臺灣博碩士論文加值系統

影響放射治療成效的因素有很多，其中器官運動是造成治療效果下降的主要原因。在放射治療期間，器官會因為病患呼吸而持續地移動，也讓腫瘤的位置產生變化，導致放射線無法精準照射於腫瘤，使劑量覆蓋率不足，無法有效地消滅病灶。所以便有使用呼吸運動補償的方法，減少呼吸運動所產生的位移來提升治療效果，但是，從偵測呼吸訊號到補償呼吸訊號之間有系統延遲存在，導致補償效果可能不顯著，因此本研究的目的是提升本團隊先前開發的二維呼吸運動補償系統的補償效果。
本研究利用二維呼吸運動模擬系統(Respiratory Motion Simulation System,RMSS)以及二維呼吸運動補償系統(Respiratory Motion Compensation System,RMCS)進行呼吸運動補償之實驗，藉由本團隊先前開發之超音波影像追蹤演算法(Ultrasound Image Tracking Algorithm, UITA)擷取真實人體呼吸訊號，而且超音波檢查屬於非侵入式的偵測方式，所以不會對人體造成治療上額外的副作用。由於訊號傳輸過程中存在著系統延遲時間的影響，導致RMCS無法立即隨著RMSS進行反向運動因而產生補償誤差。因此本研究使用LabVIEW控制軟體開發一套利用小波轉換結合相位領先補償器應用於RMCS位移補償之演算法，讓RMCS能夠隨著各種不同的呼吸波形，自動且即時調控PLC之參數，降低系統延遲時間帶來的影響，達到更好的呼吸位移補償效果。最後使用RMSS和RMCS的編碼器讀取之位置訊號，計算均方根誤差(Root mean squared error, RMSE)與系統補償率(Compensation Rate , CR)兩種指標來評估RMCS的補償效果。
實驗結果顯示，在RL向和SI向的補償率皆有所提升，補償率在RL和SI向分別介於67.96%~88.05%和70.38%~91.43%之間，尤其在追蹤頻率較慢的呼吸訊號時具有較高的補償率，但在追蹤頻率較快與振幅瞬間大幅改變的呼吸訊號時，補償效果略為下降。
相較於本團隊先前開發的補償演算法，本研究將小波轉換結合PLC應用於RMCS進行人體呼吸位移補償實驗，能夠有效地提升補償率，其中補償呼吸頻率較慢的訊號有較大地提昇，而補償呼吸頻率較快的訊號略微提升。為了能夠降低放射治療的風險，除了提升RMCS的補償效果以外，未來將更進一步探討橫膈膜運動與腫瘤運動之間的轉換公式及開發AP向的運動補償設備，達到三維的呼吸運動補償。

There are many factors that affect the effectiveness of radiotherapy, among which organ movement is the main reason for the decline of the treatment effect. During radiotherapy, the organs will constantly move due to the patient breathe, which also changes the position of the tumor. As a result, the radiation cannot be accurately irradiated to the tumor, resulting in insufficient dose coverage and unable to effectively eliminate the lesion. Therefore, there is a method of using to compensate respiratory motion to reduce the displacement generated by the respiratory motion to improve the treatment effect. However, there is a system delay between the detection of the respiratory signal and the compensation of the respiratory signal, which may cause the compensation effect to be poor. Therefore, the purpose of the research is to improve the compensation effect of the two-dimensional respiratory motion compensation system previously developed by the team.
In this study, a two-dimensional respiratory simulation system (RMSS) and RMCS were used for respiratory movement compensation experiments. Our previously developed ultrasound image tracking algorithm (UITA) was used to capture human respiratory signals. Ultrasound is a non-invasive detection method and will not cause additional therapeutic effects on the human body. Due to signal in the transmission process, the system delay time causes the RMCS fail to move in the reverse direction along with the RMSS immediately, which results in compensation errors. Therefore, this study uses LabVIEW control software to develop an algorithm for RMCS in displacement compensation by using WT combined with a PLC, so that RMCS can automatically and real-time control the PLC parameters with various respiratory waveforms, thereby reducing the impact of system delay time and achieve a better compensation effect in respiratory movement. Finally, the position signals read by the RMSS and RMCS encoders were used to calculate the Root Mean Squared Error (RMSE) and compensation rate (CR) to evaluate the compensation effect of RMCS.
The experimental results show that the compensation rate in the RL and SI directions has been improved, and CR in the RL and SI directions is 67.96% - 88.05 % and 70.38% - 91.43%, respectively. Especially when tracking a repiratory signal with a slower frequency, it has a higher compensation rate; however, when tracking a repiratory signal with a faster frequency and a sharp change in amplitude, the compensation effect is slightly reduced.
Compared with the compensation algorithm previously developed by our team, this study applies wavelet transform combined with PLC to the RMCS for human respiratory displacement compensation experiments, which can effectively increase the compensation rate. Among them, the signal with slower respiratory rate is greatly improved. The signal that compensates for a faster breathing rate is slightly increased. In order to reduce the risk of radiotherapy, in addition to improving the compensation effect of RMCS, the conversion formula between diaphragm motion and tumor motion will be further explored in the future, and AP direction motion compensation equipment will be developed to achieve three-dimensional respiratory motion compensation.

目 錄

摘 要 i
ABSTRACT iii
誌 謝 vi
目 錄 vii
表目錄 x
圖目錄 xi
第一章 緒 論 1
1.1 前言 1
1.2 研究動機與目的 2
1.3 研究步驟與優勢 3
1.4 論文架構 5
第二章 文獻回顧 7
2.1 放射治療過程產生的影響 7
2.1.1治療範圍的誤差 7
2.1.2呼吸運動造成的影響 9
2.2 解決腫瘤運動的放射治療技術 10
2.2.1擴大目標治療範圍 11
2.2.2呼吸調控放射治療技術 13
2.2.3影像導引放射治療 14
2.2.4身體立體定位放射治療 14
2.2.5螺旋刀 16
2.2.6弧形刀 17
2.2.7電腦刀 19
2.2.8智慧型真光刀 20
2.2.9 質子刀 21
2.2.10呼吸運動位移補償 22
2.3 觀察呼吸運動的方式 24
2.3.1即時呼吸調控系統 24
2.3.2基準標記物 25
2.3.3四維電腦斷層掃描 28
2.3.4核磁共振 28
2.3.5正子電腦斷層造影 29
2.3.6超音波 30
2.5橫膈膜運動與腫瘤位移之相關性 31
2.6補償呼吸運動的控制方法 33
2.6.1相位領先補償器 33
2.6.2類神經網路預測 33
2.7時頻分析 34
2.7.1傅立葉轉換 34
2.7.2小波轉換 35
第三章 材料與方法 37
3.1實驗架構 37
3.2實驗設備 37
3.2.1二維呼吸運動模擬系統 38
3.2.2二維呼吸運動補償系統 39
3.2.3超音波影像追蹤系統 40
3.2.4實驗仿體 41
3.2.5控制系統軟體 42
3.3補償呼吸運動實驗 44
3.3.1實驗呼吸訊號 44
3.3.2實驗方法 46
3.3.3相位領先補償器 47
3.3.4自動偵測呼吸頻率程式 48
3.3.5小波轉換 48
3.3.6呼吸運動補償系統之追蹤誤差 50
第四章 結果與討論 51
4.1結果 51
4.2討論 56
第五章 結論與未來研究方向 59
5.1結論 59
5.2未來展望 59
參考文獻 60

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