第八章近距离治疗剂量学课件.ppt

Carcinoma treatment with brachyterapy 远距离照射与近距离照射的基本区别 远距离照射，其放射线的能量大部分被准直器、限束器等屏蔽，只有少部分能达到组织，近距离照射则相反，大部分能量被组织吸收 近距离照射，其放射源活度较小，治疗距离较短，约在5mm~5cm之间 远距离照射与近距离照射的基本区别 远距离照射，其放射线必须经过皮肤和正常组织才能到达肿瘤，肿瘤剂量受到皮肤和正常组织耐受量的限制，为得到高的均匀的肿瘤剂量，需要选择不同能量的射线和采用多视野照射技术 由于距离平方反比定律的影响，在腔内组织间近距离照射中，离放射源近的组织剂量相当高，距放射源远的组织剂量较低，靶区剂量分布的均匀性远比远距离照射的差，应注意靶区部分组织剂量过高或部分组织剂量过低的情况发生 近距离治疗发展历史 Brachytherapy History ? Early 1900’s – radium molds for skin cancer ? Recently – Iridium 192 is used for removable prostheses in head and neck cancers ? Old method: – “hot” radium seeds placed by hand, personnel exposed ? Current method: – afterloading technique where tubes are placed in tumor and source loaded remotely 近距离治疗发展历史 Brachy: Greek word for “short” →Fast (targeted) radiation treatment →Catheter-driven insertion system →breast, head, neck, prostate, esophagus, etc. Typical sources Gamma beta emitters Small: few mm3 Geometry: cylindrical (Iridium-192, Palladium-103) 近距离治疗发展历史 The physical advantage improved localized delivery of dose to the target volume of interest. The disadvantage can only be used in cases where the tumour is well localized and is relatively small. In a typical radiotherapy department about 10 to 20% of all radiotherapy patients are treated with brachytherapy. Brachytherapy application Brachytherapy application Brachytherapy application Brachytherapy application Brachytherapy application Brachytherapy application 8.1 Radioactive Sources 8.1.1 Radioactive Sources Brachytherapy sources are usually encapsulated and the capsule serves multiple purposes: containing the radioactivity, providing source rigidity, and absorbing any α and, for photon-emitting sources, radiation produced through the source decay. 8.1.1 Radioactive Sources The useful radiation fluence from a brachytherapy source generally consists of: - Gamma rays form the most important component of the emitted radiation, - Characteristic x rays emitted incidentally through electron capture or internal conver