这项工作由美国国家癌症研究所和惠康信托基金资助，并得到了瓦里安医疗系统的额外支持。我们目前的系统使用Eclipse进行治疗计划功能。我们还要感谢 UT MD Anderson 癌症中心研究医学图书馆编辑服务的 Ann Sutton。除了RPA开发的机构资金外，我们的研究团队还获得了德克萨斯州癌症预防和研究所（CPRIT）和德克萨斯大学MD安德森癌症中心癌症信息学创新基金的资助。

所有用于评估 RPA 的患者数据均经过回顾性使用，并获得德克萨斯大学 MD 安德森机构审查委员会的批准。RPA 由一系列仪表板组成，位于 RPA 网页主菜单的左侧（图 2）。 图 2 显示了 主仪表板。所有仪表板的外观都相似，但侧重于不同的任务和人员。以下协议描述了自动创建治疗计划的关键过程。
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/65504/65504fig02.jpg"> 图 2：RPA 主仪表板的屏幕截图。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig02large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
1. 完成服务请求
<ol><li>要创建并接受新的服务请求以进行自动规划，请执行以下操作：<ol><li>单击“服务请求”通道，转到“服务请求”仪表板。</li>
		<li>单击 “新建表单 ”以生成新的服务申请表单。</li>
		<li>在第 1 部分：人口统计中，完成问题。从“处理”下拉列表中选择处理技术。单击治疗技术下拉列表中的个人<img alt="Equation 1" src="/files/ftp_upload/65504/65504eq01.jpg" style="margin: auto;">以访问治疗技术的更多详细信息。</li>
		<li>在第 2 部分： 治疗一般问题中，完成问题。这些问题对所有患者都是一样的;其目的是让用户积极参与确定 RPA 计划是否适合当前患者。</li>
		<li>第 3 部分： 治疗特定问题，完成所选治疗方法的问题，包括治疗目标和处方的详细信息。</li>
		<li>点击 提交。自动生成服务请求 PDF 后，在 患者 列表中选择患者（在 “服务请求”仪表板上）。查看服务请求 PDF（图 3），必要时滚动，然后单击 接受 以批准服务请求。 注意：在 RPA 启动自动轮廓和计划之前，此 PDF 必须被放射肿瘤学家接受。RPA计划的状态可以在“服务请求”页面确定，如 表2所示。 图 3 显示了为基于软组织的宫颈癌 4 场计划创建的示例服务请求。</li>
	</ol></li>
</ol>   
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>地位</td>
			<td colspan="4">总结</td>
		</tr><tr><td>待审核</td>
			<td colspan="4">该患者的服务请求已经创建，正在等待放射肿瘤学家接受它。</td>
		</tr><tr><td>接受</td>
			<td colspan="4">该患者的服务请求已被接受。在“接受”此患者的 CT 扫描“之前，该患者在”服务请求“仪表板中的状态不会更改。</td>
		</tr><tr><td>被用户拒绝</td>
			<td colspan="4">用户拒绝了服务请求。</td>
		</tr><tr><td>提交</td>
			<td colspan="4">该病例已提交给 RPA，有关该患者状态的更多详细信息可在主仪表板上找到。</td>
		</tr><tr><td>RPA 系统错误</td>
			<td colspan="4">RPA 已启动处理，但 RPA 遇到错误，无法完成其任务。</td>
		</tr></tbody></table>表 2：服务请求仪表板的患者状态类别。
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/65504/65504fig03.jpg"> 图 3：为基于软组织的宫颈癌 4 场计划创建的示例服务请求。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig03large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
2. 上传 CT 扫描并接受自动规划
图 4 显示了 CT 审查工作区的屏幕截图。要上传和查看 CT 扫描：
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/65504/65504fig04.jpg"> 图 4：CT 审查工作区的屏幕截图。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig04large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<ol><li>单击 CT 扫描通道，转到 CT 扫描仪表板。</li>
	<li>单击 “上传 CT ”按钮。使用自动打开的文件夹资源管理器选择存储 CT 扫描（DICOM 格式）的文件夹。按照提示确认选择。</li>
	<li>通过选择患者列表中的患者以打开该患者的 CT 查看器（图 4），查看上传的 CT 扫描，然后使用以下控件：<ol><li>通过单击 加载 CT 加载整个 3D CT 图像集。 注意：在完成此操作之前，其他导航工具不会处于活动状态。</li>
		<li>在所有视图的切片之间滚动，并使用以下任一工具：<ol><li>单击每个 CT 视图下方的 <、> 按钮以移动到下一个切片。</li>
			<li>单击每个 CT 视图下方的 <<、>> 按钮，在选定方向上移动五个切片。</li>
			<li>鼠标滚轮：将光标移到任何 CT 视图上，然后使用鼠标滚轮在切片之间滚动。</li>
			<li>单击相 交 按钮以在每个 CT 视图（轴向、日状和矢状面）上叠加十字准线。单击三个视图中的任何一个以将十字准线移动到该点，其他视图将相应地跟随。单击“ 相交 ”按钮以打开/关闭此工具。</li>
			<li>单击“ 缩放/平移 ”按钮。使用鼠标滚轮进一步查看图像以缩放光标所在的视图，或右键单击并按住 CT 视图，然后将鼠标移动到平移。</li>
			<li>单击 标记的 Iso 将 CT 视图移动到标记的等中心（基于自动检测三个不透射线的标记）。 注意：如果 3D CT 图像集尚未加载（单击加载 3D 以解决此问题）或 RPA 无法检测到标记的等中心（如三点设置所示），则此按钮处于非活动状态。</li>
		</ol></li>
	</ol></li>
	<li>单击 “参考点 ”按钮以添加参考点。<ol><li>使用 相交 工具将三个视图移动到所需的参考点位置。</li>
		<li>单击 “参考点 ”按钮以添加参考点。</li>
		<li>如果已选择参考点，则单击 “参考点 ”会将三个视图移动到该点。 注意：如果参考点不存在，此按钮会向图像添加参考点。它还可以将 CT 图像视图移动到参考点（如果已存在）。只能为未被接受的 CT 扫描选择新的参考点。以下是添加参考点的步骤：</li>
		<li>要选择新的参考点，请先通过单击 “清除参考点”（Clear Reference Point ） 清除当前参考点，然后添加一个新参考点。RPA 只接受一个参考点。</li>
	</ol></li>
	<li>接受 CT 扫描。如上所述查看患者的 CT 扫描后，执行以下步骤：<ol><li>回答 CT 图像下方的问题，以最大限度地降低风险并减少后续 RPA 计算中错误发生的事件。</li>
		<li>选择 “接受 ”，然后按照提示操作。 注意：此任务可由任何被确定为 RPA 临床用户的人执行。当前患者的状态类别可以在 CT 扫描仪表板上查看，如 表 3 所示。</li>
	</ol></li>
</ol><table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>地位</td>
			<td colspan="4">总结</td>
