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研究生:李星怡
研究生(外文):Hsing-Yi Lee
論文名稱:發展簡化式強度調控程式於全乳房放射治療之臨床應用
論文名稱(外文):A Simplified Method for The Intact Breast
指導教授:李俊信李俊信引用關係徐椿壽
指導教授(外文):Jason J. S. LeeChen-Shou Chui
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:放射醫學科學研究所
學門:醫藥衛生學門
學類:醫學技術及檢驗學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:74
中文關鍵詞:全乳房治療強度調控放射線治療多葉式準直儀
外文關鍵詞:Breast cancerIMRTMultileaf collimator
相關次數:
  • 被引用被引用:1
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  • 下載下載:44
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中文摘要

此篇論文與程式撰寫主要使用一個簡化式的強度調控放射治療技術來達到全乳房的放射治療,此技術的優點是能夠快速計算強度調控照野用以提供全乳房組織均勻的劑量分布。
  先使用傳統的兩相切照野來包含治療部位的全乳房組織,並求得個別照野中每一單位線射束( pencil beam )中在乳房組織中與另一照野角度射源有相同等效深度的中點。計算此些中點在兩傳統相切照野中所得的劑量,使乳房組織劑量均勻的理想強度分布與此計算而得的劑量呈現反比的關聯。若能有效的給予計算而得的理想強度分布,這些求得之中點在兩相切照野中將得到均等劑量,全乳房組織便能得到均勻的劑量分布。
  如何有效並準確的執行這理想的強度分布便成為很重要的問題,利用R. Alfredo C. Siochi所提出的多葉式準直儀編排的演算法rod push method來計算使用靜態式多葉式準直儀的強度調控照野。利用演算法而得的強度調控照野以及其相對強度比重輸入於臨床中所使用的電腦治療計畫系統計算最終治療劑量,全乳房組織如預期的得到相當均勻的劑量分布以及包覆性,組織中最高劑量點不超出要求劑量(prescribed dose)的110%。
  此用於全乳房治療的簡化式調控放射治療技術可以提供均勻的治療劑量並有效地節省臨床上治療計畫規劃所耗費的時間。

關鍵字:全乳房治療、強度調控放射線治療、多葉式準直儀。
Abstract

This study investigated a simplified IMRT technique for the intact breast therapy. The technique aims to produce a uniform dose distribution in the entire breast volume. Using the standard tangential beam arrangement, each pencil beam is followed until a midpoint is found such that the effective depths from the opposing pencil beams to the midpoint are equal. The dose to the midpoint from the open field is then calculated. The intensity of the pencil beam is determined as proportional to the inverse of the open field dose. With this intensity modulated beam, the dose delivered to the midpoints of all pencil beam are now equalized. A question in IMRT is how to deliver these intensity modulated beams efficiently and accurately. The leaf sequencing algorithms proposed by R. Alfredo C. Siochi were used to minimize the delivery time for static intensity modulated fields. These algorithms minimize the number of segments for a given intensity modulated field and maximize the irradiation area for each segment. Once the total numbers of required segments, their corresponding leaf positions and the relative intensity delivery units have been determined, this information is sent to the treatment planning system for final dose calculation. The resultant dose distribution in the entire treatment volume is nearly as uniform as can be achieved under the given beam arrangement.
This simplified and efficient IMRT technique for the intact breast treatment can be implemented in a clinic where breast patients represent a significant portion of the total patient load, without requiring significantly increased resources.

Keyword: Breast cancer, Intensity modulated radiation therapy, Multileaf collimator.
目錄 iv
中文摘要 vii
英文摘要 viii
附圖索引 ix
附表索引 xiii
第一章 緒論
1.1 前言 1
1.2 乳房周邊相關解剖位置與組織分期 2
1.2.1 乳房小葉和乳管 2
1.2.2 淋巴管 3
1.2.3 乳房周邊淋巴系統 3
1.2.4 乳癌分期 4
1.3 全乳房放射治療固定模具與方法 6
1.3.1 乳房治療斜板Breast Board 6
1.3.2 真空墊Vacuum Sac 9
1.3.3 熱塑型模具Thermoplastic cast 10
1.4 全乳房放射治療技術回顧與發展 11
1.4.1 傳統楔型濾片相切照野 11
1.4.2 正向式強度調控放射線治療(Forward IMRT) 14
1.4.3 逆向式強度調控放射線治療(Inverse IMRT) 15
1.5 研究背景 16
1.6 研究目的 17
1.7 相關文獻回顧 17
第二章 程式原理與方法
2.1 使用材料 21
2.1.1 程式軟體 21
2.1.2 電腦治療計畫系統 21
2.2 放射治療計畫系統介紹 21
2.2.1 放射治療計畫系統架構 21
2.2.2 放射治療計畫系統執行流程 25
2.2.3 程式支援全乳房治療計畫流程 27
2.3 射束照野規劃 28
2.4 理想強度分布計算 30
2.5 多葉式準直儀照野位置切割 33
2.5.1 強度矩陣 34
2.5.2 rod push method 36
2.6 治療劑量計算 38
2.6.1 劑量計算原理 38
2.6.2 非均質修正演算法 39
2.6.2.1 路徑長度修正法 40
2.6.2.2 等效組織空氣比修正法 42
2.6.3 劑量計算結果評估 43
2.6.3.1 等劑量曲線分布 43
2.6.3.2 劑量體積圖評估 46
第三章 劑量驗證
3.1 劑量驗證假體 48
3.1.1 固態水假體 48
3.1.2 非均質組織假體 48
3.2 劑量量測工具 50
3.2.1 游離腔偵檢器 50
3.2.2 劑量驗證軟片 51
3.3 驗證方法 53
3.3.1 點劑量量測 54
3.3.2 平面劑量量測 56
3.4 驗證結果 55
3.4.1 點劑量驗證結果 57
3.4.2 平面劑量驗證結果 58
第四章 結果與討論
4.1 簡化式強度調控程式 61
4.2 理想強度分布 61
4.3 多葉式準直儀照野位置切割 63
4.4 劑量分布比較 65
4.5 計畫規劃時間、次照野數目與總監控單位比較 67
第五章 結論與未來展望 69
參考文獻 71
參考文獻

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