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WO2018004052A1 - Procédé d'optimisation de phase de planification dans une radiothérapie guidée par la respiration à l'aide d'une relation géométrique d'un patient - Google Patents

Procédé d'optimisation de phase de planification dans une radiothérapie guidée par la respiration à l'aide d'une relation géométrique d'un patient Download PDF

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Publication number
WO2018004052A1
WO2018004052A1 PCT/KR2016/007874 KR2016007874W WO2018004052A1 WO 2018004052 A1 WO2018004052 A1 WO 2018004052A1 KR 2016007874 W KR2016007874 W KR 2016007874W WO 2018004052 A1 WO2018004052 A1 WO 2018004052A1
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Prior art keywords
radiation
tumor
patient
degree
organ
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English (en)
Korean (ko)
Inventor
강성희
김시용
김태호
김동수
신동석
조민석
김경현
노유윤
서태석
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Industry Academic Cooperation Foundation of Catholic University of Korea
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Industry Academic Cooperation Foundation of Catholic University of Korea
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • 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
    • A61N5/1064—Monitoring, verifying, controlling systems and methods for adjusting radiation treatment in response to monitoring
    • A61N5/1068—Gating the beam as a function of a physiological signal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Measuring devices for evaluating the respiratory organs
    • A61B5/087—Measuring breath flow
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/103—Measuring devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
    • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb
    • A61B5/113—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor or mobility of a limb occurring during breathing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/54—Control of apparatus or devices for radiation diagnosis
    • A61B6/541—Control of apparatus or devices for radiation diagnosis involving acquisition triggered by a physiological signal
    • 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

Definitions

  • the present invention relates to a method for finding an optimal irradiation time point by finding a time when radiation is irradiated to general tissues in the respiration of a patient.
  • the present invention defines the three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the radiation of general tissues such as the esophagus and the spine where tumors do not occur, and then, into the general tissues in the patient's respiration cycle. It relates to a method of obtaining the point of time when the radiation is least irradiated.
  • Radiation therapy is a method of clinical medicine that treats patients with very short-wavelength, high-energy radiation, and is one of the three major cancer treatments along with surgery and chemotherapy. It usually treats malignant tumors called cancer, but it also treats benign tumors and some benign diseases.
  • Radiation therapy can be divided into external radiation therapy and brachytherapy, depending on the location of the irradiator.
  • External radiation therapy is a treatment method for irradiating radiation by using various equipments outside the body, and may be classified into photo-ray therapy, electron beam therapy, and particle beam therapy (neutron therapy, proton therapy, etc.) according to the type of radiation used. Accordingly, various radiation generating devices can be used, but the most widely used radiation generating device is a linear accelerator.
  • Proximity treatment is a method of irradiating radiation to a limited area by placing a radiation generating device or isotope in the body or surface, and it can be divided into intraluminal treatment, intraluminal treatment, tissue treatment, and contact treatment according to the space or method to be inserted. have.
  • the simulation and treatment planning process is necessary before full-scale radiation therapy begins.
  • CT for radiotherapy planning is often performed. Determine the exact location and proper posture to receive treatment and mark areas of the body to be treated. If necessary, a device to fix the movement of the patient or a shielding device may be manufactured to prevent radiation from being irradiated to a normal part. Afterwards, it may be necessary to prepare meals or control urination / dungary conditions to maintain the same posture and body parts as planned during the treatment planning phase.
  • the patient is taken to a room for radiation therapy, lying on a bed with a treatment machine, posing, and being treated. Treatment is usually assessed on the first or second day of treatment and on a periodic basis.
  • the time taken depends on the method of treatment. Conventional radiation therapy takes about 10 minutes once, but in the case of intensity controlled radiation therapy, image guided radiation therapy, etc., it may take about 30 minutes. It may take more than a few hours when there is a need to maintain a low dose rate due to a large dose of radiation or a wide range of treatment, such as stereotactic or systemic radiation therapy.
  • the schedule is determined according to the type of disease, stage, and the general condition of the patient, and is usually received five times a week for five to eight weeks. However, in the case of stereotactic radiotherapy, treatment is performed 1 to 5 times unlike other treatment methods.
  • the treatment area may vary depending on the degree of urination, so that drinking and urination may be adjusted according to the treatment time.
  • the present invention defines the three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the radiation of general tissues such as the esophagus and the spine where tumors do not occur, and then, into the general tissues in the patient's respiration cycle. It is an object of the present invention to provide a user with a method of obtaining the point of time when the radiation is least irradiated.