		</tr><tr><td>待审核</td>
			<td colspan="4">CT 扫描已进行初步处理，正在等待用户查看并接受扫描。</td>
		</tr><tr><td>接受</td>
			<td colspan="4">该患者的 CT 扫描已被接受。请注意，在接受服务请求之前，该患者在 CT 扫描仪表板 中的状态不会改变。</td>
		</tr><tr><td>被用户拒绝</td>
			<td colspan="4">CT 扫描被用户拒绝。</td>
		</tr><tr><td>提交</td>
			<td colspan="4">该病例已提交给 RPA，有关该患者状态的更多详细信息可在 主仪表板上找到。</td>
		</tr><tr><td>RPA 系统错误</td>
			<td colspan="4">RPA 已启动处理，但 RPA 遇到错误，无法完成其任务。</td>
		</tr></tbody></table>表 3：CT 扫描仪表板的患者状态类别。
3. 监控规划进度
当前患者的状态类别可以在主仪表板上查看（表 4）。要对任何已完成的 RPA 计划进行初步审查并下载以供使用，请执行以下操作：
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>地位</td>
			<td colspan="4">总结</td>
		</tr><tr><td>不接受 CT 扫描</td>
			<td colspan="4">该患者没有接受 CT 扫描（但可以使用接受的服务请求）。</td>
		</tr><tr><td>未接受服务请求</td>
			<td colspan="4">该患者没有接受的服务请求（但可以接受 CT 扫描）。</td>
		</tr><tr><td>排队</td>
			<td colspan="4">该患者的数据已发送到 RPA 系统，并排队等待处理。</td>
		</tr><tr><td>加工</td>
			<td colspan="4">该患者数据的初步处理正在进行中。</td>
		</tr><tr><td>加工-轮廓</td>
			<td colspan="4">正在生成 RPA 轮廓。</td>
		</tr><tr><td>加工-轮廓报告</td>
			<td colspan="4">正在生成 RPA 轮廓报告。</td>
		</tr><tr><td>完整的 RPA 轮廓</td>
			<td colspan="4">RPA 生成的轮廓是完整的，可供用户下载和编辑（仅限 2 步工作流）。</td>
		</tr><tr><td>待定轮廓审查</td>
			<td colspan="4">规划轮廓（即用户进行编辑/添加后的轮廓）已上传回 RPA，并生成了平面轮廓报告。用户需要接受此报告（从 等值线仪表板）。</td>
		</tr><tr><td>排队平面等值线</td>
			<td colspan="4">在 RPA 规划流程之前，计划轮廓（即用户进行编辑/添加后的轮廓）将排队等待处理。</td>
		</tr><tr><td>排队 - 预计划</td>
			<td colspan="4">该患者的计划正在排队等待计划过程。</td>
		</tr><tr><td>处理 - 预先计划</td>
			<td colspan="4">预先规划处理正在进行中。</td>
		</tr><tr><td>排队优化</td>
			<td colspan="4">该患者的计划正在排队等待计划优化过程。</td>
		</tr><tr><td>处理优化</td>
			<td colspan="4">计划优化正在进行中。</td>
		</tr><tr><td>排队 - QA</td>
			<td colspan="4">该患者的计划正在排队等待自动质量保证 （QA） 流程。</td>
		</tr><tr><td>处理 – QA</td>
			<td colspan="4">QA计划正在进行中。</td>
		</tr><tr><td>处理计划报告</td>
			<td colspan="4">最终计划报告正在处理中。</td>
		</tr><tr><td>完整 – RPA 计划</td>
			<td colspan="4">RPA 计划已完成，可供下载。</td>
		</tr><tr><td>失败 – RPA 失败</td>
			<td colspan="4">RPA 进程失败。</td>
		</tr></tbody></table>表 4：主仪表板的患者状态类别。
<ol><li>通过选择患者，然后选择主仪表板顶部的“查看”来查看已完成的 RPA 计划。查看该患者的 RPA 计划报告 （PDF），该报告会在新选项卡中自动打开。 注意：RPA 计划报告 PDF 也可以从下载窗口访问。</li>
	<li>点击 下载图标，下载完整的RPA计划。等待窗口打开，DICOM 文件以及 RPA 计划报告 （PDF） 将被下载以导入治疗计划系统。</li>
</ol>4. 将RPA计划导入用户的治疗计划系统，并审查临床使用
注意：下载RPA计划（DICOM文件）后，应在用户的治疗计划系统中完成以下步骤：
<ol><li>将患者的 CT 扫描导入本地 TPS。这是上传到 RPA 的原始扫描。</li>
	<li>将 RPA 计划和 RPA 轮廓导入到本地 TPS 中。</li>
	<li>使用当地委托剂量计算算法和 使用的固定 MU 选项重新计算剂量。</li>
	<li>将导入的轮廓和计算剂量与 RPA 报告中的轮廓和计算剂量进行比较（以检查导入是否正确）。</li>
	<li>查看计划的适当性，并根据需要进行编辑。 注意：此步骤可能包括编辑字段形状和重新归一化字段。临床团队在其治疗计划系统中审查最终计划并在临床使用前进行任何编辑非常重要。</li>
</ol>5. 将最终计划上传到 RPA 网站，并查看最终计划与 RPA 计划的自动比较
已为其生成 RPA 计划的患者将显示 在计划比较仪表板中。 计划比较仪表板 提供了 表 5 中显示的当前患者的状态类别。要上传最终用户计划并查看用户计划和 RPA 计划的自动比较，请执行以下操作：
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>地位</td>
			<td colspan="4">总结</td>
		</tr><tr><td>待定计划上传</td>
			<td colspan="4">生成案例时显示此状态。</td>
		</tr><tr><td>加工</td>
			<td colspan="4">计划比较正在处理中。</td>
		</tr><tr><td>挂起的计划上传 - 重试</td>
			<td colspan="4">无法进行计划比较。用户应查看上传的文件，然后重试。此状态的可能原因包括上传不正确的文件。</td>
		</tr><tr><td>比较就绪-通过</td>
			<td colspan="4">计划比较报告已准备好进行审核。所有计划比较都通过了标准。可能会标记某些比较 - 用户应查看报告。</td>
		</tr><tr><td>比较就绪-失败</td>
			<td colspan="4">计划比较报告已准备好进行审核。一些比较未能达到设定的标准 - 用户应仔细查看报告并确定原因。</td>
		</tr></tbody></table>表 5：计划比较仪表板的患者状态类别。
<ol><li>选择患者，然后单击 “上传计划”。</li>
	<li>选择要上传的 DICOM 结构文件、计划和剂量文件。</li>
	<li>首先选择患者，查看计划比较报告。然后，查看在屏幕底部打开的 Plan Comparison 报告（图 5）（ 图 5 中显示了一个示例）。</li>
</ol><img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/65504/65504fig05.jpg"> 图 5：自动计划比较报告的示例。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig05large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>

