Controle de qualidade em radioterapia: dosimetria de fótons em acelerador linear – Mevatron MXT

The treatment of a tumor with ionizing radiation is an ongoing process with well differentiated stages. These ones include the tumor diagnosis and location, the decision on the treatment strategy, the absorbed dose planning and calculation, the treatment administration, the absorbed dose verification and the evaluation of results in short and long terms. The quality of a radiotherapy procedure is closely linked to factors that may be classified as clinical, such as the diagnosis, the tumor location, the treatment strategy chosen and the continuous treatment reassessment; dosimetric or physical, such as the uncertainty in the dose calculation, its optimization and verification, the suitability of the equipment to provide a radiation beam consistent with the treatment planning; finally, others which are related to the practical application of radiotherapy treatment and the handling of the patient. In order to analyze the radiotherapy quality, one should realize that the three aspects (medical, physical or dosimetric and practical application) should be considered in a combined way. This means that numerous actions of the radiotherapists, medical physicists and technicians in radiotherapy should be held jointly and their knowledge level will significantly affect the treatment quality. In this study, the main physical parameters used in dosimetry are defined as well as determined experimentally for a linear accelerator Mevatron - MXT. With this, it is intended to provide recommendations for the physical aspects of Quality Assurance (QA) in the radiotherapy treatments, and these will usually be applied by professionals in Medical Physics. In addition to these instructions, it is recommended that additional texts are prepared to address in detail the clinical aspects of the treatments QA

Radioterapia com elétrons

Radiotherapy is a field of medical physics, which has been going through a scientific and technological advancement, it is extreme important the professionals that work in this area continuous their study to improve the quality of service provided. For it, they should know the physical principles related as well their employment in radiotherapy. The electrons have been using in therapy of superficial tumors, because they show rapid decrease of dose in depth, they don’t expose the deeper tissues to radiation. The electron therapy has replaced the surface therapy with x-ray and mold brachytherapy, and nowadays, it represents 10 to 15% of radiotherapy treatments. This study brings the definition of physical parameters used in the dosimetry of electron beam, describes the tests for quality control of linear accelerator with a electrons beam, as well the activities realized in the Radiotherapy Division, of Hospital de Clinicas, in the Universidade Estadual of Campinas, in the Clinac 2100C machine

Métodos de Calibração e Dosimetria de Aplicadores de Betaterapia

The sources of betatherapy for clinical use in Brazil are, the vast majority of strontium-90, radioactive element that is not produced in the country, and therefore requires importation of international laboratories accredited by the International Atomic Energy Agency (IAEA).The use of these resources is always limited the crediting of characteristic values supplied by the manufacturer tables that provide the nominal value of activity and dose distribution to determine the irradiation time of the injury. The Institute of Nuclear Energy Research (IPEN / CNEN-SP) has recently researching the emission profile of these types of radiation sources, and some jobs are being developed with ionization chambers extrapolation for the purpose of standardizing a systematic calibration sources betatherapy. Other studies using parallel measures dosimeters (TLD's) and simulations with the Monte Carlo method. Radiological films have also been used in studies of applicators dosimetric analysis of strontium-90. This paper seeks to analyze the different methods for calibration of applicators betatherapy, already consolidated in studies by examining the advantages and disadvantages of each procedure

