本书从调强放疗的步骤入手，概括介绍常用的放疗设备、照射方式、放疗目的、放疗的生物学原理等；重点介绍调强放疗中的计算机应用技术，涉及剂量计算模型、放疗计划系统中的可行性问题，以及线性和非线性规划模型、放射生物学模型、带有剂量体积约束的规划模型、多目标规划模型、照射角度选择优化模型等。此外，本书对通量图的生成和调制、基于机器跳数的平滑方法和双向叶片运动通量图平滑模型等进行研究；讨论自动勾画的意义、需求和定义等，介绍阈值分割算法、区域分割算法、分水岭分割算法和马尔可夫随机场分割算法等常见的图像分割算法，重点介绍一种加入区域信息的测地线活动轮廓模型、一种改进的V-Net 模型和一种基于等效生物剂量和硬件约束的一体化逆向计划模型，并介绍凸优化求解和剂量验证等。本书介绍的内容涉及面广，有助于读者了解调强放疗中的计算机应用技术，适合作为高等学校医学影像处理相关专业研究生和高年级本科生的教材，也适合相关科研人员和对调强放疗技术感兴趣的读者阅读。

兰义华，南阳师范学院计算机与信息技术学院副教授，博士，博士后。2011年12月博士毕业于华中科技大学计算机应用技术专业，2017年11月从华中科技大学软件工程博士后流动站出站。河南省重点学科计算机应用学科带头人，河南省教育厅学术技术带头人，南阳市学术技术带头人，南阳师范学院"卧龙学者”特聘研究员岗位入选者，计算机学会高级会员。

第1 章 引言······················································································1
1.1 研究背景及意义······································································1
1.1.1 癌症的严重危害·····························································1
1.1.2 癌症的治疗方法·····························································3
1.1.3 放疗对于癌症治疗的贡献················································4
1.1.4 放疗技术发展的巨大潜力················································5
1.2 放疗技术的发展历史································································8
1.2.1 初级放疗时代································································8
1.2.2 常规放疗时代································································9
1.2.3 精准放疗时代································································9
1.2.4 小结·········································································.10
1.3 计算机应用技术对调强放疗技术的支撑作用·······························.11
第2 章 放疗中的硬件及放疗计划系统·················································.13
2.1 放疗的分类·········································································.13
2.1.1 基本概念···································································.13
2.1.2 放疗设备···································································.17
2.1.3 照射方式···································································.28
2.1.4 放疗目的···································································.32
2.1.5 放疗手段和技术··························································.33
2.1.6 剂量分割方式·····························································.37
2.2 放疗的生物学原理································································.38
2.3 调强放疗的步骤···································································.40
2.4 调强放疗中的射线调制设备····················································.43
2.5 逆向计划系统······································································.45
第3 章 调强放疗中的规划问题···························································.48
3.1 正向调强规划和逆向调强规划·················································.48
3.1.1 正向调强规划·····························································.48
3.1.2 逆向调强规划·····························································.49
3.2 调强放疗中的数学优化问题····················································.49
3.3 剂量计算模型和相关描述·······················································.50
3.4 放疗计划系统中的可行性问题·················································.51
3.5 调强放疗中的规划模型··························································.51
3.5.1 线性和非线性规划模型················································.51
3.5.2 放射生物学模型··························································.53
3.5.3 剂量体积约束模型·······················································.56
3.5.4 剂量体积约束优化问题················································.60
3.5.5 规范化距离信息排序···················································.63
3.5.6 混合整数规划模型·······················································.68
3.5.7 多目标规划模型··························································.69
3.5.8 照射角度选择优化模型················································.72
第4 章 通量图的平滑方法·································································.75
4.1 通量图的生成和调制·····························································.75
4.2 通量图的平滑······································································.78
4.3 图像去噪原理······································································.79
4.4 基于机器跳数的平滑方法·······················································.83
4.4.1 基于图像处理的平滑方法存在的问题······························.83
4.4.2 基于多叶准直器的静态调强放疗的剂量调制过程···············.84
4.4.3 无叶片碰撞约束的模型················································.87
4.4.4 后驱叶片同步约束模型················································.88
4.4.5 前驱叶片同步约束模型················································.90
4.4.6 前后叶片中心时长同步模型··········································.91
4.4.7 舌槽欠剂量效应的直接约束··········································.94
4.4.8 带叶片碰撞约束的模型················································.95
4.5 双向叶片运动通量图平滑模型·················································.96
4.5.1 双向叶片运动通量图平滑模型介绍·································.96
4.5.2 实验及结果分析··························································.99
第5 章 自动勾画技术·······································································103
5.1 自动勾画的意义···································································103
5.2 手动勾画的问题和自动勾画的需求···········································104
5.3 放疗中自动勾画的定义··························································105
5.4 放疗中需要自动勾画的医学影像··············································106
5.5 图像分割算法······································································107
5.5.1 阈值分割算法·····························································107
5.5.2 区域分割算法·····························································113
5.5.3 分水岭分割算法··························································118
5.5.4 马尔可夫随机场分割算法·············································121
5.5.5 基于活动轮廓模型的分割算法·······································125
5.5.6 基于深度学习的分割算法·············································127
5.6 一种加入区域信息的测地线活动轮廓模型及在乳腺钼靶X 射线
摄片分割中的应用································································130
5.6.1 一种加入区域信息的测地线活动轮廓模型························130
5.6.2 实验及结果分析··························································132
5.7 一种改进的V-Net 模型及其在肺结节分割中的应用···············139
5.7.1 一种改进的V-Net 模型·················································139
5.7.2 实验及结果分析··························································142
第6 章 生物医学与硬件约束······························································146
6.1 回归本质——临床医学目标问题··············································146
6.2 逆向计划的发展阶段及目前存在的问题·····································146
6.3 临床放疗物理剂量特性··························································148
6.4 细胞杀灭存活理论································································149
6.5 分次治疗及生物医学剂量·······················································152
6.6 一种基于等效生物剂量和硬件约束的一体化逆向计划模型············156
6.6.1 等效生物剂量及模型设计·············································156
6.6.2 基于多叶准直器的硬件约束设计····································159
6.6.3 调强放疗一体化逆向计划模型构建·································161
6.6.4 等效生物剂量模型验证和分析·······································162
第7 章 凸优化求解··········································································166
7.1 放疗中的凸优化技术·····························································166
7.1.1 凸优化技术在放疗中的应用··········································166
7.1.2 凸优化技术的优点·······················································166
7.1.3 凸优化技术的局限性···················································166
7.2 凸集的概念·········································································167
7.3 凸函数和保凸运算································································167
7.3.1 凸函数······································································167
7.3.2 保凸运算···································································168
7.4 凸优化问题·········································································168
7.4.1 凸优化的概念·····························································168
7.4.2 全局最优解和局部最优解·············································169
7.5 典型的凸优化模型································································171
7.5.1 线性规划模型·····························································171
7.5.2 线性约束二次规划模型················································172
7.5.3 几何规划模型·····························································173
7.6 多目标优化中的帕累托最优····················································175
7.7 凸优化中的内点法································································175
第8 章 剂量验证·············································································177
8.1 放射线电离辐射特性差异·······················································177
8.2 质量控制误差分配································································177
8.3 多级质量保证和验证·····························································178
8.4 剂量验证方法和工具·····························································180
8.5 独立计算式剂量验证方法·······················································181
8.5.1 基于修正策略的剂量计算方法·······································181
8.5.2 基于模型策略的剂量计算方法·······································186
参考文献·························································································189