使用基于 Web 的放射计划助手增强放射治疗

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LEC拥有Leo Cancer Care的股票期权。HB 现在受雇于瓦里安医疗系统公司。AJ在基因泰克公司担任咨询职位。JB在Icon Cancer Care担任顾问职位;WS 在 IBA Dosimetry 担任咨询职位;JY已获得SunHydro核公司的差旅费;HS 已收到 Cipla 的酬金。

该协议概述了使用 RPA 创建自动治疗计划的步骤。关键步骤是 （1） CT 上传和批准，（2） 服务请求完成和批准，（3） 计划下载并导入用户的 TPS 并重新计算剂量和计划编辑，以及 （4） 上传最终编辑的计划以与 RPA 计划进行比较。CT 审批和服务请求审批的顺序可以互换。一些计划，特别是针对头颈癌和宫颈癌的容量调制弧形治疗计划，是在两步过程中创建的，其中额外的用户交互以及轮廓和计划是单独生成的。然而，总体而言，这些过程是相似的，我们预计这些先进的治疗计划方法将来可以更改为一步法。这些工具以及正在为未来版本开发的工具可以预期的总体临床可接受性可以在我们已发表的著作10、12、14、15、16、17、18、19、20、21、22 中找到。
这些工具有几个局限性，正如我们之前的工作所述，该工作调查了在放射治疗诊所部署辐射计划助手时的风险 9,23。尽管用户界面的设计旨在最大限度地降低不适当数据输入的风险，例如具有足够视野的 CT 图像或手动数据输入中的错误，但仍存在错误的可能性。具体而言，人为错误、自动化偏差（过度依赖结果）和软件错误是值得关注的问题 9.仔细检查并在必要时编辑自动生成的轮廓和计划，对于安全使用辐射规划助手至关重要。一般而言，这些审查应遵循与物理学家和放射肿瘤学家审查临床计划相同的程序，尽管这可以通过使用专门制定的清单来支持，以补充对自动创建的治疗计划的人工审查24。
在某些情况下，RPA 将无法生成计划，并将向用户报告错误。在几乎所有情况下，这都是由于 RPA 遇到无法解释的意外数据引起的，例如视野或患者定位不足（例如，如果使用仰卧位拍摄 CT 图像，但患者处于俯卧位）。用户可能能够根据报告错误的位置来识别问题。在大多数情况下，这些情况只能通过手动轮廓或计划来解决。RPA 团队还可以查看日志文件以识别问题。
RPA 的设计和开发是专门为资源有限的诊所，尤其是低收入和中等收入国家的诊所提供高质量的自动轮廓和自动规划工具。我们目前正在通过监管、法律和行政程序，这些程序将导致 RPA 在临床上的应用。一旦发生这种情况，我们希望仔细监控使用情况，并对工作流程或用户界面进行更改，以应对任何意外风险或其他用户反馈。目标是提供支持放射治疗服务的工具，以便当地临床团队可以扩大他们的工作范围，改善获得高质量、一致的放射治疗计划的机会。我们希望这将改善患者的治疗效果，并减少等待时间。虽然目前的产品组合仅限于头颈癌、乳腺癌和宫颈癌，以及脑转移的全脑照射，但我们正在研究其他治疗方法，这些治疗方法将纳入未来的版本17,18,19中。

