论文标题

通过治疗计划库对质子治疗中移动肿瘤的实时图像引导治疗:一项仿真研究

Real-time image-guided treatment of mobile tumors in proton therapy by a library of treatment plans: a simulation study

论文作者

Hamaide, Valentin, Souris, Kevin, Dasnoy, Damien, Glineur, Francois, Macq, Benoit

论文摘要

目的:为了改善目标覆盖范围并减少周围器官风险(OARS)的剂量,我们基于实时控制和实时交付的预先计算的治疗计划库开发了一种图像引导的治疗方法。方法:通过优化4DCT的每个呼吸阶段的计划来构建治疗计划库。通过模拟对由真实MRI序列产生的合成CT的连续序列进行仿真。在治疗过程中,选择肿瘤在接近当前肿瘤位置的计划以提供其斑点。该研究是针对五个肝脏病例进行的。结果:我们在对肿瘤位置的不完美知识中测试了我们的方法,并以2 mm的距离误差进行了测试。平均而言,与4D鲁棒优化的治疗计划相比,我们的方法导致目标中的剂量均匀性增加了5%(定义为1-(D_5-D_95)/处方),平均肝脏剂量降低23。治疗时间大约增加了2倍,但平均降低了4分钟的因子,但平均保持低于4分钟。结论:我们的图像引导的治疗框架的表现优于本研究中所有患者的最先进的4D-robust计划,均超过目标覆盖范围和辐射率,在当前肿瘤跟踪技术的准确性下,治疗时间可接受。

Purpose: To improve target coverage and reduce the dose in the surrounding organs-at-risks (OARs), we developed an image-guided treatment method based on a precomputed library of treatment plans controlled and delivered in real-time. Methods: A library of treatment plans is constructed by optimizing a plan for each breathing phase of a 4DCT. Treatments are delivered by simulation on a continuous sequence of synthetic CTs generated from real MRI sequences. During treatment, the plans for which the tumor is at a close distance to the current tumor position are selected to deliver their spots. The study is conducted on five liver cases. Results: We tested our approach under imperfect knowledge of the tumor positions with a 2 mm distance error. On average, compared to a 4D robustly optimized treatment plan, our approach led to a dose homogeneity increase of 5% (defined as 1-(D_5-D_95)/prescription) in the target and a mean liver dose decrease of 23. The treatment time was roughly increased by a factor of 2 but remained below 4 minutes on average. Conclusions: Our image-guided treatment framework outperforms state-of-the-art 4D-robust plans for all patients in this study on both target coverage and OARs sparing, with an acceptable increase in treatment time under the current accuracy of tumor tracking technology.

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