Segundo tumor primário, radioinduzido, em pacientes com neoplasias de próstata, após radioterapia

Pós-graduação em Pesquisa e Desenvolvimento (Biotecnologia Médica) - FMB

Radioterapia de Intensidade Modulada (IMRT): princípios e técnicas

Neste trabalho, o tema central será a Radioterapia de Intensidade Modulada (IMRT). Quanto a metodologia, trata-se fundamentalmente de uma pesquisa bibliográfica somada ao acompanhamento da rotina da IMRT no Hospital Sírio Libanês e do acompanhamento do controle de qualidade do planejamento com o equipamento MapCHECK no Hospital A. C. Camargo. Os principais objetivos deste trabalho são: descrever a técnica, os seus princípios de funcionamento, os testes de aceite, o comissionamento, o controle de qualidade e a rotina clínica. Para desta maneira, avaliar a IMRT, a sua viabilidade e a importância do físico e da equipe multiprofissional no processo de implementação

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

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

Dosimetria Física e Controle de Qualidade em Radioterapia

Radiotherapy is a multidisciplinary speciality which uses complex equipment and radiation sources for delivery of treatment, using high-energy ionizing radiation to treat cancer at several stages of complexity. Since radiation therapy is a technique which involves a precalculated radiation dose, it shall be established quality assurance programs that provide an efficient and safety treatment. The International Commission on Radiation Units and Measurements (ICRU) report No. 50 has recommended dose uniformity between 5% of the prescribed dose throughout the region of interest. This is one of the most primordial points that justify the importance of a suitable attendance of the equipments quality and performance. For quality control, the medical physicist will be involved with establishing and running a Quality Control Program (QCP). He must adapt or develop the procedures of equipment acceptance and commissioning, besides verifying the use of principles and accepted protocols of national and international reports to assure the correct quality, quantity, and placement of radiation during the performance of a radiological procedure, establishing adequate protocols to ensure accurate patient dosimetry. This present work consists of a description of the activities carried through the Sectors of Radiation Therapy of the Hospital of Clinics of the Campinas State University (Unicamp), particularly in the implementation of the Quality Control Program

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

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)

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

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 Acelerador Linear Comercial para Radioterapia

This paper presents a study about the operation of the major system’s components of a linear particle acclerator (Linac). It addresses the components mainly responsible for the formation of the beam, through the inclusion of several block diagrams showing the details of the structure. Among the systems discussed may be mentioned the system modulator, automatic frequency control, dosimetry and auxiliary systems. The main objective is the dissemination of basic technology applied in linear accelerators and create literature about this subject in national language. Despite the high complexity and large number of devices that comprise a linear accelerator, it has been developed an easy to understand text that adresses the most relevant issues to the operation of the linear accelerator from the point of view of electrical engineering

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)

Avaliação teórico-experimental da distribuição de dose absorvida em radioterapia em tumores de pele

O trabalho propõe rotinas computacionais usando o Método de Monte Carlo com o Código MCNP-5, para analisar os perfis de dose de radiação liberada nos tratamentos de tumores de pele e otimizar os cálculos radiométricos dos feixes de radiação estudados. Foram realizadas medidas dosimétricas do feixe de radiação, comparando os resultados obtidos com os respectivos valores fornecidos pelo serviço de física médica das instituições, com resultados informados pelo fabricante do equipamento e com as simulações computacionais efetuadas com o Código MCNP-5. A quantificação dos erros relativos percentual entre os resultados simulados e os fornecidos pelo Serviço de Radioterapia (E1), os informados pelo fabricante (E2) e os medidos experimentalmente (E3) são inferiores a 4,0% e validam a metodologia computacional proposta para avaliação do comportamento do feixe de raios-X superficial e do feixe de raios γ da unidade de Cobaltoterapia. A metodologia de análise do espectro energético e da curva de porcentagem de dose profunda (PDP) desenvolvida neste trabalho pode ser estendida para estudos de outros feixes clínicos e subsidiar os dados radiométricos utilizados nos planejamentos e cálculos de dose realizados pelo profissional da física médica na sua rotina nos Serviços de Radioterapia

Radioterapia em câncer de mama: importância da determinação da curva de isodose

The study analyzed contours of the thoracic region of patients undergoing radiotherapy of breast tumors in Hospital Manuel de Abreu of Bauru (institution 1) and the Hospital da Faculdade de Medicina of Botucatu (Institution 2). Were prepared isodose curves corresponding to the contours of the patient, which were presented for radiotherapists doctors both hospital services that enabled the choice of the curve isodose that provides the best distribution of radiation dose in the irradiated volume. Some boundaries were digitized in one institution and sent for preparation of isodose lines in the institution 2, both curves plotted in each of the institutions and for the same contour, were compared, showing that the methodology of Curves of distance is feasible and reliable, while optimizing the routine procedures regarding the handling of isodose plans provided by different radiation equipment. It compares the calculation of the exposure time determined using the isodose curve selected by calculating the value obtained considering the PDP at the point of the middle line of separation between the internal and external fields, the difference between the two methods for determining exposure time was around 2.4%. A study on the angle of the radiation beam at the input field (region breast-air) was conducted showing that, once known a tangent angle of the input beam, one can estimate the angle of the wedge filter used in some procedures for uniformity of dose within the irradiated volume compensation and the lack of tissue in the treatment volume. A comparative study between the isodose curves produced manually with the curves obtained in a two-dimensional computer system, the computer system showed that provides further information regarding the dose gradient within the irradiated volume, in addition to reducing the time spent in preparing the curves isodose

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