发表机构
Emory University; University of Wisconsin; University of Chicago（埃默里大学; 威斯康星大学; 芝加哥大学）
机构由 AI 辅助整理，请以论文原文为准。AI 中文总结
提出数字孪生框架，利用既往患者库和两步配准预测质子治疗中治疗日CT及轮廓不确定性，量化六方向毫米级误差，并应用于临床靶区外扩。
AI 中文摘要
头颈部解剖结构在六至七周的质子治疗过程中会发生变化，而计划制定时无法对后期周的解剖结构进行成像。我们提出了一种数字孪生框架，将患者的治疗日解剖结构预测为带有传播轮廓的预测CT集合，并量化预测轮廓的不确定性。该孪生体是一个包含既往治疗患者计划CT和每周质量保证CT（QACT）的库，通过两步基础模型可变形配准实现患者特异性：跨患者场将每位库患者映射到当前患者，纵向场在当前患者坐标系中估计，将该患者的计划至QACT的变化传递到当前患者自身的计划CT上。来自88名患者的302个观察样本库为每位患者提供约300个重复样本，每个样本代表一位已治疗患者中发生的形变。传播轮廓的离散度按外法线方向解析，得到以毫米为单位的六方向轮廓不确定性。这是预测输入（即当前患者所跟随的库患者）的不确定性，而非模型参数的不确定性，且当配准引擎更换时保持不变。在十名具有两个QACT临床轮廓的患者上，仅凭库即可确定不确定性的各向异性形状（4.5至6.2毫米）；第一个QACT在不绘制轮廓的情况下将其缩小3.2至3.6倍；已批准的轮廓改善中心但未改善宽度。该估计正确排序方向，但未经过高斯校准。作为一项应用，我们计算了临床靶区外扩。
英文摘要
Head-and-neck anatomy changes over a six-to-seven-week proton course, and the anatomy of a later week cannot be imaged when the plan is made. We present a digital-twin framework that forecasts a patient's treatment-day anatomy as an ensemble of predicted CTs with propagated contours and quantifies the uncertainty of the forecast contours. The twin is a library of previously treated patients with planning and weekly quality-assurance CTs (QACTs), made patient-specific by a two-step foundation-model deformable registration: a cross-patient field carries each library patient onto the current patient, and a longitudinal field, estimated in the current patient's frame, carries that patient's planning-to-QACT change onto the current patient's own planning CT. A library of 302 observations from 88 patients yields about 300 replicates per patient, each a deformation that occurred in a treated patient. The dispersion of the propagated contours, resolved by outward normal, is six-direction contour uncertainty in millimeters. This is uncertainty in the input to the forecast, which library patient the current patient follows, rather than in model parameters, and it is unchanged when the registration engine is exchanged. On ten patients with clinician contours on two QACTs, the library alone fixes the anisotropic shape of the uncertainty (4.5 to 6.2 mm); the first QACT narrows it by a factor of 3.2 to 3.6 without a contour being drawn; an approved contour improves the center but not the width. The estimate orders directions correctly but is not Gaussian-calibrated. A clinical target volume expansion is worked out as one application.
