臺灣博碩士論文加值系統

導航螺旋刀又稱為「電腦斷層治療機」，正如同電腦斷層掃描儀掃描方式來給予劑量交付，所以在製作放射治療計畫規劃時有幾種特別的參數設定，分別為照野寬度（field width, FW）、調變因子（modulation factor, MF）與螺距（pitch），本研究主要為探討照野寬度與調變因子參數設定對於導航螺旋刀治療鼻咽癌電腦治療計畫品質的影響。材料方法以擬人形假體 (RANDO® Alderson）模擬臨床鼻咽癌病患治療靶體積與危急器官位置，並進行相同的最佳化疊代次數演算與相同的治療靶體積與危急器官權重，且另一個重要的關鍵為治療靶體積至少要有95 % 包覆性。僅改變不同照野寬度（FW = 1, 2,5, 5 cm）與不同調變因子（MF =1.0 ~ 5.0），每0.2為一個間隔）之參數設定，進行放射治療電腦計畫最佳化疊代次數演算，共設計63個組合放射治療計畫，並分析與比較其劑量分布、治療時間、劑量交付之品質驗證。
研究結果顯示使用1公分照野寬度可以更明顯減少危急器官所接受的劑量（p < 0.0001）。另外要獲得可接受的放射治療計畫，其調變因子參數設定最低限制皆為2.0，而調變的最佳速率的上限分別為2.8、3.0、3.4。照射時間與照野寬度有明顯相關，若以照野寬度5公分治療時間比值為1時，照野寬度1公分、2.5公分、5公分在治療時間比值分別為3.7 : 1.7 : 1。導航螺旋刀放射治療鼻咽癌之治療計畫，臨床上若考慮降低危急器官的劑量，則可以使用較小的照野寬度，但需要較長之治療時間。若考慮縮短治療時間，可使用較大的照野寬度，但需要注意治療靶體積外頭腳方向高劑量外擴現象。

Tomotherapy just as computer tomography scanning administered dose delivery, so there are several special parameters set in the treatment planning, respectively according to the field width (FW), modulation factor (MF) and pitch. This study examines the relationship between these parameters and their influence on the quality of the nasopharyngeal cancer treatment plans and their execution time on Tomotherapy. Target volumes and organ at risk (OAR) volumes were delineated on a computerized tomography of a phantom (RANDO® Alderson). Maintaining the weightings of each volume, treatment plans were optimized with a different combination of planning parameters (FW = 1, 2.5, 5 cm. MF =1.0 ~ 5.0 in step at 0.2). Background a key aspect of treatment planning is the coverage of the PTV by the 95% isodose. 63 different plans in terms of FW and MF were prepared. Each plan was analyzed for dose distribution, treatment time, delivery quality assurance and ripple effect.
The results show that using the field width of 1cm can more significantly reduce the of the critical organ doses received (p <0.0001). The ratio between treatment time with different field widths, when treatment time at 5 cm was 1, 1.8 and 4 times at widths of 2.5 cm and 1 cm respectively. Analysis of the quality of the obtained treatment plans allows one to specify the lower limit of the optimum MF for the nasopharyngeal cancer at the level of 2.0. And analysis of individual treatment plan time execution allows one to specify the upper limit of the optimal MF factor at the level of 2.8, 3.0 and 3.4, in the FW = 1, 2,5, 5 cm. Field width could lead to change in treatment time. Combination of small field width and small pitch yielded better planning quality, and increase in treatment time. Treatment time could be shortened with combination of large field width, at expense of increased dose to longitudinal directions.

第一章 緒論
1.1 前言
1.2 研究動機與目的
1.3 研究預期貢獻

第二章 基礎介紹
2.1 鼻咽癌介紹
2.1.1 鼻咽癌流行病學與病因
2.1.2 鼻咽癌之臨床表現與診斷
2.1.3 鼻咽癌之分期
2.1.3 鼻咽癌之治療方式
2.2 放射治療介紹
2.2.1 放射治療流程
2.2.2 輔助模具製作
2.2.3 電腦斷層模擬定位攝影
2.2.4 電腦治療計畫
2.2.5 劑量交付品質保證驗證
2.2.6 治療位置之影像驗證
2.3 導航螺旋刀介紹

第三章 研究材料與方法
3.1 研究設計
3.2 研究材料
3.2.1 侖道假體 (Rando Phantom)
3.2.2 導航螺旋刀系統
3.2.3 游離腔
3.2.4 二維劑量驗證系統與計讀系統
3.2.5 八角形假體 (Octavius Phantom)
3.3 研究方法
3.1.1 模擬定位
3.1.2 電腦斷層模擬定位掃描
3.1.3 靶體積勾畫與處方劑量
3.1.4 危急器官勾畫與耐受劑量限制
3.1.5 電腦治療計畫制定標準
3.1.6 執行放射治療及劑量交付品質保證之劑量測量
3.4 統計分析

第四章 結果
4.1 照野寬度1公分與不同調變因子電腦治療計畫
4.2 照野寬度2.5公分與不同調變因子電腦治療計畫
4.3 照野寬度5公分之與同調變因子電腦治療計畫
4.4 照野寬度1公分、2.5公分與5公分之電腦治療計畫比較

第五章 討論
5.1強度調控放射治療技術比較
5.2照野寬度與調變因子對治療靶體積的影響
5.3照野寬度與調變因子對危急器官之吸收劑量的影響
5.4照野寬度與調變因子對治療時間的影響
5.2照野寬度與調變因子對劑量交付品質驗證的影響

第六章 結論

一、英文部分
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二、中文部分
1.行政院衛生福利部國民健康署網站http://www.hpa.gov.tw (103年2月查詢)
2.國家衛生研究院鼻咽癌臨床診療指引(2011年版)