CN117679671B - Method and system for reconstructing radiation therapy 4D dose - Google Patents
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Abstract
The invention belongs to the technical field of radiotherapy, and particularly relates to a method, a system and a storage medium for reconstructing a radiation therapy 4D dose. The method comprises the following steps: extracting radiotherapy plan execution information from the plan execution log file, splitting the radiotherapy plan file, regenerating a radiotherapy sub-plan of each motion phase, and performing deformation superposition on the radiotherapy sub-plan dose. The method of the invention is based on the reconstruction of the radiotherapy planning file to obtain the real radiotherapy 4D reconstruction dose under the influence of cardiopulmonary exercise, can obtain the real irradiated dose of a patient and quantitatively evaluate the dosimetry uncertainty caused by cardiopulmonary exercise in radiotherapy, reduces the deviation between the calculated dose and the actual dose, can be used for evaluating the dose precision when various exercise management techniques are adopted to manage the cardiopulmonary exercise of the patient, and has good application prospect.
Description
Technical Field
The invention belongs to the technical field of radiotherapy, and particularly relates to a method, a system and a storage medium for reconstructing a radiation therapy 4D dose.
Background
In radiation therapy, dynamic changes in anatomy within the patient pose challenges to treatment accuracy. For example, head and neck tumor patients may experience cerebrospinal fluid flow, oral motion, swallowing reflex, and movement of the eyeball and tongue; patients with chest and abdomen tumors may be affected by heart beat, respiration, vascular pulsation, diaphragm movement and gastrointestinal motility; treatment of patients with pelvic tumors involves changes in filling of the rectum and bladder. In addition, patients may experience involuntary movements such as coughing or twitching. These movements can cause changes in the anatomy in the body, which in turn affect the radiotherapy dose distribution and ultimately lead to deviations in the dose coverage of the target volume and surrounding tissue.
The heart stereotactic radiotherapy (Cardiac stereotactic body radiotherapy, CSBRT) is an emerging technology for treating refractory arrhythmias, and has significant advantages. The method can effectively overcome the limitations faced by the traditional methods of drug therapy, implanted defibrillators, catheter radio frequency ablation and the like, such as high recurrence rate, serious side effects, insufficient tolerance of patients and the like. CSBRT, the characteristics of noninvasive property, short treatment time and capability of simultaneously treating a plurality of targets, makes the preparation become a potential treatment means. However, during CSBRT treatments, the dose bias from cardiopulmonary exercise is a key challenge. Cardiopulmonary exercise is a complex dynamic process involving not only heart beating but also respiratory exercise, and the combined motion of the two makes radiation treatment of the cardiopulmonary site more susceptible than other sites and results in more severe dose deviation. Therefore, in the application CSBRT of heart disease treatment, special attention must be paid to the effect of cardiopulmonary exercise on the dose distribution, and corresponding strategies should be taken to minimize the dose deviation caused by cardiopulmonary exercise to ensure the accuracy and safety of the treatment.
In the prior art, planning, dose calculation and dose evaluation of radiation therapy typically rely on static three-dimensional CT images, and thus the resulting 3D dose distribution does not accurately reflect the dose changes due to dynamic movement of organs within the patient. Although 4DCT techniques have been used to characterize organ motion, in practice treatment planning, dose calculation and assessment are still based on some fixed phase image or density projection image reconstructed by 4 DCT. This results in a deviation of the calculated dose distribution from the dose actually irradiated to the specific tissue or organ of the patient, whereby the resulting inaccuracy also affects the evaluation of the dosimetry index, limiting the optimization of the treatment plan and the prediction of the treatment effect.
