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Bi Ging Vt L Ht Nhn ng Dng

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

V vy khoa x tr yu cu c mt s lin kt, hp tc gia nhng nhn vin m nhn


trch nhim v y khoa, v thit b v v vt l.
V. i Ng Nhn Vin Ti Khoa X Tr:
i Ng Nhn Vin:

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

Thc hin mphng

QA & QC thit b

Thc hin iu tr

Trin Khai KT mi

Thc hin QA n gin

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

 HT. Thng Tin

 P. Nhn Bnh

Qun L H S BN

TT. Bnh Nhn

Qun L NV & TB

Vin Ph

 Khu Ho Tr

Lch T & TD

Phc & Liu Lng

TD. Ti Khm

Qun L Bit Dc

 Khu X Tr
 P. M Phng

 HT. LKH

D Liu MP

Lp KHT

Phim MP

D Liu chm Tia

 My Linac
TT iu Tr

S H Thng Mng V D Ca Mt Khoa Ung Bu

Nh Ung Bu Hc bc x: c trch nhim trong vic khm v ra quyt nh iu tr. H


s quyt nh v phng thc iu tr, ch nh liu lng v theo di bnh nhn.

i ng K S Vt L x tr: c trch nhim trong vic m bo cht lng thit b, lp k


hoch iu tr (nh hng n cht lng ca t iu tr trn bnh nhn). H a ra k
thut iu tr da trn nhng ch nh ca cc nh Ung Bu hc bc x v m bo cht
lng ca vic iu tr theo ng k thut a ra.

i ng K Thut Vin: y l i ng c mi lin h mt thit, cht ch gia cc nh Ung


Bu hc, i ng K S vt l v bnh nhn. H c trch nhim trong vic thc hin k
thut iu tr c a ra, nhng yu cu ca vic iu tr t c kt qu iu tr
mong mun. H l i ng trc tip thc hin vic iu tr, h h tr thc hin cc k thut
iu tr v l ngi c nhiu ng gp trong vic nh gi v hon thin cc k thut iu
tr ang p dng. Cng vic ca h nh hng trc tip n cht lng iu tr v n lc
iu tr ca c mt quy trnh iu tr.

Bi Ging vt L X Tr _ Trn Cng

iu dng, Y t v Nhn vin vn phng: l i ng tip nhn v gii quyt th tc cho


bnh nhn, gip h tr bc s trong khm bnh v hon tt h s bnh n. Vi trnh
chuyn mn cao hn h c th m nhim trong vic qun l v lu tr h s.

VI. H Thng Thit B Ca Mt Khoa X Tr:


H Thng Thit B:

- Thit b h tr khm bnh.


- H thng mng lu tr v trao i thng tin .
- H thit b h tr iu tr.
- H thit b hnh nh, My CT cho mc ch iu tr.
- My m phng.
- H thng lp k hoch.
- My iu tr.
- H thng thit b kim tra

VII. Quy Trnh iu Tr Ti Khoa X Tr


Qui trnh ieu tr la s khai quat cac bc cua mot t ieu tr ma ngi benh phai i
qua. Qui trnh ieu tr noi nen s logic ve to chc va noi len nhiem vu, trach nhiem cac nhom
nhan vien tham gia vao cong tac ieu tr bang bc xa. Co the khai quat qui trnh ieu tr xa
tr bang s o sau:

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.

Bi Ging vt L X Tr _ Trn Cng

H Thng Trang Thit B Trong n V iu Tr Bng Tia X


I. Tng quan v h thng trang thit b ca n v iu tr:
Cc thit b ca mt khoa x tr c gii thiu s lc trong phn trc, tuy nhin mt
cch tng quan cc thit b ch yu ca mt n v x tr s bao gm:
Thit b iu tr.
Thit b chn on
H thng lp k hoch
My m phng v h thng thit b kim tra
H thng phng muold room
H thit b o liu v QA-QC
Trong :
Thit b iu tr:
Thit b x tr ngoi:
My iu tr b mt X-quang sut liu cao
My Co_60
My gia tc tuyn tnh
My gia tc ht nng
Thit b x tr trong:
Kim phng x v Implane
My sut liu thp LDR
My sut liu cao HDR
Thit b chn on:
my chp X-Quang, CR
my siu m
my CT ct lp
my DSA
my MRI
my SPEC
my PET hoc PET/CT
H thng lp k hoch:
Lp k hoch iu tr x trong
Lp k hoch n gin 2D
Lp k hoch conformal 3D
Lp k hoch IMRT IGRT
Lp k hoch Radiosurgery.
My m phng - H thng thit b kim tra:
My m phng.
My CT-m phng
Thit B chp Port Film, CR, DR
H thng EPID
H Thng thit b phng Mould room:
My ct block cho electron v photon

Bi Ging vt L X Tr _ Trn Cng

Ni nu hp kim to block che chn


Dng c c kh, khoan, my phay v thit b khc
H thit b o liu v QA-QC:
H Phantom nc.
H thng qut trong khng kh
Phantom rn tng ng nc.
Phantom c bit (la chn)
Bung Ion ha cho chm photon.
Bung ion ha cho chm tia electron.
Nhit k.
p sut k
Electrometer
Thit b kim tra n nh ca bung ion ha
Thit b kim tra n nh ca Electrometer.
Phim chp kim tra.
H thng qut mt phim. (densitometer)
H thng o liu trn bnh nhn (TLD v Diodes).
Thit b kim tra Laser v Isocenter.
Phantom cho CT v chun phn mm lp k hoch.
Electrometer cho vic kim tra kV v mA cho my tia X.
Cc thit b t lm nu c.
II. Thit B iu Tr:
II.1. My ii tr b mt
My iu tr b mt c ch to v p dng cho nhng trng hp ung th da c xm
ln t. My iu tr b mt l nhng my X-quang sut liu cao c cc b collimator tng ng vi
cc vng din tch iu tr.
II.2. my Co-60:
My Co-60 l thit b iu tr s dng ngun bc x nng lng cao 1.33 MeV c pht
ra t ngun ng v phng x Co-60 chiu vo cc khi bu bn tronh bnh nhn. My Co60 ngy nay c thit k cng rt gn v c hnh dng ging vi cc my gia tc tuyn tnh.

II.3. Cc thit b ng dng gia tc tuyn tnh:


Cc My iu tr x tr ng dng gia tc tuyn tnh l cc thit b iu tr hin i da trn
s gia tc tuyn tnh cc ht electron trong mi trng in t trng v to ra chm tia photon
bng cch cho chm tia electron bn vo mt bia tia X. Cc my ny c th to ra c cc mc
nng lng khc nhau ca chm tia iu tr ph hp hn trong vic iu tr cc tn thng cc
v tr su. My gia tc tuyn tnh cho php la chn hoc chm tia photon hoc chm tia electron

Bi Ging vt L X Tr _ Trn Cng

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 ...

