I H C QU C GIA THNH PH H CH MINH TR NG I H C KHOA H C T NHIN

NG TRNG KA MY

M PH NG THI T B X PH U LEKSELL GAMMA KNIFE B NG CHNG TRNH MCNP5

LU N VN TH C S V T L H T NHN

TP H CH MINH, 2009

 I H C QU C GIA THNH PH H CH MINH TR NG I H C KHOA H C T NHIN

NG TRNG KA MY

M PH NG THI T B X PH U LEKSELL GAMMA KNIFE B NG CHNG TRNH MCNP5

Chuyn ngnh: V T L H T NHN M s : 60 44 05

LU N VN TH C S V T L H T NHN

NG I H NG D N KHOA H C: PGS TS MAI VN NHN

TP H CH MINH, 2009

L I C M N
Trong qu trnh h c t p t i B mn V t l H t nhn, Tr ng i h c Khoa h c T nhin, ti c s gi ng d y t n tnh c a cc th y c. Chnh ni y cung c p cho ti ki n th c v gip ti tr ng thnh trong h c t p v nghin c u khoa h c. Cho ti g i l i bi t n v i t t c cc th y c gi ng d y ti trong su t th i gian h c t i tr ng. Cho ti g i l i bi t n su s c n th y Mai Vn Nhn v c Trng Th H ng Loan nh hnh cho ti l a ch n ti ny v t n tnh h ng d n ti trong su t th i gian th c hi n lu n vn. Ti cng g i l i c m n n em ng Nguyn Phng c nh ng ki n ng gp qu bu v nhi t tnh trong su t qu trnh th c hi n lu n vn. Ti cng chn thnh c m n t p th bc s v k s v t l t i n v Gamma Knife c a B nh vi n Ch R y cung c p cho ti nh ng ti li u quan tr ng gip ti c th hon thnh c lu n vn. Xin c php g i l i c m n n cc th y trong h i ng c, nh n xt v gip ti hon ch nh lu n vn. Cu i cng, ti xin chn thnh c m n gia nh, b n b lun ng h , ng vin gip ti trong su t kha h c.

M CL C
Danh m c cc k hi u v cc ch vi t t t ..................................................................1 Danh m c cc b ng .......................................................................................................3 Danh m c cc hnh v , th .......................................................................................4 M U ......................................................................................................................7 CHNG 1 T NG QUAN V THI T B LEKSELL GAMMA KNIFE...............11 1.1 Gi i thi u v Leksell Gamma Knife .......................................................................11 1.2 L ch s c a LGK ....................................................................................................11 1.3 Cc thnh ph n chnh trong thi t b LGK ..............................................................14 1.4 Nguyn t c c a LGK ..............................................................................................15 1.5 Ti n trnh i u tr b ng LGK .................................................................................17 1.6 Gi i thi u chng trnh Gamma Plan .....................................................................18 1.7 u i m c a LGK so v i cc thi t b x ph u khc ..............................................19 CHNG 2 T NG QUAN V K THU T X TR .............................................21 2.1 Gi i thi u chung .....................................................................................................21 2.2 Qu trnh v nguyn t c i u tr b ng tia x ...........................................................22 2.3 Cc phng php i u tr b ng tia x ....................................................................23 2.4 C s v cc khi ni m lin quan v li u trong x tr .............................................24 CHNG 3 M PH NG MCNP CHO NGU N N KNH TRONG THI T B X PH U LEKSELL GAMMA KNIFE ....................................................................32 3.1 Phng php Monte Carlo .....................................................................................32 3.2 Chng trnh MCNP ..............................................................................................34

3.3 M ph ng MCNP cho ngu n n knh trong thi t b x ph u LGK......................42 3.4 Cc k t qu tnh ton v i ngu n n knh..............................................................45 CHNG 4 M PH NG MCNP CHO 201 NGU N TRONG THI T B X PH U LEKSELL GAMMA KNIFE ...........................................................................49 4.1 M ph ng MCNP5 cho 201 ngu n trong LGK ......................................................49 4.2 M ph ng cch tnh li u i v i u Zubal ............................................................52 4.3 Cc k t qu tnh ton v i 201 ngu n ......................................................................53 K T LU N ..................................................................................................................67 H NG PHT TRI N ...............................................................................................68 TI LI U THAM KH O ............................................................................................69

DANH M C CC K HI U V CC CH
Cc k hi u : l thng l ng h t (1/cm2) TL: l chi u di ng i c a h t (cm) V : l th tch c a m t voxel (cm3) W : l tr ng s qung ng A: l di n tch c a m t voxel (cm2)
: l b r ng c a voxel (cm)

VI T T T

Cc ch vi t t t LGK: CT: MRI: Leksell Gamma Knife Computed Tomography Magnetic Resonance Imaging

SPECT: Single Photon Emission Computed Tomography PET: IGRT: Positron Emission Computed Tomography Image Guided Radiation Therapy

IMRT: Intensity Modulated Radiation Therapy SSD: SAD: Source to Surface Distance Source Axis Distance

GTV: Gross Tumor Volume CTV: Clinical Target Volume PTV: Planning Target Volume

MCNP: EGS:

Monte Carlo N Particle Electron Gamma Shower

PENELOPE: Penetration and Energy Loss of Positrons and Electrons FWHM: Full Width Half Maximum

DANH M C CC B NG
B ng 3.1 B ng 4.1 So snh th i gian ch y gi a tally F4 v tally FMESH ..............................44 So snh FWHM i v i tr c Ox gi a chng trnh Gamma Plan v k t qu tnh ton .....................................................................................................63 B ng 4.2 So snh FWHM i v i tr c Oz gi a chng trnh Gamma Plan v k t qu tnh ton .....................................................................................................64

DANH M C CC HNH V ,
Hnh 1.1 Hnh 1.2 Hnh 1.3 Hnh 1.4 Hnh 1.5 Hnh 1.6 Hnh 1.7 Hnh 1.8 Hnh 2.1 Hnh 2.2 Hnh 2.3

TH

Leksell Gamma Knife model C .................................................................16 Hnh c t ngang c a Leksell Gamma Knife model C .................................16 Kch c khc nhau c a m trong LGK ......................................................17 Nguyn t c h i t 201 chm tia trong LGK ..............................................19 So snh c ng c a m t chm tia gamma m kh i u h p th ...............19 t khung vo u b nh nhn ...................................................................20 Chng trnh tnh li u b ng Gamma Plan .................................................22 So snh kch th c v li u i u tr c a m t s phng php x tr ...........23 Bi u di n cch tnh li u ph n trm ............................................................28 S bi u di n cc th tch bia trong k thu t x tr ................................30 Bi u di n ng ng li u c a CTV, PTV, v GTV trong ung th tr c trng c ch p b i CT trong vi c l p k ho ch i u tr ..........................34

Hnh 3.1

So snh phng php Monte Carlo v i cc phng php gi i tch v th i gian tnh ton v ph c t p c a c u hnh ...............................................36

Hnh 3.2 Hnh 3.3

Bi u di n qu trnh v n chuy n c a cc h t qua m t voxel ......................42 So snh li u tng i tnh b ng tally F4 v tally FMESH d c theo tr c Ox i v i phantom n c ................................................................................43

Hnh 3.4

Giao di n c a chng trnh MCNP5 .........................................................45

Hnh 3.5 Hnh 3.6 Hnh 3.7 Hnh 3.8 Hnh 3.9

M hnh ngu n n knh dng trong m ph ng MCNP...........................46 M hnh m ph ng ngu n n knh v phantom trong LGK ...................47 Ph nng l ng photon pht ra c a ngu n Co60 ........................................47 Li u phn b d c theo tr c Ox ..................................................................48 Phn b li u tng i trn m t ph ng Oxy..............................................49

Hnh 3.10 Phn b li u tng i trn m t ph ng Oxz ..............................................50 Hnh 4.1a Bi u di n s s p x p c a cc vng collimator trong helmet c a LGK .....52 Hnh 4.1b Bi u di n gc phng v c a cc vng so v i m t ph ng xOy .................52 Hnh 4.2 Hnh 4.3 Bi u di n phn b gc c a 201 ngu n trong LGK so v i m t ph ng .......53 Bi u di n ngu n c d ng hnh m t v cch b tr phantom trong m ph ng 201 ngu n ..................................................................................................54 Hnh 4.4 Hnh 4.5 M hnh u Zubal.....................................................................................55 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 4mm ...................................................................................................................56 Hnh 4.6 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 8mm ...................................................................................................................56 Hnh 4.7 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 14mm .........................................................................................................57 Hnh 4.8 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 18mm .........................................................................................................57

Hnh 4.9

Li u phn b trn m t ph ng Oxy v i collimator ng knh 18mm.......58

Hnh 4.10 Li u phn b trn m t ph ng Oxz v i collimator ng knh 18mm .......59 Hnh 4.11 Bi u di n phn b li u tng i trong phantom u Zubal v trong

phantom n c i v i 201 ngu n ..............................................................60 Hnh 4.12 So snh li u theo tr c z v i collimator ng knh 4 mm ........................61 Hnh 4.13 So snh li u theo tr c x v i collimator ng knh 4 mm ........................61 Hnh 4.14 So snh li u theo tr c x v i collimator ng knh 18 mm ......................62 Hnh 4.15 So snh li u theo tr c z v i collimator ng knh 18 mm ......................62

10

Theo th ng k c a T ch c y t th gi i, t l t vong trn th gi i do b nh ung th r t cao. Hng nm c kho ng g n 10 tri u tr ng h p m c ung th v trn 8 tri u ng i ch t do b nh ny. Vi t Nam, m i nm c tnh c kho ng 150.000 ca ung th m i trong c trn 50.000 ca t vong [1]. Nh ng th p k g n y, v i s pht tri n m nh m c a cng ngh sinh h c cng nh cc thi t b ch n on v i u tr hi n i, vi c nghin c u v ch a tr ung th c nh ng ti n b v t b c. V th m tm ra c m t s h ng d phng ch n on chnh xc hn v i u tr c hi u qu hn. Nh ng cch i u tr b nh bao g m: i u tr b ng ph u thu t, i u tr b ng tia x v i u tr b ng ha ch t. i u tr b ng tia x l phng php dng chm tia i n t ho c photon c nng l ng thch h p thng qua c ch gy ion ha nh m gy ra nh ng tc ng v m t sinh h c c a chm tia tiu di t t bo ung th ho c h n ch s pht tri n c a n. y c xem l m t trong nh ng phng php i u tr b nh h u hi u nh t nhng phng php ny v n c m t s h n ch nh t nh l b nh nhn ph i ch p nh n m t r i ro do b c x ion ha i vo c th . i u ny r t quan tr ng v l nhi m v c a cc k s v t l v bc s lm sao cho cc nh h ng do ion ha c a cc b c x ln b nh nhn m t cch th p nh t m b o an ton cho ng i b nh Hi n nay Vi t Nam nh ng thi t b ch n on v i u tr b ng tia x c a cc b nh vi n nh thi t b ch n on b ng cc ng v

vo s d ng kh ph bi n

phng x nh PET, SPECT, CT, Gamma Camera v thi t b i u tr b ng b c x ion ha r t hi n i nh my gia t c tuy n tnh v c bi t g n y nh t nm 2006 B nh vi n Ch R y TP H Ch Minh a vo my x ph u Leksell Gamma Knife (LGK), y l thi t b tin ti n nh t hi n nay ch a tr u no. Thi t b ny s d ng ngu n chi u x a knh tiu di t kh i u. Thi t b x ph u Leksell Gamma Knife c gi i

