基于4D剂量分布下适形放疗和滑窗调强放疗模体研究

目的 基于4D剂量分布,探究呼吸运动对三维适形放疗(3DCRT)和滑窗调强放疗(SW-IMRT)的计划剂量分布的影响,评估在4D剂量模式下呼吸运动引起剂量误差的大小。方法 使用动态胸部模体(CIRS-008A),设定振幅分别为5、10 mm的cos⁴(x)和sin (x)波形的运动曲线。分别进行4DCT扫描,将最大密度投影(MIP)、平均密度投影(AIP)和10个相位图像发送到计划系统,用于设计3DCRT和滑窗IMRT计划及剂量计算。将AIP计划复制到10个时相,把所有相位的剂量配准并叠加到参考相位,创建得到4D累积剂量分布。利用免冲洗胶片(EBT2)、光释光检测器(OSLD)对计划的平面剂量、点绝对剂量进行分析。结果 3DCRT和滑窗IMRT的预期4D累积剂量与EBT2测量剂量在3%/3mm误差标准下,对于不同呼吸模式的平均γ通过率分别为(98.8±0.78)%和(96.4±1.89)%,两者4D累积剂量分布与OSLD点绝对剂量在靶区内外区域显示出良好的一致性。结论 基于4DCT定位、4D累积剂量分布评估呼吸运动对放疗计划的影响是有必要的。在不同的呼吸模式下,3DCRT 和滑窗IMRT计划实际测得的剂量和预期4D累积剂量显示结果相似。

A phantom study of three-dimensional conformal radiation therapy and sliding window intensity-modulated radiation therapy based on 4D dose distribution

Objective In this paper, based on the 4D dose distribution of the treatment plan, the effects of respiratory movement on the dose distribution of three-dimensional conformal radiation therapy (3DCRT) and sliding window intensity-modulated radiation therapy (SW-IMRT) techniques were analyzed, and the dose errors caused by respiratory movement based on the 4D dose distribution were evaluated. Methods In this study, the dynamic thoracic phantom (CIRS-008A) was used to simulate the patient with a 3cm spherical insert as the tumor. Four motion patterns were simulated with cos⁴(x) and sin (x) wave forms of 10 mm and 5 mm amplitudes. The 4DCT scans with the phantom were performed in different breathing modes, and the maximum intensity projection (MIP), average intensity projection (AIP) and 10separate 4DCT phase images were transferred to the Eclipse treatment planning system. The targets were contoured on MIP, with corresponding 3DCRT and SW-IMRT plans designed and dose calculated on AIP. By copying the plan designed on the AIP to each phase image of the 4DCT set, the MATLAB software package was employed to register and superimpose all the phase-specific doses onto one of the reference phase to create a 4D-accumulated dose distribution. Both films (EBT2) and optically stimulated luminescence (OSLD) detectors were inserted in and around the target area of the phantom to measure the delivered doses. The calculated 4D-accumulated doses were compared to the measured doses and their differences were evaluated using Gamma analysis. Results Under different respiration modes, the average Gamma index (3%/3mm) passing rates between the 4D-accumulated doses and EBT2-measured doses for 3DCRT and SW-IMRT plans were (98.8±0.78)% and (96.4±1.89)%, respectively. The absolute measurements of OSLDs both inside and outside of the target area well matched the 4D-accumulated doses. Conclusions 4DCT can be effectively applied to evaluate the treatment plan dose distribution through 4D dose accumulation, which can potentially avoid cold spots and target under-coverage. Under different respiration modes, both 3DCRT and SW-IMRT plans provide dose measurements consistent with those predicted by the 4D-accumulated dose of treatment plan.