IV. H Thng Lp K Hoch iu Tr:


H thng lp k hoch l mt h thng bao gm my tnh v phn mm dng cho cng
vic m phng iu tr v tnh ton liu lng, thng s ci t my theo m hnh b tr nh
trong m phng. H thng lp k hoch s s dng cc d liu hnh nh nh nh CT, MRI, PET,
DSA sau s kt hp vi m hnh ha iu tr v cc thut ton tnh liu tnh ton s
phn b liu ti u cho vic iu tr. Trn th trng hin nay c nhiu hng cung cp h thng lp
Bi Ging vt L X Tr _ Trn Cng

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.

Cc h thng lp k hoch hin nay bao gm cc phn:


Lp k hoch iu tr x trong
Lp k hoch iu tr 2D
Lp k hoch iu tr 3D
Lp k hoch iu tr k thut IMRT - IGRT
Lp k hoch Radiosurgery
V. H thng m phng v kim tra.
H thng my m phng bao gm my m phng v h thng my tnh iu khin my
m phng cng nh lu tr v s l d liu m phng. H thng my m phng ch i km vi
my iu tr Co-60 v my gia tc tuyn tnh cc my iu tr khc c th khng s dng n my
m phng, h thng my m phng l mt my soi X-quang c cc tnh nng v m hng ging
nh my iu tr gia tc tuyn tnh hay my Co-60. chc nng ca my m phng l kim tra
vic iu tr v vic che chn c to ra t h thng lp k hoch trc khi a bnh nhn iu tr
chnh thc trn my iu tr. Cc th h my m phng khc nhau c cc tnh nng pht trin khc
nhau nh chc nng CT chng hn

VI. H thng Phng Mould room:


L phng c s dng thc hin cng vic to cc mt n, cc khun c nh cho
bnh nhn, phng mould room cng l phng to cc khi che chn, cc dng c c kh

Bi Ging vt L X Tr _ Trn Cng

phng ny cng c trang b cc h thng nh v nh trong phng m phng, v cn c


xem nh mt workshop.

VII. H Thit B o Liu v QA-QC:


H thng thit b o liu v QA-QC l h thng khng th thiu trong mt trung tm iu
tr bng bc x v l cng c chnh ca cc k s vt l thc hin cc cng tc lin quan n
cc php o c liu lng v cng tc bo m cht lng ca chm tia bc x cng nh
chnh xc, tin cy ca h thng thit b iu tr. y l h thng thit b quan trng i vi cc
nh vt l. Cc thit b cn thit ca h thng o liu n cn bn c lit k nh phn trn.

VIII. Tng Quan V My iu Tr Gia Tc Tuyn Tnh:


VIII.1. Gii Thiu V My Gia Tc:

Bi Ging vt L X Tr _ Trn Cng

VIII.2.

Cc Thnh Phn Chnh Ca My Gia Tc Tuyn Tnh:

Cu trc my gia tc tuyn tnh trong iu tr x tr c to nn t rt nhiu chi tit khc


nhau, tuy nhin mt cch tng quan ta c th chia lm 6 phn chnh:
- Phn thn my ng yn.
- Thn quay ca my hay Gantry
- u my hay Collimaytor
- Bn iu Tr.
- Phn iu Khin my
- Thit b ghi hnh kim tra.

V m t chi tit cc phn cu to ch yu cn ch bao gm:


- b pht sng cao tn RF
- Sng pht electron.
- ng gia tc.
- ng gia tc tuyn tnh.
- B b chm tia.
- Bia tia X.
- Chamber iu khin liu lng.
- B lm phng chm tia.
- B nh dng trng chiu hay Collimator chun.
- B nh dng trng chiu nhiu l MLC
- H thng quang hc.
- Bn iu tr
- H thng iu khin
- H thng nh v v kim tra EPID

Bi Ging vt L X Tr _ Trn Cng

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VIII.3.

Nguyn L Hot ng Ca My Gia Tc Tuyn Tnh:

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.

Mt S Khi Nim khi s dng my gia tc trong iu tr ung th:

Bi Ging vt L X Tr _ Trn Cng

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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

2. Gantry: L phn thn my c th quay c 3600 quanh mt tm quay, b ng gia


tc v nhiu thit b khc u nm trn Gantry. Cc chm tia bc x cng c pht
ra t mt v tr trn Gantry v ty vo v tr gc ca Gantry, cc chm tia s chiu vo
bnh nhn theo cc hng khc nhau.

3. Collimator: L mt khi gm cc Jaws hay cn gi l cc ngm cu thnh nn c


coi l phn u my nm trn Gantry. Collimator v vy xc nh kch thc v gc
quay ca cc chm tia bc x pht ra t ng gia tc. Nh gc quay ca Collimator m
cc chm bc x c lm ph hp hn vi hnh dng khi bu.
4. Jaws: l cc khi kim loi che chn s cp ca my tao ra mt kch thc v hnh
dng chm tia bc x ph hp vi ln ca vng cn chiu v ng thi che chn
vng khng cn chiu x. Cc jaws ny gm 4 ci xp theo hnh tng cp i xong
vi nhau theo hnh ch nht to thnh b gi l Collimator v c gn nm trn
Gantry
5. MLC: L mt Collimator thc cp nm pha di ca b Collimator s cp. B MLC
c to nn bi nhiu l kim loi mng gp vi nhau theo tng cp i song ging
nh 2 jaws c Collimator s cp. MLC gip to ra cc chm tia bc x ng theo
hnh dng v kch thc khi bu ti cc hng khc nhau ca Gantry.

Bi Ging vt L X Tr _ Trn Cng

12

6. Trng Chiu X (Radiation Field): l chm tia bc x chiu vo vng tn


thng vi hnh dng v kch thc c xc nh bi cc collimator s cp. kch
thc trng chiu i vi cc my gia tc tuyn tnh l kch thc o c ti tm
quay ca Gantry cch ngun 100cm

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.

Bi Ging vt L X Tr _ Trn Cng

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10. Ch Th Khong Cch Bng Quang Hc (Range Finder): l mt b n chiu c


hin th cc thang chia chnh khong cch t bia tia X n v tr ang o. Thng
dng o khong cch SSD.
11. Trays (Gi Khi Che Chn): L mt dng c bng mica cc khi che
chn. i vi cc my gia tc c MLC th cc Tray ny khng cn c s dng na.

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.

Bi Ging vt L X Tr _ Trn Cng

14

15. Breast Board: Cng l mt dng c h tr trong iu tr nh Headrest, im khc


bit l dng c ny c s dng cho cc ca ung th v v vng ngc m thi.

16. Lung Board: l dng c h tr iu tr ging nh Breast Board, nhng y l dng


c c thit k c bit cho nhng ca ung th phi.
17. Themoplastic Mask: L mt dng c dng c nh cho bnh nhn. Loi dng c
ny lm bng nha thng minh c th thay i hnh dng khi nhit thp, v khi
nhit quy nh chng s tr v hnh dng ban u. Loi mt n ny c nhiu loi
vi hnh dng v kch thc khc nhau cho tng vng ca c th nh u, bng v
vng chu.

