Glide-Hurst Carri K, Hugo Geoffrey D, Liang Jian, Yan Di
William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
Med Phys. 2008 Dec;35(12):5269-77. doi: 10.1118/1.3002304.
The purpose of this work was to demonstrate, both in phantom and patient, the feasibility of using an average 4DCT image set (AVG-CT) for 4D cumulative dose estimation. A series of 4DCT numerical phantoms and corresponding AVG-CTs were generated. For full 4D dose summation, static dose was calculated on each phase and cumulative dose was determined by combining each phase's static dose distribution with known tumor displacement. The AVG-CT cumulative dose was calculated similarly, although the same AVG-CT static dose distribution was used for all phases (i.e., tumor displacements). Four lung cancer cases were also evaluated for stereotactic body radiotherapy and conformal treatments; however, deformable image registration of the 4DCTs was used to generate the displacement vector fields (DVFs) describing patient-specific motion. Dose discrepancy between full 4D summation and AVG-CT approach was calculated and compared. For all phantoms, AVG-CT approximation yielded slightly higher cumulative doses compared to full 4D summation, with dose discrepancy increasing with increased tumor excursion. In vivo, using the AVG-CT coupled with deformable registration yielded clinically insignificant differences for all GTV parameters including the minimum, mean, maximum, dose to 99% of target, and dose to 1% of target. Furthermore, analysis of the spinal cord, esophagus, and heart revealed negligible differences in major dosimetric indices and dose coverage between the two dose calculation techniques. Simplifying 4D dose accumulation via the AVG-CT, while fully accounting for tumor deformation due to respiratory motion, has been validated, thereby, introducing the potential to streamline the use of 4D dose calculations in clinical practice, particularly for adaptive planning purposes.
本研究的目的是在体模和患者中均证明使用平均4DCT图像集(AVG-CT)进行4D累积剂量估算的可行性。生成了一系列4DCT数字体模和相应的AVG-CT。对于完整的4D剂量求和,计算每个相位的静态剂量,并通过将每个相位的静态剂量分布与已知的肿瘤位移相结合来确定累积剂量。AVG-CT累积剂量的计算方式类似,不过所有相位(即肿瘤位移)均使用相同的AVG-CT静态剂量分布。还对4例肺癌病例进行了立体定向体部放疗和适形治疗评估;然而,使用4DCT的可变形图像配准来生成描述患者特定运动的位移矢量场(DVF)。计算并比较了完整4D求和与AVG-CT方法之间的剂量差异。对于所有体模,与完整4D求和相比,AVG-CT近似产生的累积剂量略高,且剂量差异随肿瘤偏移增加而增大。在体内,使用AVG-CT结合可变形配准,对于所有GTV参数,包括最小值、平均值、最大值、靶区99%体积的剂量和靶区1%体积的剂量,产生的临床差异均不显著。此外,对脊髓、食管和心脏的分析表明,两种剂量计算技术在主要剂量学指标和剂量覆盖方面的差异可忽略不计。通过AVG-CT简化4D剂量累积,同时充分考虑呼吸运动引起的肿瘤变形,已得到验证,因此,有可能简化临床实践中4D剂量计算的使用,特别是用于自适应计划目的。