  • At least one first organ of a plurality of organs within a predetermined distance from the tumor A first step of determining the irradiation timing of the radiation using a radiation sensitivity of and a degree of geometric overlap between the first organ and the tumor; And a second step of irradiating the radiation to the tumor at the irradiation timing.
  • the radiation sensitivity and the degree of geometric overlap may vary according to breathing of the patient.
  • the irradiation timing may be a point in time where the degree of geometric overlap with the radiation sensitivity is minimal.
  • the irradiation timing is in the following equation It may be determined as the time point when the minimum.
  • i is an identification symbol for each of the first institutions
  • I is the total number of the first institutions
  • the respiratory period of the patient in one cycle may be divided by a constant N, and the time point at which the degree of geometric overlap with the radiation sensitivity is minimal among the time points from 1 / N to N / N may be determined as the irradiation timing.
  • the plurality of organs may include the esophagus, the heart and the spinal cord.
  • the step 0.5 of the plan for irradiating the tumor of the patient further comprises; wherein the step 0.5, end- is the point at which the patient exhales the most end- It may be performed using at least one image of the tumor at exhalation or end-inhalation, at which point the patient inhales most.
  • the radiation can be irradiated at a point when the degree of geometric overlap with the radiation sensitivity is minimal.
  • the device for irradiating the tumor of the patient (tumor) of another aspect of the present invention for achieving the above technical problem, at least one agent within a predetermined distance from the tumor of the plurality of organs (organic)
  • a radiation irradiator for irradiating the radiation to the tumor at the irradiation timing may vary according to breathing of the patient.
  • control unit may determine, as the irradiation timing, a point in time where the degree of geometric overlap with the radiation sensitivity is minimum.
  • control unit in the following equation The time at which the minimum becomes can be determined as the irradiation timing.
  • i is an identification symbol for each of the first institutions
  • I is the total number of the first institutions
  • the controller may classify the respiratory period of the patient in one cycle into a constant N, and determine, as the irradiation timing, a time point at which the degree of geometric overlapping with the radiation sensitivity is minimum among time points 1 / N to N / N. have.
  • the plurality of organs may include the esophagus, the heart and the spinal cord.
  • a plan for radiating the tumor of the patient is established through the control unit, and when end-exhalation is the point at which the patient exhales the most or end-inhalation is the point at which the patient inhales the most.
  • the plan can be formulated using at least one image of the tumor of.
  • the control unit may control the radiation irradiator to irradiate the radiation at a time when the degree of geometric overlap with the radiation sensitivity is minimum based on the established plan.
  • the present invention can provide a user with a method of finding the optimal irradiation time point by finding the time when radiation is irradiated to the general tissues in the breath of the patient.
  • the present invention defines the three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the radiation of general tissues such as the esophagus and the spine where tumors do not occur, and then, into the general tissues in the patient's respiration cycle.
  • the user can be provided with a way to find out when the radiation is least irradiated.
  • the radiation treatment plan is considered in consideration of the radiation sensitivity of the general tissue as well as the dose to the general tissue during the radiation treatment, thereby enabling safe radiation treatment.
  • 1 is a view for explaining the operation of CT imaging and reconstruction.
  • FIG. 2 is a schematic diagram of a general CT system 100.
  • 3A and 3B illustrate specific examples of geometric relationships of the esophagus, spinal cord, and heart in the planning target volume in relation to the present invention.
  • FIG. 4 is a view for explaining the degree of overlapping the normal tissue (normal tissue) in relation to the tumor (tumor).
  • FIG. 5 illustrates the results of a Dose Volume Histogram (DVH) evaluation between a phase (10%) when inhaling the breath and a phase (50%) when inhaling the most breath in relation to the present invention.
  • DVDH Dose Volume Histogram
  • FIG. 7 illustrates an example of a table summarizing mean doses of normal tissues in relation to the present invention.
  • FIG. 8 illustrates an example of a table comparing maximum doses in a plurality of cases in connection with the present invention.
  • FIG. 9 shows an example of a table comparing average and maximum doses in a plurality of cases in connection with the present invention.
  • 10A to 10J illustrate a comparison of a dose volume histogram (DVH) between a low value and a high value for each case in relation to the present invention.
  • DVDH dose volume histogram
  • 11A to 11J illustrate specific examples of Pearson Correlation coefficients according to sensitivity analysis (SPSS) for each case in relation to the present invention.
  • SPSS sensitivity analysis
  • FIG. 12 is a table showing the normal tissue complication probability (NTCP) separated for each case and organized according to the present invention.
  • FIG. 13 summarizes the summary of the possibility of normal tissue complications of FIG. 12 in a table.
  • FIG. 14 summarizes the summary of mean dose reduction in a table in connection with the present invention.