Bi Ging vt L X Tr _ Trn Cng

15

18. Bolus: l mt vt liu ging nh m ngi c tc dng b p phn m b thiu ht


to ra nhng vng m bng phng hoc tng b dy ca vng m c chiu x
ln t tng liu vng m gn b mt hay trn b mt ca da. Bolus c thit k
thnh cc tp ln vi cc dy khc nhau cho cc mc ch s dng khc nhau.

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.

Bi Ging vt L X Tr _ Trn Cng

16

Vai Tr Ngi Vt L v Cng Tc Vt L Trong iu Tr X Tr


I. Nh Vt L X Tr:
Nh Vt L x tr hay ni chnh xc hn l cc nh Vt l y khoa, h l nhng nh Vt
l c o to v chuyn mn ng dng Vt l ht nhn trong Y khoa bao gm kin thc
Vt l v kin thc v Y khoa. V x tr h c o to cc chuyn mn lin quan n cng tc
x tr ca mt nh Vt l. Ti cc nc pht trin, ngi Vt l y khoa c o to theo mt
chng trnh rt bi bn. nc ta hin nay, cha c trung tm hoc trng lp o to v
chuyn nghnh ny.
II. Vai Tr Ca Nh Vt L Y Khoa:
Nh vt l y khoa ng mt vai tr khng nh trong mt trung tm x tr. H m nhn
trch nhim v cc cng tc Vt l trong x tr. Nhim v chnh ca cc nh Vt l y khoa trong
x tr c th s lc nh sau:

m bo cht lng trang thit b.

m nhim cng tc v o c liu lng.

Cung cp gi liu chm tia bc xa t cc my iu tr.

T vn trong iu tr bng bc x

m nhn trch nhim v m bo cht lng vic lp k hoch iu tr.

nh gi chnh xc ca vic lp k hoch v k thut iu tr.

Lp k hoch v thc hin iu tr x.

Chun cc chm tia x ngoi v cc ngun x trong.

Thu thp d liu cho cc thit b mi.

C vn v k thut v khoa hc trong lnh vc an ton bc x.

C vn trong vic pht trin k thut, pht trin v mua mi thit b.

Nghin cu v pht trin.

Trn y trnh by mt cch tng quan v nhim v ca cc nh Vt l y khoa trong cc


trung tm x tr. Tuy nhin trong thc t, tu theo m hnh t chc, c cu t chc v iu kin
c th tng trung tm, cc nh Vt l y khoa s c phn cng v giao trch nhim c th khc
nhau trong mt mi lin h cht ch m bo cc nhim v trn c hon thnh tt nht nh
c th. Mt s nhng nhim v ch yu trn s c cp chi tit cc phn k tip.
III. T Chc i Ng Vt L Y Khoa Trong Mt Trung Tm X:
V y l i ng cn thit trong mt trung tm x tr v i ng ny c mt vai tr kh
quan trng trong qu trnh hot ng ca khoa, v vy vic t chc mt i ng nh vy l cng
vic cn c ch trng. Vic t chc bt c i ng nhn vin no u ph thuc vo m hnh
t chc v yu cu thc t ca cc trung tm. Tuy nhin y chng ta c th trnh by mt cch
chung nht v t chc mt i ng nhng nh vt l y khoa trong mt trung tm x nh sau. Mt
trung tm x c t hai my gia tc (theo thc t ti vit nam) nn c ti thiu t 5 hoc 6 nh vt
l y khoa vi vai tr nh sau:

Bi Ging vt L X Tr _ Trn Cng

17

Vt l trng: l ngi chu trch nhim chung v cng tc vt l trong khoa, Vt l


trng l ngi nm bt v hiu rt r v cng tc vt l x tr cng nh nhng yu cu
ca n t a ra: cc quy trnh lm vic, nhng yu cu cng vic v nhng phn
cng hp l cng tc vt l n cc nh vt l khc, cng nh ra cc phng hng
nghin cu, pht trin k thut v m nhn cng tc o to v lnh vc ny.
Cc nhn vin Vt l khc: l nhng nh vt l c o to chuyn mn hoc c
nhng kin thc chung v vt l x tr v cng tc vt l trong x tr. Nhim v ca
nhng nh vt l ny l thc hin cc cng vic vt l hng ngy ca trung tm x theo
ng quy trnh v yu cu ca cng tc x tr.
IV. Cng Tc Vt L Trong X Tr:
Ti Vit Nam, nhng nm gn y my gia tc c a vo x dng trong iu tr v
ang dn dn thay th cc my Co-60 c k ca nhiu thp nin trc y. Vi s thay i ny
to nn mt bc pht trin mi trong lnh vc c coi l p dng nhng k thut cao trong
y khoa. Song song vi vic p dng cc thit b hin i vo i sng l s i hi nhng nhng
i mi v con ngi v cng vic lin quan n nhng thit b k thut . Cng tc vt l
trong x tr c th ni l mt trong nhng s thay i .
Cng tc vt l trong mt trung tm x nh c lit k trong mc trn, tuy nhin
mc ny chng ta s phn tch thnh nhng khu c th ca cng tc vt l theo trnh t t
nhng yu cu cho vic chun b ban u khi thnh lp khoa cho n cc cng tc hng ngy khi
khoa i vo hot ng. Cc cng tc bao gm:
Xy dng h thng l thuyt v h thng lu tr qun l thng tin.
Xy dng chng trnh kim tra bo m cht lng trang thit b.
Xy dng chng trnh an ton bc x.
Kim chun v thu thp d liu chm tia.
Cng tc kim tra v bo m cht lng my gia tc.
Cng tc o v chun liu lng chm tia photon v chm tia electron.
nh gi, bo m cht lng d liu chm tia v h thng lp k hoch.
Cng tc lp k hoch iu tr.
Cng tc kim tra v nh gi k hoch iu tr.
K hoch pht trin v o to.
S quan trng ca mt quy trnh cng vic nh vy l v n xc nh c mc tiu,
phng hng v yu cu cng vic r rng. Mt quy trnh r rng nu c hon thin s to
nn mt h thng l thuyt khoa hc vi cch thc t chc, lu tr v bo qun d liu hiu qu
trong cng tc vt l, v l yu t quyt nh n cht lng iu tr ca trung tm cng nh m
bo v mt php l ca trung tm khi c cc cuc kin tng xy ra.
ngha ca tng cng tc c th:
Xy dng h thng l thuyt v h thng lu tr qun l thng tin: l vic xy
dng mt h thng l lun v cc quy nh v cng tc Vt L ti mt trung tm x tr bng cch
ban hnh nhng vn bn, ti liu lin quan n cc cng tc vt l x tr, ni ln mc tiu v tm
quan trng ca cc vn bn . N c xem nh mt quy trnh hay mt m hnh hot ng cho
cng tc vt l ti mt khoa x tr. Vic nh gi cc d liu thu thp c lin quan n cng
tc vt l v x tr c a ra sau , t hng dn vic thit lp h thng lu tr d liu

