| 罗素明,吴昊,何志坚,薛娴,袁继龙.调强放射治疗靶区和危及器官剂量及二维剂量分布质量核查方法研究[J].中华放射医学与防护杂志,2020,40(2):122-128 |
| 调强放射治疗靶区和危及器官剂量及二维剂量分布质量核查方法研究 |
| Development of methodology for quality audit of doses in target area and organ at risk and two dimensional dose distribution in intensity modulated radiotherapy |
| 投稿时间：2019-03-27 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.02.009 |
| 中文关键词: 调强放射治疗 免冲洗胶片 靶体积 危及器官 二维剂量分布 |
| 英文关键词:Intensity modulated radiation therapy Radiochromic film Planned target volume Organ at risk Two-dimensional dose distribution |
| 基金项目:IAEA资助项目（CPR/17821） |
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| 中文摘要: |
| 目的 研究用热释光剂量计（TLD）和放射性免冲洗胶片（Film）测量调强放射治疗（IMRT）靶体积（PTV）、危及器官（OAR）剂量和二维剂量分布质量核查方法，为我国IMRT剂量质量应用提供技术指导。方法 中国参加国际放射治疗多中心研究。国际原子能机构（IAEA）提供调强放射治疗聚苯乙烯固体模体，经CT扫描，影像传给放射治疗计划系统（TPS）勾画靶体积处方剂量，剂量限制在400 cGy，勾画危及器官剂量，剂量限制在200 cGy，静态机架，能量6 MV X射线，对IMRT固体模体，实施调强放射治疗计划。照射后的TLD和胶片邮寄至IAEA剂量学实验室测量和估算。选择加速器多，物理师水平较高的江苏、湖北、河南和四川参与验证方法研究，治疗计划的创建、勾画、照射TLD和胶片的程序与国际放射治疗多中心相同。照射后TLD和胶片邮寄至外部核查组（EAG）测量和估算。结果 按IAEA要求，靶体积和危及器官剂量，TLD测量与TPS计划处方剂量相对偏差为±7.0%。参加国际放射治疗多中心研究结果：靶体积上段和下段，TLD测量与TPS计划处方剂量相对偏差分别为-0.2%和0.8%，符合要求。危及器官上段和下段，TLD测量与TPS计划处方剂量相对偏差分别为-0.6%和-1.0%，符合要求。江苏、湖北、河南和四川参与验证方法研究结果：靶体积上段和下段，危及器官上段和下段，TLD测量与TPS计划处方剂量相对偏差分别在0~10.6%和-0.6%~20.9%范围内。按IAEA要求，二维剂量分布3 mm/3%通过率应≥ 90%。参加国际放射治疗多中心研究结果为100%，结果优秀。江苏、湖北、河南和四川参加IAEA验证方法研究结果：胶片测量与TPS计划二维剂量分布通过率在45.0%~100.0%范围内。结论 TLD用于调强放射治疗靶体积和危及器官剂量质量核查，胶片用于调强放射治疗二维剂量分布通过率质量核查，方法科学适用，可操作性强，便于邮寄，数据准确可靠，适合在我国放射治疗机构大范围开展质量保证核查。 |
| 英文摘要: |
| Objective To develop the methodology for using TLD and radiochromic film to measure the planned target volume (PTV) and organ at risk (OAR) doses and 2D dose distribution in IMRT, in order to provide technical guidance on the dose quality audit in IMRT at home. Methods China has participated in the research project launched by the international multi-radiotherapy centre (IMRC). IMRT polystyrene phantom provided by IAEA was scanned by CT scanner and then the scanned images were transmitted to TPS to outline prescribed dose to PTV and to OAR. The former was limited to 400 cGy while the latter limited to 200 cGy. IMRT was implemented with the phantom irradiated using 6 MV X-ray. The irradiated TLDs and films were sent to IAEA dosimerty laboratory for measurement and calculation. Jiangsu, Sichuan, Hubei and Henan provinces were selected to engage with this study for their variety of accelerators and highly skilled physicists. The procedures used were the same as in the IMRC and the irradiated TLDs and films were required to send to external audit group for measurement and calculation. Results According to IAEA requirement, the relative deviations of the TLD-measured and TPS planned doses are within±7.0% for PTV and OAR. The China's research results at the IMRC have shown that the relative deviation of TLD-measured and TPS-planned values for the upper and lower PTV were -0.2% and 0.8%, respectively, consistent with the IAEA requirement, and the values for upper and lower OAR were -0.6% and -1.0%, respectively, consistent with the requirement. As the results have shown in four provinces, the relative deviations of the TLD-measured and TPS-planned were within 0 to 10.6% for upper and lower PTV and -0.6% to 20.9% for upper and lower OAR. According to IAEA requirement, the passing rate should be greater than 90% for 3 mm/3% for 2D dose distribution. China's result at the IMRC is 100%, being excellent. The four provinces' results have shown that 2D dose distribution pass rate of 3 mm/3% was in the range of 45.0%-100.0%. Conclusions The uses of TLD in quality audit for PTV and OAR doses and the radiochromic film in 2D dose distribution pass rate in IMRT are characterized by scientific feasibility, strong operability, easy-to-mail and data realibility. They are can be applied to quality assurance and audit in medical institutions in the country to on a large scale. |
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