11

thi u vo nm 1951 b i gio s Lar Leksell ng i Th y i n cho n nay c 17189 b nh nhn c i u tr b ng Gamma Knife trn ton th gi i. c cc b nh nhn sau khi i u tr u c k t qu t t. Hi n nay trn th gi i, nhi u nh khoa h c cng v n d ng nhi u phng php tnh li u khc nhau kh o st phn b li u chi u trong thi t b LGK v rt ra cc k t qu ph h p v i chng trnh tnh li u Gamma Plan. Cc chng trnh c s d ng l EGS4 dng cho vi c tnh ton li u phn b c a ngu n n knh (Joel Y.C Cheung -1998) [5], tc gi dng phantom hnh c u v i ch t li u l n c c ng knh 160mm kh o st phn b li u trn cc tr c t a x, y, z. ng th i tc gi cng dng code EGS4 tnh ton s khc nhau trong phn b li u i v i cc phantom c ch t li u plastic, nh a d o (Perspex), v n c [6]. Chng trnh PENELOPE dng kh o st phn b li u trong LGK v i phantom khng ng nh t b ng ch t li u n c bao quanh bn ngoi l l p v hnh c u, l p v ny c lm b ng v t ch t tng t v i xng s [3] (Al-Dweiri, 2005), tc gi rt ra k t qu khc nhau trong phn b li u c a vi c m ph ng phantom ng nh t v khng ng nh t. ng th i ng cng tnh xc su t c a gc pht ra t ngu n LGK, k t qu tnh ton cho th y ch nh ng tia gamma pht ra v i gc c c nh d i 30 m i ng gp ng k vo phn b li u trong phantom, trong cng trnh ny tc gi a ra m hnh ngu n n gi n p ng c li u chi u ph h p nhng gi m c th i gian tnh ton. Moskvin V [7] dng PENELOPE m ph ng thng l ng pht ra t ngu n c a LGK i qua cc collimator nh m xc nh phn b li u trong phantom c u polystyrene, k t qu ny c tnh ton v so snh v i k t qu c a cc tc gi khc m ph ng b ng code EGS4. Ngoi ra code MCNP4C cng c s d ng tnh ton li u tng i pht ra t 201 ngu n c a thi t b LGK (YiPeng Li, 2002) [11]. Vi t Nam t thng 11/2006 n thng 7/2007 B nh vi n Ch R y i u tr c cho 100 b nh nhn. T t

12

Lu n vn ny nh m m c ch tm hi u su hn v thi t b x ph u Leksell Gamma Knife l c u t o, nguyn t c ho t ng cng nh cc k thu t tnh li u cho x tr . Qua vi c tm hi u c u t o v cch s p x p phn b c a cc ngu n chi u trong thi t b x ph u, m t chng trnh m ph ng c xy d ng tnh ton phn b li u v k t qu ny c so snh v i cc chng trnh m ph ng c a cc tc gi khc nh m ki m nghi m tnh ng n c a qu trnh. Chng trnh chng ti dng m ph ng trong lu n vn ny l MCNP5, l m t trong nh ng chng trnh m ph ng s d ng phng php Monte Carlo, c xem l kh chnh xc v hi n i trong vi c tnh ton li u. ti M ph ng thi t b x ph u Leksell Gamma Knife b ng chng trnh MCNP5 m ra m t h ng nghin c u m i trong vi c ng d ng chng trnh MCNP5 trong k thu t tnh li u i v i thi t b x ph u Leksell Gamma Knife. Qu trnh nghin c u b t u t vi c tm hi u t ng quan c u t o v nguyn t c ho t ng c a thi t b x ph u Leksell Gamma Knife. Gi i thi u v cc ki n th c lin quan n k thu t x tr trong c chng trnh MCNP, tm hi u c i m, c s v t l c a cc code, c u trc thnh ph n c a m t file input trong chng trnh MCNP. Sau v n d ng phng php ny m ph ng qu trnh tnh li u cho thi t b x ph u Leksell Gamma Knife. V th i gian th c hi n ti c h n nn chng ti ch m ph ng qu trnh tnh li u v phn b li u theo su cho phantom b ng v t li u n c v plastic sau chng ti m ph ng i v i phantom u Zubal cho ngu n n knh v 201 ngu n trong thi t b Leksell Gamma Knife. T m c ch v n i dung cng vi c lu n vn c b c c nh sau: Chng 1: T ng quan v c u t o, nguyn t c ho t ng v quy trnh ch a tr c a thi t b x ph u Gamma Knife. Chng ny m t m t cch chi ti t v c u trc c a thi t b x ph u t vi c phn b gc c a 201 ngu n Cobalt 60 n cc ti n trnh i u tr .

13

Chng 2: Cc ki n th c lin quan n k thu t x tr . Gi i thi u cc k thu t tnh li u x tr ngoi. Cc ki n th c ny l n n t ng c s xy d ng cc qu trnh m ph ng tng tc c a b c x v i mi tr ng v t ch t, cc nh ngha v li u chi u, kch th c tr ng chi u, h ng chi u v li u h p th . Chng 3: Gi i thi u phng php Monte Carlo. M ph ng MCNP5 cho thi t b x ph u Leksell Gamma Knife i v i ngu n n knh. Trong chng ny, c u hnh ngu n n knh c m ph ng v xu t ra k t qu phn b li u, lm c s cho qu trnh m ph ng cho 201 ngu n. Chng 4: M ph ng MCNP5 cho thi t b x ph u Leksell Gamma Knife i v i 201 ngu n v cc k t qu tnh ton i v i m hnh u Zubal.

14

CHNG 1

T NG QUAN V THI T B LEKSELL GAMMA KNIFE

1.1. Gi i thi u v Leksell Gamma Knife Leksell Gamma Knife (LGK) l thi t b ph u thu t b ng b c x gamma t p trung, nh v ba chi u. N cho php xc nh chnh xc v i u tr cc kh i u n m su trong no ho c cc kh i d d ng ng tnh m ch c ng knh nh hn 5 cm. Trong i u tr b nh l no, khi t n thng n m su, n u m h nh thng th ng, ph u thu t vin c th lm t n thng vng no lnh, gy bi n ch ng cho b nh nhn sau nh r i lo n th n kinh, tm th n, li t n a ng i ho c li t cc vng th n kinh. Th m ch n u ng ch m n nh ng trung khu th n kinh quan tr ng, b nh nhn cn c th t vong ngay trn bn m . Trong khi , x ph u b ng h th ng LGK l m t phng php tin ti n, b ng cch h i t hn 200 ngu n b c x nh t o thnh m t nng l ng c c cao tiu h y d n d n cc sang thng trong no m khng c n ph u thu t. Kh i sang thng s b tiu h y d n v bi n m t theo th i gian. Do h i t t cc ngu n nng l ng d i d ng b c x c c m nh nn b nh nhn c m th y r t bnh th ng sau i u tr v c th tham gia cng vi c ngay ngy hm sau, trnh c tm l lo l ng qu m c do b nh t t v do cc p l c khi ph i ngh vi c v b nh v ph i s p x p th i gian tr b nh. Hi n nay, LGK l m t trong nh ng thi t b x tr c s d ng r ng ri nh t trn th gi i. 1.2. L ch s c a LGK [4] Thi t b ny c thi t k b i Lar Leksell, nh gi i ph u ng i Th y i n vo nm 1967 t i vi n Karolinska, Th y i n. Nm 1968 d a vo pht minh c a Gio s

15

Lars Leksell, Cng ty ELEKTA Th y i n s n xu t thnh cng Gamma Knife v a vo s d ng ch a tr cho b nh nhn u tin i n. B t u t nh ng nm 1970 k thu t x ph u c ch trn th gi i b i s pht tri n c a cc thi t b m i nh ch p nh CT (Computed Tomography). u nh ng nm 1980, Gamma Knife c l p t Argentina v Anh. Vo nm 1987 thi t b x ph u ny l n u tin c l p t t i B c M . Nm 1990, chng trnh tnh li u Gamma Plan c a vo s d ng ph c v cho m c ch l p k ho ch x tr . T i nm 1993, Gamma Knife cng c s d ng r ng ri t t c cc chu l c. Do tnh u i m v v t tr i c a Gamma Knife so v i cc ph u thu t kinh i n trong i u tr cc kh i u, cc d d ng m ch mu v cc b nh ch c nng c a no, nn Gamma Knife ngy cng c s d ng nhi u hn. Nm 1996, Chng trnh Gamma Plan c h p nh t v i chng trnh x l nh MRI v CT. Nm 2000, Gamma Knife model C c gi i thi u c b sung h th ng nh v APS. n nm 2001 trn th gi i c 147 Trung tm Gamma Knife v n nm 2004 s Trung tm Gamma Knife tng ln l 232 (bao g m: Trung Qu c 92, Nh t 36, cc n c chu cn l i 17, Chu u 29, B c M 65, Nam M 02 v Chu Phi 01). Cho n thng 3 nm 2008 th c 259 thi t b c tri n khai trn ton th gi i. T i Vi t Nam, thi t b x ph u Leksell Gamma Knife c a vo s d ng l n u tin t i b nh vi n Ch R y vo thng 11 nm 2006. nh my h t nhn Studsvik. Trong cng nm , Gamma Knife c tri n khai i u tr t i B nh vi n Karolinska, Th y

16

Hnh 1.1 bi u di n cc thnh ph n c a thi t b x ph u LGK nhn t ngoi vo. Hnh 1.2 l m hnh c t ngang c a thi t b , qua ta c th th y m t cch chi ti t cc thnh ph n cng nh c u t o bn trong c a thi t b .