Bi Ging vt L X Tr _ Trn Cng

18

ph hp. Vic lu tr d liu l mt yu cu quan trng lin quan n mt php l v an ton


bc x v nn c t chc mt cch khoa hc, ngn np. Mt cch tt nht, vic lu tr nn
tham kho phng php lu tr d liu theo m hnh qun l d liu ca ngnh cng ngh thng
tin nu c th.
Xy dng chng trnh kim tra bo m cht lng trang thit b: y l vic thit
lp mt chng trnh hon chnh v l thuyt v cc bn ti liu lin quan n vic kim tra v
m bo cht lng cc trang thit b quan trng trong khoa. Vic xy dng ny nn c chun
b trc khi khoa i vo hot ng v n s l phng hng hot ng v cng tc vt l khi
vic iu tr trn bnh nhn c tin hnh.
Xy dng chng trnh an ton bc x: Ging nh vic xy dng chng trnh kim
tra cht lng, chng trnh an ton bc x nn c xy dng t rt sm nh c th. N ni ln
s an ton v lao ng cng nh v an ton trong iu tr ca khoa. Chng trnh an ton bao
gm v an ton bc x v an ton cho nhn vin. Chng trnh an ton boa gm nhng vn bn
php l lin quan, cc phng php theo di, x l v lu tr d liu lin quan n vn an
ton.
Kim Chun V thu thp d liu chm tia: y l mt quy trnh thin v chuyn mn
vt l i hi nhng ng gp v kin thc vt l v nhng k nng ca cc nh vt l trong vic
thu thp d liu. Cng tc ny c thc hin ngay nhng ngy u tin khi cc thit b c ci
t v y l khu chun b, kim tra trc khi a cc thit b vo iu tr trn bnh nhn.
Cng tc kim tra v bo m cht My Gia Tc: y l cng tc thng xuyn ca
cc nh vt l y khoa. Cng tc ny da trn l thuyt v cc ti liu c xy dng t chng
trnh kim tra v bo m cht lng trn. Cng tc ny nh gi s chnh xc trong iu tr v
ng gp vo kt qu iu tr c bit trong nhng trng hp iu tr k thut cao (nh iu tr
vi khung stereotacxy hoc iu tr chnh xc).
Cng tc o v chun liu lng chm tia Photon v chm tia Electron: Cng tc
ny hon ton c ngha ging nh cng tc kim tra cht lng my gia tc, n c thc hin
da trn nhng kt qu c c t chng trnh kim tra v bo m cht lng. Cng tc ny
nh gi s chnh xc v mt liu lng v mt cng tc quan trng vi cc nh vt l y khoa.
nh gi, bo m cht lng d liu chm tia v H Thng Lp K Hoch: L mt
cng tc kh quan trng i hi nhiu v cc kin thc chuyn mn ca nhng nh vt l y khoa.
Cng tc ny c thc hin trc khi h thng lp k hoch c ng v a vo cng tc
iu tr ca khoa.
Cng tc lp k hoch iu tr: Cng tc ny c th ni tu thuc vo h thng o to
v t chc ca tng quc gia, tng trung tm. Ti cc trung tm v cc nc tin tin c mt h
thng o to tt, mt i ng k thut vin c o to chuyn mn tt s l ngi thc hin
cng tc lp k hoch x tr. Tuy nhin cc nc khc ni m h thng o to v x tr cha
c hon chnh hoc cha c nh Vit Nam th n l trch nhim ca cc nh vt l, mt
khc n ph thuc vo php l ca tng quc gia. Cng tc ny i hi v k nng nhiu hn l
v kin thc chyn mn, nhng n l mt cng vic phc tp i hi s tng hp kin thc v Y
khoa v v Vt l t c mt k hoch iu tr tt. Trong cng tc ny khng ch c trch
nhim ca cc nh Vt l hay K thut vin m l s kt hp cht ch ca ngi lp k hoch v
nh Ung bu hc bc x v trong cc trng hp phc tp l cc nh chuyn mn Y khoa khc.
Cng tc kim tra v nh gi k hoch iu tr: Cng tc ny l bc th hai sau
cng tc lp k hoch, n gm hai phn: kim tra v nh gi k hoch. Kim tra m bo bn k
hoch c thc hin chnh xc v khng sai xt trong qu trnh lp k hoch. Cng tc ny i
hi s hiu bit chuyn mn ca cc nh Vt l v nn c xem l mt cng tc cn thit trong
quy trnh iu tr bng bc x ti cc trung tm x tr. Cng tc ny c thc hin bi cc nh

Bi Ging vt L X Tr _ Trn Cng

19

Vt l v l mt khu quan trng ti cc nc c ngnh x tr pht trin. nh gi k hoch l


trch nhim ca cc nh Ung bu hc, vic nh gi k hoch cho bit k hoch c hon ho
v s phn b liu, liu kim sot bu v liu kim sot bin chng hay khng. Vic nh gi
k hoch tt nht l s kt hp ca c hai i ng Vt l v cc Nh ung bu hc. Vic kim
sot bu l mt cng tc kh quan trng. Mt trung tm x tr t chc tt, vic nh gi k
hoch x tr s c ch trng, n s c gii thiu nhng trng hp tiu biu trc khoa v
l ch tho lun rt kinh nghim v v Target, la chn nng lng chm tia, la chn s
phn b liu v nhng nh gi v liu lng. T vic nh gi k hoch nh vy nhng thiu
st trong tnh ton liu, v target v thc hin iu tr s c rt kinh nghim v ng gp rt
nhiu trong vic ci tin nng cao kt qa iu tr v gip cc i ng nhn vin hiu nhau hn
cng nh hc c nhiu hn v nhng sai st trong x tr.
K Hoch Pht Trin V o To: y l cng tc ch yu ca cc nh lnh o, trong
c th l vai tr ca ngi Vt l trng. N nh hng cho vic nng cao cht lng iu tr
hin ti thng qua hc tp rt kinh nghim chuyn mn v nh hng cho vic pht trin, trin
khai cc k thut mi vo iu tr.
Trn y l s trnh by mt cch s lc v ngha, vai tr v v tr ca tng cng tc vt l
trong hot ng ca mt khoa iu tr. Tuy nhin cc thay i b xung hay thay i v ngha
v cch thc hin cn ty thuc vo thc t tng trung tm.
V. T Chc Nhn S V Cng Tc Vt L:
y l vic b tr, phn cng cng vic cho cc nhn vin Vt l. Cng tc vt l trong x
tr c nhiu phn khc nhau tu vo mi quc gia m cng tc vt l chia lm hai phn: cng tc
lin quan n lp k hoch v cng tc QA-QC. Vit Nam hin nay do cha c trung tm o
to v lnh vc x tr cho cc vt l y khoa v k thut vin, do cng vic lin quan n lp k
hoch l cng vic ca cc nh vt l.
S b tr cng vic cho i ng vt l do cng c th chia thnh hai phn chuyn mn:
lin quan Lp k hoch v v QA-QC. Vic t chc nhn s da trn hai mng chuyn mn ny
l mt yu cu tt yu v l cng tc qun l, n thuc trch nhim trc tip ca ngi Vt l
trng v ban lnh o khoa.
S b tr cng vic c th phn chia nh sau: i vi mt trung tm x vi t nht hai my
lp k hoch v hai my gia tc, ti mt thi im nn c:
-

3 nhn vin cho cng tc lp k hoch.

