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

Mestrado em Radioterapia.

Segurança do doente: o papel do técnico de radioterapia

A radioterapia (RT) desempenha um papel fundamental na terapêutica curativa ou paliativa do cancro, sendo aplicada no tratamento de 50 a 60% dos doentes diagnosticados. O seu objectivo é administrar uma dose prescrita de radiação ionizante a um volume alvo com um mínimo de dano para os tecidos sãos circundantes, preservando a sua função. Os desvios relativamente à prescrição poderão comprometer o objectivo do tratamento, levando a possíveis sobredosagens nos tecidos saudáveis e subdosagens no volume de tratamento. A maioria dos tratamentos ocorre sem incidentes e contribui para a qualidade de vida ou cura do doente. No entanto, a RT é reconhecida como um procedimento de alto risco devido à tecnologia e ambiente complexos, bem como ao elevado número de etapas e grupos profissionais envolvidos que trabalham em equipa para prescrever, planear, administrar e monitorizar a terapia. Apesar da baixa taxa de erro e das poucas ou nenhumas consequências clínicas para os doentes associadas, o verdadeiro risco reside na possibilidade de o erro não ser detectado, perpetuando-se no tempo ou afetando vários doentes. Os avanços na tecnologia que proporcionam técnicas mais sofisticadas e precisas representam também uma necessidade crescente de treino exaustivo, formação contínua e atenção por parte dos técnicos de RT que planeiam e administram a terapia. Estes integram uma equipa de especialistas, constituída por médicos, físicos e enfermeiros, que sob a supervisão do médico radioterapeuta se articulam de forma a assegurar um tratamento consistente, preciso e eficiente. Os técnicos de radioterapia trabalham com equipamentos e softwares cada vez mais sofisticados, monitorizam os tratamentos e contactam diariamente com o doente durante o seu tratamento, assumindo a autonomia e responsabilidade de interpretar todo o processo de tratamento e quando necessário articula-se com a restante equipa. A interação profunda entre funções automatizadas, equipamentos tecnologicamente avançados, decisões e atividades humanas que acompanham todo o processo da RT, aliados à pressão crescente para a aplicação das técnicas de tratamento mais avançadas a mais doentes e cumprimento de metas temporais, confere um potencial de risco à atividade do técnico de RT que é por vezes subestimado. O reconhecimento deste potencial passa pelo enquadramento da sua atividade no processo da RT e caracterização do seu papel no mesmo, revelando as suas competências e limitações.

Development of an injectable grout for concrete repair and strengthening

This paper deals with the coupled effect of temperature and silica fume addition on rheological, mechanical behaviour and porosity of grouts based on CEMI 42.5R, proportioned with a polycarboxylate-based high range water reducer. Preliminary tests were conducted to focus on the grout best able to fill a fibrous network since the goal of this study was to develop an optimized grout able to be injected in a mat of steel fibers for concrete strengthening. The grout composition was developed based on criteria for fresh state and hardened state properties. For a CEMI 42.5R based grout different high range water reducer dosages (0%, 0.2%, 0.4%, 0.5%, 0.7%) and silica fume (SF) dosages (0%, 2%, 4%) were tested (as replacement of cement by mass). Rheological measurements were used to investigate the effect of polycarboxylates (PCEs) and SF dosage on grout properties, particularly its workability loss, as the mix was to be injected in a matrix of steel fibers for concrete jacketing. The workability behaviour was characterized by the rheological parameters yield stress and plastic viscosity (for different grout temperatures and resting times), as well as the procedures of mini slump cone and funnel flow time. Then, further development focused only on the best grout compositions. The cement substitution by 2% of SF exhibited the best overall behaviour and was considered as the most promising compared to the others compositions tested. Concerning the fresh state analysis, a significant workability loss was detected if grout temperature increased above 35 degrees C. Below this temperature the grout presented a self-levelling behaviour and a life time equal to 45 min. In the hardened state, silica fumes increased not only the grout's porosity but also the grout's compressive strength at later ages, since the pozzolanic contribution to the compressive strength does not occur until 28 d and beyond. (C) 2012 Elsevier Ltd. All rights reserved.

