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WO2021206525A1 - Dispositif d'évaluation automatique de mouvement pour la poursuite d'une tumeur, et système de radiothérapie utilisant celui-ci - Google Patents

Dispositif d'évaluation automatique de mouvement pour la poursuite d'une tumeur, et système de radiothérapie utilisant celui-ci Download PDF

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Publication number
WO2021206525A1
WO2021206525A1 PCT/KR2021/004567 KR2021004567W WO2021206525A1 WO 2021206525 A1 WO2021206525 A1 WO 2021206525A1 KR 2021004567 W KR2021004567 W KR 2021004567W WO 2021206525 A1 WO2021206525 A1 WO 2021206525A1
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Prior art keywords
tumor
movement
marker
markers
image
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English (en)
Korean (ko)
Inventor
홍채선
김지훈
한민철
김진성
장지석
김동욱
박광우
이호
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University Industry Foundation UIF of Yonsei University
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University Industry Foundation UIF of Yonsei University
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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
    • A61N5/103—Treatment planning systems
    • A61N5/1037—Treatment planning systems taking into account the movement of the target, e.g. 4D-image based planning
    • 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
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • 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
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5217—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data extracting a diagnostic or physiological parameter from medical diagnostic data
    • 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
    • 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
    • A61N5/103—Treatment planning systems
    • A61N5/1039—Treatment planning systems using functional images, e.g. PET or MRI
    • 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
    • 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
    • A61N5/1065—Beam adjustment
    • A61N5/1067—Beam adjustment in real time, i.e. during treatment
    • 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
    • A61N5/1071—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan
    • 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
    • A61N2005/1061—Monitoring, verifying, controlling systems and methods for verifying the position of the patient with respect to the radiation beam using an x-ray imaging system having a separate imaging source
    • 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
    • A61N5/1071—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan
    • A61N2005/1072—Monitoring, verifying, controlling systems and methods for verifying the dose delivered by the treatment plan taking into account movement of the target

Definitions

  • the present invention relates to an automatic motion evaluation apparatus and a radiation treatment system using the same, and to an automatic movement evaluation apparatus for tracking a tumor and a radiation treatment system using the same.
  • the present invention relates to a study (No. NRF-2020R1C1C1005713) carried out with the support of the National Research Foundation with funding from the Ministry of Science and ICT (Government).
  • the conventional marker tracking method is a method of predicting the location of a tumor by tracking a marker inserted near the tumor, and has very high accuracy. There is a problem in that the movement of the tumor cannot be accurately represented by the movement according to the possibility of movement.
  • the present invention analyzes and evaluates tumor movement and marker movement in an image by inputting an image, and then proposes a combination of markers that can represent tumor movement and necessary planning margins to reduce tumor movement
  • the purpose is to represent accurately and increase the accuracy of treatment.
  • an automatic motion evaluation apparatus includes an image input unit for receiving an organ image including a movement of an internal organ of a subject, and receiving a radiographic image for a tumor or a plurality of markers; and a signal processing unit that analyzes and evaluates the movement of the tumor and the movement of the plurality of markers by using the organ image and the radiographic image, and suggests a combination of markers representing the movement of the tumor and a treatment surplus.
  • the signal processing unit determines the movement of the tumor and the movement of the plurality of markers according to the respiration of the subject using the organ image and the radiographic image, and determines the movement trajectory of the tumor and the movement of the plurality of markers. It is characterized in that it is determined whether the movement trajectories coincide.
  • the signal processing unit selects a reference image from among the organ image or the radiographic image, calculates the movement of the marker based on the detected marker, analyzes the movement trajectory of the marker, and the organ image or the radiographic image It is characterized in that the movement of the detected tumor is calculated based on the detected tumor by selecting a reference image, and the movement trajectory of the tumor is analyzed.
  • the signal processing unit detects a plurality of markers by selecting a reference image from the organ image or the radiographic image, determines an order of the plurality of markers, and uses the plurality of markers detected from the reference image.
  • the markers in each phase are detected by tracking, and the movement of the markers according to the subject's respiration is calculated based on the positions of the markers in the detected phases, and the trajectory is analyzed.
