The present application claims priority from Japanese application JP2023-030506, filed on Feb. 28, 2023, the content of which is hereby incorporated by reference into this application.
The present disclosure relates to a technique for creating a treatment planning for radiotherapy.
In radiotherapy, a biological effect index, which is a predictive index of treatment prognosis, is used. As biological effect indices, a tumor control probability (TCP) and a normal tissue complication probability (NTCP) are often used.
WO2018/116354A1 discloses a treatment planning method in which a TCP and an NTCP are calculated based on a calculation model using a prescription (a total dose, a fraction number, etc.) as an input, and the prescription is optimized so that the TCP and the NTCP are brought close to target values. In this case, it is determined that the closer the TCP is to 1, and the closer the NTCP is to 0, the better the prescription.
A plurality of calculation models for calculating a TCP are proposed in Non-Patent Literature 1 “J. H. Chang et al., RADBIOMOD: A simple program for utilising biological modelling in radiotherapy plan evaluation, Physica Medica 32, 248-254, 2016”. A Poisson statistical model will be described as an example from among them. In general, it is known that cell death caused by radiation follows Poisson statistics. Assuming that the number of cancer cells contained in a tumor (target) before the start of treatment is n and the survival probability of a cancer cell associated with radiotherapy is λ, the probability P (χ=0) that the number χ of cancer cells in the target is 0 after the end of the treatment, that is, the TCP is expressed by Equation (1).
In this case, the survival probability λ of a tumor cell associated with radiotherapy is expressed by a linear-quadratic curve model (LQ model) as in Equation (2).
In Equation (2), D is the total irradiation dose to the target, and N is the number of times that fractionated irradiation with radiation is performed. α and β are parameters indicating radiosensitivity of cancer cells. α and β can be determined by an in vitro radiation irradiation experiment or the like. The α and β are not uniquely determined, and even in a similar case, different numerical values may be adopted depending on documents and facilities.
In addition, in a calculation model (for example, an equivalent uniform dose model or the like) different from the above-described Poisson statistical model, other parameters may be used instead of α and β. Other parameters can be determined, for example, by fitting a calculation model to a graph in which a vertical axis represents past treatment results (for example, 1 for no exacerbation and 0 for exacerbation), a horizontal axis represents an equivalent uniform dose (EUD) of a target, and the like.
Non-Patent Literature 2 is “C M. van Leeuwen, et al., The alfa and beta of tumours: a review of parameters of the linear-quadratic model, derived from clinical radiotherapeutic studies. Radiat Oncol. 13, 96, 2018”.
As described above, there are multiple calculation models and parameter sets that may be used for the same case. Certainly, values of biological effect indices, such as the TCP or the NTCP, that are calculated by using a calculation model and a parameter set are different. Therefore, to create a treatment planning based on a biological effect index, a medical practitioner is required to consider and select which calculation model and parameter set to use for each patient. In addition, the medical practitioner may have difficulty in uniquely determining a calculation model and a parameter set. However, even in such cases, it is difficult for the medical practitioner to find a compromise plan between multiple calculation models and parameter sets.
One object included in the present disclosure is to provide a technology that enables creation of a treatment planning based on a plurality of calculation models.
A treatment planning system according to one aspect included in the present disclosure is a treatment planning system that is configured to create a treatment planning for radiotherapy and includes a processing device and a memory. The memory stores a plurality of calculation models, and the processing device uses at least two of the plurality of calculation models to calculate calculation values of biological effect indices representing an effect of radiotherapy with respect to a condition for radiotherapy, and searches for the condition so that at least two of the calculation values to be calculated approach a predetermined target value.
According to one aspect included in the present disclosure, it is possible to create a treatment planning based on a plurality of calculation models.
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
In the example illustrated in
The arithmetic processing device 101 is, for example, a processor such as a central processing unit (CPU), a graphic processing unit (GPU), or a field-programmable gate array (FPGA), and constitutes a control unit that controls the entire treatment planning system 100.
