12 ORMAL TISSUE TO T 正常组织的耐受 B.EMAM.M.D.J.LYMAN.PH.D..5 A.BROwN.M.D.L J.E.MUNZENRIDER.M.D.,B.SHANK.M.D..L.J.S %0 学通糖意， Mallinckrodt Institue of Radiology.Wohington Univeraity School of Med- al Sloan-Kectering Cancer Center.New York.NY 10021:'Department of Radiation T nool of Medicine and the Fox Chase Cancer Center.Philsdelphia.PA 19111:'Mass en of Radiation Medicine. Boston.MA 02114 and Harvard Medical School:an weBerkeley Laboraory. Research Medicine and Radias .CA94720 The importance of knowledge on toler dlation by radiation oncologists cannot be overemphasited.Unfartunatel →ad网uate.ith the increasing use of 3-D treatment planning and dove columetrie information.will become ewe mere critical.As a part of the force.chaired by the primary author.was formed and an extensive lite address this isue.In this manuscript we present the updated informe ues of concern in the protocols of this contraet.based on cliniclans stop of this 年龄、 感伦疾病、化疗、术后等都能与 《意在作用品政变脏器的厨受 CSTRO 2007 Dorr 2007
川北医学院放射肿瘤学教研室
第三个关键问题 能 划重复吗？
川北医学院放射肿瘤学教研室
24 不确定因素的影响 把区平均位置 系统性误差 常规放疗PTV 摆位时的日常偏差：随机误差 IMRT PTV Adapted from Clifton C.Ling 2005 STR02007
川北医学院放射肿瘤学教研室
28 靶区的生理性变动 每次照射间的内等动： INTRAFRACTIONAL MOTION (每天可能动) 头颈部肿瘤照射时，影响较小 送上下方向4卿 胸腹部肿瘤照射时，最严重 前例腺：>5mm前后方向 正常呼吸 肝：8mm standing 18,19和 11mm supine 肾：19mm mean 北医 深呼吸 mm 肝： 12直75 mm 肾：40mm mean
川北医学院放射肿瘤学教研室
34 Illusion vs Reality 研 在电脑上完美的IMRT划 错觉 系统误差 S Adaptive RT 随机误差 处理不确定因素 IGRT 每天体内靶区位置变动， 病人消瘦，机械故障等 现实 sTR02007
川北医学院放射肿瘤学教研室