  • the signal processing unit detects the tumor by selecting a reference image from the organ image or the radiographic image, or detects the tumor by inputting a radiation structure of the tumor and analyzing the movement based on the radiation structure, , It is characterized in that the movement of the tumor according to the subject's respiration is calculated based on the detected tumor and the trajectory is analyzed.
  • the signal processing unit analyzes the difference by matching the movement trajectories of the analyzed plurality of markers and the movement trajectories of the tumor according to the respiratory cycle, and proposes the correlated marker with the highest correlation among the plurality of markers,
  • the correlation marker having the highest correlation is characterized in that it is proposed through the average of the difference in the 3D displacement between the tumor and the marker based on the displacement in each direction in the 3D Cartesian coordinates.
  • the signal processing unit compares the movement of the correlation marker with the movement of the tumor, and calculates the size of the treatment surplus for the correlation marker that does not reflect the movement of the tumor according to the direction.
  • the signal processing unit applies the size of the treatment excess to the set correlation marker according to the direction to track the tumor and perform radiotherapy, analyze the dose accuracy, and record treatment-related parameters after the radiotherapy. It is characterized in that the accuracy of the dose generated during the radiation treatment is analyzed by evaluating the degree of agreement between the predictive model and the actual model using the log file.
  • the signal processing unit determines that the tumor and the correlation marker do not match, and determines the direction and length in which the correlation marker is located based on the location of the tumor. and, when the correlation is greater than or equal to a preset correlation value, it is determined that the tumor and the correlation marker match, and the correlation marker is proposed.
  • a radiation therapy system includes an image input unit that receives a long-term image including movement of an internal organ of a subject and receives a radiographic image of a tumor or a plurality of markers, and receives the organ image and the radiographic image.
  • An automatic motion evaluation device and the proposed marker including a signal processing unit that analyzes and evaluates the movement of the tumor and the movement of the plurality of markers by using the combination of the markers representing the movement of the tumor and a signal processing unit that suggests a treatment extra It includes a radiation irradiator for irradiating a radiation beam to the tumor by moving the position based on the treatment surplus.
  • the signal processing unit determines the movement of the tumor and the movement of the plurality of markers according to the respiration of the subject using the organ image and the radiographic image, and determines the movement trajectory of the tumor and the movement of the plurality of markers. It is determined whether a movement trajectory coincides, a reference image is selected from among the organ image or the radiographic image, the movement of the marker is calculated based on the detected marker, and the movement trajectory of the marker is analyzed, and the organ image or the radiation It is characterized in that the movement of the detected tumor is calculated based on the detected tumor by selecting a reference image from among the images, and the movement trajectory of the tumor is analyzed.
  • the signal processing unit detects a plurality of markers by selecting a reference image from the organ image or the radiographic image, determines an order of the plurality of markers, and uses the plurality of markers detected from the reference image.
  • the markers in each phase are detected by tracking, and the movement of the markers according to the subject's respiration is calculated based on the positions of the markers in the detected phases, and the trajectory is analyzed.
  • the signal processing unit detects the tumor by selecting a reference image from the organ image or the radiographic image, or detects the tumor by inputting a radiation structure of the tumor and analyzing the movement based on the radiation structure, , It is characterized in that the movement of the tumor according to the subject's respiration is calculated based on the detected tumor and the trajectory is analyzed.
  • the signal processing unit analyzes the difference by matching the movement trajectories of the analyzed plurality of markers and the movement trajectories of the tumor according to the respiration cycle, and proposes a marker with the highest correlation among the plurality of markers,
  • the marker with the highest correlation is suggested through the average of the difference in the 3D displacement of the tumor and the marker based on the displacement in each direction in the 3D Cartesian coordinates, and when the correlation is smaller than a preset correlation value, the It is determined that the tumor and the correlation marker do not match, so the direction and length of the correlation marker are suggested based on the location of the tumor, and when the correlation is greater than or equal to a preset correlation value, the tumor and the It is characterized in that the correlation marker is suggested by determining that the correlation marker is matched.
  • the signal processing unit compares the movement of the marker with the movement of the tumor and calculates the size of the treatment surplus for the marker that does not reflect the movement of the tumor according to the direction, and the signal processing unit corresponds to the set marker.
  • the radiation treatment is performed by tracking the tumor by applying the size of the treatment excess according to the direction, the dose accuracy is analyzed, and the degree of agreement between the predictive model and the actual model is obtained using the treatment-related parameter log file recorded after the radiation treatment. It is characterized by analyzing the dose accuracy generated during the radiation treatment by evaluating.