2 nhn vin kim tra k hoch v nhp thng tin

1 nhn vin cho cng tc m phng.

2 nhn vin cho cng vic QA-QC.

S b tr s lng nhn vin cho cc cng tc nh vy c tnh n s kim tra cho


(Double check) trong mi cng tc m bo tnh an ton v hiu qu iu tr. i vi mi
cng tc vt l trn i hi phi da theo nhng tiu chun c thng nht v ban hnh
thnh vn bn hoc cng b trong nhm vt l v trong khoa. Cc cng tc trn phi c m
bo v tnh nguyn tc trnh tnh trng khng thng nht trong cch nh gi kim tra, cng
nh vy vic m bo cht lng iu tr l da trn nhng tiu chun chung nht, nhng kin
thc chuyn mn c tho lun v thng nht. Mt s cng tc trong kim tra k hoch v
QA-QC i hi c tnh chuyn mn cao, do ti nhng khu ny cng yu cu mt n lc ln
hn v chuyn mn.
Vic phn chia cng tc trn nn c phn cng r rng ng ngi ng vic c lch
sp xp chi tit v c th. iu ny m bo c s hot ng c h thng trong khoa v hn
ch tnh trng chng cho trong cng vic.
Bi Ging vt L X Tr _ Trn Cng

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).

Hnh 1: S tng tc ca electron trong mi trng vt cht

Bi Ging vt L X Tr _ Trn Cng

21

II.2. Bia Tia X:


Nu cho mt chm electron tng tc vo mt bia mng v sau o cng tia X pht
ra ti nhng im cch u xung quanh bia ny, khi kt qu s tng tc ca nhng chm
electron nng lng khc nhau ln bia s c ch ra nh hnh_2. S biu din nh vy c gi
l s phn b gc ca tia X v bia mng trn c gi l bia tia X. Trong s phn b ny, khong
cch t bia ti ng biu din cng s cho bit cng tng i ca chm tia X ti mi
gc cho trc. Da vo s phn b nh vy ngi ta c th kt lun rng :

Hnh 2: S phn b theo gc ca tia X

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.

Hnh 3: Bia phn x v bia truyn qua

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.

Bi Ging vt L X Tr _ Trn Cng

22

III. Ph Nng Lng Chm Photon:


Trong qu trnh tng tc ca electron trong mi trng vt cht nh d cp trn, khi
cc electron tng tc vi in trng tnh in ca ht nhn nguyn t, chng s pht bc x
hm v bc x c trng. Nng lng bc x hm ph thuc vo nng lng elctron mt i trong
qu trnh tng tc , iu ny ph thuc vo in trng tnh ca ht nhn v khong cch ca
s tng tc (khong cch t electron n nhn). Vi mt vt liu lm bia cho trc, nng lng
photon pht ra s ph thuc vo khong cch tng tc. Hay ni cch khc, nu khong cch
tng tc rt nh (chng hn s tng tc l trc din) th ton b nng lng ca electron s
chuyn sang ch cho mt photon. V vy khi cho mt chm electron tng tc vi mt bia
tungsten ngi ta thy rng chm tia X sinh ra cha photon c nng lng t 0 n nng lng
ln nht ca electron, y l s phn b nng lng lin tc, v n ngc vi s phn b nng
lng gin on ca chm photon t ngun Co-60.
i vi bc x c trng, nng lng ca bc x c trng ph thuc vo bc s nguyn
t ca vt liu bia. Tm li, nng lng photon sinh ra t s tng tc electron v ht nhn
nguyn t ph thuc vo nng lng cc i ca electon v cu trc nng lng ca vt liu bia.
Tc l nu nng lng cc i ca electron ln hn nng lng lin kt cao nht ca nguyn t
vt liu bia, ngi ta s thu c nhng photon pht ra do s dch chuyn electron trong lp v
nguyn t vt liu lm bia. V sau cng ph nng lng photon ca mt chm tia X l ph tng
cng ca bc x hm v bc x c trng.

Hnh 4: Ph nng lng tia X l thuyt v thc nghim

Tm li ph bc x tia X gm hai thnh phn chnh: bc x hm v bc x c trng.


Trong bc x hm l ph nng lng lin tc, v ph bc x c trng l ph bc x gin on
(tng t ph nng lng ca photon t ngun ng v ). Ph nng lng photon l t rt thp (t
0) n gi tr cc i ca chm tia ti. Gi tr nng lng cc i ny thng thng l bng in
th gia tc ca my. Cui cng l ti vng nng lng thp hu ht cc photon nng lng thp
u b hp th bi s t lc.
IV. n V Nng Lng Ca Cc Chm Tia Bc X Trong X Tr:
Nh vy chm tia nc x t my gia tc tuyn tnh pht ra c th l chm tia Photon hoc
Electron. Cc chm tia bc x ny s c cc mc nng lng khc nhau ty thuc vo mc ch
iu tr v n v ca chng l khc nhau.
n v ca chm tia electron l MeV, v cc mc nng lng thng s dng l 5Mev
n 14 hay 16MeV.

Bi Ging vt L X Tr _ Trn Cng

23

ng v nng lng ca chm tia photon l MV v cc mc nng lng thng c s


dng l 4MV, 6MV, 10MV, 15 MV v 18MV.
Nng lng chm tia cng tng th kh nng xuyn su ca chm tia cng tng.
V. S Phn B Nng Lng Ca Chm Bc X Vi Mi Trng - S Cn Bng Electron:
S cn bng electron l mt hin tng xy ra trong phantom m, phantom m tng ng
vi nguyn liu trong phantom c c tnh phng x ging m mm chng hn nh l c tnh v
s tn x v s suy gim. Cc nguyn liu phi c bc s nguyn t v nng nh m mm,
thng l nc. Mt s nguyn liu khc nh lucite, masonite, wax .v.v. cng c nhng c tnh
nh m mm v vy cng c dng nh vt liu tng ng m.

