基于ESAPI编译结构快速处理软件的实现与评估

目的 利用ESAPI功能开发靶区与危及器官结构快速处理软件,帮助放疗临床计划制作者简化各种常见的结构后处理操作。方法 基于ESAPI功能开发SmartStructure脚本软件,并在临床工作中进行验证评估。选取直肠癌新辅助放疗、乳腺癌保乳术后放疗、宫颈癌术后放疗、鼻咽癌根治性放疗、肺部立体定向放疗(SBRT)病例各 10例,不同病种有不同的结构处理需求。每个病例分别采用常规手动处理方式(手动组)、使用SmartStructure脚本但不使用模板进行结构处理(SmaStru-N组)、使用SmartStructure脚本且使用针对该病种的临床辅助结构模板进行结构处理(SmaStru-P组)。比较3种方式的处理时间,并请临床工作者对脚本进行多方面评分,并对比脚本软件和手动两种方式的使用感受评分。结果 上述3种方法均能在临床上正常使用。在出错率方面,手动组为7.0%,SmaStru-N组为3.0%,SmaStru-P组为0%。5种病例SmaStru-N组方式较手动组平均提升60.9%的靶区及危及器官处理时间,SmaStru-P组较手动组提升93.3%处理时间。SmartStructure脚本方式使用感受评分均高于手动方式。临床工作者对脚本“适用性”与“简便性”方面评分较低,“准确性”与“效率”方面评分较高。结论 相较于常规手动处理结构方式,使用SmartStructure脚本软件能够快速准确地进行靶区与危及器官的结构处理,且随着病例需要处理结构数量的增加其优势更加明显。SmartStructure符合临床需求、降低出错率、提升计划处理速度、提升临床工作者的工作效率,为今后自适应放疗的发展提供基础。     

基于脚本函数实现ART计划剂量评估方法研究

目的 基于脚本函数实现ART计划剂量评估的方法,使各版本Pinnacle TPS均可以完成动态计划模块具有的放疗计划移植功能。方法 首先编写并嵌入脚本,然后在后程影像空间设置照射等中心点。再通过执行脚本程序完成照射野导出、导入和设置权重,实现放疗计划在不同影像空间的移植。分别用本方法和Pinnacle TPS的动态计划模块完成对1例鼻咽癌患者的ART计划评估,从计划参数和剂量学角度对比两种方法差异。结果 与动态计划模块相比,通过本方法移植的放疗计划保持了前、后程计划参数的一致性。两种方法的等中心位置存在偏差,从而导致剂量分布不同。如果将两种方法生成的ART计划移植在相同等中心位置,则剂量分布结果完全一致。结论 提出的ART计划评估方法准确、简便、易行,适用于各种版本Pinnacle TPS,且不额外占用图像存储空间。该方法提高了评估自适应放疗剂量的灵活性和精度,也为开展临床及科研工作提供了技术支持。     

基于UiBot软件实现治疗计划系统CT定位影像及轮廓自动导入功能探索

目的 实现CT定位影像和轮廓自动导入Eclipse和Monaco两套治疗计划系统(TPS)。方法 基于Eclipse和Monaco的TPS,利用流程自动化可编程程序UiBot,根据Eclipse和Monaco各自CT定位影像和轮廓导入流程,使用UiBot提供的窗口元素等功能开发出CT定位影像和轮廓自动导入的自动化脚本程序。结果 通过比较手动导入和自动导入的导入时间,自动化脚本程序不仅实现了从CT定位影像和轮廓到Eclipse和Monaco的TPS准确自动导入,而且也具有与手动导入相同的效率。大部分患者影像层数在 130~180之间,且手动导入时间与自动导入时间在此区间的平均时间为76s和75s。结论 通过利用脚本开发程序UiBot的自动化功能,结合放疗工作的实际问题和重复的工作流程可以开发出自动化的脚本,极大提高了放疗工作效率,节约了人力和时间成本,为放疗流程自动化提供了一种可选择的新方法。     

