本文選題：快速旋轉(zhuǎn)調(diào)強　切入點：靜態(tài)調(diào)強　出處：《濟南大學》2013年碩士論文

【摘要】：第一部分全盆腔淋巴結(jié)調(diào)強放射治療的劑量學研究 背景與目的：近年來開展的旋轉(zhuǎn)調(diào)強放療技術(shù)是在加速器機架連續(xù)旋轉(zhuǎn)的過程中通過動態(tài)多葉光柵連續(xù)運動并配合可變劑量率進行強度調(diào)整來完成的調(diào)強放療方式，這種新技術(shù)在保證靶區(qū)和危及器官劑量要求的前提下，極大縮短了治療時間、提高了治療效率。通過對采用不同能量X線IMRT和RapidArc計劃比較，探討射線能量和計劃方式對全盆腔淋巴結(jié)調(diào)強放射治療的劑量學影響。 方法：選取12例宮頸癌術(shù)后盆腔淋巴結(jié)轉(zhuǎn)移病例，針對每一病例分別設(shè)計等角度7野靜態(tài)調(diào)強（IMRT）、單弧（RA1=358°）RapidArc和雙�。≧A2=716°）RapidArc調(diào)強放射治療計劃，每種計劃方式分別采用6、15MV X線能量進行優(yōu)化。比較6種調(diào)強計劃間的劑量學差異。 結(jié)果：6種調(diào)強計劃均能滿足臨床要求，同能量下IMRT與RA2的CI、HI及EVI指數(shù)均優(yōu)于RA1（P0.05）；CI、HI及EVI指數(shù)在同一計劃方式不同能量間則基本相同。同一能量下的3種計劃方式的危及器官受量間，只有小腸V_(40)之間的差異具有統(tǒng)計學意義（IMRTRA2RA1，P0.05）。不同能量下的同種計劃方式間危及器官差異均無統(tǒng)計學意義（P0.05）。IMRT計劃的機器跳數(shù)平均約為RA1和RA2計劃的3.90和3.56倍。 結(jié)論：相對于IMRT，除機器跳數(shù)和照射時間外，RapidArc進行全盆腔淋巴結(jié)照射并不具有明顯的劑量學優(yōu)勢；應(yīng)用調(diào)強放療進行全盆腔淋巴結(jié)照射時，，6MV X線應(yīng)作為首選。 第二部分RapidArc聯(lián)合主動呼吸控制技術(shù)應(yīng)用于胸段食管癌調(diào)強放療的劑量學研究 背景與目的：近年來開展的旋轉(zhuǎn)調(diào)強放療技術(shù)是在加速器機架連續(xù)旋轉(zhuǎn)的過程中通過動態(tài)多葉光柵連續(xù)運動并配合可變劑量率進行強度調(diào)整來完成的調(diào)強放療方式，這種新技術(shù)在保證靶區(qū)和危及器官劑量要求的前提下，極大縮短了治療時間、提高了治療效率。 放療過程中如果不考慮呼吸運動引起的目標靶區(qū)的三維運動，會造成部分靶區(qū)在部分呼吸時相位于射野之外而周圍正常組織和器官進入射野。胸段食管受呼吸運動影響較大，放療中容易造成靶區(qū)漏照、劑量分布不均勻，消弱了調(diào)強技術(shù)對食管癌放療的潛在優(yōu)勢。為了減少呼吸運動對胸段食管癌調(diào)強放療的負面影響，本研究應(yīng)用RapidArc聯(lián)合ABC技術(shù)設(shè)計胸段食管癌放療計劃，探討其劑量學受益。 方法：選取10例接受放療的胸段食管癌患者。在ABC輔助下80%適度深吸氣（mDIBH）和自由呼吸（FB）狀態(tài)下分別行定位CT掃描，應(yīng)用三維治療計劃系統(tǒng)為每例患者設(shè)計FB下的IMRT（IMRT-FB）和mDIBH下的RapidArc（RA-ABC）兩種調(diào)強放射治療計劃。評價靶區(qū)和正常組織的相關(guān)劑量體積參數(shù)，以及總的加速器輸出單位（MU）、總控制點數(shù)（control points）和治療時間。 結(jié)果：所有患者配合良好，均能耐受30s的屏氣時間。PTV的平均體積由FB下的376cm~3減少到了mDIBH下的260cm~3。mDIBH下的雙肺平均體積為5964.6cm~3,而FB則為3838.8cm~3，增加了35%；mDIBH和FB狀態(tài)下平均心臟體積分別為524.4cm~3和642.7cm~3。RA-ABC計劃正常組織各項劑量參數(shù)均優(yōu)于IMRT-FB計劃，但靶區(qū)的CI、HI指數(shù)及D2%、D98%均稍差于IMRT-FB計劃（P0.05）。RA-ABC計劃雙肺的V_(20)、V_(30)、V_(40)、V_(50)受照體積及平均劑量Dmean均明顯低于IMRT-FB (P0.05)，心臟的V_(20)、V_(30)、V_(40)、Dmean及脊髓Dmax也有不同程度的下降(P0.05)。另外，RA-ABC計劃的總機器跳數(shù)、子野數(shù)和治療時間也明顯少于IMRT-FB計劃(P0.05)。
[Abstract]:The dosimetry study of the first part of the total pelvic lymph node intensity modulated radiation therapy
Background and purpose: rotation IMRT technique developed in recent years is in the process of continuous rotation of the accelerator frame through a dynamic multi leaf collimator and continuous motion with IMRT dose rate variable intensity adjustment to complete, this new technique to ensure the target and organ at risk requirements, greatly shorten the the treatment time, improve the treatment efficiency. By using different energy X-ray IMRT and RapidArc plan, to investigate the dosimetric effect of X-ray energy and plan for whole pelvic lymph node IMRT.
Methods: 12 cases of cervical cancer patients after pelvic lymph node metastasis, respectively for each case design angle of 7 Wild intensity-modulated (IMRT), single arc (RA1=358 degrees) and RapidArc (RA2=716 ~ RapidArc) double arc IMRT plans, each plan using 6,15MV X-ray energy optimization comparison of 6 IMRT plans between the dosimetric differences.
Results: 6 kinds of IMRT plans could meet the clinical requirements, with the energy of IMRT and RA2 CI, HI and EVI index were better than those of RA1 (P0.05); CI, HI and EVI index is basically the same in the same way between different energy plans. The 3 plans the same energy under the threaten of organ the amount, only V_ in the small intestine (40) there were significant differences between (IMRTRA2RA1, P0.05). In the same way under different energy plan between organs showed no significant difference (P0.05).IMRT machine hop average is about RA1 and RA2 plan 3.90 and 3.56 times.
