TREATMENT INDIVIDUALIZATION AMID GEOMETRIC UNCERTAINTY

几何不确定性中的个体化治疗

• 批准号: 8102827
• 负责人: RANDALL K TEN HAKEN
• 金额: $ 40.25万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/8102827
• 关键词: Accounting; Anatomy; Area; Breathing; Clinical; Communities; Complex; Conformal Radiotherapy; Data; Databases; Devices; Dose; Ensure; Error Sources; Evaluation; Exhibits; Face; Goals; Human; Image; Immobilization; Individual; Intervention; Investigation; Knowledge; Measurement; Measures; Methodology; Methods; Metric; Modeling; Modification; Monitor; Motion; Movement; Organ; Outcome; Patients; Planning Techniques; Positioning Attribute; Principal Investigator; Radiation therapy; Relative (related person); Research; Resources; Risk; Shapes; System; Techniques; Time; Time Study; Tissues; Toxic effect; Uncertainty; Update; Variant; improved; meetings; population based; process optimization; programs; reconstruction; soft tissue; tool; treatment planning; tumor

This project will study the incorporation of individual patient related geometric uncertainties in the calculation, compilation and treatment of optimized radiotherapy dose distributions. Even advanced treatment planning techniques nearly always rely on population-based rules to ensure that the majority of patients receive adequate dose in the face of positioning errors and organ motion. This "one size fits all" approach potentially penalizes patients who exhibit exceptionally large variation in position or motion, requiring more intensive measures to ensure adequate target volume coverage. However, it also penalizes a substantial proportion of patients with less uncertainty in their target position, who through the use of smaller margins would be at lesser risk for treatment related toxicity or eligible for higher tumor dose. We believe that a new combined approach involving a) dose computation strategies that already include the effects of geometric uncertainties, b) rigorous in-room methodologies for rapidly assessing target and patient configuration and c) accounting for delivered dose and its influence on subsequent treatment delivery optimization will yield improvements in efficient and accurate dose delivery, optimally tailored for each patient. Thus, the project's specific aims are to 1) implement general clinical frameworks for inclusion of patient related setup uncertainties and organ motion into the computation of dose distributions, 2) assess improvements in accuracy achieved through inroom, on-treatment measurement and action, 3) investigate human anatomic changes over short and long time periods and how to accumulate dose to date using this information, and 4) determine the best ways to react to differences between what is seen at treatment and what had been planned. In addition to better tailoring overall treatments, these investigations will help determine how much complexity (in modeling, measurement and intervention) is actually beneficial for a given patient, thus helping to establish the most efficient use of advanced in-room imaging resources within the radiotherapy community.

该项目将研究将单个患者相关的几何不确定性纳入计算， 优化放疗剂量分布的汇编和处理。甚至高级治疗计划 技术几乎总是依靠基于人群的规则来确保大多数患者接受 面对定位错误和器官运动的足够剂量。这种“一种尺寸适合所有”的方法可能有可能 惩罚表现出极大差异的位置或运动差异的患者，需要更密集 确保足够目标量覆盖率的措施。但是，这也惩罚了很大一部分 目标位置不确定性较小的患者，通过使用较小的边缘将是 较小的治疗风险相关毒性或有资格接受较高的肿瘤剂量。我们相信新的合并 涉及a）剂量计算策略的方法已经包括几何不确定性的影响， b）用于快速评估目标和患者配置和c）会计的严格室内方法论 对于交付的剂量及其对随后的治疗交付优化的影响将产生改善 在有效，准确的剂量递送中，适合每个患者的最佳量身定制。因此，项目的具体目的是 到1）实施一般临床框架，以包括患者相关的设置不确定性和器官 运动剂量分布计算，2）评估通过房间实现准确性的改进， 治疗测量和作用，3）研究人类解剖变化在短而长 时间段以及如何使用此信息来累积剂量，以及4）确定最佳方法 对治疗中所见的差异与计划的内容之间的差异做出反应。除了更好 调整整体治疗方法，这些研究将有助于确定多少复杂性（在建模中， 测量和干预）实际上对给定患者是有益的，因此有助于确定最多的患者 放射治疗社区内有效利用先进的室内成像资源。