基于遗传算法的三维适形放疗射野入射角度最优化研究

目的 建立一种基于遗传算法的三维适形放疗治疗机架入射角度最优化算法.方法 从Pinnacle v7.2计划系统上读取患者几何轮廓信息和三维剂量分布文件,把几何轮廓信息和三维剂量分布在同一坐标系下融合后作为最优化算法输入数据.对每组角度组合都计算其最优射野权重,用基于遗传算法角度最优化方法挑选出最优角度组合,最后把得到的角度组合和各角度射野权重重新输入到Pinnacle v7.2计划系统,和常规三维适形计划相比较.对2例肺癌病例和1例脑瘤病例比较了优化入射角度和常规三维适形计划下剂量分布、DVH图差异和适形度指标.结果 和常规三维适形计划相比,优化计划适形指数分别为0.59和0.70,高于常规三维适形计划的0.36和0.58.DVH图上看肺癌病例,使用优化算法后脊髓受到的最高量分别下降了17.8%和22.4%,肺V:.分别降低了3.1%和4.4%,肺V30分别降低了4.5%和1.5%;对脑瘤病例,晶体和眼球受照剂量也有显著下降.结论 所建立的角度最优化方法可作为计划设计的辅助工具.     

食管癌调强放疗计划剂量学验证研究

目的 对比分析食管癌调强放疗(IMRT)计划的三种剂量验证方法.方法 使用Pinnacle 8.0 h计划系统完成7例食管癌IMRT计划,选用二、三维剂量验证设备MATRIXX和Delta4完成测量验证.IMRT原计划和Delta4移植计划使用蒙特卡罗方法重新计算.评价MATRIXX和Delta4测量的gamma通过率;Pinnacle计算,Delta4测量与蒙特卡罗模拟结果分别比较gamma图,中心层面剂量分布,剂量曲线和剂量体积直方图.结果 gamma误差设定为3%/3 mm,MATRIXX测量通过率＞98%,Delta4测量通过率为94.4%,其中有4个射野＜90%.Delta4测量和蒙特卡罗模拟比较,误差限定为2 mm/2%和3 mm/3%时,gamma通过率分别为97.6%和99.8%.Pinnacle计划系统计算的中心层面剂量分布、剂量曲线与蒙特卡罗模拟计算结果、Delta4测量结果比较一致.Delta4测量与蒙特卡罗模拟计算的剂量体积直方图一致性很好,均与Pinnacle计划系统计算略有差异.结论 3种方法均能完成食管癌IMRT计划的验证,蒙特卡罗和Delta4方法在验证过程中无数据丢失.Delta4实现了三维的剂量验证,蒙特卡罗能够在每个患者的实际CT图像上进行模拟计算.

Abstract：

Objective To compare the results of three dose verification solutions of esophageal carcinoma IMRT plans. Methods Seven esophageal carcinoma cases were planned with Pinnacle 8.0 h.The MATRIXX and Delta4 were chosen as the two-dimensional dosimetry and three-dimensional dosimetry.IMRT plans and Delta4 phantom plans were also recalculated by Monte Carlo. Gamma values were evaluated for MATRIXX and Delta4 with 3 mm/3% gamma criteria. For the comparison of Pinnacle, Delta4 and Monte gamma maps, the dose distribution in central plane, dose profiles and dose-volume histograms were used to evaluate the agreement. Results The gamma maps comparison show that with 3 mm/3% gamma criteria an over 98% pass ratio was obtained by MATRIXX measurement. A 94. 4% gamma pass ratio whicl.contains 4 fields gamma pass ratio lower than 90%, was obtained by Delta4 measurement. A 97.6% and 99. 8% gamma pass ratio was obtained between the Delta4 measurement and Monte Carlo simulation with 2 mm/2% and 3 mm/3% gamma criteria. The dose distribution in central plane and dose profiles from Pinnacle calculation were almost in agreement with both the Monte Carlo simulation and Delta4 measurement. The DVH plot have slightly differences between Pinnacle and Delta4 measurement as well as Pinnacle and Monte Carlo simulation, but have excellent agreement between Delta4 measurement and Monte Carlo simulation. Conclusions It was shown that all the three methods can be used very efficiently to verify esophageal carcinoma IMRT delivery, Delta4 and Monte Carlo simulation no data missed. The primary advantage of Delta4 is the fact it can measure true 3D dosimetry while Monte Carlo can simulate in patients CT images but not in phantom.     