预计到 2030 年，全球癌症病例数将增长到约 2460 万例，其中低收入和中等收入国家负担最重1。放疗是一种具有成本效益的治愈性姑息性癌症治疗方法，为大约 50% 的癌症患者和低收入国家 60-70% 的患者提供益处，这些患者更有可能在晚期就诊 2,3。然而，全世界获得放射治疗的机会有限4;例如，非洲没有一个国家具备满足其估计需求的放射治疗能力5。一些研究估计了这些即将到来的短缺以及满足即将到来的需求所需的条件6,7。
《柳叶刀》肿瘤学委员会提出了一个令人信服的理由，即投资于提高放射治疗能力不仅可以挽救生命，还可以带来积极的经济效益3。他们还特别指出，放射治疗轮廓和治疗计划的自动化可以通过显着减少肿瘤学家和物理学家在这些任务上花费的时间来帮助临床团队扩大他们的工作范围，从而使目标更容易实现。
我们的研究小组一直在与MD安德森和世界各地医院的临床团队合作，开发基于网络的自动化工具。这套工具（称为RPA）提供基于人工智能的轮廓（在CT扫描中勾勒出肿瘤和附近器官）和放射治疗计划（准确定义放射的传递方式）。这个基于网络的平台的优势在于减少了为每位患者准备高质量计划所需的时间和资源。
我们在MD安德森使用基于人工智能的工具的早期版本的经验表明，自动轮廓可以为每位患者节省多达2小时的时间，从而大大简化了工作流程。这意味着目前的临床工作人员将能够扩大他们的工作范围，用更高质量的放射治疗来治疗更多的患者。通过基于网络的全自动服务（辐射计划助手 [RPA] ，RPA.mdanderson.org）提供这些工具，我们可以最大限度地降低患者和提供者的成本，并最大限度地扩大该工具的覆盖范围。
我们开发 RPA 已有 6 年了，自从我们首次发布 RPA 工作流8 以来，已经进行了几项重大更改。其中包括将 RPA 开发成基于 Web 的工具，从而降低与安装和维护相关的成本，并提高系统的健壮性。其他改进包括更改用户界面以提高可用性并降低错误9 的风险，以及扩展治疗选择（特别是乳房切除术后乳房10 和脑转移11 的放射治疗计划）。因此，这里描述的协议比以前发布的初始版本先进得多。
RPA 使用一步式流程来创建轮廓和计划，在这种情况下，通常不需要编辑轮廓来创建治疗计划。这包括宫颈癌的四野箱治疗计划（基于骨标志或自动生成的软组织轮廓）12、13、14、15、切向或锁骨上野用于乳房切除术后乳腺癌11，以及用于全脑治疗的对侧野16。在不久的将来，我们预计将增加小儿癌症的颅脊髓治疗17，直肠癌的三领域治疗18，以及各种姑息性病例（椎体、髋关节和肋骨）19以及肺癌和膀胱癌的治疗计划。目前，更先进的治疗方法，特别是容量调制弧形疗法（VMAT），需要一个两步过程，在治疗计划之前编辑自动生成的轮廓13,20。然而，基于深度学习的自轮廓的质量如此之高，我们期望在未来将这些规划方法更改为一步到位的过程。该协议侧重于一步规划。
图 1 显示了使用 RPA 创建放射治疗计划的整体工作流程， 表 1 显示了有关不同任务的更多详细信息。总之，RPA 需要完整的服务请求（包括剂量处方和治疗方法等信息）和患者的个人 CT 扫描。放射肿瘤学家必须接受服务请求。临床用户必须接受 CT 扫描，以确保在正确的 CT 扫描上执行 RPA 计算。一旦 RPA 生成了计划，应从 RPA 网站下载并导入用户的治疗计划系统，并在其中重新计算剂量。这是必要的，因为 RPA 计算标准光束（可用于多种直线加速器型号）的计划，这可能与局部直线加速器的光束特性不完全匹配。采用这种方法是为了降低成本，但如果局部光束与我们的标准光束有很大不同，则可能需要定制。用户（治疗计划者和放射肿瘤学家）可以对计划进行编辑。然后，该计划进入用户的典型临床工作流程，包括本地质量保证检查。最后，用户应将其最终（重新计算和编辑）计划上传到 RPA 网站，在那里执行最终计划和 RPA 计划之间的自动比较。这是对整个工作流中数据完整性的有用检查。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/65504/65504fig01.jpg"> 图 1：自动化治疗计划流程的工作流程。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig01large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody><tr><td>图 1 中的任务 #</td>
			<td colspan="3">任务描述</td>
			<td colspan="2">位置</td>
		</tr><tr><td></td>
			<td colspan="3">查看任何既往患者的状态</td>
			<td colspan="2">主仪表板</td>
		</tr><tr><td>1</td>
			<td colspan="3">在RPA网站上完成服务请求</td>
			<td colspan="2">“服务请求”仪表板</td>
		</tr><tr><td>2</td>
			<td colspan="3">将 CT 扫描上传到 RPA 网站</td>
			<td colspan="2">CT 扫描仪表板</td>
		</tr><tr><td rowspan="2">3</td>
			<td colspan="3">检查患者的状态</td>
			<td colspan="2">主仪表板</td>
		</tr><tr><td colspan="3">查看并下载 RPA 计划</td>
			<td colspan="2">主仪表板</td>
		</tr><tr><td>4</td>
			<td colspan="3">将计划导入用户的 TPS，重新计算剂量，并根据需要进行编辑</td>
			<td colspan="2">本地 TPS</td>
		</tr><tr><td rowspan="2">5, 6</td>
			<td colspan="3">将最终计划上传到 RPA 网站</td>
			<td colspan="2">计划比较仪表板</td>
		</tr><tr><td colspan="3">查看最终计划和 RPA 计划的自动比较</td>
			<td colspan="2">计划比较仪表板</td>
		</tr><tr><td>-</td>
			<td colspan="3">该计划进入用户的常规临床工作流程，包括定期的质量保证</td>
			<td colspan="2">用户自己的软件</td>
		</tr></tbody></table>表 1：使用 1 步工作流创建 RPA 计划所涉及的任务概述。 本地 TPS：用户的治疗计划系统。
本文描述了 RPA 的这一一步式工作流程，并介绍了治疗计划流程输出的一些示例结果。目前，以下规划方法使用这种一步式工作流程：i） 宫颈癌患者的四视野箱治疗计划（基于骨地标的孔）;ii）宫颈癌患者的四野箱治疗方案（基于软组织的野孔）;iii） 胸壁患者的切线和锁骨上治疗计划;iv） 全脑治疗计划。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Radiation Planning Assistant</td>
			<td>MD Anderson Cancer Center</td>
			<td>na</td>
			<td>webpage</td>
		</tr>
	</tbody>
</table>

radiation planning assistant - a web-based tool to support high-quality radiotherapy in clinics with limited resources

