TREATMENT INDIVIDUALIZATION AMID GEOMETRIC UNCERTAINTY

该项目将研究在计算中纳入个别患者相关的几何不确定性， 优化放射治疗剂量分布的汇编和治疗。即使是高级治疗计划 技术几乎总是依赖于基于人口的规则来确保大多数患者 在面对定位误差和器官运动的情况下，适当的剂量。这种“一刀切”的方法有可能 惩罚那些姿势或运动变化特别大的患者，需要更多的强化训练 确保足够的目标数量覆盖率的措施。然而，它也惩罚了相当大比例的 目标体位不确定性较小的患者，通过使用较小的利润率将处于 与治疗相关的毒性风险较低，或有资格获得更高的肿瘤剂量。我们相信，一个新的联合 涉及a)已包括几何不确定性影响的剂量计算策略的方法， B)用于快速评估目标和患者配置以及c)核算的严格的室内方法 对于提供的剂量及其对后续治疗的影响，提供优化将产生改进 高效、准确的剂量传递，为每个患者量身定做。因此，该项目的具体目标是 1)实施一般临床框架，以纳入与患者相关的设置不确定性和器官 移动到剂量分布的计算中，2)评估通过InRoom实现的精度改进， 治疗中的测量和行动，3)调查人体在短和长时间内的解剖变化 时间段以及如何使用这些信息积累迄今的剂量，以及4)确定最佳方法 对治疗中看到的和计划的之间的差异做出反应。除了更好的 量身定做整体治疗，这些调查将有助于确定复杂性有多大(在建模中， 测量和干预)实际上对给定的患者是有益的，因此有助于建立最 在放射治疗社区内高效使用先进的室内影像资源。

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.