Professional Documents
Culture Documents
Cn Bn V iu Tr
Bng Liu Php Bc X
Mc Lc
Tng Quan V iu Tr X Tr ............................................................................................. 1
I. iu tr bng tia x l g ?............................................................................................. 1
II. Cc Phng thc iu tr trong x tr: .......................................................................... 1
III. C s vt l trong iu tr x tr:................................................................................... 1
IV. Khoa iu Tr Bng Bc X: ....................................................................................... 1
V. i Ng Nhn Vin Ti Khoa X Tr:.......................................................................... 2
VI. H Thng Thit B Ca Mt Khoa X Tr:................................................................... 4
VII. Quy Trnh iu Tr Ti Khoa X Tr............................................................................ 4
H Thng Trang Thit B Trong n V iu Tr Bng Tia X........................................ 5
I. Tng quan v h thng trang thit b ca n v iu tr:............................................. 5
II. Thit B iu Tr:.......................................................................................................... 6
III. H Thng Thit B Hng nh: ....................................................................................... 7
IV. H Thng Lp K Hoch iu Tr: .............................................................................. 7
V. H thng m phng v kim tra.................................................................................... 8
VI. H thng Phng Mould room: ...................................................................................... 8
VII. H Thit B o Liu v QA-QC: .................................................................................. 9
VIII.Tng Quan V My iu Tr Gia Tc Tuyn Tnh: ..................................................... 9
Vai Tr Ngi Vt L v Cng Tc Vt L Trong iu Tr X Tr ............................... 17
I. Nh Vt L X Tr: ..................................................................................................... 17
II. Vai Tr Ca Nh Vt L Y Khoa: .............................................................................. 17
III. T Chc i Ng Vt L Y Khoa Trong Mt Trung Tm X:.................................. 17
IV. Cng Tc Vt L Trong X Tr: ................................................................................. 18
V. T Chc Nhn S V Cng Tc Vt L:.................................................................... 20
Nhng Vn Vt L C Bn Trong X Tr Cc Thng S Vt L C Bn ............... 21
I. Cc Loi Bc X Pht Ra T my Gia tc c s dng trong x tr: ...................... 21
II. Bia Tia X Trong My Gia Tc Tuyn Tnh................................................................ 21
III. Ph Nng Lng Chm Photon:................................................................................ 23
IV. n V Nng Lng Ca Cc Chm Tia Bc X Trong X Tr:............................... 23
V. S Phn B Nng Lng Ca Chm Bc X Vi Mi Trng - S Cn Bng
Electron:...................................................................................................................... 24
VI. Chm Tia Bc X V Trng Chiu:......................................................................... 26
VII. Beam Profile V Penumbra: ....................................................................................... 27
VIII.S ng u Ca Trng : ........................................................................................ 30
Nhng Thng S Vt L C Bn Trong Tnh Ton Liu ................................................. 32
I. Gii Thiu:.................................................................................................................. 32
II. H s lch trc OAF: .................................................................................................. 32
III. H s Output: .............................................................................................................. 32
IV. Phn Trm Liu Su (PDD):............................................................................... 34
V. S Phn B ng Liu: .............................................................................................. 35
VI. Thng S Ca Chm Tia Nng Lng Cao TMR v TPR:........................................ 37
VII. Cc h s tnh liu khc: ............................................................................................. 39
Tng Quan V iu Tr X Tr
I. iu tr bng tia x l g ?
iu tr bng tia bc x hay cn gi tt l X Tr l vic p dng cc ngun bc x
ht nhn hay cc chm tia bc x vo vic iu tr bnh trong y hc ni chung, iu tr bnh
nhn ung th ni ring.
Vic p dng bc x ht nhn trong y hc nh vy c thc hin t rt sm ngay t nhng
ngy u tin khi tia X c pht hin ra bi nh vt l Roentgen v sau ba khm ph quan
trng: Tia X bi Roentgen; S bc x t nhin bi Becquerel v Ra-226 bi Marie Curie. Cc
loi bc x c p dng trong iu tr trong nhng ngy u l nhng chm tia X c nng
lng thp, tuy nhin ngy nay chng ta c nhiu la chn a dng hn nh chm tia X nng
lng thp, chm tia X nng lng cao hay cn gi l chm photon hay tia gamma, chm tia
electron hay cc chm ht nng nh proton, He, Cacbon cng bt u c s dng mt s
nc tin tin trn th gii nhng gi thnh kh cao.
