MindMap Gallery Medicine - Tumor radiation therapy simulation positioning technology
There is no positioning technology mind map for tumor radiotherapy, including an overview of two-dimensional x-ray simulation positioning, x-ray simulation positioning technology for common tumor radiotherapy, etc.
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Tumor radiation therapy simulation positioning technology
Overview of 2D X-ray Simulation Positioning
Introduction to positioning technology of X-ray simulation positioning machine
Determine the accurate target area through imaging methods, and reflect it in a two-dimensional or three-dimensional manner, determine multi-angle body surface projections, and formulate reasonable plans in sequence. The methods and methods of simulated treatment can be called simulated positioning.
history
Before the advent of analog positioning machines, ordinary diagnostic x-ray machines were used
In the late 1960s, X-ray simulation positioning machines were used in clinical radiotherapy
Radiographs - manual target area drawing - estimating human body surface markers in relation to human anatomy (Disadvantage: The plane information position is inconsistent with the patient's position during radiation therapy)
After radiography, various geometric parameters used by the treatment machine can be simulated, so that the patient's position during simulated positioning and positioning is the same as during actual treatment. The working principle is similar to that of an X-ray, diagnosing and providing diagnostic quality imaging data with field scale markers.
Source Piping SSD Technology
Treatment technology where the isocenter falls on the surface of the skin or body membrane
Advantages: Simple and easy to use, intuitive and reliable
Disadvantages: limited to bone metastasis, skin surface and other diseases, unable to treat esophageal cancer, gastric cancer, lung cancer and other tumors
Source Wheelbase SAD Technology
Also called isocenter technology, this center point is the intersection point of the rack rotation axis, the bed isocenter rotation axis, and the collimator rotation axis. Place the patient's tumor center at this isocenter during treatment
Advantages: accurate positioning of deep tumors, simple and comfortable patient position, easy fixation and good repeatability
Application of X-ray simulation positioning machine in radiotherapy
Six major functions
Target area and important organ positioning
Determine the range of motion of the target area
Treatment options
Outline radiation fields and positioning/positioning reference markers
Take radiation field positioning or confirmation films
Check the shape and position of the radiation field block
Positioning using x-ray simulation positioning machine
Assist patient position fixation
Realize target area positioning
Make marks for reference in outlining the field of view, positioning and positioning
Using the laser system on the X-ray simulation positioning machine, the radiotherapist outlines the field of view on the patient's fixture or on the skin surface, and marks the laser positioning line as a basis for the radiotherapy technician to position the patient on the treatment machine.
Take plain films of the field of view and design lead blocks
Validation and simulation of treatment plans
Attach therapeutic accessories during verification and simulation
Compare with the corresponding field direction view given by the treatment planning system
Measure target depth
Carry out other clinical work
Preparations before X-ray simulation positioning
weekly
Test simulated positioning and various data accuracy
daily
Check the accuracy of the isocenter of the field of view and the laser device
laser light
Ensure patients receive accurate positional repetitions
X-ray simulation positioning technology for common tumor radiotherapy
Head and neck tumors (Take three-field isocenter irradiation for pituitary tumors as an example)
Patient supine position
The main axis of the head and body is parallel to the longitudinal axis of the treatment bed and perpendicular to the center beam of the irradiation field.
Use a special pillow with a special height and number, keep your chin as close as possible, and use the line connecting the eyebrow tubercle and the external ear hole perpendicular to the bed surface as the benchmark
Conventional thermoplastic film head fixation device
position
Place the center of the light indicator field at the intersection point slightly above the midline of the body and the horizontal line of the eyebrow arch.
For the source-to-skin distance (100cm) and radiation field (4cm×4cm-6cm×6cm), adjust the center position through fluoroscopy so that the radiation avoids the orbit.