全世界获得放射治疗的机会有限。放射计划助手 （RPA） 是一种全自动的、基于 Web 的工具，正在开发中，旨在为资源有限的诊所提供全自动放射治疗计划工具。目标是帮助临床团队扩大他们的工作范围，从而惠及更多的癌症患者。用户通过网页连接到RPA，完成服务请求（处方和有关放射治疗目标的信息），并上传患者的CT图像集。RPA 提供了两种自动化规划方法。在一步式规划中，系统使用服务请求和 CT 扫描自动生成必要的轮廓和治疗计划。在两步规划中，用户在 RPA 继续生成容量调制弧形治疗计划之前查看和编辑自动生成的轮廓。最终计划从RPA网站下载并导入用户的本地治疗计划系统，其中为本地委托的直线加速器重新计算剂量;如有必要，在批准临床使用之前对计划进行编辑。

主仪表板（图 1）的目的是在 RPA 中提供当前患者状态的快速概览，允许快速查看已完成的计划，下载已完成的计划以在用户的治疗计划系统中进行审查和编辑，并提供高级患者导航和排序工具。对于患者来说，他们必须至少具有以下一项：（1） 可接受的 CT 扫描或 （2） 接受的服务表。当前患者的状态类别可以在主仪表板上查看（表 4）。
全脑放疗计划的侧场示例如 图 6 所示。 图 7 显示了基于骨地标的宫颈癌 4 场箱形计划的侧场示例。在这两种情况下，都必须下载最终计划，然后将其导入用户的治疗计划系统，在该系统中必须查看、编辑和重新计算结果。RPA 还会创建最终计划报告 （PDF），其中包括服务请求（参见 图 3 中的示例）、CT 批准报告和治疗计划的其他详细信息。
“服务请求”仪表板（表 2）的目的是为 RPA 中的当前患者提供服务请求的快速状态概述、创建新的服务请求、接受已完成的服务请求以及编辑服务请求。已提交或已接受服务请求的患者将显示在此仪表板上，RPA 的所有用户都可以访问该仪表板。但是，只有在 RPA 系统中注册为放射肿瘤学家的用户才能接受服务请求。
CT 仪表板（表 3）的目的是为 RPA 中的当前患者提供 CT 扫描的快速状态概述，上传新的 CT 扫描，查看和接受 CT 扫描，以及为 CT 扫描添加参考点。添加了参考点以在某些特定情况下指导 RPA，例如当用户想要使用非标准的上边框进行宫颈癌的简单 4 场框计划时。此处显示了已上传 CT 扫描的患者。任何用户都可以查看 CT 仪表板，但只有注册为临床用户的用户才能接受 CT 扫描。
一旦用户确认了他们的最终计划，他们就可以从他们的 TPS 中导出它并将其上传到 RPA。此过程的目的是提供一种方法来检查数据是否在不同设备之间正确通信。
已为其生成 RPA 计划的患者将显示 在计划比较仪表板中。 计划比较仪表板 提供了 表 5 中显示的当前患者的状态类别。
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/65504/65504fig06.jpg"> 图 6：全脑放疗的典型侧场。 此视图显示了结构轮廓的投影以及主准直器（黄色）和多叶准直器（蓝色）的位置。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig06large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/65504/65504fig07.jpg"> 图 7：基于骨地标的宫颈癌 4 场箱形计划的侧场示例。 此视图显示了主准直器（黄色）和多叶准直器（蓝色）的位置。 <a href="https://www.jove.com/files/ftp_upload/65504/65504fig07large.jpg" target="_blank">请点击这里查看此图的较大版本.</a>

Watch this Scientific Journal Video about Author Spotlight: Improving Radiation Therapy Access with Radiation Planning Assistant at JoVE.com

作者聚焦：使用 Radiation Planning Assistant 改善放射治疗可及性

该协议描述了一系列专为高质量放射治疗、自体轮廓和自动计划而设计的自动化工具，这些工具被打包到基于 Web 的服务中，以最大限度地提高稳健性和可扩展性，同时最大限度地降低运营成本。

放射计划助手 - 一个基于网络的工具，以支持资源有限的诊所进行高质量的放射治疗

Access to radiotherapy worldwide is limited. The Radiation Planning Assistant (RPA) is a fully automated, web-based tool that is being developed to offer ...

我们开发了放射规划助手，作为一种基于网络的工具，旨在帮助低收入和中等收入国家扩大其努力，为患者提供高质量的轮廓和治疗计划。在世界上大多数地方，获得放射治疗的机会非常有限，这是由于多种因素造成的，包括人员和合格的放射肿瘤学家、放射治疗技师和医学物理学家的短缺。我们希望RPA能够解决其中的一些挑战。辐射规划助手旨在以最低的成本提供高质量的轮廓和计划。我们希望为那些原本无法访问的诊所免费提供这些工具。现在我们已经完成了辐射规划助手的第 1 版，我们将开始开发下一个版本。我们将尝试减少手动上传和下载数据的需要，并添加新的治疗地点和方法。

radiation-planning-assistant-web-based-tool-to-support-high-quality

Research

JoVE Journal

Medicine

Radiation Planning Assistant - A Web-based Tool to Support High-quality Radiotherapy in Clinics with Limited Resources

1.2K 次观看.  The University of Texas MD Anderson Cancer Center. 我们开发了放射规划助手，作为一种基于网络的工具，旨在帮助低收入和中等收入国家扩大其努力，为患者提供高质量的轮廓和治疗计划。在世界上大多数地方，获得放射治疗的机会非常有限，这是由于多种因素造成的，包括人员和合格的放射肿瘤学家、放射治疗技师和医学物理学家的短缺。我们希望RPA能够解决其中的一些挑战。辐射规划助手旨在以最低的成本提供高?...