Cc chm tia bc x ny c pht ra t cc my pht hay nhng ngun ng v phng x chng
hn nh my gia tc tuyn tnh, my gia tc vng hoc ngun ng v Co-60, ngun Ir, Ra.
II. Cc Phng thc iu tr trong x tr:
X tr c chia lm hai phng thc iu tr l x tr trong v x tr ngoi.
X tr trong l vic a cc cht ng v phng x vo bn trong vng cn iu tr v ti
cc chm tia bc x c pht ra cc hng xung quanh tiu dit t bo ung th xung
quanh.
X tr ngoi hay x tr t xa l vic s dng cc my pht hay cc ngun ng v bc x t
bn ngoi bnh nhn c nh hng chiu vo cc khi u bn trong bnh nhn. Vi x tr
ngoi hng chiu hay ng i ca cc chm bc x cn c xc nh khi lp k hoch
iu tr cho bnh nhn. Cc my pht bc x trong x tr ngoi tu theo nng lng chm tia
v mc ch s dng m c ch to khc nhau. iu tr cho ung th b mt da thng
thng l cc my tia X nng lng thp hay cc ngun ng v phng x nng lng thp,
cho nhng khi u nm su hn bn di b mt da ca bnh nhn cc my pht tia X nng
lng cao c p dng: trc y cc my Co-60 nng lng 1.33 MeV c s dng kh
ph bin, nhng vi thp nin gn y cc my gia tc tuyn tnh vi nhiu mc nng lng
khc nhau t 4 MV, 5 MV, 6MV, 10 MV n nng lng rt cao hn 21 MV v c th pht
c cc chm bc x electron ang c s dng kh ph bin. My gia tc tuyn tnh ngy
nay do nhng u im hn hn my Co-60 cho thy nhng u vit ca n.
III. C s vt l trong iu tr x tr:
IV. Khoa iu Tr Bng Bc X:
Khoa iu tr bng bc x hay khoa x tr l mt n v khm v iu tr cc bnh
c ch nh s dng cc loi tia bc x trong iu tr bnh, ch yu l cc bnh nhn ung
th. Tu theo c cu t chc t tng nc, tng thnh ph v tng bnh vin m mt n v x
tr c th l mt trung tm hay khoa x tr c lp ca mt bnh vin, hoc l mt n v trc
thuc mt khoa ca bnh vin v cc hnh thc t chc khc.
Khoa iu tr bng bc x thc hin iu tr bnh nhn da trn cc thit b c bit
cho cng tc ca n nh: cc my pht bc x, cc h thng my tnh iu khin v lp k
hoch cho vic iu tr, cc thit b ph tr c bit c yu cu cho vic iu tr.
Bi Ging vt L X Tr _ Trn Cng
Nh Ung Bu Hc bc x.
i ng vt l x tr.
i ng k thut vin.
i ng iu dng, y t v nhn vin vn phng.
Trong :
Mi nhm nhn vin ny c chc nng v nhim v khc nhau trong mi lin h rng buc ca
cng tc x tr nh c minh ho trong s sau:
BS X Tr
Vt L
K Thut Vin
Khm v Ch nh
Lp KHT
QA & QC thit b
Thc hin iu tr
Trin Khai KT mi
Nghin cu
ng gp v KT mi
nh gi KHT
Theo Di-ng Gi
Trin Khai P mi
iu Dng &
Nhn Vin Vn
Gip BS lp HST
Cng tc VP & BHYT
Qun l Bnh n
Kt qu T
S Mu V T Chc Khoa X Tr
Bi Ging vt L X Tr _ Trn Cng
Server
Hnh Anh Hc
CT, MRI, PET
Phng Khm
TT. Bnh n
P. Nhn Bnh
Qun L H S BN
Qun L NV & TB
Vin Ph
Khu Ho Tr
Lch T & TD
TD. Ti Khm
Qun L Bit Dc
Khu X Tr
P. M Phng
HT. LKH
D Liu MP
Lp KHT
Phim MP
My Linac
TT iu Tr
T s o tren cho thay mot quy trnh ieu tr xa tr hoan chnh la mot quy trnh phc
tap gom nhieu bc, nhieu khau co moi quan he khang kht vi nhau cau thanh nen. Tai moi
v tr, moi khau o vai tro va trach nhiem cua moi nhom nhan vien la khac nhau, nhng co
moi quan he qua lai tng ho lan nhau.
iu tr trc tip cho bnh nhn. Cc phng php v k thut iu tr bng my gia tc ang
ngy cng pht trin v em li hiu qu cao.
