DVH mi yoksa XXX index mi Peki hangi index Conformity index Gradient index Paddick Conformity indexi Coverage index Homogeneity index Radiation Conformity index ID: 806025
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Slide1
BEYİN METASTAZLARINDA PLAN DEĞERLENDİRME KRİTERLERİ
Slide2DVH mi
yoksa XXX index mi???
Slide3Peki hangi index?
Conformity index
Gradient indexPaddick Conformity indexiCoverage indexHomogeneity indexRadiation Conformity indexSelectivity indexEnergy index ……………………………………………..
Slide4RTOG; 1993
(
PMID 8262852): Coverage Coverage = Dmin / PDDmin = minimum dose within target volumePD = prescribed doseMinor deviation if <0.9, major deviation if <0.8
GammaKnife için Coverage index farklı!!
Slide5RTOG; 1993
(
PMID 8262852): Homogeneity Homogeneity MDPD = MD / PDMD = maximum dose within target volumePD = prescribed doseMinor deviation if >2.0, major deviation if >2.5
Slide6RTOG; 1993
(
PMID 8262852): Conformity Index Conformity Index PITV = PIV / TVPI = prescription isodose volumeTV = target volumeNormal 1.0-2.0, minor deviation if >2.0 or <1.0, major deviation if >2.5 or <0.9
Slide7Knoos; 1998
(
PMID 9869245): Radiation Conformity Index RCIi = PTV / PIVPTV: Planning target volume = CTV + IM + SMPIV = Prescription Isodose VolumeInverse of RTOG Conformity Index
Slide8ICRU; 1999
(
ICRU Report): Conformity Index CI = TV / PTVTV: Treated volume = volume eclosed by a given isodose surface (e.g. 50%, 95%)PTV: Planning target volume = CTV + IM + SMRTOG conformity index with ICRU terminology
Slide9Paddick; 2000
(
PMID 11143252): Paddick Conformity Index Paddick CI = (TVPIV)2 / (TV x PIV)TVPIV = Target Volume covered by Prescription Isodose Volume
TV = Target Volume
PIV = Prescription Isodose Volume
This is two separate ratios multiplied together:
Undertreatment ratio: TV
PIV
/ TV
Coverage GK
Overtreatment ratio: TV
PIV
/ PIV
Selectivity GK
Slide10Nakamura; 2001
(
PMID 11728692): New Conformity Index NCI = (TV x PIV) / (TVPIV)2Inverse Paddick Conformity Index
Slide11Paddick; 2006
(
PMID 18503356): Dose Gradient Index GI = PIVhalf / PIVPIVhalf = Prescription isodose volume, at half the prescription isodose (e.g. at 25%)PIV = Prescription isodose volume (e.g. at 50%)
Simplified UF Gradient Index
Slide12Oliver; 2007
(
PMID 17194494): Radical Dose Homogeneity Index rDHI = Dmin / DmaxDmin = minimum dose within target volume
D
max
= maximum dose within target volume
Oliver; 2007
(
PMID 17194494
): Moderate Dose Homogeneity Index
mDHI = D
95%
/ D
5%
D
95%
= dose to 95% of target volume
D
5%
= dose to 5% of target volume
Slide13Yomo; 2010 (
PMID 19809786
): Energy Index EI = ID / (TV x PD)ID = integral dose within target volumePD = prescribed doseMeasure of dose homogeneity within target volume
Slide14Slide15CI=1,2
CI(Pad)=0,7
Slide16Slide17CI=1,4
CI(Pad)=0,7
Slide18Slide19CI=1,2
CI(Pad)=0,8
Slide20Slide21CI=1,5
CI(Pad)=0,7
Slide22Slide23CI=1,0
CI(Pad)=0,9
Slide24Slide25CI=1,0
CI(Pad)=0,9
Slide26CI=1.1
GI=4,7
Plan 1_20Gy
Slide27CI=1,0
GI=4,8
Plan2
Slide28CI=1,2
GI=3,3
Plan3
Slide29CI=1,3
G=3,2
Plan4
Slide30Tüm planlar PIV
20Gy
Slide31Tüm planlar PIV/2
10Gy
Slide32Tüm planlar PIV/4
5Gy
Slide33Slide34Slide35Plan1_5Gy
Slide36Plan2_5Gy
Slide37Plan3_5Gy
Slide38Plan4_5Gy
Slide39Slide40Slide41Slide42Slide43Plan1_13Gy
CI=1,19
GI=5,87
Slide44Plan2
CI=1,84
GI=5,92
Slide45Plan3
CI=1,93
GI=4,71
Slide46Plan4
CI=1,96
GI=4,66
Slide47Tüm Planlar_PIV
13Gy
Slide48Tüm Planlar_PIV/2
6,5Gy
Slide49Tüm Planlar_PIV/4
3
Gy
Slide50Slide51Slide52Slide53Slide54Slide55RTOG 1119
Slide56*TMR10 yeterli mi, doku heterojenitesi ne olacak?
GK
*Hasta sabitleme tamam ama pozisyon doğruluğu nasıl kontrol edilecek? GK*Tedavi süresi boyunca termoplastik maske yeterli sabitliği sağlar mı? Linac*TPS algoritmaları hacimleri doğru hesaplıyor mu? GK Linac
Slide57ÖNERİLER
DVH önemli ama herşey değil (İndex bak)
İndex ler önemli ama herşey değil(DVH bak)İdeal DVH ve ideal index değerleri gerçekçi mi?Hasta yükü ve TPS hızına bağlı olarak her klinik kendi değerlendirme kriterlerini optimize etmeli
Slide58Teşekkürler