图像引导放疗技术下癌症治疗质量保证和质量控制的研究进展(1)
[摘要] 国内恶性肿瘤患者病例数越来愈多，死亡率也居高不下。放射治疗是目前治疗癌症的三大有效方式之一，放疗环节中的质量保证和质量控制对于提高肿瘤患者的治愈率有重要的作用，先进的图像引导下的放疗技术能够在治疗过程中准确的核定治疗的位置，保证剂量投射的精度，较大程度的提高了肿瘤患者的治疗效果。同时放疗计划的二维及三维模体剂量验证也是质量保证的重要部分，其在一定程度上确保放疗物理师设计的放疗剂量与直线加速器出束的剂量能相对一致。如何精确有效地保证放疗各环节中的治疗质量是放射治疗界的重点研究方向。本文主要探讨目前放射治疗中图像引导技术实施及放疗计划剂量验证中的质量保证与控制，同时针对日新月异的设备与技术，探索新的放疗质量保证措施。
[关键词] 图像引导;肿瘤放疗;剂量验证;质量保证;质量控制
[中图分类号] R734.2 [文献标识码] A [文章编号] 1673-9701(2019)13-0163-06
[Abstract] The number of cases of malignant tumors in China is increasing， and the mortality rate is also high. Radiation therapy is one of the three effective ways to treat cancer. Quality assurance and quality control of the radiotherapy play an important role in improving the cure rate of cancer patients. The advanced image-guided radiotherapy technology can accurately verify the position of the treatment during the treatment process， ensure the accuracy of the dose projection， and greatly improve the treatment effect. At the same time， the two-dimensional and three-dimensional phantom dose verification of the radiotherapy plan is also an important part of the quality assurance， which ensures that the radiotherapy dose designed by the radiotherapy physicist is relatively consistent with the dose of the linear accelerator. How to accurately and effectively ensure the quality of treatment in all aspects of radiotherapy is the key research direction of the radiotherapy community. This article mainly discusses the current quality assurance and control in the image-guided technology implementation and dose verification in radiotherapy， and explores new radiotherapy quality assurance measures for the ever-changing equipment and technology.
[Key words] Image guidance; Tumor radiotherapy; Dose verification; Quality assurance; Quality control
2018年全球癌癥统计数据报告了185个国家中的36类癌症的发病率与死亡率，其中全球全年新发癌症病例1810万，亚洲区域占近一半，癌症死亡患者约960万，亚洲区域占近70%。肺癌依旧是发病率(11.6%)与死亡率(18.4%)最高的恶性肿瘤，其次发病率最高的为乳腺癌(11.6%)，死亡率最高为结直肠癌(9.2%)。中国的癌症数据在2018年统计中发病率与死亡率占全球最高，新增病例380.4万例，死亡病例229.6万[1]。放射治疗是目前治疗多种恶性肿瘤的重要方式之一，约50%～70%的癌症患者需接受放射治疗，放疗效果也得到医学界的广泛认可[2-4]。但在放射治疗过程中，不仅需要考虑恶性肿瘤靶区得到充分的治疗，且需要对重要器官加以保护。肿瘤放射治疗的根本目的是给予肿瘤靶区足够高的治疗剂量，同时使周边正常组织和器官(Organs at risk，OAR)的受照射剂量尽量降低，从而提高肿瘤治疗的局部控制率，降低危及器官的放疗副反应[5-6]。目前放疗技术不断精进，从二维适形到广泛应用的图像引导的三维弧形旋转调强及螺旋断层放疗等，放疗精度越来越高，同时放疗设备更新换代也逐渐提高了剂量标准。本文主要针对图像引导的肿瘤放射治疗技术及相关放射设备的质量保证和质量控制进行讨论，旨在提高放射治疗整个实施流程中的安全性认识，保证癌症患者治疗的精确性，尽可能降低放疗带来的毒副反应，进一步改善患者的治疗效果和预后。
1 质量保证和质量控制的定义, 百拇医药(张磊 刘鲁迎 方敏)
[关键词] 图像引导;肿瘤放疗;剂量验证;质量保证;质量控制
[中图分类号] R734.2 [文献标识码] A [文章编号] 1673-9701(2019)13-0163-06
[Abstract] The number of cases of malignant tumors in China is increasing， and the mortality rate is also high. Radiation therapy is one of the three effective ways to treat cancer. Quality assurance and quality control of the radiotherapy play an important role in improving the cure rate of cancer patients. The advanced image-guided radiotherapy technology can accurately verify the position of the treatment during the treatment process， ensure the accuracy of the dose projection， and greatly improve the treatment effect. At the same time， the two-dimensional and three-dimensional phantom dose verification of the radiotherapy plan is also an important part of the quality assurance， which ensures that the radiotherapy dose designed by the radiotherapy physicist is relatively consistent with the dose of the linear accelerator. How to accurately and effectively ensure the quality of treatment in all aspects of radiotherapy is the key research direction of the radiotherapy community. This article mainly discusses the current quality assurance and control in the image-guided technology implementation and dose verification in radiotherapy， and explores new radiotherapy quality assurance measures for the ever-changing equipment and technology.
[Key words] Image guidance; Tumor radiotherapy; Dose verification; Quality assurance; Quality control
2018年全球癌癥统计数据报告了185个国家中的36类癌症的发病率与死亡率，其中全球全年新发癌症病例1810万，亚洲区域占近一半，癌症死亡患者约960万，亚洲区域占近70%。肺癌依旧是发病率(11.6%)与死亡率(18.4%)最高的恶性肿瘤，其次发病率最高的为乳腺癌(11.6%)，死亡率最高为结直肠癌(9.2%)。中国的癌症数据在2018年统计中发病率与死亡率占全球最高，新增病例380.4万例，死亡病例229.6万[1]。放射治疗是目前治疗多种恶性肿瘤的重要方式之一，约50%～70%的癌症患者需接受放射治疗，放疗效果也得到医学界的广泛认可[2-4]。但在放射治疗过程中，不仅需要考虑恶性肿瘤靶区得到充分的治疗，且需要对重要器官加以保护。肿瘤放射治疗的根本目的是给予肿瘤靶区足够高的治疗剂量，同时使周边正常组织和器官(Organs at risk，OAR)的受照射剂量尽量降低，从而提高肿瘤治疗的局部控制率，降低危及器官的放疗副反应[5-6]。目前放疗技术不断精进，从二维适形到广泛应用的图像引导的三维弧形旋转调强及螺旋断层放疗等，放疗精度越来越高，同时放疗设备更新换代也逐渐提高了剂量标准。本文主要针对图像引导的肿瘤放射治疗技术及相关放射设备的质量保证和质量控制进行讨论，旨在提高放射治疗整个实施流程中的安全性认识，保证癌症患者治疗的精确性，尽可能降低放疗带来的毒副反应，进一步改善患者的治疗效果和预后。
1 质量保证和质量控制的定义, 百拇医药(张磊 刘鲁迎 方敏)