Adragna, Celeste (2019) Implementación de braquiterapia adaptativa guiada por imágenes de resonancia magnética nuclear en pacientes con cáncer ginecológicos / Implementation of image guided apative brachytherapy using magnetic resonance imaging on gynecological cancer patients. Maestría en Física Médica, Universidad Nacional de Cuyo, Instituto Balseiro.
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Resumen en español
La braquiterapia es fundamental en el tratamiento de cáncer ginecológico. El uso de imágenes en asistencia de la planificacion ha evolucionado de 2-D a 3-D, incluyendo tomografía y resonancia magnética. En el presente se trabajo sobre la transición en FUESMEN desde tratamientos con planificación basada en imágenes planares hacia una braquiterapia con alta tasa de dosis guiada por Resonancia Magnética. La puesta en marcha de esta técnica requiere controles de calidad previos a su implementación que aseguren que la planificacion y entrega del tratamiento sean correctos. Con este fin se realizaron pruebas sobre las imágenes de resonancia, incluyendo la caracterizacion de los aplicadores en el resonador a utilizar y un estudio de distorsión y artefactos, así como pruebas sobre el Sistema de Planificacion de Tratamientos. Para poder implementar dichos controles se diseñaron y elaboraron dos fantomas específicos. Ademas se hicieron controles para dosimetría de fuentes, con una intercomparación de la cámara de pozo con otra institucion. Las distintas pruebas permitieron establecer una base para poder implementar de manera adecuada la Braquiterapia HDR guiada por imágenes 3-D en el servicio, abarcando aspectos clínicos, uso del planificador, protocolos de imagen, y procedimientos para controles de calidad. Por otro lado, con la resonancia se pueden definir y delimitar órganos a riesgo y volumen blanco y evaluar el volumen tumoral grueso, a diferencia del enfoque convencional de planificación 2-D ortogonal que se emplea aun en FUESMEN. Para reflejar el impacto que tiene esto en las distribuciones de dosis, se realizaron planificaciones 3-D de casos clínicos, comparando las dosimetrías obtenidas contra las resultantes de una planificación basada en puntos (2-D). En estos casos se demostró una mejor protección de estructuras críticas mientras que se sigue cumpliendo con la prescripción de dosis al volumen blanco. Esto gracias a que la optimización de la planificación y el análisis de los Histogramas Dosis-Volumen permitieron adaptar la forma de pera de las isodosis típicas a las características individuales del tumor y anatomía particular de los órganos en riesgo.
Resumen en inglés
Brachytherapy is essential in the treatment of gynecological cancer. The use of images in assistance of treatment planning has evolved from 2-D to 3-D, including tomography and magnetic resonance imaging (MRI). This work is focused in the transition from planar images based plannifications towards a high dose rate MRI guided brachytherapy in FUESMEN. Quality controls prior to the implementation of this technique are required in order to assure that treatment planning and delivery are correct. To this end, tests were performed on the resonance images, including the characterization of the applicators in the resonator to be used and a study of distortion and artifacts, as well as tests on the Treatment Planning System. In order to implement these controls, two specic phantoms were designed and developed. In addition, controls were made for source dosimetry, with an inter-comparison of the well chamber with another institution. The different tests allowed to establish a foundation on which high dose rate 3-D guided brachytherapy could be safely implemented in the service; covering clinical aspects, use of the planning system, image protocols, and procedures for quality controls. On the other hand, with magnetic resonance imaging, organs at risk and target can be dened and delimited, as well as an evaluation of the gross tumor volume, unlike the conventional 2-D planning approach that is still used in FUESMEN. In order to reffect the impact on dose distributions, 3-D planning of clinical cases was performed, comparing the dosimetries obtained against those resulting from a point-based planning (2-D). In these cases a better protection of critical structures was demonstrated, while still achieving the desired dose prescription to the target volume. This resulted from the planning optimization and Dose-Volume Histograms analysis, that allowed adaptation of the typical pear-shaped isodoses to the individual characteristics of the tumor and anatomy of the organs at risk.
| Tipo de objeto: | Tesis (Maestría en Física Médica) |
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| Palabras Clave: | Magnetic resonance; Resonancia magnética; Quality control; Control de calidad; [Adaptive brachytherapy; Braquiterapia adaptativa; 3-D planning; Planificación 3-D; High dose rate; Alta tasa de dosis] |
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| Materias: | Medicina > Radioterapia |
| Divisiones: | FUESMEN |
| Código ID: | 893 |
| Depositado Por: | Tamara Cárcamo |
| Depositado En: | 09 Abr 2021 11:20 |
| Última Modificación: | 12 Abr 2021 11:42 |
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