Análise do plano de radioproteção em radioterapia

Ionizing radiation is used nowadays in various sectors such as agriculture, industry and medicine. The main specialties of medicine which use radiation are the diagnostic radiology, nuclear medicine and radiotherapy. Radiotherapy is a therapeutic modality that is a well established feature for the treatment of malignant disease or not. However, the inadvertent use of ionizing radiation can produce deleterious effects that result in sequels that compromise the welfare of the people involved. The analysis of radiological protection emphasizes the importance of avoiding inappropriate exhibitions aimed at protecting the health of patients, the professionals involved and the general public. The basic principles of radioprotection are justification, optimization and restriction for individual dosage. The departments of radiotherapy are regulated in accordance with specific technical standards of the National Commission of Nuclear Energy (CNEN), which during the inspection for issue and renewal of the authorization of operation requires the submission of a radioprotection plan, this document that requires great demand of time, and has generated much debate among professionals in medical physics, given the difficulties encountered in their preparation. After examining the radioprotection plan of some radiotherapy services, as suggested in order to guide those responsible for drawing up these plans, especially beginners in the career of the physics of radiation, this paper presents a model plan that is in line radioprotection it requires the Technical Standards of CNEN and can easily be the reality of appropriate services

Cálculo das funções de anisotropia e radial de dose para braquiterapia com semente de 192Ir em diferentes materiais de interesse em radiologia com o auxílio do programa baseado no método de Monte Carlo MCNPX

The brachytherapy braquiterapia is an x-ray modality radiotherapy in which stamped or halfstamped radioactive sources in format of seeds are used, wires or to one short distance, in contact or implanted to the fabric to be treated. All the treatment modalities require a previous planning. The formalism recommended for calculation of dose was considered by the AAPM for the first TG-43 Report. In it distributions of dose of isolated seeds measured and calculated by Monte Carlo method in water instead of with models half-empiricists. In this work we in accordance with present some preliminary results of the calculation of functions of radial anisotropy and of dose in the distance for seed of 192Ir, wide used in brachytherapy treatments of high tax of dose (HDR), with the aid of the program based on the Monte Carlo method MCNPX v2.50 (Mount Carlo N ParticleeXtended). The materials chosen in the simulation beyond water, had been MS20 and estriado muscle

Análise dosimétrica de aplicadores de Betaterapia

Betatherapy is a special medical technique using a radioactive source of strontium-90 for the treatment of superficial lesions, especially in dermatology and ophthalmology. Strontium-90 sources emit β radiation, which possesses high ionization power, but a very short distance propagation into matter. This work presents a method of dosimetric analysis of betatherapy using strontium- 90-based instrumentation, commonly used against superficial diseases, such as keloid and pterygium, aiming the description of the dosimetry analysis procedures, which can be easily implemented on tradiotherapy services that offers the betatherapy treatment. IBF-MEDIX radiographic films (conventional films) were exposed to betatherapy applicators during different time intervals according to the activity of the source, and afterwards the optical densities (O. D.) of the radiographic images were measured using an optical densitometer MACBETH. Therefore, the parameters used to make the dosimetric analysis in betatherapy were standardized, as the exposure time depended on the geometry and size of the source, providing an efficient and fast method of dosimetric analysis of the betatherapy equipment of the services, the majority of which do not have the scientific structure to perform this study

Levantamento radiométrico, cálculo de blindagem e planejamentos rotineiros realizados no Instituto de Radioterapia do Vale do Paraíba e no Hospital Regional de Taubaté no período de 2006, 2007,e 2008

Not only the progress of the radiotherapy, but also the improve of the dose in the patient with adjusted radiotherapy plannings, calculation of shield, radiometric survey, among others, are responsibilities of the medical physic inside of a sector of radiotherapy. This monograph has as objective to above show some of these cited functions of the medical physicis, starting with a theoretical basement and at as a moment to present the calculations and the results found during a visit in the Institute of Radiotherapy of the Valley of the Paraíba, located in the city of São José dos Campos, and in the Regional Hospital of Taubaté in the period of 2006, 2007 and 2008

Método de pontos interiores no planejamento ótimo do tratamento de câncer por radioterapia

