Method for intra-operational dosimetry

FIELD: medicine.

SUBSTANCE: the present innovation deals with measuring radioactivity in alive organisms and could be applied for detecting really absorbed dosage under conditions of intra-operational impact. The method suggested includes detecting clinical volume for the target of radiation impact including the volume of healthy tissues to be subjected for radiation impact, developing the plan of radiation impact based upon data obtained with the help of tissue-equivalent phantoms, location in interest sites of clinical volume of sterilized separate fragments of dosimetric device being the matrix of functional units and designed as thermoluminescent detectors being hermetically isolated at the distance of 10 mm between their edges and fixed between the layers of flexible biocompatible material, registering the location of detectors, performing the séance for intra-operational radiation therapy followed by removing the fragments of dosimetric device out of target's volume. Information should be read from thermoluminescent detectors.

EFFECT: higher accuracy of measuring.

1 cl, 1 dwg, 1 ex

 

The invention relates to medicine, in particular to methods for measurement of radioactivity in living organisms, and can be used to determine the actually absorbed dose in terms of intraoperative radiation therapy.

The known method of control of radiation exposure of man, intended for the detection and determination of internal exposure dose of man, as well as to control the radiation therapy and consists in the fact that the register value of the charging state of the acupuncture points, bioelectricity associated with the examined part of the body, control of radiation exposure of man carried out by the charge value at this point acupuncture, and to determine the absolute dose value of charge at the point of acupuncture are calibrated by an external source of radiation with certain characteristics (patent RF №2112993, publ. 10.06.98. Bull. No. 16). The known method cannot be used to determine the actually absorbed internal organs dose in terms of intraoperative radiation therapy.

There is also known a method of intraoperative detection and treatment of tumors using radioactive labeled labeled antibodies that accumulate in the tumor and are determined intraoperatively (US 4932412). However, in the case of the known method is not p is establece possible to determine the amount actually absorbed by the internal organs of the dose in terms of intraoperative radiation therapy.

The claimed invention is directed to solving the problems of the adequate prediction of therapeutic outcome intraoperative radiation therapy (hereinafter - IORT) and planning further treatment.

Use in clinical practice, the proposed method allows to achieve several technical (medical) results:

- ability to determine the true dose distribution in real conditions IORT,

- the possibility of determining the amount actually absorbed tissue dose at all points of interest, regardless of their location on the wound surface,

- ability to predict treatment outcome IORT,

- the possibility of extrapolation of measured data for subsequent sessions IORT,

- possibility of individual planning postoperative irradiation.

These therapeutic results by carrying out the invention are achieved due to the fact that intraoperative dosimetry is carried out by defining the clinical target volume of radiation exposure, the formation of the plan of radiation exposure on the basis of data obtained with the use of tissue-equivalent phantoms, placement, point-of-interest fragments dosimetric device that represents geometrically correct matrix containing thermoluminescent detectors (hereinafter TLD), sealed zafiksirovan the e between layers of flexible biocompatible material, logging occupancy detectors, implementation session IORT, removal from the surgical field fragments dosimetric devices, auxiliary detectors, read the received data logging and analysis.

The invention consists in the following.

When conducting IORT first of all define the clinical target volume, including the volume of healthy tissue adjacent to the rendered volume of the tumor and are subject to radiation exposure. To implement directly the session form the plan of radiation exposure using standard planning programs irradiation, initial parameters for which are the results obtained using absolute dosimeters on tissue-equivalent phantoms. At this stage of treatment, the value of the absorbed dose in a given clinical amount of exposure is determined on the basis of dosimetric calculations on systems planning (indirect dosimetry). However, when using the known systems planning radiation exposure is not possible to determine the true dose distribution in real conditions of irradiation session. At the same time, information about the true distribution of the dose required for forecasting and planning future treatment. what it is:

- predict treatment of the IORT,

- extrapolation of measured data for a subsequent session intraoperative radiation

individual planning of postoperative irradiation.