Retreatment in leprosy: a case-control study

OBJECTIVE: To assess risk factors for retreatment of leprosy patients. METHODS: A case-control study with patients from two reference care units in Recife, northeastern Brazil, in 2003. The case group included retreated patients (N=155) and the control group comprised those patients who were not retreated (N=155) matched by year of diagnosis and health care unit. Univariate and multivariate analyses were conducted to test the associations and odds ratios and related 95% confidence intervals were estimated. RESULTS: The following factors were found to be significantly associated (p<0.05) with retreatment: occurrence of adverse immunological reactions after treatment completion (OR=2.3; 95% CI=1.18;4.83), final bacterial index > 1 (OR=6.43; 95% CI=1.67;24.74), therapeutic regimen consisting of sulfone monotherapy (OR=10; 95% CI=0.01;0.78) and reports of household contacts (OR=2.2; 95% CI=0.24;0.85). CONCLUSIONS: The study findings reinforce that the use of dapsone monotherapy should be discontinued, and highlight the need for epidemiological monitoring of specific groups of leprosy patients after treatment completion through periodical clinical and laboratory evaluation. Further studies to explore the association between final bacterial index and retreatment are strongly recommended.

Verificação dos desvios de setup e cálculo de margem de PTV em tumores de próstata com 3DCRT

Mestrado em Radioterapia

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

Mestrado em Radioterapia

Evaluating the efficiency of a vegetal coagulant in the treatment of industrial effluents

The present work aims at evaluating the efficiency of an organic polymer from vegetal source used as coagulant for treating different types of industrial effluents. This coagulant (Flox-QT) is obtained from the Black Acacia (Acacia mearnsii). The effluents studied were produced in petrochemical, leather, cork stoppers, metalworking, olive oil, glue, paint (printing), textile and paper industries. The parameters analyzed in the effluents before and after treatment were selected according to the type of wastewater and included pH, conductivity, apparent colour, turbidity, total suspended solids (TSS), chemical oxygen demand (COD) and some metals. The coagulant proved to be efficient for almost all effluents tested. The best results were obtained for the paper industry wastewater, with 91% removal of chemical oxygen demand and 95% of total suspended solids removal. The estimated cost of this treatment would be only 0.24 Euro per cubic meter of treated effluent, only regarding the price of the coagulant and the required dosage. The use of this coagulant is also adequate for the valorisation of the sludge obtained, which in this case could be recycled for paper production.

Differential expression of the eukaryotic release factor 3 (eRF3/GSPT1) according to gastric cancer histological types

Background: There are now several lines of evidence to suggest that protein synthesis and translation factors are involved in the regulation of cell proliferation and cancer development. Aims: To investigate gene expression patterns of eukaryotic releasing factor 3 (eRF3) in gastric cancer. Methods: RNA was prepared from 25 gastric tumour biopsies and adjacent non-neoplastic mucosa. Real time TaqMan reverse transcription polymerase chain reaction (RT-PCR) was performed to measure the relative gene expression levels. DNA was isolated from tumour and normal tissues and gene dosage was determined by a quantitative real time PCR using SYBR Green dye. Results: Different histological types of gastric tumours were analysed and nine of the 25 tumours revealed eRF3/GSPT1 overexpression; moreover, eight of the 12 intestinal type carcinomas analysed overexpressed the gene, whereas eRF3/GSPT1 was overexpressed in only one of the 10 diffuse type carcinomas (Kruskal-Wallis Test; p , 0.05). No correlation was found between ploidy and transcript expression levels of eRF3/GSPT1. Overexpression of eRF3/GSPT1 was not associated with increased translation rates because the upregulation of eRF3/GSPT1 did not correlate with increased eRF1 levels. Conclusions: Overexpression of eRF3/GSPT1 in intestinal type gastric tumours may lead to an increase in the translation efficiency of specific oncogenic transcripts. Alternatively, eRF3/GSPT1 may be involved in tumorigenesis as a result of its non-translational roles, namely (dis)regulating the cell cycle, apoptosis, or transcription.

The use of non-standard CT conversion ramps for Monte Carlo verification of 6 MV prostate IMRT plans