The 4D dose reconstruction is an advanced technique in radiation therapy that takes into account the effect of anatomical changes in the patient's body on the dose distribution during the treatment. By dose accumulation in the time dimension, the 4D dose can more truly reflect dose exposure in dynamic changes of the target region and adjacent normal tissue. Currently, most 4D dose reconstruction methods form the final dose distribution by mapping the 3D dose data to individual respiratory phases and accumulating them. The assumption of this approach is that each respiratory phase completely performs the entire radiotherapy plan, but this is different from the actual situation. In practice, each respiratory phase corresponds to only a fraction of the control points during the execution of the radiotherapy plan, and thus the 4D dose reconstructed in this way may deviate significantly. In order to reconstruct the 4D dose under the influence of cardiopulmonary motion more accurately, the whole radiotherapy procedure should be analyzed and the whole irradiation procedure subdivided by control points. However, there is currently no relevant analysis and processing method, and a 4D dose reconstruction process for dose calculation at control points included in each respiratory phase cannot be achieved.
Disclosure of Invention
Based on the above-described deficiencies of the prior art, the present invention provides a method, system and storage medium for radiotherapy 4D dose reconstruction.
A method of radiation therapy 4D dose reconstruction, comprising the steps of:
Step 1, executing a radiotherapy plan and generating a log file;
step 2, extracting control point information from the log file;
Step 3, according to the control point information and the set conditions, splitting control points of the DICOM-RP plan file according to time sequence, sequentially integrating the control points belonging to the same motion time phase into the same RP file, and creating a radiotherapy sub-plan corresponding to each motion time phase;
Step 4, calculating the dose of the radiotherapy sub-plan of each motion phase obtained in the step 3;
And 5, deforming the dose of the radiotherapy sub-plan of each motion phase to a corresponding reference phase image, and superposing to obtain a reconstructed 4D dose.
Preferably, in step 1, the radiotherapy plan is a cardiac stereotactic radiotherapy plan designed based on an Eclipse treatment planning system on a cardiac motion four-dimensional CT reference phase image and a respiratory motion four-dimensional CT average density projection image, respectively.
Preferably, in step 2, each control point has a time sequence, a duration time and an interval time, and the control point information includes corresponding MLC aperture information and MU value information; the MU value information includes MU weights.
Preferably, the MLC aperture information is represented in MLC leaf coordinates; the MU weight is represented by the weight of the control point MU value to the total MU value of the plan.
Preferably, in step 3, the setting conditions are as follows: the patient movement period is set to be a fixed value T seconds, movement phases are divided into n, the duration of each movement phase is T/n seconds, and a phase which is 0% of the movement period when the medical linear accelerator firstly emits beams is set;
The DICOM-RP plan file is a CSBRT plan file derived from the Eclipse treatment planning system.
Preferably, step 4 specifically includes:
Step 4.1, importing the radiotherapy sub-plans of each motion phase into an Eclipse treatment planning system and correlating the radiotherapy sub-plans to corresponding CT images;
And 4.2, performing dose calculation in the Eclipse treatment planning system by using preset planning parameters.
Preferably, step 5 specifically includes:
Step 5.1, registering each motion phase image and the reference phase image by using a deformation registration algorithm to generate respective spatial deformation displacement vector fields;
Step 5.2, deforming all doses of the radiotherapy sub-plan one by one to corresponding reference time phase images by using a space deformation displacement vector field;
And 5.3, superposing to obtain a reconstructed 4D dose.
Preferably, in step 5, the registration process uses the reference phase image as a registered fixed image and each moving phase image except the reference phase image as a registered floating image.
The invention also provides a system for radiation therapy 4D dose reconstruction, comprising:
the input module is used for inputting data, wherein the input data comprises a log file generated by executing a radiotherapy plan and an original CSBRT plan DICOM-RP file;
a 4D dose reconstruction module for performing the method of radiotherapy 4D dose reconstruction described above;
an output module for outputting the reconstructed 4D dose.
The present invention also provides a computer-readable storage medium having stored thereon: a computer program for implementing a method of radiotherapy 4D dose reconstruction as described above, or a system of radiotherapy 4D dose reconstruction as described above.
