Desvio de posicionamento em radioterapia para patologias de cabeça e pescoço e próstata: revisão de literatura

Introdução – Numa era em que os tratamentos de Radioterapia Externa (RTE) exigem cada vez mais precisão, a utilização de imagem médica permitirá medir, quantificar e avaliar o impacto do erro provocado pela execução do tratamento ou pelos movimentos dos órgãos. Objetivo – Analisar os dados existentes na literatura acerca de desvios de posicionamento (DP) em patologias de cabeça e pescoço (CP) e próstata, medidos com Cone Beam Computed Tomography (CBCT) ou Electronic Portal Image Device (EPID). Metodologia – Para esta revisão da literatura foram pesquisados artigos recorrendo às bases de dados MEDLINE/PubMed e b-on. Foram incluídos artigos que reportassem DP em patologias CP e próstata medidos através de CBCT e EPID. Seguidamente foram aplicados critérios de validação, que permitiram a seleção dos estudos. Resultados – Após a análise de 35 artigos foram incluídos 13 estudos e validados 9 estudos. Para tumores CP, a média (μ) dos DP encontra-se entre 0,0 e 1,2mm, com um desvio padrão (σ) máximo de 1,3mm. Para patologias de próstata observa-se μDP compreendido entre 0,0 e 7,1mm, com σ máximo de 7,5mm. Discussão/Conclusão – Os DP em patologias CP são atribuídos, maioritariamente, aos efeitos secundários da RTE, como mucosite e dor, que afetam a deglutição e conduzem ao emagrecimento, contribuindo para a instabilidade da posição do doente durante o tratamento, aumentando as incertezas de posicionamento. Os movimentos da próstata devem-se principalmente às variações de preenchimento vesical, retal e gás intestinal. O desconhecimento dos DP afeta negativamente a precisão da RTE. É importante detetá-los e quantificá-los para calcular margens adequadas e a magnitude dos erros, aumentando a precisão da administração de RTE, incluindo o aumento da segurança do doente. - ABSTRACT - Background and Purpose – In an era where precision is an increasing necessity in external radiotherapy (RT), modern medical imaging techniques provide means for measuring, quantifying and evaluating the impact of treatment execution and movement error. The aim of this paper is to review the current literature on the quantification of setup deviations (SD) in patients with head and neck (H&N) or prostate tumors, using Cone Beam Computed Tomography (CBCT) or Electronic Portal Image Device (EPID). Methods – According to the study protocol, MEDLINE/PubMed and b-on databases were searched for trials, which were analyzed using selection criteria based on the quality of the articles. Results – After assessment of 35 papers, 13 studies were included in this analysis and nine were authenticated (6 for prostate and 3 for H&N tumors). The SD in the treatment of H&N cancer patients is in the interval of 0.1 to 1.2mm, whereas in prostate cancer this interval is 0.0 to 7.1mm. Discussion – The reproducibility of patient positioning is the biggest barrier for higher precision in RT, which is affected by geometrical uncertainty, positioning errors and inter or intra-fraction organ movement. There are random and systematic errors associated to patient positioning, introduced since the treatment planning phase or through physiological organ movement. Conclusion – The H&N SD are mostly assigned to the Radiotherapy adverse effects, like mucositis and pain, which affect swallowing and decrease secretions, contributing for the instability of patient positioning during RT treatment and increasing positioning uncertainties. Prostate motion is mainly related to the variation in bladder and rectal filling. Ignoring SD affects negatively the accuracy of RT. Therefore, detection and quantification of SD is crucial in order to calculate appropriate margins, the magnitude of error and to improve accuracy in RTE and patient safety.

Positive solutions of fourth order problems with clamped beam boundary conditions

n this paper we make an exhaustive study of the fourth order linear operator u((4)) + M u coupled with the clamped beam conditions u(0) = u(1) = u'(0) = u'(1) = 0. We obtain the exact values on the real parameter M for which this operator satisfies an anti-maximum principle. Such a property is equivalent to the fact that the related Green's function is nonnegative in [0, 1] x [0, 1]. When M < 0 we obtain the best estimate by means of the spectral theory and for M > 0 we attain the optimal value by studying the oscillation properties of the solutions of the homogeneous equation u((4)) + M u = 0. By using the method of lower and upper solutions we deduce the existence of solutions for nonlinear problems coupled with this boundary conditions. (C) 2011 Elsevier Ltd. All rights reserved.

Comparação do cálculo de dose com os algoritmos Analytical Anisotropic Algorithm e Pencil Beam Convolution na patologia de pulmão

Mestrado em Radioterapia.

Modelling a Rotating Shaft as an Elastically Restrained Bernoulli-Euler Beam

Industrial rotating machines may be exposed to severe dynamic excitations due to resonant working regimes. Dealing with the bending vibration, problem of a machine rotor, the shaft - and attached discs - can be simply modelled using the Bernoulli-Euler beam theory, as a continuous beam subjected to a specific set of boundary conditions. In this study, the authors recall Rayleigh's method to propose an iterative strategy, which allows for the determination of natural frequencies and mode shapes of continuous beams taking into account the effect of attached concentrated masses and rotational inertias, including different stiffness coefficients at the right and the left end sides. The algorithm starts with the exact solutions from Bernoulli-Euler's beam theory, which are then updated through Rayleigh's quotient parameters. Several loading cases are examined in comparison with the experimental data and examples are presented to illustrate the validity of the model and the accuracy of the obtained values.