Rotate the large gantry to 90°, raise the bed appropriately and place the center of the radiation field in the pituitary fossa through fluoroscopy. The central axis of the radiation field should be parallel to the cranial baseline. You can turn the handpiece smaller and move the bed longitudinally to make the radiation field reach requirements, record the small handpiece angle and tumor depth
Tumor depth=100cm-source skin distance
Draw a marking line, and then turn the large frame 180° to the opposite side. The positioning method is the same as the opposite side.
Turn the machine to a larger frame, return the small machine head to 0°, and check through fluoroscopy whether the irradiation field avoids the eye socket. If the field of view is satisfactory, Draw the center on the thermoplastic film, read the source-skin distance, and calculate the height of the raised bed (raised bed height = 100cm - current source-skin distance)
Record the irradiation field size, irradiation depth, gantry angle, collimator and zero source skin distance (bed height) and other parameters in the patient's treatment plan sheet
Overview of Ct simulation positioning technology
Overview
CT simulation positioning machine is a positioning system that has dual functions of conventional X-ray simulation positioning machine and diagnostic CT. The machine that obtains the patient's positioning parameters through CT scans to simulate treatment is an integral part of modern radiotherapy technology.
Include
A CT scanner with a wide field of view
A set of software with three-dimensional reconstruction display and visual field simulation functions of CT images
A dedicated laser light system
Ct simulation positioning and its application in radiotherapy
Delineate tumor target areas and organs at risk
dose calculation
Mobile laser positioning, etc.
Position verification and simulation before treatment
Treatment efficacy monitoring
Ct simulates positioning process
Machine preparation
Temperature and humidity: The computer room temperature is 18~24° (±5°), the humidity is controlled at 30%~60%; the operating room temperature is 18~28°C (±5°C), and the relative humidity is 20%~80%
Turn on the CT machine
Check that the disk storage space of the CT positioning machine is sufficient
Turn on the high-pressure syringe power
Ct laser calibration
Inspection of Ct indoor fixtures
Preparation of emergency medicines and equipment
patient preparation
Check the patient’s positioning request form
Uncooperative patients
Patients whose sutures were not removed after surgery
Ct simulation scanning patient positioning and fixation
Patient positioning and immobilization
Scanning plan
Scan range
contrast agent
Special considerations and guidance
reference mark
virtual simulation
Flag treatment plan results
Read positioning process
Fix body position according to requirements and patient's condition
Mark cross lines on the membrane body, attach Mark points, and draw cross line projections on the patient's body
Scan images and upload to planning system
Remove the membrane and draw laser light projection on the body surface
The use and precautions of contrast media in Ct positioning
high pressure syringe
Understand the patient's physical condition
Ask the patient about their history of iodine allergy
Patient's iodine allergy test
Contrast agent injection method, dosage, injection rate and scan delay time
Pay attention to the observation of patients after enhanced scanning
4D-CT simulation positioning
Prospective 4D-CT scan
Each scan is in the same respiratory phase and needs to be coordinated with respiratory gated radiotherapy.
Retrospective 4D-CT scan.
Collect images of all respiratory phases, observe the range of movement of the target area, and formulate personalized PTV for targeted radiotherapy (more applications)
CT simulation positioning technology for common tumor radiotherapy
Preparation before Ct positioning examination
Preparation of the positioning device
Hair, clothing and denture requirements
Use of mouthpieces and dental trays
Briefly introduce the process of CT positioning scan to patients
Fixation and positioning
Set reference mark point coordinates
Archiving and scanning
MR, pet-ct simulation positioning
MR simulation positioning technology
The combination of Ct and MRI is currently a commonly used method
Magnetic resonance has high resolution for soft tissue, but the image is distorted and there is no electron density information required for dose calculation. Fusion with CT can clarify the location and extent of the tumor
Pet-ct simulated positioning
The fusion of functional imaging and anatomical imaging can obtain information about lymph node metastasis and lesion invasion of surrounding tissues through the degree of lesion cohesion and delayed scan changes. Greatly improve tumor location and staging accuracy