Hnh 1.1 Leksell Gamma Knife model C

Hnh 1.2 Hnh c t ngang c a Leksell Gamma Knife model C

17

1.3 Cc thnh ph n chnh trong thi t b LGK Thi t b x ph u LGK g m c 3 ph n chnh: 1. Ngu n trong thi t b x ph u LGK (Radiation Unit) g m 201 ngu n Co60, m i ngu n c ho t g n 30 Ci. Cc ngu n ny c s p x p thnh dy hnh trn n m trong b ph n che ch n lm b ng v t li u c s kh i l n (th ng l ch). Cc ngu n ny nh m phng nh ng tia phng x gamma n nh ng i m bia trong b no b nh nhn. 2. M (Collimator Helmet): Gamma Knife c cung c p b n lo i m v i cc kch c cc collimator l 4mm, 8mm, 14mm, 18mm. Cc m ny c g n c nh v i gi ng b nh nhn b ng cc inh vt. Cc m ny l cc colimator cho cc tia phng x t ngu n pht ra chi u vo kh i u m t cch chnh xc. V nh c lo i m ny m li u chi u t p trung m t cch chnh xc t i cc kh i u nn m c nh h ng c a cc tia phng x t i cc vng xung quanh l khng ng k . Ty theo th tch c a kh i u m cc k s v t l c th dng cc collimator c ng knh khc nhau.

Helmet v i cc kch c khc nhau

Collimators 4mm, 8mm, 14mm, 18mm

M t trong h th ng gamma knife

Hnh 1.3 Kch c khc nhau c a m trong LGK

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3. Gi ng ch a tr b nh nhn (Patient Treatmen Couch): L thi t b c th mang b nh nhn d ch chuy n vo v ra trong su t qu trnh chi u x , c th t i u ch nh v tr kh p m v i cc knh chi u v cc v tr chi u. 1.4 Nguyn t c c a LGK 1.4.1. V t l v nguyn l c b n c a LGK Nguyn t c v t l c b n c a LGK l d a trn s phn r pht ra tia gamma c a ngu n phng x Co60. Ngu n Co60 ny s phn r beta v t o thnh ng v Ni60 v i chu k bn r l 5.26 nm.
27

Co 60 28 Ni 60 + e +

M t ph n c a ti n trnh phn r l t o ra electron c nng l ng 315 keV v hai tia gamma c nng l ng 1.17 MeV v 1.33 MeV c pht ra. Electron b h p th tr l i b i ngu n Co60 ho c v ch a ngu n v v nng l ng th p nn c th b qua hi n t ng bremstrahlung. 1.4.2. Nguyn t c ho t ng c a LGK Nguyn t c ho t ng c b n c a LGK l d a trn vi c h i t cc chm tia gamma nng l ng cao pht ra t 201 ngu n Co60 t p trung ln m t th tch i u tr c li u phng x r t cao. Hnh 1.4 bi u di n s h i t nng l ng t 201 ngu n. Vi c chi u phn b 201 ngu n x nh m lm cho phn b li u xung quanh th tch vng i u tr khng l n gy ra nh ng tc ng ng k no v m t sinh h c, t i thi u ha vi c tiu di t cc t bo lnh ln c n. Vi c tnh ton m t cch r rng c bi u th trong Hnh 1.5 cho th y phn b li u x i v i 6 chm tia so v i 201 chm tia. D a trn Hnh 1.5 ta th y n u chi u vo th tch kh i u b ng 6 chm tia th c ng c a m t chm l 17%, nhng n u chi u b ng 201 chm tia th c ng c a m t chm

19

gi m ch cn 0.5%. i u ny cho th y s gi m ng k xung quanh n u tng s l ng chm tia.

nh h ng ln cc m lnh

Hnh 1.4 Nguyn t c h i t 201 chm tia trong LGK

Hnh 1.5 So snh c ng c a m t chm tia gamma m kh i u h p th Ngoi ra LGK cho php ng i s d ng c th i u khi n s ngu n chi u sao cho ph h p v i th tch c n chi u b ng cch dng cc nt b ng tungsten b t kn nh ng

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l (collimator) khng c n thi t. Trong m t s tr ng h p ng i ta ch c n chi u v i kho ng 150 ho c 102 ngu n. 1.5 Ti n trnh i u tr b ng Leksell Gamma Knife 1. t khung: Dng m t khung c nh u b nh nhn v nh v vng ch a tr . Quy trnh t khung ny do cc bc s ph i h p v i cc k s v t l th c hi n.

Hnh 1.6 t khung vo u b nh nhn 2. Ch n on hnh nh: Dng phng php ch p nh MRI ch p v tr v hnh d ng c a kh i u. Cc nh ny c ch p nhi u l n theo cc h ng khc nhau v l n l t thay i cc v tr ch p theo su xc nh chnh xc v tr kh i u. 3. L p k ho ch i u tr : ph n m m Gamma Plan c s d ng khi ph c l i hnh d ng c a u b nh nhn cng nh th tch c a kh i u t nh ch p. D a trn cc k t qu phn tch c cc k s v t l v bc s i u tr s quy t nh c p li u v cc h ng chi u nh m t i u ha hi u qu c a vi c i u tr . Chng trnh ny bao g m vi c tnh ton li u chi u, v tr chi u, cc kch c collimator khc nhau cho m i l n chi u v th i gian chi u cho m t kh i u c th . 4. Ch a tr : Sau khi l p k ho ch ch a tr xong v c ki m tra m b o tnh an ton v chnh xc. B nh nhn c a vo phng ch a tr , c t trn

21

m t chi c gi ng c i u khi n t ng, u b nh nhn c c nh t i tm c a helmet. Sau khi cc bc s r i kh i phng m t chng trnh bn ngoi c l p trnh s n s i u khi n cho c a t ng c a thi t b m ra v b nh nhn c a t ng vo trong ngu n x . Chuy n ng c a chi c gi ng c l p trnh s n b ng Gamma Plan v th i gian cho m i l n chi u v nh v tr c a gi ng cho m i l n chi u b ng h th ng t ng a vo v a ra. 1.6 Gi i thi u chng trnh Gamma Plan Gamma Plan l chng trnh l p k ho ch ch a tr ch dng ring cho thi t b LGK. Chng trnh ny c dng tnh li u h p th phn b b i 201 ngu n pht ra nh ng chm photon t p trung vo m i vng th tch c n i u tr . Li u c tnh ton cho m i kch c c a collimator c th . Trong chng trnh Gamma Plan th ty theo th tch v hnh d ng kh i u khc nhau m cc k s v t l s quy t nh dng bao nhiu shot chi u khc nhau, c m i shot chi u l m t vng (khoanh trn) c nh v tr c. Chi u sao cho t t c cc shot s bao trm c h t ton b kh i u v gi m thi u t i a nh h ng t i cc vng xung quanh. Chng trnh Gamma Plan cng cho ta bi t c cc ng ng li u quanh kh i u. Hnh 1.7 minh h a chng trnh tnh li u b ng Gamma Plan. Pha bn tri c a hnh l nh ng lt c t bi u di n v tr c a kh i u, cc ng ng li u bao quanh gip cho cc k s v t l xc nh chnh xc li u c n cung c p. Pha d i bn ph i l m hnh trong khng gian bi u di n chnh xc v tr c a kh i u trong no.

22

Hnh 1.7 Chng trnh tnh li u b ng Gamma Plan

1.7 u i m c a LGK so v i cc thi t b x ph u khc V i 201 ngu n Co60 t c nh v u b nh nhn c nh v b ng khung Stereotactic, LGK c coi l thi t b c chnh xc cao nh t hi n nay trong x tr li u cao. LGK c chnh xc cao v c kh, sai s c a ton b h th ng lun nh hn 0.5 mm, cho php s d ng li u b c x cao i u tr cc t n thng nh y c m nh thn no, giao thoa th nh ng vng

23

So v i cc phng php khc, ph u thu t cc kh i u b ng LGK an ton, hi u qu hn, r t t bi n ch ng v khng c t vong. Ch nh i u tr r ng ri, ngay c cc b nh nhn c kh i u v tr ph c t p.

Ph u thu t b ng Gamma Knife khng c n ph i gy m, b nh nhn v n t nh to hon ton trong qu trnh ph u thu t. Khng c nguy c nhi m trng, khng ch y mu, khng au n Hnh 1.8 m t u i m c a Gamma Knife so v i cc k thu t x tr khc, l c th t p trung m t li u r t cao vo trong m t vng th tch r t nh do hi u qu tiu di t t bo ung th l t t hn so v i cc k thu t x tr cn l i.

Hnh 1.8: So snh kch th c v li u i u tr c a m t s phng php x tr

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CHNG 2

T NG QUAN V K THU T X TR
Chng ny nh m m c ch cung c p cc ki n th c lin quan n k thu t x tr m b t c m t k s v t l no cng c n ph i n m r. l nh ng ki n th c n n t ng v tng tc c a b c x v i v t ch t, v li u h p th c a m khi m t b c x truy n qua lm c s xy d ng cc qu trnh m ph ng. 2.1 Gi i thi u chung i u tr b ng tia x l qu trnh i u tr c s d ng b c x ion ha ho c phng x cho nhi u b nh khc nhau. M c ch l nh m a m t li u phng x r t chnh xc t i m t th tch bia xc nh v i m t m c t n thng nh nh t cho cc m lnh bao quanh, k t qu l s lo i tr b nh t t, ko di s s ng hay c i thi n ch t l ng cu c s ng. Do , k thu t x tr c xy d ng ch a b nh ho c lm nh b t b nh t t m t cch hi u qu . Khi s d ng phng php i u tr b ng tia x c n ph i xc nh m c ch c a vi c i u tr
i u tr t n g c: l lo i tr t t c cc t bo ung th t i u nguyn pht, t i cc t

ch c xung quanh m kh i u lan t i v nh ng h ch t i vng c th b xm l n. i u tr t n g c th ng l li u x cao, c th gy ra m t s bi n ch ng ph , th i gian ko di v i s ch p nh n c a b nh nhn.

i u tr t m th i: nng cao ch t l ng i s ng nh ch ng au, ch ng t c do

chn p, ch ng ch y mu. i u tr t m th i th ng l li u th p v th i gian chi u x ng n.

25

Ty theo m c ch i u tr khc nhau m bc s v cc k s v t l quy t nh li u chi u cng nh cc k thu t chi u x thch h p. 2.2 Qu trnh v nguyn t c i u tr b ng tia x 2.2.1. Qu trnh i u tr b ng tia x M t qu trnh i u tr b ng tia x r t ph c t p. u tin bc s ph i ch n on v nh gi lm sng xc nh m m b nh c a kh i u (c tnh hay lnh tnh) sau s quy t nh phng th c i u tr thch h p nh m lm gi m nh b nh hay i u tr t n g c. M t quy trnh t o nh v l p pht i u tr c th c hi n b ng cc k thu t ch p nh c t l p (CT), ch p c ng h ng t (MRI), X-quang hay ch p nh b ng pht x photon (SPECT), positron (PET). D a vo cc nh ny ta c th xc nh c th tch bia c n chi u x , khoanh vng th tch vo t o d ng tr ng chi u. Sau s xy d ng chng trnh m ph ng th c t i u tr , tnh ton s phn b li u v t i u ha li u c n chi u. 2.2.2. Nguyn t c i u tr b ng tia x [1] Quy trnh i u tr b ng tia x ph i d a trn nh ng nguyn t c sau: nh gi s lan r ng c a kh i u b ng cc bi n php CT scanner, X-quang, MRI bi t th tch c n chi u. Bi t r nh ng c i m b nh l c a kh i u. Ch n l a nh ng phng php thch h p: ch dng x tr hay ph i h p ph u thu t, ha ch t hay ch n ph i h p c hai phng php, ch n lo i tia thch h p, chi u t ngoi vo hay t t i kh i u. Quy nh li u t i u v th tch chi u d a trn v tr gi i ph u, c tnh v c u trc lnh trong vng chi u.

