CN105833434A - Manufacture method of brachytherapy source applicator template - Google Patents
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- 238000000034 method Methods 0.000 title claims abstract description 16
- 238000004519 manufacturing process Methods 0.000 title claims abstract description 5
- 238000002725 brachytherapy Methods 0.000 title abstract description 10
- 238000011282 treatment Methods 0.000 claims abstract description 20
- 210000000056 organ Anatomy 0.000 claims abstract description 16
- 238000004088 simulation Methods 0.000 claims abstract description 11
- 210000001215 vagina Anatomy 0.000 claims description 8
- 239000000463 material Substances 0.000 claims description 4
- 231100000252 nontoxic Toxicity 0.000 claims description 4
- 230000003000 nontoxic effect Effects 0.000 claims description 4
- 239000004744 fabric Substances 0.000 claims 1
- 239000007943 implant Substances 0.000 claims 1
- 238000002372 labelling Methods 0.000 claims 1
- 238000012856 packing Methods 0.000 abstract description 10
- 206010028980 Neoplasm Diseases 0.000 abstract description 6
- 230000000694 effects Effects 0.000 abstract description 3
- 238000001959 radiotherapy Methods 0.000 description 8
- 206010008342 Cervix carcinoma Diseases 0.000 description 6
- 208000006105 Uterine Cervical Neoplasms Diseases 0.000 description 6
- 201000010881 cervical cancer Diseases 0.000 description 6
- 230000005855 radiation Effects 0.000 description 2
- 230000002285 radioactive effect Effects 0.000 description 2
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- 238000005516 engineering process Methods 0.000 description 1
- 238000011156 evaluation Methods 0.000 description 1
- 230000003631 expected effect Effects 0.000 description 1
- 238000009472 formulation Methods 0.000 description 1
- 238000003384 imaging method Methods 0.000 description 1
- 210000000936 intestine Anatomy 0.000 description 1
- 239000000203 mixture Substances 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000002604 ultrasonography Methods 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
- A61N5/1002—Intraluminal radiation therapy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1001—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy using radiation sources introduced into or applied onto the body; brachytherapy
- A61N5/1014—Intracavitary radiation therapy
- A61N5/1016—Gynaecological radiation therapy
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N5/00—Radiation therapy
- A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
- A61N5/1048—Monitoring, verifying, controlling systems and methods
- A61N5/1049—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam
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- B—PERFORMING OPERATIONS; TRANSPORTING
- B33—ADDITIVE MANUFACTURING TECHNOLOGY
- B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
- B33Y80/00—Products made by additive manufacturing
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Abstract
本发明涉及一种近距离治疗施源器模板制作方法，其包括如下步骤：阴道填塞；三维模拟定位；在治疗计划系统里勾画靶区、需要保护的正常器官及阴道填塞后形成的轮廓；模拟制定计划，重建施源器，布源并调整驻留时间，形成剂量分布；评价计划，若剂量分布不满意，则通过调整施源器位置和/或数量来重新模拟制定计划；标记重建的施源器在阴道轮廓上的位置及其通道；3D打印带通道的阴道轮廓形成阴道模板。本方法根据患者治疗时肿瘤和邻近正常器官的相对位置及所需要的剂量分布设计个体化模板，通过该模板引导，使得施源器能够放置到预期的位置，从而治疗时的剂量分布能达到预期效果。
The invention relates to a brachytherapy source applicator template manufacturing method, which comprises the following steps: vaginal packing; three-dimensional simulation positioning; delineating target areas, normal organs to be protected, and contours formed after vaginal packing in a treatment planning system; simulating Make a plan, rebuild the applicator, deploy the source and adjust the dwell time, and form the dose distribution; evaluate the plan, if the dose distribution is not satisfactory, re-simulate the plan by adjusting the position and/or number of applicators; mark the reconstructed applicator The position of the source device on the vaginal contour and its channel; the 3D printed vaginal contour with channel forms a vaginal template. This method designs an individualized template based on the relative position of the tumor and adjacent normal organs during treatment and the required dose distribution. Guided by the template, the applicator can be placed at the expected position, so that the dose distribution during treatment can reach the expected level. Effect.
Description
技术领域 technical field
本发明涉及一种近距离治疗施源器模板的制作方法。 The invention relates to a method for making a brachytherapy applicator template.
背景技术 Background technique
放疗是宫颈癌主要的治疗手段之一，超过三分之二的宫颈癌患者需接受放疗。对于早期宫颈癌，放疗和手术均可选择，二者疗效相当；对于中晚期宫颈癌，放疗是惟一可能到达根治效果的治疗手段。 Radiotherapy is one of the main treatments for cervical cancer, and more than two-thirds of cervical cancer patients need radiotherapy. For early cervical cancer, radiotherapy and surgery are both options, and the curative effects of the two are equivalent; for advanced cervical cancer, radiotherapy is the only treatment that may achieve a radical effect.