Pinnacle TPS计划设计过程备份与还原可行性探讨

目的 建立放疗计划设计过程中的数据备份及还原方案,提高计划设计效率及数据安全性。方法 设计数据保存(Script_Save)和系统退出(Script_Exit)脚本来代替TPS内置的保存(File-Save)和退出(File-Exit)菜单,脚本在完成与系统菜单相同的功能外,还按物理师的要求将当前的工作状态备份。放疗计划设计过程中因调整参数而导致计划质量变差或因其它原因导致数据受损时,可通过备份数据还原计划,保证数据的安全性,提高工作效率。结果 与原设计方案相比,本方案的保存数据和退出系统操作更加简单,备份过程不影响计划设计工作;治疗计划设计过程中平均备份次数为27.1次/计划,每次备份需要的磁盘空间为2.7 MB,每例患者备份需要的磁盘空间为59.4 MB,1.9%的治疗计划在设计过程中会出现差错从而需要被还原;还原操作发生在1天、1周及1个月的比例分别为65%、80%及87.6%,4个月后仍然有个别计划需要还原。结论 在Pinnacle TPS上实现计划设计过程备份与还原具有临床可行性,可提高计划设计效率和数据安全性。     

基于危及器官DVH预测模型的前列腺癌自动计划研究

目的 评估利用危及器官DVH预测模型来实现前列腺癌自动计划的可行性。方法 从42例前列腺癌放疗计划数据库随机选择30例作为训练集,根据膀胱、直肠与靶区边界的空间距离将其依次分割成层厚为3 mm的亚体积元(Ai),采用偏正态高斯函数拟合各Ai的微分DVH,优化得微分DVH的精确数学模型;利用嵌入在Pinnacle脚本中的C⁺⁺子程序获取另外12例验证集患者OARs的各Ai体积,基于建立的数学模型预测各OARs的DVH参数,将其作为目标函数生成个性化Pinnacle脚本实现自动计划。配对t检验比较原临床计划、预测值和自动计划的剂量差异。结果 DVH预测结果显示其膀胱、直肠60 Gy以上剂量的体积分数均低于原临床计划;自动计划的膀胱V70、V60、V50以及直肠V70、V60值均比原临床计划明显降低(P<0.05),但靶区的覆盖率和适形度基本不变,均匀性略降低(P>0.05)。结论 基于危及器官DVH预测模型的前列腺癌自动计划降低了OARs照射剂量,提高治疗计划设计效率。     

Pinnacle与Eclipse计划系统对感兴趣区体积计算的比较

目的 分析Pinnacle与Eclipse计划系统在计算靶区与正常器官感兴趣区(ROI)体积上的差异,为临床应用提供参考.方法 在Pinnacle计划系统上、在层厚分别为1、3、5mm的CT上分别勾画1、2、5个层面的正方形和圆形ROI.同时选取头、胸、腹部肿瘤病例各5例.在患者CT上勾画常见的正常器官ROI.将图像和ROI通过DICOM协议传输至Pinnacle和Eclipse计划系统,分析两种计划系统计算的ROI体积.结果 小体积的ROI两种计划系统计算结果有明显的差异,ROI体积越小体积差异越大(小体积相差12倍,大体积基本相同);体积计算的差异受许多因素的影响,感兴趣区的层数和几何体的大小与体积计算的差异显著线性相关(R2=1.000,P=0.000),CT层厚(R2=0.200,P=0.972)和几何体形状(R2=0.200,P=0.089)的对体积计算的差异的影响不显著.几何中心不一致对Pinnacle的ROI体积计算无影响,Eclipse的ROI体积计算有3%左右的增加.CT层厚与R0I体积呈正比(Pinnacle的R2=0.548,P=0.011;Eclipse的R2=0.502,P=0.027).对视交叉、视神经和晶体的体积差异均＞35%.结论 两种计划系统间传输ROI,特别是小体积ROI,需要注意两种计划系统在计算ROI体积时的差异.

