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| COMMENTARY |
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| Year : 2016 | Volume
: 2
| Issue : 3 | Page : 97-100 |
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National key research and development program of China: Three-dimensional visible treatment planning system beyond reality and dream
Jianguo Sun1, Shaoxiang Zhang2, Yizhu Wang3, Yi Wu2, Zhengtang Chen1
1 Cancer Institute of Chinese People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
2 Institute of Digital Medicine, College of Biomedical Engineering, Third Military Medical University, Chongqing 400038, China
3 Yorktal Digital Medical Imaging Technology Co. Ltd., Shenzhen 518000, Guangdong, China
| Date of Web Publication | 24-Nov-2016 |
Correspondence Address:
Prof. Jianguo Sun
Cancer Institute of Chinese People's Liberation Army, Xinqiao Hospital, Third Military Medical University, Chongqing 400037
China
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2226-8561.194691
How to cite this article:
Sun J, Zhang S, Wang Y, Wu Y, Chen Z. National key research and development program of China: Three-dimensional visible treatment planning system beyond reality and dream. Digit Med 2016;2:97-100 |
How to cite this URL:
Sun J, Zhang S, Wang Y, Wu Y, Chen Z. National key research and development program of China: Three-dimensional visible treatment planning system beyond reality and dream. Digit Med [serial online] 2016 [cited 2023 Mar 29];2:97-100. Available from: http://www.digitmedicine.com/text.asp?2016/2/3/97/194691 |
Malignant tumors pose a great threat to human health. Among the treatment of tumors, radiotherapy is a primary choice. At present, imported radiotherapy equipment has a monopoly on the market and charges a high price, which makes it urgent to develop Chinese homemade radiotherapy equipment. The current research program named "three-dimensional Visible Treatment Planning System (3DV+TPS): Design of Integrated Solution" led by the Third Military Medical University (TMMU) in collaboration with Yorktal Digital Medical Imaging Technology, Co. Ltd. in Shenzhen has won financial support of 12 million Yuan from National Key Research and Development Project (No. 2016YFC0106400) in 2016. This project may hopefully break up the monopoly of imported radiation TPS and realize rapid, efficient, and precise 3D treatment in homemade radiotherapy equipment.
According to the World Health Statistics, malignant tumors are the second leading cause of death next to cardiovascular diseases. GLOBOCAN reports showed that there were about 14.1 million new cancers and up to 8.2 million cancer-related deaths worldwide in 2012. [1] International Agency for Research on Cancer estimates that global cancer cases will increase with years and reach approximately 19 million by 2025 and 24 million by 2035. Surgery, chemotherapy, radiotherapy, and biotherapy are the four most commonly used strategies to treat malignancies. About 60%-70% of cancer patients receive single or multiple fractions of radiotherapy during the course of disease, among whom 40%-50% receive radiation during the initial treatment, while 15%-20% receive palliative radiotherapy after tumor recurrence or metastasis. [2]
Precise radiotherapy is an important means to realize precise treatment of cancer. However, the existing radiotherapy planning shows low efficiency, and homemade radiotherapy equipments lack standard operating procedures. Therefore, it is urgent for grass-roots hospitals to improve the integration, precision, and individualization of radiotherapeutic techniques. At present, hundreds of radiotherapy centers in China have purchased homemade medical accelerators, but due to the lack of standards for integrated application of homemade equipments or clinical consensus for reference or special institutions for training the application skills, the centers cannot provide uniform high-level radiotherapy, thus unable to solve the social problems of difficulty and high expense in accessing medical service, especially the grass-roots hospitals that have inaccurate delineation of regions of interest (ROIs), inadequate treatment precision, and disordered operating procedures. TPS is a technology-intensive, large-scale, complex, and specialized computer software system that supports the use of medical linear accelerators. The quality of TPS determines the rationality and precision of dose distribution. At present, the two companies of Varian and Elekta are the main vendors and operators of TPS in the world, whereas Chinese homemade TPS products in domestic radiotherapy centers are of lower product quality. Therefore, developing high-performance, novel-type TPS becomes urgent in China, which is also a critical step to promote integrated application of Chinese homemade radiotherapy equipments.