The method integrates control points belonging to a specific time phase and calculates corresponding doses based on the data; by registering the deformation of the phase-specific dose and superimposing the dose, the 4D dose distribution caused by cardiac and respiratory motion is reconstructed, respectively. By adopting the method, the invention realizes the following beneficial technical effects: the radiation therapy 4D dose under the influence of cardiopulmonary exercise can be accurately reconstructed, so that the real irradiated dose of a patient in the radiation therapy process can be accurately estimated in an individuation mode, and the occurrence probability of potential radiotherapy complications is reduced as much as possible while the tumor control rate is ensured.
Furthermore, the method can be used to evaluate the effects of various physiological movements, including cardiopulmonary movements, on dose distribution, as well as the effectiveness of different movement management techniques in controlling these dosimetry effects. The method provides an important reference for the patient to select a proper motion management technology, and is finally beneficial to improving the radiotherapy curative effect of the tumor patient and improving the radiotherapy benefit of the patient. Therefore, the invention has good application prospect.
It should be apparent that, in light of the foregoing, various modifications, substitutions and alterations can be made herein without departing from the spirit and scope of the invention as defined by the appended claims.
The above-described aspects of the present invention will be described in further detail below with reference to specific embodiments in the form of examples. It should not be understood that the scope of the above subject matter of the present invention is limited to the following examples only. All techniques implemented based on the above description of the invention are within the scope of the invention.
Drawings
Fig. 1 is a schematic flow chart of embodiment 1, wherein T i is the duration of the ith control point, and T i is the interval time between the ith and i+1 control points.
Detailed Description
It should be noted that, in the embodiments, algorithms of steps such as data acquisition, transmission, storage, and processing, which are not specifically described, and hardware structures, circuit connections, and the like, which are not specifically described may be implemented through the disclosure of the prior art.
Example 1A method of radiation therapy 4D dose reconstruction
The method for reconstructing a radiation therapy 4D dose provided in this embodiment is shown in fig. 1, and includes the following steps:
Step 1, the accelerator actually executes the radiotherapy plan and generates a log file.
The radiotherapy plan is a cardiac stereotactic radiotherapy (Cardiacstereotactic body radiotherapy, CSBRT) plan designed based on an Eclipse treatment planning system (TREATMENT PLANNING SYSTEM, TPS) on a cardiac motion four-dimensional CT reference phase image and a respiratory motion four-dimensional CT mean density projection image, respectively.
And 2, extracting control point information from the log file.
Each control point has time sequence, duration and interval time, and the control point information comprises corresponding Multi-leaf collimator (Multi-leaf Collimator, MLC) aperture information and accelerator unit (MU) value information; the MU value information includes MU weights. The MLC aperture information is represented by MLC leaf coordinates; the MU weight is represented by the weight of the control point MU value to the total MU value of the plan.
And step 3, splitting control points of the DICOM-RP plan file according to the control point information and the set conditions according to time sequence, sequentially integrating the control points belonging to the same motion time phase into the same RP file, and creating a radiotherapy sub-plan corresponding to each motion time phase.
Wherein, the setting conditions are as follows: the patient movement period is set to be a fixed value T seconds, movement phases are divided into n from 0% phase to (n-1)% phase, the duration of each movement phase is T/n seconds, and the phase which is in 0% of the movement period when the medical linear accelerator firstly emits beams is set. The DICOM-RP plan file is a CSBRT plan file derived from the Eclipse treatment planning system.
And 4, calculating the dose of the radiotherapy sub-plan of each motion phase obtained in the step 3.
Specifically, step 4 includes the following steps:
Step 4.1, importing the radiotherapy sub-plans of each motion phase into an Eclipse treatment planning system and correlating the radiotherapy sub-plans to corresponding CT images;
And 4.2, performing dose calculation in the Eclipse treatment planning system by using preset planning parameters.
And 5, deforming the dose of the radiotherapy sub-plan of each motion phase to a corresponding reference phase image, and superposing to obtain a reconstructed 4D dose.
Specifically, step 5 includes the following steps:
and 5.1, registering each motion phase image with the reference phase image by using a deformation registration algorithm to generate respective spatial deformation displacement vector fields.
