Med phy tps_ch_07_04

Clinical Treatment Planning in External
Photon Beam Radiotherapy
10/July/2018
Ossama Anjak, oanjak@yahpoo.com 1

IV
Clinical Treatment Planning in External Photon Beam
Radiotherapy




–
Chapter 7: Clinical Treatment Planning in
External Photon Beam Radiotherapy
Ossama Anjak,
IAEA
International Atomic Energy Agency
7/17/20182
Ossama Anjak, 7/17/20183
‫ﺍﻟﺳﻠﻭﻛﻳﺔ‬ ‫ﺍﻷﻫﺩﺍﻑ‬:
•‫ﺇﺗﻘﺎﻥ‬‫ﺍﻟ‬ِ‫ﺔ‬‫ﺍﻟﺣﺩﻳﺛ‬ ِ‫ﺕ‬‫ﺗﻘﻧﻳﺎ‬‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﻟﻠﻣﻌﺎﻟﺟﺔ‬‫ﺑ‬‫ﺎﺳ‬‫ﺣﺯﻡ‬ ‫ﺗﺧﺩﺍﻡ‬
‫ﺇﻟﻰ‬ ‫ﺍﻟﻭﺻﻭﻝ‬ ‫ﺑﻬﺩﻑ‬ ‫ﺍﻟﻔﻭﺗﻭﻧﺎﺕ‬ ‫ﻣﻥ‬ ‫ﺧﺎﺭﺟﻳﺔ‬:
–ِ‫ﺔ‬‫ﺟﺭﻋ‬ ‫ﺗﻭﺯﻳﻊ‬‫ﻣﺗﺟﺎﻧﺱ‬َ‫ﺍﻟﻬﺩﻑ‬ ِ‫ﺣﺟﻡ‬ ‫ﺩﺍﺧﻝ‬
–‫ﺇﻟﻳﻬﺎ‬ ‫ﺍﻟﻭﺻﻭﻝ‬ ‫ﻣﻣﻛﻥ‬ ‫ﺟﺭﻋﺔ‬ ‫ﺃﻗﻝ‬‫ﺍﻟ‬ ِ‫ﺔ‬‫ﺍﻷﻧﺳﺟ‬ ‫ﻓﻲ‬ِ‫ﺍﻟﺗﻲ‬ ‫ﺳﻠﻳﻣﺔ‬ُ‫ﺗ‬ُ‫ﻁ‬‫ﺣﻳ‬
‫ﺑ‬َ‫ﺎﻟﻬﺩﻑ‬.
‫ﺍﻟﻣﺣﺗﻭﻯ‬
.1‫ﻣﻘﺩﻣﺔ‬
.2‫ﺍﻟﺣﺟﻡ‬ ‫ﺗﻌﺭﻳﻑ‬Volume Definition
.3‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻭﺍﺻﻔﺎﺕ‬Dose Specification
.4‫ﻭﺍﻟﻣﺣﺎﻛﺎﺓ‬ ‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﺍﻟﺑﻳﺎﻧﺎﺕ‬ ‫ﺍﻛﺗﺳﺎﺏ‬Patient Data Acquisition and
Simulation
.5ِ‫ﺔ‬ّ‫ﻌ‬‫ﻷﺷ‬ ‫ﺍﻟﺳﺭﻳﺭﻳﺔ‬ ‫ﺍﻻﻋﺗﺑﺎﺭﺍﺕ‬ِ‫ﻧ‬‫ﺍﻟﻔﻭﺗﻭ‬‫ﺎﺕ‬.
.6‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬Treatment Plan Evaluation.
.7‫ﺍﻟﻣﺭﺍﻗﺑﺔ‬ ‫ﻭﺣﺩﺍﺕ‬ ‫ﻭﻋﺩﺩ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬
Monitor Unit Calculations.
.6
TREATMENT PLAN EVALUATION

10/July/2018
Ossama Anjak,
.6‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬:
•‫ﺗﻘﻳﻳﻡ‬ ‫ﺇﺟﺭﺍء‬ ‫ﺍﻟﻣﻔﻳﺩ‬ ‫ﻣﻥ‬”‫ﺍﻟﺟﻭﺩﺓ‬quality“‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺧﻁﺔ‬
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻭﺣﺳﺎﺑﺎﺕ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺩﺭﺍﺳﺔ‬ ‫ﺟﺭﻯ‬ ‫ﺳﻭﺍء‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬:
–‫ﺍﻟﺣﺎﺳﺏ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻡ‬on computer
–.ً‫ﺎ‬‫ﻳﺩﻭﻳ‬ ‫ﺃﻭ‬or by hand.
•‫ﺗﻛﻭﻥ‬”‫ﺍﻟﺟﻭﺩﺓ‬quality“‫ﺗﻭﺯﻉ‬ ‫ﺣﺳﺎﺑﺎﺕ‬ ‫ﻛﺎﻧﺕ‬ ‫ﺇﺫﺍ‬ ‫ﺟﻳﺩﺓ‬
‫ﺍﻟﺳﺭﻳﺭﻱ‬ ‫ﺍﻟﻬﺩﻑ‬ ‫ﻣﻊ‬ ‫ﻣﺗﻁﺎﺑﻘﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬
‫ﻟﻠﻣﻌﺎﻟﺟﺔ‬.
•‫ﺍﻟﻣﻌﺎﻟﺟ‬ ‫ﻁﺑﻳﺏ‬ ‫ﻗﺑﻝ‬ ‫ﻣﻥ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬ ‫ﻳﺗﻡ‬ ‫ﺃﻥ‬ ‫ﻳﺟﺏ‬‫ﺔ‬
‫ﻟﻸﻭﺭﺍﻡ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬radiation oncologist
7/17/20187Ossama Anjak,
•‫ﺍﻟﺣﺳ‬ ‫ﻓﻳﻬﺎ‬ ‫ﺟﺭﻯ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﻁﺭﻳﻘﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬ ‫ﻳﻌﺗﻣﺩ‬‫ﺎﺑﺎﺕ‬.
•‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻳﻊ‬ ‫ﻋﻠﻰ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺃﻥ‬ ‫ﻳﻣﻛﻥ‬:
.1‫ﺍﻟﻬﺎﻣﺔ‬ ‫ﺍﻟﻣﻭﺍﺿﻊ‬ ‫ﻣﻥ‬ ‫ﻣﺣﺩﻭﺩ‬ ‫ﻋﺩﺩ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻌﻳﻳﻥ‬few
significant points‫ﺍﻟﻣﻌﺎﻟﺞ‬ ‫ﺍﻟﻬﺩﻑ‬ ‫ﺿﻣﻥ‬target volume.
.2‫ﺍﻟﺑﻌﺩ‬ ‫ﺛﻧﺎﺋﻲ‬ ‫ﻣﺳﺗﻭﻱ‬ ‫ﻓﻲ‬2D (oxy)‫ﺍﻟﺟﺳﻡ‬ ‫ﻣﺣﻳﻁ‬ ‫ﺿﻣﻥ‬ ‫ﻟﻠﻧﻘﻁ‬
contour‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﺃﻭ‬image)‫ﺻﻭﺭ‬ ‫ﻣﻘﺎﻁﻊ‬ ‫ﻣﻥ‬ ‫ﻣﻘﻁﻊ‬‫ﺍﻟـ‬CT.(
.3‫ﺍﻟﻣﻌﺎﻟ‬ ‫ﻟﻠﻣﻧﻁﻘﺔ‬ ‫ﺍﻟﺛﻼﺛﺔ‬ ‫ﺑﺎﻷﺑﻌﺎﺩ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺩﺭﺍﺳﺔ‬‫ﺟﺔ‬
full three-dimensional array‫ﺍﻟﺑﻧﻳﺔ‬ ‫ﺍﻻﻋﺗﺑﺎﺭ‬ ‫ﺑﻌﻳﻥ‬ ‫ﺁﺧﺫﻳﻥ‬
‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﻟﺟﺳﻡ‬ ‫ﺍﻟﺗﺷﺭﻳﺣﻳﺔ‬patient’s anatomy.
7/17/20188
Ossama Anjak,
•‫ﺑﻁﺭﻳﻘﺗﻳﻥ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺧﻁﺔ‬ ‫ﺍﻟﺟﻭﺩﺓ‬ ‫ﺗﻘﻳﻳﻡ‬ ‫ﻳﺟﺭﻱ‬:
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻘﺎﻁﻊ‬Treatment portals:‫ﺍﻟﺗﺄﻛﺩ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﻭﺫﻟﻙ‬
‫ﺍﻟﻣﺧﻁﻁ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﺗﻐﻁﻲ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺃﻥ‬ ‫ﻣﻥ‬PTV‫ﻫﻭ‬ ‫ﻟﻣﺎ‬ ً‫ﺎ‬‫ﻭﻓﻘ‬
‫ﺍﻟﻁﺑﻳﺔ‬ ‫ﺍﻟﻭﺻﻔﺔ‬ ‫ﻓﻲ‬ ‫ﻭﺍﺭﺩ‬.
–‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺩﺭﺍﺳﺔ‬Isodose distribution‫ﻣﻥ‬
‫ﺟﺭﻯ‬ ‫ﻭﺃﻧﻪ‬ ‫ﺍﻟﻬﺩﻑ‬ ‫ﺗﻐﻁﻲ‬ ‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺃﻥ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﺃﺟﻝ‬
‫ﺑﺎﻟـ‬ ‫ﺍﻟﻣﺣﻳﻁﺔ‬ ‫ﺍﻟﺣﺭﺟﺔ‬ ‫ﺍﻟﻧﺳﺞ‬ ‫ﺗﺟﻧﺏ‬PTV.
‫ﺍﻟﺗ‬ ‫ﺍﻷﺩﻭﺍﺕ‬ ‫ﺗﺳﺗﺧﺩﻡ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬‫ﺎﻟﻳﺔ‬:
.1‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﻣﻧﺣﻧﻳﺎﺕ‬Isodose curves.
.2‫ﺍﻟﻣﺗﻌﺎﻣﺩﺓ‬ ‫ﺍﻟﻣﺳﺗﻭﻳﺎﺕ‬Orthogonal planes‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻭﺳﻭﻳﺎﺕ‬
isodose surfaces.
.3‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻟﺗﻭﺯﻉ‬ ‫ﺍﻹﺣﺻﺎﺋﻳﺔ‬ ‫ﺍﻟﺗﻘﻧﻳﺎﺕ‬Dose distribution
statistics.
.4‫ﺍﻟﺗﻔﺭﻳﻘﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﻣﺧﻁﻁ‬Differential Dose Volume
Histogram
.5‫ﺍﻟﺗﺟﻣﻳﻌﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﻣﺧﻁﻁ‬Cumulative Dose Volume
Histogram.
7/17/201810
Ossama Anjak,
.6.1‫ﺍﻟﺠﺮﻋﺔ‬ ‫ﻣﻨﺤﻨﻴﺎﺕ‬Isodose curves
•‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﺗﺳﺗﺧﺩﻡ‬Isodose curves‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬
‫ﻓﻲ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬‫ﻭﺍﺣﺩ‬ ‫ﻣﺳﺗﻭﻱ‬‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﺿﻣﻥ‬ ‫ﻣﺳﺗﻭﻳﺎﺕ‬ ‫ّﺓ‬‫ﺩ‬‫ﻋ‬ ‫ﺃﻭ‬..
7/17/201811
A
Ossama Anjak,
example:
Isodose line through the ICRU
reference point
is 152 %.
Maximum dose 154 %.
The 150 % isodose curve
completely covers the PTV.
[%]
-150
-140
-130
-120
-100
- 70
- 50
7/17/201812
P(Q)

