CN107743409B - 剂量规划系统 - Google Patents
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Abstract
本发明的目的是改进处置规划。该目的通过剂量规划系统来实现，所述剂量规划系统包括活检图创建模块，所述活检图创建模块被配置用于接收针对感兴趣器官的活检信息，所述活检信息涉及活检位置以及所述活检位置处发现的组织的组织特性，其中，所述活检图创建模块还被配置用于通过将关于所述活检位置的空间信息与在对应的活检位置处发现的组织的所述组织特性链接来创建针对所述器官的空间地注释的活检图。所述剂量规划系统还包括：概率图计算模块，其被配置用于通过使用来自所述活检位置的肿瘤特性和/或组织特性计算针对所述器官中的未从其采取活检的位置的肿瘤概率来创建肿瘤概率图；以及剂量规划模块，其被配置用于基于所述肿瘤概率图来创建剂量计划，其中，规划约束使得平均较高肿瘤概率实现较高规划剂量，并且平均较低肿瘤概率实现较低规划剂量。
Description
技术领域
本发明涉及一种用于对器官的患病组织进行治疗处置的剂量规划系统，并且更具体地，本发明涉及一种用于肿瘤学领域中的处置的剂量规划系统。
背景技术
癌症患者中的肿瘤的处置可以使用若干方法来执行，所述方法的范围从诸如近距离放射治疗的微创方法到包含肿瘤的整个器官被移除的手术方法。由于早期检测和筛查的改进以及潜在地降低的副作用，较小侵入性的局灶性治疗越来越受欢迎。
从癌症诊断到处置的工作流程包括几个阶段。通常在诊断阶段期间执行活检以评估肿瘤类型并提供关于癌症范围的评分。活检通常在多个位置进行，并且总体评分被生成。若干方法被用于产生该总体评分：
1、每核的癌症的毫米数
2、所有核间的癌症的总毫米数
3、每核的癌症的百分比
4、整个标本中癌症的总百分比
5、阳性核的数量
6、阳性核的分数(阳性核的数量和总核的数量)
US 7831293B2描述了一种定义用于处置的生物学目标的方法。该文献描述了一种方法，其中，可检测标记留在活检位置处。该标记用于将组织病理学数据与功能成像相关联。由于用于产生肿瘤处置计划的数据集可以区分和分辨目标组织不同区域的特定病理学和肿瘤进展或侵袭性，因此处置计划可以用于将治疗以不同的强度引导到分立的生物目标体积组织的不同区域。针对肿瘤的病理学定义的点与功能研究(例如，MRSI、SPECT、PET或光学活检)相关，使得功能图像上的阳性发现可以充当针对已知疾病部位的已知标记。如果功能研究能够检测迄今为止的隐匿性肿瘤病灶的这些区，那么在功能研究上示出活动的其他区可以被视为表示额外的隐匿性肿瘤病灶，从而被用于定义用于处置的生物学目标体积。
发明内容
本发明的目的是改进处置规划。该目的通过用于对感兴趣器官的患病组织进行治疗处置的剂量规划系统来实现，所述剂量规划系统包括：
-活检图创建模块，其被配置用于接收针对感兴趣器官的活检信息，所述活检信息涉及活检位置以及所述活检位置处发现的组织的组织特性，其中，所述活检图创建模块还被配置用于通过将关于所述活检位置的空间信息与对应的活检位置处发现的组织的所述组织特性链接来创建针对所述器官的空间地注释的活检图，
-概率图计算模块，其被配置用于通过使用来自所述活检位置的肿瘤特性和/或组织特性计算针对所述器官中的未从其采取活检的位置的肿瘤概率来创建肿瘤概率图，以及
-剂量规划模块，其被配置用于基于所述肿瘤概率图来创建剂量计划，其中，规划约束使得针对具有平均较高肿瘤概率的区，较高规划剂量被规划，并且针对具有平均较低肿瘤概率的区，较低规划剂量被规划。
目前在辐射处置中存在两个重要挑战。首先是肿瘤组织的精确划定可能是复杂的。基于医学图像，由不同观察者所做的划定之间存在许多变化。此外，正确的剂量的确定能够是具有挑战性的。已经提出基于肿瘤侵袭性来改变肿瘤内的剂量以增加肿瘤控制概率并减少副作用。然而，这种所谓的数字剂量绘制方法总是依赖于组织的(功能)成像(例如PET、扩散加权MRI、动态对比增强MRI)。发明人认识到，这些成像技术仅提供肿瘤概率和肿瘤侵袭性的间接度量。因此，通过直接使用活检结果来计算肿瘤概率图(其继而是剂量规划模块的输入)，可以改进处置计划。肿瘤概率图可以是提供估计的肿瘤存在几率的空间分布的图。其也可以提供关于预期的肿瘤细胞密度或侵袭性水平(例如，在前列腺癌情况下的Gleason评分)的空间分布。