  • the present invention has the effect of reducing the dose by increasing the accuracy of radiation treatment by accurately identifying the movement of the tumor through the correlation between the marker and the tumor inserted into the human body. .
  • FIG. 1 is a view showing a radiation treatment system according to an embodiment of the present invention.
  • FIG. 2 is a flowchart illustrating a treatment process of a radiation treatment system using an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • FIG. 3 is a flowchart illustrating in detail the performance of the radiation treatment system using the automatic motion evaluation apparatus according to an embodiment of the present invention.
  • FIGS. 4 and 9 are diagrams illustrating an analysis of a motion trajectory of a marker of an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • FIG. 10 is a diagram illustrating an analysis of a movement trajectory of a tumor of an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • FIG. 11 is a diagram illustrating a movement trajectory of a marker and a movement trajectory of a tumor of an automatic movement evaluation apparatus according to an embodiment of the present invention.
  • FIG. 12 is an exemplary diagram illustrating a user interface of an apparatus for automatic motion evaluation according to an embodiment of the present invention.
  • module and “part” for the components used in the following description are given or mixed in consideration of only the ease of writing the specification, and do not have a meaning or role distinct from each other by themselves.
  • the present invention relates to an automatic motion evaluation device for tracking a tumor and a radiation treatment system using the same.
  • FIG. 1 is a view showing a radiation treatment system according to an embodiment of the present invention.
  • an automatic motion evaluation apparatus 10 includes an image input unit 100 and a signal processing unit 200 .
  • the automatic motion evaluation apparatus 10 may omit some of the various components illustrated by way of example or may additionally include other components.
  • the radiation treatment system 40 is implemented as a radiation irradiator 20 including a radiation emitting unit 21 and a rotating gantry 23, a phantom or a subject is positioned in the vertical lower portion, and the radiation 24 for treatment is are investigated
  • the radiation treatment system 40 further includes an imaging device 30, and each imaging device 31, 32 is located at least one around the phantom or the bed in which the subject is located to verify the treatment plan according to the radiation irradiation plan. A subsequent diagnostic image may be acquired.
  • the image captured by the photographing apparatus 30 may be transmitted to the image input unit 100 of the automatic motion evaluation apparatus 10 .
  • Phantoms are radioactive materials used in biological experiments.
  • the subject represents the person being tested.
  • the marker may be directly inserted into the subject by using an instrument, or may be inserted in the form of a liquid or gel by injecting it into the body through an instrument such as a syringe.
  • an instrument such as a syringe.
  • a plurality of tumors may be located and a plurality of markers may be inserted.
  • the radiation therapy system 40 using the automatic motion evaluation device 10 may use various markers and the like to evaluate the location of the tumor in radiation therapy and to track the movement of the tumor.
  • the marker may be implemented as a fiducial marker of a metal, a surrogate such as a diaphragm, or a high-density material such as titanium or pure gold.
  • the radiotherapy system 40 using the automatic motion evaluation device 10 can increase the accuracy of treatment only when the marker can accurately represent the movement of the tumor.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 inputs an image, analyzes and evaluates the movement of the tumor and the movement of the marker in the image, and then the combination of markers that can represent the movement of the tumor and the necessary Planning margins may be suggested.
  • the radiation therapy system 40 using the automatic motion evaluation device 10 can match one marker to one tumor, and determines whether matching is based on the correlation calculated based on how far the marker is from the tumor. can judge Here, when the marker does not match the tumor, a margin may be given in the direction in which the tumor is located from the marker closest to the tumor.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 analyzes the movement trajectory and degree of the marker in the inputted patient image to analyze the movement trajectory and degree of the tumor to match it according to the respiratory cycle, and the most correlation It is possible to find the combination of markers with high correlation, suggest the marker with the highest correlation, calculate the treatment margin in the direction of low correlation, perform radiation therapy, and evaluate the accuracy of treatment after radiation therapy.
  • the image input unit 100 may receive an organ image including movement of an internal organ of a subject, and may receive a radiographic image representing the radiation structure of the tumor 14 or the plurality of markers 12 .