26

nh gi t ng giai o n v th l c b nh nhn, s p ng c a kh i u v th tr ng c a t ch c lnh trong khu v c i u tr . Bc s i u tr ph i cng lm vi c ch t ch v i i ng v t l, k ho ch i u tr

v b ph n o l ng, khng th nh m l n c nh ng nh gi lm sng hay khng hon h o trong vi c l p pht i u tr . 2.3 Cc phng php i u tr b ng tia x [2] 2.3.1. Phng php x tr b ng chm tia ngoi X tr b ng chm tia ngoi l m t phng php ph bi n nh t trong k thu t x tr . Ng i ta th ng ti n hnh v i chm photon, thng th ng l cc tia X mang nng l ng cao c t o ra b i my gia t c tuy n tnh, nhng ng i ta cng th ng dng chm tia gamma t o ra t my Cobalt-60 v cc tia X mang nng l ng trong kho ng 50-300kV. Thm vo , chm electron nng l ng megavolt cng c s d ng i u tr cc kh i u tng i nng s c i thi n c chnh xc hnh h c hn cc photon, do n cng c s d ng r ng ri ngy nay. X tr ngoi v i cc b c x h t khc cng c a ra, trong tr ng h p h t neutron, v ki m tra r ng ri. M t s pht tri n m i y trong k thu t x tr ngoi tng ln do vi c s d ng my tnh tng. Chng khng ch c kh nng l p k ho ch tnh ton trong khng gian ba chi u m cn c kh nng i u khi n thi t b i u tr sao cho vng li u cao c th bi n i cho ph h p v i th tch bia trong khng gian ba chi u. S pht tri n ny song song v i cc k thu t t o nh nh ch p c t l p hay t o nh c ng h ng t (MRI), n s ng m t vai tr quan tr ng trong vi c phc h a th tch kh i u. Cc my mc c s d ng cho x tr t xa bao g m cc my pht tia X, my pht chm tia gamma, my gia t c i n t v my pht neutron. T t c nh ng thi t b x tr t xa i h i u ph i c b o v b c x khc nhau v c n ph i x l theo cc

27

nguyn t c ring c a n. X tr t xa l phng php s d ng r ng ri nh t i u tr nh ng kh i u, h ch n m su trong c th . 2.3.2. X tr b ng ngu n phng x kn L k thu t i u tr s d ng cc ngu n ng v phng x t trong th tch kh i u a ra m t li u r t c c b nh m t i thi u ha li u x t i cc m lnh bao quanh. Tuy nhin k thu t ny h n ch khi th tch kh i u nh . S pht tri n trong lnh v c ny bao g m vi c s d ng cc ngu n phng x c su t li u cao, cc ngu n ny c a qua cc ng thng t vo cc v tr kh i u. 2.4 C s v cc khi ni m lin quan v li u trong x tr cho vi c i u tr b ng tia x t hi u qu t i u th vi c n m v ng cc khi ni m v li u l ng, s phn b li u t i cc th tch bia, tm hi u c s v t l cng nh cc k thu t tnh ton li u chi u l th t s c n thi t. 2.4.1. Li u l ng h c lm sng
Li u l ng (dose)

n v tnh l Roentgen (R), tnh cho b c x tia X ho c tia gamma. M t Roentgen l nng l ng b c x (R0) i qua m t cm3 khng kh, i u ki n tiu chu n (00C, 760mmHg) t o ra m t n v tnh i n, cng d u dng ho c d u m.
Su t li u (dose rate)

L li u l ng trong m t n v th i gian. n v c a su t li u l n v c a li u chia cho th i gian (R/h ho c R/min).

Li u l ng h p th

c xc nh nh nng l ng h p th b i m t n v kh i l ng c a ch t b chi u x (hay chnh l nng l ng ion ha c a b c x b h p th b i n v kh i l ng

28

v t ch t. Gi tr li u h p th b c x ph thu c vo tnh ch t c a b c x v mi tr ng h p th . S h p th nng l ng i v i tia b c x l do tng tc c a b c x v i electron c a nguyn t v t ch t. n v l J/kg J/kg l li u l ng h p th b c x c o b i nng l ng m t Jun c a b c x ion ha b t k h p th b i kh i l ng m t kilogram c a ch t b chi u x .
Li u su ph n trm (percentage deep dose)

L t s c a li u h p th (Dd) t i i m kh o st

m t su x no so v i
0

li u h p th c c i t i i m kh o st trn tr c chm tia ( Dd ).

Hnh 2.1 Bi u di n cch tnh li u ph n trm Li u su ph n trm: D (%) =

Dd 100 Dd0

T s m khng kh (target air ratio)

L t s li u h p th t i i m cho tr c trong m so v i li u l ng c o ngoi khng kh trong m t th tch cho tr c l n t o ra li u c c i t i i m .

29

H ng s SSD (source to surface distance) L kho ng cch t ngu n pht tia t i b m t da b nh nhn.

H ng s SAD (source axis distance)

L kho ng cch t ngu n pht t i tm c a kh i u, c t tr c chm tia. Trong i u tr b ng tia x th ngoi vi c n m v ng cc l thuy t v li u l ng ta ph i tnh ton cc y u t nh h ng n li u chi u, l nng l ng b c x , kho ng m t cch t ngu n n da v kch th c tr ng chi u. Li u l ng trong m t kh i u

su no so v i li u trn b m t da c ngha r t quan tr ng. Li u su tnh b ng ph n trm cng l n th hi u qu i u tr cng cao. Li u su ph thu c nhi u nh t vo nng l ng b c x . Khi tng nng l ng ln th tng c su v do tng c hi u qu i u tr . Ngoi ra, li u su tng theo kch th c tr ng chi u. 2.4.2. M t s nh ngha lin quan n th tch bia v s phn ph i li u Li u l ng v phn b li u l ng l m t trong nh ng y u t quan tr ng ng gp vo s thnh cng c a i u tr b ng tia x . Phn b li u l ng h p l c th hi n b ng s t p trung li u cao t i th tch kh i u (cn c g i l bia) v li u th p t i vng bin (l cc t ch c lnh bao quanh kh i u). Trong qu trnh l p k ho ch x tr cho m t b nh nhn ung th, m t s lo i th tch c n c cc bc s lm sng xc nh. Ng i lm cng tc tnh ton li u chi u cng c n ph i hi u c m t s lo i th tch a ra c phc i u tr t i u. V v y hi u c cc lo i th tch cng l m t i u quan tr ng. i u tr cho m t b nh nhn ung th ph i qua qu trnh xc nh cc th tch. Hai lo i th tch c n c xc nh tr c khi l p k ho ch i u tr l:
Th tch kh i u (gross tumor volume GTV) Th tch bia lm sng (clinical taget volume CTV)

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Trong qu trnh l p k ho ch i u tr m t s lo i th tch sau c n ph i c xc nh:

Th tch bia l p k ho ch Cc t ch c nguy c p Th tch i u tr Th tch chi u x

A B C D

A. Th tch kh i u B. Th tch bia lm sng C. Th tch bia l p k ho ch D. Th tch i u tr

Hnh 2.2 S bi u di n cc th tch bia trong k thu t x tr . Trong th tch i u tr l tr ng chi u x trong th c t v bao g m c th tch kh i u (GTV), th tch bia lm sng (CTV), v c th tch bia l p k ho ch (PTV). 2.4.2.1. Th tch kh i u (gross tumor volume GTV) L th tch c th s , n n hay nhn th y c, bi u hi n s lan r ng hay khu tr c a cc pht tri n c tnh. Th tch kh i u bao g m c kh i u nguyn ch t, cc h ch di cn hay cc di cn khc. Th tch kh i u th ng ng v i cc ph n c a s pht tri n c tnh m m t t bo u l l n nh t.

Hnh d ng kch th c v s khu tr c a th tch kh i u c th c xc nh b ng nhi u cch khc nhau: ki m tra lm sng (khm, s , n n, n i soi ...), ho c b ng

31

cc k thu t hnh nh khc nhau (ch p X-quang, ch p c t l p CT, c ng h ng t MRI v phng php ch p ng v phng x ). 2.4.2.2. Th tch bia lm sng (clinical target volume CTV) L m t th tch t bo v m bao g m c th tch kh i u (GTV) v cc t ch c r t nh c n lm sng ph i xt n khi i u tr c th m t cch tri t . Kinh nghi m lm sng cho th y r ng quanh th tch kh i u th ng c lin quan n c n lm sng, ngha l n g m b n thn cc t bo c tnh, cc m t bo nh hay nh ng lan r ng r t nh , r t kh pht hi n. Th tch bao quanh m t kh i u l n th ng c m t t bo u l n, g n k v i mp c a th tch kh i u, v m t gi m i v pha ngo i vi c a th tch ny. Th tch kh i u cng v i th tch bao quanh ny c a cc t ch c lin quan t i ch c g i l th tch bia lm sng (CTV) v th ng c bi u di n nh m t th tch bia lm sng b c 1 (CTV-1). Nh ng th tch ph khc c xem nh l s lan t a c n lm sng cng c n ph i c i u tr . Chng cng c nh ngha l cc th tch c n lm sng v g i l cc th tch bia lm sng b c 1, b c 2. V v y, trong th c t , thng th ng khng ch c m t th tch c n lm sng m cn c th c nhi u hn th n a. Trong m t s tr ng h p, ta c th i u tr m t trong hai th tch bia lm sng v i cc li u l ng khc nhau. Tr ng h p th ng g p l i u tr tng c ng, ngha l m t th tch li u cao n m bn trong m t th tch li u th p. Cc nh ngha v th tch kh i u v th tch bia lm sng ny v nguyn t c c d a trn cc nguyn t c chung v ung th h c v khng ch gi i h n cho vi c p d ng i u tr b ng chm tia ngoi. V vy, v m t ph u thu t, m t ng bin an ton quanh th tch kh i u c tnh m t cch ph h p v i cc qui t c lm sng v i u ny c hi u ng nh cc khi ni m th tch bia lm sng khi i u tr b ng chm tia

32

ngoi. Cc th tch ny l c s c a vi c ch nh i u tr v ph i c xc nh tr c khi ch nh li u l ng. 2.4.2.3. Th tch bia l p k ho ch (planning target volume PTV) Th tch bia l p k ho ch l m t khi ni m hnh h c, c xc nh l a ch n kch th c c a chm tia v phn b chm tia m t cch thch h p, c tnh n hi u qu cao nh t c a t t c cc thay i hnh h c c th c, sao cho m b o li u l ng ch nh c h p th th c bn trong th tch bia lm sng. m b o r ng t t c cc m bn trong th tch bia lm sng nh n c m t li u l ng ch nh, v nguyn t c chi u x ng i ta ph i l p k ho ch chi u x m t th tch hnh h c l n hn th tch bia lm sng. M t cch l t ng th v tr, kch th c, hnh d ng c a th tch bia lm sng v cc chm tia c quan h n m t h t a c nh chung trong m t phng c nh v c th sao chp l i c. Tuy nhin trong th c t i u ny khng th th c hi n c. C th th y s khc nhau trong v gi a cc t phn chia li u l ng, th i gian t nh ng y u t sau:
S chuy n ng c a cc t ch c ch a th tch bia (ch ng h n s ht th , c ng

c a b nh nhn).
Nh ng s khc nhau v kch th c, hnh d ng c a cc t ch c ch a bia lm

sng (ch ng h n nh s ch a y c a bng quang).