Comparação entre o pencil beam convolution algorithm e o analytical anisotropic algorithm em tumores de mama

Mestrado em Radioterapia

Monte Carlo modeling and simulations of the High Definition (HD120) micro MLC and validation against measurements for a 6 MV beam

Purpose: The most recent Varian® micro multileaf collimator(MLC), the High Definition (HD120) MLC, was modeled using the BEAMNRCMonte Carlo code. This model was incorporated into a Varian medical linear accelerator, for a 6 MV beam, in static and dynamic mode. The model was validated by comparing simulated profiles with measurements. Methods: The Varian® Trilogy® (2300C/D) accelerator model was accurately implemented using the state-of-the-art Monte Carlo simulation program BEAMNRC and validated against off-axis and depth dose profiles measured using ionization chambers, by adjusting the energy and the full width at half maximum (FWHM) of the initial electron beam. The HD120 MLC was modeled by developing a new BEAMNRC component module (CM), designated HDMLC, adapting the available DYNVMLC CM and incorporating the specific characteristics of this new micro MLC. The leaf dimensions were provided by the manufacturer. The geometry was visualized by tracing particles through the CM and recording their position when a leaf boundary is crossed. The leaf material density and abutting air gap between leaves were adjusted in order to obtain a good agreement between the simulated leakage profiles and EBT2 film measurements performed in a solid water phantom. To validate the HDMLC implementation, additional MLC static patterns were also simulated and compared to additional measurements. Furthermore, the ability to simulate dynamic MLC fields was implemented in the HDMLC CM. The simulation results of these fields were compared with EBT2 film measurements performed in a solid water phantom. Results: Overall, the discrepancies, with and without MLC, between the opened field simulations and the measurements using ionization chambers in a water phantom, for the off-axis profiles are below 2% and in depth-dose profiles are below 2% after the maximum dose depth and below 4% in the build-up region. On the conditions of these simulations, this tungsten-based MLC has a density of 18.7 g cm− 3 and an overall leakage of about 1.1 ± 0.03%. The discrepancies between the film measured and simulated closed and blocked fields are below 2% and 8%, respectively. Other measurements were performed for alternated leaf patterns and the agreement is satisfactory (to within 4%). The dynamic mode for this MLC was implemented and the discrepancies between film measurements and simulations are within 4%. Conclusions: The Varian® Trilogy® (2300 C/D) linear accelerator including the HD120 MLC was successfully modeled and simulated using the Monte CarloBEAMNRC code by developing an independent CM, the HDMLC CM, either in static and dynamic modes.

James W. Carey. Uma voz que clamou por mais e melhor democracia

A notícia da morte de James W. Carey, aos 71 anos, no passado dia 23 de Maio de 2006 deixou um profundo vazio na comunidade de estudiosos da comunicação e do jornalismo. Considerado nos EUA como um dos mais influentes pensadores do último terço do século XX nesta área de estudo, embora pouco conhecido na Europa, Carey foi e será uma referência para quem, nos tempos actuais, insiste, mesmo que romanticamente, em pensar a comunicação como ritual cultural de cooperação e democracia.

Comparison of the pencil beam convolution algorithm and the analytical anisotropic algorithm in breast tumors

The calculation of the dose is one of the key steps in radiotherapy planning1-5. This calculation should be as accurate as possible, and over the years it became feasible through the implementation of new algorithms to calculate the dose on the treatment planning systems applied in radiotherapy. When a breast tumour is irradiated, it is fundamental a precise dose distribution to ensure the planning target volume (PTV) coverage and prevent skin complications. Some investigations, using breast cases, showed that the pencil beam convolution algorithm (PBC) overestimates the dose in the PTV and in the proximal region of the ipsilateral lung. However, underestimates the dose in the distal region of the ipsilateral lung, when compared with analytical anisotropic algorithm (AAA). With this study we aim to compare the performance in breast tumors of the PBC and AAA algorithms.

Blistering of W-Ta composites at different irradiation energies

Pure tungsten and tantalum plates and tungsten-tantalum composites produced via mechanical alloying and spark plasma sintering were bombarded with He+ and D+ energetic ion beams and deuterium plasmas. The aim of this experiment is to study the effects caused by individual helium and deuterium exposures and to evidence that the modifications induced in the composites at different irradiation energies could be followed by irradiating the pristine constituent elements under the same experimental conditions, which is relevant considering the development of tailored composites for fusion applications. Higher D retentions, especially in tungsten, and superficial blistering are observed in both components after helium exposure. The blistering is magnified in the tantalum phase of composites due to its higher ductility and to water vapour production under deuterium irradiation. At lower irradiation energies the induced effects are minor. After plasma exposure, the presence of tantalum does not increase the D content in the composites. (C) 2013 Elsevier B.V. All rights reserved.

