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

Dosimetria e análise de incertezas em braquiterapia ginecológica

Mestrado em Radiações Aplicadas às tecnologias da Saúde

Implementação do TFM na Sakthi Portugal com recurso à metodologia Kaizen

No âmbito da unidade curricular Dissertação/Projeto/Estágio do 2ºano do Mestrado em Engenharia mecânica – Ramo Gestão Industrial do Instituto Superior de Engenharia do Porto, o presente trabalho de dissertação foi enquadrado num projeto industrial de melhoria com Instituto Kaizen, empresa de consultoria operacional. O projeto foi desenvolvido numa empresa de produção de componentes em ferro nodular destinados à indústria automóvel do mercado europeu, a Sakthi Portugal,SA. A realização deste projeto teve como objetivo a implementação do sistema de planeamento em Pull (produção puxada) na logística interna da Sakthi Portugal,SA recorrendo à metodologia Kaizen. Esta metodologia consiste na aplicação de ferramentas de TFM - Total Flow Management, integradas no Kaizen Management System. Neste projeto recorreu-se especialmente a um dos pilares que o constituem, o pilar do “Fluxo da Logística Interna”. Neste pilar encontram-se as várias metodologias utilizadas na otimização do fluxo de material e informação na logística interna. Estas metodologias foram aplicadas, com o objetivo do sistema produtivo operar de acordo com a necessidade do cliente, obtendo deste modo a minimização dos custo e o aumento da produtividade e qualidade. Em resultado da aplicação da metodologia seguida, foi possível atingir-se os objetivos definidos inicialmente e em alguns casos foi possível superar esses objetivos. Em função da abordagem integrada que foi seguida, conseguiu-se uma diminuição do “lead time” do processo de fabrico, redução dos produtos em curso de fabrico, libertação de espaço e redução de inventários. Estas melhorias resultaram numa movimentação interna na fábrica mais facilitada e num aumento global da produtividade. Como consequência positiva dos efeitos deste trabalho, pode-se apontar o facto de que a Sakthi Portugal SA aumentou a sua competitividade por tornar-se numa empresa mais dinâmica, mais adaptada ao mercado e com níveis de satisfação do cliente muito superiores.

Estudo dos desvios detectados pelas imagens portais no cancro da próstata em radioterapia conformacional (3DCRT)

Mestrado em Radioterapia

Tissue composition and density impact on the clinical parameters for 125I prostate implants dosimetry

The MCNPX code was used to calculate the TG-43U1 recommended parameters in water and prostate tissue in order to quantify the dosimetric impact in 30 patients treated with (125)I prostate implants when replacing the TG-43U1 formalism parameters calculated in water by a prostate-like medium in the planning system (PS) and to evaluate the uncertainties associated with Monte Carlo (MC) calculations. The prostate density was obtained from the CT of 100 patients with prostate cancer. The deviations between our results for water and the TG-43U1 consensus dataset values were -2.6% for prostate V100, -13.0% for V150, and -5.8% for D90; -2.0% for rectum V100, and -5.1% for D0.1; -5.0% for urethra D10, and -5.1% for D30. The same differences between our water and prostate results were all under 0.3%. Uncertainties estimations were up to 2.9% for the gL(r) function, 13.4% for the F(r,θ) function and 7.0% for Λ, mainly due to seed geometry uncertainties. Uncertainties in extracting the TG-43U1 parameters in the MC simulations as well as in the literature comparison are of the same order of magnitude as the differences between dose distributions computed for water and prostate-like medium. The selection of the parameters for the PS should be done carefully, as it may considerably affect the dose distributions. The seeds internal geometry uncertainties are a major limiting factor in the MC parameters deduction.