Hnh 5: S qung chy ca Electron gn b mt phn cch m v khng kh

By gi ta s xem xt v s cn bng ny, xt mt phantom m ln vi mt phn cch m


khng kh t ti khong cch SSD t ngun. Cho mt chm photon c chiu vo b mt
phantom, mt s photon s tng tc vi nguyn liu phantom v to ra nhng electron c vn tc
cao. Liu hp th trong mi trng l do s mt nng lng ca nhng electron trn qung
ng i ca chng trong mi trng. Mi electron c tm nh hng ch trong qung ng i
ca n do nh hng ca mi electron trong mi trng c th c biu din bi mt ng
thng bng qung ng i ca n hnh_5. Nu gi s rng tt c nhng qung ng l bng
nhau v cng chiu vi chiu chm tia. V s tng tc ca mt photon hon ton l mt tin trnh
ngu nhin, v nu nh hng ca lut t l nghch bnh phng v s suy gim ca nguyn liu
m c b qua tc l khng c s suy gim ca chm bc x trong m, th s photon tng tc
ti bt c su no trong phantom s l ging nhau. khi s qung ng khi u ti tt c
cc su l bng nhau. Liu hp th di b mt m khng kh s ph thuc vo s track i qua
su . S track bng qua nhng su khc nhau c ch ra pha di ca s . Nu s
track ny c v nh l mt hm theo su, kt qu s cho thy mt s thay i liu theo
su.

Bi Ging vt L X Tr _ Trn Cng

24

Hnh 6: ng c tnh Build-up

T th hnh_6 ta thy liu hp th bng khng ti b mt, v tng tuyn tnh n mt


su cc i bng qung chy electron, v sau n l hng s. Cng trong th ny ta c liu
hp th o thc t c biu din bng ng lin nt. C th thy rng hnh dng chung l ging
nhau, nhng c mt vi s khc nhau quan trng. S khc nhau l do m hnh qung ng
ziczac ca electron, s suy gim v s tn x ca chm photon trong phantom, v do lut t l
nghch bnh phng khong cch. V v vy liu hp th trn b mt s khc khng. Mt khc
nhng electron c to ra bn ngoi phantom nh trong khng kh v trong cu trc collimator
ni chung cng to ra mt liu hp th b mt gii hn. Ngoi ra s suy gim v lut t l nghch
bnh phng s lm gim lin tc cng chm tia, v v vy gim liu hp th theo su. Do
v tr liu hp th cc i l cng gi tr nhng ni chung ti mt su nh hn qung chy
electron.
Hiu ng ng hp th tng t mt gi tr thp ti b mt n mt gi tr cc i xc nh
c gi l hiu ng BUILD-UP. Vng liu hp th gia tng ny c gi l vng Build-up. Ti
v tr cc i, hoc su Build-up, ta ni t c mt iu kin cn bng electron. Vi iu
kin ny ti v tr , s eletron vo th tch nh ca mi trng l bng vi s electron di th
tch . c tnh build-up c tm thy trong tt c cc chm photon v ty thuc vo nng
lng ca chm tia. Cc chm tia nng lng khc nhau c trng bi su Build-up nh ch ra
trong bng sau.
Chm Photon
100 KV
250 KV
Cs_137
Co_60
6 MV
10 MV
25 MV

Nng lng cc i
100 Kev
250 Kev
660 Kev
1.33 Mev
6 Mev
10 Mev
25 Mev

Nng lng trung bnh


33 Kev
80 Kev
660 Kev
1.25 Mev
2 Mev
3.3 Mev
7 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.

Cng tng t nh vy cc chm tia electron khi tng tc vi mi trng cng xy ra cc


qu trnh tng tc tng t v cng to ra vng Build-Up khi tng tc vi mi trng, nhng
im khc bit ca chm tia electron vi cc chm tia photon l:
- Ngay t khi tip xc vi mi trng cc chm tia electron gy ra s tng tc trc tip
ngay lp tc do liu ti b mt ca mi trng trong trng hp ny cao hn so vi cc
chm photon.

Bi Ging vt L X Tr _ Trn Cng

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.

Hnh 7: S phn b liu hp th ca chm tia bc x trong mi trng

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.

VI. Chm Tia Bc X V Trng Chiu:


VI.1.
Chm Tia Bc X:
Mt chm tia bc x v mt no c th c xem nh mt chm nh sng pht ra t
mt ngun im, v c hai c tnh quan trng sau:
tit din chm tia t l vi bnh phng khong cch t ngun :
2

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.

Trong x tr chm tia bc x c th c pht ra t mt ngun ng v phng x (ngun


Co-60) hay l chm tia bc x pht ra t mt my gia tc tuyn tnh. Nu l ngun ng v th
chm ng v pht ra l ng hng, nu l chm tia pht ra t mt my chiu x th s c nh
hng theo mt hng hu dng no .

Bi Ging vt L X Tr _ Trn Cng

26

VI.2.

Trng chiu ca chm tia Photon

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:

Hnh 8: Beam profile ca trng hnh ch nht

T hnh_8, gi s hnh ch nht ABCD l trng chiu ca mt chm bc x trong khng


kh. V ng thng MNPQ qua trng chiu v sau o st liu chiu hoc cng chm
bc x dc theo ng ny, chng ta s thu c mt th sut liu hoc cng chm bc x
dc theo ng MNPQ. th ny c gi l Beam Profile ca trng bc x dc theo ng
MNPQ.
Beam profile: c nh ngha l s phn b liu chiu dc theo mt ng thng i qua
trng. Nu by gi ta v mt ng thng xuyn qua tm v chia trng thnh hai phn bng
nhau gi l trc chnh ca trng (Principal Axis). T hnh trn ta thy rng beam profile ca
ng RS cho thy sut liu chiu ti bt c v tr no trong trng u l hng s, v ti mi
im bn ngoi trng sut liu u bng khng. Beam profile dc theo nhng trc chnh l rt
quan trng, v thng thng ngi ta hay ch n beam profile dc theo trc chnh ca trng.
VII.2.

Penumbra ca chm tia:

Bi Ging vt L X Tr _ Trn Cng

27

Hnh 9: nh hng ca lut t l nghch bnh phng

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

Hnh 10: Beam profile ca ngun im

Do ti nhng im cng cch xa im O th sut liu cng thp hn ti O. V vy cng


trong vng AB nh xt trn s khng l hng s m gim dn t tm ra bin nh ng
AB hnh_10. S suy gim ny l do lut t l nghich bnh phng. Ngoi ra ti cc im ngoi
vng AB lun lun c mt % no ca bc x xuyn qua vt liu che chn. Cng chm bc
Bi Ging vt L X Tr _ Trn Cng

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:

Hnh 11: Beam profile ca ngun c kch thc

t D l khong cch t ngun n li ra (hay n b mt ca diapragms), d0 l khong


cch t ngun n ti im O (tm trng). Xt phn trung tm ca beam profile (gia A v B):
gi s ngun c chia thnh nhiu phn nh sao cho mi phn tng ng vi mt ngun im.
Khi xut liu trong khong AB s l tng s ng gp ca tt c cc ngun im . Nhng
nhng im trong UA v BV li hon ton khc nhau. T cc im trong AB c th nhn thy
ton b ngun. Tuy nhin khi ti v tr Q, khi ch mt phn ca ngun l c th nhn thy v
mt phn ngun kia b che bi vt liu che chn ngun. Kt qu l sut liu chiu ti Q l tng s
ng gp ca tt c nhng ngun im c nhn thy ti v tr ny. V vy ti nhng im trong
UA v VB cng s l tng tt c nhng s ng gp trc tip t nhng ngun im c nhn
thy cng vi s ng gp ca phn xuyn qua ca nhng ngun im khng nhn thy.
Ni chung Beam profile ca mt ngun c kch thc bao gm:
Trc tin ti vng trung tm (on AB), mi im u nhn thy ton b ngun, v vy
s thay i cng trong vng ny l do qui lut t l nghch bnh phng khong cch.
Tip theo l pha ngoi vng UV, ti nhng v tr ny hon ton khng nhn thy ngun, v
do cng o c ch yu ch do bc x chuyn qua vt liu che chn, sau tip
tc c hiu chnh theo lut t l nghch bnh phng khong cch.