Monte Carlo (MC) dose calculation algorithms have been widely used to verify the accuracy of intensity-modulated radiotherapy (IMRT) dose distributions computed by conventional algorithms due to the ability to precisely account for the effects of tissue inhomogeneities and multileaf collimator characteristics. Both algorithms present, however, a particular difference in terms of dose calculation and report. Whereas dose from conventional methods is traditionally computed and reported as the water-equivalent dose (Dw), MC dose algorithms calculate and report dose to medium (Dm). In order to compare consistently both methods, the conversion of MC Dm into Dw is therefore necessary. This study aims to assess the effect of applying the conversion of MC-based Dm distributions to Dw for prostate IMRT plans generated for 6 MV photon beams. MC phantoms were created from the patient CT images using three different ramps to convert CT numbers into material and mass density: a conventional four material ramp (CTCREATE) and two simplified CT conversion ramps: (1) air and water with variable densities and (2) air and water with unit density. MC simulations were performed using the BEAMnrc code for the treatment head simulation and the DOSXYZnrc code for the patient dose calculation. The conversion of Dm to Dw by scaling with the stopping power ratios of water to medium was also performed in a post-MC calculation process. The comparison of MC dose distributions calculated in conventional and simplified (water with variable densities) phantoms showed that the effect of material composition on dose-volume histograms (DVH) was less than 1% for soft tissue and about 2.5% near and inside bone structures. The effect of material density on DVH was less than 1% for all tissues through the comparison of MC distributions performed in the two simplified phantoms considering water. Additionally, MC dose distributions were compared with the predictions from an Eclipse treatment planning system (TPS), which employed a pencil beam convolution (PBC) algorithm with Modified Batho Power Law heterogeneity correction. Eclipse PBC and MC calculations (conventional and simplified phantoms) agreed well (<1%) for soft tissues. For femoral heads, differences up to 3% were observed between the DVH for Eclipse PBC and MC calculated in conventional phantoms. The use of the CT conversion ramp of water with variable densities for MC simulations showed no dose discrepancies (0.5%) with the PBC algorithm. Moreover, converting Dm to Dw using mass stopping power ratios resulted in a significant shift (up to 6%) in the DVH for the femoral heads compared to the Eclipse PBC one. Our results show that, for prostate IMRT plans delivered with 6 MV photon beams, no conversion of MC dose from medium to water using stopping power ratio is needed. In contrast, MC dose calculations using water with variable density may be a simple way to solve the problem found using the dose conversion method based on the stopping power ratio.

Controlo da qualidade dosimétrico no serviço de radioterapia do Hospital CUF Descobertas (HCD): importância do controlo da qualidade do sector da física e resultados da auditoria ESTRO-EQUAL

A calibração e o controlo da qualidade de um acelerador linear são passos muito importantes num serviço de Radioterapia, para garantir a qualidade dos tratamentos prestados. O sector da Física da Unidade de Radioterapia do Hospital Cuf Descobertas implementou um rigoroso Programa de controlo de qualidade ao equipamento produtor de radiação e aos equipamentos medidores de radiação, de acordo com o Dec-Lei 180/2002 e com os protocolos internacionais. Para tal, foram implementados procedimentos, criadas folhas de cálculo, instruções de trabalho e impressos. Foram ainda implementados testes aos equipamentos com periodicidade definida: controlo de qualidade diário e controlo de qualidade após intervenções (manutenções preventivas e correctivas). No decorrer do ano de 2005, o sector da Física colaborou activamente com toda a equipa da Radioterapia na implementação da Norma ISO 9001:2000 no serviço, contribuindo com o seu know how na implementação desta, numa área tão importante como a da garantia da qualidade dos feixes de radiação e das respectivas calibrações em dose. Numa procura de melhoria contínua da qualidade dos serviços prestados aos pacientes, decorre ainda uma auditoria externa da EQUAL-ESTRO*, intercomparação postal com dosímetros termoluminescentes. A qualidade dos feixes de energias utilizados diariamente é analisada, tanto ao nível das calibrações absolutas de cada um dos feixes de fotões e de electrões, como ao nível dos cálculos de dose obtidos com o sistema de planimetria XiO da CMS. Os resultados das duas primeiras fases da intercomparação, relativa aos dois feixes de fotões de 6 MV e 15 MV e feixes de electrões de 4 MeV, 8 MeV e 12 MeV, foram considerados pela EQUAL-ESTRO num nível óptimo (desvio máximo na dose medida em relação à dose de referência |d| ≤ 3%).

Comparison of different breast planning techniques and algorithms for radiation therapy treatment

This work aims at investigating the impact of treating breast cancer using different radiation therapy (RT) techniques – forwardly-planned intensity-modulated, f-IMRT, inversely-planned IMRT and dynamic conformal arc (DCART) RT – and their effects on the whole-breast irradiation and in the undesirable irradiation of the surrounding healthy tissues. Two algorithms of iPlan BrainLAB treatment planning system were compared: Pencil Beam Convolution (PBC) and commercial Monte Carlo (iMC). Seven left-sided breast patients submitted to breast-conserving surgery were enrolled in the study. For each patient, four RT techniques – f-IMRT, IMRT using 2-fields and 5-fields (IMRT2 and IMRT5, respectively) and DCART – were applied. The dose distributions in the planned target volume (PTV) and the dose to the organs at risk (OAR) were compared analyzing dose–volume histograms; further statistical analysis was performed using IBM SPSS v20 software. For PBC, all techniques provided adequate coverage of the PTV. However, statistically significant dose differences were observed between the techniques, in the PTV, OAR and also in the pattern of dose distribution spreading into normal tissues. IMRT5 and DCART spread low doses into greater volumes of normal tissue, right breast, right lung and heart than tangential techniques. However, IMRT5 plans improved distributions for the PTV, exhibiting better conformity and homogeneity in target and reduced high dose percentages in ipsilateral OAR. DCART did not present advantages over any of the techniques investigated. Differences were also found comparing the calculation algorithms: PBC estimated higher doses for the PTV, ipsilateral lung and heart than the iMC algorithm predicted.