S khc nhau v tnh ch t hnh h c c a chm tia (ch ng h n nh kch th c

chm tia, cc h ng c a chm tia). Ty theo hon c nh lm sng (nh i u ki n c a b nh nhn, v tr th tch bia lm sng) v k thu t ch n, th tch bia l p k ho ch cng c th trng v i th tch bia lm sng (ch ng h n nh ng kh i u nh trn da, cc kh i u tuy n yn) hay ng c l i, cc th tch bia l p k ho ch c th l n hn nhi u.

33

Th tch bia l p k ho ch c th l n hn bin gi i gi i ph u bnh th ng (ch ng h n bao g m c ph n c u trc xng khng nh h ng v m t lm sng). V v y, th tch bia l p k ho ch l m t khi ni m hnh h c v c nh, c dng cho vi c l p k ho ch i u tr . Th c t , th tch bia l p k ho ch khng i di n cho cc t ch c m xc nh hay cc bin gi i c a cc m. Th tch bia l p k ho ch l m t th tch c s d ng tnh ton li u l ng v s phn b li u l ng bn trong th tch bia l p k ho ch ph i c cn nh c sao cho th hi n c s phn b li u l ng i v i th tch bia lm sng v cc t ch c nguy c p. Khi xc nh th tch bia l p k ho ch i v i th tch bia lm sng cho, ng i ta ph i nh gi h t t m quan tr ng c a nh ng s khc nhau c th lin quan n s phn b chm tia ch n, cn nh c thm v s phn b gi i ph u, s p d ng cc d ng c c nh b nh nhn. 2.4.2.4. Cc t ch c nguy c p Cc t ch c nguy c p l cc m lnh ni m nh y c m c a tia x c th (t ch c nguy c p ch ng h n nh t y s ng). 2.4.2.5. Th tch i u tr Th tch i u tr l th tch c bao quanh b i m t ng ng li u trn b m t, c cc nh i u tr tia x l a ch n v nh r sao cho t c m c ch i u tr . nh

h ng m t cch c ngha n vi c l p k ho ch i u tr v li u l ng c ch nh

34

Hnh 2.3 Bi u di n ng ng li u c a CTV, PTV, v GTV trong ung th tr c trng c ch p b i CT trong vi c l p k ho ch i u tr M t cch l t ng, li u l ng ch phn b trn th tch bia l p k ho ch. Tuy nhin, do nh ng h n ch c a k thu t i u tr tia x , m c ch ny khng th th c hi n c, v i u ny d n n vi c ph i xc nh m t th tch i u tr . Khi m t li u l ng t i thi u i v i m t th tch bia l p k ho ch c ch n m t cch thch h p, trong m t s tr ng h p, th tch i u tr th ng l n hn nhi u so v i th tch bia l p k ho ch. 2.4.2.6. Th tch chi u x Th tch chi u x l th tch m cc m nh n c m t l ng li u c coi l c ngha trong vi c lin quan n t ng li u ch u c c a cc m lnh. Vi c so snh gi a cc th tch i u tr v th tch chi u x i v i nh ng s phn b chm tia khc nhau c th c s d ng nh l m t ph n c a qu trnh l a ch n.

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CHNG 3

M PH NG MCNP CHO NGU N N KNH TRONG THI T B X PH U LEKSELL GAMMA KNIFE

Chng ny trnh by cch th c m ph ng ngu n n knh trong thi t b LGK b ng chng trnh MCNP5. u tin chng ti gi i thi u v phng php Monte Carlo, chng trnh m ph ng MCNP5 v tnh u vi t c a chng trnh, trong chng ti cng gi i thch v sao ch n chng trnh MCNP5 cho bi ton m ph ng ny. Sau chng ti s gi i thi u qu trnh m ph ng ngu n n knh bao g m vi c m ph ng c u trc hnh h c c a m t ngu n n knh, cch b tr cc v t li u trong ngu n, qua rt ra c k t qu phn b li u h p th trn cc tr c Ox, Oy v Oz i v i ngu n n knh. 3.1 Phng php Monte Carlo y l phng php dng m ph ng s tng tc c a cc photon, neutron v i nhau hay l v i mi tr ng. Cc m hnh t nhin c m ph ng d a trn cc l thuy t ng l c h c c n thi t theo yu c u c a h . Trong qu trnh m ph ng m t photon ho c electron c xem nh h t c sinh ra t m t ngu n bao g m nng l ng ban u, v tr tng tc, gc tn x trn c s c a cc tng tc v t l, b ng ti t di n m r ng v s gi ng u nhin. M t h t c t o ra b ng cch l y m u m t ngu n c nng l ng E t danh sch c a cc nng l ng c s n k t h p v i v tr u tin r v h ng t i . Trong khng gian pha cho m i qu trnh tng tc v v tr m i l i c l y m u k t h p v i nng l ng cn l i v m t h ng m i. Qu trnh ny c l p l i cho n khi ngu n h t v t t c cc h t th c p l i ton b nng l ng c a n.

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Phng php Monte Carlo r t thch h p khi gi i cc bi ton ph c t p khng th m hnh b ng cc chng trnh my tnh theo cc phng php t t nh (deterministic methods). Th t v y, trong lnh v c y h c, v i s pht tri n c a cc thi t b k thu t cao dng trong vi c i u tr b nh nhn th yu c u chnh xc trong vi c tnh ton li u chi u ngy cng c quan tm, trong khi vi c gi i bi ton v i cc c u hnh ph c t p d ng nh khng th th c hi n c b ng cc phng php gi i tch thng th ng. V v y, s d ng phng php Monte Carlo trong vi c m ph ng s v n chuy n b c x tr nn r t ph bi n trong vi c tnh ton phn b li u trong k thu t x tr i u tr cho b nh nhn. Hnh 3.1 cho th y khi c u trc hnh h c cng ph c t p, cng g n v i th c t th m c kh khn c a vi c gi i quy t bi ton theo phng php gi i tch cng tng nhanh hn nhi u so v i phng php m ph ng Monte Carlo.

Hnh 3.1 So snh phng php Monte Carlo v i cc phng php gi i tch v th i gian tnh ton v ph c t p c a c u hnh

37

Ngy nay, chng trnh m ph ng Monte Carlo c s d ng cho nhi u m c ch khc nhau. M t trong nh ng ng d ng l chng trnh MCNP. 3.2 Chng trnh MCNP (Monte Carlo N Particle) 3.2.1. Gi i thi u chng trnh MCNP [10] Chng trnh MCNP c pht tri n ban u b i phng th nghi m qu c gia Los Alamos c a M . Cc nh bc h c Fermi, Von Neumanm, Ulam, Metropolis v Richtmyer l nh ng ng i ng gp chnh trong vi c xy d ng chng trnh tnh ny. D i s ch o c a nh ng nh bc h c ny chng trnh tnh MCNP c ra i v i cng s c c a hn 400 nh khoa h c. MCNP l chng trnh ng d ng phng php Monte Carlo m ph ng cc qu trnh v t l h t nhn i v i neutron, photon, electron mang tnh th ng k (cc qu trnh phn r h t nhn, tng tc gi a cc tia b c x v i v t ch t, thng l ng neutron). MCNP s d ng cc th vi n d li u c a cc qu trnh h t nhn, cc quy lu t th ng k, s ng u nhin ghi l i cc s ki n c a m t h t trong su t qu trnh k t khi pht ra t ngu n n h t th i gian s ng c a n. Chng trnh c m t s c i m sau:
Chng trnh c th tnh ton i v i ring neutron, ring photon, ring

electron, n c th tnh ton i v i c p neutron v photon cng nh c p neutron v electron.

Gi i nng l ng tnh v i neutron: 10-11 MeV n 20 MeV; d i nng

l ng tnh v i photon v electron l 1 keV n 1000 MeV.

MCNP cho php m t hnh h c c a bi ton, m t v t li u, ch n cc gi

tr ti t di n.

38

MCNP cho php tnh dng qua b m t (surface current), m t dng qua

b m t (surface flux), tnh qung ng m t dng trong cell (track length estimate of cell flux), m t dng t i m t i m, tnh qung ng theo nng l ng phn h ch, v phn b nng l ng c a cc xung trong i m o. 3.2.2. M hnh ha tng tc c a photon ln v t ch t trong chng trnh MCNP Chng trnh MCNP t o ra s h t theo yu c u ng i s d ng, sau gi i quy t v n va ch m c a cc h t qua hai m hnh: m hnh v t l n gi n v m hnh chi ti t d a trn l thuy t c a b n lo i tng tc l tn x Compton, tn x Rayleigh, hi u ng quang i n v hi u ng t o c p. Trong m hnh v t l n gi n ng i ta khng tnh n tn x Thomson v photon hunh quang trong hi u ng quang i n. M hnh ny dng cho cc bi ton m photon c nng l ng cao ho c cc bi ton m i n t l t do. Trong m hnh chi ti t ng i ta c tnh n tn x Thomson v cc photon hunh quang. M hnh chi ti t c p d ng cho cc bi ton c nng l ng th p hn (<100 MeV) v mi tr ng c lin k t i n t . Cc bi ton tnh ton cho li u, hi u su t che ch n (dng v t li u che ch n c Z cao) i v i cc ngu n pht photon t nhin cng thu c ph m vi p d ng m hnh chi ti t. Ngoi ra trong MCNP, cc qu trnh tng tc c a h t ln v t ch t c tnh ton r t chi ti t. l cc hi u ng quang i n, hi u ng Compton v hi u ng t o c p. B i v vi c tnh ton cc hi u ng ny tng i ph bi n trong cc ti li u nn trong ph m vi c a lu n vn ny s khng trnh by l i. 3.2.3. i u ki n m ph ng m t chng trnh MCNP
Ngu n m ph ng ph i l ngu n th c bao g m cc thng s : nng l ng, gc

tn x , kho ng khng gian phn b v th i gian ph thu c

C u hnh ph i c xc nh y kch th c v v tr.