The registration process uses the reference phase images as registered fixed images and the motion phase images except the reference phase images as registered floating images. Wherein the corresponding reference phase images should be determined according to the specific clinical use needs. The motion phase image and the reference phase image which participate in registration are four-dimensional CT images of cardiopulmonary motion, and the cardiopulmonary motion comprises heart pulsation and respiratory motion.
In this embodiment, the deformation registration algorithm is specifically selected as a B-spline based non-rigid registration algorithm integrated in open source software Elastix (Version 5.0.1, utlecht, THE NETHERLANDS).
Step 5.2, deforming all doses of the radiotherapy sub-plan one by one to corresponding reference time phase images by using a space deformation displacement vector field;
And 5.3, superposing to obtain a reconstructed 4D dose.
Example 2 System for radiation therapy 4D dose reconstruction
This embodiment provides a system for implementing the radiation therapy 4D dose reconstruction method of embodiment 1, comprising:
the input module is used for inputting data, wherein the input data comprises a log file generated by executing a radiotherapy plan and an original CSBRT plan DICOM-RP file;
a 4D dose reconstruction module for performing the method of radiotherapy 4D dose reconstruction described in example 1;
an output module for outputting the reconstructed 4D dose.
The technical scheme of the invention is further described through experiments:
Experimental example 1 reconstruction of 4D dose and static 3D dose contrast by the method of the invention
1. Experimental method
In this experimental example, the experimental group re-established the 4D dose according to the method of example 1, and the control group obtained a static 3D dose according to the method of the prior art (i.e. the dose calculated directly with CSBRT's program). In particular, experimental data were collected for 5 patients with ventricular tachycardia who received stereotactic cardiac radio-ablative treatment, including their clinically CSBRT planned static 3D doses and the 4D dose (including heart beat and respiratory motion) under the influence of cardiopulmonary motion reconstructed according to the method of example 1, versus the difference in target area and dosimetry index for each organ at risk between the static 3D dose and the reconstructed 4D dose.
The above dose index includes maximum dose D max, minimum dose D min, average dose D mean, and clinically usual doseAnd/>，/>Represents the dose n% by volume,/>Represents the volume of the received nGy dose. In addition to this, the conformality index (conformity index, CI), uniformity index (homogeneityindex, HI) and 3 Gradient Indices (GI), each of the dosimetry indices are formulated as follows:
Wherein, in the formula Refers to the volume of intersection of ITV region and 25Gy isodose line region,/>Is the volume of ITV,/>Volume occupied by 25Gy dose,/>Represents the dose received in n% by volume,/>Mean dose,/>Represents the volume of the dose of nGy,/>、/>And/>Each of 3 gradient indices.
2. Experimental results
Patient movement cycle takes t=4 seconds and the number of movement phases takes n=10. The results of comparing the 4D dose to the static 3D dose for the target area and organs at risk under the influence of the reconstructed heart motion by the method of example 1 are shown in tables 1 and 2, respectively.
Table 1 target dosimetry index statistics of 4D reconstructed dose versus 3D dose for cardiac pulsatility
TABLE 2 organoleptics index statistics of 4D reconstructed dose versus 3D dose for cardiac beats
The comparison of the 4D dose to the static 3D dose for the target area and organs at risk under the influence of respiratory motion reconstructed by the method of example 1 is shown in tables 3 and 4, respectively.
Table 3 target dosimetry index statistics of 4D reconstructed doses and 3D doses of respiratory motion
TABLE 4 organ-at-risk dosimetry index statistics of 4D reconstructed doses and 3D doses of respiratory motion
From experimental results, no matter heart beats or respiratory movements exist, obvious deviation exists between the 3D dose and the reconstructed 4D dose, the actual irradiated dose of a patient in the radiotherapy process can be accurately quantified through reconstructing the 4D dose, and the dosimetry influence caused by the heart and lung movements of the patient can be further evaluated, so that the tumor control rate is ensured in the radiotherapy of the patient, and the probability of potential radiotherapy complications is reduced as much as possible.