The input device 102 is a device that receives various types of information from an operator who operates the treatment planning system 100, and is, for example, a mouse, a keyboard, or the like. The display device 103 is a device that displays various types of information such as a treatment plan, and is, for example, a display.
The memory 104 and the database 105 are configured as the same or different recording media, and record a program (computer program) that defines the operation of the arithmetic processing device 101, and various types of information (for example, calculation models to be described later) used and generated in the arithmetic processing device 101. Examples of the recording media include a magnetic storage medium such as a hard disk drive (HDD), semiconductor storage media such as a random access memory (RAM), a read only memory (ROM), and a solid state drive (SSD), and a combination of an optical disk such as a digital versatile disk (DVD) and an optical disk drive. Note that the arithmetic processing device 101 reads the program from either one or both of the recording media at the start of the operation of the treatment planning system 100 (for example, when treatment planning system 100 is turned on), executes the read program, and executes various types of processing regarding the treatment planning, thereby controlling the entire treatment planning system 100.
The communication device 106 is a communication interface communicably connected to an external device. In the example illustrated in
In the present embodiment, an example in which the present invention is applied to a treatment planning system supporting spot scanning type particle beam therapy will be described. However, the present invention can be similarly applied to X-ray therapy or particle beam therapy other than the spot scanning method, and the same effect can be obtained. In the spot scanning method, points (spots) are three-dimensionally arranged inside and around a target region to be irradiated with radiation in a patient body, particularly a tumor or the like, and each spot is irradiated with a small-diameter beam. A prescribed dose of a beam to be emitted is determined for each spot, and when a certain spot is irradiated with a prescribed dose, the beam is deflected to the next spot, and the beam is sequentially emitted. By irradiating all the spots with a prescribed dose, a desired irradiation dose distribution is formed in the target region.
Examples of treatments other than the spot scanning method include intensity modulated radiotherapy (IMRT) using an X-ray and a treatment planning system supporting volumetric modulated arc therapy (VMAT), and the present invention is also applicable to the therapy. In an X-ray therapy apparatus that performs intensity modulation such as IMRT or VMAT, the target is irradiated with X-rays from a plurality of directions. Although the dose distribution formed in the target by X-rays emitted from each direction is not uniform, a uniform dose distribution matching the three-dimensional shape of the target is imparted to the patient body by superimposing contributions from all directions. In this case, a fluence distribution of the X-rays to be emitted from each direction can be obtained by solving an inverse problem using the treatment planning system. A multi-leaf collimator may also be placed between an x-ray source and an isocenter to obtain any fluence distribution of X-rays. Even in a treatment planning system corresponding to such a radiotherapy apparatus, the present invention can obtain an effect equivalent to the effect in the present embodiment.
In the treatment planning creation process, first, the arithmetic processing device 101 receives a target region to be irradiated with radiation and an excluded region to be avoided from being irradiated with radiation (step S1). For example, the arithmetic processing device 101 displays each slice image of a CT image of the patient on the display device 103, and receives a target region and an excluded region for each slice image from the operator via the input device 102. The target region is, for example, a region of a tumor or the like. The excluded region is, for example, a region of an organ at risk (OAR). Hereinafter, the excluded region that is a risk region may be referred to as an OAR. In addition, both the target region and the OAR may be referred to as a region of interest.
The description returns to
Next, the arithmetic processing device 101 receives a target tumor control probability TCPobj, which is a target value of a therapeutic effect, for the target region 301 (step S3). In addition, the arithmetic processing device 101 receives a target normal tissue complication probability NTCPobj, which is a target value of the therapeutic effect, for the OAR 302. Furthermore, the arithmetic processing device 101 receives weights wTCP and wNTCP for the target region 301 and the OAR 302, respectively. A region of interest having a larger weight is prioritized in the optimization of the prescription.