Bi Ging vt L X Tr _ Trn Cng

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)

i vi my gia tc trng c xc nh ti mt b mt cch ngun mt khong cch l 100cm


gi l SAD, khi do = SAD.
SAD
kch thc vng penumbra = [ S ]
1 (4)
D

T biu thc ny thy rng vng Penumbra thay i khi:


a) S : tng hoc gim
b) SAD: tng hoc gim
c) D : tng hoc gim.
i vi my gia tc S l mt hng s, SAD=100cm khng i; D khng thay i v vy
Penumbra ca mt chm tia photon t my gia tc l khng i.
S tn ti ca vng penumbra lm cho vic xc nh kch thc trng bc x phc tp
hn. Khng nh trong trng hp ngun im, kch thc trng c th d dng c xc nh
bi rng ca vng cng cha b thay i t ngt. Trong trng hp ngun c kch thc,
kch thc trng tbc x l hai ln rng t tm n v tr liu t 50% so vi liu ti tm
(im O). R rng kch thc trng trong trng hp ny ln hn AB nhng nh hn UV.
VIII. S ng u Ca Trng :
Trong iu tr, thng thng cn c mt chm bc x vi mt cng ng u trn
ton vng tit din ca n v ngi ta mun c mt liu ng u cho khi u. Trong iu kin ,
ngi ta mun bt u vi mt chm tia ng u n c th d dng thay i theo mong mun
trong mt trng hp c bit no . Tt c nhng my gia tc u c mt b lm phng chm
tia tia nh hnh_12. V tr ca b lm phng chm tia l cc k quan trng trong my gia tc tuyn
tnh nng lng cao n nh hng n phng (flattness) v i xng (symetry) ca chm tia.
V vy phng (flatness) ca trng c nh ngha l s thay i ln nht ca cng
so vi gi tr cng ti tm chm tia trong trng (hay trong beam profile), ngoi tr vng
penumbra. phng ca trng ph thuc vo ba h s : kch thc trng, khong cch t
ngun, c tnh t nhin ca ngun.

Bi Ging vt L X Tr _ Trn Cng

30

Hnh 12: S dng b lc chm tia X nng lng cao

phng v i xng ca trng l hai yu t lin quan n tnh an ton trong vn


hnh thit b, khi mt trong hia gi tr ny vt khi mt gii hn quy nh my gia tc s ngng
pht tia.

Bi Ging vt L X Tr _ Trn Cng

31

Nhng Thng S Vt L C Bn Trong Tnh Ton Liu


I. Gii Thiu:
Trong chng trc chng ta a ra nh ngha beam profile. Beam profile c dng
m t s thay i liu hoc sut liu trong mt phng ngang theo cc trc chnh ca trng bc
x. Tuy nhin s m t ny thc cht nh vy, v trong thc t beam profile nn c m t ba
chiu. Ton b hnh nh ba chiu s l mt bc tranh rt thc t, v n cn thit trong s dng
thc t.
Mc tiu ca x tr ngoi l cung cp mt liu thch hp v ng u cho mt vng th
tch no , ng thi cng cn ch n s khc nhau v liu cho nhng c quan trng yu
khc. Beam profile mc d cha mt s thng s vt l quan trng nh phng chm tia, kch
thc trng, kch thc penumbra, v s truyn qua pha ngoi ca trng. Tuy nhin chnh
nhng thng s ny cng khng thc hin vic nh liu cho mc ch iu tr. Nhng s
liu m t trong chng ny s gip chng ta hiu hn trong vic tnh ton phn b liu.
II. H s lch trc OAF:
Beam profile th hin nhng gi tr tng i o c dc theo trc chnh ca trng.
Nhng gi tr o c ny trong thc t l mt phn b 3 chiu v c s dng tnh ton liu
khi c kt hp thm cc h s hiu chnh ring khc. Trong tnh ton liu Beam profile th hin
sut liu chiu hay liu chiu tng i ca nhng im trong trng chiu ngoi trc trung tm
ca chm tia so vi sut liu chiu hay liu chiu ti tm trng chiu. V vy n c s dng
tnh ton liu ti nhng im ny t th hin mt s phn b liu ba chiu trong trng
chiu v vic o h s lch trc thc cht chnh l vic o c beam profile nh hnh_1.
OAF
1.2000,

1.0000,

0.8000,

0.6000,

0.4000,

0.2000,

0.0000,
1

11

13

15

17

19

21

23

25

27

29

31

Hnh 1: Biu din ca h s OAF

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.

Hnh 2: nh hng ca tn x theo gc m ca Collimator

S thay i c th thy c theo hnh_2. Ba s trong hnh ng vi SSD nh nhau,


nhng c gc m collimator khc nhau to ra nhng kch thc trng khc nhau aa, bb v
cc. Trong mi trng hp, ta o sut liu chiu ti tm ca trng chiu, chn mt im Q
chung ti b mt collimator v c th xem nh mt ngun bc x tn x. Thnh phn s cp
ca sut liu chiu trong mi trng hp l khng i v ngun v khong cch t ngun n
im o l khng i (SSD khng i). nu xt trng trung bnh b b, nhng photon tn x trn
h thng collimator v n im o. Tuy nhin vi trng kch thc nh hn nh a a, cc
photon tn x ny c th li b tng tc vi cu trc collimator mt ln na, v v vy s khng
c ghi nhn bi detector. Sau cng vi kch thc trng rt ln, nh cc, gc tn x l khng
thun li v v vy mt ln na khng c ghi nhn bi detector. T ngi ta c th tin
on rng, sut liu tng theo kch thc trng, tin ti mt gi tr cc i v gim t t khi
kch thc trng rt ln.
Thc t, sut liu chiu cho nhng trng kch thc khc nhau c biu din bi
sut liu tng i v gi l Output Factor. Gi s sut liu chiu cho trng c hnh dng v

Bi Ging vt L X Tr _ Trn Cng

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.