1. Cc c tnh ca cc my ng dng s gia tc tuyn tnh
- C th la chn hai loi chm tia bc x Photon v Electron.
- C nhiu mc nng lng khc nhau ca hai loi chm tia bc x photon v electron.
- an ton bc x cao.
- chnh xc v liu lng v chuyn ng c kh chnh xc.
- C nhiu s la chn v cu hnh v tnh nng
- p dng cc k thut iu tr hin i khc nhau.
2. Cc loi my p dng gia tc tuyn tnh hin nay:
- My gia tc tuyn tnh Linac: Siemens, Varian, Elekta
- My Cyber Knife
- My Tomotherapy
- My iu tr bng ht nng
II.4. My x tr trong:
iu tr x tr trong l iu tr cc tn thng hoc cc khi ung th bng cch a cc
ngun ng v phng x vo pha bn trong vng tn thng hay khi bu t pht tia bc
x ph hy khi bu. iu tr x trong theo t ting anh l Brachytherapy tc l iu tr p st,
iu ny cn c ngha l cc ngun ng v phng x tip xc, p st vo khi bu. Cc h
thng ng dng trong iu tr x trong bao gm
Kim phng x v Implane
My sut liu thp LDR
My sut liu cao HDR
III. H Thng Thit B Hng nh:
Thit b hnh nh hc trong h thng trang thit b iu tr x tr c vai tr rt quan trng.
Cc thit b ny m nhim hai chc nng chnh: Chc nng chn on hnh nh v chc nng
thu thp d liu u vo cho h thng lp k hoch iu tr. Cc d liu hnh nh t cc loi
hnh nh khc nhau c th c s dng kt hp li hin th hnh nh tn thng tt nht.
Trong n v iu tr x tr nn c t nht mt my CT, my CR v my siu m, cc thit b khc
c th kt ni vi khoa chn on hnh nh nh PET/CT, SPEC, MRI ...
k hoch khc nhau vi nhng thut ton tnh ton liu v vi nhng k thut iu tr kh phc tp.
Vit Nam cng vic lp k hoch l mt trch nhim ca ngi Vt L Y Khoa.
VIII.2.
10
VIII.3.
Nguyn tc hot ng ca my gia tc tuyn tnh da trn s gia tc cc chm tia electron
pht ra t mt sng bn electron, cc chm electron ny c gia tc trong mt trng in t cao
tn c pht t b pht sng cao tn trong mt ng gia tc thng. cc chm electron ny c gia
tc ti vn tc gn bng vn tc nh sng sau cc chm tia ny c chiu theo hng li ra
ca my s dng iu tr cho bnh nhn, hoc c hng bn vo mt bia kim loi to ra
chm tia photon iu tr cho bnh nhn.
VIII.4.
11
1. Isocenter (Tm quay, Tm chiu x): L mt im trong khng gian cch bia tia X
100cm v l giao im ca 2 trc i xng: Trc i xng ca chm tia X pht ra t
bia tia X v trc quay i xng ca gantry
12
7. Trng nh Sng (Light Field ): l chm tia nh sng m phng cho chm
tia bc x. Trng anh snh c kch thc v hnh dng ging chm bc x pht ra v
kch thc hnh dng trng nh sng cng c xc nh bi cc Collimator s cp
v MLC th cp.
8. SAD: (Khong cch t ngun ti isocenter): l khong cch tnh t bia tia X n
Isocenter. Khong cch ny l 100cm i vi cc my gia tc tuyn tnh.
9. SSD (Khong cch ngun ti b mt da): l khong cch tnh t bia tia X n b
mt da ca bnh nhn.
13
12. Khi Che Chn (Block): L nhng khi c bng hp kim c tc dng dng che
chn, bo v m lnh hay cc c quan trng yu nm gn khi u cn chiu x. cc
khi che chn c hnh dng ty thuc vo thit k che chn trong lp k hoch v
c gn ln cc Tray trong khi iu tr. Trong trng hp cc my gia tc c MLC
s khng cn s dng cc khi che chn na.
13. Port Film (Phim Chp Hnh Dng Trng Chiu X): L phim chm hnh dng
v kch thc chm tia bc x chiu ra ti mt v tr gc no ca Gantry v gc
quay no ca Collimator tng ng vi mt cha chn no hay mt sp xp no
ca MLC. Hnh nh ca Port Film c lin quan n mc gii phu ca bnh nhn
v l c s cho vic so snh vi chm tia bc x trog lp k hoch m bo s
iu tr l chnh xc.
