臺灣博碩士論文加值系統

呼吸產生的腫瘤移動是放射治療需要考量到的問題之一。 在治療過程中搭配呼吸調控(respiratory management)技術可以有效改善治療部位的劑量給予分布，而定期實施品質保證(quality assurance, QA)作業可確保監測系統之運作準確性，在QA測試上需可以呈現移動模擬假體輔以驗證。商業化動態假體即包含肺部腫瘤移行與體表起伏，但由於固態(rigid)材質的使用，相較於真實肺部組織的移動模式仍有其限制。
本研究旨在發展出一套自製形變式移動假體(deformable motion phantom) 模擬人體呼吸情況，嘗試以二維馬達驅動方式達到體內腫瘤及體表收張變化。材料與方法會從結構設計、材質選用逐一分析，並介紹假體原形機及移動參數設定。現階段實驗著重在假體自身再現性(reproducibility)測試，包含橫膈與內部形變、胸腔肋骨開閉。另外也將此假體先行運用於兩種監測系統之定位準確性測試。最後就實驗結果討論假體可行性及其需要再改進之處，以及未來實驗發展運用。

The tumor displacement caused by respiratory motion is one of issue that should be concern in radiotherapy. Using respiratory management technique can improve the dose distribution of treatment site effectively. Performing the quality assurance (QA) regularly can keep the constancy of monitoring system accuracy, and a simulation phantom could help us doing the QA process. Some commercialized motion phantom can provide tumor simulation and external extension, but due to the using of rigid material, there still have restriction comparing to the realistic lung motion pattern.
The aim of this study is to develop a home-made deformable motion phantom for human respiratory simulation, trying to use 2-dimentinal (2D) motor driving to perform internal and external deformity. The materials and methods would include structure design, materials selection, and the introduction of prototype machine parameter setting. The present experiment would focus on the reproducibility test of home-made phantom, including internal deformation of diaphragm /tumor and chest rib extension. Also, we applied the phantom with clinical system to perform localization accuracy test. In the end, we would base on the result of each experiment to discuss the feasibility of phantom, and figure out the improvement for future work.

目錄
中文摘要..........i
Abstract..........ii
目錄..........iii
圖目錄..........vi
表目錄..........ix
第1章 緒論
1.1前言..........1
1.2 文獻回顧..........2
1.2.1 體內標記偵測..........6
1.2.2 體表偵測..........7
1.2.3 肺容積量測..........8
1.2.4 治療技術..........9
1.3 研究目的..........12
1.3.1 假體發展..........13
1.3.2 設備與技術應用..........15
1.4 研究架構..........16
第2章 材料與方法
2.1 假體概念..........17
2.1.1 假體材質..........19
2.1.2 原形機與參數操作介面..........22
2.2 假體再現性驗證..........22
2.2.1 內部動態測試..........22
2.2.2 胸腔驅動再現性..........23
2.3 臨床設備應用..........24
2.3.1 VisionRT®系統..........24
2.3.2 電子驗證成像裝置..........27
2.3.3 靜態準確度比較..........28
2.3.4 體表動態監測..........29
第3章 實驗討論
3.1 內部動態測試..........30
3.2 胸腔驅動再現性..........33
3.3 臨床設備準確性應用..........35
3.3.1 靜態準確性..........35
3.3.2 VisionRT®相異ROI 動態量測比較..........39
第4章 結論..........42
第5章 未來發展
5.1 內部形變分析..........44
5.2 體積流量驗證..........44
5.3 移動關聯性..........45
5.4 臨床劑量驗證..........46
參考文獻..........47