39

V t li u ph i c xc nh y v chnh xc k c vi c khai bo tinh

khi t bao nhiu ph n trm. 3.2.4. C u trc c a chng trnh MCNP [8] Ph n quan tr ng c m t chng trnh MCNP chnh l t p u vo. Trong t p u vo cc thng s nh s h t c n gieo, cc thng s chnh xc c a ngu n c khai bo, cc thng s v phantom nh kch th c v ch t li u. Qua cc thng s nh n c MCNP s d ng th vi n s li u h t nhn v cc qu trnh tnh ton, gieo s ng u nhin tun theo quy lu t phn b , ghi l i s ki n l ch s pht ra t ngu n cho n h t th i gian s ng c a n. Kh nng m t hnh h c ba chi u c a MCNP l r t t t trong t p s li u vo chu n c chia ra lm 3 ph n l nh ngha m t, nh ngha m ng (cell) v nh ngha v t li u. Chng c ngn cch nhau b ng cc dng tr ng. nh ngha m t l cc d ng ton phng lin k t t o thnh cc m ng. G m cc lo i m t v k hi u nh sau: M t ph ng: PX 1.0 l m t ph ng vung gc v i tr c x t i i m x = 1.0 cm

PY -10.0 l m t ph ng vung gc v i tr c y t i i m y = -10.0 cm PZ 1.0 M t c u: SO 100.1 l m t c u c tm t i g c t a v c bn knh l 100.1 cm l m t ph ng vung gc v i tr c z t i i m z = 1.0 cm

SY 10.0 3.0 l m t c u c tm n m trn tr c y t i i m y = 10.0 cm v c bn knh 3.0 cm.

40

S 1.0 2.0 4.5 2.0 l m t c u c tm t i i m c t a (1.0, 2.0, 4.5) v c bn knh 2.0 cm. M t tr : CY 1.0 l m t tr n m trn tr c y c bn knh l 1.0 cm C/Z 3.0 5.0 2.4 l m t tr song song v i tr c z c tm n m t i t a (x, y) = (3,5)cm v c bn knh l 2.4 cm. Ngoi ra MCNP cn c s d ng vi t cc m t khc nh m t nn, m t elip, m t parabol hay m t hyperbol. nh ngha m ng (Cell) Cell c nh ngha l s giao nhau c a m t hay nhi u m t, m i cell c xc nh b i m t s nh t nh. Trong m i cell ta c n ph i khai bo v t li u, m t v t ch t. V d : c Cell cards c ngha l b t u khai bo cc thng s trong ph n cell. 10 -1 cell s m t l cell tr ng n m bn c nh m t 1 (theo chi u m).

2 1 -2.7 1 -2 cell s hai l cell lm b ng v t li u 1 c m t v t ch t l 2.7 g/cm3 n m bn c nh m t 2 (theo chi u m). 3 0 -2 cell s 3 l cell tr ng n m bn ngoi cell 2.

nh ngha v t li u y l ph n khai bo cc v t li u trong qu trnh m ph ng. V t li u c nh ngha b ng m t s ng tr c ch M. v d v t li u s 4 c vi t l M4.

41

V t li u c xc nh b ng s nguyn t c a nguyn t theo sau l s kh i (ho c 3 s 0 n u m c nh), thnh ph n ph n trm c a nguyn t trong v t ch t. V d khai bo v t li u H chi m 66.7% trong v t ch t ta k hi u 1000 0.667. Trong nh ngha d li u c n khai bo: ngu n, v t li u c u t o cc m ng, lo i nh gi c n tnh ton, s h t gieo c s p x p theo trnh t sau:
Cc dng thng bo (ty )

-------------------------------------------------------------- (dng tr ng)

M t dng thng bo tn bi ton nh ngha cc m ng

-------------------------------------------------------------- (dng tr ng)

nh ngha cc m t

-------------------------------------------------------------- (dng tr ng)

nh ngha d li u

3.2.5. Tally trong MCNP [8] MCNP cung c p cc lo i tally tnh nng l ng c a cc h t truy n trong mi tr ng v t ch t. S khc nhau gi a cc lo i tally c th nh h ng n tnh chnh xc c a vi c tnh ton li u. Ty vo m c ch tnh ton khc nhau, m ta s d ng lo i tally no tng ng. MCNP cung c p t t c l 7 lo i tally g m c F1, F2, F4, F5, F6, F7, F8, ngoi ra trong chng trnh MCNP5 ng i ta cung c p thm m t lo i tally l tally Fmesh. Tuy nhin trong ph m vi c a lu n vn ch s d ng hai lo i tally l tally F4 v tally Fmesh xc nh li u h p th trong phantom. Tally F4: c s d ng xc nh di v t ng v i cc kho ng nng l ng c chia. Cc k t qu ghi nh n c trong Tally F4 l di v t c a cc photon c

42

nng l ng tng ng i qua cc voxel trong m t cell . Khi h t i qua m t voxel th n s b l i nng l ng do tng tc v i cc v t ch t trong cell . Hnh 3.2 bi u di n qu trnh v n chuy n c a h t qua m t voxel (l ph n chia nh c a m t cell). N u g i l thng l ng v TL l chi u di ng i c a h t (cm), V l th tch c a m t voxel (cm3), th c xc nh theo cng th c:

TL V
TL V

(3.1)

V t c a ng i c a h t trong tally c tnh theo cng th c: W W l tr ng s qung ng A: l di n tch c a m t voxel

: l b r ng c a voxel

C: l v tr va ch m

Hnh 3.2 Qu trnh v n chuy n c a cc h t qua m t voxel Tally F4 c xc nh l : F 4 =

1 WT VL N

(3.2)

Trong N l s h t pht ra t ngu n.

43

y l php tnh kh tin c y b i v c r t nhi u v t c a h t trong cell d n n vi c c nhi u s ng gp cho tally ny. Trong lu n vn ny tally F4:p c s d ng cng v i DE v DF tnh li u h p th c a h t trong m t cell. Tally FMESH: l n u tin tally ny c a vo chng trnh MCNP5 nng cao kh nng tnh ton v ti t ki m c th i gian tnh ton. Tally FMESH cng c dng tnh di v t c a thng l ng trung bnh c a h t. Tuy nhin tnh u vi t c a tally FMESH l khng chia m t cell thnh cc voxel nh hn v v y MCNP5 khng m t th i gian tnh ton cc va ch m c a h t i qua t ng voxel nh nn th i gian tnh ton i v i tally FMESH l c c nhanh. ki m tra tnh chnh xc c a tally FMESH, chng ti kh o st phn b li u tng i o c v i ngu n n knh, kh o st d c theo tr c Ox ch y b ng tally F4 v tally FMESH. S h t gieo l 10 tri u h t. K t qu c a kh o st ny c bi u di n trn Hnh 3.3, t hnh ny ta th y r ng k t qu tnh ton phn b li u gi a tally F4 v tally FMESH g n nh tng t nhau.

Hnh 3.3 So snh li u tng i tnh b ng tally F4 v tally Fmesh d c theo tr c Ox i v i phantom n c

44

Bn c nh t B ng 3.1 so snh th i gian tnh ton c a tally FMESH v tally F4 v i cng c u hnh m ph ng gamma knife v phantom, ta th y n u dng tally FMESH th i gian gi m g n 1460 l n so v i th i gian ch y b ng tally F4. B ng 3.1 So snh th i gian ch y gi a tally F4 v tally FMESH Lo i tally F4 FMESH Th i gian ch y 6671.2 pht 4.57 pht

3.2.6. u i m c a chng trnh MCNP5 [9] Chng trnh MCNP5 ra i vo nm 2005, l chng trnh c pht tri n d a trn n n t ng c a chng trnh MCNP4C, tuy nhin MCNP5 b sung thm cc tnh nng cho php ng i s d ng c th tnh ton li u m t cch nhanh chng hn. Ngoi ra chng trnh Visual Editor h tr thm v 3D, c th hi n th ngay c u hnh mu gip ng i dng c th d dng pht hi n ra nh ng thi u st trong qu trnh m ph ng. Hnh 3.4 bi u di n giao di n c a chng trnh MCNP5.

45

Hnh 3.4 Giao di n c a chng trnh MCNP5 3.3 M ph ng MCNP cho ngu n n knh trong thi t b x ph u LGK Bi ton t ra l m ph ng m t ngu n Co60 pht ra tia gamma thng qua collimator lm b ng cc ch t li u tungsten, ch, s t v thp. Thnh ph n c a cc v t li u v kho ng cch gi a chng c bi u di n trn Hnh 3.5. Trong ngu n cobalt c t gi a, bao quanh l m t l p s t dy 2cm. Ti p theo l l p tungsten dy 6.5cm. K ti p l l p ch dy 9.2cm v cu i cng l l p tungsten dy 6cm. M hnh ngu n ny ph h p cho vi c s d ng chng trnh MCNP m ph ng. D a vo m hnh ny ta c th tnh ton phn b li u trong phantom. M hnh phantom chng ti s d ng y l phantom hnh h p, c kch th c 160 x160 x160 mm3. Vng khng gian gi a ngu n v phantom c l p y b i khng kh. S h t photon c gieo l 107

46

h t. Hnh 3.6 bi u di n m hnh m ph ng ngu n v phantom trong thi t b x ph u LGK.

Hnh 3.5 M hnh ngu n n knh dng trong m ph ng MCNP

47

Hnh 3.6 M hnh m ph ng ngu n n knh v phantom trong LGK D a vo c u hnh m ph ng ny ta c th tnh c xc su t pht tia gamma ra kh i knh chi u c a LGK ng v i cc tia gamma c cc nng l ng khc nhau pht ra t ngu n Co60. n gi n, thay v m ph ng hai tia gamma c nng l ng 1.17 MeV v 1.33 MeV nh trong th c t , ta m ph ng m t tia gamma v i nng l ng 1.25 MeV. Hnh 3.7 bi u di n xc su t pht ra c a tia gamma theo nng l ng.

Hnh 3.7 Ph m ph ng nng l ng photon pht ra c a ngu n Co60

48

Sau ph nng l ng photon pht ra ny c s d ng m ph ng tnh ton li u h p th trong cc phantom lm b ng v t li u n c v plastic. M c ch c a vi c tnh ton ny l so snh s khc nhau c a li u phn b trn hai v t li u n c v plastic. T rt ra nh n xt xem ch t li u lm phantom c nh h ng n li u phn b trong phantom hay khng. 3.4 Cc k t qu tnh ton v i ngu n n knh Chng trnh MCNP5 c s d ng m ph ng li u h p th trong cc

phantom hnh h p 160 x160 x160 mm3 c lm b ng n c v plastic v i c u hnh ngu n n knh nh trong Hnh 3.5. Phn b li u c kh o st theo tr c Ox v i g c t a c ch n t i tm c a hnh h p. 3.4.1. Li u phn b theo tr c Ox th so snh phn b li u trong phantom lm b ng ch t li u n c v plastic theo tr c Ox.