The Medical Physics has been developing very fast due to the progress of the technologies and to the increase of the concerns with cure of diseases. One of the Medical Physics main performances at the present time is the use of ionizing radiations for cancer treatment, especially, services as Radiotherapy. The radiotherapy technique uses ionizing radiation with therapeutic end of cancer controls, avoiding your proliferation and it worsens of the patient. For the treatment a radiation bunch is used, with rectangular form, that it passes through the different types of tissues of the patient's body, and depending on the attenuation and of the depth of the fabrics, a great amount of energy is deposited inside in different points of the body. Like this, to plan this treatment type it should be obtained the dimension of the distribution and dose absorption along the volume. For this, it is necessary in the planning of the treatment of the cancer for radiotherapy to build isodose curves, which are lines that represent points of same amount of dose to be deposited in the area to be treated. To aid the construction of the curves of form isodose to reach the best result in the planning of the treatment, in other words, a great planning, providing the maximum of dose in the tumor and saving the healthy and critical organs, it has been using mathematical tools and computational. A plan of cancer treatment for radiotherapy is considered great when all the parameters that involve the treatment, be them physical or biological, they were investigated and adapted individually for the patient. For that, is considered the type and the location of the tumor, worrying about the elimination of the cancer without damaging the healthy tissue of the treated area, mainly the risk organs, which are in general very sensitive to the radiations. This way, the optimization techniques... (Complete abstract click electronic access below)

A experiência de trabalhar em ambiente de radioterapia

O procedimento da radioterapia não traz em si a garantia de qualquer resultado favorável, é preciso, antes, apostar em um planejamento minucioso e implementação cuidadosa do tratamento necessário para potencializar os benefícios da radioterapia através de sua aplicação. Primeiramente é preciso aplicar uma dose de radiação para as células tumorais em quantidade suficiente para matar as células cancerigenas no menor tempo possivel, aumentanto a possibilidade de controle da doença maligna, matando as células malignas e elevando a probabilidade de controlar a doença maligna, enquanto ao mesmo tempo, limita a dose para os tecidos saudáveis que circunda a célula com o tumor maligno, para que a probabilidade de dano induzindo a esses tecidos seja reduzida ao mínimo. Dentro desta perspectiva, o estudo teve por objetivo apresentar as atividades realizadas na Clínica de Radioterapia de São Carlos, procurando ampliar o conhecimento sobre a radioterapia para melhorar o atendimento aos pacientes com diagnóstico de cancer de mama e de cancer de prostata. Foi possivel neste período acompanhar a rotina de trabalho dos físicos médicos, que permitiram participar ativamente das atividades de planejamento, posicionamento do paciente, cálculo de dose, procurando manter a qualidade no atendimento aos pacientes. O estágio como componente curricular desempenha um papel fundamental no processo de formação. Responsável pela introdução do aluno no campo profissional, realmente possibilita a análise contextual dessa realidade na perspectiva de uma ação interventiva. Como aprendizagem maior é possível dizer que o estágio mostrou que nos dias atuais, os novos profissionais, se quiserem conquistar seu lugar, precisam juntar inteligência, conhecimento e capacidade emocional e social para enfrentar e poder atuar rumo às mudanças requeridas, a qualificação humana precisa ir além... (Resumo completo, clicar acesso eletrônico abaixo)

Sistema de cálculo para determinação do tempo de exposição em radioterapia veterinária

Radiotherapy in veterinary practice is already known and widely distributed in large specialized centers of developed countries. In early 2000, there were about 30 radiotherapy equipment specifically designed for the veterinary clinic in the United States. In Brazil, the veterinary radiotherapy is still confined to research in universities, where most of the procedures is radiation therapy performed with superficial x-ray machines, with a voltage between 50 and 150 kVp, focus-distance surface (DFS) between 20,0cm and 40,0cm. As that occurs in human medicine, new research strengthens the development and prospects for the use of radiotherapy as a safe option for treating cancer in animals. This paper presents a methodology for calculating the exposure time for superficial radiotherapy procedures in veterinary medicine for small animals (dogs and cats). The dosimetric parameters of X-rays are determined using a spreadsheet tool for Microsoft Office Excel, developed in this paper for a device Dermopan 2, Veterinary Hospital of UNESP in Araçatuba. Using the worksheet helps the veterinarian to determine the time of exposure to radiation determined for each clinical case, optimize the workflow for professionals in veterinary radiotherapy procedures, which often lack the medical physics in team and at the time of radiotherapy. The correct use of spreadsheet decreases the chances of errors in dose rates of radiation, providing a higher quality of care