  • the image input unit 100 may receive an image captured through the imaging device 30 of the radiation treatment system 40 , and an organ image including the movement of an internal organ of the subject and the tumor 14 or a plurality of markers 12 . .
  • the signal processing unit 200 receives the organ image and the radiographic image, analyzes and evaluates the movement of the tumor 14 and the movement of the plurality of markers 12 , and a combination of the markers 12 representing the movement of the tumor 14 . and treatment may be suggested.
  • the signal processing unit 200 determines the movement of the tumor 14 and the plurality of markers 12 according to the respiration of the subject using the organ image and the radiographic image, and determines the movement trajectory of the tumor 14 and Automatic motion evaluation apparatus, characterized in that it is determined whether the motion trajectories of the plurality of markers (12) coincide.
  • the signal processing unit 200 calculates the movement of the marker 12 based on the detected marker 12 by selecting a reference image from among the organ image or the radiographic image, and analyzes the movement trajectory of the marker 12 , and the organ image or radiation
  • a movement of the detected tumor 14 may be calculated based on the detected tumor 14 by selecting a reference image from among the images, and a movement trajectory of the tumor 14 may be analyzed.
  • the signal processing unit 200 detects a plurality of markers 12 by selecting a reference image from among an organ image or a radiographic image, determines an order of the plurality of markers 12, and determines a plurality of markers 12 detected from the reference image. to detect and track the marker 12 in each phase using can
  • the signal processing unit 200 calculates the degree of movement and position tracking according to the respiration of the examinee for the marker 12, and calculates and evaluates the degree of motion and the position trajectory for a combination of a plurality of markers. Device.
  • the signal processing unit 200 detects the tumor 14 by selecting a reference image from among a long-term image or a radiographic image, or detects the tumor 14 by inputting a radiation structure of the tumor 14 and analyzing movement based on the radiation structure. And, based on the detected tumor 14, it is possible to calculate the movement of the tumor 14 according to the subject's respiration and analyze the trajectory.
  • the signal processing unit 200 analyzes the difference by matching the movement trajectories of the analyzed plurality of markers 12 and the movement trajectories of the tumor 14 according to the respiratory cycle, and suggests the correlated marker with the highest correlation among the plurality of markers. And, the correlation marker with the highest correlation can be suggested through the average of the 3D displacement difference between the tumor 14 and the marker 12 based on the displacement in each direction in the 3D Cartesian coordinates.
  • the signal processing unit 200 may compare the movement of the correlation marker with the movement of the tumor 14 and calculate the size of the treatment surplus for the correlation marker that does not reflect the movement of the tumor 14 according to the direction.
  • the signal processing unit 200 determines that the tumor 14 and the correlation marker do not match, and suggests the direction and length of the correlation marker based on the location of the tumor 14 . can do.
  • the signal processing unit 200 may determine that the tumor 14 and the correlation marker match and suggest the correlation marker.
  • the higher the correlation the higher the accuracy can be obtained by calculating the treatment redundancy in the lower direction.
  • the signal processing unit 200 may perform radiation treatment by tracking the tumor 14 by applying the size of the treatment excess to the set correlation marker according to the direction, and analyze the dose accuracy.
  • the signal processing unit 200 may analyze the dose accuracy generated during radiation treatment by evaluating the degree of agreement between the predictive model and the actual model by using the treatment-related parameter log file recorded after radiation treatment.
  • the radiation irradiation apparatus 20 may irradiate a radiation beam to the tumor 14 by moving its position based on the proposed marker's treatment surplus.
  • the radiation therapy system 40 is a system for removing the tumor 14 by tracking the location of the tumor 14 in the subject.
  • the tumor 14 can be removed by continuing to track the relocated tumor 14 .
  • the radiation therapy system 40 acquires images of the tumor 14 and the marker 12 that are changed by the activity of the subject using the image input in real time, and obtains the images of the tumor 14 and the marker 12 Based on this, the location of the tumor 14 can be tracked and removed in real time.
  • the radiation treatment system 40 can monitor the position of the tumor 14 or the marker 12 through a computing device indoors, and in addition, radiation treatment according to various embodiments of the present invention
  • the system 40 is implemented to monitor the location of the tumor 14 or the marker 12 through a user terminal such as a smartphone or tablet, so that the location of the tumor 14 or the marker 12 can be checked regardless of the location. It may be possible.