圖目錄
圖1.1.1 十大癌症死因死亡率--105年vs. 95年。..........1
圖1.2.1 ICRU 62號報告中對各個靶體積的定義關係。PTV為CTV考慮到體內邊緣(IM)及設定邊緣(SM)所涵蓋的範圍。..........3
圖1.2.2 吸氣過程中(a)橫膈收縮往下移動與(b)肋間肌收縮拉提肋骨以增加胸腔空間直徑。..........4
圖1.2.1.1 (a)金製植入標記物(直徑2mm)，(b)標記於透視攝影定位系統下之顯示。..........6
圖1.2.2.1 (a)光學攝影方式、(b)體表呼吸振幅變化記錄。.......7
圖1.2.2.2 體表標記與體內腫瘤移動之時間比較，(a)無相位偏移、(b)具顯著性相位偏移。..........8
圖1.2.3.1 (a)使用肺量計(SDX®系統)之病人設置、(b)呼吸訊號記錄介面。..........9
圖1.2.4.1兩種柵控技術的概念圖示。(a)振幅柵控、(b)相位柵控。..........10
圖1.2.4.2 病人進行DIBH的呼吸曲線示意圖。深吸氣後屏氣容積變化如圖中的平坦部份呈現。..........11
圖1.2.4.3 分別使用(a)自由呼吸與(b)DIBH的矢狀切面CT。可以看到DIBH的腫瘤位置(白色輪廓)較自由呼吸時遠離脊髓的部份。.......11
圖1.3.1.1 可變形式肺部假體之變形示意圖，(a)吐氣相(b)吸氣相。..........14
圖1.3.1.2 加入外在體廓設計概念的形變式肺部假體。..........14
圖2.1.1 呼吸變化參考圖形。EI：吸氣終點、EE：吐氣終點。.....18
圖2.1.1.1 壓克力材質之模擬腫瘤。(a)直徑5 cm、(b) 直徑4 cm、(c) 直徑3 cm。..........21
圖2.2.1.1加上金屬標記線之模擬腫瘤。(a)直徑5 cm、(b) 直徑4 cm、(c) 直徑3 cm。..........23
圖2.3.1.1 VisionRT®於治療室內的安裝位置。(a)床板左右兩側、(b)床板上方。..........25
圖2.3.1.2 VisionRT® 操作介面。黃框處之紅色量表顯示該方向移動量超過系統設置移動範圍。..........26
圖2.3.1.3 VisionRT®每日品保用之校正板。..........26
圖2.3.2.1 (a)EPID於治療機器的安裝位置、(b)近觀。..........27
圖3.1.1 (a)腫瘤中心及(b)腫瘤下緣之移動量與橫膈吐氣相移動對應。..........31
圖3.1.2 腫瘤中心與下緣對應橫膈吐氣相移動量。..........32
圖3.2.1三組肋骨對應各馬達參數之移動量。..........34
圖3.3.1.1 兩系統量測修正值與實驗點的對應。..........36
圖3.3.1.2 兩系統量測值與實驗預測值之誤差分布趨勢。.........37
圖3.3.1.3 目標偏離影像中心之投影扭曲現象。..........38
圖3.3.2.1 各ROI量測振幅對時間分布圖形。(a) ROI-A / ROI-B / ROI-C、(b) ROI-A / ROI-U / ROI-M / ROI-L。..........41
圖5.2.1 體積再現分析示意圖。(a)吸氣相、(b)吐氣相。........44
圖5.4.1 臨床劑量驗證搭配調控技術概念示意圖。..........46

表目錄
表1.2.1 肺部腫瘤移動研究統計資料 (單位：mm) 。..........5
表1.3.1 與定位設備相關之品保報告。..........12
表2.1.1 各年齡層與性別平均胸廓移動量。..........18
表2.1.1.1 各假體模擬部位特性與材質。..........19
表2.1.1.2 常見人體組織CT值範圍對照。..........20
表2.1.1.3 實驗備選材料之CT值。..........20
表3.1.1 橫膈伸縮設定與各量測點之實際位移對應。..........32
表3.2.1 胸腔開閉設定與各量測點之實際位移對應(LR分量)。.....34
表3.3.2.1各ROI之量測最大振幅值、最小振幅值與對應框架速度。..........40
表5.3.1 呼吸訊號與腫瘤移動之關聯性研究整理。..........45

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