Mutation accumulation in Tetrahymena

Background - The rate and fitness effects of mutations are key in understanding the evolution of every species. Traditionally, these parameters are estimated in mutation accumulation experiments where replicate lines are propagated in conditions that allow mutations to randomly accumulate without the purging effect of natural selection. These experiments have been performed with many model organisms but we still lack empirical estimates of the rate and effects of mutation in the protists. Results - We performed a mutation accumulation (MA) experiment in Tetrahymena thermophila, a species that can reproduce sexually and asexually in nature, and measured both the mean decline and variance increase in fitness of 20 lines. The results obtained with T. thermophila were compared with T. pyriformis that is an obligate asexual species. We show that MA lines of T. thermophila go to extinction at a rate of 1.25 clonal extinctions per bottleneck. In contrast, populations of T. pyriformis show a much higher resistance to extinction. Variation in gene copy number is likely to be a key factor in explaining these results, and indeed we show that T. pyriformis has a higher mean copy number per cell than T. thermophila. From fitness measurements during the MA experiment, we infer a rate of mutation to copy number variation of 0.0333 per haploid MAC genome of T. thermophila and a mean effect against copy number variation of 0.16. A strong effect of population size in the rate of fitness decline was also found, consistent with the increased power of natural selection. Conclusions - The rate of clonal extinction measured for T. thermophila is characteristic of a mutational degradation and suggests that this species must undergo sexual reproduction to avoid the deleterious effects detected in the laboratory experiments. We also suggest that an increase in chromosomal copy number associated with the phenotypic assortment of amitotic divisions can provide an alternative mechanism to escape the deleterious effect of random chromosomal copy number variation in species like T. pyriformis that lack the resetting mechanism of sexual reproduction. Our results are relevant to the understanding of cell line longevity and senescence in ciliates.

Gene expression regulation and lineage evolution: the North and South tale of the hybrid polyploid Squalius alburnoides complex

The evolution of hybrid polyploid vertebrates, their viability and their perpetuation over evolutionary time have always been questions of great interest. However, little is known about the impact of hybridization and polyploidization on the regulatory networks that guarantee the appropriate quantitative and qualitative gene expression programme. The Squalius alburnoides complex of hybrid fish is an attractive system to address these questions, as it includes a wide variety of diploid and polyploid forms, and intricate systems of genetic exchange. Through the study of genome-specific allele expression of seven housekeeping and tissue-specific genes, we found that a gene copy silencing mechanism of dosage compensation exists throughout the distribution range of the complex. Here we show that the allele-specific patterns of silencing vary within the complex, according to the geographical origin and the type of genome involved in the hybridization process. In southern populations, triploids of S. alburnoides show an overall tendency for silencing the allele from the minority genome, while northern population polyploids exhibit preferential biallelic gene expression patterns, irrespective of genomic composition. The present findings further suggest that gene copy silencing and variable expression of specific allele combinations may be important processes in vertebrate polyploid evolution.

Characterization of a polyubiquitin gene in T. thermophila and of ubiquitin gene expression during sexual reproduction and under stress conditions

A 5-unit polyubiquitin gene, TTU3, was isolated from a T. thermophila genomic library and sequenced. This gene presents an extra triplet coding for Phe, a AGAGA motif and a putative HSE element in its 5'-non-coding region. The ubiquitin gene expression in this ciliate was investigated by Northern blot hybridization in conjugating cells or cells under stress conditions. Exponentially growing cells express two ubiquitin mRNAs of 0.75 and 1.8 kb and a new species of 1.4 kb is induced under hyperthermic stress. During sexual reproduction of the cells (conjugation) the 1.8-kb mRNA is still transcribed whereas the steady-state population of the 0.75 mRNA transcripts is strongly diminished. Southern blot analysis suggests that ubiquitin in T. thermophila constitutes a large family of about ten members.

Produção de biodiesel via catálise heterogénea básica

Mestrado em Engenharia Química. Ramo Tecnologias de Protecção Ambiental.