Different styles of image-guided radiotherapy
Different styles of image-guided radiotherapy
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DOI：
10.1016/j.semradonc.2007.07.003
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发表时间：
2007-10-01
影响因子：
3.5
通讯作者：
van Herk, Marcel
中科院分区：
文献类型：
--
作者：
van Herk, Marcel
考虑到放射治疗期间的几何不确定性，应用了安全裕度。在许多情况下，这些边缘与风险器官重叠，从而限制了剂量递增。图像引导放射治疗的目的是通过在照射前在机器上对肿瘤和关键结构进行成像来提高准确性。高质量的成像系统和机器上的自动图像配准的可用性导致了许多新的临床应用，例如脑转移瘤和孤立长肿瘤的高精度低分割治疗，以及在线肿瘤位置校正。在这篇综述中，首先描述了图像引导在计划、图像采集和处理方面的先决条件。然后，讨论了各种校正方法，如工作台移位和旋转以及机器参数的直接自适应。然后，在线，离线，和馏分内校正策略进行了讨论。最后，一些成像剂量问题进行了讨论，显示千伏锥束计算机断层扫描的指导有一个净的积极影响的积分剂量，利润减少所造成的增益大于图像剂量。我们可以得出结论，图像引导放射治疗是非常临床现实和最佳的临床协议的发展，目前应该是研究的重点。
To account for geometric uncertainties during radiotherapy, safety margins are applied. In many cases, these margins overlap organs at risk, thereby limiting dose escalation. The aim of image-guided radiotherapy is to improve the accuracy by imaging tumors and critical structures on the machine just before irradiation. The availability of high-quality imaging systems and automatic image registration on the machine leads to many new clinical applications, such as high-precision hypofractionated treatments of brain metastases and solitary long tumors with online tumor position corrections. In this review, the prerequisites for image guidance in terms of planning, image acquisition, and processing are first described. Then, the various methods of correction are discussed such as table shifts and rotation and direct adaptation of machine parameters. Then, online, offline, and intrafraction correction strategies are discussed. Finally, some imaging dose issues are discussed showing that kilovoltage cone-beam computed tomography guidance has a net positive impact on the integral dose; the gain caused by margin reduction is larger than the image dose. We can conclude that image-guided radiotherapy is very much a clinical reality and that the development of optimal clinical protocols should currently be the focus of research.