视频: 作者聚焦：使用 Radiation Planning Assistant 改善放射治疗可及性

Stem Cell Transplantation Strategies for the Restoration of Cognitive Dysfunction Caused by Cranial Radiotherapy

Radiotherapy often provides the only clinical recourse for those afflicted with primary or metastatic brain tumors. While beneficial, cranial irradiation can induce a progressive and debilitating decline in cognition that may, in part, be caused by the depletion of neural stem cells. Given the increased survival of patients diagnosed with brain cancer, quality of life in terms of cognitive health has become an increasing concern, especially in the absence of any satisfactory long-term treatments.
To address this serious health concern we have used stem cell replacement as a strategy to combat radiation-induced cognitive decline. Our model utilizes athymic nude rats subjected to cranial irradiation. The ionizing radiation is delivered as either whole brain or as a highly focused beam to the hippocampus via linear accelerator (LINAC) based stereotaxic radiosurgery. Two days following irradiation, human neural stem cells (hNSCs) were stereotaxically transplanted into the hippocampus. Rats were then assessed for changes in cognition, grafted cell survival and for the expression of differentiation-specific markers 1 and 4-months after irradiation. Our cognitive testing paradigms have demonstrated that animals engrafted with hNSCs exhibit significant improvements in cognitive function. Unbiased stereology reveals significant survival (10-40%) of the engrafted cells at 1 and 4-months after transplantation, dependent on the amount and type of cells grafted. Engrafted cells migrate extensively, differentiate along glial and neuronal lineages, and express a range of immature and mature phenotypic markers.
Our data demonstrate direct cognitive benefits derived from engrafted human stem cells, suggesting that this procedure may one day afford a promising strategy for the long-term functional restoration of cognition in individuals subjected to cranial radiotherapy. To promote the dissemination of the critical procedures necessary to replicate and extend our studies, we have provided written and visual documentation of several key steps in our experimental plan, with an emphasis on stereotaxic radiosurgey and transplantation.

Brain tumor patients routinely undergo cranial radiotherapy, and while beneficial, this treatment often results in debilitating cognitive dysfunction. This serious unresolved problem has at present, no clinical recourse, and has driven our efforts to devise stem cell based therapies for the recovery of radiation-induced cognitive decrements.

颅放疗引起的认知功能障碍恢复干细胞移植策略

Radiotherapy often provides the only clinical recourse for those afflicted with primary or metastatic brain tumors. While beneficial, cranial irradiation ...

科研

医学

Quantifying Cognitive Decrements Caused by Cranial Radiotherapy

With the exception of survival, cognitive impairment stemming from the clinical management of cancer is a major factor dictating therapeutic outcome. For many patients afflicted with CNS and non-CNS malignancies, radiotherapy and chemotherapy offer the best options for disease control. These treatments however come at a cost, and nearly all cancer survivors (~11 million in the US alone as of 2006) incur some risk for developing cognitive dysfunction, with the most severe cases found in patients subjected to cranial radiotherapy (~200,000/yr) for the control of primary and metastatic brain tumors1. Particularly problematic are pediatric cases, whose long-term survival plagued with marked cognitive decrements results in significant socioeconomic burdens2. To date, there are still no satisfactory solutions to this significant clinical problem.
We have addressed this serious health concern using transplanted stem cells to combat radiation-induced cognitive decline in athymic rats subjected to cranial irradiation3. Details of the stereotaxic irradiation and the in vitro culturing and transplantation of human neural stem cells (hNSCs) can be found in our companion paper (Acharya et al., JoVE reference). Following irradiation and transplantation surgery, rats are then assessed for changes in cognition, grafted cell survival and expression of differentiation-specific markers 1 and 4-months after irradiation. To critically evaluate the success or failure of any potential intervention designed to ameliorate radiation-induced cognitive sequelae, a rigorous series of quantitative cognitive tasks must be performed. To accomplish this, we subject our animals to a suite of cognitive testing paradigms including novel place recognition, water maze, elevated plus maze and fear conditioning, in order to quantify hippocampal and non-hippocampal learning and memory. We have demonstrated the utility of these tests for quantifying specific types of cognitive decrements in irradiated animals, and used them to show that animals engrafted with hNSCs exhibit significant improvements in cognitive function3.
The cognitive benefits derived from engrafted human stem cells suggest that similar strategies may one day provide much needed clinical recourse to cancer survivors suffering from impaired cognition. Accordingly, we have provided written and visual documentation of the critical steps used in our cognitive testing paradigms to facilitate the translation of our promising results into the clinic.

Cognitive impairment resulting from the radiotherapeutic management of brain tumors represents a clinically intractable condition that adversely impacts quality of life. The capability to critically evaluate potential interventions for ameliorating radiation-induced cognitive decrements ultimately depends on the capability to undertake rigorous quantitative assessments of cognition.

量化颅放疗引起的认知递减

With the exception of survival, cognitive impairment stemming from the clinical management of cancer is a major factor dictating therapeutic outcome. For ...

