten sheets or lead baffles of the multi-leaf collimator to shield areas outside the conformal irradiation field;
(4) the dose distribution of the conformal irradiation field in the tumor region of the patient is accurately calculated: calling a high-precision photon beam three-dimensional dose calculation module for photon beam irradiation, calculating three-dimensional dose distribution of photon beams in a human body, calling a high-precision electron beam three-dimensional dose calculation module for electron beam irradiation, and calculating three-dimensional dose distribution of electron beams in the human body;
(5) adjusting and controlling the accelerator according to the calculated accurate dose, so that the beam emitted from the accelerator directly irradiates in the tumor region;
the fourth step: calculating the dose of photon beam or electron beam conformal radiation therapy;
e) The reverse planning scheme design module of photon beam intensity modulation treatment mainly comprises the following contents:
step one, setting a photon beam: setting the number of photon beam beams, determining a beam direction for each photon beam, dividing the radiation field on a reference cross section into a plurality of micro-beam photons, dividing the tumor area and nearby critical organs into a plurality of volume elements, and determining the total number of all spatial points and the position coordinates thereof, wherein the dose is to be calculated;
secondly, calling a high-precision photon beam three-dimensional dose calculation module, applying a photon pen beam model based on a characteristic line algorithm, calculating a photon beam element with unit intensity of mark I, calculating the dose d (I, j) generated at a calculation point with mark j on a target area or an organ to be treated, and calculating the dose d (I, j) multiplied by I (I) generated at the calculation point j when the intensity of the photon beam element I is I (I);
third, assuming the intensity of each photon beam element is I (I), the above process is repeated to calculate the dose produced by all the beam elements of the entire photon beam at the target or calculated point of the critical organ labeled jThen calculating all photon beams one by one for all calculated points of the target area and critical organsThe dose of all beam elements at each calculation point;
fourthly, according to the prescribed dose determined by the doctor on the target area and the tolerance dose on the critical organ, the intensity of all photon beam elements is required to be designed, so that the calculated dose on all the calculation points of the target area and the critical organ just provides the prescribed dose p (j) which the doctor wants to assign; by applying the K space projection operator algorithm provided by the invention, the key problem is solved efficiently and accurately, and the intensity distribution data of photon beams is obtained.
Fifthly, after the intensity distribution data of the photon beam is obtained, the photon beam intensity distribution data is converted into the motion parameters of the leaves of the multi-leaf collimator for carrying out intensity modulated radiation therapy, or a group of compensators which can meet the requirements of intensity modulated radiation therapy of patients and are made of lead alloy plates are designed according to the data.
2. The accurate radiation treatment planning system of claim 1, wherein: the method for segmenting the CT scanning image comprises the following steps:
firstly, determining the resolution of a reference tomographic image according to the length actually represented by a scale and corresponding pixel coordinates of two end points on a scanned image;
secondly, selecting a tomogram to be segmented by using a rectangular frame on the reference tomogram;
thirdly, using the end point of the scale on the reference tomographic image as a reference point, and locking the relative position relation between the rectangular frame and the scale reference point;
fourthly, determining the resolution of other tomographic images according to the method of the first step, dividing the resolution of the reference tomographic image by the resolution of the other tomographic images to obtain a scaling ratio, and scaling the other tomographic images according to the scaling ratio to keep the scaling ratio of the other tomographic images consistent with the scaling ratio of the reference tomographic image;
fifthly, determining the position of the rectangular frame on other tomograms by taking the scale end points on other tomograms corresponding to the reference points on the reference tomograms as the reference points according to the relative position relation between the locked rectangular frame and the scale reference points determined in the third step, wherein the area surrounded by the rectangular frame is a tomogram needing to be segmented;
and sixthly, repeating the fourth step and the fifth step until all other sectional images are segmented one by one.
3. An accurate radiation treatment planning system according to claim 1, wherein: the generation of the reconstructed three-dimensional medical image of the tumor target area and the critical organs by the surface three-dimensional reconstruction technology based on the slice level is carried out according to the following steps:
firstly, extracting contour lines of human organs and tumor target areas distributed on each tomographic image of CT;
secondly, matching contour points of contour lines extracted from all fault positions of the CT to construct triangular plates;
and thirdly, fitting the triangular plates into the outer surfaces of corresponding organs and tumor entities by taking the triangular plates as units so as to obtain a reconstructed three-dimensional morphological entity of the human organ and the tumor target area.
