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1、肺癌放疗中的运动管理,1,Han Bai,Study on Administrating Movement of Lung Tumor for Radiotherapy,肺癌放疗中的运动管理,2,Content,肺癌放疗中的运动管理,3,Lung Tumor is moving when treatment.,Radiotherapy is completed after several fractions,and tumor position is not identical with planning position.Position movement can be devided in
2、to two sorts:1) interfraction movement2)intrafraction movement,肺癌放疗中的运动管理,4,Respire movement is a major model of intrafraction movement.,肺癌放疗中的运动管理,5,Respire movement is a major model of intrafraction movement.,肺癌放疗中的运动管理,6,4DCT is a good way for respire movement.,肺癌放疗中的运动管理,7,4DCT Configuration,肺癌放
3、疗中的运动管理,8,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,9,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,10,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,11,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,12,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,13,CT Image of Respiratory Cycle,肺癌放疗中的运动管理,14,CT Image of Respiratory Cyc
4、le,肺癌放疗中的运动管理,15,Retrospective 4DCT,肺癌放疗中的运动管理,16,Managment thinkings for intrafraction movement.,1. curving the total movement: Expand the PTV to cover the total ranges of target motions along all three directions,Problems:. Difficult to generate isodose distributions conforming to the moving targe
5、t such as lung tumor with 3DCRT. Unable to minimize the doses to the surrounding normal tissues. Therefore limiting total dose and dose fraction sizes,肺癌放疗中的运动管理,17,Managment thinkings for intrafraction movement.,1. curving the total movement:,肺癌放疗中的运动管理,18,Managment thinkings for intrafraction move
6、ment.,2.curving the part movement: Expand the PTV to cover the part ranges of target motions along all three directions,Problem: How to select ONopportunity and off opportunity?,肺癌放疗中的运动管理,19,Managment thinkings for intrafraction movement.,2.curving the part movement:,肺癌放疗中的运动管理,20,Managment thinkin
7、gs for intrafraction movement.,2.curving the part movement:,How to select ONopportunity and off opportunity?1)Movement velocity of tumor in field and 2)distancebetween important organ and tumor.,肺癌放疗中的运动管理,21,Managment thinkings for intrafraction movement.,3.point: the PTV only cover some phase of t
8、arget total motion,Extend the residence time of tumor at this point.,肺癌放疗中的运动管理,22,Managment thinkings for intrafraction movement.,4.real-time tracking:field is just a follower of tumor no matter where the tumor .,肺癌放疗中的运动管理,23,text i here,Special ways for intrafraction movement.,1. curving the tota
9、l movement:Max IP,肺癌放疗中的运动管理,24,Special ways for intrafraction movement.,1. curving the total movement:Image Registration,text i here,肺癌放疗中的运动管理,25,Special ways for intrafraction movement.,1. curving the total movement: Planning,text i here,肺癌放疗中的运动管理,26,Special ways for intrafraction movement.,1. c
10、urving the total movement: Advantages,1. curving the total movement: Defects,1)dont observe where tumor is.2)working procedure and equipment are easy,1)involve more organs2)increase dose exposed on organ 3)working procedure of registering CT image is multifarious,肺癌放疗中的运动管理,27,Special ways for intra
11、fraction movement.,2.curving the part movement:How to know tumor position.,肺癌放疗中的运动管理,28,Special ways for intrafraction movement.,2.curving the part movement:How to treat tumor.,肺癌放疗中的运动管理,29,Special ways for intrafraction movement.,2.curving the part movement:Advantages.,2.curving the part movement
12、:Defects.,1) reduce PTV2)decrease dose exposed on organ,1)working procedure and equipment are complex.2)establish and exchange relationship between external mark and tumor in vivo.3)working procedure of registering CT image is multifarious.,肺癌放疗中的运动管理,30,Special ways for intrafraction movement.,3.po
13、int:How to extend the residence time of tumor at this point.,肺癌放疗中的运动管理,31,Special ways for intrafraction movement.,3.point:equipment.,ABC techology,肺癌放疗中的运动管理,32,Advantages of ABC techology,2)Decrease normal lung tissue density, therefore less healthy tissuein path of irradiation,1)reduce PTV at th
14、e most large.,肺癌放疗中的运动管理,33,Defects of ABC techology, Initial patient set up Detecting patient movement duringtreatment Patient training Patient compliance Repeatability of breath holding Margins added to compensate for all the above,肺癌放疗中的运动管理,34,Special ways for intrafraction movement.,4.real-time
15、 tracking:equipment.,肺癌放疗中的运动管理,35,Special ways for intrafraction movement.,4.real-time tracking:Advantages.,4.real-time tracking:Defects.,1)initiative pathway.2)quality assurance and quality control is uncertain.3)algorithm is very complex.,1)dont observe where tumor is.,肺癌放疗中的运动管理,36,Average position,1)dont observe where tumor is.2)working procedure and equipment are easy.3) reduce PTV to a certain degree.4)decrease dose exposed on organ.,肺癌放疗中的运动管理,37,肺癌放疗中的运动管理,38,肺癌放疗中的运动管理,39,Thank You!,