Validação do uso de cone-beam computed tomography de kilovoltagem de um LINAC para a realização de estudos dosimétricos

Mestrado em Radioterapia

Radioterapia adaptativa: utilização do cone-beam computed tomography para o cálculo de dose em radioterapia

Mestrado em Radiações Aplicadas às Tecnologias da Saúde - Ramo de especialização: Terapia com Radiações

James W. Carey as critical theorist of the information age

This paper suggests that the thought of the North-American critical theorist James W. Carey provides a relevant perspective on communication and technology. Having as background American social pragmatism and progressive thinkers of the beginning of the 20th century (as Dewey, Mead, Cooley, and Park), Carey built a perspective that brought together the political economy of Harold A. Innis, the social criticism of David Riesman and Charles W. Mills and incorporated Marxist topics such as commodification and sociocultural domination. The main goal of this paper is to explore the connection established by Carey between modern technological communication and what he called the “transmissive model”, a model which not only reduces the symbolic process of communication to instrumentalization and to information delivery, but also politically converges with capitalism as well as power, control and expansionist goals. Conceiving communication as a process that creates symbolic and cultural systems, in which and through which social life takes place, Carey gives equal emphasis to the incorporation processes of communication.If symbolic forms and culture are ways of conditioning action, they are also influenced by technological and economic materializations of symbolic systems, and by other conditioning structures. In Carey’s view, communication is never a disembodied force; rather, it is a set of practices in which co-exist conceptions, techniques and social relations. These practices configure reality or, alternatively, can refute, transform and celebrate it. Exhibiting sensitiveness favourable to the historical understanding of communication, media and information technologies, one of the issues Carey explored most was the history of the telegraph as an harbinger of the Internet, of its problems and contradictions. For Carey, Internet was seen as the contemporary heir of the communications revolution triggered by the prototype of transmission technologies, namely the telegraph in the 19th century. In the telegraph Carey saw the prototype of many subsequent commercial empires based on science and technology, a pioneer model for complex business management; an example of conflict of interest for the control over patents; an inducer of changes both in language and in structures of knowledge; and a promoter of a futurist and utopian thought of information technologies. After a brief approach to Carey’s communication theory, this paper focuses on his seminal essay "Technology and ideology. The case of the telegraph", bearing in mind the prospect of the communication revolution introduced by Internet. We maintain that this essay has seminal relevance for critically studying the information society. Our reading of it highlights the reach, as well as the problems, of an approach which conceives the innovation of the telegraph as a metaphor for all innovations, announcing the modern stage of history and determining to this day the major lines of development in modern communication systems.

The telegraph as an omen of the future in James W. Carey's vision

In the history of modern communication, after the development of the printing press, the telegraph unleashed a revolution in communications. Today, Internet is in many ways its heir. Reflections on the telegraph may open up perspectives concerning tendencies, possibilities and pitfalls of the Internet. The telegraph has been well explored in important literature on communication and media which tends to emphasize the history of this technology, its social context and institutional meaning [e.g. Robert L. Thompson, 1947, Tom Standage, 2007 [1998]. James W. Carey, the North- American critical cultural studies' mentor, in his essay "Technology and Ideology. The Case of the Telegraph" (2009 [1983]), suggests a distinctive approach. In the telegraph, Carey sees the prototype of many subsequent commercial empires based on science and technology, a pioneer model for complex business management; an example of interest struggle for the patents control; an inductor of changes both in language and in structures of knowledge; and a promoter of a futurist and utopian thought of information technologies. Having in mind a revolution in communications promoted by the Internet, this paper revisits this seminal essay to explore its great attainment, as well as the problems of this kind of approach which conceives the innovation of the telegraph as a metaphor for all the innovations announcing the modern stage of history and determining still today the major lines of development in modern communication systems.

A abordagem cultural da Comunicação de James W. Carey

A perspectiva cultural ou ritual de James W. Carey, expoente dos estudos culturais críticos nos EUA, para pensar a Comunicação, os media e o Jornalismo permanece praticamente desconhecida na língua portuguesa. Carey integra um conjunto de teóricos que, a partir da década de 1960, na Europa e nos EUA, procuraram caminhos alternativos à tradição de investigação norte-americana dominante, centrada nos efeitos, funções e usos dos mass media . Este artigo incide no ensaio fundador da sua proposta A cultural approach of communication (1975), embora não se confine ao mesmo. Três questões fundamentais são abordadas: Comunicação, Comunicação e modernidade e a visão cultural ou ritual da Comunicação. A hermenêutica crítica é a metodologia utilizada. Procura-se ir além das respostas de Carey ao seu contexto, destacando a sua contribuição para um entendimento da Comunicação como um ritual participatório no qual e através do qual os seres humanos geram, mantêm e transformam a cultura em que vivem.

Comparação entre o pencil beam convolution algorithm e o analytical anisotropic algorithm em tumores de mama

Objectivo do estudo: comparar o desempenho dos algoritmos Pencil Beam Convolution (PBC) e do Analytical Anisotropic Algorithm (AAA) no planeamento do tratamento de tumores de mama com radioterapia conformacional a 3D.