4. The accurate radiation treatment planning system of claim 1, wherein: in the conformal irradiation design of photon beam or electron beam irradiation field, the projection contour line method of field conformal irradiation for determining the projection area of the beam section of tumor at the exit of accelerator includes the following main steps:
1) Calling a three-dimensional medical image reconstruction module for reproducing the human organ and the tumor target area, and constructing a three-dimensional structure of the human organ and the tumor target area which are formed by taking a triangular plate as a unit;
2) Establishing an orthogonal projection coordinate system by taking a connecting line of an isocenter point and a beam origin of the medical accelerator as a Z axis and taking a plane passing through the isocenter and perpendicular to the Z axis as a projection plane;
3) Projecting the solid envelope of a three-dimensional tumor target region constructed by taking a triangular plate as a unit on an XOY plane of a projection coordinate system by using a photon beam or an electron beam at an outlet of an accelerator to obtain a maximum-surrounded rectangular region, and establishing a marked image which is adaptive to the size of the rectangular region;
4) Drawing a projection line segment of each side of a triangular plate for constructing a three-dimensional tumor target area entity on a marked image, projecting two vertexes of the triangular side to an XOY plane to obtain two end points of the projection line segment, then mapping the two end points to the marked image and drawing a line to obtain a two-dimensional marked image of the tumor target area, and drawing a region formed by marked image pixels, namely a projection region corresponding to a three-dimensional anatomical structure of the tumor target area, wherein the outermost edge of the projection line segment is a projection contour line of the tumor target area, and a projection contour line surrounding region of the tumor target area is a beam at an accelerator outlet to tumor irradiation region;
5) Projecting the contour line on the obtained projection plane onto a reference plane at the beam outlet of the accelerator to obtain the contour line on the reference plane, and setting the positions of the multiple She Zhunzhi device blades and completing the design of a lead block according to the shape of the contour line on the reference plane so that the shape of the cross section of the photon or electron beam passing through the multi-blade collimator or the lead block is exactly matched with the projection contour line of the beam direction on the tumor target area.
5. The accurate radiation treatment planning system of claim 1, wherein: in the planning of the inverse plan of the photon beam intensity modulation treatment, the obtained photon beam intensity distribution data is converted into the motion parameters of the leaves of the multi-leaf collimator for carrying out the intensity modulation radiotherapy, and the method comprises the following steps:
applying contour line principle to the intensity distribution of each beam of photons according to the maximum photon intensity I max Dividing the image into N equal-strength layers for reference, and drawing equal-strength curve graphs in reference planes, wherein each two adjacent circles of equal-strength curves areThe intensity difference is Delta, the maximum photon intensity I max N Δ, so that the continuous distribution of photon beam intensities is transformed into a distribution of discrete equal intensity layers in a two-dimensional reference plane, the equal intensity curve of each layer of photon beams corresponds to an irregular field formed by the multi-leaf collimator, called a sub-field, and each sub-field either passes the photon beam with the intensity Δ or cannot pass the photon beam, so that the sub-fields with different shapes can be formed by adjusting and controlling the leaves at the two sides of the multi-leaf collimator at the exit of the accelerator, and the photon beam is irradiated to each sub-field once after N times of irradiation in a certain sequence, and the photon with the intensity Δ passes through the sub-fields. After the photon beam irradiates through N sub-fields with different shapes, the synthesized dose distribution in the tumor area is very close to the prescription dose designed by a doctor.
6. The accurate radiation treatment planning system of claim 1, wherein: in the reverse planning scheme design of the photon beam intensity modulation treatment, the obtained photon beam intensity distribution data is converted into the lead alloy plate compensator designed for the patient to carry out intensity modulation radiotherapy, and the method comprises the following steps:
first, for each photon k, according to its photon intensity distribution
Obtaining the thickness of the lead alloy plate compensator:
where μ is the absorption coefficient of photons in the lead alloy plate, T (x) i ，y j ) Is the thickness of the lead alloy plate compensatorCloth, T 0 Is an adjustable reference thickness which guarantees T min ＝Min[T(x i ，y j )]＞d 0 ，T min Is the thickness of the thinnest part of the compensator, and T is used for ensuring the proper strength of the compensator min Should be greater than or equal to a very thin thickness d 0 When uniform in strengthAfter passing through the lead plate compensator, the intensity distribution of the photon beam is changed into a photon beam meeting the intensity modulation requirement;
secondly, using a precision milling machine to obtain a lead alloy plate according to the T (x) i ，y j ) Milling the lead alloy plate to a thickness distribution satisfying the formula T (x) i ，y j ) A required compensator; in the case of multiple photon irradiation, one such beam compensator is designed and fabricated as described above for each photon beam.
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