Abstract：

Objective To compare the difference region of interest volume (ROI) calculation method between Pinnacle and Eclipse treatment planning system. Methods To acquire CT image with 3 of slice thickness (1 mm, 3 mm, and 5 mm). Delineate 1, 2 and 5 slices square and circle contours in Pinnacle treatment planning system. Meanwhile 15 cases that include 5 cases with head neck tumor, 5 with thorax tumor and 5 with abdomen tumor were selected. Those image and ROI were transfer to Eclipse treatment plan system by DICOM RT protocol . The ROI volume was compared between two TPS . Results For ROI with small volume, the volume difference between TPS was obvious (for small volume ROI have 12 times difference, for big volume ROI almost same). The volume difference between TPS was influenced by many factors. The number of ROI slice and the magnitude of ROI was related with the difference between TPS (R2 = 1. 000, P = 0. 000). The CT thickness (R2 = 0. 200, P = 0. 972 ) and the shape of ROI ( R2 =0. 200, P = 0. 089) were not significant factors. The center of ROI on different axis was not affect the volume calculation in Pinnacle, which cause 3% different in Eclipse. The CT thickness was proportional to the ROI volume ( Pinnacle R2 = 0. 548, P = 0. 011; Eclipse R2 = 0. 502, P = 0. 027 ). In clinical case, optic chiasm and Len averagely have more than 35% volume difference between those two TPS. Conclusions We should pay more attention about the difference volume calculation algorithm between Pinnacle and Eclipse,especially when transfer small volume ROI to another TPS, which may have significant difference.     

放疗计划自动分析系统的开发研究

目的开发一款放疗计划自动分析系统,通过智能解析Pinnacle3治疗计划系统(TPS)的治疗计划底层数据,实现放疗计划剂量参数的自动化分析。方法将12例接受放射治疗的食管癌患者的治疗计划纳入研究。自动分析系统自动检索Pinnacle3 TPS数据库,获取12例治疗计划原始数据,并自动解析底层原始数据,重建轮廓、射野和剂量参数,并重新计算剂量分布和"剂量-体积"直方图。通过与在线TPS中原始计划输出体积和剂量数据进行对比,来评估新系统重新计算体积和剂量数据的准确性。结果自动分析系统成功解析治疗计划的底层数据,并重建治疗计划参数。新系统计算轮廓的体积与原计划的体积偏差≤0.1%;重新计算GTV、PGTV、CTV和PTV的Dmax、Dmean、D95和D50等参数,与原计划的剂量偏差≤1.0%;重新计算ROIs的Dmax和Dmean,与原计划的剂量偏差<5%。结论自动分析系统可直接分析Pinnacle3 TPS治疗计划的底层数据,重建治疗计划,计算轮廓体积和剂量参数,与原计划的剂量偏差满足临床要求。     