Hnh 3: S thay i ca h s Output theo kch thc trng chiu

Output factor l h s c lp vi mnh ngun. N c s dng trong nhng trng


hp tnh liu cho nhng kch thc trng khc nhau ti mt khong cch SSD chn trc. Do
h s ny khng cho ta kch thc trng, m l t s sut liu chiu cho nhng ci t collimator
khc nhau, tc l t s sut liu chiu cho nhng kch thc trng khc nhau. Hay ni cch khc
output factor c trng cho s ci t collimator.
IV. Phn Trm Liu Su (PDD):
Khi kho st s phn b liu ca chm tia bc x torng mi trng ngi ta bit rng s
to ra vng build-up v mt im liu hp th cc i. im liu hp th cc i ny l duy nht,
n l im nm trn trc trung tm v ti su dm. Nu ta o liu hp th ti nhng su khc
nhau th ta c th to ra mt ng cong m t s thay i liu hp th theo chiu su gi l s
phn b liu theo su. S phn b liu theo su ny gip cho vic tnh ton liu ti nhng
su khc nhau. Tuy nhin, nu chng c biu din bng s hng % ca liu cc i th b d
liu ny c lp vi Ouput ca my v d liu ny c gi l phn trm liu su hay gi
l PDD.

Hnh 4: M t php o PDD

Bi Ging vt L X Tr _ Trn Cng

34

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)

trong D(P) v D(Q ) l liu hp th ti P v Q tng ng trong cng iu kin o nh


thi gian pht tia, kch thc trng chiu, SSD v cht lng chm bc x khng i. m t
ton b chm bc x trong mt phantom, vic thit lp bng gi tr PDD trong mt mng ba chiu
l rt cn thit tnh ton liu ti cc im khc nhau, ti nhng su khc nhau trong phantom.
Nhng biu din v dng d liu nh vy s rt tr ngi. C mt tp hp d liu con n gin v
hu dng hn: n l gi tr PDD dc theo trc trung tm, c gi l PDD trc trung tm. Nhng
gi tr PDD cho nhng nng lng photon khc nhau vi kch thc trng chiu v SSD khc
nhau c thit lp thnh bng. Mi trng khi s c biu din bi mt ct gi tr PDD ti
nhng su khc nhau. Mc d nhng gi tr khng mang thng tin v ng u chm tia
hoc c tnh penumpra, nhng chng c s dng rng ri cho y hc do tnh n gin trong
biu din.

Hnh 5:ng phn b liu hp th theo su

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.

Hnh 6: Beam profile v s phn b ng liu

Nhng ng thng hoc ng cong ng liu l nhng ng giao ca b mt ng


liu v mt phng c chn la. thu c mt ng cong ng liu trong mt mt phng
chn trc l rt n gin. Liu hp th ti mt s ln nhng im trong mt b mt trc tin
c o sau nu ni tt c nhng im liu bng nhau li vi nhau ta s c mt ng cong
l ng ng liu v hnh dng nhng ng c th tin on c. Trong hnh_6, gi s
profile chm tia c bit trc. t Z l mt im bn trong phantom, nm trn trc trung tm
sao cho PDD l 50%. By gi xt im X khc im Z, nhng cng su di b mt phantom.
PDD ti X c tin on l thp hn ti Z do ba l do:
im X xa ngun hn im Z (lut bnh phng khong cch)
RX l ln hn OZ v v vy s hp th ti X ln hn ti Z
S ng gp phn tn x t hn
Do , mt im vi mt liu phn trm su PDD l 50% dc tia RYX phi l mt
im nm pha trn X khong cch ngn hn s lm tng liu n 50%. Tng t, ngi ta
c th xc nh nhng im liu 50% cho nhng tia khc v kt qu ng cong ng liu 50%
c ch ra. ng ny khi t ti su ca liu cc i dm, phi ct ti V m cng
trn beam profile l 50%, v l kch thc trng su ny trong phantom. C nh vy ta c
th thu c ng cong ng liu cho nhng PDD khc. mt tp hp nhng ng ng liu
biu din kiu ny l mt th ng liu. Nhng th ng liu ny c s dng hin th
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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)

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Hnh 7: M hnh php o TMR v TPR

ch rng gi tr TMR ti dm s chnh xc bng 1. Nu liu hp th ti dm bit trc, Dm(A,dm),


liu ti su khc D(A,d) c th c xc nh nh mi lin h sau:
D(A,d) = Dm(A,dm) x TMR(A,d)

(7)

Dm c th c xc nh mt cch th nghim trong phantom v ngi ta a ra mt s hng khc,


h s liu tng i (RDF) v c nh ngha nh sau:
RDF(A) = Dm(A,dm)/ Dm(trng chun,dm)

TPR (Fd , Dd ) =

DD(Fd , Dd ) S p (Dd ) SourcetoDd


*
*
DD(Fd , Dr ) S p (Dr ) SourcetoDr

(8)

Vi RDF o, liu cho mt vi trng c th tnh ton bi s lin h sau:


D(A,d) = Dm(trng chun,dm) x RDF(A) x TMR(A,d)

(9)

Mt vn trong nh ngha ca TMR chnh l s xc nh ca Dm. Bit rng vi nhng


chm photon nng lng cao, dm la mt hm ca kch thc trng (v d mt chm tia 5 x 5 cm2
25 MV, dm khong 4 cm. Nhng vi chm tia rng hn, bc x tn x c quynh hng y dm
hn v pha b mt, tc l vi chm tia 30 x 30, dm s l 1.5 cm). Do cu hi t ra l ngi
ta s thay i im chun dm nh th no khi kch thc trng thay i tha mn nh nghi
TMR. Nu iu ny c thc hin, khi s tnh ton liu s rt phc tp, c bit khi lut t l
nghch bnh phng c p dng vo. y l l do cho vic a vo s hng mi, t s m
phantom TPR.
ngha ca TPR tng t nh TMR nhng thay v chn dm l im chun, ngi ta chn
mt su tin li ln hn cho mi kch thc trng ( th phi hnh_7). Khi TPR c
nh ngha nh sau:
TPR = (liu hp th ti im d cm phantom)/ (liu hp th ti im dr cm phantom)
S chun ha sau s c thc hin trong phantom ti su dr , su chun thay v
dm. TPR c s dng tng t nh TMR, TPR l d liu tnh ton liu.
Mt khc cc gi tr TMR v TPR c th c tnh ton t cc gi tr ca PDD, v trong
thc t thun tin trong vic o c d liu chm tia cc php o phn b liu theo su PDD
s c o c cho cc kch thc trng chiu khc nhau sau cc gi tr TMR hoc TPR s
c tnh ton t cc gi tr PDD o c theo cng thc.

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VII. Cc h s tnh liu khc:


Ngoi cc h s gii thiu trn tnh ton liu hp th ti cc im trong vng th
tch c chiu x di iu kin iu tr chng ta cn mt s cc h s khc bao gm:
1. H s truyn qua block
2. H s wedge
3. Khong cch ngun o
Ngoi ra ty theo thut ton tnh ton liu s cn phi s dng thm cc tham s khc nhau, nhng
cc tham s trnh by trn l cc tham s c bn nht.

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