10/July/2018
Ossama Anjak,
•‫ﻣﺟﺎﻝ‬ ‫ﺿﻣﻥ‬ ‫ﺍﻟﻬﺩﻑ‬ ‫ﻣﻧﻁﻘﺔ‬ ‫ﺗﻐﻁﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﻛﺎﻧﺕ‬ ‫ﺇﺫﺍ‬
‫ﺍﻟﻣﻘﺑﻭﻟﺔ‬ ‫ﺍﻟﻧﺳﺑﺔ‬(e.g., 95  100 %)‫ﻳﻣﻛﻥ‬ ‫ﻋﻧﺩﺋﺫ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﻟﻠﺟﺭﻋﺔ‬
‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺃﻥ‬ ‫ﺍﻻﻋﺗﺑﺎﺭ‬ ‫ﺑﻌﻳﻥ‬ ‫ﺁﺧﺫﻳﻥ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﻗﺑﻭﻝ‬
‫ﺍﻟﺣﺭﺟﺔ‬ ‫ﺍﻷﻋﺿﺎء‬critical organ doses‫ﺍﻟﻣﺳﻣﻭﺡ‬ ‫ﺍﻟﺣﺩﻭﺩ‬ ‫ﺗﺗﺟﺎﻭﺯ‬ ‫ﻻ‬
‫ﺑﻬﺎ‬.
•‫ﺍﻟﻣ‬ ‫ﻋﺩﺩ‬ ‫ﻛﺎﻥ‬ ‫ﺇﺫﺍ‬ ‫ﻣﻘﺑﻭﻟﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﻧﻬﺟﻳﺔ‬ ‫ﻫﺫﻩ‬‫ﻘﺎﻁﻊ‬
‫ﺻﻐﻳﺭ‬ ‫ﺍﻟﻣﺩﺭﻭﺳﺔ‬.
.6‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬:
.6.2‫ﺍﻟﺠﺮﻋﺔ‬ ‫ﻣﻨﺤﻨﻴﺎﺕ‬ ‫ﻭﺳﻄﺢ‬ ‫ﺍﻟﻤﺘﻌﺎﻣﺪﺓ‬ ‫ﺍﻟﻤﺴﺘﻮﻳﺎﺕ‬Orthogonal planes and Isodose curves
•‫ﺍﻟﻌﺭﺿﻳﺔ‬ ‫ﺍﻟﻣﻘﺎﻁﻊ‬ ‫ﻣﻥ‬ ‫ﻛﺑﻳﺭ‬ ‫ﻋﺩﺩ‬ ‫ﺩﺭﺍﺳﺔ‬ ‫ﻋﻧﺩ‬transverse planes‫ﺃﺟﻝ‬ ‫ﻣﻥ‬
‫ﺗ‬ ‫ﻋﻠﻰ‬ ‫ﺑﺎﻹﻋﺗﻣﺎﺩ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬ ‫ﻳﺟﺭﻱ‬ ‫ﺍﻟﺟﺭﻋﺎﺕ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺣﺳﺎﺏ‬‫ﻭﺯﻉ‬
‫ﺍﻟﻣﺭﻛﺯﻱ‬ ‫ﺍﻟﻣﺳﺗﻭﻱ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬axial slice isodose distributions.
•‫ﺍﻟ‬ ‫ﺍﻟﻣﺳﺗﻭﻱ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﻧﻅﺭ‬ ‫ﻳﻣﻛﻥ‬ ‫ﺃﻳﺿﺎ‬ ‫ﺍﻟﺣﺎﻟﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻓﻲ‬‫ﻣﻌﺎﻣﺩ‬
‫ﺍﻟﻣﺩﺭﻭﺳﺔ‬ ‫ﻟﻣﻣﻘﺎﻁﻊ‬orthogonal CT planes‫ﺭﺳﻡ‬ ‫ﺇﻋﺎﺩﺓ‬ ‫ﺧﻼﻝ‬ ‫ﻣﻥ‬ ‫ﻭﺫﻟﻙ‬
‫ﻣﻘﺎﻁﻊ‬CT.
•‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﻭﺯﻉ‬ ‫ﺗﺧﻁﻳﻁ‬ ‫ﻧﻅﻡ‬ ‫ﻣﻌﻅﻡ‬ ‫ﺍﻟﻌﻣﻭﻡ‬ ‫ﻋﻠﻰ‬3D treatment planning
systems‫ﺍ‬‫ﺍﻟﺛﻼﺛﺔ‬ ‫ﺑﺎﻷﺑﻌﺎﺩ‬ ‫ﺍﻟﻧﺗﺎﺋﺞ‬ ‫ﺗﻅﻬﺭ‬ ً‫ﺎ‬‫ﺣﺎﻟﻳ‬ ‫ﻟﻣﺗﻭﻓﺭ‬)‫ﺑﺷﻛﻝ‬‫ﺣﺟﻣﻲ‬3D(
‫ﻭﺍﻹﻛﻠﻳﻠﻲ‬ ‫ﺍﻟﺳﻬﻣﻲ‬ ‫ﺍﻟﻣﺳﺗﻭﻱ‬ ‫ﻓﻲ‬ ‫ﺻﻭﺭ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺣﺻﻭﻝ‬ ‫ﻭﻳﻣﻛﻥ‬, sagittal
and coronal plane isodose distributions
7/17/201814
‫ﺍﻟﻌﺭﺿﻳﺔ‬ ‫ﺍﻟﻣﻘﺎﻁﻊ‬Transverse planes
Ossama Anjak,
Transverse or Axial planes
7/17/201815
‫ﺍﻹﻛﻠﻳﻠﻳﺔ‬ ‫ﺍﻟﻣﻘﺎﻁﻊ‬Coronal planes
Ossama Anjak,
Coronal CT Scan of Abdomen
7/17/201816
‫ﺍﻟﺳﻬﻣﻳﺔ‬ ‫ﺍﻟﻣﻘﺎﻁﻊ‬Sagittal planes
Ossama Anjak,
Sagittal planes
Trachea
7/17/201817
.6.2‫ﺍﻟﺠﺮﻋﺔ‬ ‫ﻣﻨﺤﻨﻴﺎﺕ‬ ‫ﻭﺳﻄﺢ‬ ‫ﺍﻟﻤﺘﻌﺎﻣﺪﺓ‬ ‫ﺍﻟﻤﺴﺘﻮﻳﺎﺕ‬
Dose distribution for a free-breathing
IMRT plan for a lung tumor superimposed
on CT images in the axial, Sagittal, and
coronal plane for :
a) The original plan without the
intermediate dose calculation
module,
b) The new plan with the intermediate
dose calculation module. Isodose
lines for 105% (purple), 100%
(yellow), and 95% (green) of the
prescription dose and 10 Gy (brown),
and 5 Gy (cyan) are shown. Note the
increased homogeneity in the target,
which corresponds to a decrease in hot
spots in the new plan.

10/July/2018
Ossama Anjak,
‫ﺍﻷﺯﻕ‬ ‫ﺍﻟﻠﻭﻥ‬:‫ﺍﻟﻬﺩﻑ‬TV
‫ﺍﻷﺑﻳﺽ‬ ‫ﺍﻟﻠﻭﻥ‬:‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬
‫ﺍﻟﻭﺻﻔﺔ‬ ‫ﺣﺳﺏ‬.
ً‫ﺎ‬‫ﺃﻳﺿ‬ ‫ﺍﻟﺷﻛﻝ‬ ‫ﻓﻲ‬ ‫ﻳﻅﻬﺭ‬
‫ﺍﻟﻣﺳﻘﻳﻡ‬rectum:‫ﺍﻷﺧﺿﺭ‬ ‫ﺍﻟﻠﻭﻥ‬
‫ﺍﻟﻣﺛﺎﻧﺔ‬Bladder:‫ﺍﻟﻠﻭﻥ‬
‫ﺍﻟﺑﻧﻔﺳﺟﻲ‬.
.6‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬:
‫ﺑﺭﻭﺳﺗﺎﺕ‬ ‫ﻭﺭﻡ‬Prostate cancer
‫ﺍ‬ ‫ﺃﻥ‬ ‫ﻣﻥ‬ ‫ﻭﺍﻟﺗﺣﻘﻖ‬ ‫ﺍﻟﻌﻼﺟﻳﺔ‬ ‫ﺍﻟﺧﻁﺔ‬ ‫ﺗﻘﻳﻡ‬ ‫ﻓﻲ‬ ‫ﺟﻳﺩﺓ‬ ‫ﺍﻟﻁﺭﻳﻘﺔ‬ ‫ﻫﺫﻩ‬‫ﻟﺟﺭﻋﺔ‬
‫ﺍﻟﻬﺩﻑ‬ ‫ﺗﻐﻁﻲ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬TV.
‫ﺍﻟﻣﺳﺎﻭﺉ‬Disadvantages:
•‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺗﻭﺿﺢ‬ ‫ﻻ‬‫ﻭﺍﻷ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﺑﻳﻥ‬ ‫ﺍﻟﻣﺳﺎﻓﺔ‬‫ﻋﺿﺎء‬
)‫ﺍﻟﺣﺟﻭﻡ‬(‫ﺍﻟﺗﺷﺭﻳﺣﺔ‬anatomical volumes.
•‫ﺃﻳﺔ‬ ‫ﺍﻟﻁﺭﻳﻘﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺗﻌﻁﻲ‬ ‫ﻻ‬‫ﻣﻌﻠﻭﻣﺎﺕ‬‫ﺍﻟﺣﺟﻭﻡ‬ ‫ﺣﻭﻝ‬ ‫ﻛﻣﻳﺔ‬
)quantitative volume. (
7/17/201820
Ossama Anjak,
.6.3‫ﺑﺎﻟﺠﺮﻋﺔ‬ ‫ﺍﻟﺨﺎﺹ‬ ‫ﺍﻹﺣﺼﺎء‬Dose statistics
•‫ﻋﻠﻰ‬ ‫ﺍﻟﺣﺻﻭﻝ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬‫ﻛﻣﻳﺔ‬ ‫ﻣﻘﺎﺩﻳﺭ‬‫ﺃﺩﻭﺍﺕ‬ ‫ﺇﺩﺧﺎﻝ‬ ‫ﺟﺭﻯ‬ ،‫ﺃﻛﺛﺭ‬
‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺗﺧﻁﻳﻁ‬ ‫ﺑﺭﺍﻣﺞ‬ ‫ﺇﻟﻰ‬ ‫ﺇﺣﺻﺎﺋﻳﺔ‬:
•‫ﺍﻷﺩﻭﺍﺕ‬ ‫ﻓﺈﻥ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺑﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﺍﻟﺧﺎﺻﺔ‬ ‫ﺍﻷﺩﻭﺍﺕ‬ ‫ﻣﻊ‬ ‫ﺑﺎﻟﻣﻘﺎﺭﻧﺔ‬
‫ﺍﻹﺣﺻﺎﺋﻳﺔ‬statistics tools‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺧﺎﺹ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺃﻱ‬ ‫ﺗﻅﻬﺭ‬ ‫ﻻ‬
‫ﻣﻘﺎﻁﻊ‬ ‫ﻓﻭﻕ‬‫ﺍﻟـ‬CT‫ﺟﺭﺓ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺗﺷﺭﻳﺣﻳﺔ‬ ‫ﺍﻷﺟﺯﺍء‬ ‫ﻋﻠﻰ‬ ‫ﺃﻭ‬
‫ﻣﻘﺎﻁﻊ‬ ‫ﻋﻠﻰ‬ ‫ﺗﺣﺩﻳﺩﻫﺎ‬‫ﺍﻟـ‬CT‫ﻣﻧﺣﻧﻳﺎﺕ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺣﺎﻝ‬ ‫ﻫﻭ‬ ‫ﻛﻣﺎ‬ ،
‫ﺍﻟﺟﺭﻋﺔ‬
•،‫ﺫﻟﻙ‬ ‫ﻋﻥ‬ ‫ﻋﻭﺿﺎ‬‫ﺗﻅﻬﺭ‬‫ﻛﻣﻳﺔ‬ ‫ﻣﻌﻠﻭﻣﺎﺕ‬ ‫ﺍﻹﺣﺻﺎﺋﻳﺔ‬ ‫ﺍﻷﺩﻭﺍﺕ‬
‫ﻛﻣﻳﺔ‬ ‫ﺇﻟﻰ‬ ‫ﺑﺎﻹﺿﺎﻓﺔ‬ ‫ﺍﻟﺣﺳﺎﺳﺔ‬ ‫ﺍﻷﻋﺿﺎء‬ ‫ﺃﻭ‬ ‫ﺍﻟﻬﺩﻑ‬ ‫ﺣﺟﻡ‬ ‫ﺣﻭﻝ‬
‫ﺍﻟﺣﺟﻡ‬ ‫ﺫﻟﻙ‬ ‫ﺗﻠﻘﺎﻫﺎ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬dose received by that volume.
‫ﻋﻠﻰ‬ ‫ﺍﻹﺣﺻﺎﺋﻳﺔ‬ ‫ﺍﻟﺑﻳﺎﻧﺎﺕ‬ ‫ﻣﻥ‬ ‫ﻧﺣﺻﻝ‬:
‫ﻟﻠﺣﺟﻡ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫ﺍﻟﺩﻧﻳﺎ‬ ‫ﺍﻟﺟﺭﻋﺔ‬.Minimum dose to the volume
‫ﻟﻠﺣﺟﻡ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫ﺍﻷﻋﻅﻣﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬Maximum dose to the volume
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺗﻭﺳﻁ‬Mean dose to the volume.
‫ﺇﻟﻳﻬﺎ‬ ‫ﺗﻌﺭﺽ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬95%‫ﺍﻟﻣﻌﺎﻟﺞ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﻣﻥ‬.Dose
received by at least 95 % of the volume
‫ﻣﻘﺩﺍﺭﻫﺎ‬ ‫ﺇﺷﻌﺎﻋﻳﺔ‬ ‫ﻟﺟﺭﻋﺔ‬ ‫ﺗﻌﺭﺽ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺣﺟﻡ‬95%‫ﻗﻳﻣﺔ‬ ‫ﻣﻥ‬
‫ﺑﺎﻟﻭﺻﻔﺔ‬ ‫ﺍﻟﻣﺣﺩﺩﺓ‬ ‫ﺍﻟﺟﺭﻋﺔ‬.Volume irradiated to at least 95 % of
the prescribed dose
7/17/201822
Ossama Anjak,
PTV
OAR
7/17/201823
Ossama Anjak,
•‫ﺗﻭﺻﻳﺎﺕ‬ ‫ﺑﺣﺳﺏ‬‫ﺍﻟـ‬ICRU:
•‫ﺍﻟﺗﺄﻛﺩ‬ ‫ﻳﺟﺏ‬‫ﺃﻥ‬ ً‫ﺎ‬‫ﺩﻭﻣ‬‫ﺣﺟﻡ‬ ‫ﻛﺎﻣﻝ‬‫ﺍﻟـ‬PTV‫ﺑﻣﻘﺩﺍﺭ‬ ‫ﻣﻐﻁﻰ‬95%
‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻥ‬prescription dose.
•‫ﺃﻥ‬ ‫ﻳﺟﺏ‬ ‫ﺃﻱ‬‫ﺗﻘﻝ‬ ‫ﻻ‬‫ﻣﻥ‬ ‫ﺟﺯء‬ ‫ﺃﻱ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬‫ﺍﻟـ‬PTV‫ﻋﻥ‬
5%‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻥ‬.
•‫ﻣﻥ‬ ‫ﻣﻭﺿﻊ‬ ‫ﺃﻱ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺃﻥ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﻳﺟﺏ‬ ً‫ﺎ‬‫ﺃﻳﺿ‬‫ﺍﻟـ‬PTV
‫ﻋﻥ‬ ‫ﺗﺯﻳﺩ‬ ‫ﻻ‬7%‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻥ‬.
•‫ﺗﻭﻓﺭ‬ ‫ﺍﻟﻣﻔﻳﺩ‬ ‫ﻣﻥ‬ ‫ﺇﺫﺍ‬‫ﺍﻟﻛﻣﻳﺔ‬ ‫ﺍﻹﺣﺻﺎﺋﻳﺔ‬ ‫ﺍﻟﺑﻳﺎﻧﺎﺕ‬‫ﺍ‬ ‫ﻟﻣﻧﻁﻘﺔ‬‫ﻟﻬﺩﻑ‬
Target dose statistics‫ﺍﻟﻣﺣﻳﻁﺔ‬ ‫ﺍﻷﺧﺭﻯ‬ ‫ﻭﺍﻷﻋﺿﺎء‬organ
dose statistics. 7/17/201824