The inventive method of intraoperative dosimetry allows to determine the absolute value of individual absorbed dose obtained under conditions of intraoperative irradiation, using TLD. In medical practice for the implementation of monitoring use different types of detectors (semiconductor, diamond, ionization chambers, and so on). To implement the developed method intraoperative dosimetry were selected TLD for several reasons: small size (the size of the TLD is about 5.0 mm in diameter, a thickness of about 1.0 mm) reliability, autonomy from the power source, ease of information processing. The latter advantage is due to the properties of the material used for the TLD, to accumulate radiation energy and to store information about quantity over a significant time interval. This is especially important when implementing direct dosimetry in terms of direct radiation exposure during surgery. In addition, commercially available TLD provide the ability to measure radiation doses in a wide range of radio is active radiation minor, medium and high energy and can be used for different types of radiation exposure.

The method is as follows.

In the preoperative period is made dosimetric device representing geometrically correct matrix containing TLD, which is tightly fixed between the layers of a flexible biocompatible material. The material for the matrix must be sufficiently flexible to fragments of a dosimetric device could be placed on the wound space in compliance with the conditions of dense contact with living tissue without the use of additional means of fixation and at the same time not creating obstacles to remove them. Moreover, the material must meet certain sanitary and technical requirements, namely:

- does not have the property of accumulation of radio emission;

to be non-toxic to wound tissue;

- be cold sterilization;

- be able arbitrary division into separate fragments;

As the biocompatible material may be polypropylene or polyethylene medical tape, which meets all the above requirements and, in addition, will allow to achieve a high level of sealing that ensures the integrity of the of electoral, excludes direct contact with living tissues and, therefore, does not distort the data when reading. For the manufacture of dosimetric devices on a rectangular base of two layers of polypropylene or polyethylene medical tape (the size is determined individually in each case) parallel straight rows place the detectors in such a way that the distance between the edges of the detectors was 10 mm, the workpiece is covered with two layers of the same material. Using a high-temperature press the base and the upper layer film fixed to each other so that each of the detectors was isolated from neighboring detector band fixation. The width of the strip edge fixation of the matrix is at least 5 mm Above the geometrical parameters of the detectors in the matrix satisfy the condition necessary and sufficient number of detectors per unit area of the wound surface to measure really absorbed dose of radiation, as well as the condition of dense commit each individual detector inside a cell of the matrix. Thus form a tight matrix, which can be used in the field of radiation of any configuration and of any size and avoids migration of detectors operating on the wound and distortion data. Depending on the intended for the ACI finished matrix is divided into fragments, contains different number of functional units - part of a matrix that includes one detector. Double layer film and a high level of sealing can keep the integrity of the detectors and to allow sterilization made of a matrix. This allows you to measure doses of radiation directly in terms of aseptic wounds, and at the same time eliminates direct contact of the detectors with living tissues.

On stage, preoperative preparation carry out a preliminary simulation of the planned volume of exposure taking into account the original tumor and the planned volume of surgical intervention. Preliminary planning session intraoperative irradiation is performed using a computer system dosimetric planning "Gameplan". However, depending on the specific clinical situation using the data distribution of the absorbed dose of electron radiation in a homogeneous tissue-equivalent phantom.

During surgical intervention produce sterilization harvested matrix with an antiseptic solution (1% chlorhexidine) by immersing it in the solution for 30 minutes.

After the implementation of surgical access to the planned volume of irradiation (tumor bed or a tumor) determine necessary and until the sufficient number of detectors, located in the area of exposure, and the number and shape of the fragments of the matrix. Prepared sterilized fragments of the matrix is set at the point of interest is critical organs (organs and tissues located in and/or out of the field of irradiation, the violation of which can lead to life-threatening), the boundaries of the field of exposure, levels, located as superficial and as deeply as possible, the space beyond the boundaries of the field of irradiation. The layout of the fragments of the matrix is determined individually, depending on the specific clinical situation. The location of the detectors should log.