  • the radiation treatment system 40 includes not only the location of the tumor 14 or the marker 12, but also the movement of the tumor 14 and the marker 12 according to respiration, treatment-related log files, calculated motions and actual motions. The results of analyzing and evaluating agreement and accuracy, and calculating and evaluating the accuracy of the dose delivered to the patient, can be additionally monitored.
  • the radiation therapy system 40 can irradiate radiation according to the movement of the marker 12 and the tumor 14 according to the respiration of the subject, so that the optimized radiation therapy is possible and the By minimizing the exposure dose, it is possible to ensure that the radiation treatment is accurate.
  • the radiation therapy system 40 is not limited to being used in the lungs or liver, it is applied to all organs in the lungs and abdomen, and is not limited to some organs or diseases, and radiation therapy is performed to improve the effect of radiation therapy. possible treatment can be applied.
  • the automatic motion evaluation apparatus 10 In order to improve the effects of exposure and radiation treatment due to unnecessary radiation exposure, it is necessary to accurately represent the movement of the tumor 14 through the marker 12, so the automatic motion evaluation apparatus 10 according to an embodiment of the present invention The radiation treatment system 40 using the radiation treatment is performed.
  • the embodiment shown in Figure 1 is shown to help understand the implementation of the radiation treatment of the present invention, the radiation irradiation apparatus 20 and the automatic motion evaluation apparatus 10 are provided separately, and the radiation irradiation apparatus 20
  • the automatic motion evaluation device 10 receives the obtained image and checks the marker 12 that accurately represents the movement of the tumor 14, and can be used in conjunction with radiation therapy.
  • the present invention can improve the precision of the radiation treatment, it is possible to accurately know the location of the tumor 14, it is possible to improve the radiation treatment effect of the patient, it is possible to reduce unnecessary radiation exposure to the patient.
  • the tumor moves inside the body by the patient's breathing. use the method This requires constant breathing of the patient and precise breathing monitoring during treatment.
  • the present invention relates to an invention that can play such a role, and in addition, in radiation therapy for the left breast or lung cancer, tumor movement due to heartbeat must also be considered.
  • the actual tumor movement by the heartbeat during respiration can be checked through image analysis, and it can be used to set the irradiation area in consideration of this.
  • FIG. 2 is a flowchart illustrating a treatment process of a radiation treatment system using an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • the treatment process of the radiation treatment system 20 using the automatic motion evaluation device 10 includes receiving a long-term image including the movement of the patient's internal organs and receiving a radiographic image of the radiation structure of the tumor or marker (S210), A step of analyzing the movement trajectory of the marker or the movement trajectory of the tumor through long-term images and radiographic images (S220), matching the analyzed movement trajectory of the marker and the movement trajectory of the tumor according to the respiration cycle to obtain a marker representing the movement of the tumor It includes a setting step (S230) and a step of applying the treatment excess size to the set marker according to the direction to track the tumor to perform radiation treatment, and to analyze the dose accuracy (S240).
  • step S210 is performed by the image input unit 100 of the automatic motion evaluation apparatus 10
  • steps S220 and S230 are performed by the signal processing unit 200 of the automatic motion evaluation apparatus 10
  • step S240 may be performed by the radiation irradiation apparatus 20 of the radiation treatment system 20 .
  • FIG. 2 although it is interposed as executing each process sequentially, this is only illustratively described, and those skilled in the art change the order described in FIG. Alternatively, various modifications and variations may be applied by executing one or more processes in parallel or adding other processes.
  • FIG. 3 is a flowchart illustrating in detail the performance of the radiation treatment system using the automatic motion evaluation apparatus according to an embodiment of the present invention.
  • the performance of the radiation treatment system using the automatic motion evaluation device may be performed by the radiation treatment system 40 using the automatic motion evaluation device 10, and detailed information about the operation performed by the radiation treatment system using the automatic motion evaluation device is performed. A description that overlaps with the description will be omitted.
  • the performance of the radiation treatment system using the automatic motion evaluation device can be performed by dividing it into two processes, extracting the marker 12 having a high correlation with the movement of the tumor 14 to calculate the treatment extra. Based on the course and treatment-related log files after radiation treatment, it can be performed by dividing it into a process of evaluating motion and dose accuracy.
