TREATMENT INDIVIDUALIZATION AMID GEOMETRIC UNCERTAINTY

该项目将研究在计算中纳入与个体患者相关的几何不确定性， 编辑和处理优化的放射治疗剂量分布。甚至先进的治疗计划 技术几乎总是依赖于基于人群的规则，以确保大多数患者接受 在面对定位误差和器官运动的情况下提供足够的剂量。这种“一刀切”的做法可能会 惩罚那些在位置或运动上表现出异常大的变化的患者，需要更密集的 采取措施确保适当的目标量覆盖。然而，它也惩罚了很大一部分人， 目标位置不确定性较小的患者，通过使用较小的边缘， 治疗相关毒性的风险较低或适合较高的肿瘤剂量。我们相信一个新的组合 方法涉及a）已经包括几何不确定性的影响的剂量计算策略， B）用于快速评估目标和患者配置的严格室内方法，以及c）核算 对于输送剂量及其对后续治疗输送优化的影响， 为每位患者量身定制的高效、准确的剂量输送。因此，该项目的具体目标是 1）实施一般临床框架，以纳入患者相关的设置不确定性和器官 运动到剂量分布的计算中，2）评估通过室内， 治疗中的测量和行动，3）调查人体解剖学变化，在短期和长期 时间段以及如何使用该信息累积剂量，以及4）确定最佳方法， 对治疗时所见与计划之间的差异作出反应。除了更好的 剪裁整体治疗，这些调查将有助于确定有多少复杂性（在建模， 测量和干预）实际上对给定的患者有益，从而帮助建立最 在放射治疗领域有效利用先进的室内成像资源。

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.