根据本发明的实施例，剂量规划系统还包括图像引导的活检系统，所述图像引导的活检系统被配置用于从所述器官中的预定位置采取活检，并且还被配置用于向所述活检图创建模块提供关于所述活检位置的至少空间信息。该实施例是有利的，因为其可以帮助改进肿瘤处置工作流程。可以执行靶向活检，并基于活检的组织病理学分析，可以直接创建活检图，所述活检图然后可以用于计算概率图和剂量计划。该计划可以直接用于处置。图像引导可以例如借助于超声或磁共振成像来提供。
根据本发明的另一实施例，图像引导的活检系统包括光子针。对由光子探针检索的光谱的自动分析还将加速诊断到处置过程。
根据本发明的另一实施例，图像引导的活检系统包括配准模块，所述配准模块被配置为将由超声系统采集的所述器官的图像与借助于第二成像模态采集的所述器官的图像配准，其中，所述活检位置是至少部分地基于由第二医学图像系统采集的图像确定的。该实施例是有利的，因为尽管超声波对于图像引导能够是非常好的，但在某些情况下，如例如对于前列腺癌，超声可能不是确定包含可疑组织的位置的选择的成像模态。在这些情况下，可以基于利用不同的成像模态(例如，如MRI、PET、SPECT、(对比增强)CT)采集的图像来确定可疑的组织位置。在图像配准之后，通过由第二医学图像系统采集的图像发现的可疑位置可以被转化到超声坐标系。
剂量规划系统可以被配置用于创建针对以下项中的一项的剂量规划：放射治疗、质子治疗、冷冻治疗、射频消融、激光消融或高强度聚焦超声处置。
参考下文描述的实施例，本发明的这些和其它方面将变得显而易见并得到阐述。
附图说明
图1示出了根据本发明的剂量规划系统，并且
图2示出了肿瘤概率图的范例，并且
图3示出了对应于图2的肿瘤概率图的剂量计划。
具体实施方式
图1示出了根据本发明的剂量规划系统10。剂量规划系统包括活检图创建模块13、概率图计算模块14和剂量规划模块15。使用本发明的剂量规划工作流程可以从感兴趣的器官的图像的采集11开始，基于所述图像，可以识别器官内的可疑位置。也可以识别非可疑位置。这些图像可以例如是磁共振(MR)图像。MR图像可以被提供给配准模块12。在活检流程期间，图像引导的活检系统102可以借助于超声系统101来采集用于活检引导的超声图像。超声图像中的至少一幅被提供给配准模块12。配准模块然后将超声图像与MR图像配准，使得所识别的器官的可疑位置和非可疑位置可以被转化到超声系统101的成像坐标系。系统的操作者然后可以将光子针100引导到识别的位置以在组织17上进行组织病理学分析。
备选地，活检可以被采取并传送到病理科以进行分析。组织分析得到如肿瘤细胞密度、肿瘤细胞百分比、肿瘤侵袭性等的组织特性。从活检组织17和活检位置16确定的组织特性被提供到活检图创建模块13，所述活检图创建模块通过将活检位置链接到对应的组织特性来创建活检图。
活检图用作针对概率图计算模块14的输入，概率图计算模块14使用所述活检图来计算肿瘤概率图18。此处，线103围绕一区，其中，肿瘤概率超过特定阈值。概率图计算模块14可以被配置用于基于内插或肿瘤形状模型来创建肿瘤概率图18。内插可能是有利的，因为该方法不需要关于肿瘤形状的先验知识。
肿瘤形状模型可利用关于肿瘤扩散的可用统计信息，其与例如肿瘤细胞密度、肿瘤侵袭性、DNA突变、DNA表达水平、活检材料中发现的蛋白质水平有关。例如，从以下文献已知肿瘤形状模型：Shen等人的Optimized prostate biopsy via a statistical atlas ofcancer spatial distribution(Medical Image Analysis 8(2004)139-150)。在他们的方法中，他们以实验的方式生成全局概率云，以找到阳性活检发现，并将其用于最优针放置。此处用于本发明的关键项是概率分布，其可以用于对肿瘤概率图进行建模。
描述可以用作输入以生成肿瘤概率图的肿瘤分布的参考文献的其他范例是Menze等人的Image-based modeling of tumour growth in patients with glioma(Optimalcontrol in image processing，Springer，Heidelberg/Germany，2011.hal-00825866)以及Gevertz等人的Simulating tumour growth in confined heterogeneousenvironments(Phys.Biol.5(2008)036010)。也可以收集关于特定位置上的肿瘤存在的可能性的另外的数据，给定另一位置处的阳性或阴性活检样本。