  • the medical imaging apparatus is a device for acquiring an internal structure of an object as an image.
  • the medical image processing apparatus is a non-invasive inspection apparatus, which photographs and processes structural details, internal tissues, and fluid flow in the body and shows them to the user.
  • a user such as a doctor may diagnose a health state and a disease of a patient by using the medical image output from the medical image processing apparatus.
  • a device for photographing an object by radiating a patient is typically a computed tomography (CT) device.
  • CT computed tomography
  • Computed tomography (CT) device of the medical image processing apparatus may provide a cross-sectional image of the object, and the internal structure of the object (for example, organs such as kidneys, lungs, etc.) do not overlap as compared to a general x-ray device.
  • CT image the medical image acquired by the computed tomography apparatus is called a CT image.
  • CT data of an object is performed by using a computed tomography apparatus to obtain raw data.
  • the CT image is reconstructed using the obtained ru data.
  • the data may be a sinogram that is a projection data or a collection of projection data obtained by projecting radiation onto an object.
  • an image reconstruction operation must be performed using a sinogram obtained by CT imaging.
  • 1 is a view for explaining the operation of CT imaging and reconstruction.
  • FIG. 1A is a diagram for describing a CT imaging operation of a computed tomography apparatus that acquires data by moving at predetermined angular intervals.
  • 1B is a diagram for describing a sinogram and a reconstructed CT image obtained by CT imaging.
  • the computed tomography apparatus generates an X-ray and irradiates the object to an X-ray, and detects the X-ray passing through the object by an X-ray detector (not shown).
  • the X-ray detector generates ru data corresponding to the detected X-rays.
  • the X-ray generator 20 included in the CT apparatus irradiates an X-ray to the object 25.
  • the X-ray generating unit 20 rotates around the object and acquires a plurality of rub data 30, 31, and 32 corresponding to the rotated angle.
  • the first ruler data 30 is obtained by detecting the X-ray applied to the object at the P1 position
  • the second ruler data 31 is obtained by detecting the ray applied to the object at the P2 position.
  • the X-ray applied to the object is detected at the P3 position to obtain the third rudata P3.
  • the data may be projection data.
  • the plurality of ruble data 31, 31, and 32 are obtained by moving the X-ray generator 20 at predetermined angular intervals.
  • One sinogram 40 can be obtained.
  • the sinogram 40 is back-projected to restore the CT image 50.
  • the reconstructed CT image 50 is forward-projected to obtain a simulated sinogram, and the simulated sinogram and CT images are obtained.
  • an error existing in the reconstructed CT image 50 may be corrected.
  • the CT system may provide a cross-sectional image of the object, an internal structure of the object (for example, an organ such as a kidney and a lung) may be overlapped with each other, compared to a general X-ray imaging apparatus.
  • an internal structure of the object for example, an organ such as a kidney and a lung
  • the CT system may provide a relatively accurate cross-sectional image of an object by acquiring and processing image data having a thickness of 2 mm or less tens or hundreds per second.
  • image reconstruction techniques include the following techniques.
  • SSD Shade surface display
  • VR volume rendering
  • Virtual endoscopy A technique that allows endoscopic observation in three-dimensional images reconstructed by the VR or SSD technique.
  • MPR multi planar reformation
  • VOI voxel of interest
  • Computed tomography (CT) system 100 can be described with reference to the accompanying FIG.
  • CT system 100 may include various types of devices.
  • FIG. 2 is a schematic diagram of a general CT system 100.
  • the CT system 100 may include a gantry 102, a table 105, an X-ray generator 106, and an X-ray detector 108.
  • the gantry 102 may include an X-ray generator 106 and an X-ray detector 108.
  • the object 10 may be located on the table 105.
  • the table 105 may move in a predetermined direction (eg, at least one of up, down, left, and right) during the CT imaging process.
  • a predetermined direction eg, at least one of up, down, left, and right
  • the table 105 may be tilted or rotated by a predetermined angle in a predetermined direction.
  • the gantry 102 may also be inclined by a predetermined angle in a predetermined direction.
  • an object of the present invention is to provide a user with a method of finding an optimal irradiation time point by finding a time when radiation is irradiated to the general tissues in the patient's breath.
  • the present invention defines the three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the radiation of general tissues such as the esophagus and the spine where tumors do not occur, and then, into the general tissues in the patient's respiration cycle. It is an object of the present invention to provide a user with a method of obtaining the point of time when the radiation is least irradiated.
  • CT imaging is performed on the assumption that the patient is fixed.
  • the patient is difficult to remain stationary at all times, and breathing occurs little by little, which eventually leads to blur in the CT image.
