PDF(Pubmed)
Abstract：
Adaptive radiation therapy is a feedback process by which imaging information acquired over the course of treatment, such as changes in patient anatomy, can be used to reoptimize the treatment plan, with the end goal of improving target coverage and reducing treatment toxicity. This review describes different types of adaptive radiation therapy and their clinical implementation with a focus on CT-guided online adaptive radiation therapy. Depending on local anatomic changes and clinical context, different anatomic sites and/or disease stages and presentations benefit from different adaptation strategies. Online adaptive radiation therapy, where images acquired in-room before each fraction are used to adjust the treatment plan while the patient remains on the treatment table, has emerged to address unpredictable anatomic changes between treatment fractions. Online treatment adaptation places unique pressures on the radiation therapy workflow, requiring high-quality daily imaging and rapid recontouring, replanning, plan review, and quality assurance. Generating a new plan with every fraction is resource intensive and time sensitive, emphasizing the need for workflow efficiency and clinical resource allocation. Cone-beam CT is widely used for image-guided radiation therapy, so implementing cone-beam CT-guided online adaptive radiation therapy can be easily integrated into the radiation therapy workflow and potentially allow for rapid imaging and replanning. The major challenge of this approach is the reduced image quality due to poor resolution, scatter, and artifacts. Keywords: Adaptive Radiation Therapy, Cone-Beam CT, Organs at Risk, Oncology © RSNA, 2023.
摘要：
自适应放射治疗是一种反馈过程，通过该过程可以在治疗过程中获取成像信息，比如病人解剖结构的变化，可用于重新优化治疗计划，最终目标是提高目标覆盖率和降低治疗毒性。这篇综述描述了不同类型的自适应放射治疗及其临床实施，重点是CT引导的在线自适应放射治疗。根据局部解剖变化和临床背景，不同的解剖部位和/或疾病阶段和表现受益于不同的适应策略。在线适应性放射治疗，其中在每个部分之前在室内采集的图像用于调整治疗计划，而患者仍在治疗台上，已经出现，以解决治疗部分之间不可预测的解剖变化。在线治疗适应给放射治疗工作流程带来了独特的压力，需要高质量的日常成像和快速轮廓重建，重新规划,计划审查,和质量保证。用每个分数生成新计划是资源密集型和时间敏感的，强调对工作流效率和临床资源分配的需求。锥形束CT广泛用于图像引导放射治疗，因此，实施锥形束CT引导的在线自适应放射治疗可以很容易地集成到放射治疗工作流程中，并可能允许快速成像和重新计划。这种方法的主要挑战是由于分辨率差导致图像质量下降，分散，和文物。关键词:适应性放射治疗,锥形束CT,处于危险中的器官,肿瘤学©RSNA，2023年。
