臺灣博碩士論文加值系統

近年來隨著術中放射治療(intraoperative radiotherapy, IORT)技術的引進與進步，成為患者與醫生對於早期乳癌患者的首要治療選項。對於術中放射治療技術的劑量均勻性已經受到患者和醫師的質疑。本研究開發出左乳含有 30 cm3空腔的侖道假體，並以壓克力(polymethylmethacrylate, PMMA)製成。熱發光劑量計
（Thermoluminescent dosimetry , TLD）方法用於評估 20 Gy，50 kV，在利用 Xoft Axxent 放射治療儀暴露於 IORT 的輻射下的輻射劑量。劑量在氣球型裝療器(balloon applicator)表面時為 20 Gy，在距離管球表面 0.7cm 處，劑量為 17.04 Gy，有明顯的下降。在距離管球表面 1.2cm 處，劑量為 6.88 Gy，下降更明顯。這項研究將是有用的，可以被推薦給患者親屬、醫師、放射師，和主管機關參酌。

In recent years, the newly developed intraoperative radiotherapy (IORT) is the first choice for early breast cancer patients. Radiation homogeneity of this technique
have been questioned to the patients and physicians. A left breast with a 30 cm3 cavity of Rando phantom had been developed and made of polymethylmethacrylate (PMMA). Thermoluminescent dosimetry (TLD) approach was used to evaluate radiation doses under 20 Gy, 50 kV of Xoft Axxent exposure of extra radiations undergoing IORT. Doses was 20 Gy at the surface of balloon applicator, 17.04 Gy was
found at the 0.7 cm away from surface, and dropped apparently. More clearly dropped, 6.88 Gy was indicated at the 1.2 cm away from surface. This study will be useful and recommended to the relatives, physicians and radiologists and authorit.

致謝........................ ................................I
中文摘要................................................II
Abstract .............................................III
目錄...................................................IV
圖目錄..................................................VI
表目錄................................................VIII
第一章 緒論............................................. 1
1-1 論文架構 ........................................... 2
1-2 研究背景 ........................................... 4
1-3 動機與目的 ......................................... 4
第二章 文獻回顧......................................... 6
2-1 乳癌介紹 ........................................... 6
2-2 IORT 之臨床應用 .................................... 8
2-3 國內外研究現況 .................................... 10
2-4 國際輻射防護委員會之報告 ............................ 11
2-4-1 吸收劑量 ......................................... 12
2-4-2 輻射加權因數與等價劑量 ............................ 12
第三章 材料與方法....................................... 13
3-1 IORT設備........................................... 13
3-2 熱發光劑量計 ....................................... 17
3-2-1 計讀原理 ......................................... 17
3-2-2 輝光曲線 ......................................... 18
3-3 劑量計讀系統 ....................................... 19
3-3-1 靜電計(Electrometer).............................. 20
3-3-2 熱發光劑量計之準確度篩選 .......................... 21
3-3-3 熱發光劑量計之線性校正 ............................ 23
3-4 假體簡介及佈點 ..................................... 25
3-4-1 侖道假體 ........................................ 26
3-4-2 自研女性左乳房假體 ............................... 27
3-4-3 熱發光劑量計佈點位置 ............................. 29
3-5 術中放射線治療技術( Intraoperative radiotherapy, IORT )..................................................... 31
3-6 患者手術情形 ...................................... 32
3-7 治療計畫 .......................................... 33
第四章 分析結果與討論................................... 36
4-1 實驗誤差之評估 .................................... 36
4-2 劑量轉換公式 ...................................... 37
4-3 自研女性左乳房假體的劑量分布 ....................... 38
4-4 侖道假體由左向右(Left-Right, L-R)方向的表面劑量分布.. 39
4-5 侖道假體由上到下(Superior-Interior, S-I)方向的表面劑量分布.................................................... 42
4-6 與治療計畫的劑量比較 ............................... 45
4-7 鉛屏蔽阻擋效果 ..................................... 47
4-8 侖道假體內器官劑量 ................................. 50
4-9 其他文獻比較 ...................................... 51
第五章 結論.............................................54
第六章 未來展望......................................... 55
參考文獻............................................... 56

