Open this publication in new window or tab >>2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]
Carcinoma of the cervix is a global problem, and brachytherapy is one of the main radiation therapy components used in the treatment of patients with this type of cancer. With the advent of scientific and technological developments in treatment planning, inverse optimization in brachytherapy and its thorough comparison with traditional manual optimization methods is warranted. In this work, the physical parameters; minimum dose received by 98% and 90% of the target volume represented by D98 and D90, respectively, were used to evaluate the treatment plans with respect to the target while the minimum dose received by 2cm3 volume, D2cm3, was used to investigate complications in organs at risk. The conformity index, COIN, was used to describe the coverage of the target by the prescribed dose and the fraction of each organ at risk volume that receives the critical dose, which may cause complications. The treatment plan evaluation was also performed in terms of the radiobiological parameter complication-free tumor control probability, P+. The physical and radiobiological evaluation corresponding to two brachytherapy inverse planning algorithms have been compared with homologous manual graphical optimization plans. The main observations from this study are that well tuned class solutions of inverse optimization methods may produce similar dose volume histograms to those produced with manual graphical optimization plans, and inverse methods have the potential to spare organs at risk while delivering an acceptable dose to the target. In addition, radiobiological indexes such as the P+ can be useful complements to the physical parameters in treatment plan evaluation. The Elekta Leksell Gamma Knife® unit has been successfully utilized in the management of intracranial malignancies for more than half a century. As required by national and international regulation, adequate knowledge of risks posed by ionizing radiation instrumentation is necessary in order to protect the patient, workers, public, and the environment. In that perspective, the Nuclear Physics research group at the Department of Physics of Stockholm University (Stockholm, Sweden) in collaboration with Elekta Instrument AB (Stockholm, Sweden) have conducted investigation on the radiation field in the vicinity of the Gamma Knife utilizing the High Purity Germanium (HPGe) detector. As part of the ongoing research, the principal objective of the present work was to improve the modeling and characterization of the radiation field around the Gamma Knife to interrogate the efficacy of the National Council on Radiation Protection and Measurements (NCRP) methodology for structural shielding design and evaluation for the Leksell Gamma Knife treatment room. Acquisition of high-resolution γ-ray spectra and ambient dose equivalent H*(10) in the field of the Gamma Knife-PerfexionTM took place at the Division of Neurosurgery, Radiumhemmet (Department of Oncology), Karolinska University Hospital (Stockholm, Sweden). A p-type coaxial HPGe detector and a satellite survey meter were utilized to acquire the γ-ray spectra and H*(10), respectively. The measured configurations were simulated on Pegasos Monte Carlo system. A phase space on a cylindrical surface enclosing the Gamma Knife with open doors and the phantom assembled was used as the source of radiation. About 4·107 γ photons were collected on the phase space corresponding to 2·1012 decays. With the Gamma Knife doors open, most of the radiation was measured in the forward direction up to θ = 45o in relation to the z axis. The Monte Carlo simulations reproduced the measured results and; therefore, good agreement was achieved between response measurements and simulated spectra. The recent Gamma Knife models PerfexionTM, IconTM, and EspritTM are dosimetricaly equivalent and represent more than half the total number of Gamma Knife systems installed around the globe. Given the increasing importance of these machines in the treatment of patients with intracranial malignancies, research and development of tools for radiological protection around the Gamma Knife unit is topical and will continue to evolve, especially with the advent of new models or versions of Gamma Knife units integrating novel technology such as the satellite cone-beam computed tomography (CBCT) imaging system. The Monte Carlo method is a powerful tool for simulation of radiation transport in matter. It reproduced the measured results and may be used in structural shielding design calculations for γ-photons from the Gamma Knife.
Place, publisher, year, edition, pages
Stockholm: Department of Physics, Stockholms universitet, 2024. p. 108
Keywords
Brachytherapy, treatment planning optimization, radiobiology, complication-free tumor control probability, Leksell Gamma Knife, stereotactic radiation surgery, HPGe detector, detector response, Monte Carlo simulation, dosimetry, radiological protection
National Category
Physical Sciences
Research subject
Medical Radiation Physics
Identifiers
urn:nbn:se:su:diva-233393 (URN)978-91-8014-933-4 (ISBN)978-91-8014-934-1 (ISBN)
Public defence
2024-10-25, Room FB42, AlbaNova Campus, Roslagstullsbacken 21, Stockholm, 10:00 (English)
Opponent
Supervisors
2024-10-022024-09-112024-10-08