Implicações da certificação pela NP 4427:2004 na função recursos humanos

Este estudo tem como principal objetivo compreender as mudanças na função recursos humanos após a certificação do sistema de gestão de recursos humanos de uma empresa no âmbito da Norma Portuguesa 4427:2004 – “Sistemas de gestão de recursos humanos – requisitos”. Neste sentido, foi realizada uma abordagem teórica à evolução da função recursos humanos, apresentada a NP 4427:2004 e a contextualização teórica e normativa das práticas de gestão de recursos humanos desenvolvidas nesse âmbito. De forma a dar resposta à questão de pesquisa foi utilizada uma metodologia qualitativa, com recurso ao estudo de caso único numa empresa portuguesa certificada no âmbito da NP 4427:2004. No processo de recolha de dados recorremos à análise documental e à realização de entrevistas aos treze colaboradores vinculados à empresa desde data anterior à certificação. Os resultados sugerem mudanças ao nível da atuação da gestão de recursos humanos na empresa que, com a implementação e certificação pela NP 4427:2004, se tornou mais estratégica e dinamizadora de práticas de recursos humanos sistematizadas e preocupadas com o desenvolvimento das pessoas. Depois de apresentados e discutidos os resultados, o estudo apresenta também sugestões de pesquisa futura sobre o tema da NP 4427:2004 e contributos práticos da investigação para a empresa objeto de estudo.

Comparação dosimétrica de dois sistemas de planeamento de tratamento em radioterapia conformacional 3D

Dissertação de mestrado em Biofísica e Bionanossistemas

A peripheral dose calculation model for estimating second cancer risk after breast radiotherapy