  • the marker 12 having a high correlation is the above-described correlation marker.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 has an image input unit 100 for a patient medical digital image and communication (Digital Imaging and Communications in Medicine, DICOM) image (eg, 4DCT, fluoroscopic image, etc.) and DICOM-RT Structure may be input (S310).
  • DICOM Digital Imaging and Communications in Medicine
  • the received image may be used to analyze the marker 12 and the tumor 14 , and may be performed through the signal processing unit 200 .
  • the image received by the image input unit 100 may be an X-ray image or a 4DCT image.
  • the CT may be a three-dimensional image, but a four-dimensional image is used to observe the movement of the marker 12 and the tumor 14 .
  • the marker 12 analysis is performed by detecting and setting a target marker (Fiducial Mark) in the reference phase image among the 4DCT images (S320), using the set target marker (Fiducial Mark) to detect the target marker (Fiducial Mark) in all phases of 4DCT. It includes the step of tracking (S322) and calculating the three-dimensional movement of the target marker (Fiducial Mark) according to the respiration (S324).
  • the fiducial mark serves as the origin of each coordinate when the coordinate value is calculated, and may mean a marker located at an index centered in an image, but is not necessarily limited thereto.
  • the step (S322) of tracking the target marker (Fiducial Mark) in all phases of 4DCT using the set target marker (Fiducial Mark) tracks the trajectory of the target marker (Fiducial Mark), and the target marker (Fiducial Mark) by respiration, etc. If it moves, it can be tracked.
  • the analysis of the tumor 14 includes the steps of searching for the location of the tumor and setting the tumor center (S330), tracking the tumor movement according to respiration based on the tumor structure (S332), and three-dimensional movement of the tumor according to respiration and calculating ( S334 ).
  • the signal processing unit 200 matches the three-dimensional movement of the marker and the tumor according to the respiration cycle through the analysis of the marker and the tumor, thereby having a high correlation with the movement of the tumor (Fiducial Mark) and the target marker (Fiducial Mark) It is possible to extract a combination of (S340).
  • a target marker having a high correlation is a marker in which the position of the correlation marker is implemented as the origin.
  • the signal processing unit 200 may calculate a three-dimensional treatment margin through a three-dimensional motion correlation analysis based on a combination of the extracted target marker (Fiducial Mark) and the target marker (Fiducial Mark) (S350).
  • a post-treatment treatment-related log file may be obtained from the treatment equipment (S360).
  • the treatment equipment may be the radiation irradiation apparatus 20 of the radiation treatment system 40 .
  • the treatment-related log file is a file that records all data used to perform treatment, and refers to all data calculated through the above-described process.
  • the signal processing unit 200 may analyze and evaluate the coincidence and accuracy of the calculated motion and the actual motion (S380), and may calculate and evaluate the accuracy of the dose delivered to the patient (S390).
  • a method of tracking a fiducial mark and calculating a motion may be performed through an artificial intelligence technique, an automated algorithm, etc., and tracking a fiducial mark and calculating a motion Through all the calculation methods, it can be calculated by tracking the movement over time.
  • FIGS. 4 and 9 are diagrams illustrating an analysis of a motion trajectory of a marker of an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • FIG. 4 is a cross-sectional image (Transverse View) showing an image obtained by dividing a human body into top and bottom, and is a diagram illustrating marker detection by selecting a reference image from among the images input to the image input unit 100 .
  • the image input unit 100 receives a long-term image and a radiographic image captured through the imaging device 30 of the radiation treatment system 40, and selects a reference image among the received images to automatically detect and set the marker 12.
  • Fig. 5 (a) is a diagram in which numbers are assigned when a plurality of markers are provided
  • Fig. 5 (b) is a view showing a plurality of markers provided in the right lung and left lung of Fig. 5 (a) for each case. am.
  • numbers may be assigned by determining the order as shown in FIG. 5(a), and the assigned numbers do not overlap.
  • the classification of the inserted plurality of markers is illustrated as assigning a number, but the present invention is not limited thereto, and may be assigned to identify different markers such as alphabets and Roman numerals.
  • FIG. 6 is a diagram illustrating automatic tracking and detection of a marker.
  • the signal processing unit 200 may automatically track and detect the markers in all phases of 4DCT using the markers detected and set in the initial reference image.