Exercise session IORT. At the end of the session IORT hermetic fragments of the matrix is removed from the wound, washed with an antiseptic solution, dried, lasermedizin by opening film base, incubated for 24 hours at room temperature and perform information reading apparatus TLD, for example, harshaw tdl 3500. At the final stage, the information obtained should log and analyze. In accordance with the results of the analysis predict the result produced by IORT, plan optimal dose distribution in a given volume in the case of using an additional (post-operative or repeated intraoperative) irradiation with the inclusion of a known volume of radiation.

Clinically the cue.

Patient A., after removal of malignant tumors of the mucosa of the alveolar ridge of the upper jaw, there appeared a large defect sizes 20×15 cm, extending from the median line of the neck, to the front edge of the rear muscle groups of the neck, below the upper edge of the clavicle, to the level of the zygomatic arch. The planned volume of irradiation - surgical wounds, including the trunk of the common carotid artery, the root of the tongue, part of the thyroid gland. Thus, there is a given clinical situation, the amount of irradiation of irregular shape with irregular contours and different depth parameters. Prepared sterilized fragments of the matrix were placed in specific points of interest. The location of the fragments dosimetric device on the wound surface shown in the drawing.

- slice # 1-5 functional units - the area of the thyroid gland

- slice # 2-5 functional units - the tumor bed between graft carotid artery and the lateral edge of the wound,

- slice # 3-5 functional units on the upper edge of the wound (surface)

- slice # 4-10 functional units - the front surface of the barrel of the common carotid artery along transplant,

- slice # 5-2 functional units - the maximum depth of the wound,

- slice # 6-5 functional units (photo not shown) tumor bed under t is ransplantation (most remote from the surface of the wound point Lodge tumors),

- slice # 7-10 functional units on the lateral edge of the wound, starting from the ear,

fragment No. 8-9 functional units of surface area of the wound.

The location of the detectors historical. In accordance with the standard program Gammaplan, based on the parameters generated after removal of the tumor bed, the planned session mode intraoperative irradiation. The planned dose absorbed, calculated to a depth of 3 cm was 15 Gy. For the implementation of the session in accordance with these parameters it was decided to use the electron beam 19 MeV. Implemented session IORT. At the end of the session IORT hermetic fragments of the matrix were removed from the wound, washed with an antiseptic solution, drained, depressurized and after 24 hours produced an information reading apparatus harshaw TLD tdl 3500. As a result of reading the information from the dosimeters, prisoners in slice # 6 (5 functional units - removed tumor bed under the graft at a depth of 3 cm), it was found that the actual absorbed dose in the study was from of 13.75 to 14,77 G that differs from the planned dose. As a result of reading the information from the dosimeters, prisoners in slice # 4 (10 functional units - the front surface of the barrel of the common carotid artery along transplant chap who Bina 2.5 cm from the wound, it was found that the actual absorbed dose in different points of the graft was 12,27 to 14,26 Gr, i.e. the absorbed dose at certain points transplant was similar in magnitude with the dose absorbed some point Lodge transplant. The obtained results were used for a differentiated approach when planning dose postoperative radiation at these points due to the need to avoid nedouplotneniya bed of the tumor and the overexposure of the graft, which could subsequently affect the treatment outcome (complications and/or local recurrence).

Thus, the inventive method has considerable advantages over known methods of the same purpose and meets the criteria of patentability.

1. Method of intraoperative dosimetry, including the definition of clinical target volume of radiation exposure, including the amount of healthy tissue adjacent to the rendered volume of malignant tumors that are subject to radiation exposure, the formation of a plan of radiation exposure on the basis of data obtained with the use of tissue-equivalent phantoms, placing in the points of interest clinical volume sterilized individual fragments dosimetric devices, representing a matrix of funktionalanalysis, made in the form of thermoluminescent detectors, sealed and isolated, at a distance of 10 mm between edges fixed between layers of flexible biocompatible material, logging placement of detectors, the session intraoperative radiation therapy, removal of the target volume of individual fragments dosimetry device, reading data from thermoluminescent detectors and analysis.

2. The method according to claim 1, characterized in that as a flexible biocompatible material use polypropylene or polyethylene film.



 

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