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1、2011/8/271快速旋转放射治疗快速旋转放射治疗 -原理与计划设计原理与计划设计胡逸民中国医学科学院北京协和医科大学 肿瘤研究所肿瘤医院提高治疗增益比的技术(历史)进程Conventional RT 常规放疗3D Conformal RT 适形放疗20世纪 70年代未3D Conformal RT 适形放疗Intensity Modulation RT 调強放疗20世纪 90年代初肿瘤放射治疗技术的历史发展IMRT原理进展5：质子IMRT(IMPT)Proton IMRTPhoton IMRT调强适形放射治疗适形放疗 3D CRT 调强适形放疗 IMRT 调强治疗实现方式的分类调强治疗实现
2、方式的分类 The ways to create intensity-modulated beams (IMBS) )调强实现方法调强实现方法2D物理补偿 Physical Compensator 多叶准直器 MLC 断层治疗 Tomotherapy 电磁扫描 Magnetic Scanning 棋盘准直器 NOMOS V olume Box 其它方式 Other Modes 静态 Static 动态 Dynamic 旋转 IMART 步进 Index 螺旋 Spiral独立准直器 Indepedent Collimator 移动条 Moving Bar调强适形放射治疗适形放疗 3D CRT
3、调强适形放疗 IMRT 调强治疗实现方式的分类调强治疗实现方式的分类 The ways to create intensity-modulated beams (IMBS) )调强实现方法调强实现方法2D 物理补偿 Physical Compensator 多叶准直器 MLC 断层治疗 Tomotherapy 电磁扫描 Magnetic Scanning 棋盘准直器 NOMOS Volume Box 其它方式 Other Modes 静态 Static 动态 Dynamic旋转 IMART步进 Index螺旋 Spiral 独立准直器 Indepedent Collimator 移动条 Mov
4、ing Bar2011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011/8/272调强适形放射治疗调强方式调强方式: 动态动态MLC调强调强(Dynamic MLC)Intensity调强治疗实现方法分类调强治疗实现方法分类强度分布Position调强适形放射治疗适形放疗 3D CRT 调强适形放疗 IMRT 调强治疗实现方式的分类调强治疗实现方式的分类 The ways to create intensity-modulated beams (IMBS) )调强实现方法调强实现方法2D 物理补偿 Physical Compen
5、sator 多叶准直器 MLC 断层治疗 Tomotherapy 电磁扫描 Magnetic Scanning 棋盘准直器 NOMOS Volume Box 其它方式 Other Modes 静态 Static 动态 Dynamic旋转 IMART步进 Index螺旋 Spiral 独立准直器 Indepedent Collimator 移动条 Moving Bar调强适形放射治疗子野1 Surbeam1子野4 Surbeam4调强方式调强方式: MLC静态调强静态调强I(x)调强治疗实现方法分类调强治疗实现方法分类(a)(b)子野2 Surbeam2子野3 Surbeam3子野5 Surbe
6、am5子野6 Surbeam6XBeam 5,6,7,8Beam 9,10,11Beams 12,13,14放疗技术进展放疗技术进展Beam 15,16,17Beam 1,2,3,4 IMRT Step and Shoot调强适形放射治疗适形放疗 3D CRT 调强适形放疗 IMRT 调强治疗实现方式的分类调强治疗实现方式的分类 The ways to create intensity-modulated beams (IMBS) )调强实现方法调强实现方法2D 物理补偿 Physical Compensator 多叶准直器 MLC 断层治疗 Tomotherapy 电磁扫描 Magnetic
7、 Scanning 棋盘准直器 NOMOS Volume Box 其它方式 Other Modes 静态 Static 动态 Dynamic 旋转 IMART 步进 Index 螺旋 Spiral独立准直器 Indepedent Collimator 移动条 Moving Bar调强适形放射治疗调强方式调强方式: 动态旋转动态旋转(IMAT)IntensityGA1GA4调强治疗实现方法分类调强治疗实现方法分类强度分布PositionGA2GA5GA3GA62011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011/8/273Be
8、am 5,6,7,8Beam 9,10,11Beams 12,13,14放疗技术进展放疗技术进展Beam 15,16,17Beam 1,2,3,4IMAT MultiArcBeam 9,10,11Beams 12,13,14IMAT to VMAT (RapidARC)调强适形放射治疗Beam 15,16,17VMAT(Rapid ARC) is an integration of multi-comformal beams and gantry rotationWhats VMAT or RapidARC ?VMAT (Volumetric Modulated Arc Therapy):Do
9、se volume is delivered during continuous gantry and MLC motion.the simultaneous use of dynamic multileaf collimator (DMLC) techniques and gantry arcing.From: Karl Otto, Med. Phys. 35(1):310-317, January 2008ARC 1VMAT or RapidARC is an integration of gantry rotation and multi-comformal beams with cha
10、ngebale weightingsARC 2VMAT or RapidARC is an integration of gantry rotation and multi-comformal beams with changebale weightingsDynamically changing 射野参数同时调整射野参数同时调整 Gantry Angle Gantry Speed MLC Leaves Position Collimator Angle Independent Jaws Dose Rate Multi-ArcsShort delivery Time实现快速治疗实现快速治疗(2
11、-3分钟分钟) Elekta InfinityNew Approaches for IMAT Delivery 旋转调強(IMAT)技术新进展Simultaneous dynamic control, during radiation treatment, of : 照射中同时调整下列参数：VMAT (Elekta方式) Rapid Arc (Varian方式)MLC Leaves MLC叶片位置YES YESCollimator Jaws 独立准直器位置YESYES独立准直器位置YES YESGantry 机架旋转YES YESCollimator Rotation 准直器旋转YES NOD
12、ose rate 剂量率YES YESMultiple arcs 多弧旋转YES 单弧Treatment times 照射时间2-3分钟1-2分钟2011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011全国放射治疗计划设计高级培训班2011/8/274In order to maintain a similar level of patient throughput it will be necessary to develop a treatment plan optimization and Improved the patient careBUTincreas
13、ed overall treatment timeWhy use VMAT or Rapid ARC ?delivery platform that is:1.Time efficient;2.Capable of producing highly conformal dose distributions which are3.Delivered with superior dosimetric accuracy.IGRTIMRTIn a single arcUsing a full 360 deg range of gantry directionWith high resolution s
14、ampling of beam directions during planningFrom: Karl Otto, Med. Phys. 35(1):310-317, January 2008 How to plan(1) ?VMATVMATDi MLCDi MLCGtAiGtAiInstantaneous MLC position and MU weights optimization for each gantry sampleDynamic MLCDynamic MLCModeling dynamic source as a series of static source positi
15、on samplesGantry ArcingGantry ArcingFrom: Karl Otto, Med. Phys. 35(1):310-317, January 2008How to plan(2) ?Progressive sampling of gantry motionFrom: Karl Otto, Med. Phys. 35(1):310-317, January 2008How to plan? A similar aperture-based method that incorporates MLC leaf positions and MU weights as optimization parameters was employed.? The cost function is based on dose-volume constraints and defi