  • the signal processing unit 200 may use a deformable image registration (DIR) technique to automatically track and detect the marker, but is not necessarily limited thereto.
  • DIR deformable image registration
  • Deformable Image Registration can detect markers by registering two CT images with different phases.
  • the phantom is moved using a deformable vector field (DVF).
  • DVF is a result of registering two CT images with different phases using Deformable Image Registration (DIR), and is a collection of vectors indicating the direction and magnitude of movement of voxels of the transformed CT image for registration. Therefore, if a tetrahedral phantom is produced for a CT image of a specific phase and the produced tetrahedral phantom is transformed using DVF, in principle, a 4D tetrahedral computational phantom that can accurately and realistically simulate the continuous movement of markers according to respiration can be developed The phantom is used instead of the examinee and may be implemented as the examinee.
  • the image 24 in which the marker is detected may be calculated by matching the moving image 20 and the fixed image 22 .
  • FIG. 7 is a diagram for analyzing the trajectory of a marker.
  • the signal processing unit 200 may calculate a three-dimensional movement of the marker according to respiration based on the position of the marker detected in each phase of 4DCT and analyze the trajectory.
  • FIG. 7 shows the movement trajectories of markers from T0 to T90 over time, and calculates the trajectories by calculating the movement of the markers based on the positions of the markers detected in each phase over time.
  • the trajectory may be expressed based on the target marker.
  • each of the images 24a, 24b, 24c, and 24d may detect a movement trajectory based on the position of the marker at T0.
  • FIGS. 8 and 9 are diagrams illustrating motion trajectories calculated by analyzing a motion trajectory of a selected marker and combining a plurality of markers.
  • FIG. 8(a) is a diagram illustrating the analysis of the motion trajectory of the first marker 12a
  • FIG. 8(b) is a diagram illustrating the analysis of the motion trajectory of the second marker 12b
  • FIG. 8(c) is a diagram in which the motion trajectory obtained by combining the first marker 12a and the second marker 12b is analyzed.
  • the motion trajectory obtained by combining the first marker 12a and the second marker 12b may be implemented as an average of the motion trajectory of the first marker 12a and the motion trajectory of the second marker 12b, which is not necessarily limited thereto. it is not
  • the movement trajectory combining the first marker 12a and the second marker 12b can be combined by giving priority to the first marker 12a and the second marker 12b.
  • have For example, 0.7 may be assigned to the first marker 12a and 0.3 may be assigned to the second marker 12b to be combined.
  • the priority may be set in the order that the markers are close to the tumor, and the value given may be changed in proportion to the distance.
  • FIG. 9 is a diagram illustrating a plurality of markers and a combination of a plurality of markers.
  • a total of six markers 12 may be located, and #1, #2, #3, #4, Numbers #5 and #6 may be assigned, and each of the markers located on the left or right side may be combined. Specifically, marker #1 and marker #2, marker #2 and marker #3, marker #4 and marker #5, and marker #5 and marker #6 may be combined. Although not shown in FIG. 9, marker #1 and marker #2 and marker #4 and marker #6 may also be combined to form.
  • the present invention is not limited thereto, and a plurality of markers may be combined to detect a motion trajectory.
  • the degree of movement and location tracking according to respiration for individual target markers (Fiducial Mark), as well as the degree of motion and location trajectory for a combination of a plurality of target markers (Fiducial Mark) can be calculated and evaluated.
  • the target marker (Fiducial Mark) is a marker, and may indicate coordinates as a reference for detecting a motion trajectory.
  • FIG. 10 is a diagram illustrating an analysis of a movement trajectory of a tumor of an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • Figure 10 (a) is a diagram showing the contour contrast of the gross tumor volume of each phase (Contouring GTV of each phase),
  • Figure 10 (b) is a masking procedure according to the contour showing the (Masking procedure according to contour)
  • FIG. 10(c) is a diagram showing the Calculate Center of mass of filled 3D area, and
  • FIG. 10(d) is a trajectory tracking according to the center of mass of each phase. It is a diagram showing tracking according to Center of mass of each phase).
  • the gross tumor volume may mean an actual tumor confirmed by imaging methods such as MRI, CT, and positron emission tomography, but is not necessarily limited thereto.