TMMU is a "2110 Project" military key university, and the Cancer Institute of PLA in the Second Affiliated Hospital (Xinqiao Hospital) of TMMU, which has been equipped with internationally advanced radiotherapy facilities, is renowned for rapid diagnosis and effective treatment of various solid tumors in Southwest China and even the whole country. As a collaborator, the Institute of Digital Medicine in TMMU has built up an internationally advanced platform for digital medicine research and established eight datasets of Chinese visible human. In addition, Yorktal Digital Medical Imaging Technology, Co. Ltd. in Shenzhen is a national high- and new-technology enterprise and a provider of systematic solutions to realize the informatization, intelligentization, digitalization, virtualization, and networking of medical treatment. Therefore, the current project on 3D visible human system launched together by the above three institutions will take a leading position in both national and international fields of industry application. Moreover, the principal investigator (PI) of the project, Prof. Jianguo Sun, who is the Deputy Director of the Cancer Institute of PLA and a doctoral supervisor, has been a radiation oncologist for many years and has influential academic appointments in radiotherapy committees of various levels, including municipal, PLA, and national levels. Taking advantage of the PIs academic status and the disciplinary impact, the advanced digital medicine platform, and the patent imaging processing technique, the current project will integrate the high-level technologies in computer medicine, digital medicine, and imaging medicine and is expected to produce a set of software program of 3DV+TPS, which will enhance the competitiveness of Chinese radiotherapy equipment and promote the breakthrough progress of homemade TPS in medical industry. Finally, this 3DV+TPS program may be comparable with imported TPS, hopefully breaking up the monopoly of foreign-made TPS.
Therefore, centered upon the precise radiotherapy for malignant tumors and based on the integrated and optimized 3DV+TPS in combination with Visible Human Dataset, the current project plans to realize automatic recognition of ROIs, 3D reconstruction, and visible radiotherapy planning, followed by dosage investigation in digital and physical phantoms to obtain the standard data for 3DV+TPS quality control. Next, the project will conduct a multicenter comparative clinical trial in patients with nasopharyngeal carcinoma, one of the most common malignant head and neck tumors, in collaboration with four to five hospitals of different ranks using two types of homemade accelerators, to provide standard operating procedures for homemade radiotherapy equipments, and to formulate clinical consensus finally.
The 3DV+TPS shall have seven core functions:
- Basic function: Dissecting at any section; multifunctional delineating; automatic image fusion; function modules to set treatment planning; planning of external radiotherapy; application of compensations; dosage calculation; management of radiotherapeutic machines; tools to assess treatment plans; planning of intensity-modulated radiation therapy; advanced aperture optimization modules; output of plans; function modules to control plan quality; software package of network and its interface; and DICOM interface package
- Characteristic function: Automatic delineation of target volumes; 3D reconstruction module; automatic beam system of radiotherapy; 3D display of radiotherapy plans; docking with homemade or imported accelerators; and testing of their compatibility
- Quality control standards: Ability to obtain standardized physical parameters based on verification in digital and physical phantoms
- Standard data of the human body: High-resolution imaging data in continuous thin layers
- Visible radiation model in deformable humanoid shape, which can be used for deformable registration with individualized imaging data
- Ability to compare individualized images with the standard human body data to obtain complete and continuous information of tumor and affected organs
- Ability to simulate and calculate irradiation dosages and thus to optimize radiotherapy planning.
The current project will require development and application of a large number of software programs to solve the problems encountered in the research process. For example, new algorithms and software modules are needed for the 3D reconstruction of nerve bundles in the head and neck and nasopharynx. In the meantime, a large amount of new techniques that break the bottleneck of existing technologies, especially those for image processing, will be applied to the field of radiotherapy and undergo integrated optimization to produce next-generation 3DV+TPS. All the techniques will be protected as inventions by a patent, such as dosage algorithms and visualized display based on 3D reconstructed images.
As the current project progresses, five novel features will appear in 3DV+TPS:
| Rapid and precise determination of regions of interest | |  |
Based on self-developed algorithms for edge enhancement and precise recognition of ROIs, 3DV+TPS can provide a segmenting approach to rapidly and automatically determine ROIs. Moreover, the system shall also provide a method that enables operators to interactively delineate or adjust the target volume. With this method, doctors could use the interactive tools to manually modify the automatically segmented volumes according to their clinical experience. Hence, the time for human-machine interaction can be significantly reduced, and the efficiency of target volume delineation can be increased over 10 times. Furthermore, the precision of target volumes will also be greatly improved, thus reducing the damage of irradiation to the normal tissues.