10/July/2018
Ossama Anjak,
7/17/2018
26
Ossama Anjak,
For OARs
7/17/201827
.6
.6.4‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬-‫ﺍﻟﺣﺟﻡ‬
Dose-volume histograms (DVH)
Ossama Anjak,
.6.4‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬-‫ﺍﻟﺣﺟﻡ‬Dose-volume histograms (DVH)
•‫ﻳﻠﺧﺹ‬‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬-‫ﺍﻟﺣﺟﻡ‬DVHs‫ﻓﻲ‬ ‫ﺍﻟﻣﺗﻭﻓﺭﺓ‬ ‫ﺍﻟﻣﻌﻠﻭﻣﺎﺕ‬
‫ﺍﻟﺛﻼﺛﺔ‬ ‫ﺑﺎﻷﺑﻌﺎﺩ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬.
•‫ﺿﻣ‬ ‫ﺍﻟﺛﻼﺛﺔ‬ ‫ﺑﺎﻷﺑﻌﺎﺩ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺍﻟﻣﻌﻠﻭﻣﺎﺕ‬ ‫ﺗﻠﻙ‬ ‫ﺗﺿﻡ‬‫ﺍﻟﺑﻧﻳﺔ‬ ‫ﻥ‬
‫ﻟﻠﻣﺭﻳﺽ‬ ‫ﺍﻟﺗﺷﺭﻳﺣﻳﺔ‬.
•‫ﻣﺧﻁﻁﺎﺕ‬ ‫ﺗﻌﺗﺑﺭ‬‫ﺍﻟـ‬DVHs‫ﺗﻘﺩﻳﺭ‬ ‫ﺗﻌﻁﻲ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻷﺩﻭﺍﺕ‬ ‫ﺃﻫﻡ‬ ‫ﻣﻥ‬
‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺍﻟﺣﺟﻣﻲ‬ ‫ﺍﻟﺗﻭﺯﻉ‬ ‫ﺣﻭﻝ‬ ‫ﻛﻣﻲ‬.
7/17/201829
Frequency
Dose value
Ossama Anjak,
•‫ﻣﺧﻁﻁ‬ ‫ﻳﻅﻬﺭ‬‫ﺍﻟـ‬DVH‫ﺿﻣﻥ‬ ‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺍﻟﺣﺟﻣﻲ‬ ‫ﺍﻟﺗﻭﺯﻉ‬ ‫ﺗﻭﺍﺗﺭ‬
‫ﻣﺛﻝ‬ ‫ﺍﻟﻣﺣﺩﺩ‬ ‫ﺍﻟﻌﺿﻭ‬:
–‫ﺍﻟﺣﺟﻡ‬PTV.
–‫ﻟﻠﺣﺟﻡ‬ ‫ﺍﻟﻣﺟﺎﻭﺭﺓ‬ ‫ﺍﻷﻋﺿﺎء‬PTV
.6.4‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬-‫ﺍﻟﺣﺟﻡ‬(DVH)
7/17/201830

10/July/2018
Ossama Anjak,
Percentvolumeof
totalvolume
Dose value in Gy
•‫ﺍﻟ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﻣﻥ‬ ‫ﻟﻠﺣﺟﻡ‬ ‫ﺍﻟﻣﺋﻭﻳﺔ‬ ‫ﺍﻟﻧﺳﺑﺔ‬ ‫ﻳﻅﻬﺭ‬ ‫ﺃﻥ‬ ‫ﻳﻣﻛﻥ‬ ً‫ﺎ‬‫ﺃﻳﺿ‬‫ﻛﻠﻲ‬
“per cent volume of total volume”‫ﺍﻟﺷﺎﻗﻭﻟﻲ‬ ‫ﺍﻟﻣﺣﻭﺭ‬ ‫ﻋﻠﻰ‬
OY‫ﺍﻷﻓﻘﻲ‬ ‫ﺍﻟﻣﺣﻭﺭ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬OX
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬ ‫ﻣﻥ‬ ‫ﻧﻭﻋﺎﻥ‬ ‫ﻳﻭﺟﺩ‬-‫ﺍﻟﺣﺟﻡ‬DVH:
‫ﺍﻟﻣﺑﺎﺷﺭ‬Direct DVH)‫ﺍﻟﺗﻔﺭﻳﻘﻲ‬
differential(
‫ﺍﻟﺗﺟﻣﻳﻌﻲ‬Cumulative DVH
)‫ﺍﻟﺗﻛﺎﻣﻠﻲ‬integral(.
7/17/201832
Ossama Anjak,
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬-‫ﺍﻟﻣﺑﺎﺷﺭ‬ ‫ﺍﻟﺣﺟﻡ‬DVHDirect:
‫ﻋﻠﻰ‬ ‫ﻟﻠﺣﺻﻭﻝ‬direct DVH‫ﻋﺩﺩ‬ ‫ﺑﺟﻣﻊ‬ ‫ﺍﻟﺣﺎﺳﻭﺏ‬ ‫ﻳﻘﻭﻡ‬‫ﺍﻟﻔﻭﻛﺳﻝ‬
voxels)‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﻋﻧﺻﺭ‬(‫ﺍﻟﻧﺗﻳ‬ ‫ﺭﺳﻡ‬ ‫ﻭﻳﺟﺭﻱ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻧﻔﺱ‬ ‫ﻟﻬﺎ‬ ‫ﺍﻟﺗﻲ‬‫ﺟﺔ‬
)‫ﻟﻠﻌﺿﻭ‬ ‫ﺍﻟﻛﻠﻲ‬ ‫ﻟﻠﺣﺟﻡ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫ﺍﻟﻣﺋﻭﻳﺔ‬ ‫ﺍﻟﻧﺳﺑﺔ‬ ‫ﺃﻭ‬total organ
volume(‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﻛﺗﺎﺑﻊ‬
‫ﻟـ‬ ‫ﺍﻟﻣﺛﺎﻟﻲ‬ ‫ﺍﻟﺭﺳﻡ‬DVH‫ﺍﻟﻬﺩﻑ‬ ‫ﺣﺟﻡ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬target volume‫ﻫﻭ‬
‫ﻣﻔﺭﺩ‬ ‫ﻋﻣﻭﺩ‬single column‫ﺇﻟﻰ‬ ‫ﻳﺷﻳﺭ‬100%‫ﺗﻠﻘﻰ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﻣﻥ‬
‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬.
‫ﺍﻟﺣﺭﺟﺔ‬ ‫ﺍﻷﻋﺿﺎء‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬critical structure‫ﻣﺧﻁﻁ‬ ‫ﻳﺿﻣﻥ‬ ‫ﺃﻥ‬ ‫ﻳﻣﻛﻥ‬
‫ﺍﻟـ‬DVH‫ﺍﻟﻘﻣﻡ‬ ‫ﻣﻥ‬ ‫ﻋﺩﺩ‬several peaks‫ﺍﻟﻣﺧﺗﻠﻔﺔ‬ ‫ﺍﻷﺟﺯﺍء‬ ‫ﻋﻠﻰ‬ ‫ﺗﺩﻝ‬
‫ﻟﻬﺎ‬ ‫ﺗﻌﺭﺽ‬ ‫ﺍﻟﺗﻲ‬ ‫ﻟﻠﺟﺭﻋﺎﺕ‬ ً‫ﺎ‬‫ﻭﻓﻘ‬ ‫ﺍﻟﻌﺿﻭ‬ ‫ﻣﻥ‬ ‫ﻟﻸﻋﺿﺎء‬
‫ﺍﻟﻣﺛﺎﻝ‬ ‫ﺳﺑﻳﻝ‬ ‫ﻋﻠﻰ‬:‫ﺑﺭﻭﺳﺗﺎﺕ‬ ‫ﻭﺭﻡ‬
‫ﺍﻟﻬﺩﻑ‬
Target
‫ﺍﻟﻣﺳﺗﻘﻳﻡ‬
Rectum
Differential DVHs
7/17/201834
Ossama Anjak,
‫ﺍﻟﺗﺟﻣﻳﻌﻲ‬ ‫ﺍﻟﻣﺧﻁﻁ‬Cumulative DVH:
‫ﻳﻁﺭﺡ‬ ‫ﺃﻥ‬ ‫ﺍﻟﻣﻌﺗﺎﺩ‬ ‫ﻣﻥ‬‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻁﺑﻳﺏ‬‫ﺍﻟﺗﺎﻟﻲ‬ ‫ﺍﻟﺳﺅﺍﻝ‬:”‫ﻣﺎ‬
‫ﺇﻟﻰ‬ ‫ﺗﻌﺭﺽ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻟﻭﺭﻣﻲ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﻣﻘﺩﺍﺭ‬ ‫ﻫﻭ‬95 %‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻥ‬95
% isodose line“.
‫ﺍﻟﺛﻼ‬ ‫ﺑﺎﻷﺑﻌﺎﺩ‬ ‫ﺍﻟﻌﻼﺟﻳﺔ‬ ‫ﺍﻟﺧﻁﺔ‬ ‫ﺑﺩﺭﺍﺳﺔ‬ ً‫ﺎ‬‫ﺩﻭﻣ‬ ‫ﻣﺭﺗﺑﻁ‬ ‫ﺍﻟﺳﺅﺍﻝ‬ ‫ﻫﺫﺍ‬‫ﺛﺔ‬3-
D treatment planning‫ﺍﻟﺳﺅﺍﻝ‬ ‫ﻫﺫﺍ‬ ‫ﻋﻠﻰ‬ ‫ﻭﺍﻹﺟﺎﺑﺔ‬‫ﻣﻣﻛﻧﺔ‬ ‫ﻏﻳﺭ‬
‫ﺍﻟﻣﺑﺎﺷﺭ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻡ‬direct DVH.‫ﺍﻟﻭﺍﺟﺏ‬ ‫ﻣﻥ‬ ‫ﺣﻳﺙ‬
‫ﻋﻥ‬ ‫ﺗﺯﻳﺩ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺑﻣﺳﺗﻭﻳﺎﺕ‬ ‫ﺍﻟﻣﻐﻁﺎﺓ‬ ‫ﺍﻟﻣﺳﺎﺣﺔ‬ ‫ﺗﺣﺩﻳﺩ‬95 %
‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻥ‬.
7/17/201835
Example: Prostate cancer
Ossama Anjak,
Integral DVHs
‫ﺍﻟﻬﺩﻑ‬
Target
Critical structure
‫ﺍﻟﻣﺳﺗﻘﻳﻡ‬Rectum
7/17/201836