Combination Radiotherapy in an Orthotopic Mouse Brain Tumor Model

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the understanding of the mechanics of tumor invasion, and direct intracerebral inoculation of tumor provides the opportunity of observing the invasive process in a physiologically appropriate environment2. As far as human brain tumors are concerned, the orthotopic models currently available are established either by stereotaxic injection of cell suspensions or implantation of a solid piece of tumor through a complicated craniotomy procedure3. In our technique we harvest cells from tissue culture to create a cell suspension used to implant directly into the brain. The duration of the surgery is approximately 30 minutes, and as the mouse needs to be in a constant surgical plane, an injectable anesthetic is used. The mouse is placed in a stereotaxic jig made by Stoetling (figure 1). After the surgical area is cleaned and prepared, an incision is made; and the bregma is located to determine the location of the craniotomy. The location of the craniotomy is 2 mm to the right and 1 mm rostral to the bregma. The depth is 3 mm from the surface of the skull, and cells are injected at a rate of 2 &mu;l every 2 minutes. The skin is sutured with 5-0 PDS, and the mouse is allowed to wake up on a heating pad. From our experience, depending on the cell line, treatment can take place from 7-10 days after surgery. Drug delivery is dependent on the drug composition. For radiation treatment the mice are anesthetized, and put into a custom made jig. Lead covers the mouse's body and exposes only the brain of the mouse. The study of tumorigenesis and the evaluation of new therapies for GBM require accurate and reproducible brain tumor animal models. Thus we use this orthotopic brain model to study the interaction of the microenvironment of the brain and the tumor, to test the effectiveness of different therapeutic agents with and without radiation.

The purpose of this article is to describe the use of an orthotopic glioblastoma model for chemoradiation studies. This article will go though cell processing, implanting, and radiotherapy of the mouse using an intracranial model.

在原位小鼠脑肿瘤模型结合放疗

Glioblastoma multiforme (GBM) are the most common and aggressive adult primary brain tumors1. In recent years there has been substantial progress in the ...

Clinical Examination Protocol to Detect Atypical and Classical Scrapie in Sheep

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated prion protein by post mortem tests. Unless a random sample of the sheep or goat population is actively monitored for scrapie, identification of scrapie cases relies on the reporting of clinical suspects, which is dependent on the individual&#39;s familiarization with the disease and ability to recognize clinical signs associated with scrapie. Scrapie may not be considered in the differential diagnosis of neurological diseases in small ruminants, particularly in countries with low scrapie prevalence, or not recognized&#160;if it presents as nonpruritic form like atypical scrapie. To aid in the identification of clinical suspects, a short examination protocol is presented to assess the display of specific clinical signs associated with pruritic and nonpruritic forms of TSEs in sheep, which could also be applied to goats. This includes assessment of behavior, vision (by testing of the menace response), pruritus (by testing the response to scratching), and movement (with and without blindfolding). This may lead to a more detailed neurologic examination&#160;of reporting animals as scrapie suspects. It&#160;could also be used in experimental TSE studies of sheep or goats to evaluate disease progression or to identify clinical end-point.

A short clinical examination protocol is presented to aid in the detection of classical and atypical scrapie in sheep and goats.

临床检查协议检测非典型和经典刮在绵羊

The diagnosis of scrapie, a transmissible spongiform encephalopathy (TSEs) of sheep and goats, is currently based on the detection of disease-associated ...

Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these techniques, patients hold their breath while radiotherapy is delivered, pushing the heart down and away from the radiotherapy field. Despite clear dosimetric benefits, these techniques are not yet in widespread use. One reason for this is that commercially available solutions require specialist equipment, necessitating not only significant capital investment, but often also incurring ongoing costs such as a need for daily disposable mouthpieces. The voluntary breath-hold technique described here does not require any additional specialist equipment. All breath-holding techniques require a surrogate to monitor breath-hold consistency and whether breath-hold is maintained. Voluntary breath-hold uses the distance moved by the anterior and lateral reference marks (tattoos) away from the treatment room lasers in breath-hold to monitor consistency at CT-planning and treatment setup. Light fields are then used to monitor breath-hold consistency prior to and during radiotherapy delivery.

The current priority in breast cancer radiotherapy is to reduce cardiac doses without compromising target tissue coverage. The voluntary breath-hold technique described here is a simple, inexpensive solution to this problem and capable of being instituted widely without the need for specialized equipment.

自愿屏气技术减少心脏剂量的左乳房放射治疗

Breath-holding techniques reduce the amount of radiation received by cardiac structures during tangential-field left breast radiotherapy. With these ...

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the anterior chest wall or the flexion-compression injury of the trunk, there is a need to retain each sternal fragment in the correct position while neutralizing shearing forces to the sternum. Anterior sternal plating provides the best stability and is therefore increasingly used in most cases. However, many surgeons are reluctant to perform sternal osteosynthesis due to possible complications such as difficulties in preoperative planning, severe injuries to mediastinal organs, or failure of the performed method.
This manuscript describes one possible safe way to stabilize different types of sternal fractures in a step by step guidance for anterior sternal plating using low profile locking titanium plates. Before surgical treatment, a detailed survey of the patient and a three dimensional reconstructed computed tomography is taken out to get detailed information of the fracture&#8217;s morphology. The surgical approach is usually a midline incision. Its position can be described by measuring the distance from upper sternal edge to the fracture and its length can be approximated by the summation of 60 mm for the basis incision, the thickness of presternal soft tissue and the greatest distance between the fragments in case of multiple fractures.
Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates prevents injuries to mediastinal organs and vessels.
Transverse fractures and oblique fractures at the corpus sterni are plated longitudinally, whereas oblique fractures of manubrium, sternocostal separation and any longitudinally fracture needs to be stabilized by a transverse plate from rib to sternum to rib. Usually the high convenience of a patient is seen during follow up as well as a precise reconstruction of the sternal morphology.

Here we present a method to stabilize sternal fractures by using locked titanium plates in a low profile design. Performing subperiosteal dissection along the sternum while reducing the fracture, using depth limited drilling, and fixing the plates provides a safe surgical way.

胸骨骨折内固定手术：术前设计和安全的手术技术采用锁定钛板和深度钻探有限公司

Different ways to stabilize a sternal fracture are described in literature. Respecting different mechanisms of trauma such as the direct impact to the ...