14. Headrest: l dng c h tr cho vic iu tr. y l dng c dng u ca
bnh nhn trong mt t th iu tr mong mun. Dng c ny ty theo nh cung cp
m c nhng cch b tr v kiu dng khc nhau.
14
15
19. Wedge (nm): l mt dng c lm bng kim loi dng hiu chnh s phn b liu
lng ng u hn trong nhng trng hp vng chiu x khng phng v c
cong no . Cc Wedge c thit k vi cc gc khc nhau ph hp vi cc gc
cong tng tng ca b mt chiu x. cc Wedge ny c chia lm nhiu loi ty
thuc theo vic chn mua thit b gm
Physical Wedge lm bng kim loi nm bn ngoi my c lm vo khi cn s
dng
Dynamic Wedge: l Wedge bng kim loi nhng nm bn trong u my gia tc,
khi s dng s t ng c a vo v tr.
Vitrual Wedge: L Wedge khng c thc n c to ra bng cch hiu chnh
cng chiu x dc theo mt hng no t to ra s thay i v s phn
b liu ging nh cc wedge bng kim loi. y l mt la chn (option) khi mua
my gia tc.
16
T vn trong iu tr bng bc x
17
18
19
20
Nhng Vn Vt L C Bn Trong X Tr
I. Cc Loi Bc X Pht Ra T my Gia tc c s dng trong x tr:
Nh c cp phn trn v nguyn l hot ng ca my gia tc tuyn tnh. Cc
electron c pht ra t sng bn electron c gia tc trong mi trng sng in t cao tn t
ti vn tc rt cao sau c bn vo mt bia tia X pht ra chm tia Photon.
Nh vy chm bc x s dng trong iu tr x tr s l mt chm tia Photon, tuy nhin vi my
gia tc cn c th s dng trc tip chm tia electron cho mc ch iu tr bng cch cho pht
trc tip chm electron m khng qua bia tia X.
Cc chm tia Photon v Electron t my gia tc c th c pht ra vi nhiu mc nng lng
khc nhau ty thuc s la chn ca khch hng v nhu cu s dng.
II. Bia Tia X Trong My Gia Tc Tuyn Tnh
II.1. S Tng Tc Ca Electron Trong Mi Trng Vt Cht:
Khi cho mt chm electron tng tc vo mt mi trng vt cht, cc electron mang
nng lng cao ny s b mt nng lng do s va chm v s bc x nng lng. Nng lng
ca electron mt i do s ion ha, mt do s kch thch v do cc hin tng nhit c gi chung
l s mt nng lng do va chm. Ngc li, nng lng electron mt i to ra nhng dng
nng lng mi nh photon, s bc x c trng v bc x hm pht ra t mi trng vt cht
c gi chung l s mt nng lng do bc x. Nng lng electron mt i do va chm l nng
lng ca electron b hp th trong mt mi trng vt cht, v v vy ta c liu hp th, trong
khi s mt nng lng do bc x l nng lng electron mt i to ra cc bc x dng
photon, v do trong trng hp ny ta c cc ngun pht tia X v liu chiu do ngun tia X
pht ra. Hiu sut pht tia X chnh l phn nng lng ca electron c chuyn sang tia X, n t
l vi bc s nguyn t ca vt liu bia, v t l vi ln nng lng ca electron th ba
(electron cc lp ngoi dch chuyn v lp l trng).
21
Vi chm electron nng lng thp, ni chung chm tia X c pht ra theo hng vung
gc vi hng ca chm electron tng tc. Do ti nhng mc nng lng thp, bia tia X s
c b tr nghing mt gc so vi hng ca chm electron ti v c gi l bia phn xa
hnh_3.
Ti nhng mc nng lng cao hn ni chung tia X s pht ra theo hng ca chm
electron bn ti. Vi cc my x tr nng lng cao nh my gia tc tuyn tnh bia tia X s c
b tr theo kiu ny. Chm bc x hu dng s c ly ra ti cnh pha bn kia ca bia, bia tia X
kiu ny c gi l bia truyn qua.