| Automatic and dynamic calculation of three-dimensional radiation doses | | |
3DV+TPS is able to automatically generate precise 3D reconstruction of images, and to analyze, extract, process, and display all the medical images, delineated regions, and calculated doses involved in radiotherapy planning. The integrated visualization of basic, labeled, and dosage data fields by the system will assist physicians with judgment and modification of treatment plans. Meanwhile, the automatic, real-time dynamic calculation of radiation doses within the 3D target volume can complete the rapid calculation by measuring the 3D volume of ROIs, the field size, and the beam angle on the basis of 3D visualization.
| Three-dimensional visualization of the regions of interest and its fusion and registration with the digital phantom | | |
Based on the precise segmentation of ROIs, 3DV+TPS can reconstruct the extracted ROIs and display the lesion area and its surrounding tiny blood vessels and soft tissues in an intuitive and a stereoscopic manner. The system will allow rapid, precise fusion and registration of the reconstructed images with the imaging data of digital phantom or from multiple modes (e.g. MRI and PET), especially with the important information (e.g. optical tracts, functional brain areas, tiny blood vessels, nerves, and lymph nodes), to avoid radiation-induced damage to important issues. In addition, 3DV+TPS can allow other operations on the 3D ROIs, including magnification, minification, rotation, and transparentization, for the convenience of localizing ROIs and observing it from different perspectives; the system shall allow dissection of ROIs at any section and modulation of transparency to enable observation of internal and external structures of ROIs; it can also allow movement and combination of different 3D models of one patient to enable observation of the relationship between ROIs and surrounding tissues. Therefore, combination of standard human data with individual imaging data by 3DV+TPS will promote the development of radiotherapy into a new form characterized by integration, individualization, and precision, finally improving the conception of modern radiotherapy.
| Formulation of programs for integrated application of homemade radiotherapy equipment with three-dimensional visible + treatment planning system as the core | | |
Integrated application of homemade radiotherapy software (3DV+TPS) and hardware (medical accelerators) will probably formulate a set of standard operating procedures for homemade radiotherapy equipment, to greatly increase the efficiency of radiotherapy plans and the precision of radiation therapy, and to remarkably improve the treatment in grass-roots hospitals. Featured by its core advantages in delineating target volumes, calculating radiation doses, and displaying reconstructed images, 3DV+TPS will not only be a listed new-type TPS but also provide a model for the application of core solutions, which is of great significance for handling inadequacies and difficulties encountered in the radiotherapy process.
| Integration of manufacturing, teaching, research, treatment, and detection and its demonstration effects and application potentials | | |
The current project is an integration that involves enterprise manufacturing, teaching, research, medical treatment, and detection, and that will generate products able to benefit clinical practice in many aspects, showing typical demonstration effects. The technical advantages of 3DV+TPS products will endow the current project with more application potentials: (1) automatic measurement of the changes in target volume before and after radiotherapy to facilitate evaluation of radiation effects and follow-up management of treatment; (2) summarization and analysis by built-in large database of experts able to provide guiding suggestions based on big data; (3) automatic recognition of ROIs and visualized display to promote teaching and science popularization.
Taken together, the research results of 3DV+TPS will remarkably enhance the technical competence of Chinese homemade digital radiotherapy equipment, make a breakthrough in the development of homemade TPS in medical industry, and promote the recognition of Chinese homemade digital radiotherapy equipment as internationally leading facility. In addition, the outcomes can effectively lower the equipment procurement cost compared with purchasing imported equipment and solve the problem of money shortage for grass-roots hospitals. Visualized automatic recognition of ROIs can greatly reduce human negligence or errors due to inadequate knowledge or experience, and this function will maximally optimize radiotherapy planning, relieve toxic and side effects, and improve the rationality of radiotherapy plans. Therefore, the current project will make substantial progress in clinical practice of radiotherapy, relieve the cost burden of health insurance for China, and reduce the medical costs for patients.
| References | | |
| 1. | International Agency for Research on Cancer. Latest World Cancer Statistics Global Cancer Burden Rises to 14.1 Million New Cases in 2012. Vol. 223. Geneva: World Health Organization; 2013. p. 1-3.  |
| 2. | Tyldesley S, Boyd C, Schulze K, Walker H, Mackillop WJ. Estimating the need for radiotherapy for lung cancer: an evidence-based, epidemiologic approach. Int J Radiat Oncol Biol Phys 2001;49:973-85. |
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