Pinnacle与Eclipse计划系统对感兴趣区体积计算的比较

目的 分析Pinnacle与Eclipse计划系统在计算靶区与正常器官感兴趣区(ROI)体积上的差异,为临床应用提供参考.方法 在Pinnacle计划系统上、在层厚分别为1、3、5mm的CT上分别勾画1、2、5个层面的正方形和圆形ROI.同时选取头、胸、腹部肿瘤病例各5例.在患者CT上勾画常见的正常器官ROI.将图像和ROI通过DICOM协议传输至Pinnacle和Eclipse计划系统,分析两种计划系统计算的ROI体积.结果 小体积的ROI两种计划系统计算结果有明显的差异,ROI体积越小体积差异越大(小体积相差12倍,大体积基本相同);体积计算的差异受许多因素的影响,感兴趣区的层数和几何体的大小与体积计算的差异显著线性相关(R2=1.000,P=0.000),CT层厚(R2=0.200,P=0.972)和几何体形状(R2=0.200,P=0.089)的对体积计算的差异的影响不显著.几何中心不一致对Pinnacle的ROI体积计算无影响,Eclipse的ROI体积计算有3%左右的增加.CT层厚与R0I体积呈正比(Pinnacle的R2=0.548,P=0.011;Eclipse的R2=0.502,P=0.027).对视交叉、视神经和晶体的体积差异均＞35%.结论 两种计划系统间传输ROI,特别是小体积ROI,需要注意两种计划系统在计算ROI体积时的差异.     

应用射野角度和多目标优化提高肺癌放疗计划的执行效率

背景与目的：呼吸运动会给肺癌的放疗带来不利影响，而提高放疗计划的执行效率会在一定程度上减轻这一影响。该研究旨在探究运用射野角度和多目标优化（beam angle and multicriteria optimization，BAMCO）技术进行肺癌放疗计划设计的可行性和执行效率。方法：将10个肺癌临床计划数据由Pinnacle计划系统导出到RayStation计划系统。在RayStation系统中新建计划，以对应的临床计划射野角度为初始条件，在三维适形模块下优化射野角度。以优化结果为基础，执行多目标优化（multicriteria optimization，MCO），导航并确定临床需要的最佳妥协方案，然后生成可执行计划。最后，对比分析BAMCO计划和临床计划。结果：BAMCO计划设计不需要反复试错，一次MCO优化可确定最优计划；BAMCO计划和临床计划的靶区剂量分布和危及器官受量差异无统计学意义。BAMCO计划的跳数相比临床计划明显减少（31.1%±16.9%）。结论：BAMCO技术在保证计划质量的前提下，可有效提升计划的执行效率。     

Molecular disruption of NBS1 with targeted gene delivery enhances chemosensitisation in head and neck cancer

Background:

A fibroblast growth factor 2 (FGF2)-targeted adenoviral system can alter viral tropism and allow for improved transduction and reduced systemic toxicity. This study is to investigate if the FGF2-targeted adenoviral mutant Nijmegen breakage syndrome 1 (FGF2-Ad-NBS1) gene transfer can enhance cisplatin chemosensitisation not only by targeting DNA repair, but also through the induction of antiangiogenesis, whereas at the same time reducing toxicities in treating head and neck squamous cell carcinoma (HNSCC).

Methods:

The human HNSCC cell line was treated in vitro and in a nude mouse xenograft model. We conducted verification of binding ability of mutant NBS1 and downregulation of MRN complex, evaluation of transduction efficiency and combined antitumour activities. The antiangiogenesis mechanism was also investigated. Finally, we estimated the distribution of adenoviral vector in the liver.

Results:

The mutant NBS1 protein retains the binding ability and effectively suppresses the expression level of the MRN in infected cells. Transduction efficiency in vitro and cisplatin chemosensitisation were upregulated. The FGF2-Ad-NBS1 also showed detargeting the viral vectors away from the liver. The downregulation of NF-κB expression was supposed to correlate with increased antiangiogenesis.

Conclusions:

FGF2-targeted adenoviral system enhances the cisplatin chemosensitisation of mutant NBS1 and may avoid viral-associated liver toxicities.     