Conclusion: compared with IMRT, RapidArc has no advantage in dosimetry for all pelvic lymph node irradiation except for machine hopping and irradiation time. 6MV radiography should be the first choice when using intensity modulated radiation therapy for total pelvic lymph node irradiation.
The second part RapidArc combined active breathing control technique used in the dosimetry study of thoracic esophageal carcinoma with intensity modulated radiation therapy
Background and purpose: rotation IMRT technique developed in recent years is in the process of continuous rotation of the accelerator frame through a dynamic multi leaf collimator and continuous motion with IMRT dose rate variable intensity adjustment to complete, this new technique to ensure the target and organ at risk requirements, greatly shorten the the treatment time, improve the treatment efficiency.
In the process of radiotherapy without considering the three-dimensional motion of the target area caused by respiratory motion, will cause the target zone in the respiratory phase in field and surrounding normal tissues and organs into the field. The thoracic esophagus affected by respiratory movement, resulting in easy radiotherapy target area leakage according to dose distribution. The potential advantages of weakened IMRT for esophageal cancer radiotherapy. In order to reduce the negative influence of respiratory motion on intensity modulated radiotherapy for thoracic esophageal carcinoma, this study combined application of RapidArc ABC technology in the design of thoracic esophageal cancer radiotherapy, to investigate the dosimetric benefit.
Methods: 10 patients received radiotherapy of thoracic esophageal cancer patients. In ABC assisted 80% moderate deep inspiration (mDIBH) and free breathing (FB) condition were performed CT scanning and positioning, the application of three-dimensional treatment planning system for each patient to design FB IMRT (IMRT-FB) and mDIBH RapidArc (RA-ABC) two kinds of IMRT planning. Dose volume parameters to evaluate the target and normal tissue, and the total output accelerator unit (MU), the total number of control points (control points) and the duration of treatment.
Results: all patients with a good, can the average volume of breath holding time tolerance of 30s by FB.PTV of the 376cm~3 to reduce the mean lung volume mDIBH 260cm~3.mDIBH under 5964.6cm~3, and FB 3838.8cm~3, an increase of 35%; the average heart volume of mDIBH and FB state respectively. The parameters of normal tissue dose 524.4cm~3 and 642.7cm~3.RA-ABC were superior to IMRT-FB, but the target area CI, HI index and D2%, D98% were lower than that of the IMRT-FB plan (P0.05).RA-ABC double lung V_ (20), V_ (30), V_ (40), V_ (50) irradiation volume and average dose of Dmean was significantly lower than that of IMRT-FB (P0.05), the heart of the V_ (20), V_ (30), V_ (40), Dmean and Dmax in the spinal cord has decreased (P0.05). In addition, the total machine plan RA-ABC hops, the number of segments and the treatment time is less than IMRT-FB plan (P0.05).

【學位授予單位】：濟南大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R730.55

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相關(guān)期刊論文 前1條

1 張富利;陳靜;高軍茂;陳建平;鄭明民;;宮頸癌術(shù)后盆腔三種放射治療計劃設(shè)計方法的劑量學研究[J];中國醫(yī)學物理學雜志;2010年01期

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