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 辐射疗法的最终目标是最大程度地杀死肿瘤，同时最小化 放射治疗期间的正常组织损伤。尽管肿瘤控制已得到显着改善 高级光束输送和图像引导技术的出现，正常的组织毒性继续为 诊所日益关注的关注点。有四个主要原因：（1）与 商业治疗计划系统（TPS）剂量不准确考虑高级梁的交付 计算方法； （2）仅针对患者的轮廓器官进行TPS剂量计算 解剖学的兴趣量，同时不提供非含有器官的剂量信息； （3）器官剂量 在治疗日，由于器官体积，形状和形状变化的变化，可能与计划的剂量完全不同 地点; （4）总剂量积累中不认为千压成像剂量为当前商业 TPS无法模拟千压力X射线剂量沉积。由于这些原因，没有警告一些 随着时间的流逝，患者可能会在放射敏感的器官中积累危险的高剂量，并且容易受到影响 辐射相关的副作用。最近的许多研究表明，不可忽略的第二癌风险 与散射和泄漏辐射的器官剂量增加有关，这些剂量不正确 由商业tps占用。为了获得最小的现代放射疗法的最大益处 正常组织毒性，必须对 个体患者。因此，我们建议开发一个个人器官剂量档案（PODA），其中3D剂量 记录所有相关器官的分布，治疗计划和辐射响应 接受放疗的个体患者。我们的想法是，通过全面的跟踪和准确 在所有器官中的剂量积累映射我们可以提供预警和帮助的安全机制 改善针对单个患者的辐射治疗的临床决策，类似于海底地形 详细说明海洋地理。该项目的目的是开发基于个人器官档案的个人剂量档案 随着时间的流逝，在3D器官剂量跟踪和映射中 改进了放射疗法，包括护理前和后护理管理。该项目的具体目的是：1） 开发基于图形处理单元（GPU）的蒙特卡洛发动机，以进行准确和快速的计算 在患者中； 2）建立基于剂量跟踪和可变形图像的个人器官剂量存档 登记; 3）通过跟踪40来评估发达的个人器官档案档案的有效性 诊所接受放疗的患者。我们假设这是对 从治疗梁和图像引导程序中的器官剂量可用于提高患者安全 并降低与放射疗法有关的正常组织毒性。