图2示出了肿瘤概率图的范例。图2示出了前列腺204的超声图像。借助于“-”符号202指示已经进行了活检但没有发现肿瘤的位置。已经进行了活检并且在活检样本中发现了肿瘤的位置利用“+”符号203指示。肿瘤概率从位置203朝向线204减小，线204是指示肿瘤概率的特定值(例如95％)的等值线。
将肿瘤概率图提供给剂量规划模块15，剂量规划模块15基于肿瘤概率图创建剂量计划19。图3示出了对应于图2的肿瘤概率图的剂量计划。将由等值线204围绕的区视为总肿瘤体积(GTV)，并且如此规划处置。
备选地，剂量规划模块可以例如借助于放射生物学模型基于肿瘤概率图来创建剂量计划。这些模型通常考虑肿瘤细胞密度，但是它们也可以考虑肿瘤侵袭性或缺氧水平，这些至少影响放射治疗结果，并且可以基于例如HIF-1水平来确定。这些值可以从活检样本获得并且用在肿瘤概率图中。辐射剂量也可以基于内插来确定。备选地，也可以选择向具有高(例如>95％)肿瘤概率的区域应用增强剂量，并将标准剂量应用于具有低至中等肿瘤概率(例如，5-95％)的区域。剂量规划模块还可以被配置为对位于要处置的器官附近的风险器官使用剂量约束。然而，其他范例是可能的，并且本发明不限于所公开的范例。
尽管已经在附图和前面的描述中详细说明和描述了本发明，但是这样的说明和描述被认为是说明性的或示范性的而非限制性的；本发明不限于所公开的实施例，并且可以用于疾病处置领域中的剂量规划。
Claims (10)
1.一种用于对感兴趣器官的患病组织进行治疗处置的剂量规划系统，包括：
活检图创建模块，其被配置用于接收针对感兴趣器官的活检信息，所述活检信息涉及活检位置以及在所述活检位置处发现的组织的组织特性，其中，所述活检图创建模块还被配置用于通过将关于所述活检位置的空间信息与在对应的活检位置处发现的组织的所述组织特性链接来创建针对所述器官的空间地注释的活检图，
概率图计算模块，其被配置用于通过使用来自所述活检位置的肿瘤特性和/或组织特性计算针对所述器官中的未从其采取活检的位置的肿瘤概率来创建肿瘤概率图，以及
剂量规划模块，其被配置用于基于所述肿瘤概率图来创建剂量计划，其中，规划约束使得针对具有平均较高肿瘤概率的区规划较高规划剂量，并且针对具有平均较低肿瘤概率的区规划较低规划剂量。
2.根据权利要求1所述的剂量规划系统，其中，所述肿瘤概率图是以下中的一项的空间分布：估计的肿瘤存在几率、预期肿瘤细胞密度或肿瘤侵袭性水平。
3.根据权利要求1或2所述的剂量规划系统，还包括图像引导的活检系统，所述图像引导的活检系统被配置用于从所述器官中的预定位置采取活检，并且还被配置用于向所述活检图创建模块提供关于所述活检位置的至少空间信息。
4.根据权利要求3所述的剂量规划系统，其中，所述图像引导的活检系统包括光子针，其中，所述光子针被配置用于向所述活检图创建模块提供针对所述感兴趣器官的活检信息，所述活检信息涉及活检位置以及在所述活检位置处发现的组织的组织特性。
5.根据权利要求3所述的剂量规划系统，其中，所述图像引导的活检系统包括用于在活检期间的图像引导的超声系统。
6.根据权利要求5所述的剂量规划系统，包括配准模块，所述配准模块被配置为将由所述超声系统采集的所述器官的图像与借助于第二成像模态采集的所述器官的先前的图像进行配准，其中，所述活检位置是至少部分地基于所述先前的图像而确定的。
7.根据权利要求1或2所述的剂量规划系统，其中，所述剂量规划模块还被配置用于创建针对包括以下项的处置的组中的至少一项的剂量计划：近距离放射治疗、质子治疗、冷冻治疗、射频消融、激光消融以及高强度聚焦超声处置。
8.根据权利要求1或2所述的剂量规划系统，其中，所述概率图计算模块被配置用于基于所述活检位置之间的所述肿瘤特性和/或所述组织特性的内插或基于使用所述肿瘤特性和/或所述组织特性作为输入的肿瘤形状模型来创建所述肿瘤概率图。
9.根据权利要求1或2所述的剂量规划系统，其中，所述肿瘤特性是包括以下项的特性的至少一个组：细胞密度、活检样本中的肿瘤的尺寸、每活检样本的肿瘤的百分比或与肿瘤侵袭性有关的度量。
10.根据权利要求1或2所述的剂量规划系统，其中，所述剂量规划模块还被配置为将剂量约束用于被定位于要被处置的所述器官附近的风险器官。
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