近距离治疗是宫颈癌放疗的重要组成部分，近距离治疗依靠调整放射源在施源器中驻留的位置和驻留时间获得需要的剂量分布，满意的剂量分布要求靶区剂量尽可能高而邻近的正常器官剂量尽可能低。近距离治疗具有局部高剂量但覆盖范围小的特点，宫颈癌患者的治疗区域与肠道、膀胱等正常器官邻近，因此施源器位置的准确性对获得满意的剂量分布具有十分重要的意义。 Brachytherapy is an important part of radiotherapy for cervical cancer. Brachytherapy relies on adjusting the residence position and residence time of the radiation source in the source applicator to obtain the required dose distribution. A satisfactory dose distribution requires that the target dose be as high as possible. Adjacent normal organ doses were kept as low as possible. Brachytherapy has the characteristics of high local dose but small coverage. The treatment area of cervical cancer patients is adjacent to normal organs such as intestines and bladder. Therefore, the accuracy of the applicator position is of great significance to obtain a satisfactory dose distribution.
近距离治疗的通常步骤是：放置施源器、定位、计划、治疗。在放置施源器的时候无法预测施源器与靶区及邻近正常器官的位置关系，导致设计放疗计划时很可能因施源器位置的原因，无论如何调整放射源的驻留点和驻留时间都不能达到满意的剂量分布，即使在放置施源器时利用超声或其他影像进行辅助，使施源器能够到达某一点，但不能确定施源器到达的路径是否最优且仍无法预知最终形成的剂量分布。此外，由于每位患者肿瘤的形态、位置、肿瘤与邻近正常器官的关系均不相同，以及治疗过程中肿瘤的变化等原因，无法用同一种施源器适用于所有患者或者同一个患者不同时期的治疗。 The usual steps in brachytherapy are: place applicator, locate, plan, treat. When placing the source applicator, it is impossible to predict the positional relationship between the source applicator and the target area and adjacent normal organs. As a result, when designing a radiotherapy plan, it is possible to adjust the dwell point and dwell of the radioactive source due to the location of the source applicator. Even if ultrasound or other imaging is used to assist in placing the applicator, so that the applicator can reach a certain point, it cannot be determined whether the path of the applicator is optimal and the final result cannot be predicted. The resulting dose distribution. In addition, due to the different shape and location of each patient's tumor, the relationship between the tumor and the adjacent normal organs, and the change of the tumor during the treatment, it is impossible to use the same applicator for all patients or the same patient in different periods. Treatment.
发明内容 Contents of the invention
本发明的目的在于克服现有技术的缺陷，提供一种近距离治疗施源器模板制作方法，通过该模板引导，使得施源器能够通过设计的路径放置到预期的位置，并且使治疗时的剂量分布达到预期效果。 The purpose of the present invention is to overcome the defects of the prior art and provide a method for making a brachytherapy applicator template. Guided by the template, the applicator can be placed at the expected position through the designed path, and the treatment time The dose distribution achieved the expected effect.
为了实现上述目的，本发明采取的技术方案如下： In order to achieve the above object, the technical scheme that the present invention takes is as follows:
一种近距离治疗施源器模板制作方法，其关键技术在于，其包括如下步骤： A brachytherapy applicator template manufacturing method, its key technology is that it comprises the following steps:
阴道填塞，用于获取患者的阴道填塞后形成的轮廓； Vaginal packing, used to obtain the contour of the patient's vaginal packing;
三维模拟定位； 3D simulation positioning;
在治疗计划系统里勾画靶区、需要保护的正常器官及阴道填塞后形成的轮廓； Outline the target area, normal organs to be protected and the outline formed after vaginal packing in the treatment planning system;
模拟制定计划，根据靶区、需要保护的正常器官的位置和剂量要求模拟重建施源器，布源并调整驻留时间，形成剂量分布； Simulate and formulate a plan, simulate and reconstruct the source applicator according to the target area, the position of the normal organ to be protected, and the dose requirements, deploy the source and adjust the residence time to form a dose distribution;
评价计划，若剂量分布不满意，则调整重建的施源器的位置和/或数量直至达到满意的剂量分布为止； Evaluate the plan and, if the dose distribution is not satisfactory, adjust the location and/or number of reconstructed applicators until a satisfactory dose distribution is achieved;
标记重建的施源器在阴道轮廓上的位置及其通道； Mark the position of the reconstructed applicator on the vaginal contour and its passage;
3D打印带通道的阴道轮廓形成阴道模板。 3D printed vaginal contours with channels form the vaginal template.