10/July/2018
Ossama Anjak,
‫ﺍﻟﺗﺟﻣﻳﻌﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬ ‫ﺍﻧﺗﺷﺎﺭ‬ ‫ﺃﺳﺑﺎﺏ‬cumulative DVH:
‫ﺍﻟﻬﺩﻑ‬ ‫ﺣﺟﻡ‬ ‫ﺣﺳﺎﺏ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺣﺎﺳﻭﺏ‬ ‫ﻳﻌﻣﻝ‬)‫ﺍﻟﺣﺭﺟﺔ‬ ‫ﺍﻷﻋﺿﺎء‬ ‫ﺃﻭ‬(
‫ﺍﻟﺣﺟﻡ‬ ‫ﻣﺧﻁﻁ‬ ‫ﺭﺳﻡ‬ ‫ﺛﻡ‬ ‫ﻭﻣﻥ‬ ‫ﻟﻺﺷﻌﺎﻉ‬ ‫ﺗﺗﻌﺭﺽ‬ ‫ﺍﻟﺗﻲ‬)‫ﺍﻭ‬‫ﺍﻟﻧﺳﺑﺔ‬
‫ﻟﻠﺣﺟﻡ‬ ‫ﺍﻟﻣﺋﻭﻳﺔ‬(‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﻊ‬.
‫ﺍﻟﻣﺧﻁﻁ‬ ‫ﻳﺑﺩﺃ‬DVH‫ﻣﻥ‬ ‫ﺍﻟﺗﺟﻣﻳﻌﻲ‬‫ﺍﻟـ‬100 %‫ﺍﻟﻣﻘﺎﺑﻝ‬ ‫ﻟﻠﺣﺟﻡ‬
‫ﺻﻔﺭ‬ ‫ﻟﻠﺟﺭﻋﺔ‬)‫ﺟﺭﻋﺔ‬ ‫ﺃﻳﺔ‬ ‫ﻳﺗﻠﻘﻰ‬ ‫ﻟﻡ‬ ‫ﺍﻟﺣﺟﻡ‬ ‫ﻛﺎﻣﻝ‬ ‫ﺃﻱ‬no dose.(
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻗﻳﺩ‬ ،‫ﺃﻳﺿﺎ‬tolerances‫ﻳﻌﻁﻰ‬ ‫ﺍﻟﺣﺭﺟﺔ‬ ‫ﻟﻸﻋﺿﺎء‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬
‫ﻣﻘﺩﺭ‬ ‫ﻟﻠﺣﺟﻡ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬‫ﺑـ‬.3cm
7/17/201837
Ossama Anjak,
• should cover a large volume as well (>95%)
• provisional selection of this isodose level for dose
prescription 7/17/201838
Ossama Anjak,
Differential DVHs
• nice tool for assessing PTV dose uniformity
7/17/201839
.6
.6.5TREATMENT EVALUATION
Ossama Anjak,
.6.5‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﻘﻳﻳﻡ‬Treatment evaluation
‫ﺍﻷﻓﻼﻡ‬Port films
•‫ﺍﻟﺣﺎﻟ‬ ‫ﻫﺫﻩ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬ ‫ﺍﻷﻓﻼﻡ‬‫ﺔ‬
‫ﺇﺷﻌﺎ‬ ‫ﺗﺻﻭﻳﺭ‬ ‫ﻓﻠﻡ‬ ‫ﻋﻥ‬ ‫ﻋﺑﺎﺭﺓ‬ ‫ﻫﻲ‬‫ﻋﻲ‬
‫ﻭﺭﻗﻲ‬ ‫ﺑﻐﻼﻑ‬ ‫ﻣﻐﻠﻑ‬‫ﻋﺎﺗﻡ‬‫ﻟﻠﺿﻭ‬‫ء‬
‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﻣﺳﺎﺭ‬ ‫ﻓﻲ‬ ‫ﻳﻭﺿﻊ‬
‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﺗﺣﺕ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬.
•‫ﺍﻟﻣﻐﻠﻑ‬ ‫ﻣﻥ‬ ‫ﺍﻟﻔﻠﻡ‬ ‫ﻹﺧﺭﺍﺝ‬ ‫ﺣﺎﺟﺔ‬ ‫ﻻ‬
‫ﺃﻓﻼﻡ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺣﺎﻝ‬ ‫ﻫﻭ‬ ‫ﻛﻣﺎ‬ ‫ﺍﻟﻭﺭﻗﻲ‬
‫ﺍﻹﺷﻌﺎﻋﻲ‬ ‫ﺍﻟﺗﺷﺧﻳﺹ‬.
‫ﺍﻷﻓﻼﻡ‬ ‫ﺍﺳﺗﺧﺩﺍﻡ‬Port films:
•‫ﻟﺣﺳﺎﺳﻳﺔ‬ ً‫ﺎ‬‫ﺗﺑﻌ‬ ‫ﺍﻷﻓﻼﻡ‬ ‫ﻣﻥ‬ ‫ﻧﻭﻋﻳﻥ‬ ً‫ﺎ‬‫ﺗﺟﺎﺭﻳ‬ ‫ﻳﺗﻭﻓﺭ‬)‫ﺳﺭﻋﺔ‬(‫ﺍﻟﻔﻠﻡ‬:‫ﺃﻓﻼﻡ‬
‫ﺑﻁﻳﺋﺔ‬ ‫ﻭﺃﻓﻼﻡ‬ ‫ﺳﺭﻳﻌﺔ‬.‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺗﺳﺗﺧﺩﻡ‬ ‫ﻫﺫﻩ‬:
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻭﺿﻊ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬Localization:
‫ﺳﺭﻳﻊ‬ ‫ﻓﻠﻡ‬ ‫ﻳﻭﺿﻊ‬fast film‫ﺍﻟﻣﺷ‬ ‫ﻟﻠﻣﺻﺩﺭ‬ ‫ﺍﻟﻣﻘﺎﺑﻠﺔ‬ ‫ﺍﻟﺟﻬﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﺧﻠﻑ‬‫ﻊ‬
‫ﺃ‬ ‫ﻣﻥ‬ ‫ﻭﺫﻟﻙ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻥ‬ ‫ﺍﻻﻧﺗﻬﺎء‬ ‫ﻋﻧﺩ‬ ‫ﺃﻭ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺑﺎﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺍﻟﺑﺩء‬ ‫ﻋﻧﺩ‬‫ﺟﻝ‬
‫ﺗﻁ‬ ‫ﻳﺗﻡ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺻﺣﻳﺣﺔ‬ ‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﻭﺿﻌﻳﺔ‬ ‫ﺃﻥ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬‫ﺑﻳﻘﻬﺎ‬
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬.
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬Verification:
‫ﺑﻁﻲء‬ ‫ﻓﻠﻡ‬ ‫ﻳﻭﺿﻊ‬slow film‫ﻣﺩﺓ‬ ‫ﻁﻠﻳﺔ‬ ‫ﻣﻛﺎﻧﻪ‬ ‫ﻭﻳﺑﻘﻰ‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫ﺣﺯﻣﺔ‬ ‫ﻛﻝ‬ ‫ﻓﻲ‬
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬)‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﻟﺗﻠﻙ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬(
7/17/201842

