肺癌放疗中的运动管理.ppt

HanBai,StudyonAdministratingMovementofLungTumorforRadiotherapy,Content,LungTumorismovingwhentreatment.,Radiotherapyiscompletedafterseveralfractions,andtumorpositionisnotidenticalwithplanningposition.Positionmovementcanbedevidedintotwosorts:1)interfractionmovement2)intrafractionmovement,Respiremovementisamajormodelofintrafractionmovement.,Respiremovementisamajormodelofintrafractionmovement.,4DCTisagoodwayforrespiremovement.,4DCTConfiguration,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,CTImageofRespiratoryCycle,Retrospective4DCT,Managmentthinkingsforintrafractionmovement.,1.curvingthetotalmovement:ExpandthePTVtocoverthetotalrangesoftargetmotionsalongallthreedirections,Problems:.Difficulttogenerateisodosedistributionsconformingtothemovingtargetsuchaslungtumorwith3DCRT.Unabletominimizethedosestothesurroundingnormaltissues.Thereforelimitingtotaldoseanddosefractionsizes,Managmentthinkingsforintrafractionmovement.,1.curvingthetotalmovement:,Managmentthinkingsforintrafractionmovement.,2.curvingthepartmovement:ExpandthePTVtocoverthepartrangesoftargetmotionsalongallthreedirections,Problem:HowtoselectONopportunityandoffopportunity?,Managmentthinkingsforintrafractionmovement.,2.curvingthepartmovement:,Managmentthinkingsforintrafractionmovement.,2.curvingthepartmovement:,HowtoselectONopportunityandoffopportunity?1)Movementvelocityoftumorinfieldand2)distancebetweenimportantorganandtumor.,Managmentthinkingsforintrafractionmovement.,3.point:thePTVonlycoversomephaseoftargettotalmotion,Extendtheresidencetimeoftumoratthispoint.,Managmentthinkingsforintrafractionmovement.,4.real-timetracking:fieldisjustafolloweroftumornomatterwherethetumor.,textihere,Specialwaysforintrafractionmovement.,1.curvingthetotalmovement:MaxIP,Specialwaysforintrafractionmovement.,1.curvingthetotalmovement:ImageRegistration,textihere,Specialwaysforintrafractionmovement.,1.curvingthetotalmovement:Planning,textihere,Specialwaysforintrafractionmovement.,1.curvingthetotalmovement:Advantages,1.curvingthetotalmovement:Defects,1)dontobservewheretumoris.2)workingprocedureandequipmentareeasy,1)involvemoreorgans2)increasedoseexposedonorgan3)workingprocedureofregisteringCTimageismultifarious,Specialwaysforintrafractionmovement.,2.curvingthepartmovement:Howtoknowtumorposition.,Specialwaysforintrafractionmovement.,2.curvingthepartmovement:Howtotreattumor.,Specialwaysforintrafractionmovement.,2.curvingthepartmovement:Advantages.,2.curvingthepartmovement:Defects.,1)reducePTV2)decreasedoseexposedonorgan,1)workingprocedureandequipmentarecomplex.2)establishandexchangerelationshipbetweenexternalmarkandtumorinvivo.3)workingprocedureofregisteringCTimageismultifarious.,Specialwaysforintrafractionmovement.,3.point:Howtoextendtheresidencetimeoftumoratthispoint.,Specialwaysforintrafractionmovement.,3.point:equipment.,ABCtechology,AdvantagesofABCtechology,2)Decreasenormallungtissuedensity,thereforelesshealthytissueinpathofirradiation,1)reducePTVatthemostlarge.,DefectsofABCtechology,InitialpatientsetupDetectingpatientmovementduringtreatmentPatienttrainingPatientcomplianceRepeatabilityofbreathholdingMarginsaddedtocompensateforalltheabove,Specialwaysforintrafractionmovement.,4.real-timetracking:equipment.,Specialwaysforintrafractionmovement.,4.real-timetracking:Advantages.,4.real-timetracking:Defects.,1)initiativepathway.2)qualityassuranceandqualitycontrolisuncertain.3)algorithmisveryc