两套TPS之间VMAT计划优化质量评价研究

目的 探讨两套商用TPS实施VMAT优化的性能特点。方法 随机选取本院宫颈癌和前列腺癌患者各10例,分别利用瓦里安Eclipse和飞利浦Pinnacle TPS设计VMAT计划(宫颈癌2Arc、3Arc,前列腺癌1Arc、2Arc),采用瓦里安Clinac iX加速器配备RapidArc技术实施照射。从剂量分布、实施效率、治疗照射参数等方面评价治疗计划质量的差异。对组间比较行配对t检验。     

Electronic patient-reported outcome systems in oncology clinical practice

Answer questions and earn CME/CNE Patient‐reported outcome (PRO) questionnaires assess topics a patient can report about his or her own health. This includes symptoms (eg, nausea, fatigue, diarrhea, pain, or frequent urination), physical functioning (eg, difficulty climbing stairs or difficulty fastening buttons), and mental health (eg, anxiety, fear, or worry). Electronic PRO (ePRO) systems are used in oncology clinical care because of 1) their ability to enhance clinical care by flagging important symptoms and saving clinicians time; 2) the availability of standardized methods for creating and implementing PROs in clinics; and 3) the existence of user‐friendly platforms for patient self‐reporting like tablet computers and automated telephone surveys. Many ePRO systems can provide actionable links to clinical care such as summary reports in a patient's electronic medical record and real‐time e‐mail alerts to providers when patients report acute needs. This review presents 5 examples of ePRO systems currently in use in oncology practice. These systems support multiple clinical activities, including assessment of symptoms and toxicities related to chemotherapy and radiation, postoperative surveillance, and symptom management during palliative care and hospice. Patient self‐reporting is possible both at clinical visits and between visits over the Internet or by telephone. The implementation of an ePRO system requires significant resources and expertise, as well as user training. ePRO systems enable regular monitoring of patient symptoms, function, and needs, and can enhance the efficiency and quality of care as well as communication with patients. CA Cancer J Clin 2012. © 2012 American Cancer Society.     

Physician behaviors, patient perceptions, and patient characteristics as predictors of satisfaction of hospitalized adult cancer patients

To examine potential predictors of cancer patient satisfaction with physician behavior, 366 cases were studied. Physician behavior was measured on morning rounds using the Physician Behavior Check List (PBCL). Patient satisfaction and perceptions were assessed after the visit. Patient characteristics were obtained from the chart and the physician. Results showed wide variation in physician behavior; no "standard" set of behaviors was seen in all interactions. Patient satisfaction was high (mean = 87.8 mm on a 100-mm scale). Path analysis showed four variables predicted 62% of the variance in patient satisfaction. The strongest predictor was the patient perception item, "perception of needs addressed that day." Other predictors were perception of emotional support provided by the physician, age (older), and one physician behavior, "discusses treatment." Patient perceptions of needs met or emotional support provided were predicted by perceptions of the occurrence of physician behaviors involving information such as the diagnosis and tests and treatment. Overall, patient perceptions of physician behaviors were stronger predictors of patient satisfaction than the actual occurrence or absence of those behaviors.     

Evaluating the cost‐effectiveness of cancer patient navigation programs: Conceptual and practical issues

Patient navigators—individuals who assist patients through the healthcare system to improve access to and understanding of their health and healthcare—are increasingly used for underserved individuals at risk for or with cancer. Navigation programs can improve access, but it is unclear whether they improve the efficiency and efficacy of cancer diagnostic and therapeutic services at a reasonable cost, such that they would be considered cost‐effective. In the current study, the authors outline a conceptual model for evaluating the cost‐effectiveness of cancer navigation programs. They describe how this model is being applied to the Patient Navigation Research Program, a multicenter study supported by the National Cancer Institute's Center to Reduce Cancer Health Disparities. The Patient Navigation Research Program is testing navigation interventions that aim to reduce time to delivery of quality cancer care (noncancer resolution or cancer diagnosis and treatment) after identification of a screening abnormality. Examples of challenges to evaluating cost‐effectiveness of navigation programs include the heterogeneity of navigation programs, the sometimes distant relation between navigation programs and outcome of interest (eg, improving access to prompt diagnostic resolution and life‐years gained), and accounting for factors in underserved populations that may influence both access to services and outcomes. In this article, the authors discuss several strategies for addressing these barriers. Evaluating the costs and impact of navigation will require some novel methods, but will be critical in recommendations concerning dissemination of navigation programs. Cancer 2009. © 2009 American Cancer Society.