Hnh 3.8 Li u phn b d c theo tr c Ox

49

T hnh 3.8 ta th y c s t p trung cao li u chi u vo trung tm. Phn b li u t p trung quanh vng khng gian c bn knh 1cm quanh tr c chi u v gi m d n kho ng cch xa ngu n chi u. Hnh 3.8 cng cho th y ng phn b li u i v i phantom lm b ng ch t li u n c v plastic g n nh trng kh p ln nhau. i u ny ch ng t r ng v t li u lm phantom khng nh h ng ln s tnh ton phn b li u. 3.4.2. Li u phn b trn m t ph ng Oxy v Oxz th y c li u t p trung t i tm m t cch r rng hn. D a vo k t qu m ph ng thu c, chng ti dng chng trnh Matlab v phn b li u trn m t ph ng Oxy.

Hnh 3.9 Phn b li u tng i trn m t ph ng Oxy

50

Hnh 3.10 Phn b li u tng i trn m t ph ng Oxz D a vo hai hnh 3.9 v 3.10 chng ta th y phn b li u trn m t ph ng c d ng ph h p v i cc k t qu th c t l phn b li u t p trung quanh vng khng gian c bn knh 1cm quanh tr c chi u v gi m d n kho ng cch xa ngu n chi u.

51

CHNG 4

M PH NG MCNP CHO 201 NGU N TRONG THI T B X PH U LEKSELL GAMMA KNIFE

V i k t qu kh o st phn b li u c a ngu n n knh cho th y khng c s khc bi t gi a cc phantom lm b ng cc ch t li u n c v plastic, do v y ch c n kh o st phantom v i m t ch t li u duy nh t l . Trong lu n vn ny, phantom b ng n c c ch n ti p t c kh o st phn b li u. N i dung c a chng 4 ny t p trung vo vi c tnh ton phn b li u trong phantom lm b ng v t li u n c khi chi u 201 ngu n Co60, cc k t qu c so snh v i [11]. ng th i trong chng ny, phn b li u trong phantom u Zubal cng c m ph ng. 4.1 M ph ng MCNP5 cho 201 ngu n trong LGK Bi ton t ra l tnh ton li u phn b trong phantom khi chi u cng lc 201 ngu n Co60 pht tia gamma thng qua cc collimator v i cc ng knh 4mm, 8mm, 14mm, 18mm trong helmet c a LGK. Hnh 4.1a v 4.1b bi u di n c u hnh c a helmet trong gamma knife. M i helmet trong gamma knife c 5 vng, ta k hi u m i vng c tn g i l A, B, C, D, E. Trn m i vng s l ng cc collimator phn b l n l t l: trn vng A c 44 collimator, trn vng B c 44 collimator, trn vng C c 39 collimator, trn vng D c 39 collimator v trn vng trong cng vng E c 35 collimator. Cc vng trn ny ng tm [3].

52

Hnh 4.1a Bi u di n s s p x p c a cc vng collimator trong helmet c a LGK

Hnh 4.1b Bi u di n gc phng v c a cc vng so v i m t ph ng xOy m ph ng c u hnh c a 201 ngu n b ng chng trnh MCNP, ta ph i xc nh cc gc t ngu n t i m t ph ng, c cc phn b gc. Hnh 4.2 bi u di n m hnh tnh ton phn b gc gi a cc vng v i m t ph ng.

53

Hnh 4.2 Bi u di n phn b gc c a 201 ngu n trong LGK so v i m t ph ng T m hnh phn b 201 ngu n tnh ton ta dng chng trnh MCNP5 m ph ng. Ta xem cc ngu n ny c d ng m t, v i m i m t pht ra nng l ng nh tnh trong ngu n n knh. tnh ton phn b li u trong phantom ta s d ng m hnh phantom b ng ch t li u n c c d ng hnh h p c kch th c 16 x 16 x 16 cm3. Hnh 4.3 bi u di n m hnh phn b ngu n v phantom i v i 201 ngu n b ng MCNP. V i m c ch l tng th tch vng tnh li u ln c th kh o st li u trong m t vng l n hn v c th xem nh h ng c a cc vng ln c n c th hn nn khc v i trong m ph ng ngu n n knh, trong ph n m ph ng v i 201 ngu n ny chng ti ch n vng th tch bia c gi i h n trong hnh h p c kch th c 8 x 8 x 8 cm3 trung tm c a hnh h p. tnh li u h p th t i t ng i m trong vng quan tm, chng ti s d ng tally FMESH. Vng khng gian gi a ngu n v phantom c l p y b i khng kh. S h t photon c gieo l 107 h t.

54

Hnh 4.3 Bi u di n ngu n c d ng hnh m t v cch b tr phantom trong m ph ng 201 ngu n 4.2 M ph ng cch tnh li u i v i u Zubal Ta dng c u hnh m ph ng i v i 201 ngu n p d ng tnh li u i v i m hnh u Zubal, m hnh ny c l y trong th vi n cc m hnh phantom y h c h t nhn c a MCNP5 v i m c ch so snh cc k t qu tnh c v i cc k t qu th c t nh m ki m nh tnh chnh xc c a qu trnh m ph ng. Hnh 4.4 bi u di n m hnh u Zubal, m hnh ny c m ph ng g n gi ng v i th c t v i hn 15 lo i v t ch t khc nhau bao g m xng, v no, tuy n yn, hai h c m t, th y tinh th , mi, s n, thi dng. Trong m hnh ny ng i ta chia ra thnh cc voxel, g m c 85 x 109 x 120 voxel, m i voxel c kch th c l 2.2 x 2.2 x 1.4 mm3[8].

55

Hnh 4.4 M hnh u Zubal

4.3 Cc k t qu tnh ton v i 201 ngu n Phn b li u h p th theo hai tr c Ox v Oz c tnh ton v i 201 ngu n Co60 c th c hi n v i phantom n c v phantom u Zubal. Kch th c cc collimator c thay i l n l t cc gi tr 4, 8, 14, 18 mm. 4.3.1. Phn b li u theo cc tr c t a i v i phantom n c

56

1 0.9 0.8

Ox Oz

Li u tng i

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 -4 -3 -2 -1 0 1 2 3 4

d (cm)

Hnh 4.5 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 4 mm

1 0.9 0.8

Ox Oz

Li u tng i

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 -4 -3 -2 -1 0 1 2 3 4

d (cm)

Hnh 4.6 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 8 mm

57

1 0.9 0.8

Ox Oz

Li u tng i

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 -4 -3 -2 -1 0 1 2 3 4

d (cm)

Hnh 4.7 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 14mm

1 0.9 0.8

Ox Oz

Li u tng i

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 -4 -3 -2 -1 0 1 2 3 4

d (cm)

Hnh 4.8 So snh phn b li u tng i trn hai tr c Ox v Oz v i collimator 18mm

58

T cc hnh 4.5, 4.6, 4.7 v 4.8 ta th y li u phn b theo cc tr c Ox v Oz l i x ng v t p trung xung quanh vng trung tm. Phn b li u d c theo tr c x c s suy gi m theo t a ch m hn l suy gi m theo tr c z. 4.3.2. Phn b li u theo m t ph ng Tng t nh tnh ton trong ngu n n knh, ta cng v phn b li u trn m t ph ng Oxy v Oxz trong tnh ton i v i 201 ngu n xc nh phn b li u t p trung m t cch r rng hn.

Hnh 4.9 Li u phn b trn m t ph ng Oxy v i collimator ng knh 18mm

59

Hnh 4.10 Li u phn b trn m t ph ng Oxz v i collimator ng knh 18mm T Hnh 4.9 v 4.10 ta th y phn b li u trn m t ph ng c d ng ph h p phn b li u theo tr c, l phn b li u t p trung quanh vng khng gian c bn knh 1cm quanh tr c chi u v gi m d n kho ng cch xa ngu n chi u.

4.3.3. K t qu tnh ton i v i phantom u Zubal Phn b li u trong phantom u Zubal c tnh v i m t m ng l i 85 x 109 x 120 voxel, m i voxel c kch th c l 2.2 x 2.2 x 1.4 mm3. so snh, phantom n c cng c chia thnh cc voxel tng t nh trong phantom u Zubal. Vi c so snh ny nh m xc nh xem cc li u tnh ton c i v i phantom b ng n c hay plastic c th c s d ng ln k ho ch x tr trong tr ng h p b nh nhn th t s hay khng.

60

1 0.9 0.8

phantom n c phantom Zubal

Li u tng i

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 -4 -3 -2 -1 0 1 2 3 4

x(cm)

Hnh 4.11 Bi u di n phn b li u tng i trong phantom u Zubal v trong phantom n c i v i 201 ngu n T Hnh 4.11 phn b li u ta th y c s ph h p t t gi a cc k t qu m ph ng v i cc nh n nh v kh nng c a thi t b . Thi t b cung c p m t li u chi u t p trung vo vng trung tm, v i s t p trung li u chi u ny chng ta c th tiu di t c t bo ung th ng th i h n ch c tc h i i v i cc m lnh xung quanh m t cch ng k . K t qu ny l b c u trong vi c nghin c u phn b li u b ng phng php Monte Carlo h tr vi c ch a tr ung th no b ng Leksell Gamma Knife. 4.3.4. So snh v i cc profile Dng cc k t qu tnh ton c chng ti so snh v i cc k t qu tnh ton c a tc gi Yipeng Li th th y hon ton trng kh p, ch ng t k t qu thu c l hon ton ng.

