Comprehensive analysis and mitigation of the clinical effects of delineation and geometric uncertainties in conformal radiation therapy

项目总结/摘要 放射治疗（RT）输送的进展寻求改善剂量符合性以提高治疗比。一 该过程中的关键步骤是描绘治疗目标和正常组织避开区域。作为 如果不考虑描绘变异性，则描绘体积周围的治疗边界缩小， 通过不同的描绘器、不同的成像模式和不同的结构映射识别体积 算法可以支配个体患者治疗的功效和治疗的集体结果。 临床试验虽然应通过改善描绘一致性来提高疗效，但改善基线 成像（包括功能成像），以更清楚地看到组织，并改进了可变形配准 算法，以更好地对齐来自不同图像的轮廓，从这种改进中受益， 直到量化和传达患者特异性残留的临床影响的方法 这些过程中存在不确定性。不确定性量化既能缓解也能确定 当进一步的不确定性降低没有带来好处时。该项目旨在（1）确定临床情况， 该描绘可变性根据其它固有治疗对治疗功效产生负面影响 不确定性，（2）模型描绘可变性，以便可以在每个患者的基础上进行估计， 与治疗团队沟通，以及（3）制定治疗计划和实施方法， 放射治疗中的轮廓和其他不确定性的联合效应，从而产生有效的放射 治疗计划

Project Summary / Abstract Advances in radiotherapy (RT) delivery seek to improve dose conformity to increase the therapeutic ratio. A key step in this process is the delineation of treatment targets and normal tissue avoidance regions. As treatment margins around delineated volumes shrink, if delineation variability is not accounted for, disparate volumes identified by different delineators, different imaging modalities, and different structure mapping algorithms may dominate the efficacy of both an individual patients' treatment and the collective results of clinical trials. While efficacy should be enhanced with improved delineation consistency, improved baseline imaging (including functional imaging) to more clearly see the tissues, and improved deformable registration algorithms to better align delineations from different images, benefits from such improvements will be jeopardized until methods to quantify and communicate the clinical effects of the patient-specific residual uncertainties in these processes exist. Uncertainty quantification enables mitigation as well as determination of when further uncertainty reductions provide no benefit. This project aims to (1) identify clinical situations in which delineation variability negatively impacts treatment efficacy in light of other inherent treatment uncertainties, (2) model delineation variability so that it may be estimated on a per-patient basis and communicated to the treatment team, and (3) develop treatment planning and delivery methods that mitigate the joint effect of delineation and other uncertainties in radiation therapy, thereby creating efficacious radiation therapy treatment plans.