22
23
24
Nng lng cc i
100 Kev
250 Kev
660 Kev
1.33 Mev
6 Mev
10 Mev
25 Mev
su Build-up
App. 0
0.2 mm
1.5 mm
5 mm
1.5 cm
2 cm
4 cm
Bng 1 : Chiu su khc nhau cho nhng chm photon khc nhau.
25
Cc chm tia electron c qung chy trong mi trng ngn, suy gim rt nhanh trong mi
trng nn c s suy gim ngay sau vng Build-Up.
Chm tia Electron l bc x ion ha trc tip v chm tia photon l bc x ion ha gin tip.
Chm tia Electron l bc x ion ha trc tip v chm tia photon l bc x ion ha gin tip.
Chm tia Electron c qung chy gii hn trong mi trng, chm tia photon khng c qung
chy gii hn trong mi trng.
A1 d1
(1)
=
A 2 d 2
trong A1, A2 l din tch tng ng ti d1, d2.
cng chm tia t l nghch vi bnh phng khong cch:
2
I1 d 2
(2)
=
I 2 d 1
trong I1, I2 l cng chm tia ti khong cch d1, d2 tng ng.
26
VI.2.
T cc chm tia bc x pht ra ngi ta thng dng cc thit b che chn chn bt
chm tia bc x chiu ra t to ra mt chm bc x hng theo mt li ra duy nht c mt din
tch nht nh thng l din tch vung hay ch nht vi b mt cn chiu x gi l trng bc
x hay trng chiu.
Hai im cn ch ca trng chiu l:
hnh dng v kch thc ca trng chiu: chnh l din tch ca mt chm tia ti
mt khong cch cho trc t ngun bc x.
Sut liu trong trng chiu: ti bt k mt im no bn trong chng chiu (trong
vng din tch ca trng chiu) Sut liu chiu u l mt hng s khc khng, v ti
bt c v tr no bn ngoi trng chiu sut liu u l bng khng.
VII. Beam Profile V Penumbra:
VII.1.
Beam Profile:
27
Nu ta xt mt trng chiu hnh ch nht hay hnh vung khi kch thc trng chiu
c vit l ab, trong a, b l di v rng ca trng chiu. V tm i xng ca hnh
ch nht c gi l tm trng chiu (im O). ng thng ni im O vi ngun bc x l
ng thng c khong cch ngn nht v c gi l trc chm tia (beam axis) hay trc trung
tm chm tia(central axis).
Nu chng ta gi thit rng ngun l ngun im v bc x pht ra t ngun l ng
hng (isotropic), ng thi gi thit rng ngun c bao bc bi vt liu hp th bc x v c
mt li ra cho php to ra mt chm hay mt trng chiu c hnh dng v kch thc xc nh
nh hnh_9.
Gi do l khong cch t ngun ti im O, gi s sut liu ti im ny l 100. Ta xt cc
im Q c khong cch d1 t ngun (d1> d0), sut liu ti im ny l:
X1 = 100 (do/d1)2 < 100
Tng t ta xt ti im A c khong cch d2 t ngun (d2 > d1 > d0), sut liu ti ba im ny l:
X2 = 100 (do/d2)2 < X1 = 100 (do/d1)2 < 100
28
x xuyn qua cng tun theo lut t l nghch bnh phng khong cch (RR v QQ trong hnh,
trong RR l kt qu o c vi cht hp th dy hn).
Tm li, vi ngun im cng chm bc x ln nht ti tm trng chiu v gim dn
theo khong cch t tm do lut t l nghch bnh phng khong cch, sau gim t ngt n
mt gi tr ph thuc vo s xuyn qua cht hp th ca lp che chn ngun v sau cng gim
chm mt ln na theo lut t l nghch bnh phng khong cch. y l beam profile ca mt
chm tia bc x.
Tuy nhin trong thc t ngun ca cc my x tr khng phi l ngun im m c th
c coi l c kch thc nh hnh_11. Nu t kch thc ngun l S, khi nh hng ca mt
ngun c kch thc n beam profile s c minh ha nh sau:
29
Sau cng l nhng im trong vng UA v BV: Ti U l im khng nhn thy ngun v
vy ch c bc x xuyn qua. Ngc li ti A ton b ngun c nhn thy v v vy
cng ti y tng ng vi cng im trung tm. i vi nhng im gia U v
A cng tng dn t U ti A v cng tin v A phn ngun nhn thy cng nhiu hn.
Vng ny l c trng ca beam profile ca mt ngun c kch thc.
