臺灣博碩士論文加值系統

本研究使用編修直線加速器內建之多葉式準直儀（MultiLeaf Collimator）之葉片移動描述檔案（leaf sequences file），改變其放射線照野強度分布，進而應用在臨床放射治療以解決技術上的難題而達到準確的劑量給予。本研究中處理兩個問題：1. 呼吸運動造成放射治療劑量與預期劑量會不一致。針對此議題本研究提出使用動態式多葉準直儀技術（DMLC）做動態追蹤照射（dynamic tracking）之可行性研究，確認在良好的同步追蹤前提下可以達到正確的照射劑量。2. 在空間受限的小治療室中難以兼顧照射劑量均勻及準確降低肺部劑量之臨床需求。本研究使用編修之DMLC雙照野銜接方法施行正反面（AP/PA）照射，經使用假體做劑量驗證後顯示可符合臨床之需求。

we applied an aperture adaptive technique with a visual guiding system to tackle the problem of respiratory motion. A homemade computer program showing a cyclic respiratory pattern was projected onto the ceiling to visually help the patient adjust their respiration. Once the respiratory motion became regular, the leaf sequence could be synchronized with the target motion. An oscillator was employed to simulate the patient’s breathing pattern. Two simple fields and one IMRT field were measured to verify the accuracy. Preliminary results showed that after appropriate training, the amplitude and duration of a volunteer’s breathing could be well controlled by the visual guiding system. The high dose gradient at the edges of the radiation fields were successfully retained. The aperture adaptive technique with the visual guiding system can be an inexpensive and feasible alternative without compromising delivery efficiency in clinical practice.
this study was to develop a total body irradiation technique that does not require additional devices or sophisticated procedures to overcome the space limitation of a small treatment room by modifying the leaf sequences of intensity modulated fields.The technique treated the patient lying on the floor anteriorly and posteriorly. For each AP/PA treatment, two complementary fields with dynamic field edges were matched over an overlapped region defined by the marks on the body surface.The results confirmed that the technique is capable of delivering a uniform dose distribution to the midline of the body in a small treatment room while keeping the lung dose within the tolerance level.

Abstract I
誌謝 III
Table of Contents IV
List of Figures VII
List of Tables XII
Chapter 1. Introduction 1
Chapter 2. Dynamic multileaf collimator (DMLC) 5
2.1. MLC design and structure 5
2.2. Dynamic intensity modulated radiotherapy (IMRT) 8
2.2.1. The generation of DMLC 9
2.2.2. Leaf motion calculator (LMC) 11
2.2.3. Leaf sequences algorithm 13
2.2.4. Large IMRT field splitting 16
2.2.5. Dynalog file viewer (DFV) 19
Chapter 3. The management of respiratory motion 22
3.1. Dose delivery under free breathing 24
3.2. Dose delivery with breath hold 25
3.3. Treatments incorporate Gating technique 26
3.4. Active breathing control during radiation delivery 27
3.5. Dynamic tracking of target motion 27
Chapter 4. Total body irradiation (TBI) 32
4.1. Conventional TBI treatment 32
4.2. Beam delivery with gantry rotation 33
4.3. Beam delivery with couch Translation 36
4.4. Linac-base intensity modulated TBI 38
4.5. TBI delivery with Helical tomotherapy 41
Chapter 5. Correction of respiratory motion for IMRT using aperture adaptive technique and visual guidance 42
5.1. Introduction 42
5.2. Methods and Materials 45
5.2.1. Synchronization 45
5.2.2. Visual guidance of patient’s respiratory motion 46
5.2.3. Simulating respiratory motion 47
5.2.4. Simple field measurements 49
5.2.5. IMRT field measurements 49
5.2.6. Verifying effects of visual guiding system 50
5.3. Results 50
5.4. Discussion 56
Chapter 6. Total body irradiation with step translation and dynamic field-matching 60
6.1. Introduction 60
6.2. Materials and methods 63
6.2.1. Dynamic field-matching 64
6.2.2. Dynamic MLC field editing 66
6.2.3. Treatment setup 67
6.2.4. Beam intensity compensator 69
6.2.5. Optimal overlapping widths in the phantom 70
6.2.6. Dose profiles in the overlapped region at different depths 71
6.2.7. Total dose profile of the dynamic matching fields 72
6.2.8. Percentage depth dose in the buildup region 73
6.2.9. Rando phantom dosimetry 73
6.3. Results 74
6.3.1. Beam intensity compensator 74
6.3.2. Optimal overlap width of dynamic matching fields 75
6.3.3. Dose profiles in the overlapped region at depths 79
6.3.4. Total dose profiles of dynamic matching fields 80
6.3.5. Percentage depth dose in the buildup region 81
6.3.6. Rando phantom dosimetry 83
6.4. Discussion 88
Chapter 7. Conclusions and future works 94
References 97

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