为评估应用第三方治疗计划系统独立验算病人治疗计划剂量以实现调强放 射治疗（IMRT）质量保证的可行性和准确性。实验基于瓦里安 Trilogy 加速器， 以 LinaTech（雷泰医疗）公司的 TiGRT 治疗计划系统（TPS）作为剂量独立验算 工具，在将AAA算法与Acuros XB算法进行剂量精度比较后，基于AAPM TG-119 号报告中模体数据和处方剂量的要求在瓦里安 Eclipse TPS 中设计模体计划，用 电离室 Famer 2571 测量模体计划的点剂量，比较电离室测量值和不同 TPS 的计 算值。其次选取瓦里安 Eclipse TPS 中已治疗的鼻咽癌患者 6 例、乳腺癌术后放 疗患者 8 例，用 TiGRT TPS 对选取病例进行独立剂量验算并进行剂量比较和分 析。在 TG-119 几何模体验证中，原计划点剂量、验算计划点剂量与测量值基本 一致，整体剂量原计划与验算计划也基本一致。在病例计算中，原计划与验算计 划在乳腺癌中的差异较小，在鼻咽癌中的差异相对较大。在中心层面剂量的γ通 过率评估中，所有病例在 3mm/3%的标准下的γ通过率均在 90%以上。TG119 模 体计划的通过率最高，AAA 原计划和 Acuros XB 原计划与验算计划相比分别为 （98.9±1.69）%和（98.8±0.81）%，其次为乳腺癌，通过率分别为（97.6±1.56）% 和（97.1±1.10）%，鼻咽癌的通过率相对较低，分别为（92.6±3.46）%和（93.5 ±3.12）%。应用第三方 TPS 进行剂量独立验算来实现调强放疗治疗保证的方法 具备可行性，验证过程方便快捷，同时可基于病人解剖结构和 DVH 差异，更全 面控制和提升放射治疗质量，为临床剂量验证提供一种更新更快捷的验证方式。 关键词：放射治疗计划系统；调强放射治疗；质量保证II Abstract To assess the feasibility and accuracy of “secondary check” by the third-party treatment planning systems. Choosing the Linatech treatment planning system, researched and developed by Linatech company, as the third-party check tools. All of experiment is based on the Varian Trilogy Accelerator First, dosimetric precision is compared between AAA algorithm and Acuros XB algorithm. After the accuracy verification, using Linatech TPS for recomputing treatment plans for geometrical phantoms designed in TG -119 and patients. after computation, compared the point dose with the measured data of phantoms（Using chameberNo.2571 to measure point dose）and original plans. Using PTW verisoft with a criteria of 3% dose difference and 3mm distance to agreement to assess the dose distribution on center level .After then ,you can assess the accuracy of treatment plans. For comparing measured data with recomputed plans and original plans, the dose data were found basically identical in TG-119 phantoms. And for patients ,the differences between recomputed plans and AAA original plans or Acuros XB original plans were smaller in breast cancer, but they were even bigger in nasopharynx cancer., all patient cases showed a gamma passing rate more than 90%.The gamma passing rate of AAA original plans and Acuros XB original plans were（98.9±1.69）% and（98.8±0.81）%for breast cancer, and （92.6±3.46）% and （93.5±3.12）%for nasopharynx cancer. Utilizing the third-party treatment planning system as a third-party check tools to assess the accuracy of plans is a newer and more convenient method to quality assurance ,but some functions still need to improve and the scope of differences still need more patient cases to determine . Key words: TPS; IMRT; QAIII 目 录 摘要..................................................................................................................................I Abstract.............................................................................................................................II 第 1 章 绪论...................................................................................................................1 1.1 放射治疗的发展.....................................................................................................2 1.2 调强放射治疗和旋转调强放射治疗....................................................................5 1.3 放射治疗过程中的质量控制和质量保证............................................................7 1.4 剂量验证..............................................................................................................11 1.4.1 点剂量仪......................................................................................................12 1.4.2 凝胶剂量计..................................................................................................12 1.4.3 平面二维剂量验证......................................................................................13 1.4.4 三维剂量验证..............................................................................................17 1.5 算法的差异性......................................................................................................18 1.6 报告的内容..........................................................................................................19 第 2 章 AAA 算法和 Acuros XB 在乳腺癌胸壁放疗计划设计中的应用中.............. 21 1 研究目的..................................................................................................................21 2 研究方法..................................................................................................................21 2.1 临床实例.........................................................................................................21 2.2 体位固定和 CT 扫描......................................................................................21 2.3 放疗计划制定..................................................................................................22 2.4 剂量学差异评价..............................................................................................22 3 结果.........................................................................................................................22 3.1 两种算法的等剂量曲线图..............................................................................22 3.2AAA 算法和 Acuros XB 算法的剂量指标比较............................................23 3.3 两种算法在 IMRT 及 VMAT 计划间相对差异程度比较.............................25 4 结果分析及结论.....................................................................................................25 第 3 章 利用第三方计划系统进行放疗计划的独立验证研究...................................29 1 研究目的..................................................................................................................29 2 研究方法..................................................................................................................29IV 2.1 验算流程..........................................................................................................................29 2.2 模体验证..........................................................................................................................30 2.3 病例验证..........................................................................................................................30 2.4 剂量学差异比较............................................................................................................31 3.结果..........................................................................................................................31 3.1 TG119 模体测量结果...................................................................................................31 3.2 病例中靶区及危机器官剂量参数比较...................................................................32 3.3 中心层面γ通过率比较.................................................................................................35 4 结果分析及结论......................................................................................................36 第 4 章 结论及展望.......................................................................................................................39