S thay i t ngt ca cng trong ngun im c thay bi mt vng cng
thay i t t ngt hn. Kch thc ca vng ny l UA, BV v ch yu do cc h s hnh hc
nh S, do v D to thnh. Vng ny c gi l Penumbra ca trng chiu. rng ca vng
penumbra c th c tnh ton t tam gic ng dng hnh I-10, tam gic S1S2Z v ZUA l hai
tam gic ng dng, v vy:
S
UA
=
S1Z AZ
ZA
hoc UA = S
S1Z
S1Z
D
=
ZA d 0 D
d D
UA = S 0
= S 0 1
D
D
(3)
30
31
1.0000,
0.8000,
0.6000,
0.4000,
0.2000,
0.0000,
1
11
13
15
17
19
21
23
25
27
29
31
III. H s Output:
Mt h s vt l quan trng khc cn thit trong vic xc nh liu lng thng qua vic
o c xut liu chiu hay cn gi l Output ca my ti tm trng chiu. V trong trng
chiu sut liu chiu thay i t v tr ny sang v tr khc, nn n gin ngi ta chn tm
Bi Ging vt L X Tr _ Trn Cng
32
trng chiu lm chun v n l im d xc nh. Thng thng sut liu chiu ti v tr ny cng
l sut liu chiu cc i ca trng.
Output c o c bng bung ion ha trong mt phantom nc, gi tr o c t bung
ion ha s bao gm hai thnh phn: thnh phn s cp v thnh phn ng gp ca tn x. Trong
thnh phn s cp l nhng phonton n trc tip t ngun, v nhng photon tn x c to
ra t s tng tc ca chm photon s cp vi cc lp che chn nh collimator Nu ta gi X l
liu chiu tng, Xp l thnh phn liu chiu do chm s cp, v Xs l thnh phn liu do photon
tn x to thnh, khi ta c th vit nh sau:
X = Xp + Xs (1)
Xp ph thuc vo mnh ca ngun v khong cch t ngun (theo lut t l nghch bnh
phng khong cch), nhng khng ph thuc vo cu trc vt l my nh cu trc ca
collimator. Xs ph thuc vo cng chm photon s cp, v v vy, n ph thuc vo tt c cc
h s m chm photon s cp ph thuc vo. Do ngi ta c th vit :
Xs = k .Xp
(2)
X = Xp(1 + k) (3)
Trong gi tr k ph thuc vo cu trc hnh hc v c tnh vt l ca collimator. T
ta thy rng sut liu chiu ph thuc vo k, tc l ph thuc vo cu trc hnh hc v c tnh vt
l ca thit b che chn nh collimator v vy h s Output s thay i ph thuc vo cu trc
hnh hc v c tnh vt l ca thit b che chn hay ph thuc vo Collimator
Nu sut liu chiu ti mt khong cch cho trc t ngun c o theo s thay i ca
kch thc trng chiu bng cch thay i ci t collimator, ngi ta thy rng nhng gi tr
l khc nhau.
33
kch thc khc nhau l Xa, Xb , v gi s Xr l sut liu chiu ca mt trng chiu c chn
lm chun thng l 10x10 cm. Output factor c th c nh ngha nh sau:
OFq = Xq/ Xr
(4)
Trong OFq l Output Factor v Xq l sut liu chiu cho trng q x q. Hnh_3 m t
hnh dng ca h s Output Factor theo nhng m Collimator khc nhau.
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Vic xc nh PDD c thc hin bng cch o c liu ti nhng su khc nhau
trong mt phantom nc. Trong hnh_4, im P cho thy im liu cc i, v Q l mt im no
trong phantom. PDD ti im Q c xc nh nh sau:
PDD(Q) = [D(Q)/D(P)] x 100
(5)
Khi nng lng chm photon tng vng build-up cng s tng do su cc i dm ln
hn v qung chy electron rng hn v PDD ca chm tia cng tng theo nng lng.
Khi kch thc hoc hnh dng ca mt trng bc x thay i PDD tng hu nh tuyn tnh t
kch thc trng rt nh, sau tng t t v t n gi tr cc i ti mt vi kch thc
trng ln hn.