AbstractBreast cancer is one of the most common cancers affecting one in eight women during their lives. Survival rates have increased steadily thanks to early diagnosis with mammography screening and more efficient treatment strategies. Post-operative radiation therapy is a standard of care in the management of breast cancer and has been shown to reduce efficiently both local recurrence rate and breast cancer mortality. Radiation therapy is however associated with some late effects for long-term survivors. Radiation-induced secondary cancer is a relatively rare but severe late effect of radiation therapy. Currently, radiotherapy plans are essentially optimized to maximize tumor control and minimize late deterministic effects (tissue reactions) that are mainly associated with high doses (» 1 Gy). With improved cure rates and new radiation therapy technologies, it is also important to evaluate and minimize secondary cancer risks for different treatment techniques. This is a particularly challenging task due to the large uncertainties in the dose-response relationship.In contrast with late deterministic effects, secondary cancers may be associated with much lower doses and therefore out-of-field doses (also called peripheral doses) that are typically inferior to 1 Gy need to be determined accurately. Out-of-field doses result from patient scatter and head scatter from the treatment unit. These doses are particularly challenging to compute and we characterized it by Monte Carlo (MC) calculation. A detailed MC model of the Siemens Primus linear accelerator has been thoroughly validated with measurements. We investigated the accuracy of such a model for retrospective dosimetry in epidemiological studies on secondary cancers. Considering that patients in such large studies could be treated on a variety of machines, we assessed the uncertainty in reconstructed peripheral dose due to the variability of peripheral dose among various linac geometries. For large open fields (> 10x10 cm2), the uncertainty would be less than 50%, but for small fields and wedged fields the uncertainty in reconstructed dose could rise up to a factor of 10. It was concluded that such a model could be used for conventional treatments using large open fields only.The MC model of the Siemens Primus linac was then used to compare out-of-field doses for different treatment techniques in a female whole-body CT-based phantom. Current techniques such as conformai wedged-based radiotherapy and hybrid IMRT were investigated and compared to older two-dimensional radiotherapy techniques. MC doses were also compared to those of a commercial Treatment Planning System (TPS). While the TPS is routinely used to determine the dose to the contralateral breast and the ipsilateral lung which are mostly out of the treatment fields, we have shown that these doses may be highly inaccurate depending on the treatment technique investigated. MC shows that hybrid IMRT is dosimetrically similar to three-dimensional wedge-based radiotherapy within the field, but offers substantially reduced doses to out-of-field healthy organs.Finally, many different approaches to risk estimations extracted from the literature were applied to the calculated MC dose distribution. Absolute risks varied substantially as did the ratio of risk between two treatment techniques, reflecting the large uncertainties involved with current risk models. Despite all these uncertainties, the hybrid IMRT investigated resulted in systematically lower cancer risks than any of the other treatment techniques. More epidemiological studies with accurate dosimetry are required in the future to construct robust risk models. In the meantime, any treatment strategy that reduces out-of-field doses to healthy organs should be investigated. Electron radiotherapy might offer interesting possibilities with this regard.RésuméLe cancer du sein affecte une femme sur huit au cours de sa vie. Grâce au dépistage précoce et à des thérapies de plus en plus efficaces, le taux de guérison a augmenté au cours du temps. La radiothérapie postopératoire joue un rôle important dans le traitement du cancer du sein en réduisant le taux de récidive et la mortalité. Malheureusement, la radiothérapie peut aussi induire des toxicités tardives chez les patients guéris. En particulier, les cancers secondaires radio-induits sont une complication rare mais sévère de la radiothérapie. En routine clinique, les plans de radiothérapie sont essentiellement optimisées pour un contrôle local le plus élevé possible tout en minimisant les réactions tissulaires tardives qui sont essentiellement associées avec des hautes doses (» 1 Gy). Toutefois, avec l'introduction de différentes nouvelles techniques et avec l'augmentation des taux de survie, il devient impératif d'évaluer et de minimiser les risques de cancer secondaire pour différentes techniques de traitement. Une telle évaluation du risque est une tâche ardue étant donné les nombreuses incertitudes liées à la relation dose-risque.Contrairement aux effets tissulaires, les cancers secondaires peuvent aussi être induits par des basses doses dans des organes qui se trouvent hors des champs d'irradiation. Ces organes reçoivent des doses périphériques typiquement inférieures à 1 Gy qui résultent du diffusé du patient et du diffusé de l'accélérateur. Ces doses sont difficiles à calculer précisément, mais les algorithmes Monte Carlo (MC) permettent de les estimer avec une bonne précision. Un modèle MC détaillé de l'accélérateur Primus de Siemens a été élaboré et validé avec des mesures. La précision de ce modèle a également été déterminée pour la reconstruction de dose en épidémiologie. Si on considère que les patients inclus dans de larges cohortes sont traités sur une variété de machines, l'incertitude dans la reconstruction de dose périphérique a été étudiée en fonction de la variabilité de la dose périphérique pour différents types d'accélérateurs. Pour de grands champs (> 10x10 cm ), l'incertitude est inférieure à 50%, mais pour de petits champs et des champs filtrés, l'incertitude de la dose peut monter jusqu'à un facteur 10. En conclusion, un tel modèle ne peut être utilisé que pour les traitements conventionnels utilisant des grands champs.Le modèle MC de l'accélérateur Primus a été utilisé ensuite pour déterminer la dose périphérique pour différentes techniques dans un fantôme corps entier basé sur des coupes CT d'une patiente. Les techniques actuelles utilisant des champs filtrés ou encore l'IMRT hybride ont été étudiées et comparées par rapport aux techniques plus anciennes. Les doses calculées par MC ont été comparées à celles obtenues d'un logiciel de planification commercial (TPS). Alors que le TPS est utilisé en routine pour déterminer la dose au sein contralatéral et au poumon ipsilatéral qui sont principalement hors des faisceaux, nous avons montré que ces doses peuvent être plus ou moins précises selon la technTque étudiée. Les calculs MC montrent que la technique IMRT est dosimétriquement équivalente à celle basée sur des champs filtrés à l'intérieur des champs de traitement, mais offre une réduction importante de la dose aux organes périphériques.Finalement différents modèles de risque ont été étudiés sur la base des distributions de dose calculées par MC. Les risques absolus et le rapport des risques entre deux techniques de traitement varient grandement, ce qui reflète les grandes incertitudes liées aux différents modèles de risque. Malgré ces incertitudes, on a pu montrer que la technique IMRT offrait une réduction du risque systématique par rapport aux autres techniques. En attendant des données épidémiologiques supplémentaires sur la relation dose-risque, toute technique offrant une réduction des doses périphériques aux organes sains mérite d'être étudiée. La radiothérapie avec des électrons offre à ce titre des possibilités intéressantes.