作为本发明进一步的改进，所述阴道填塞是使用对人体无毒、兼容CT的快速成型材料进行阴道填塞。 As a further improvement of the present invention, the vaginal packing is made of a rapid prototyping material that is non-toxic to the human body and compatible with CT.
作为本发明进一步的改进，所述剂量要求是指本次计划应该达到的剂量分布要求，或是各学术组织推荐的剂量要求，亦或是针对具体患者的个体化剂量要求。 As a further improvement of the present invention, the dosage requirements refer to the dosage distribution requirements that should be achieved in this plan, or the dosage requirements recommended by various academic organizations, or the individualized dosage requirements for specific patients.
一种利用上述模板引导施源器放置的方法：根据所需要的剂量分布来设计施源器的位置，通过阴道模板来引导施源器到达预期的位置。由于模板是个体化制作，符合个体化的阴道特征，因此在实际治疗时能重复模拟定位时的位置，从而确保施源器能够通过模板从设计的路径到达预期的位置。 A method of using the above-mentioned template to guide the placement of the applicator: the position of the applicator is designed according to the required dose distribution, and the applicator is guided to the expected position through the vaginal template. Since the template is made individually and conforms to the characteristics of the individual vagina, the position during the positioning can be simulated repeatedly during the actual treatment, so as to ensure that the applicator can reach the expected position from the designed path through the template.
与现有技术相比，本发明所取得的有益效果如下： Compared with prior art, the beneficial effect that the present invention obtains is as follows:
本发明方法所制作的施源器模板适应患者个体化肿瘤的形态和分布，根据所需要的剂量分布来逆向设计施源器的位置，通过阴道模具内的通道进行引导，能将施源器准确地通过设计的路径放置到预计的位置，从而使放疗剂量符合预期的剂量分布。 The template of the applicator produced by the method of the present invention is adapted to the shape and distribution of individualized tumors of the patient, and the position of the applicator is reversely designed according to the required dose distribution, guided through the channel in the vaginal mold, and the applicator can be accurately positioned. The radiotherapy dose is placed in the expected position through the designed path, so that the radiation dose conforms to the expected dose distribution.
附图说明 Description of drawings
附图1为本发明方法的流程图。 Accompanying drawing 1 is the flowchart of the method of the present invention.
具体实施方式 detailed description
以下结合附图1和具体实施例对本发明进行进一步详细的叙述。 The present invention will be further described in detail below in conjunction with accompanying drawing 1 and specific embodiments.
如附图1所示，近距离治疗施源器模板制作方法具体如下： As shown in Figure 1, the brachytherapy applicator template manufacturing method is as follows:
阴道填塞。使用对人体无毒、兼容CT的快速成型材料进行阴道填塞，目的是获取阴道轮廓，此轮廓能够体现患者阴道填塞后的阴道形态以及肿瘤的形态、位置。 Vaginal packing. Using non-toxic and CT-compatible rapid prototyping materials for vaginal packing, the purpose is to obtain the contour of the vagina, which can reflect the shape of the patient's vagina after vaginal packing and the shape and location of the tumor.
三维模拟定位并将图像传输到治疗计划系统。 3D simulation positioning and transfer of images to the treatment planning system.
在治疗计划系统内勾画靶区、需要保护的正常器官及阴道填塞后形成的轮廓，并进行三维重建。 Outline the target area, normal organs to be protected and the contour formed after vaginal packing in the treatment planning system, and perform three-dimensional reconstruction.
在治疗计划系统内模拟计划。根据靶区、需要保护的正常器官的位置模拟重建施源器，施源器拟布源的部分位于靶区内并尽量远离靶区邻近的正常器官，施源器进入组织的路径避开需保护的重要器官。 Simulate planning within the treatment planning system. Simulate and rebuild the applicator according to the target area and the position of the normal organ to be protected. The part of the applicator to distribute the source is located in the target area and as far away as possible from the normal organs adjacent to the target area. The path of the applicator into the tissue avoids the need to be protected. vital organs.
在治疗计划系统内对重建的施源器布源，按照对靶区的剂量要求和对正常器官的剂量要求调整各放射源驻留点的驻留时间，形成剂量分布。对靶区的剂量要求和对正常器官的剂量要求是指本次计划应该达到的剂量分布要求，可以是各学术组织推荐的剂量要求，也可以是针对具体患者的个体化剂量要求。 In the treatment planning system, the source distribution of the reconstructed source applicator is adjusted according to the dose requirements for the target area and the dose requirements for normal organs to form a dose distribution. The dose requirements for target areas and normal organs refer to the dose distribution requirements that should be met in this plan, which can be the dose requirements recommended by various academic organizations, or individualized dose requirements for specific patients.
