同时优化多个计划在一个疗程与剂量寻径暂时羽毛放射治疗

IF 3.2 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Medical physics Pub Date : 2025-09-10 DOI:10.1002/mp.18123
Julius Arnold, Chengchen Zhu, Gian Guyer, Silvan Mueller, Barbara Knäusl, Olgun Elicin, Marco FM Stampanoni, Peter Manser, Michael K Fix, Jenny Bertholet
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引用次数: 0

摘要

放疗工作流程通常在整个治疗过程中多次提供一个治疗计划。与体积调制电弧治疗(VMAT)等广泛使用的技术相比,具有光束角优化或剂量优化寻路(DOP)的非共面技术利用额外的自由度来改善剂量分布的空间一致性。剂量递送的时间维度可以在一个疗程内使用多个计划(子计划)加以利用。例如,暂时羽状放射治疗(TFRT)使用等治疗子计划,与单一计划相比,向选定的高危器官(OARs)提供更高和更低剂量的交替,促进健康组织的动态恢复过程。本研究提出了一种基于直接孔径优化的同步优化框架,用于在一个疗程内优化多个共面或非共面子方案,并展示了其在TFRT规划中的应用。方法该框架的目标是使每个子计划或联合总计划剂量分布的加权上、下剂量-体积、广义等效均匀剂量和正常组织目标组成的目标函数最小化。创建参考VMAT和动态准直轨道放疗(collidtrt)单一计划,并用于导出TFRT计划的目标。将TFRT高到低剂量调制整合到客观列表中,并使用三种变化(“软”,“中”,“硬”)系统地研究了数字学术幻影。此外,一个“超软”变体对所有五个子计划使用相同的目标(即,没有高低剂量调制)。此外,为3例临床动机更为复杂的头颈部病例创建了带有碰撞- dtrt的“中等”TFRT子计划。结果:对于幻肢,子方案在1.6%的参考方案内达到98%的目标疗效。实现了高到低的OAR剂量调制,VMAT的高、低剂量部分的中位数Dmean差异为处方剂量的2.7%(软)、3.3%(中)和4.4%(硬)。coli - dtrt的中位OAR Dmean差异为处方剂量的2.8%(软)、6.3%(中)和6.1%(硬)。与参考方案相比,总方案剂量分布的均匀性指数较高(HI = D98%/D2%)。与参考方案相比,总方案中软、中、硬TFRT变化的OAR平均值较低。然而,在超软的变化中,10个有羽毛的桨中只有5个显示出这种减少。对于3例临床动机的coli - dtrt病例,高、低剂量部分的中位OAR Dmean差异分别为处方剂量的3.5%、4.2%和7.5%。总方案的剂量分布HIs高于各自的参考方案,除咽部外,所有有羽桨的Dmean均低于或等于参考方案。结论建立了一个疗程内多个共面或非共面子方案同时优化的框架。同时优化研究了一个幻影和三个临床动机的TFRT计划。与参考计划相比,在各子计划中实现了桨叶辐射剂量调制,同时增加了总计划剂量分布中的目标均匀性,减少了桨叶辐射剂量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy

Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy

Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy

Simultaneous optimization of multiple plans within one treatment course with dosimetric pathfinding for temporally feathered radiation therapy

Background

Radiotherapy workflows conventionally deliver one treatment plan multiple times throughout the treatment course. Non-coplanar techniques with beam angle optimization or dosimetrically optimized pathfinding (DOP) exploit additional degrees of freedom to improve spatial conformality of the dose distribution compared to widely used techniques like volumetric-modulated arc therapy (VMAT). The temporal dimension of dose delivery can be exploited using multiple plans (sub-plans) within one treatment course. For instance, temporally feathered radiation therapy (TFRT) uses iso-curative sub-plans to deliver an alternance of higher and lower doses compared to a single plan to selected organs-at-risk (OARs), facilitating the dynamic recovery process of healthy tissues.

Purpose

This study presents a simultaneous optimization framework based on direct aperture optimization with or without DOP to optimize multiple coplanar or non-coplanar sub-plans within one treatment course and demonstrates its use for TFRT planning.

Methods

The goal of the framework was to minimize an objective function consisting of weighted upper or lower dose-volume, generalized equivalent uniform dose, and normal tissue objectives set on the dose distribution of each sub-plan or the combined total plan. Reference VMAT and dynamic collimator trajectory radiotherapy (colli-DTRT) single plans were created and used to derive the objectives for TFRT planning. The TFRT high-to-low dose modulation was integrated into the objective list and systematically investigated for a digital academic phantom using three variations (“soft”, “medium”, “hard”). Additionally, a “super-soft” variation used the same objectives for all five sub-plans (i.e., no high-to-low dose modulation). Furthermore, “medium” TFRT sub-plans with colli-DTRT were created for three more complex clinically motivated head and neck cases.

Results

For the phantom, the sub-plans were iso-curative with target D98% within 1.6% of the reference plans. High-to-low OAR dose modulation was achieved with median Dmean differences between high and low dose fractions of 2.7% of the prescription dose (soft), 3.3% (medium), and 4.4% (hard) for VMAT. Median OAR Dmean differences were 2.8% of the prescription dose (soft), 6.3% (medium), and 6.1% (hard) for colli-DTRT. The dose distributions of the total plans had higher homogeneity indices (HI = D98%/D2%) compared to the reference plans. Lower OAR Dmean were achieved for the soft, medium, and hard TFRT variation in the total plans compared to the reference plan. However, in the super-soft variation only five of the 10 feathered OARs showed this reduction.

For the three clinically motivated cases with colli-DTRT, median OAR Dmean differences between the high and low dose fractions were 3.5%, 4.2%, and 7.5% of the prescription dose. The total plans’ dose distributions had higher HIs compared to their respective reference plans and lower or equal Dmean for all feathered OARs except for pharynx in one case.

Conclusion

A framework for the simultaneous optimization of multiple coplanar or non-coplanar sub-plans within one treatment course was developed. Simultaneous optimization was investigated with a phantom and three clinically motivated cases for TFRT planning. OAR dose modulation in the sub-plans was achieved while increasing target homogeneity and reducing OAR doses in the dose distribution of the total plans compared to the reference plans.

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来源期刊
Medical physics
Medical physics 医学-核医学
CiteScore
6.80
自引率
15.80%
发文量
660
审稿时长
1.7 months
期刊介绍: Medical Physics publishes original, high impact physics, imaging science, and engineering research that advances patient diagnosis and therapy through contributions in 1) Basic science developments with high potential for clinical translation 2) Clinical applications of cutting edge engineering and physics innovations 3) Broadly applicable and innovative clinical physics developments Medical Physics is a journal of global scope and reach. By publishing in Medical Physics your research will reach an international, multidisciplinary audience including practicing medical physicists as well as physics- and engineering based translational scientists. We work closely with authors of promising articles to improve their quality.
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