V. S Phn B ng Liu:
T s phn b liu ti cc su khc nhau chng ta bit c ng c trng Build Up
v PDD dc theo trc trung tm ca chm tia t kt hp vi cc h s khc c th tnh ton
c liu hp th ti cc im di b mt phn cch dc trc trung tm ca chm tia. Hay ni
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cch khc ta c th thu c s phn b liu dc theo trc trung tm. Nhng trong thc tin ngi
ta cn bit liu trn ton th tch ca khi bu v vy nhng thng s liu dc trc trung tm l
khng , v liu ti nhng im bn ngoi trc trung tm cng cn c tnh ton. tnh ton
c liu trong mt vng th tch nh vy ngi ta c th thit lp mt bng PDD cho tt c
nhng im trong trng chiu bng mt mng ba chiu v t c th tnh ton liu ti bt k
im no trong vng th tch c chiu. Nhng vic tnh ton thit lp bng liu nh vy l
khng thch hp cho vic biu din s phn b liu lng v trong thc t ngi ta cn s phn b
liu trc quan hn. V vy khi p dng vo thc tin vic biu din liu tng i thng c
thc hin trn mt mt phng hai chiu theo dng ca mt s phn b ng liu. Thun li ca
vic s dng s phn b hai chiu l: s biu din n gin, ngi ta c th biu din d liu
theo dng mt chui nhng ng cong ng liu gi l ng ng liu v mt phn b nh
vy gi l s phn b ng liu.
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s phn b liu trong ton vng th tch chiu tia nh gi s phn b liu lng trn ton b
vng th tch .
VI. Thng S Ca Chm Tia Nng Lng Cao TMR v TPR:
Vi cc h s lch trc OAF, h s collimator v s phn b liu theo su chng ta
c th tin on v tnh ton c mt s biu din phn b liu ti cc im bt k trong mt
vng th tch chiu x. Tuy nhin chng ta cha th hon ton tch ton c gi tr liu hp th
hay cc gi tr ci t tham s chiu cho my nh MU hay thi gian chiu. tnh ton c liu
hp th ti mt im hay tch ton cc gi tr MU nh vy chng ta cn thm cc thng s quan
trng khc. Cc thng s ny c mi quan h vi cc gi tr ca s phn b liu theo su PDD.
Tuy nhin ty thuc vo vng nng lng s dng trong iu cng ty thuc s pht trin ca lnh
vc iu tr bc x ngi ta c cc tham s khc nhau nh PSF, TAR, TMR v TPR.
Cc tham s PSF v TAR thng c p dng cho cc chm tia nng lng thp v cc
php o c thc hin o c trong khng kh vi mt Buildup-cap, tuy nhin vi cc chm tia
bc x nng lng cao v s tnh chnh xc hn cc nh hng trong c th cc php o trong
khng kh khng cn ph hp v su liu cc i dm ln hn khng nh hng n php o
PDD, nhng gy nh hng ti php o TAR.
Vi photon nng lng cao khi thc hin cc php o trong khng kh ngi ta s cn mt
builup cap ln t 8-10 cm ng knh, v build-up cap ny s tr thnh mt phantom c kch
thc ln v s tn x trong phantom buildup cap ny l khng th trnh khi, c bit vi kch
thc trng nh s tn x l quan trng. V d cho trng 4 x 4 cm2, r rng builup cap ln hn
kch thc trng, v gi tr c c t bung ion ha phi cha mt thnh phn tn x. V s
ion ha tp hp trong bung l ch yu to bi s tng tc ca photon trong build-up cap, v gi
tr c c lc ny l gi tr trung bnh ca ton b th tch build-up cap. Mt khc mt buildupcap dy cng lm suy gim chm tia ng k, v v vy gi tr c c t bung s biu din
thnh phn s cp suy gim. V l do ny hai s hng mi TMR (t s m cc i: Tissuemaximum-ratio) v TPR (t s m phantom: tissue-phantom-ratio) c a vo s dung. Mc d
nhng s hng ny c s dng trong tnh ton liu ging nh trong trng hp TAR, nhng
chng c mt ngha khc vi TAR.
TMR v TPR:
tm hiu v h s TMR v TPR trc tin ta xt m hnh o nh hnh_7, s bn tri,
im P c t trn trc chnh ti khong cch SAD t ngun, bn trong mt phantom nc xc
nh c trng chiu l A v ti su dm. Trn s phi tng t nh vy, ngoi tr dy
nguyn liu pha trn im P thay i t dm thnh d. TMR c nh ngha l:
TMR(A,d) = ( liu hp th vi d cm phantom)/ ( liu hp th vi dm cm phantom)
= D(A,d)/Dm(A,dm)
(6)
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(7)
TPR (Fd , Dd ) =
(8)
(9)
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