10/July/2018
‫ﺍﻟﻣﺳﺎﻭﺉ‬Disadvantage
‫ﺍﻟﺳﺎﺣ‬ ‫ﻷﺟﻝ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻣﻬﺎ‬ ‫ﻳﻧﺻﺢ‬ ‫ﻻ‬‫ﺎﺕ‬
‫ﺇﻟﻰ‬ ‫ﻧﺣﺗﺎﺝ‬ ‫ﺃﻥ‬ ‫ﻳﻣﻥ‬ ‫ﺣﻳﺙ‬ ‫ﺍﻟﻛﺑﻳﺭﺓ‬
‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺃﻓﻼﻡ‬ ‫ﺃﺭﺑﻌﺔ‬
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬.
‫ﺍﻟﻣﺣﺎﺳﻥ‬Advantages
‫ﺟ‬ ‫ﺫﺍﺕ‬ ‫ﺻﻭﺭ‬ ‫ﺗﻧﺗﺞ‬ ‫ﺍﻟﺳﺭﻳﻌﺔ‬ ‫ﺍﻷﻓﻼﻡ‬‫ﻭﺩﺓ‬
‫ﺃﻓﺿﻝ‬.
‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻣﻬﺎ‬ ‫ﻳﻧﺻﺢ‬
‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﺻﻐﻳﺭﺓ‬ ‫ﺑﺳﺎﺣﺎﺕ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻥ‬
‫ﺍﻟﻣﻌﻘﺩﺓ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬complex
beam arrangements.
‫ﺍﻷﻋﺿﺎء‬ ‫ﺃﻭ‬ ‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﺣﺭﻛﺔ‬ ‫ﺗﺅﺛﺭ‬ ‫ﻻ‬
‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﺟﻭﺩﺓ‬ ‫ﻋﻠﻰ‬.
Ossama Anjak,
‫ﺍﻷﻓﻼﻡ‬ ‫ﻧﻭﻋﻲ‬ ‫ﺑﻳﻥ‬ ‫ﻣﻘﺎﺭﻧﺔ‬
Localization (fast) vs. verification (slow) films
•‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬ ‫ﺍﻷﻓﻼﻡ‬ ‫ﺗﺣﺗﺎﺝ‬ ‫ﻻ‬Localization films‫ﺇﻟﻰ‬‫ﺩﺭﺋﻳﺔ‬
‫ﺗﻌﺯﻳﺯ‬intensifying screens‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺣﺎﻝ‬ ‫ﻫﻭ‬ ‫ﻛﻣﺎ‬
‫ﺍﻟﺳﻳﻧﻳﺔ‬ ‫ﺑﺎﻷﺷﻌﺔ‬ ‫ﺍﻟﺗﺷﺧﻳﺻﻲ‬.
•‫ﻣﻧﺎﺳﺑﺔ‬ ‫ﻣﺎﺩﺓ‬ ‫ﻣﻥ‬ ‫ﺭﻗﻳﻘﺔ‬ ‫ﻁﺑﻘﺔ‬ ‫ﺗﻭﺿﻊ‬)‫ﺍﻷﻟﻣﻧﻳﻭﻡ‬ ‫ﺃﻭ‬ ‫ﻧﺣﺎﺱ‬(‫ﺍ‬ ‫ﻋﻠﻰ‬‫ﻟﻔﻠﻡ‬
)‫ﺍﻷﺷﻌﺔ‬ ‫ﺩﺧﻭﻝ‬ ‫ﺟﻬﺔ‬(‫ﺍﻟﺻﻭﺭ‬ ‫ﻛﻔﺎءﺓ‬ ‫ﺯﻳﺎﺩﺓ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﻭﺫﻟﻙ‬ ‫ﺍﻟﻔﻠﻡ‬ ‫ﻋﻠﻰ‬‫ﺓ‬.
–‫ﻣﻧﻁﻘﺔ‬ ‫ﺣﺫﻑ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻁﺑﻘﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺗﻌﻣﻝ‬‫ﺍﻟـ‬Build-up‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﻟﻠﺣﺯﻣﺔ‬.
•‫ﺍﻟﺧﻠﻔﻳﺔ‬ ‫ﺍﻟﻁﺑﻘﺔ‬backing layer‫ﻣﺿﺎﻋﻔﺔ‬ ‫ﺗﻛﻭﻥ‬ ‫ﺍﻷﺣﻳﺎﻥ‬ ‫ﺑﻌﺽ‬ ‫ﻓﻲ‬
double emulsion films‫ﺇﻟﻛﺗﺭﻭﻧﺎﺕ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺣﺻﻭﻝ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬
backscatter electrons..
7/17/201844
Ossama Anjak,
‫ﺑﺗﻘﻧﻳﺗﻳﻥ‬ ‫ﻟﻺﺷﻌﺎﻉ‬ ‫ﺍﻷﻓﻼﻡ‬ ‫ﺗﻌﺭﻳﺽ‬ ‫ﻳﺗﻡ‬:‫ﻭﺍﺣﺩ‬ ‫ﺗﻌﺭﻳﺽ‬single exposure‫ﺗﻌﺭﻳﺽ‬ ‫ﺃﻭ‬
‫ﻣﺯﺩﻭﺝ‬double exposure.
•‫ﺍﻟﻣﻔﺭﺩ‬ ‫ﺍﻟﺗﻌﺭﻳﺽ‬Single exposure:
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺳﺎﺣﺔ‬ ‫ﻓﻘﻁ‬ ‫ﺍﻟﻔﻠﻡ‬ ‫ﺗﻌﺭﻳﺽ‬ ‫ﻳﺗﻡ‬.‫ﻛﺎﻧﺕ‬ ‫ﺇﺫﺍ‬ ‫ﻣﻧﺎﺳﺑﺔ‬ ‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﻫﺫﻩ‬‫ﺳﺎﺣﺔ‬
‫ﻭ‬ ‫ﺑﻭﺿﻭﺡ‬ ‫ﻣﺷﺎﻫﺩﺗﻬﺎ‬ ‫ﻳﻣﻛﻥ‬ ‫ﺍﻟﺗﺷﺭﻳﺣﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﻡ‬ ‫ﻭﺍﺿﺢ‬ ‫ﻣﻭﺿﻊ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬‫ﻣﻥ‬
‫ﺍﻟﻣ‬ ‫ﺳﺎﺣﺔ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺗﻠﺗﻘﻁ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻷﻓﻼﻡ‬ ‫ﻛﺎﻓﺔ‬ ‫ﺍﻟﻌﻣﻠﻳﺔ‬ ‫ﺍﻟﻧﺎﺣﻳﺔ‬‫ﻌﺎﻟﺟﺔ‬
verification films‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﺑﻬﺫﻩ‬ ‫ﺗﺗﻡ‬.
•‫ﺍﻟﻣﺯﺩﻭﺝ‬ ‫ﺍﻟﺗﻌﺭﻳﺽ‬Double exposure:
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺳﺎﺣﺔ‬ ‫ﺍﻷﻭﻟﻰ‬ ‫ﺍﻟﻣﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻔﻠﻡ‬ ‫ﺗﻌﺭﻳﺽ‬ ‫ﻳﺟﺭﻱ‬.
–‫ﺍﻟﺣﻣﺎﻳ‬ ‫ﺣﺫﻑ‬ ‫ﻣﻊ‬ ‫ﺍﻻﺗﺟﺎﻫﺎﺕ‬ ‫ﻛﺎﻓﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬ ‫ﺃﺑﻌﺎﺩ‬ ‫ﺯﻳﺎﺩﺓ‬ ‫ﻳﺗﻡ‬ ‫ﺛﻡ‬‫ﺎﺕ‬
)‫ﻭﺟﺩﺕ‬ ‫ﺇﻥ‬(‫ﺛﺎﻧﻳﺔ‬ ‫ﻣﺭﺓ‬ ‫ﻟﻺﺷﻌﺎﻉ‬ ‫ﺍﻟﻔﻠﻡ‬ ‫ﺗﻌﺭﻳﺽ‬ ‫ﺗﻡ‬ ‫ﺛﻡ‬.
–‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺳﺎﺣﺔ‬ ‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﺑﻬﺫﻩ‬ ‫ﻋﻠﻳﻬﺎ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﺗﻅﻬﺭ‬‫ﻭ‬‫ﺍﻷﻋﺿ‬‫ﺎء‬
‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﻣﻭﺿﻊ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺣﻘﻖ‬ ‫ﺧﻼﻟﻬﺎ‬ ‫ﻣﻥ‬ ‫ﻳﻣﻛﻥ‬ ‫ﻭﺍﻟﺗﻲ‬ ‫ﺍﻟﻣﺟﺎﻭﺭﺓ‬ ‫ﺍﻟﺗﺷﺭﻳﺣﻳﺔ‬
‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬.
Single exposure technique:
Simulation Image
EPID Image
7/17/201846
Ossama Anjak,
Double exposure technique:
‫ﺍﻵﻧﻳﺔ‬ ‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻧﻅﻡ‬Online portal imaging
systems
•‫ﻣﻥ‬ ‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻧﻅﺎﻡ‬ ‫ﻳﺗﺄﻟﻑ‬:
–‫ﺫﺭﺍﻉ‬ ‫ﻣﻊ‬ ‫ﻣﻭﺻﻭﻝ‬ ‫ﻣﻧﺎﺳﺏ‬ ‫ﺇﺷﻌﺎﻋﻲ‬ ‫ﻛﺎﺷﻑ‬
‫ﺍﻟﺧﻁﻲ‬ ‫ﺍﻟﻣﺳﺭﻉ‬.
–‫ﻧﻅﺎﻡ‬Data acquisition system‫ﺍﻟﺑﻳﺎﻧﺎﺕ‬ ‫ﻟﺗﻠﻘﻲ‬
‫ﺍﻟﺣﺎﺳﻭﺏ‬ ‫ﺇﻟﻰ‬ ‫ﻭﻧﻘﻠﻬﺎ‬ ‫ﺍﻟﻛﺎﺷﻑ‬ ‫ﻣﻥ‬.
–‫ﻭﺇﻅﻬﺎﺭ‬ ‫ﺍﻟﺑﻳﺎﻧﺎﺕ‬ ‫ﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﺎﺻﺔ‬ ‫ﺑﺭﻣﺟﻳﺎﺕ‬
‫ﺍﻟﺻﻭﺭﺓ‬
•‫ﻣﻥ‬ ‫ﻋﺩﻳﺩﺓ‬ ‫ﺃﻧﻣﺎﻁ‬ ‫ﺍﻷﻧﻅﻣﺔ‬ ‫ﻫﺫﻩ‬ ‫ﻓﻲ‬ ‫ﻳﺳﺗﺧﺩﻡ‬
‫ﻭﺇﻅﻬﺎﺭ‬ ‫ﺍﻷﺷﻌﺔ‬ ‫ﺗﻠﻘﻲ‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﻣﻝ‬ ‫ﺍﻟﻛﻭﺍﺷﻑ‬
‫ﺍﻟﺣﺎﺳﻭﺏ‬ ‫ﻋﻠﻰ‬ ‫ﺑﺎﻻﻋﺗﻣﺎﺩ‬ ‫ﺻﻭﺭ‬
•‫ﻟﻠﺗﻘﻧﻳﺔ‬ ً‫ﺎ‬‫ﺗﺑﻌ‬ ‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﺟﻭﺩﺓ‬ ‫ﺗﺧﺗﻠﻑ‬
‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬.
7/17/201848

10/July/2018
Ossama Anjak,
• Electronic portal imaging device ( EPID )
‫ﺍﻵﻧﻳﺔ‬ ‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻧﻅﻡ‬Online portal imaging systems‫ﺗﺿﻡ‬ ‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬:
.1‫ﺍﻟﺗﺄﻟﻖ‬ ‫ﻛﻭﺍﺷﻑ‬Fluoroscopic detectors.
.2‫ﺍﻟﺗﺄﻳﻥ‬ ‫ﺣﺟﻳﺭﺍﺕ‬ ‫ﻛﻭﺍﺷﻑ‬Ionization chamber detectors.
.3‫ﺍﻟﻛﻭﺍﺷﻑ‬‫ﺍﻟﺳﻳﻠﻳﻛﻭﻧﻳﺔ‬Amorphous silicon detectors.
7/17/201850
Ossama Anjak,
•‫ﺍﻟﻛﻭﺍﺷﻑ‬ ‫ﺫﺍﺕ‬ ‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻧﻅﻡ‬Fluoroscopic:
–‫ﺍﻟﻣﺣﺎﻛﺎﺓ‬ ‫ﺟﻬﺎﺯ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻣﺭﻛﺏ‬ ‫ﺍﻟﺗﻧﻅﻳﺭ‬ ‫ﻧﻅﺎﻡ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺣﺎﻝ‬ ‫ﻫﻭ‬ ‫ﻛﻣﺎ‬ ‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﻫﺫﻩ‬ ‫ﺗﻌﻣﻝ‬
simulator image intensifier system.
–‫ﻣﻌﺩﻧﻳﺔ‬ ‫ﻁﺑﻘﺔ‬ ‫ﻫﻭ‬ ‫ﺍﻟﻛﺎﺷﻑ‬metal plate‫ﻣﻥ‬ ‫ﻭﺩﺭﻳﺋﺔ‬fluorescent phosphor
screen‫ﺑﺯﺍﻭﻳﺔ‬ ‫ﺑﻣﺭﺁﺓ‬ ‫ﻭﻣﺯﻭﺩ‬45°‫ﺗﻠﻔﺯﻳﻭﻧﻳﺔ‬ ‫ﻛﺎﻣﻳﺭﺍ‬ ‫ﻣﻊ‬TV camera.
–‫ﺇﻟﻛﺗﺭ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻟﺳﻳﻧﻳﺔ‬ ‫ﺍﻷﺷﻌﺔ‬ ‫ﻓﻭﺗﻭﻧﺎﺕ‬ ‫ﺗﺣﻭﻳﻝ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻣﻌﺩﻧﻳﺔ‬ ‫ﺍﻟﻁﺑﻘﺔ‬ ‫ﺗﻌﻣﻝ‬‫ﻭﺗﺣﻭﻝ‬ ‫ﻭﻧﺎﺕ‬
‫ﺍﻟﻔﻠﻭﺭﺓ‬ ‫ﺩﺭﻳﺋﺔ‬fluorescent screen‫ﻋ‬ ‫ﺗﺳﻘﻁ‬ ‫ﺿﻭﺋﻳﺔ‬ ‫ﻓﻭﺗﻭﻧﺎﺕ‬ ‫ﺇﻟﻰ‬ ‫ﺍﻹﻟﻛﺗﺭﻭﻧﺎﺕ‬‫ﻠﻰ‬
‫ﺍﻟﻣﺭﺁﺓ‬.
–‫ﺍﻟﺗﻠﻔﺯﻳﻭﻧﻳ‬ ‫ﺍﻟﻛﺎﻣﻳﺭﺍ‬ ‫ﻧﺣﻭ‬ ‫ﺍﻟﺿﻭﺋﻳﺔ‬ ‫ﺍﻟﻔﻭﺗﻭﻧﺎﺕ‬ ‫ﺍﻧﺣﺭﺍﻑ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻣﺭﺁﺓ‬ ‫ﺗﻌﻣﻝ‬‫ﺗﻠﺗﻘﻁ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺔ‬
‫ﺿﺋﻳﻝ‬ ‫ﺟﺯء‬(<0.1 %)‫ﺗﻭﻟ‬ ‫ﻋﻠﻰ‬ ‫ﺑﺩﻭﺭﻫﺎ‬ ‫ﺗﻌﻣﻝ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺿﻭﺋﻳﺔ‬ ‫ﺍﻟﻔﻭﺗﻭﻧﺎﺕ‬ ‫ﻣﻥ‬‫ﻳﺩ‬
‫ﺍﻟﺻﻭﺭﺓ‬
–‫ﺟﻳﺩﺓ‬ ‫ﺍﻟﻧﺎﺗﺟﺔ‬ ‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﻛﺎﻧﻳﺔ‬ ‫ﺍﻟﺗﻣﻳﺯ‬ ‫ﺩﻗﺔ‬)‫ﺍﻟﻁﺑﻘﺔ‬ ‫ﺳﻣﺎﻛﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﺗﻣﺩ‬ ‫ﺍﻟﺗﻲ‬‫ﺍﻟﻔﻠﻭﺭﺓ‬.(
–‫ﻣﻥ‬ ‫ﻗﻠﻳﻝ‬ ‫ﻟﻌﺩﺩ‬ ‫ﻓﻘﻁ‬ ‫ﻧﺣﺗﺎﺝ‬MU‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﺑﻬﺫﻩ‬ ‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﺣﺻﻭﻝ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬.
•‫ﺍﻟﻛﻭﺍﺷﻑ‬ ‫ﺫﺍﺕ‬ ‫ﺍﻟﺗﺻﻭﻳﺭ‬ ‫ﻧﻅﻡ‬Fluoroscopic:
7/17/201852
Ossama Anjak,
•‫ﺍﻟﺗﺄﻳﻥ‬ ‫ﺣﺟﻳﺭﺍﺕ‬ ‫ﻣﻥ‬ ‫ﻣﺻﻔﻭﻓﺔ‬ ‫ﺍﻟﻛﺎﺷﻑ‬Matrix ionization chamber detectors:
–‫ﺷﺑﻛﺔ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻡ‬ ‫ﺗﻌﻣﻝ‬‫ﻣﺗﺻﺎﻟﺑﺔ‬‫ﺍﻟﺗﺄﻳﻥ‬ ‫ﺣﺟﻳﺭﺍﺕ‬ ‫ﻣﻥ‬grid of ion chamber‫ﺍﻟﺗﻲ‬
‫ﻵﺧﺭ‬ ‫ﻣﻭﺿﻊ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺗﺄﻳﻥ‬ ‫ﻗﻳﺎﺱ‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﻣﻝ‬.
–‫ﺑﻳﻧﻬﻣﺎ‬ ‫ﺍﻟﻣﺳﺎﻓﺔ‬ ‫ﻣﻌﺩﻧﻳﺗﻳﻥ‬ ‫ﺻﻔﻳﺣﺗﻳﻥ‬ ‫ﻣﻥ‬ ‫ﺍﻟﻛﺎﺷﻑ‬ ‫ﻳﺗﺄﻟﻑ‬1mm‫ﻋﺎﺯﻝ‬ ‫ﺑﻳﻧﻬﻣﺎ‬ ‫ﻳﻭﺟﺩ‬
‫ﻣﻥ‬isobutene.‫ﺇﻟﻰ‬ ‫ﻣﻘﺳﻣﺔ‬ ‫ﺻﻔﻳﺣﺔ‬ ‫ﻛﻝ‬256.‫ﺍﻷﻗﻁﺎﺏ‬electrodes‫ﻭﺍﻟﺻﻔﺎﺋﺢ‬
plates‫ﺯﺍﻭﻳﺔ‬ ‫ﺗﺷﻛﻝ‬ ‫ﺍﻷﻭﻟﻰ‬ ‫ﺍﻟﺻﻔﻳﺣﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻷﻗﻁﺎﺏ‬ ‫ﻳﻛﻭﻥ‬ ‫ﺑﺣﻳﺙ‬90°‫ﺑﺎﻟﻧﺳﺑﺔ‬
‫ﺍﻷﺧﺭﻯ‬ ‫ﻟﻠﺻﻔﻳﺣﺔ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻸﻗﻁﺎﺏ‬
–‫ﻛﻣﻭﻥ‬ ‫ﻓﺭﻕ‬ ‫ﺗﻁﺑﻳﻖ‬ ‫ﻳﺗﻡ‬Voltage‫ﻗﻳﺎﺱ‬ ‫ﻭﻳﺟﺭﻱ‬ ‫ﺍﻟﻌﺎﺯﻟﺔ‬ ‫ﺍﻟﻁﺑﻘﺔ‬ ‫ﻋﺑﺭ‬ ‫ﺍﻟﻘﻁﺑﻳﻥ‬ ‫ﺑﻳﻥ‬
‫ﺍﻟﺗﺄﻳﻥ‬.‫ﺍﻟﺑﻌﺩ‬ ‫ﺛﻧﺎﺋﻳﺔ‬ ‫ﺍﻟﺗﺄﻳﻥ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺧﺭﻳﻁﺔ‬ ‫ﻋﻠﻰ‬ ‫ﻧﺣﺻﻝ‬ ‫ﻭﺑﺎﻟﻧﺗﻳﺟﺔ‬2D ionization
map‫ﺃﺑﻌﺩﻫﺎ‬ ‫ﺻﻭﺭﺓ‬ ‫ﺇﻟﻰ‬ ‫ﺗﺣﻭﻳﻠﻬﺎ‬ ‫ﻳﺟﺭﻱ‬ ‫ﻭﺍﻟﺗﻲ‬256  256 pixels.
–‫ﻋﻠ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺗﻠﻙ‬ ‫ﻣﻥ‬ ‫ﺃﺻﻐﺭ‬ ‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﺑﻬﺫﻩ‬ ‫ﻋﻠﻳﻬﺎ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺻﻭﺭﺓ‬‫ﻳﻬﺎ‬‫ﺑﺎﻟﻔﻠﻭﺭﺓ‬
fluoroscopic systems.
7/17/201854