  • the present invention basically uses a radiation method in consideration of the patient's breathing.
  • the image is reconstructed using only the image of the end-inhalation.
  • reconstruct the image using only the image at the end-exhalation For example, assuming that the time when the patient inhales the most breath is called end-inhalation, and the time when the patient exhales the most is called end-exhalation, the image is reconstructed using only the image of the end-inhalation. Or reconstruct the image using only the image at the end-exhalation.
  • the doses of the OAR can be different for each phase because they can be different.
  • the planning target volume is difficult to irradiate the radiation only to the target area, which may mean a plan for the minimum area capable of irradiating the radiation including the target.
  • a result value (Cost Value) is obtained for each phase by using radiation sensitivity and geometric overlap of each tissue (organ, organ), and the irradiation is performed at the moment (or phase) of which the result value is the smallest.
  • OVH overlap Volume Histogram
  • Tolerance dose is the value obtained by subtracting the radiation sensitivity from TD50 (Tolerance Dose). In other words, the Tolerance dose can be seen as indicating 50% probability of necrosis when receiving radiation.
  • OAR organ at risk
  • TD biological factors
  • Patient data and image acquisition may require 4DCT image data of lung cancer patients with tumors located relatively near the esophagus, heart, and spinal cord.
  • target volumes and normal tissue volumes are determined by ICRU 62. Determined according to definitions, contouring can be performed in all phases for all patients.
  • the same beam energy, the number of beams, the beam directions, and the use of wedges may be equally applied.
  • peripheral OARs and particles such as esophagus, heart, and spinal cord can be traced using overlap volume histograms in the Lung cancer case for the planning phase optimization process for each patient.
  • Three dimensional geometric relationships of a planning target volume (PTV) may be defined.
  • the biological index can be included in the process to properly reflect the biological characteristics of the relatively radiation-sensitive OAR in the score.
  • a result value (Cost Value) is obtained for each phase by using the radiation sensitivity and geometric overlap of each tissue (organ, organ), and the radiation is irradiated at the moment (or phase) having the smallest result value.
  • Such a result value (Cost Value) according to the present invention can be calculated by the following equation (1).
  • Equation 1 Means OAR (organ at risk) for the organs around the targeting tumor.
  • Means the degree of overlap of the tumor (tumor) and the surrounding organs (organ), the case of 1 may be the worst timing at the time of irradiation.
  • r is a value that the user specifies the degree of overlap of the tumor (tumor) and the surrounding organs (organ), for example, the user can specify the r value to 1mm or 2mm.
  • the r value becomes a constant determined by the user's specification.
  • Is a value that indicates the degree of necrosis with a 50% chance of receiving radiation.
  • it may mean a radiation acceptance standard allowed for each organ.
  • Equation 1 i means a situation when each organ (organ).
  • the optimum effect may be generated by irradiating radiation at a point when the cost value is minimized.
  • 3A and 3B illustrate specific examples of geometric relationships of the esophagus, spinal cord, and heart in the planning target volume in relation to the present invention.
  • FIG. 4 is a view for explaining the degree of overlapping the normal tissue (normal tissue) in relation to the tumor (tumor).
  • Figure 4 shows the OVH of the heart (heart), (b) shows the OVH of the esophagus (Esophagus), (c) shows the OVH of the spinal cord (spinal cord).
  • Dose Volume Histogram (DVH) evaluation was performed between the phase (10%) when inhaling the most breath and the phase (50%) when inhaling the most breath using Equation 1, and FIG. In relation to this, the results of the Dose Volume Histogram (DVH) evaluation are shown between the phase of inhaling breath (10%) and the phase of inhaling breath (50%).
  • FIG. 7 illustrates an example of a table in which mean doses of normal tissues are summarized in relation to the present invention.
  • FIG. 8 shows an example of a table comparing maximum doses in a plurality of cases in connection with the present invention.
  • FIG. 9 illustrates an example of a table comparing average and maximum doses in a plurality of cases in connection with the present invention.
  • FIGS. 10A to 10J illustrate a comparison of the Dose Volume Histogram (DVH) between a low value and a high value for each case in relation to the present invention.
  • 10A to 10J show the results of each case in the DVH (Dose Volume Histogram) between the phase of inhaling the breath (10%) and the phase of inhaling the breath (50%). .
  • 11A to 11J illustrate specific examples of Pearson Correlation coefficients according to sensitivity analysis (SPSS) for each case in relation to the present invention.
  • SPSS sensitivity analysis
  • FIG. 11A shows the Pearson Correlation coefficient between the organ and the dose that contributed most to score formation in Case 1 in the Esophagus.
