放射治疗技术的进步与计算机技术的发展关系十分密切，作为肿瘤治疗手 段之一的放射治疗随着计算机系统的发展，放射治疗技术方式由普通常规放射 治疗技术到 CT 模拟放射治疗技术，逐步发展为三维适形放射治疗和适形调强放 射治疗技术，精确放射治疗概念迅速得到普及。独立准直器静态调强是调强放 射治疗技术实现的方法之一，能够完成独立准直器静态调强放射治疗计划设计 的商业软件系统－Prowess Panther TPS，已经由美国 Prowess 公司生产并投入临 床使用，目前国内已有部分放射治疗单位应用此套系统。 本文简单介绍了独立准直器静态调强技术的基本算法和开展方法。对具有 独立准直器静态调强功能（Jaws-only IMRT）软件的放射治疗计划系统 Prowess Panther TPS 的可行性等进行了多方面详细的比较研究。比较了 Jaws-only IMRT 在不同加速器数据条件的选择和不同肿瘤部位的选择上的计划设计结果，及与 MLC-IMRT 结果进行了全面评估比较，总结出 Jaws-only IMRT 均可达到调强计 划设计的指标要求，其操作程序简单，适形程度较好，可适用于脑部、鼻咽和 盆腔等部位的肿瘤。在放疗单位直线加速器未配置多叶准直器情况下，Jaws-only IMRT 是较为适合的开展实施调强技术的解决方案。 关键词： 独立准直器 调强治疗 放射治疗计划系统Abstract The evolution of modern radiotherapy techniques is closely correlated with the development of computer science. As one of major treatment modality for cancer treatment, accurate radiotherapy techniques have been widely implemented with the advance of computer technology. Traditional 2-D radiotherapy techniques have been replaced by CT simulation techniques and more recently by 3D CRT and IMRT. Jaws-only IMRT is one of recently developed IMRT techniques and a commercial treatment planning system, Prowess Panther TPS (Prowess, US), has been introduced to the clinic to realize jaws-only IMRT treatment planning. Currently some centers in China have installed this TPS. In the present work, the theory behind jaws-only IMRT has been briefly reviewed, including the basic algorithms and the methods to realize jaws-only IMRT delivery. The feasibility of Prowess Panther TPS in jaws-only IMRT treatment planning has been evaluated. The advantages and disadvantages of jaws-only IMRT have been determined by comparison of jaws-only IMRT treatment plans between different linac conditions and tumor locations, and by comparison of jaws-only IMRT with MLC-IMRT. The jaws-only IMRT, with its benefit of ease of use, can provide a relatively conformal dose distribution which can fulfill most of clinical requirements for IMRT. It can be used in treatment of brain tumor, nasopharyngeal carcinoma, cervix cancer, and so on. Our experiments have demonstrated that the jaws-only IMRT techniques were a suitable solution to implement IMRT treatment in radiotherapy departments which had installed a linac without MLC. Keywords: Jaws-only IMRT Treatment Planning System目 录 第 1 章 引言................................................................................................1 1.1 选题背景和意义 ................................................................................1 1.2 研究工作的主要内容 .........................................................................2 1.3 报告各部分主要内容 .........................................................................3 第 2 章 调强放射治疗实现方法..................................................................4 2.1 引言 ...................................................................................................4 2.2 二维物理补偿器调强 .........................................................................4 2.3 静态多叶准直器调强 .........................................................................4 2.4 动态多叶准直器调强 .........................................................................5 2.5 断层扫描式调强 ................................................................................5 2.6 电磁扫描调强 ....................................................................................5 2.7 独立准直器静态调强 .........................................................................6 2.8 小结 ...................................................................................................6 第 3 章 独立准直器调强放疗技术 ..............................................................7 3.1 独立准直器静态调强计划系统 ..........................................................7 3.2 独立准直器静态调强的优化算法 ......................................................7 3.3 静态 JO-IMRT 的主要优势 ................................................................8 3.4 JO-IMRT 存在问题 .............................................................................9 3.5 JO-IMRT 临床应用与进展..................................................................9 3.6 小结 .................................................................................................11 第 4 章 不同型号直线加速器的 JO-IMRT 计划比较研究 .........................12 4.1 引言 .................................................................................................124.2 材料和方法......................................................................................12 4.3 计划评估指标 ..................................................................................14 4.4 计划结果 .........................................................................................17 4.5 讨论 .................................................................................................22 4.6 小结 .................................................................................................22 第 5 章 不同部位肿瘤 Jaws-only IMRT 和 MLC-IMRT 计划的研究.........24 5.1 引言 .................................................................................................24 5.2 材料和方法......................................................................................24 5.3 鼻咽肿瘤正向与逆向设计 MLC-IMRT 计划比较 ............................28 5.4 鼻咽部肿瘤 JO-IMRT 与 MLC-IMRT 计划比较 .............................31 5.5 脑部、鼻咽和盆腔肿瘤 JO-IMRT 计划结果间的评估比较 .............34 5.6 讨论 .................................................................................................38 5.7 本章小结 .........................................................................................40