10/July/2018
Ossama Anjak,
•‫ﺍﻟﻛﻭﺍﺷﻑ‬‫ﺍﻟﺳﻳﻠﻳﻛﻭﻧﻳﺔ‬‫ﺍﻟﻣﺗﺑﻠﻭﺭﺓ‬ ‫ﻏﻳﺭ‬Amorphous silicon detectors:
–‫ﻛﺎﺷﻑ‬ ‫ﻋﻥ‬ ‫ﻋﺑﺎﺭﺓ‬Solid-state detector‫ﻣﻥ‬ ‫ﻣﺻﻧﻊ‬ ‫ﺍﻟﺷﻛﻝ‬ ‫ﻣﺳﺗﻁﻳﻝ‬ ،‫ﻭﺍﺳﻊ‬
‫ﺳﻳﻠﻳﻛﻭﻧﻳﺔ‬ ‫ﺩﻳﻭﺩﺍﺕ‬silicon photodiodes‫ﺣﻘﻠﻳﺔ‬ ‫ﻭﺗﺭﺍﻧﺯﺳﺗﻭﺭﺍﺕ‬field-effect
transistors
–‫ﺩﺭﻳﺋﺔ‬ ‫ﻳﺳﺗﺧﺩﻡ‬ ‫ﺍﻟﻔﻠﻭﺭﺓ‬ ‫ﻛﻭﺍﺷﻑ‬ ‫ﻓﻲ‬ ‫ﺍﻟﺣﺎﻝ‬ ‫ﻫﻭ‬ ‫ﻛﻣﺎ‬‫ﻓﻠﻭﺭﺓ‬metal
plate/fluorescent phosphor screen.‫ﻣﻥ‬ ‫ﺃﺯﻭﺍﺝ‬ ‫ﺍﻟﺿﻭﺋﻳﺔ‬ ‫ﺍﻟﻔﻭﺗﻭﻧﺎﺕ‬ ‫ﺗﻧﺗﺞ‬
‫ﺇﻟﻛﺗﺭﻭﻧﻳﺔ‬ ‫ﺛﻘﻭﺏ‬electron-hole pairs‫ﺍﻟﺿﻭﺋﻳﺔ‬ ‫ﺍﻟﺩﻳﻭﺩﺍﺕ‬ ‫ﻓﻲ‬
photodiodes‫ﺑﺎﻟﺣﺻﻭﻝ‬ ‫ﻳﺳﻣﺢ‬ ‫ﺍﻟﺫﻱ‬ ‫ﺍﻷﻣﺭ‬ ‫ﺍﻟﺷﺩﺓ‬ ‫ﻣﻊ‬ ‫ﻣﺗﻧﺎﺳﺏ‬ ‫ﻋﺩﺩﻫﺎ‬
‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﻋﻠﻰ‬.
–‫ﺍﻟﺗﻘﻧ‬ ‫ﻣﻥ‬ ‫ﺃﻓﺿﻝ‬ ‫ﺟﻭﺩﺓ‬ ‫ﺫﺍﺕ‬ ‫ﺍﻟﺗﻘﻧﻳﺔ‬ ‫ﺑﻬﺫﻩ‬ ‫ﻋﻠﻳﻬﺎ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺻﻭﺭﺓ‬‫ﻳﺎﺕ‬
‫ﺍﻷﺧﺭﻯ‬.
7/17/201856
Ossama Anjak,
–‫ﺻﻐﻳﺭﺓ‬ ‫ﺗﻛﻭﻥ‬ ‫ﺍﻟﺻﻭﺭﺓ‬ ‫ﺍﻟﺗﻘﺎﻁ‬ ‫ﺧﻼﻝ‬ ‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﻳﺗﻠﻘﺎﻫﺎ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬
–‫ﺍﻟﻣﻛﺎﻧﻳﺔ‬ ‫ﺍﻟﺗﻣﻳﺯ‬ ‫ﻭﺩﻗﺔ‬ ‫ﻟﻠﺻﻭﺭﺓ‬ ‫ﻋﺎﻟﻳﺔ‬ ‫ﺟﻭﺩﺓ‬2mm0.784x0.784resolution of.
Simulation Image
(kV image)
EPID Image
(MV Image)
7/17/201858
7/17/2018Ossama Anjak,59
.7‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺟﻠﺴﺔ‬ ‫ﻣﺪﺓ‬ ‫ﺣﺴﺎﺏ‬
‫ﺍﻟﻤﺮﺍﻗﺒﺔ‬ ‫ﻭﺣﺪﺍﺕ‬ ‫ﻋﺪﺩ‬ ‫ﺃﻭ‬
TREATMENT TIME AND MONITOR
UNIT CALCULATIONS

10/July/2018
Ossama Anjak,
.7‫ﺍﻟﻣﺭﺍﻗﺑﺔ‬ ‫ﻭﺣﺩﺍﺕ‬ ‫ﻋﺩﺩ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬
‫ﻭﺍﻷﻣﻠﺛﺔ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧﻁﻳﻁ‬ ‫ﺇﻟﻰ‬ ‫ﻳﻧﻅﺭ‬ ‫ﺭﺑﻣﺎ‬optimization‫ﺗﻭﺯﻉ‬ ‫ﻓﻲ‬
‫ﻋﻠﻰ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫ﺷﻲء‬ ‫ﻛﻝ‬ ‫ﺗﻣﺛﻝ‬ ‫ﺃﻧﻬﺎ‬‫ﻳﺟﺭ‬ ‫ﺣﻳﺙ‬‫ﻱ‬
‫ﺍﻟﻧﺳﺑﻲ‬ ‫ﺍﻟﺗﻭﺯﻉ‬ ‫ﺣﺳﺎﺏ‬‫ﻟﻠﺟﺭﻉ‬relative dose distribution‫ﺍﻟﺣﺟﻡ‬ ‫ﺿﻣﻥ‬PTV
‫ﺍﻟﻣﻘﺑﻭﻝ‬ ‫ﺑﺎﻟﺷﻛﻝ‬.
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺧﻁ‬ ‫ﺃﻥ‬ ‫ﺍﻟﻣﺛﺎﻝ‬ ‫ﺳﺑﻳﻝ‬ ‫ﻋﻠﻰ‬95% isodose curve‫ﺣﺟﻡ‬ ‫ﻛﺎﻣﻝ‬ ‫ﻳﻐﻁﻲ‬
‫ﺍﻟـ‬PTV.
‫ﻫﻧﺎﻙ‬ ‫ﺑﻝ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫ﺷﻲء‬ ‫ﻛﻝ‬ ‫ﻟﻳﺱ‬ ‫ﻫﺫﺍ‬ ‫ﻭﻟﻛﻥ‬‫ﻛﺑﻳﺭ‬ ‫ﺑﺷﻛﻝ‬ ‫ﻳﺅﺛﺭ‬ ‫ﻫﺎﻡ‬ ‫ﻋﺎﻣﻝ‬‫ﻋﻠ‬‫ﻰ‬
”‫ﺟﻭﺩﺓ‬“‫ﺑﺎﻟﺟﺭﻋﺔ‬ ‫ﻳﺗﺣﻛﻡ‬ ‫ﻭﺍﻟﺫﻱ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬absolute dose،‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﻳﺗﻠﻘﺎﻫﺎ‬ ‫ﺍﻟﺗﻲ‬
‫ﻫﻭ‬ ‫ﺍﻟﻣﻌﺎﻣﻝ‬ ‫ﻭﻫﺫﺍ‬:
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬ ‫ﺇﻣﺎ‬Treatment time)‫ﺍﻟﻛﻭﺑﺎﻟﺕ‬ ‫ﻷﺟﻬﺯﺓ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬-60(
‫ﺍﻟﻭﺣﺩﺍﺕ‬ ‫ﻣﻘﺩﺍﺭ‬ ‫ﺣﺳﺎﺏ‬ ‫ﺃﻭ‬MUs)Monitor units(‫ﺍﻟﺧﻁﻳﺔ‬ ‫ﻟﻠﻣﺳﺭﻋﺎﺕ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬.
‫ﺍﻟﺧﺎﺻﺔ‬ ‫ﺍﻟﻘﻳﻡ‬ ‫ﻋﻠﻰ‬ ‫ﻧﺣﺻﻝ‬ ‫ﺍﻟﺣﺎﺿﺭ‬ ‫ﺍﻟﻭﻗﺕ‬ ‫ﻓﻲ‬‫ﺍﻟﻣﻌﺎﻟﺟ‬ ‫ﺑﺯﻣﻥ‬‫ﺔ‬‫ﻭ‬/‫ﺃﻭ‬
‫ﻭﺣﺩﺍﺕ‬ ‫ﻋﺩﺩ‬MUs‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﺧﻁﻳﻁ‬ ‫ﺃﻧﻅﻣﺔ‬ ‫ﻣﻥ‬modern TPS
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﺣﺩﻳﺩ‬ ‫ﻋﻘﺏ‬ ‫ﻭﺫﻟﻙ‬”dose prescription”
.7‫ﺍﻟﻣﺭﺍﻗﺑﺔ‬ ‫ﻭﺣﺩﺍﺕ‬ ‫ﻋﺩﺩ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬:
‫ﻣﻥ‬ ‫ﻭﻟﻛﻥ‬‫ﻳﺩﻭﻳ‬ ‫ﺍﻟﻘﻳﻡ‬ ‫ﻫﺫﻩ‬ ‫ﺣﺳﺎﺏ‬ ً‫ﺍ‬‫ﺟﺩ‬ ‫ﺍﻟﻬﺎﻡ‬ً‫ﺎ‬
‫ﺍﻟﺗﺧﻁﻳﻁ‬ ‫ﻧﻅﺎﻡ‬ ‫ﻋﻥ‬ ‫ﻣﺳﺗﻘﻝ‬ ‫ﺑﺷﻛﻝ‬TPS.
‫ﻟﻠﺣﻭﺍ‬ ‫ﺍﻟﻬﺎﻣﺔ‬ ‫ﺍﻟﻌﻭﺍﻣﻝ‬ ‫ﻣﻥ‬ ‫ﺍﻟﻘﻳﻡ‬ ‫ﻫﺫﻩ‬ ‫ﺗﻌﺗﺑﺭ‬‫ﺩﺙ‬
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺃﻗﺳﺎﻡ‬ ‫ﻓﻲ‬ ‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬Accidents
in radiotherapy.
7/17/201862
Ossama Anjak,
‫ﻻ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺑﺣﺳﺎﺏ‬ ‫ﺍﻟﺧﺎﺻﺔ‬ ‫ﺑﺎﻟﺗﻔﺎﺻﻳﻝ‬ ‫ﺍﻟﺩﺧﻭﻝ‬ ‫ﻗﺑﻝ‬‫ﻓﻬﻡ‬ ‫ﻣﻥ‬
‫ﺍﻟﺗﺎﻟﻳﺔ‬ ‫ﺍﻟﻣﻭﺍﺿﻳﻊ‬:
1. Techniques used for patient setup:
– Fixed SSD setup
– Isocentric setup
2. Methods used for :
– Dose prescription
– Additional of dose from multiple fields.
3. Formulas used for central axis dose
calculations
‫ﺍﻟﻣﺭﻳﺽ‬ ‫ﻭﺿﻌﻳﺔ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬ ‫ﺍﻟﻁﺭﺍﺋﻖ‬ ‫ﻣﻧﺎﻗﺷﺔ‬ ‫ﺟﺭﻯ‬patient
setup‫ﺳﺎﺑﻖ‬ ‫ﻭﻗﺕ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻼﻝ‬:
•‫ﺑﻁﺭﻗﺗﻳﻥ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺟﺭﻱ‬:
–fixed SSD
–isocentric technique
•‫ﻣ‬ ‫ﺑﻬﺎ‬ ‫ﺍﻟﺧﺎﺻﺔ‬ ‫ﺍﻟﺑﺎﺭﺍﻣﺗﺭﺍﺕ‬ ‫ﺍﻟﺳﺎﺑﻘﺔ‬ ‫ﺍﻟﻁﺭﺍﺋﻖ‬ ‫ﻣﻥ‬ ‫ﻁﺭﻳﻘﺔ‬ ‫ﻟﻛﻝ‬‫ﻥ‬
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﻭﺣﺳﺎﺏ‬ ‫ﺍﻟﺟﺭﻉ‬ ‫ﺗﻭﺯﻉ‬ ‫ﺩﺭﺍﺳﺔ‬ ‫ﺃﺟﻝ‬.
7/17/201864
‫ﻛﻮﺑﺎﻟﺖ‬ ‫ﺑﺤﺰﻣﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬-60
SSD
SSD= 80 or 100cm
‫ﻛﻮﺑﺎﻟﺖ‬ ‫ﺑﺤﺰﻣﺔ‬ ‫ﺍﻟﻤﻌﺎﻟﺠﺔ‬-60
SAD
SAD= 80 or 100cm
Isocenter

