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研究生:林芯妤
研究生(外文):Hsin-Yu Lin
論文名稱:子宮頸癌近接治療使用不同裝療器之劑量分佈
論文名稱(外文):Dose distribution of various applicator materials in cervical cancer brachytherapy
指導教授:許世明許世明引用關係
指導教授(外文):Shih-Ming Hsu
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:臨床醫學研究所碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:104
中文關鍵詞:Henschke裝療器屏蔽效應治療計畫系統
外文關鍵詞:Henschke applicatorshielding effectTPS
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本研究評估銥-192射源實施子宮頸癌高劑量率近接治療時,使用不同裝療器之劑量分佈,藉由microSelectron 遠隔治療系統和熱發光劑量計,測量不同裝療器於自製假體內之劑量分佈情形,探討危急器官在具有屏蔽材質之裝療器時,其所導致之劑量分佈差異。自製壓克力水箱假體,用以置放核通公司Henschke裝療器(型號#084.400)、Standard CT/MR裝療器(型號#101.020),並藉由熱發光劑量計實際測量臨床輻射劑量。本研究中,亦使用小體積游離腔測量Henschke 裝療器配件於Med-Tec商業水假體內各參考點之劑量分佈。探討熱發光劑量計實際測量值、小體積游離腔測量值、電腦治療計畫計算值之劑量差異。實驗結果顯示自製水假體能應用於測量高劑量率近接治療劑量分佈。當子宮頸癌高劑量率腔內近接治療使用Henschke裝療器時,因其內具有屏蔽材質會減少膀胱與直腸之輻射接受劑量,實驗結果顯示近接治療計畫將高估膀胱與直腸之劑量達 13.6 % ~ 53.74 %;而Standard CT/MR裝療器各點劑量之實測值與治療計畫計算值符合。意即Henschke裝療器的使用,對直腸與膀胱產生屏蔽效應,降低其13.6 % ~ 53.74 %的劑量接受。因此,近接治療計畫系統,應該針對此型號之裝療器,進行治療計畫系統修正,確保病人所接受之輻射劑量,增進子宮頸癌高劑量率近接治療之成效。

關鍵字:Henschke 裝療器、屏蔽效應、治療計畫系統
Abstract
In this study, we evaluated the dose distributions of various applicators for the treatment of uterine cervical cancer with high-dose-rate (HDR) 192Ir brachytherapy sources. Dose measurements of different applicators involved microSelectron® remote afterloading system and thermoluminescence (TLD-100H cube) in homemade phantom. This study focuses on the dose distributions in critical organs with shielded applicator. The homemade poly-methymethacrylate (PMMA) water phantom was not only designed to set up Henschke applicator set (complete Set, part#084.400) and the Standard CT/MR applicator set (complete Set, part#101.020) from Nucletron company (Nucletron, Netherlands) but also provided repeated measures of clinical condition with TLD-100H dosimetry. In this study, the pin-point ionization chamber (IBA CC01) was used to measure the dose distributions of the reference points with Henschke applicator of the components (tandem; ovoid) in a commercialized phantom (Med-Tec) The dosimetry of TLD-100H and pin-point ionization chamber were measured. Then, discrepancies between calculated value of treatment planning system (TPS) and experimental measurements were also assessed. This study indicated that the homemade water phantom is feasible for clinical to measure HDR brachytherpay dose distribution. When a Henschke applicator was used to treat uterine cervical cancer with intracavitary HDR brachytherapy, the shielding material can decrease the dose of irradiation received by the rectum or bladder. The experimental results showed that the brachytherapy TPS overestimated the bladder and rectum dose up to 13.6 to 53.74 % and the Standard CT/MR applicator set was in good agreement with the calculation values from TPS Henschke applicator-induced shielding effect diminished 13.6 to 53.74 % radiation dose of the rectal and bladder. Therefore, TPS should be modified when Henschke shielding applicator was used. It could make sure the radiated dose of the patient received and increased efficiency of the treatment of uterine cervical cancer.

Keywords: Henschke applicator、shielding effect、TPS
致謝 II
中文摘要 III
ABSTRACT IV
目錄 V
圖目錄 VII
表目錄 VIII
附錄 IX
第1章. 緒論 1
1-1 前言 1
1-2 文獻回顧 4
1-2-1 子宮頸癌高劑量率近接治療 4
1-2-2 近接治療劑量計算的演進 5
1-2-3 高劑量率近接治療的劑量測量方式 11
1-2-4 裝療器的使用 13
1-2-5 固態水假體的設計 14
1-3 研究目的 16
1-4 論文步驟流程圖 17
第2章. 研究理論 18
2-1 近接治療理論基礎 18
2-1-1 近接治療技術之劑量分佈計算 18
2-1-2 子宮頸癌劑量評估模式 21
2-2 熱發光劑量計工作原理 26
2-2-1 熱發光劑量計使用之工作原理 26
2-2-2 TLD-100H輻射偵測特性 29
2-3 多功能水假體設計 30
第3章. 材料與方法 32
3-1 實驗設備 32
3-1-1 輻射照射之儀器 32
3-1-2 劑量測量之驗證假體 34
3-1-3 熱發光劑量計及計讀系統 38
3-1-4 游離腔 41
3-1-5 裝療器 41
3-2 實驗步驟 43
3-2-1 自製水假體性能測試 43
3-2-2 TLD校正 44
3-2-3 裝療器與劑量計擺置 45
3-2-4 建立近接治療計畫 48
3-2-5 近接治療實際劑量測量 51
3-2-6 裝療器內部屏蔽材質的分布 51
3-2-7 裝療器OVOID 遮蔽效應影響範圍測定 53
第4章. 結果與討論 56
4-1 實驗結果 56
4-1-1 近接治療計畫劑量計算 57
4-1-2 近接治療計畫劑量測量 63
4-2 實驗討論 78
4-2-1 結果分析 78
4-2-2 誤差分析 85
第5章. 結論與展望 89
5-1 結論 89
5-2 未來展望 90
參考文獻 92
附錄 98
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