  • the signal processing unit 200 may automatically detect and set a tumor through an automated algorithm by selecting a reference image from among the images input to the image input unit 100 , and may detect the movement of the tumor.
  • the reference image may represent an end-expiration image in a four-dimensional CT image, but is not limited thereto.
  • the signal processing unit 200 may input the radiation structure (RT-structure) of the tumor and analyze the movement based on the radiation structure (RT-structure).
  • the signal processing unit 200 may calculate the three-dimensional movement of the tumor according to respiration and analyze the trajectory.
  • the three-dimensional movement trajectory of the tumor can be confirmed through (d) of FIG. 7 .
  • FIG. 11 is a diagram illustrating a movement trajectory of a marker and a movement trajectory of a tumor of an automatic movement evaluation apparatus according to an embodiment of the present invention.
  • Fig. 11 (a) is a diagram showing the movement trajectories of tumors and markers from T0 to T90
  • Fig. 11 (b) is a diagram showing the coincidence of movement trajectories of tumors and markers from T0 to T90.
  • the signal processing unit 200 may match the analyzed movement trajectory of the marker with the movement trajectory of the tumor according to the respiration cycle.
  • the motion trajectory of the marker may be a motion trajectory obtained by combining the motion trajectories of a plurality of markers as well as the motion trajectory of one marker.
  • the signal processing unit 200 may analyze a difference between a plurality of markers and a movement trajectory of a tumor and suggest markers with high correlation.
  • the highly correlated marker means a marker and a combination of markers applicable to actual radiation therapy.
  • Equation (1) The most optimal combination of markers can be formulated as an optimization problem as shown in Equation (1).
  • S is defined as a subset of the set of fiducial marks, and u, v, and w mean displacements in each direction in three-dimensional orthogonal coordinates.
  • the subscripts T and S for each displacement indicate markers belonging to subsets of tumor and target markers, respectively.
  • Equation 1 the objective function f(minimize f(S)) represents the average of the three-dimensional displacement difference between the tumor and the marker, ie, the average of Np phases and N S marker combinations.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 can remove the tumor through the marker calculated through the above-described process, and can compensate for the direction in which the marker does not accurately reflect the movement of the tumor.
  • the size of the treatment surplus can be calculated and suggested according to the direction.
  • the treatment surplus is moved to the left by 2 mm during radiation treatment. It can be proposed to the irradiation device 20 .
  • the treatment excess may include a size that moves in the direction of the x, y, and z axes according to the position on the 3D.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 may evaluate the degree of agreement between the predictive model and the actual model by using the treatment-related parameter log file recorded after radiation treatment.
  • the radiation treatment system 40 using the automatic motion evaluation device 10 may analyze the dose accuracy during actual treatment.
  • FIG. 12 is an exemplary diagram illustrating a user interface of an automatic motion evaluation apparatus according to an embodiment of the present invention.
  • the user interface may identify positions of the plurality of markers and movement trajectories of the plurality of markers according to time.
  • the user interface may check not only the motion trajectory of the plurality of markers according to time but also the motion trajectory in which the plurality of markers are combined, and may check based on the origin.
  • the user interface is illustrated as confirming the positions of a plurality of markers and movement trajectories according to time, it is not necessarily limited thereto, and data recorded in the treatment-related parameter log file such as the position of the tumor and movement trajectories according to time can be provided. have.

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Abstract

La présente invention concerne un dispositif d'évaluation de mouvement automatique et un système de radiothérapie utilisant celui-ci, le dispositif d'évaluation automatique de mouvement comprenant : une unité d'entrée d'image qui reçoit une entrée d'une image d'organe comprenant le mouvement d'un organe interne d'un sujet, et reçoit une entrée d'une image radiographique d'une tumeur ou d'une pluralité de marqueurs ; et une unité de traitement de signal qui analyse et évalue le mouvement de la tumeur et le mouvement de la pluralité de marqueurs au moyen de l'image d'organe et de l'image radiographique, et suggère des marges de planification et une combinaison de marqueurs représentant le mouvement de la tumeur.
PCT/KR2021/004567 2020-04-10 2021-04-12 Dispositif d'évaluation automatique de mouvement pour la poursuite d'une tumeur, et système de radiothérapie utilisant celui-ci Ceased WO2021206525A1 (fr)

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