In summary, the invention provides a radiotherapy 4D dose reconstruction technology considering the influence of cardiopulmonary motion based on a radiotherapy plan file, which can accurately evaluate the actual irradiated dose of a specific radiotherapy patient under the influence of cardiopulmonary motion in the radiotherapy process, more accurately predict the treatment effect of the patient, guide the further optimization of the radiotherapy plan, and ensure the tumor control rate and simultaneously reduce the occurrence probability of radiotherapy complications as much as possible. Meanwhile, the method can also evaluate the dosimetry influence caused by the heart and lung movement of the patient and the dosimetry deviation effect caused by various movement management technologies in controlling the movement, provides important guiding basis for the patient to select proper movement management technology, and achieves the purposes of finally improving the radiotherapy curative effect of the patient and increasing the clinical benefit of the patient.
Claims (8)
1. A method of radiation therapy 4D dose reconstruction, comprising the steps of:
Step 1, executing a radiotherapy plan and generating a log file;
step 2, extracting control point information from the log file;
Step 3, according to the control point information and the set conditions, splitting control points of the DICOM-RP plan file according to time sequence, sequentially integrating the control points belonging to the same motion time phase into the same RP file, and creating a radiotherapy sub-plan corresponding to each motion time phase;
The setting conditions are as follows: the patient movement period is set to be a fixed value T seconds, movement phases are divided into n, the duration of each movement phase is T/n seconds, and a phase which is 0% of the movement period when the medical linear accelerator firstly emits beams is set;
Step 4, calculating the dose of the radiotherapy sub-plan of each motion phase obtained in the step 3;
Step 5, deforming the dose of the radiotherapy sub-plan of each motion phase to a corresponding reference phase image, and superposing to obtain a reconstructed 4D dose;
The step 5 specifically comprises the following steps:
Step 5.1, registering each motion phase image and the reference phase image by using a deformation registration algorithm to generate respective spatial deformation displacement vector fields;
Step 5.2, deforming all doses of the radiotherapy sub-plan one by one to corresponding reference time phase images by using a space deformation displacement vector field;
And 5.3, superposing to obtain a reconstructed 4D dose.
2. A method of radiation therapy 4D dose reconstruction according to claim 1, characterized in that: in step 1, the radiotherapy plan is a cardiac stereotactic radiotherapy plan designed on a cardiac motion four-dimensional CT reference phase image and a respiratory motion four-dimensional CT average density projection image based on an Eclipse treatment planning system.
3. A method of radiation therapy 4D dose reconstruction according to claim 1, characterized in that: in the step 2, each control point has time sequence, duration and interval time, and the control point information comprises corresponding MLC aperture information and MU value information; the MU value information includes MU weights.
4. A method of radiation therapy 4D dose reconstruction according to claim 3, characterized in that: the MLC aperture information is represented by MLC leaf coordinates; the MU weight is represented by the weight of the control point MU value to the total MU value of the plan.
5. A method of radiation therapy 4D dose reconstruction according to claim 1, characterized in that: the DICOM-RP planning file is a cardiac stereotactic radiation treatment planning file derived from the Eclipse treatment planning system.
6. The method of radiation therapy 4D dose reconstruction according to claim 1, wherein step 4 comprises in particular:
Step 4.1, importing the radiotherapy sub-plans of each motion phase into an Eclipse treatment planning system and correlating the radiotherapy sub-plans to corresponding CT images;
And 4.2, performing dose calculation in the Eclipse treatment planning system by using preset planning parameters.
7. A method of radiation therapy 4D dose reconstruction according to claim 6, characterized in that: in step 5, the registration process uses the reference phase image as a registered fixed image and each moving phase image except the reference phase image as a registered floating image.
8. A system for radiation therapy 4D dose reconstruction, comprising:
the input module is used for inputting data, wherein the input data comprises a log file generated by executing a radiotherapy plan and a DICOM-RP file of an original heart stereotactic radiotherapy plan;
A 4D dose reconstruction module for performing the method of radiotherapy 4D dose reconstruction of any one of claims 1-7;
an output module for outputting the reconstructed 4D dose.
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