The description returns to
Furthermore, the arithmetic processing device 101 receives a calculation model for calculating the TCP or the NTCP, a weight wmodel Of the calculation model, and a parameter set of the calculation model for the target region 301 and the OAR 302 (step S5). The arithmetic processing device 101 records the received calculation model, weight wmodel, and parameter set in the memory 104 or the database 105 (step S6). Similarly to the weights wTCP and wNTCP, when a plurality of calculation models are set, a calculation model with a larger weight wmodel is prioritized in the optimization of the prescription.
The calculation model and the parameter set can be selected by the operator from a list of calculation models and parameter sets previously stored in the database 105. When the operator selects a model addition button 401 illustrated in
The procedure in which the operator inputs the target tumor control probability TCPobj used for the target region 301, the calculation model for the TCP, the weight wmodel of the model, and the parameter set has been described above with reference to
When the model setting is completed for all regions of interest, the operator selects an optimization start button 304 illustrated in
The description returns to
The arithmetic processing device 101 sets an objective function for the prescription search based on the information recorded in the memory 104 or the database 105 (step S7). The objective function is expressed by Equation (3).
Next, as an example of a TCP calculation method by the arithmetic processing device 101, a Poisson statistical model will be described as an example of a model. It is known that the probability of cancer cells having received radiation follows Poisson statistics. Therefore, the probability Pk (χ=0) that the number of cancer cells included in a voxel k in the target region 301 will be 0 at the end of treatment is expressed by Equation (4).
In this case, the survival probability λk of the cancer cells in the voxel k associated with radiotherapy is expressed by a linear-quadratic curve model (LQ model) as in Equation (5).
Dk is the total irradiation dose to the voxel k, and N is the number of times that fractionated irradiation is performed. αi and βi are parameters of a model i indicating the radiosensitivity of the cancer cells.
Since the TCP is a probability that the number of cancer cells included in the target region 301 will be 0 after the end of treatment, it is calculated by calculating the product of the probabilities P (χ=0) for all voxels included in the target region 301 as in Equation (6).
In the present embodiment, the TCP calculation method using the Poisson statistical model has been exemplified, but another model such as an equivalent uniform dose model can be used, and in that case, the same effect as that of the present embodiment can be obtained.
Next, an example of a method of calculating the NTCP by the arithmetic processing device 101 will be described. According to a representative model, the NTCP of the OAR is calculated according to Equation (7).
Here, t is expressed by Equation (8).
Furthermore, DmaxVnp is expressed by Equation (9).
Here, V represents the volume of the entire OAR, and v represents the volume per voxel. k is a number of a voxel included in the OAR. np, mp, and TD50 are parameters determined based on past clinical data and the like, and are stored in advance in the database 105 by the operator.
Dk′ is the converted total irradiation dose to the voxel k, and indicates the total irradiation dose for obtaining the biological effect equivalent to the irradiation in which the total irradiation dose is Dk and the number of times that fractionated irradiation is performed is N in a case where an irradiation dose for irradiation performed one time is dref=2 Gy. As described above, the probability λk that normal tissue included in the voxel k survives by the irradiation in which the total irradiation dose is Dk and the number of times that fractionated irradiation is performed is N can be expressed by Equation (10).
Here, αj and βj are parameters of a calculation model j indicating radiosensitivity of normal tissue cells. Therefore, the converted total irradiation dose Dk′ can be obtained as in the Equations (11) and (12).
Note that the NTCP calculation method described in the present embodiment is an example, and it is also possible to calculate the NTCP using another model equation, and in that case, the same effect as that of the present embodiment can be obtained.
The dose Dk for each voxel obtained in the calculation of the TCP and the NTCP is calculated based on Equation (13) indicating the relationship between a vector (hereinafter, also referred to as an absorbed dose vector) having the absorbed dose of each voxel included in the target region 301 and the OAR 302 as an element and a vector (hereinafter, also referred to as a spot dose vector) having a beam dose to each spot as an element.
Dk is the absorbed dose vector, and {right arrow over (x)} is the spot dose vector.