  • FIG. 11B shows the Pearson Correlation coefficient between the organ and dose that contributed most to score formation in case of heart 2 in case of heart.
  • FIG. 11C shows the Pearson Correlation coefficient between the organ and dose most contributing to score formation in case 3 of heart.
  • FIG. 11D shows the Pearson Correlation coefficient between the organ and dose most contributing to score formation in Case 4 in the Esophagus.
  • FIG. 11E shows the Pearson Correlation coefficient between the organ and dose most contributing to score formation in case of heart 5 in heart.
  • FIG. 11F shows the Pearson Correlation coefficient between the organ and dose that contributed most to score formation in Case 6 in the Esophagus.
  • FIG. 11G illustrates a Pearson Correlation coefficient between the organ and the dose most contributing to the score formation in case of spinal cord (case 7).
  • FIG. 11H shows the Pearson Correlation coefficient between the organ and dose most contributing to score formation in case of heart 8 in case of heart.
  • FIG. 11I shows the Pearson Correlation coefficient between the organ and the dose that contributed most to the score formation in case of case 9 in the heart.
  • FIG. 11J illustrates a Pearson Correlation coefficient between the organ and the dose most contributing to score formation in case 10 of the spinal cord.
  • FIG. 12 illustrates a normal tissue complication probability (NTCP) according to the present invention.
  • FIG. 13 summarizes the summary contents of the normal tissue complications of FIG. 12 in a table.
  • p value of Cord may also be significant when Wilcoxon code rank verification is performed.
  • FIG. 14 summarizes the summary of mean dose reduction in a table in connection with the present invention.
  • the present invention defines a three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the normal tissues such as the esophagus and the spine where the tumor has not occurred, thereby radiating the general tissues in the patient's respiratory cycle. This is how to find the least investigated time.
  • a result value (Cost Value) is obtained for each phase by using radiation sensitivity and geometric overlap of each tissue (organ, organ), and the radiation is irradiated at the moment (or phase) having the smallest result value.
  • the present invention can provide a user with a method of finding the optimal irradiation time point by finding the time when radiation is irradiated to the general tissues in the breath of the patient.
  • the present invention defines the three-dimensional geometrical relationship between the surrounding tissue and the target volume using the biological characteristics and the overlap volume histogram of the radiation of general tissues such as the esophagus and the spine where tumors do not occur, and then, into the general tissues in the patient's respiration cycle.
  • the user can be provided with a way to find out when the radiation is least irradiated.
  • the radiation treatment plan is considered in consideration of the radiation sensitivity of the general tissue as well as the dose to the general tissue during the radiation treatment, thereby enabling safe radiation treatment.

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Abstract

La présente invention concerne un procédé permettant d'obtenir un point temporel de rayonnement optimisé en trouvant le moment auquel le rayonnement est au moins irradié au tissu général pendant la respiration d'un patient. En particulier, la présente invention concerne un procédé permettant d'obtenir le moment auquel le rayonnement est au moins irradié au tissu général pendant la période respiratoire d'un patient en définissant une relation géométrique tridimensionnelle entre le tissu périphérique et un volume cible en utilisant les caractéristiques biologiques du tissu général, tels que l'oesophage ou la colonne vertébrale, où les tumeurs ne sont pas formées, pour un rayonnement et un histogramme de volume de chevauchement. Dans un procédé d'irradiation d'une tumeur d'un patient selon un aspect de la présente invention, le procédé comprend : une première étape consistant à déterminer un moment d'irradiation du rayonnement en utilisant la sensibilité au rayonnement d'au moins un premier organe à une distance prédéterminée de la tumeur parmi une pluralité d'organes et le degré de chevauchement géométrique entre le premier organe et la tumeur ; et une seconde étape consistant à irradier le rayonnement vers la tumeur au moment de l'irradiation, la sensibilité au rayonnement et le degré de chevauchement géométrique pouvant varier en fonction de la respiration du patient.
PCT/KR2016/007874 2016-06-30 2016-07-20 Procédé d'optimisation de phase de planification dans une radiothérapie guidée par la respiration à l'aide d'une relation géométrique d'un patient Ceased WO2018004052A1 (fr)

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RU2733321C1 (ru) * 2019-10-07 2020-10-01 Федеральное государственное бюджетное образовательное учреждение высшего образования "Оренбургский государственный медицинский университет" Министерства здравоохранения Российской Федерации Способ предоперационного планирования повторных операций на щитовидной железе
CN112867537A (zh) * 2019-09-27 2021-05-28 西安大医集团股份有限公司 患者移动状态的检测方法、装置及系统

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