10/July/2018
‫ﺃﻫﻣﻳﺔ‬ ‫ﻣﺎ‬‫ﺍﻟـ‬SSD‫ﻭ‬‫ﺍﻟ‬‫ـ‬SAD‫؟؟‬
•‫ﺍﻟﺧﺎﺭﺟ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺟﻬﻳﺯﺍﺕ‬ ‫ﻣﻌﺎﻳﺭﺓ‬ ‫ﻳﺗﻡ‬‫ﻳﺔ‬
‫ﺍﻟﻣﺳﺎﻓﺔ‬ ‫ﻋﻧﺩ‬SSD‫ﺃﻭ‬SAD
•‫ﻓﻲ‬ ‫ﺗﻐﻳﺭ‬ ‫ﺃﻱ‬‫ﺍﻟﻣﺳﺎﻓﺔ‬‫ﺇﻟ‬ ‫ﻳﺅﺩﻱ‬ ‫ﺳﻭﻑ‬‫ﻰ‬
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻗﻳﻣﺔ‬ ‫ﻓﻲ‬ ‫ﺗﻐﻳﺭ‬”‫ﺍﻟﺗﺭ‬ ‫ﻗﺎﻧﻭﻥ‬‫ﺑﻳﻊ‬
‫ﺍﻟﻌﻛﺳﻲ‬“.
Ossama Anjak,
Fixed SSD technique Isocentric technique
The fixed SSD technique
results in an isodose distribution
that is typically governed by
percentage depth dose data
(PDD%).
The isocentric technique results
in an dose distribution that is
typically governed by tissue-
maximum ratios TMR (or
tissue-phantom ratios TPR).
7/17/201868
Ossama Anjak,
‫ﺍﻟﻌﻼﺟﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻭﺻﻑ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬ ‫ﺍﻟﻁﺭﻕ‬dose prescription
‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺗﻌﻳﻳﻥ‬ ‫ﻳﻌﺗﻣﺩ‬(MUs)‫ﺍﻟﺣﺎﺳﻭﺏ‬ ‫ﺑﺎﺳﺗﺧﺩﺍﻡ‬ ‫ﺃﻭ‬ ً‫ﺎ‬‫ﻳﺩﻭﻳ‬
‫ﻋﺎﻣﻠﻳﻥ‬ ‫ﻋﻠﻰ‬:
.I‫ﺍﺧﺗﻳﺎﺭ‬‫ﺍﻟﻣﻭﺿﻊ‬‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺍﻟﻣﻧﺎﺳﺏ‬point for dose
prescription.
‫ﺗﻭﺻﻳﺎﺕ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻻﻁﻼﻉ‬ ‫ﻳﻣﻛﻥ‬ICRU)ICRU reference point.(
.II‫ﻣﻘﺩﺍﺭ‬‫ﺍﻟﺟﺭﻋﺔ‬‫ﺍﻟﻧﻘﻁﺔ‬ ‫ﺗﻠﻙ‬ ‫ﻋﻧﺩ‬absolute dose at this point.
Isodose distributions of a three field treatment of
the prostate using fixed SSD on a 6 MV linac
ICRU point
[%]
-150
-140
-130
-120
-100
- 70
- 50
• The ICRU point is
located at the
intersection of
three fields.
• A dose of 200 cGy
per fraction is
prescribed at the
ICRU point.
Example:
7/17/201870
A
(IP)
Ossama Anjak,
‫ﺍﻟﻌﻼﺟﻳﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻭﺻﻑ‬ ‫ﻓﻲ‬ ‫ﺍﻟﻣﺳﺗﺧﺩﻣﺔ‬ ‫ﺍﻟﻁﺭﻕ‬dose prescription:
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺧﻁﻁ‬ ‫ﺍﺳﺗﺧﺩﺍﻡ‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﺗﻣﺩ‬ ‫ﺃﺧﺭﻯ‬ ‫ﻁﺭﻳﻖ‬ ‫ﻳﻭﺟﺩ‬ ً‫ﺎ‬‫ﺃﻳﺿ‬
‫ﺍﻟﺣﺟﻣﻲ‬dose volume histogram (DVH).
‫ﺑﺗﻘﻧﻳﺔ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﻁﺑﻳﻖ‬ ‫ﻋﻧﺩ‬ ‫ﻣﻔﻳﺩﺓ‬ ‫ﺍﻟﻁﺭﻳﻘﺔ‬ ‫ﻫﺫﻩ‬IMRT‫ﻳﺟﺭﻱ‬ ‫ﺣﻳﺙ‬
‫ﺍﻟﻬﺩﻑ‬ ‫ﻓﻲ‬ ‫ﻣﺧﻁﻁ‬ ‫ﻋﻠﻰ‬ ‫ﺑﺎﻻﻋﺗﻣﺎﺩ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻁﺔ‬ ‫ﺗﻘﻳﻳﻡ‬DVH.
‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺗﻭﺳﻁ‬ ‫ﺇﻟﻰ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻌﻳﻳﻥ‬ ‫ﻳﺗﻡ‬median
dose‫ﺍﻟﻬﺩﻑ‬ ‫ﻣﻧﻁﻘﺔ‬ ‫ﻓﻲ‬target volume.
median dose
7/17/201872
• An example is shown
in the DVH:
Median dose is the dose at the
50 % volume level.
• Methods used for dose prescription
(continued)

10/July/2018
Ossama Anjak,
Methods used for adding the dose at the ICRU point from
multiple fields:
1. The most simple method (usually not used):
Each field contributes to the total prescribed dose at the ICRU point
using an equal number of MU (or equal treatment time).
2. Each field contributes to the total prescribed dose at
the ICRU point with different weights.
Prescribed weights for individual fields may refer to:
– the ICRU point IP (used for the isocentric techniques)
– the point of maximum dose Dmax of each field
(used for fixed SSD techniques).
‫ﺣﺳﺎﺏ‬ ‫ﻳﺗﻡ‬‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬‫ﺍﻟﺧﻣﺳﺔ‬ ‫ﺍﻟﺧﻁﻭﺍﺕ‬ ‫ﺑﺗﻁﺑﻳﻖ‬five steps‫ﺍﻟﺗﺎﻟﻳﺔ‬:
(1)‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺧﺭﺝ‬ ‫ﻣﻌﺭﻓﺔ‬calibrated output‫ﺍﻟﻧﻘﻁﺔ‬ ‫ﻋﻧﺩ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺟﻬﺎﺯ‬
‫ﺍﻟﻣﺭﺟﻌﻳﺔ‬reference point.
(2)‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻟﺗﻠﻘﻲ‬ ‫ﺍﻋﺗﻣﺎﺩﻩ‬ ‫ﺟﺭﻯ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﻧﻘﻁﺔ‬ ‫ﻋﻧﺩ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻌﻳﻥ‬ICRU point
(IP)‫ﺣﺯﻣﺔ‬ ‫ﻟﻛﻝ‬.‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﻟﺗﻛﻥ‬ ‫ﺃﻭﻟﻲ‬ ‫ﺑﺷﻛﻝ‬100 MU.
(3).‫ﻗﻳﻡ‬ ‫ﺗﻌﺩﻳﻝ‬MUs‫ﺍﻟﻧﻘﻁﺔ‬ ‫ﻋﻧﺩ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻣﺳﺎﻫﻣﺔ‬ ‫ﻣﻊ‬ ‫ﻟﻳﻧﺳﺟﻡ‬)maxDorIP(‫ﻣﺗﻧﺎﺳﺑﺔ‬
‫ﻗﻳﻡ‬ ‫ﺟﻣﻊ‬ ‫ﻳﺟﺭﻱ‬ ‫ﺛﻡ‬ ‫ﻣﺳﺑﻘﺎ‬ ‫ﺍﻟﻣﺣﺩﺩ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﻭﺯﻥ‬ ‫ﻣﻊ‬‫ﺍﻟـ‬MUs‫ﺍﻟﺣﺯﻡ‬ ‫ﻟﻛﺎﻓﺔ‬ ‫ﺍﻟﻣﻌﺩﻟﺔ‬.
(4)‫ﺗﻌﻳﻳﻥ‬‫ﺍﻟﻧﺳﺑﺔ‬‫ﺍﻟﻣﻭﺿﻊ‬ ‫ﻋﻧﺩ‬ ‫ﺍﻟﺟﻣﻊ‬ ‫ﻭﻧﺎﺗﺞ‬ ‫ﺍﻟﻣﻭﺻﻭﻓﺔ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺑﻳﻥ‬(IP)‫ﺣﺻﻠﻧﺎ‬ ‫ﺍﻟﺫﻱ‬
‫ﺍﻟﺳﺎﺑﻘﺔ‬ ‫ﺍﻟﺧﻁﻭﺓ‬ ‫ﻓﻲ‬ ‫ﻋﻠﻳﻪ‬step 3.
(5)‫ﻗﻳﻡ‬ ‫ﻓﻲ‬ ‫ﺗﻌﺩﻳﻝ‬ ‫ﺇﺟﺭﺍء‬ ‫ﺃﺧﺭﻯ‬ ‫ﻣﺭﺓ‬MUs‫ﺍﻟﺧﻁﻭﺓ‬ ‫ﻓﻲ‬ ‫ﻋﻠﻳﻬﺎ‬ ‫ﺣﺻﻠﻧﺎ‬ ‫ﺍﻟﺗﻲ‬3‫ﺑﺎﺳﺗﺧﺩﺍﻡ‬
‫ﺍﻟﺧﻁﻭﺓ‬ ‫ﻓﻲ‬ ‫ﻋﻠﻳﻬﺎ‬ ‫ﺣﺻﻠﻧﺎ‬ ‫ﺍﻟﺗﻲ‬ ‫ﺍﻟﻧﺳﺑﺔ‬4‫ﻗﻳﻡ‬ ‫ﻋﻠﻰ‬ ‫ﻟﻠﺣﺻﻭﻝ‬ ‫ﻭﺫﻟﻙ‬MUs‫ﺍﻟﻣﻁﻠﻭﺑﺔ‬.
7/17/201874
Ossama Anjak,
Step 1: Calibrated output of the machine
 For kilovoltage X ray generators and teletherapy units
the output is usually given in Gy/min.
 For clinical accelerators the output is given in Gy/MU.
 For superficial and orthovoltage beams and
occasionally for beams produced by teletherapy
radionuclide machines, the basic beam output may
also be stated as the air kerma rate in air (Gy/min) at a
given distance from the source and for a given nominal
collimator or applicator setting.
‫ﺍﻹﺷﻌﺎﻋﻲ‬ ‫ﺍﻟﺧﺭﺝ‬ ‫ﺗﻌﻳﻳﻥ‬ ‫ﻳﺟﺭﻯ‬output for a
radiotherapy machine‫ﻳﻠﻲ‬ ‫ﻟﻣﺎ‬ ‫ﻭﻓﻘﺎ‬:
–In a water phantom
–As the dose rate for a point P
at a reference depth zref
(often the depth of
maximum dose zmax)
–For a nominal source-surface
distance (SSD) or source-axis
distance (SAD), and
–Reference field size Aref
(often 10×10 cm2) on the phantom
surface or the isocentre.
7/17/201876
The photon dose calculation problem
(a) beam calibration in
water
(b) calculation of the dose
distribution in patient
cS pS PDDISL FT,FW OAR
Fixed SSD Calculation Formalism
Reference
Dose Rate
Collimator
Scatter SSD
Phantom
Scatter
Attenuati
on and
scatter at
depth
Accessory
Attenuation
at depth
Primary
intensity
off-axis