Scheduling in virtual infrastructure

For the execution of the scientific applications, different methods have been proposed to dynamically provide execution environments for such applications that hide the complexity of underlying distributed and heterogeneous infrastructures. Recently virtualization has emerged as a promising technology to provide such environments. Virtualization is a technology that abstracts away the details of physical hardware and provides virtualized resources for high-level scientific applications. Virtualization offers a cost-effective and flexible way to use and manage computing resources. Such an abstraction is appealing in Grid computing and Cloud computing for better matching jobs (applications) to computational resources. This work applies the virtualization concept to the Condor dynamic resource management system by using Condor Virtual Universe to harvest the existing virtual computing resources to their maximum utility. It allows existing computing resources to be dynamically provisioned at run-time by users based on application requirements instead of statically at design-time thereby lay the basis for efficient use of the available resources, thus providing way for the efficient use of the available resources.

Review of the Nursing Home Subvention Scheme

Review of the Nursing Home Subvention Scheme The government decided in 1997 to approve proposals from the Minister for Finance for a process of expenditure reviews as a key part of the financial management systems that are central to the Strategic Management Initiative and are intended to ensure greater predictability in resource planning. The aims of the expenditure review process are as follows: Click here to download PDF 873kb

Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: implications for secondary cancer risk assessment.

To make a comprehensive evaluation of organ-specific out-of-field doses using Monte Carlo (MC) simulations for different breast cancer irradiation techniques and to compare results with a commercial treatment planning system (TPS). Three breast radiotherapy techniques using 6MV tangential photon beams were compared: (a) 2DRT (open rectangular fields), (b) 3DCRT (conformal wedged fields), and (c) hybrid IMRT (open conformal+modulated fields). Over 35 organs were contoured in a whole-body CT scan and organ-specific dose distributions were determined with MC and the TPS. Large differences in out-of-field doses were observed between MC and TPS calculations, even for organs close to the target volume such as the heart, the lungs and the contralateral breast (up to 70% difference). MC simulations showed that a large fraction of the out-of-field dose comes from the out-of-field head scatter fluence (>40%) which is not adequately modeled by the TPS. Based on MC simulations, the 3DCRT technique using external wedges yielded significantly higher doses (up to a factor 4-5 in the pelvis) than the 2DRT and the hybrid IMRT techniques which yielded similar out-of-field doses. In sharp contrast to popular belief, the IMRT technique investigated here does not increase the out-of-field dose compared to conventional techniques and may offer the most optimal plan. The 3DCRT technique with external wedges yields the largest out-of-field doses. For accurate out-of-field dose assessment, a commercial TPS should not be used, even for organs near the target volume (contralateral breast, lungs, heart).

Revised Criteria and Procedures for the Establishment of New Primary Schools - Report of the Commission on School Accommodation

Part One explores the background factors relating to new school establishment, outlines the views received as a result of consultation with the public and the New Schools Advisory Committee (NSAC) and reviews international practice in relation to establishment of new schools. The population of the country experienced an unprecedented increase in the past ten years. Despite the current economic downturn, the effect of this recent population increase is that growth in demand for school places is set to increase over the short to medium term. The overriding objective is to ensure that a school place is available to every child. Part Two explores issues around planning for new schools in the future. It discusses patron selection, the mechanism for identifying the need for a new school and proposals for cost effectiveness, including campus arrangements. A school is of central importance to a local community and therefore the establishment of a new school must be carried out with reference to the overall plan of the local authority for any given area. Guidelines published under Section 28 of the Planning Act entitled “The Provision of Schools and the Planning System” (July 2008) establish a 7 framework for co-operation between the Department and planning authorities to ensure the timely and cost-effective provision of school facilities.