按照对剂量分布的要求评价该模拟的计划，若剂量分布不满意，则调整重建的施源器的位置和/或调整施源器数量，再次形成剂量分布，如此重复直至达到满意的剂量分布为止。 Evaluate the simulated plan according to the requirements for dose distribution, if the dose distribution is not satisfactory, adjust the position of the reconstructed applicator and/or adjust the number of applicators to form the dose distribution again, and repeat until a satisfactory dose distribution is achieved .
将模拟重建的施源器的位置及所需通道在三维重建的阴道轮廓进行标记，形成带施源器通道的阴道轮廓三维模型。 Mark the location of the simulated and reconstructed applicator and the required channels on the 3D reconstructed vaginal contour to form a 3D model of the vaginal contour with applicator channels.
在软件内修饰带施源器通道的阴道轮廓三维模型，打磨尖锐处，避免对患者造成伤害，使用对人体无毒的材料3D打印此带施源器通道的阴道轮廓，获得模板。 Modify the 3D model of the vaginal contour with the applicator channel in the software, polish the sharp points to avoid harm to the patient, and use non-toxic materials to the human body to 3D print the vaginal contour with the applicator channel to obtain a template.
通过本方法制作制作个体化的阴道模板，在实际放置阴道模板时可以很好地重复模拟计划时阴道轮廓的位置，从而保证施源器可以通过阴道模板上的通道通过设计的路径到达模拟计划中的理想位置。由于是基于三维剂量分布逆向设计模板，因此在实际治疗时的放疗计划与模拟计划具有良好的重复性，从而确保获得理想的剂量分布。在实际应用中，重复模拟计划时放射源的驻留点和驻留时间，形成剂量分布，靶区剂量的误差约5%，膀胱D2cc（接受最高剂量的2cm3体积）剂量误差约6%，直肠D2cc（接受最高剂量的2cm3体积）剂量误差约8%。 By making individualized vaginal templates by this method, the position of the vagina contour in the simulation plan can be well repeated when the vaginal template is actually placed, so as to ensure that the applicator can reach the simulation plan through the channel on the vaginal template through the designed path ideal location. Since the template is reverse-designed based on the three-dimensional dose distribution, the radiotherapy plan and the simulation plan during the actual treatment have good repeatability, thus ensuring an ideal dose distribution. In practical application, the dwell point and dwell time of the radioactive source are repeated in the simulation plan to form a dose distribution. The dose error of the target area is about 5%, and the dose error of bladder D2cc (the volume of 2cm 3 receiving the highest dose) is about 6%. The rectal D2cc (the volume of 2 cm 3 receiving the highest dose) dose error was about 8%.
本发明方法中所述的模拟制定计划和评价计划均可采用现有技术中的剂量要求和分布的常规计算方法进行计算，此处不再赘述，其均适用于本申请的方法，属于本申请的精神领域范围。 The simulation formulation plan and evaluation plan described in the method of the present invention can be calculated using the conventional calculation methods of dose requirements and distribution in the prior art, and will not be repeated here. They are all applicable to the method of this application and belong to this application range of the spiritual realm.
以上所述实施方式仅为本发明的优选实施例，而并非本发明可行实施的穷举。对于本领域一般技术人员而言，在不背离本发明原理和精神的前提下对其所作出的任何显而易见的改动，都应当被认为包含在本发明的权利要求保护范围之内。 The implementation manners described above are only preferred embodiments of the present invention, rather than an exhaustive list of feasible implementations of the present invention. For those skilled in the art, any obvious changes made without departing from the principle and spirit of the present invention should be considered to be included in the protection scope of the claims of the present invention.
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| CN112023281A (en) * | 2020-09-30 | 2020-12-04 | 重庆大学附属肿瘤医院 | Manufacturing method of applicator for treating cervical cancer |
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| CN113018674A (en) * | 2021-03-18 | 2021-06-25 | 广西医科大学附属肿瘤医院 | Method for manufacturing guide plate for tissue insertion and guide plate for tissue insertion |
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| CN109499014A (en) * | 2018-12-29 | 2019-03-22 | 王世广 | The production method of dress operation auxiliary device after a kind of gynecological tumor |
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| CN112516471A (en) * | 2020-12-01 | 2021-03-19 | 北京航空航天大学 | Radiotherapy plan simulation design method and system based on expansion and contraction theory |
| CN113069680A (en) * | 2021-03-17 | 2021-07-06 | 江苏省肿瘤防治研究所（江苏省肿瘤医院） | Applicator brachytherapy device with balloon fixation device and method of use |
| CN113069680B (en) * | 2021-03-17 | 2021-10-26 | 江苏省肿瘤防治研究所（江苏省肿瘤医院） | Applicator brachytherapy device with balloon fixation device and method of use |
| CN113018674A (en) * | 2021-03-18 | 2021-06-25 | 广西医科大学附属肿瘤医院 | Method for manufacturing guide plate for tissue insertion and guide plate for tissue insertion |
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