61

Hnh 4.12 So snh li u theo tr c z v i collimator ng knh 4mm

Hnh 4.13 So snh li u theo tr c x v i collimator ng knh 4mm

62

Hnh 4.14 So snh li u theo tr c x v i collimator ng knh 18 mm

Hnh 4.15 So snh li u theo tr c z v i collimator ng knh 18 mm

63

4.3.5. So snh FWHM v i k t qu xu t ra c a Gamma Plan m b o tnh chnh xc c a vi c tnh ton, chng ti so snh di m t n a (FWHM) c a cc ng phn b li u trong cc profile v i k t qu tnh c trong Gamma Plan. T b ng 4.1 v b ng 4.2 k t qu so snh c nh gi l kh ph h p. B ng 4.1 So snh FWHM i v i tr c Ox gi a chng trnh Gamma Plan v i k t qu tnh ton ng knh collimator (mm) 4 8 14 18 FWHM (mm) Gamma Plan 6.0 11.2 19.1 24.4 K t qu tnh ton 5.0 10.7 18.8 23.9 Sai khc (%) 16.6 4.4 1.6 2.1

B ng 4.2 So snh FWHM i v i tr c Oz gi a chng trnh Gamma Plan v i k t qu tnh ton ng knh collimator (mm) 4 8 14 18 FWHM (mm) Gamma Plan 4.8 9.2 15.8 20.0 K t qu tnh ton 4.1 8.4 15.0 19.3 Sai khc (%) 14.5 8.6 5.1 3.5

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K T LU N
Vi c tnh ton li u trong x tr l m t bi ton h t s c ph c t p do chnh tnh ch t ph c t p c a tng tc c a b c x v i v t ch t v tnh ch t ph c t p c a c u hnh. Trong nh ng nm g n y vi c nghin c u v s d ng code MCNP trong qu trnh m ph ng tnh ton li u trong k thu t x tr tr nn ph bi n do nh ng u i m c a chng trnh ny mang l i. Lu n vn ny v i m c ch tm hi u v gi i thi u phng php tnh c a chng trnh MCNP5 cung c p cho cc k s v t l m t ti li u tham kh o b ch. ng th i xy d ng bi ton tnh ton phn b li u i v i thi t b x ph u LGK b ng chng trnh MCNP5 ki m tra tnh ng n c a qu trnh tnh ton so v i k t qu th c t . Qua vi c m ph ng c u hnh ngu n n knh v c u hnh c a 201 ngu n v t cc k t qu phn b li u chi u thu c trong phantom, chng ti th y r ng vi c tnh ton phn b li u i v i thi t b x ph u LGK b ng chng trnh MCNP5 l kh ph h p v i cc k t qu th c t . i u ny m ra m t h ng nghin c u m i l c th d ng chng trnh MCNP5 trong vi c ln k ho ch x tr b ng Gamma Knife. Hi n nay ng i ta s d ng chng trnh Gamma Plan trong vi c l p k ho ch tnh ton li u x tr cho Gamma Knife. Chng trnh ny c cung c p b i nh s n xu t km v i thi t b x ph u LGK nn vi c ki m tra tnh chnh xc c a chng trnh ny cng ang l v n quan tm c a cc k s v t l. V v y, vi c s d ng chng trnh MCNP5 m t cch c l p v song song v i chng trnh Gamma Plan trong vi c l p k ho ch x tr b ng Gamma Knife s em l i hi u qu i u tr m t cch t i u. ng

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H NG PHT TRI N
Do h n ch v th i gian cng nh tnh ph c t p c a bi ton tnh li u, chng ti ch m i p d ng tnh ton li u cho phantom n c v plastic c hnh h p, cng nh ch tnh ton phn b li u tng i cho phantom u Zubal. pht huy vai tr c a chng trnh MCNP5 trong tnh ton phn b li u cho k thu t x tr b ng thi t b Leksell Gamma Knife, chng ti hy v ng r ng trong tng lai c th xy d ng m t chng trnh tnh li u c th cho t ng v tr trn kh i u th c t v c th m ph ng tnh li u cho m t kh i u c hnh d ng b t k.

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DANH M C CC CNG TRNH

1. Investigating the absorbed dose of Leksell Gamma Knife with 201 sources by using MCNP, ng Trng Ka My, ng Nguyn Phng, Mai Vn Nhn, Trng Th H ng Loan. 8th Asia-Oceania Congress of Medical Physics. 2. Tnh ton phn b li u trong phantom c a Gamma Knife b ng chng trnh MCNP, ng Trng Ka My, ng Nguyn Phng, Mai Vn Nhn, Trng Th H ng Loan, H i ngh khoa h c l n th 6 i H c Qu c Gia TP H Ch Minh.

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TI LI U THAM KH O
Ti ng Vi t [1] Nguy n Thi H, TS Nguy n c Thu n, (2006), Y h c h t nhn v k thu t x tr , NXB Bch Khoa, H N i. Ti ng n c ngoi [2] E.B.Podgorsak, (2005), Radiation Oncology Physics: A Handbook for Teachers and Students, International Atomic Energy Agency, Vienna. [3] Feras M.O, Al Dweri and Antonio M. Lallena, (2004), A simplified model of the source channel of the Leksell Gamma Knife: testing multisource configurations with PENELOPE, http://arxiv.org/abs/physics/0406142v1 [4] Gamma Knife Center, History of Leksell Gamma Knife, Crowell Hospital. [5] Joel YC Cheung, (1998), Monte Carlo calculation of single beam dose profiles used in a gamma knife treatment planning system, American Association of Physicists in Medicine. [6] Joel YC Cheung, (2002), Choice of phantom materials for dosimetry of Leksell Gamma Knife unit: A Monte Carlo study, American Association of Physicists in Medicine. [7] Moskvin, (2007), MCNP based computational model for the Leksell Gamma Knife, American Association of Physicists in Medicine. [8 ] R.D Hugtenbug, (2004), Practical Monte Carlo Using MCNP4C, http://members.lycos.co.uk/hugtenburg [9] Tim Goorley, Forrest Brown, Lawerence J. Cox, (2003), MCNP5 Improvement for Windows PCS, Los Alamos National Laboratory. [10] X-5 Monte Carlo Team, (2003), MCNP A General Monte Carlo N-Particle Transport Code, Version 5, Los Alamos National Laboratory. [11] Yipeng Li, (2002), Absorbed dose measurements and MCNP modeling for the Leksell Gamma Knife, The Ohio State University, USA.

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PH L C
Ph l c A: Gamma Knife model with single source c gamma knife model with single sources c **************** Cell Card ********************** 1 2 3 4 5 6 7 8 9 10 20 30 10 40 10 30 10 40 10 50 10 60 0 0 -0.0012 -19.250 -0.0012 -11.340 -0.0012 -19.250 -0.0012 -7.8600 -0.0012 -1.0512 -6 6 -6 6 -6 6 -8 7 -7 1 -9 2 -9 3 -9 4 -9 8 -2 1 -3 2 -4 3 -5 4 4 -5 -5 -4 -3 -2 imp:p=1 $ air imp:p=1 $ tungsten imp:p=1 $ air imp:p=1 $ lead imp:p=1 $ air imp:p=1 $ tungsten imp:p=1 $ Co-60 source imp:p=1 $ cast iron: pure Fe imp:p=1 $ air gap -17 imp:p=1

12 -13

14 -15 16 -20

#(12 -13 14 -15 16 -17) 20 imp:p=0

#(-9 1 -5) imp:p=1

c **************** Surface Card ******************** 1 PZ 16.5 2 PZ 22.5 3 PZ 31.7 4 PZ 38.2 5 PZ 40.2 6 KZ 41.831 0.0004587 -1 $ cone surface

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c 7 CZ 0.217 $ primary collimator 7 CZ 0.05005 8 CZ 0.05 $ Co-60 source cylinder 9 CZ 5 $ the cylinder containing the model c 11 so 8 $ the phantom R = 8cm 12 PX -8 13 PX 8 14 PY -8 15 PY 8 16 PZ -8 17 PZ 8 20 so 50 $ the whole sphere $ hinh hop

c ************** Problem Type ************** mode p c c ************** Source Term ************** sdef POS=0 0 39.2 AXS=0 0 1 RAD=d1 EXT=d2 & VEC=0 0 -1 DIR=d3 ERG=1.25 c si1 0 0.05 si2 1 si3 0.99 1 sp3 0 1

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c c *************** Tally ************************** fmesh4:p GEOM=xyz ORIGIN=-2 -2 -2 IMESH= 2 IINTS=40 JMESH= 2 JINTS=40 KMESH= 2 KINTS=40 AXS= 0 0 1 VEC=0 1 0 OUT=ik de0 0.010 0.015 0.020 0.030 0.040 0.050 0.060 0.080 0.100 & 0.150 0.200 0.300 0.400 0.500 0.600 0.800 1.000 1.500 df0 2.96e-012 1.21e-012 6.41e-013 2.91e-013 2.04e-013 & 1.91e-013 2.07e-013 2.76e-013 3.67e-013 & 6.32e-013 9.16e-013 1.49e-012 2.03e-012 2.56e-012 & 3.06e-012 3.97e-012 4.81e-012 6.58e-012 c ************* Material ******************* m10 7000 -.755 8000 -.232 18000 -.013 $ air m50 26000 1.0 $ cast iron: pure Fe m30 82000 1.0 $ lead m40 74000 1.0 $ tungsten m60 1000 2.0 8000 1.0 $ phantom H2O

c m60 1000 0.077 $ for H c 6000 0.923 $ for C c m20 1000 2.0 8000 1.0 c c ************* Energy Card ****************

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phys:p 2 SPDTL force fm4 1.0 c ************* Cutoff Card **************** nps 10000000

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Ph l c B: Gamma Knife model with 201 sources c gamma knife model with 201 sources c **************** Cell Card ********************** 10 20 30 60 -1.0512 12 -13 14 -15 16 -17 imp:p=1 -20 imp:p=1

10 -0.0012 #(12 -13 14 -15 16 -17) 0 20 imp:p=0

c **************** Surface Card ******************** 12 PX -4 13 PX 4 14 PY -4 15 PY 4 16 PZ -4 17 PZ 4 20 so 50 $ the whole sphere 301 p 16.371056 0.000000 2.058770 272.250000 .... 501 p 13.325163 -1.165801 9.660794 272.250000 $ hinh hop

c ************** Problem Type ************** mode p c c ************** Source Term ************** sdef sur=d202 pos=fsur d203 rad=d204 dir=-1 erg=1.25

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c si202 L 301 302 303 304 305 306 307 308 309 310 . . . 501 sp202 1 1 1 1 1 1 1 1 1 1 . . . 1 ds203 S 1 2 3 4 5 6 7 8 9 10 . . . 201 si1 L 16.371056 0.000000 2.058770 sp1 1 .... si201 L 13.325163 -1.165801 9.660794 sp201 1 c si204 H 0 0.9 sp204 -21 1 c c *************** Tally ************************** c F4:p 10(10<40 [-30:30 -30:30 -30:30]) c fmesh4:p GEOM=xyz ORIGIN=-4 -4 -4 IMESH= 4 IINTS=80 JMESH= 4 JINTS=80 KMESH= 4 KINTS=80 AXS= 0 0 1 VEC=0 1 0 OUT=ik

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de0 0.010 0.015 0.020 0.030 0.040 0.050 0.060 0.080 0.100 & 0.150 0.200 0.300 0.400 0.500 0.600 0.800 1.000 1.500 df0 2.96e-012 1.21e-012 6.41e-013 2.91e-013 2.04e-013 & 1.91e-013 2.07e-013 2.76e-013 3.67e-013 & 6.32e-013 9.16e-013 1.49e-012 2.03e-012 2.56e-012 & 3.06e-012 3.97e-012 4.81e-012 6.58e-012 c ************* Material ******************* m10 7000 -.755 8000 -.232 18000 -.013 $ air c m50 26000 1.0 $ cast iron: pure Fe c m30 82000 1.0 $ lead c m40 74000 1.0 $ tungsten m60 1000 2.0 8000 1.0 $ phantom H2O

c m60 1000 0.077 $ for H c 6000 0.923 $ for C c m20 1000 2.0 8000 1.0 c c ************* Energy Card **************** phys:p 2 SPDTL off c ************* Cutoff Card **************** nps 1e7