Techniques for Processing Eyes Implanted with a Retinal Prosthesis for Localized Histopathological Analysis: Part 2 Epiretinal Implants with Retinal Tacks

Retinal prostheses for the treatment of certain forms of blindness are gaining traction in clinical trials around the world with commercial devices currently entering the market. In order to evaluate the safety of these devices, in preclinical studies, reliable techniques are needed. However, the hard metal components utilised in some retinal implants are not compatible with traditional histological processes, particularly in consideration for the delicate nature of the surrounding tissue. Here we describe techniques for assessing the health of the eye directly adjacent to a retinal implant secured epiretinally with a metal tack.
Retinal prostheses feature electrode arrays in contact with eye tissue. The most commonly used location for implantation is the epiretinal location (posterior chamber of the eye), where the implant is secured to the retina with a metal tack that penetrates all the layers of the eye. Previous methods have not been able to assess the proximal ocular tissue with the tack in situ, due to the inability of traditional histological techniques to cut metal objects. Consequently, it has been difficult to assess localized damage, if present, caused by tack insertion.
Therefore, we developed a technique for visualizing the tissue around a retinal tack and implant. We have modified an established technique, used for processing and visualizing hard bony tissue around a cochlear implant, for the soft delicate tissues of the eye. We orientated and embedded the fixed eye tissue, including the implant and retinal tack, in epoxy resin, to stabilise and protect the structure of the sample. Embedded samples were then ground, polished, stained, and imaged under various magnifications at incremental depths through the sample. This technique allowed the reliable assessment of eye tissue integrity and cytoarchitecture adjacent to the metal tack.

Here we describe histological techniques for visualising ocular tissue directly adjacent to a metal epiretinal tack and retinal prosthesis.

为处理眼植入视网膜假体的局部病理组织学分析技术：第2部分视网膜前植入视网膜大头钉

Retinal prostheses for the treatment of certain forms of blindness are gaining traction in clinical trials around the world with commercial devices ...

Treatment of Liver Metastases Using an Internal Target Volume Method for Stereotactic Body Radiotherapy

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For inoperable patients, local ablation therapies, such as stereotactic body radiotherapy (SBRT), can provide effective local tumor control with minimal toxicity. Because of its high precision and accuracy, SBRT delivers a higher radiation dose per fraction, is more effective, and targets smaller irradiation volumes than does conventional radiotherapy. In addition, steep dose gradients from target lesions to surrounding normal tissues are achieved using SBRT; thus, SBRT provides more effective tumor control and exhibits fewer side effects than conventional radiotherapy. The use of SBRT is prevalent for treating intracranial lesions (known as stereotactic radiosurgery); however, it is now also used for treating spinal and adrenal metastases. Because of advancements in image-guided assistance and respiratory motion management, several studies have investigated the use of SBRT for treating lung or liver tumors, which move as a patient breathes. The results of these studies have suggested that SBRT favorably controls tumors in the case of moving lesions.
Four-dimensional computed tomography (4D-CT) with an abdominal compressor (AC) is clinically convenient for effective respiratory motion management. Because this method is noninvasive and allows free breathing, its use reduces complications. Furthermore, patients consider this method convenient. Moreover, it is considered more efficient than other methods of respiratory motion management by physicians and therapists. The use of 4D-CT with an AC for treating pulmonary lesions has also been widely investigated, and the technique is gaining acceptance for treating hepatic lesions. However, the protocols for using 4D-CT with an AC for treating hepatic lesions are different from those used for treating pulmonary lesions. In this article, we describe a new protocol for SBRT with 4D-CT and an AC for treating liver metastases.

Stereotactic body radiotherapy (SBRT) requires rigorous accuracy and precision for delivering high radiation doses per fraction to small treatment volumes to improve tumor control and simultaneously reduce toxicity. Herein, we present a noninvasive and clinically convenient respiratory motion management protocol for SBRT for liver metastases.

内靶容积法治疗肝转移瘤的立体定向体放疗

The prognosis of patients with metastatic cancers has improved in the past decades due to effective chemotherapy and oligometastatic surgery. For ...

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff.

Radiation therapy is a highly complex cancer treatment that requires multiple specialists to create a treatment plan and provide quality assurance (QA) prior to delivery to a patient. This protocol describes the use of a fully automated system, the Radiation Planning Assistant (RPA), to create high-quality radiation treatment plans.

放射规划助理-一个流线型的全自动放疗治疗计划系统

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated ...

使用 Dixon MRI 的综合 3D 肝脏脂肪功能分布模型

A 3D Quantification Technique for Liver Fat Fraction Distribution Analysis Using Dixon Magnetic Resonance Imaging

This study presents a 3D quantification methodology for the distribution of liver fat fraction (LFF) through the utilization of Dixon MRI image analysis. The central aim is to offer a highly accurate and non-invasive means of evaluating liver fat content. The process involves the acquisition of In-phase and Water-phase images from a Dixon sequence. LFF maps are then meticulously computed voxel by voxel by dividing the Lipid Phase images by the In-phase images. Simultaneously, 3D liver contours are extracted from the In-phase images. These crucial components are seamlessly integrated to construct a comprehensive 3D-LFF distribution model. This technique is not limited to healthy livers but extends to those afflicted by hepatic steatosis. The results obtained demonstrate the remarkable effectiveness of this approach in both visualizing and quantifying liver fat content. It distinctly discerns patterns that differentiate between normal and steatotic livers. By harnessing Dixon MRI to extract the 3D structure of the liver, this method offers precise LFF assessments spanning the entirety of the organ, thereby holding great promise for the diagnosis of hepatic steatosis with remarkable effectiveness.

作者聚焦：一种使用 3D Dixon MRI 评估和区分肝脏脂肪模式的非侵入性工具 

This study introduces a unique 3D quantification method for liver fat fraction (LFF) distribution using Dixon Magnetic Resonance Imaging (Dixon MRI). LFF maps, derived from in-phase and water-phase images, are integrated with 3D liver contours to differentiate LFF patterns between normal and steatotic livers, enabling precise assessment of liver fat content.

使用Dixon磁共振成像分析肝脏脂肪分数分布的3D定量技术

This study presents a 3D quantification methodology for the distribution of liver fat fraction (LFF) through the utilization of Dixon MRI image analysis. ...