Avanzo M.,Rink A., Dassie A. et al., 2012. In vivo dosimetry with radiochromic films in low-voltage intraoperative radiotherapy of the breast. Med Phys. 39:2359-2368.
Baghani H. R.Aghamiri S. M., Mahdavi S. R. et al., 2015. Dosimetric evaluation of Gafchromic EBT2 film for breast intraoperative electron radiotherapy verification.
Phys Mes. 31:37-42.
Dubois J. B., Bussieres E., Richaud P. et al., 2011. Intra-operative radiotherapy of rectal cancer: results of the French multi-institutional randomized study. Radiation
Oncl. 98:298–303.
Eaton D. J., 2012. Quality assurance and independent dosimetry for an intraoperative x-ray device. Med Phys. 39:6908-6920.
Eaton D. J., Best B., Duck S. et al., 2012. In vivo dosimetry for single-fraction targeted intraoperative radiotherapy (TARGIT) for breast cancer. Int J Radiat Oncol Biol Phys. 82:819-824.
Eaton D. J., Gonzalez R., Duck S.,Keshtgar M., 2011. Radiation protection for an intra-operative X-ray device. Br J Radio. 84:1034-1039.
Ebert M. A., Carruthers B., 2003. Dosimetric characteristics of a low-kV intra-operative x-ray source: implications for use in a clinical trial for treatment of
low-risk breast cancer. Med Phys. 30:2424-2431.
Fogg P., Das K. R., Kron T. et al., 2010. Thermoluminescence dosimetry for skin dose
assessment during intraoperative radiotherapy for early breast cancer. Australas Phys Eng Sci Med. 33:211-4.
Goubert M., Parent L. 2015. Dosimetric characterization of INTRABEAM® miniature accelerator flat and surface applicators for dermatologic applications. Phys Med. 31:224-232.
Grobmyer S. R., Lightsey J. L., Bryant C. M., et al., 2013. Low-Kilovoltage, Single-Dose Intraoperative Radiation Therapy for Breast Cancer: Results and
Impact on a Multidisciplinary Breast Cancer Program. J Am Coll Sur. 216:617-723.
Huang H. N., Yang P. S., Dai H. C., Chen Y. J.,2015. Intraoperative radiotherapy of extrahepatic cholangiocarinoma – a case report. Therapeut Radiol Oncol.
22:315-321.
International Comissionon Radiological Protection, 2007. Recommendations of the International Comission on Radiological Protectio. Technical report 103.
Jung I. H., Kim J. W., Park K. W. et al., 2015. Evaluation of safety by skin dosimetry in Intraoperative Radiotherapy for breast cancer patients. Journal of the Korean
Society for Radiotherapeutic Technology. 27:13-22.
Price C., Pederson A., Duttenhaver J., 2013. In vivo dosimetry with optically stimulated dosimeters and RTQA2 radiochromic film for intraoperative radiotherapy of the breast. Med. Phys. 40:091716.
Rivera T.,2012. Thermoluminescence in medical dosimetry. Appl Radiat Isot. 71:30-4.
Xiao Z. H., Bin O., Wang Z.,Huang B., Wen B., 2015. The Dosimetric Characteristics and Potential Limitation in Clinical Application of a Low Energy Photon
Intra-Operative Radiotherapy System. International Joural of Medical Physics, Clinical Enginering and Radiation Oncology. 4:184-195.
Schneider F., Clausen S., Thölking J., Wenz F., Abo-Madyan., 2014. A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. J Appl Clin Phys. 15:4502.
Turner J. E., 2007. Atoms, Radiation, and Radiation Protection.Third, Completely Revised and Enlarged Edition. Wiley-VCH Verlag GmbH&Co. KgaA. USA.
Williams N. R., Pigott K. H., Brew-Graves C., Keshtgar M. R. S., 2014. Intraoperative radiotherapy for breast cancer. Gland Surgery. 3:109-199.
Vaidya J. S., Tobias J. S., Baum M. et al., 2004. Intraoperative radiotherapy for breast cancer. Lancet Oncol. 5:165-173.
Vaidya J. S.,Baum M., Tobias J. S. et al., 2002. The novel technique of delivering targeted intraoperative radiotherapy (Targit) for early breast cancer. Eur J Surg Oncl. 28;447-454.
Vaidya J. S., Baum M., Tobias J. S. et al., 2001. Targeted intraoperative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann. Oncl.
12;1075-1080.
Xoft company, Electronic Brachytherapy System , 2018。website：http://www. xoftinc.com/axxent-mpx.html
陳昌震，2009，LiF:Mg,Cu,P 熱發光劑量計能量依持性與角度依持性研究，台灣
應用輻射與同位素雜誌 Taiwanese Journal of Applied Radiation and Isotopes.，5（2）637-644。
蔡宜芳，2017，術中放射治療於早期乳癌病患的應用與現況，臨床醫學,79.4.038。
廖鴻霖，2017，評估以 TomoEDGE 進行鼻咽癌治療計劃之劑量分佈，碩士論文，中山醫學大學生物醫學科學學系研究所。
蔡玉真，2016，術中放射治療不是乳癌治療選項，和信醫院雙週刊 309。
彭鈺婷，2016，術中放射治療儀使用低能量光子搭配球型裝療器之治療前品保與劑量評估，碩士論文，元培醫事科技大學醫學影像暨放射科學系碩士在職專班。
賴威豪，2015，以侖道假體與自研數學假體評估鼻咽癌病人在動態弧形調控放射治療下的輻射劑量分布與 TLD-100H 之最小可測之輻射劑量，碩士論文，中山醫學大學醫學學系研究所。
黃瀚生，2015，評估侖道假體在亞瑟刀直線加速器照射鼻咽癌下的治療是環境劑量，碩士論文，中山醫學大學生物醫學科學系研究所。
王崇義，2013，早期乳癌乳房保留手術治療之新利器 – 部份乳房近接治療，台灣醫學，56.2。
翁寶山，1999，保健物理學，國興出版社。
行政院衛生福利部，105 年國人死因統計結果，2017。網址 :https://
www.mohw.gov.tw/cp-16-33598-1.html
癌症基金會，2015。網址：http://www.cancerfund.org/tc/breast-cancer.html