A matrix A is a matrix representing the dose given to each voxel k by radiation applied to each spot, and is calculated based on an irradiation direction set in advance by the operator and in-vivo information of a CT image.
The description returns to
The absorbed dose vector indicated on the left side of Equation (13) can be estimated based on the assumption that the dose in the target region 301 is Dmean and is uniformly distributed and isotropically decreases outside the target according to the distance from the target region 301 even when the spot dose vector included on the right side of Equation (13) is unknown. Under this assumption, the dose Dmean can be used as a search parameter instead of the spot dose vector. As a result, since the number of search parameters is reduced, fast convergence can be expected. However, after the search for the number N of times that fractionated irradiation is performed and the central dose Dmean is completed, a procedure for determining a spot dose vector again based on an objective function F′ expressed in Equation (14) is required.
However, the relationship between the absorbed dose vector and the spot dose vector is as expressed in Equation (13).
The description returns to
The embodiments described above are examples for describing the present invention, and are not intended to limit the scope of the present invention only to those embodiments. A person skilled in the art can implement the present invention in various other aspects without departing from the scope of the present invention. In addition, the above-described embodiment includes the following items. However, the items included in the present embodiment are not limited to the following items.
A treatment planning system is configured to create a treatment planning for radiotherapy, and includes a memory configured to store a plurality of calculation models, and a processing device configured to calculate calculation values of biological effect indices representing an effect of radiotherapy with respect to a condition for the radiotherapy using at least two of the plurality of calculation models, and search for the condition so that at least two of the calculation values to be calculated approach a predetermined target value.
According to this, since the condition is searched so that the calculation values of the biological effect indices calculated using two or more calculation models approach the target value, it is possible to create a robust treatment planning independent of one calculation model and a parameter set.
In the treatment planning system described in Item 1, the processing device searches for the condition using an objective function based on a difference between the calculation values and the target value. Therefore, the condition can be searched by the optimization of the objective function.
In the treatment planning system described in Item 2, the objective function is a function that weights the difference between the calculation values and the target value by a weight specified for the at least two calculation models so as to add the weight to the difference. According to this, it is possible to optimize prescription by giving priority to each calculation model.
In the treatment planning system described in Item 3, the processing device searches for the condition so as to minimize a value of the objective function.
In the treatment planning system described in Item 1, the processing device calculates the biological effect indices for a target region to be irradiated with radiation and/or a risk region not to be irradiated with the radiation in radiotherapy.
In the treatment planning system described in Item 5, the biological effect indices are a tumor control probability of the target region and a normal tissue complication probability of the risk region. According to this, it is possible to search for a prescription that optimizes the tumor control probability and the normal tissue complication probability.
In the treatment planning system described in Item 1, the condition includes the number of times that fractionated irradiation is performed and an irradiation dose to each spot in spot scanning irradiation. This makes it possible to search for the optimum number of times that fractionated irradiation is performed and the irradiation dose to each spot.
The treatment planning system described in Item 1 further includes a display device, and the processing device displays, on the display device, a management screen indicating information regarding the at least two calculation models used for calculation of the biological effect indices. According to this, a treatment planning creator can create the treatment planning while confirming which calculation model to use.
In the treatment planning system described in Item 8, the processing device displays, on the display device, a selection screen that enables selection of a calculation model that is among the plurality of calculation models stored in the memory and is to be used for the calculation of the biological effect indices. According to this, the treatment planning creator can select a calculation model on the selection screen and create the treatment plan.
The treatment planning system according to claim 5 further includes a display device, and the processing device displays, on the display device, a management screen indicating information regarding the at least two calculation models used for calculation of the biological effect indices, in association with a region of interest for which the biological effect indices are calculated. According to this, the treatment planning creator can create the treatment planning while confirming the region of interest and the calculation model on the screen.
Number | Date | Country | Kind |
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2023-030506 | Feb 2023 | JP | national |