外照射治疗计划物理方面在剂量上，如何实现这一问题.pptVIP

* For both modalities good PTV coverage was achieved and mean doses within the PTV were relatively similar. Nonetheless small increase in dose inhomo and max were seen IMRT. For bladder and RW improved dose distr are reflected in DVHs between 20 and 50 Gy. In contrast, on average almost similar DVHs were observed for both photon tech for SB. Their results for small bowel is different than the other results in the literature, also compared to studies where para-aortic lymph nodes are included in the CTV. They point out that the procedure for delineation of the structure may be of significant importance. IMRT er bedre med hensyn p? rectum og bl?re, men samme for small bowel * the multileaf collimator aperture is shaped dynamically to conform to the target * * Average DVHVMAT showed a slightly improved target coverage in terms of D2% . No sign diff in min dose. Also dose healty tissue was significsnt lower and inetgral dose. Future studies will have to assess the role of non-coplanar and the necessary number of modulated arcs to achieve the ‘‘ideal’’ dose distribution 外照射治疗计划– 物理方面在剂量上，如何实现这一问题? Taran Paulsen Hellebust Medical physicist/Associate professor Oslo University Hospital/The Norwegian Radium Hospital Oslo, Norway 前后野对穿技术 基于X射线的四野盒技术 三维适形技术 调强放射治疗 旋转技术 (容积旋转调强放射治疗) 螺旋断层放疗 我们有什么样的技术提供? 前后野对穿 15 MV Kahn 1994 6 MV 基于X射线成像 四野盒技术 前后位 侧位 基于三维的治疗计划(CT) 前后野对穿 四野盒 治疗计划系统比较前后野对穿 vs 四野盒技术 Van de Bunt et al 2006 10 MV 6 MV 15 MV IMRT – 调强放射治疗 1 4 3 2 5 6 7 三维适形 vs 调强治疗 四野盒 15 MV 7个均分的共面野 15 MV 调强的优势在于危及器官的保护！ Van de Bunt et al 2006 适形 vs 调强 14例宫颈癌病人, 调强: 7 野, 10 MV 适形 vs 调强 Organ Parameter 3D-CRT IMRT Small bowel V30Gy(%) 38.2 41 V45Gy(%) 9.5 13.1 Rectum wall V30Gy(%) 93.8 90 V45Gy(%) 79.3 64.1 Bladder V30Gy(%) 92.8 76.6 V45Gy(%) 56.0 33.8 5 例宫颈癌病人 Georg et al Strahlenther Onkol 2008 IMRT IMRT 15 MV 15 MV，7个均分的共面照射野 MLC is shaped dynamically to conform to the target 容积旋转调强治疗- VMAT 单个或多个不间断的圆弧放射光束在病人周围扫描 调强 vs 容积旋转调强 IMRT VMAT (Rapid Arc) Cozzi et al RO 2008