Page 25 - 《中国医疗器械杂志》2025年第2期
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Chinese Journal of Medical Instrumentation                                         2025 年 第49卷 第2期

                                                     研   究   与   论   著



              总治疗时间。因此,物理师需在制订计划时确保采                            将实现更智能化的治疗方案,为患者带来更高效、
              用协议里包含的结构。此外,还可以通过深度学习                            更精准的治疗体验。
              卷积神经网络(convolutional neural networks, CNN)
              图像分割模型,完成更多器官的智能自动分割,构建                                               参考文献
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              更加完善的勾画协议集,改善自动勾画的准确性。                                A A, et al. Global radiotherapy: current status and future

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                              (a) Bowel的自动勾画                        radiotherapy  for  postoperative  treatment  of  endometrial
                          (a) Automatic contouring of the bowel
                                                                    and  cervical  cancer:  a  prospective  single-arm  phase  2
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                            (c) Bowel bag形变配准的勾画                [5]   YOCK A D, AHMED M, AYALA-PEACOCK D, et al.
                     (c) Contouring of bowel bag deformation registration  Initial  analysis  of  the  dosimetric  benefit  and  clinical
               图6   影响靶区器官生成阶段在Cervix协议里选取三种不同                      resource   cost   of   CBCT-based   online   adaptive
                             结构的勾画效果显示                              radiotherapy  for  patients  with  cancers  of  the  cervix  or
                 Fig.6  Demonstration of the contouring effects of three different
                                                                    rectum[J]. J Appl Clin Med Phys, 2021, 22(10): 210-221.
                structures selected in the cervix protocol affecting the target organ
                                generation phase                [6]   LECHNER  W,  KANAALAS  D,  HAUPT  S,  et  al.

                                                                    Evaluation  of  a  novel  CBCT  conversion  method
                  为解放医师和物理师,精简工作流程,可实施                              implemented  in  a  treatment  planning  system[J].  Radiat
              治疗师轮廓绘制的培养计划。初期,对治疗师进行                                Oncol, 2023, 18(1): 191.
              解剖学、放射物理等日常授课,在医师的全程在线                            [7]   孙莹莹, 洪天航, 王宏, 等. Unity MR加速器临床应用各
                                                                    阶段时间统计分析[J]. 中华放射肿瘤学杂志, 2022,
              指导下让治疗师尝试勾画影响靶区器官和危及器
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              官,随着临床经验的不断累积,在医师对治疗师考                            [8]   NASSER N, PEREZ B A, PENAGARICANO J A, et al.
              核通过后,可直接由治疗师进行勾画,完成后由医                                Technical  feasibility  of  novel  immunostimulatory  low-
              师审核确认,以减轻医师的工作量。治疗师能够熟                                dose  radiation  for  polymetastatic  disease  with  CBCT-
                                                                    based online adaptive and conventional approaches[J]. J
              练勾画影响靶区器官和危及器官后,建立靶区勾画
                                                                    Appl Clin Med Phys, 2024, 25(6): e14303.
              阶梯训练库,进行由医师主导的在线轮廓修改实践                            [9]   POKHAREL S, PACHECO A, TANNER S. Assessment
              练习,及时进行计划调整和故障排除;定期考核,                                of efficacy in automated plan generation for Varian Ethos
              比较治疗师与医师勾画靶区的时间,评估两者计划                                intelligent optimization engine[J]. J Appl Clin Med Phys,
              的靶区覆盖率和剂量分布。考核通过后,实施由治                                2022, 23(4): e13539.
                                                                [10]   WANG  Y  F,  PRICE  M  J,  ELLISTON  C  D,  et  al.
              疗师主导的OART。
                                                                    Enhancing  safety  in  AI-driven  cone  beam  CT-based

                                                                    online  adaptive  radiation  therapy:  development  and
              4    总结与展望
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                  本研究探讨了Ethos OART技术,其提升了患者
                                                                [11]   STANLEY  D  N,  HARMS  J,  POGUE  J  A,  et  al.  A
              的治疗精度,但面临治疗时间延长的挑战。从机器                                roadmap for implementation of kV-CBCT online adaptive
              维护、病种选择、患者管理、图像质量和人员培养                                radiation  therapy  and  initial  first  year  experiences[J].  J
              5个方面提出了优化策略,有望显著提高治疗效率,                               Appl Clin Med Phys, 2023, 24(7): e13961.
                                                                [12]   KIM J Y, TAWK B, KNOLL M, et al. Clinical workflow
              为OART技术的持续改进和临床应用提供参考。未                               of  cone  beam  computer  tomography-based  daily  online
              来,随着技术的进步和流程的精细化管理,OART                               adaptive  radiotherapy  with  offline  magnetic  resonance


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