Modelos de tratamento para adenocarcinomas de próstata tratados por radioterapia conformacional 3D

Radiotherapy is a branch of medical physics related to the treatment of malignant neoplasm, being an important instrument in the fight against cancer, when combined with the effort of a multidisciplinary team, composed of, physicians, physicists, nurses and technicians. Every year more than 3.5 million new cases of cancer are recorded in the world, being the prostate cancer responsible for approximately 25% of this amount (INCA and IARC, 2008). In this type of cancer, radiotherapy is a method indicated for treatement. The technological advance in this area over years has allowed a greater accuracy in the tumor location, more conformation of the radiation beam around the tumor, reducing the dose in healthy tissues and a consequent dose increase on treatment (Bedford et al., 1999). A radiotherapy planning, in which the physicist develops an important role, is composed of several steps, including choosing the best configuration of treatment beams. This choice has a close relationship with success of therapy and is critical to achieve the best distribution of dose inside the tumor and expose the least as possible the healthy tissue to radiation. In this work, two options for setting up camps in the first phase in a treatment of prostate cancer were simulated in computer planning: 4 fields orthogonal or “Box” with gantry angles in 00, 1800, 2700 e 90° and 4 fields angled or “X” (1350, 450, 3150 e 2250). The percentage of the rectal volume exposed to 40, 50, 60, 72 and 76 Gy should be limited to 60, 50, 25, 15 and 5% respectively (Greco et al., 2003). The femoral toxicity have limited dose by 70% of the total dose prescribed in a prostate treatment (Bedford et al., 1999). The planning of 27 patients with prostate adenocarcinoma submitted to 3D conformal radiotherapy were accompanied. As a result, it was assessed that the best TCP (tumor control probability)... (Complete abstract click electronic access below)

Sistema de cálculo computacional da unidade monitora para feixes de elétrons em radioterapia

In radiation theraphy with electron beam, the electrons are produced in linear accelerators, and energy the most used have between 4MeV and 20MeV. Generally, the treatments are done for superficial injuries, because the low penetration of these particles. In this work a system for calculation of monitor units (U.M.) for cases of treatments with electron beam was developed. The Excel program of Microsoft was used and is easily found in the operational system of the personal microcomputers. In the Excel has been inserted the pertinent data of the linear accelerator of Varian, model 2100C, used in the Service of radiation theraphy of the Hospital of the Clinics of the College of Medicine of the UNESP of Botucatu. For some values of the physical parameters, such as: factors field and factors calibration, not supplied in the tests of acceptance of the machine, still proceeded calculations from interpolation and extrapolation. The mathematical formulas for automatic search of these and others factors used in the calculations of the determination of the U.M had been developed in agreement available routines in Excel. For this the functions had been used the function IF (that it imposes search condition) and the PROCH (that looks a value in a column from determined line), beyond the basic functions of addition, multiplication and division. It is intended to optimize the routine of the Services of radiation theraphy that perform through eletrontheraphy procedures, speeding the calculations and minimizing the occurrence of errors and uncertainties deriving of the maken a mistake manipulation of the parameters gotten in tables of data of electron beams

Uso do método de Monte Carlo para simulação e detecção do espectro de raios-X gerado com feixes de elétrons em alvo de Molibdênio, utilizando o Geant4

