Tracking Organ Doses for Patient Safety in Radiation Therapy

跟踪器官剂量以确保放射治疗中的患者安全

• 批准号: 9326287
• 负责人: Jun Deng
• 金额: $ 37.69万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9326287
• 关键词: Adverse effects; Algorithms; Anatomy; Archives; Back; Brachytherapy; Caring; Clinic; Clinical; Clinical effectiveness; Community Clinical Oncology Program; Dangerousness; Data; Databases; Deposition; Diagnostic Procedure; Dose; Effectiveness; Electrons; Extravasation; Geography; Goals; Head; Image; Institutional Review Boards; Intervention; Ionizing radiation; Lesion; Literature; Location; Maps; Measurement; Methods; Modernization; Monte Carlo Method; Normal tissue morphology; Oceans; Organ; Patient Simulation; Patients; Pelvis; Photons; Procedures; Protons; Publishing; Radiation; Radiation Oncology; Radiation Tolerance; Radiation induced damage; Radiation therapy; Recruitment Activity; Risk; Roentgen Rays; Safety; Scanning; Second Primary Cancers; Shapes; Source; System; Technology; Therapeutic; Therapeutic procedure; Time; Toxic effect; United States; Update; Water; Work; base; cancer risk; clinically relevant; image guided; image registration; improved; individual patient; interest; killings; novel; patient safety; prevent; radiation response; radiosensitive; treatment duration; treatment planning; tumor; voltage

Abstract The ultimate goal of radiation therapy is to maximize tumor killing with lethal radiation doses while minimizing normal tissue damage during radiation treatment. Although tumor control has been improved significantly with the advent of advanced beam delivery and image-guidance technologies, normal tissue toxicity continues to be of growing concern in the clinic. There are four major reasons: (1) leakage and scatter doses associated with advanced beam delivery are not accurately considered by commercial treatment planning system (TPS) dose calculation methods; (2) TPS dose calculations are only performed for contoured organs within a patient's anatomical volume of interest while providing no dose information for non-contoured organs; (3) organ doses on treatment day can be quite different from planned doses due to changes in organ volume, shape and location; (4) kilo-voltage imaging doses are not considered in total dose accumulation as current commercial TPS cannot simulate kilo-voltage x-rays dose deposition. For these reasons and without warning some patients may accumulate dangerously high doses in radiosensitive organs over time and be susceptible to radiation-related side effects. A number of recent studies have shown that non-negligible second cancer risks are associated with increased organ doses from scatter and leakage radiations that are not correctly accounted for by commercial TPS. In order to achieve maximal benefits of modern radiotherapy with minimal normal tissue toxicities, one must have an accurate and comprehensive account of organ doses for the individual patient. Hence, we propose to develop a personal organ dose archive (PODA) where 3D dose distributions, treatment plans and radiation responses of all the relevant organs are recorded for each individual patient undergoing radiotherapy. Our idea is that through comprehensive tracking and accurate mapping of dose accumulation in all organs we can provide a safety mechanism for early warning and help improve clinical decisions regarding radiation treatment for individual patient, similar to submarine topography detailing the geography of oceans. The goal of this project is to develop a personal organ dose archive based on 3D organ dose tracking and mapping for individual patients over time so that the safety of patients receiving radiation therapy is improved including pre and post care management. The specific aims of this project are: 1) to develop a graphics processing unit (GPU) based Monte Carlo engine for accurate and fast dose calculations in patients; 2) to build a personal organ dose archive based on dose tracking and deformable image registration; and 3) to assess the effectiveness of the developed personal organ dose archive by tracking 40 patients undergoing radiotherapy in the clinic. We hypothesize that an accurate and comprehensive account of organ doses from both therapy beams and image-guidance procedures may be used to improve patient safety and reduce normal tissue toxicities associated with radiotherapy.

抽象的 放射治疗的最终目标是通过致命的放射剂量最大限度地杀死肿瘤，同时最大限度地减少肿瘤的死亡。 放射治疗期间的正常组织损伤。尽管肿瘤控制已显着改善 随着先进光束传输和图像引导技术的出现，正常组织毒性仍然存在 越来越受到临床的关注。主要原因有四个： (1) 泄漏和分散剂量 商业治疗计划系统 (TPS) 剂量未准确考虑先进射束传输 计算方法； (2) TPS 剂量计算仅针对患者体内的轮廓器官进行 感兴趣的解剖体积，同时不提供非轮廓器官的剂量信息； (3)器官剂量 由于器官体积、形状和器官的变化，治疗当天的剂量可能与计划剂量有很大不同。 地点; (4) 目前商用的总剂量累积中不考虑千伏成像剂量 TPS 无法模拟千伏 X 射线剂量沉积。由于这些原因，并且在没有警告的情况下，一些 随着时间的推移，患者可能会在放射敏感器官中积累危险的高剂量，并且容易受到 与辐射相关的副作用。最近的一些研究表明，不可忽视的第二种癌症风险 与不正确的散射和泄漏辐射导致的器官剂量增加有关 按商业 TPS 计算。为了以最小的代价实现现代放射治疗的最大效益 正常组织毒性，必须准确、全面地考虑器官剂量，以确保 个别患者。因此，我们建议开发个人器官剂量档案（PODA），其中 3D 剂量 记录每个器官的所有相关器官的分布、治疗计划和辐射反应 接受放射治疗的个别患者。我们的理念是通过全面的跟踪和准确的 绘制所有器官的剂量累积图，我们可以提供预警和帮助的安全机制 改善个体患者放射治疗的临床决策，类似于海底地形 详细介绍海洋地理。该项目的目标是开发一个基于个人器官剂量档案的 随着时间的推移对个别患者进行 3D 器官剂量跟踪和绘图，以便患者接受治疗的安全 放射治疗得到改善，包括术前和术后护理管理。该项目的具体目标是：1） 开发基于图形处理单元 (GPU) 的蒙特卡罗引擎，以实现准确、快速的剂量计算 在患者中； 2）基于剂量跟踪和变形图像建立个人器官剂量档案 登记; 3) 通过跟踪 40 来评估已开发的个人器官剂量档案的有效性 在诊所接受放射治疗的患者。我们假设准确而全面的说明 来自治疗光束和图像引导程序的器官剂量可用于提高患者安全 并减少与放射治疗相关的正常组织毒性。