肺癌放疗中的运动管理课件

HanBaiStudyonAdministratingMovementof

LungTumorforRadiotherapyContentcontentSpecialwaysforintrafractionmovement.Averageposition.Managmentthinkingsforintrafractionmovement.4DCTisagoodwayforrespiremovement.LungTumorismovingwhentreatment.LungTumorismovingwhentreatment.Radiotherapyiscompletedafterseveralfractions,andtumorpositionisnotidenticalwithplanningposition.Positionmovementcanbedevidedintotwosorts:1)interfractionmovement2)intrafractionmovementRespiremovementisamajormodelofintrafractionmovement.Scanningmodel

Modelofdealingwithimages

SpiralandStep.Retrospectiveandperspective.4DCTisagoodwayforrespiremovement.4DCTConfigurationCTImageofRespiratoryCycleCTImageofRespiratoryCycleCTImageofRespiratoryCycleCTImageofRespiratoryCycleCTImageofRespiratoryCycleRetrospective

4DCTManagmentthinkingsforintrafractionmovement.1.curvingthetotalmovement:MaximumdensityprojectionABcurvingthetotalmovementManagmentthinkingsforintrafractionmovement.2.curvingthepartmovement:

ExpandthePTVtocoverthepartrangesof

targetmotionsalongallthreedirections12345PTVONONONoffoffProblem:Howtoselect"ON"opportunityand"off"opportunity?Managmentthinkingsforintrafractionmovement.2.curvingthepartmovement:

13233phases4phasesManagmentthinkingsforintrafractionmovement.3.point:

thePTVonlycoversomephase

of

targettotalmotion

12345PTVoffONoffONExtendtheresidencetimeoftumoratthispoint.Managmentthinkingsforintrafractionmovement.4.real-timetracking:fieldisjustafolloweroftumornomatterwherethetumor

.textihereSpecialwaysforintrafractionmovement.1.curvingthetotalmovement:MaxIPSpecialwaysforintrafractionmovement.1.curvingthetotalmovement:PlanningtextihereSpecialwaysforintrafractionmovement.1.curvingthetotalmovement:Advantages1.curvingthetotalmovement:Defects1)don'tobservewheretumoris.2)workingprocedureandequipmentareeasy1)involvemoreorgans2)increasedoseexposedonorgan3)workingprocedureofregisteringCTimageismultifariousSpecialwaysforintrafractionmovement.2.curvingthepartmovement:Advantages.2.curvingthepartmovement:Defects.1)reducePTV2)decreasedoseexposedonorgan1)workingprocedureandequipmentarecomplex.2)establishandexchangerelationshipbetweenexternalmarkandtumorinvivo.3)workingprocedureofregisteringCTimageismultifarious.Specialwaysforintrafractionmovement.3.point:Howtoextendtheresidencetimeoftumoratthispoint.Specialwaysforintrafractionmovement.3.point:equipment.ABCtechologyAdvantagesofABCtechology2)Decrease

normallungtissuedensity,thereforelesshealthytissueinpathofirradiation1)reducePTVatthemostlarge.

DefectsofABCtechology•Initialpatientsetup•Detectingpatientmovementduringtreatment•Patienttraining•Patientcompliance•Repeatabilityofbreathholding•MarginsaddedtocompensateforalltheaboveSpecialwaysforintrafractionmovement.4.real-timetracking:equipment.Specialwaysforintrafractionmovement.4.real-timetracking:Advantages.4.real-timetracking:Defects.1)initiativepathway.2)qualityassuranceandqualitycontrolisuncertain.3)algorithmisverycomplex.1)don'tobservewheretumoris.Averageposition1)don'tobservewheretumoris.2)workingprocedureandequipmentareeasy.3)reducePTVtoacertaindegree.4)decreasedoseexposedonorgan.3phases4phasesIMRTplan1parameters：LungV20=30%，V5=60%，MLD=15Gy100%PTV=8200cGydefect：missingIMRTplan2parameters:LungV20=35%，V5=70%，MLD=20Gy100%PTV=6000cGydefect:doseisnotenough;doseisexposedonlungistoohigh.8200×3/4>60