The huge demand for procedures involving ionizing radiation promotes the need for safe methods of experimentation considering the danger of their biological e ects with consequent risk to humans. Brazilian's legislation prohibits experiments involving this type of radiation in humans through Decree 453 of Ministry of Health with determines that such procedures comply with the principles of justi cation, optimization and dose limitation. In this line, concurrently with the advancement of available computer processing power, computing simulations have become relevant in those situations where experimental procedures are too cost or impractical. The Monte Carlo method, created along the Manhattan Project duringWorldWar II, is a powerful strategy to simulations in computational physics. In medical physics, this technique has been extensively used with applications in diagnostics and cancer treatment. The objective of this work is to simulate the production and detection of X-rays for the energy range of diagnostic radiology, for molybdenum target, using the Geant4 toolkit. X-ray tubes with this kind of target material are used in diagnostic radiology, speci cally in mammography, one of the most used techniques for screening of breast cancer in women. During the simulations, we used di erent models for bremsstrahlung available in physical models for low energy, in situations already covered by the literature in earlier versions of Geant4. Our results show that although the physical situations seems qualitatively adequate, quantitative comparisons to available analytical data shows aws in the code of Geant4 Low Energy source

Programação linear no planejamento do tratamento de câncer por radiocirurgia

Medical Physics has been reaching an important role among several lines in Science, providing means for the improvement of several theories and procedures. Currently, its main application is related with the use of ionizing radiations, specially, in treatment procedures such as Radiotherapy. Radiosurgery is a Radiotherapy technique which consists in administering a single tumoricidal dose of radiation exclusively to the tumorous lesion. It becomes then an interesting alternative to surgical treatment, mainly in cerebral metastases, which are the most frequent cerebral tumors in the central nervous system. The radio neurosurgical team works out a planning for the Radiosurgery treatment, aiming for obtaining an appropriate ideal treatment for each case. For the working out of this treatment planning, Computed Tomography images of the region to be treated are obtained, digitalized and later, fused with nuclear magnetic resonance images. Through these images, critical structures, organs at risk and lesions are localized. After this, calculations are made to determine three-dimensional positions of isocenters, isodose curves, prescribed dose, collimators sizes, position, numbers and respective weight of isocentric conformal fields, and others. The treatment planning is commonly based in desired levels of dose for specific types of tumors and organs at risk concerning the irradiated region. Theses levels of dose are chosen in a way that a high probability of cure may be achieved and meanwhile, that the probability of complications, in whichever organ at risk, may be minimal. Thus, many researches have been carried out, showing that mathematical techniques may help to obtain an optimal planning for the treatment of cerebral metastases. Among the methods of optimization in the study...(Complete abstract click electronic access below)

Braquiterapia com sementes de iodo-125: manufatura e tratamento

According to the National Institute of Cancer – INCA, 466.730 new cancer cases will occur in Brazil in 2009. Prostate and Lung cancer in man are the most incident types (in exception of the non-melanoma cancer). The brachytherapy with 125-iodine sources is an important method of prostate cancer treatment. The implant with iodine-125 seeds uses aproximately 100 seeds that are imported impossibilitating the treatment in large scale. For this reason, a multidisciplinary group was created at the Energetic and Nuclear Research Institute – Radiation Technology Center (IPEN –CTR / SP) to develop a national 125-iodine source and established a facility for local production. The seeds manufacture in Brazil will diminish the cost of treatment and prostate brachytherapy will be offered to more patients. This work aim is to observe and discuss the methods used in seeds manufacture there are being developed in Brazil and to present an prostate cancer case folloied in A.C. Camargo Hospital. The 125-iodine is adsorbed in an silver wire, then deposited at titanium coat. The weld is made by an process of plasm sealing. The seeds goes through several test to guarantee that there is no leakage. The result is an high quality and cheaper product. The implant tecnique is an fast and save procedure. The medical physicst preplan the case to stipulate the quantity of seeds there will be used. At the dat of the implant the medical physicst replan the procedure due to changes of volume in the organ. That assure the correct dose distribution in the target. Besides, the 125-iodine low energy is absorbed at the volume of interrest saving sourronding healthy tissues such as the rectum and the urethra