Helical tomotherapy (HT) for the treatment of anal canal cancer: preliminary clinical results, and dosimetric comparison between HT and intensity-modulated or 3D conformal radiotherapy

Background: To report a single-center experience in 19 patients (pts) with anal canal cancer treated with helical tomotherapy (HT) and concurrent chemotherapy, and compare the dosimetric results with fixed-field intensitymodulated radiotherapy (IMRT) and 3D conformal radiotherapy (3D RT). Materials and Methods: Between 2007 and 2008, 19 consecutive pts were treated with HT and concurrent CT for anal canal cancer. Median age was 59 years (range, 38−83), and female/male ratio was 14/5. The majority of the pts had T2 or T3 tumours (68.4%), and 52.6% had positive lymph nodes. In all 19 pts, pelvic and inguinal nodes, and tumour irradiation was given using HT upto a median dose of 36 Gy (1.8 Gy/fr) followed by a 1-week gap. A boost dose of 23.4 Gy (1.8 Gy/fr) was delivered to the tumour and involved nodes using 3DRT (n = 12), HT (n = 6), or IMRT (n = 1). Simultaneous integrated boost was used in none of the pts. All but one patient with a T1N0 tumour received concomitant mitomycin/5- fluorouracil (n = 12) or mitomycin/capecitabin (n = 7) CT. Toxicity was scored according to the Common Terminology Criteria for Adverse Events (NCICTCAE v3.0). HT plans and treatments were generated using Tomotherapy, Inc., software and hardware; and 3D or IMRT boost plans with the CMS treatment planning system (TPS), using 6−18 MV photons from a Siemens Primus accelerator. For dosimetric comparison, computed tomography data sets of 10 pts were imported into the TPS, and 3D and 5-field step-andshoot IMRT plans were generated for each case. Plans were optimized with the aim of assessing organs at risk (OAR) and healthy-tissue sparing while enforcing highly conformal target coverage, and evaluated by dose-volume histograms (DVH) of planning target volumes (PTV) and OAR. Results: With a median follow-up of 13 months (range, 3−18), all pts are alive and well; except one patient developing local recurrence at 12 months. No patient developed grade 3 or more acute toxicity. No unplanned treatment interruption was necessary because of toxicity. With 360-degree-of-freedom beam projection, HT showed an advantage over 3D or IMRT plans in terms of dose conformity around the PTV, and dose gradients were steeper outside the PTV, resulting in reduced doses to OARs. Using HT, acute toxicity was acceptable, and seemed to be better than historical standards. Conclusion: We conclude that HT combined with concurrent chemotherapy for anal canal cancer is effective and tolerable. Compared to 3DRT or 5-field IMRT, there is better conformity around the PTV, and OAR sparing.

Implantació d'un ERP en el Club d'Esports Laietana

Implantació i anàlisi d'un cas conceptual i pràctic d'un sistema de gestió integral empresarial (Enterprise Resource Plannig -ERP-) per a un club esportiu.

Behavioral ecology of Heteragrion consors Hagen (Odonata, Megapodagrionidae): a shade-seek Atlantic forest damselfly

Behavioral ecology of Heteragrion consors Hagen (Odonata: Megapodagrionidae): a shade-seek Atlantic forest damselfly. The intensity of the inter and intra-sexual selection can affect male behavioral traits as territorial fidelity and aggressiveness allowing the existence of different strategies. However, its differential success could be affected by environmental - as the diel variation in temperature - and physiological constrains - as the variation in thermoregulatory abilities. In this context, we present a behavioral analysis of Heteragrion consors (Zygoptera, Megapodagrionidae) trying to characterize its mating system, diel activity pattern, temporal budget, territoriality and reproductive biology. These data were obtained based on field observations using the focal individual method and mark-recapture techniques in 120 m of a shaded Atlantic Forest stream in Brazil. The males of this species were territorial, varying in its local fidelity, while the females appear sporadically. Males were perched in the majority of the time, but were also observed in cleaning movements, longitudinal abdominal flexion, wing flexion and sperm transfer during perch. The males presented a perched thermoregulatory behavior related to an exothermic regulation. Foraging and agonistic interactions were rare, but dominate the other behavioral activities. Abdominal movements associated to long lasting copula pointed to the existence of sperm competition in this species. Males performed contact post-copulatory guarding of the females. These observations pointed to a non-resource mating system for this species.