Dose Uncertainty Management and Probabilistic Planning

放射治疗技术的发展与机载3D靶向的改进 成像和实时自适应调强放射治疗重新计划使更多适形剂量的交付成为可能 与既往放射治疗相比，对边际大幅降低的靶点的分布 练习一下。图像引导自适应放射治疗(IGART)的一个关键组成部分是计划和跟踪 患者解剖的多个变形表现的剂量分布。执行如此复杂的操作 快速调强放射治疗优化背景下的剂量计算提出了许多科学挑战。第一 变形解剖的剂量计算可能会增加剂量不确定性，从而导致减少 治疗效果。其次，IGART的最佳应用将要求精确的剂量计算 执行速度比目前的算法快得多。最后，即使是在3D飞机上 应用基于成像的设置调整，剩余的系统和随机不确定性将保持不变 需要在规划时加以考虑。 该项目的目标是：(1)开发评估和尽量减少剂量误差和剂量的方法 通过添加在患者不同表现形式下获得的剂量分布引入的不确定度 解剖，以准确量化和确保IGART的有效剂量传递。(2)发展和发展 验证用于变形图像集的高效、准确的剂量算法，以实现快速计划重新 IGART的优化和方案重新评估。(3)开发和比较计算残差的方法 IGART治疗计划调强放疗优化过程中剂量学和靶向的不确定性和误差 送货。 该计划的长期目标是开发和实施最佳的IGART方法，以使用 这些方法可实现每部分剂量的递增，并通过提供 剂量不确定度最小的高保角剂量分布。 该项目将通过开发技术来改善辐射的量化，从而使公众健康受益 随着患者解剖结构的变化，在整个放射治疗过程中给予患者的治疗剂量 由于对治疗或其他过程的反应。该项目将开发技术，以减少 照射正常组织的量，从而能够降低并发症发生率并改善 接受放射治疗的患者的控制率。

The evolution of radiation therapy treatment techniques coupled with improved targeting by 3D onboard imaging and real-time adaptive IMRT replanning makes possible the delivery of more conformal dose distributions to targets with substantially reduced margins in comparison with historical radiation therapy practice. A key component of image guided adaptive radiation therapy (IGART) is planning and tracking of dose distributions on multiple deforming presentations of the patient anatomy. Performing such complex dose calculations in the context of rapid IMRT optimization presents a number of scientific challenges. First dose computation on deforming anatomies may add dose uncertainties, which results in decreased treatment effectiveness. Secondly, optimal IGART application will require that accurate dose calculations be performed much more rapidly than is possible with present algorithms. Finally, even when onboard 3D imaging-based setup adjustments are applied, residual systematic and random uncertainties will remain and need to be considered during planning. The goals of this Project are: (1) To develop methods to evaluate and minimize dose errors and dose uncertainty introduced by adding dose distributions acquired at different presentations of the patient's anatomy so as to accurately quantify and ensure effective dose delivery for IGART. (2) To develop and validate efficient, accurate dose algorithms for use with deformed image sets so as to enable rapid plan re- optimization and plan re-evaluation for IGART. (3) To develop and compare methods to account for residual dosimetric and targeting uncertainties and errors during plan IMRT optimization for IGART treatment delivery. The long term objectives of this Program are to develop and implement optimal IGART methods, to use these methods to enable dose-per-fraction escalation, and to improve patient outcomes through delivery of highly conformal dose distributions with minimal dose uncertainty. This project will benefit public health by developing techniques that will improve quantification of radiation therapy doses delivered to patients throughout their course of radiation therapy as their anatomy changes due to responses to the treatment or other processes. The project will develop techniques to reduce the amount of normal tissues irradiated, thereby enabling a reduction in complication rates and improvement in control rates for patients treated with radiationtherapy.