10/July/2018
cS
pS TPR
ISL
FT,FW OAR
Isocentric SAD Calculation Formalism
Reference
Dose Rate
Collimator
Scatter
SAD
Phantom
Scatter
Attenuati
on and
scatter at
depth
Accessory
Attenuation
at depth
Primary
intensity
off-axis
Ossama Anjak,
• Second step is performed differently
depending on whether the fixed SSD set-up
or the isocentric set-up is used.
fixed SSD set-up isocentric set-up
7/17/201880
Ossama Anjak,
.7.1‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺣﺳﺎﺏ‬fixed SSD set-up:
Example of isodose distributions of a three field treatment of the prostate using
fixed SSD on a 6 MV linac
7/17/201881
ICRU point
[%]
-150
-140
-130
-120
-100
- 70
- 50
AP
LPOPRPOP
0.53=FW
FW
=0.53
Ossama Anjak,
‫ﺍﻷﻣﺎﻣﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬
Anterior field (A):
open field2cm7.5×7.5
weight W = 1.0
‫ﺍﻟﻳﺳﺭﻯ‬ ‫ﺍﻟﺟﺎﻧﺑﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬
Left posterior field (LPO):
wedge field2cm7.5×6.5
weight W = 0.8
wedge factor WF =0.53
‫ﺍﻟﻳﻣﻧﻰ‬ ‫ﺍﻟﺟﺎﻧﺑﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬
Right posterior field (RPO):
wedge field2cm7.5×6.5
weight W = 0.8
•‫ﺍﻹﺷﻌﺎﻋﻳﺔ‬ ‫ﺍﻟﺣﺯﻣﺔ‬ ‫ﺑﺎﺭﺍﻣﺗﺭﺍﺕ‬)، ‫ﺍﻟﻣﺳﺎﻓﺔ‬ ، ‫ﺍﻟﺳﺎﺣﺔ‬ ‫ﺃﺑﻌﺎﺩ‬( ....‫ﺍﻟﻣﺣ‬ ‫ﻣﻥ‬ ‫ﺍﻟﻣﻛﺗﺳﺑﺔ‬‫ﺎﻛﺎﺓ‬
7/17/201882
Ossama Anjak,
ICRU point
[%]
-150
-140
-130
-120
-100
- 70
- 50
Note:
Prescribed weights refer to
the point of maximum dose
in each field:
PA W = 1.0
PLPO W = 0.8
PRPO W = 0.8
7/17/201883
AP
LPOPRPOP
0.53=FW
FW
=0.53
Ossama Anjak,
ICRU point is at
isocenter: 152 %
[%]
-150
-140
-130
-120
-100
- 70
- 50
• A normalization was
firstly performed for each
field individually:
Method of normalization:
7/17/201884
Fixed SSD isodose distribution for a three field treatment of the prostate
AP
LPOPRPOP
 Anterior field:
Dmax refers to 100 %
 Right posterior field:
Dmax refers to 80 %
 Left posterior field:
Dmax refers to 80 %
The isodose lines
are then obtained by
summing up the
individual %-values.

10/July/2018
Ossama Anjak,
Relative dose factor RDF describes the field size dependence:
 For a given beam energy E (h), the dose at the calibration
point P (at depth zref) depends on the field size A.
 The ratio of dose to that of reference field size Aref is called
the output factor, also known as total scatter factor.
 The IAEA Handbook is using the expression: relative dose
factor (RDF):
7/17/2018
85
relative dose factor (RDF) = SC,P=SC
Ossama Anjak,
 RDF is defined as:
refZp
A
f=SSD
refA
p
10x10cm
7/17/201886
Ossama Anjak,
Step 3: Rescale the MUs such that the dose contributions at
Dmax are proportional to the pre-defined weights and
sum up the total resultant dose using the rescaled MUs.
(dose) = 148.96
Field
Starting
MU
Dose at
Dmax Weight
Weighted dose
at Dmax
Rescaled
MU
Dose at
IP
Anterior 100 98.0 1.0 100 %=98.0 100 69.5
Left post. 100 51.4 0.8 80 % =78.4 152 39.7
Right post. 100 51.4 0.8 80 % =78.4 152 39.7
7/17/201887
Ossama Anjak,
7/17/201889
• The monitor settings MU for points PA, PLPO and
PRPO are calculated as follows
Step 4: Determine the ratio between the
prescribed dose and the sum dose at
IP obtained in step 3.
Prescribed dose = 200 cGy
Calculated dose = 148.96 cGy
•7/17/2018Ossama Anjak, 90

10/July/2018
Ossama Anjak,
Step 5: Rescale again the MUs (from step 3) by the ratio
obtained in step 4 to get finally the required MU.
• Anterior field: 100 MU  1.343 = 134 MU
• Left posterior field: 152 MU  1.343 = 205 MU
• Right posterior field: 152 MU  1.343 = 205 MU
.7.2‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺃﺟﻝ‬ ‫ﻣﻥ‬ ‫ﺍﻟﺣﺳﺎﺏ‬isocentric set-ups:
Example: for an isodose distribution obtained for a 3
field prostate boost treatment with an isocentric
technique
ICRU point
240%
In this example, the
normalization was
performed for each beam
individually such that
Disocenter :is 100 % times
the beam weight.
Isodose lines are then
obtained by summing up
the individual %-values.
7/17/201892
Ossama Anjak,
Anterior field:
open field2cm8×8
PDD = 70.9, W = 1.0
Left posterior field:
wedge field2cm8×7
PDD = 50.7, W = 0.7
Right posterior field:
wedge field2cm8×7
PDD = 50.7, W = 0.7
0.53=FWwedge factor
Field parameters as obtained from the treatment planning:
‫ﺍﻟﻣﺭﺍﻗﺑﺔ‬ ‫ﻭﺣﺩﺍﺕ‬ ‫ﻋﺩﺩ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬:
Step 2: For each field i, the dose at the ICRU point,
Di(IC), is calculated by (using 100 MU):
where:
is the calibrated output of the machine.
is the tissue-maximum-ratio at depth z.
WF is the wedge factor.
RDF(A,E) is the relative dose factor.
ISF is the inverse-square factor (see next slide).
‫ﺍﻟﻣﺭﺍﻗﺑﺔ‬ ‫ﻭﺣﺩﺍﺕ‬ ‫ﻋﺩﺩ‬ ‫ﺃﻭ‬ ‫ﺍﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﻣﺩﺓ‬ ‫ﺣﺳﺎﺏ‬:
7/17/201894
• When the calibrated output factor
is used in isocentric calculations, it must be
corrected by the inverse-square factor (ISF)
unless the machine is actually calibrated at the
isocenter:
7/17/2018Ossama Anjak,95
Ossama Anjak,
Step 3: Rescale the MUs such that the dose
contributions at the IP are proportional to the
pre-defined weights and sum up the total
resultant dose using the rescaled MUs.
(dose) = 175.44MU
Field Starting
MU
Dose at
IP
Weight Weighted dose
at IP
Rescaled
MU
Anterior 100 73.1 1.0 100 %=73.1 100
Left post. 100 28.7 0.7 70 % =51.2 178
Right post. 100 28.7 0.7 70 % =51.2 178
7/17/201896

10/July/2018
Ossama Anjak,
Step 4: Determine the ratio between the prescribed dose and
the sum dose at IP obtained in step 3.
• Prescribed dose = 200 cGy
• Calculated dose = 175.44 cGy
‫ﺍﻟﺧﺎﻣﺳﺔ‬ ‫ﺍﻟﺧﻁﻭﺓ‬:
Step 5: Rescale again the MUs (from step 3) by the ratio
obtained in step 4 to get finally the required MU.
•‫ﺍﻷﻣﺎﻣﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬:100 MU x 1.14 = 114 MU
•‫ﺍﻟﻳﺳﺭﻯ‬ ‫ﺍﻟﺟﺎﻧﺑﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬:178 MU x 1.14 = 203 MU
•‫ﺍﻟﻳﻣﻧﻰ‬ ‫ﺍﻟﺟﺎﻧﺑﻳﺔ‬ ‫ﺍﻟﺳﺎﺣﺔ‬:178 MU x 1.14 = 203 MU
7/17/201898
Ossama Anjak,
7/17/201899
• The dose distribution shown that delivers a dose
of 240 cGy to the ICRU reference point Q,
Ossama Anjak,
7/17/2018100
• To calculate the linac monitor chamber setting in MUs, it is first
necessary to calculate the doses from each beam at the isocentre at
a depth of maximum dose D(Qmax), where SSD = SAD –zmax. The
TMR is obtained for each field and used in the calculation as
follows:
Ossama Anjak,
7/17/2018101
• Calculate the MU setting (MU) from the basic linac output
D(zmax,10,f, E) multiplied by the RDF(AQ), the ISF and other
transmission factors as applicable
Ossama Anjak,
7/17/2018102
• Calculate the MU setting (MU):

10/July/2018
Ossama Anjak,
Important: Dose distributions can be normalized in different ways:
Normalized to maximum
Normalized such that
100% = 100cGy
•‫ﻣﻁﺎﺑﻘﺔ‬ ‫ﻳﺗﻡ‬ ‫ﻣﺎ‬ ً‫ﺎ‬‫ﻏﺎﻟﺑ‬)‫ﻣﻭﺍﺋﻣﺔ‬(‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬dose distribution
normalization‫ﺍﻷﻋﻅﻣﻳﺔ‬ ‫ﻟﻠﺟﺭﻋﺔ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬maximum dose
•‫ﺗﻭﺻﻳﺎﺕ‬ ‫ﺑﺣﺳﺏ‬ICRU‫ﻓﻲ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺃﻥ‬ ‫ﺑﻔﺭﺽ‬ ‫ﺍﻟﺟﺭﻋﺔ‬ ‫ﺗﻭﺯﻉ‬ ‫ﻣﻁﺎﺑﻘﺔ‬ ‫ﻳﺟﺭﻱ‬
‫ﺍﻟﻭﺻﻔﺔ‬ ‫ﻣﻭﺿﻊ‬prescription point‫ﺗﺳﺎﻭﻱ‬100 %
• As a consequence, values of the dose distribution larger
than 100 % will be obtained if the prescription point is not
located at the point of maximum dose.
• If the isodose values generated by the TPS itself are used
for the monitor calculations, the method of normalization
used in the TPS must be taken into account.
7/17/2018104
Ossama Anjak,
• Modern treatment planning systems give the user the ability to
take into account several dosimetric parameters in the dose
distribution affecting the beam output.
• For example, the isodose values in a dose distribution may
already include:
– Inverse square law factors for extended distance treatments.
– Effects on dose outputs from blocks in the field.
– Tray and wedge factors.
• If the isodose values generated by the TPS are used for the
monitor calculations, it is of utmost importance to know
exactly what the isodose lines mean.
• Treatment time calculations for orthovoltage
units and cobalt-60 teletherapy units are carried
out similarly to the above examples except that
machine outputs are stated in cGy/min and the
treatment timer setting in minutes replaces the
monitor setting in MU.
• Shutter correction should be included in the time
set.
7/17/2018106
Ossama Anjak,
‫ﺃﺳـــــﺌﻠﺔ‬
‫ﻭﻣﻨﺎﻗﺸـــــﺔ‬
7/17/2018107Ossama Anjak, 7/17/2018108

Med phy tps_ch_07_04

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