ZAŠTITA OD ZRAČENJA PACIJENATA U TOKU RADIOTERAPIJSKOG TRETMANA PRIMJENOM MODERNIH TEHNIKA ZRAČENJA

• Published in: ZAŠTITA OD JONIZIRAJUĆEG ZRAČENJA KOD MEDICINSKE EKSPOZICIJE pp. 39 - 62
• Main Authors: Trokić, Danijela, Marošević, Goran, Jaroš, Dražan, Kostovski, Aleksandar, Ćazić, Dejan, Arsovski, Oliver, Vujošević, Božica, Marić, Slavica, Banović, Pavle, Kolarević, Goran, Milaković, Milomir
• Format: Book Chapter
• Language: Bosnian; Croatian; Serbian
• Published: Bosnia and Herzegovina Akademija Nauka i Umjetnosti Bosne i Hercegovine 2018; Academy of Sciences and Arts of Bosnia and Herzegovina
• Subjects: Health and medicine and law; IMRT; radiation; protection; SRT/SBRT
• ISBN: 9789926410308; 9926410308

Purpose: to present the methodology of radiotherapy practice using modern radiotherapy techniques. Background: Technological progress resulted in implementation of new radiotherapy techniques for precise high-dose delivery to target volume with maximal protection of surrounding healthy tissue. Methodology: patient preparation on 4DCT-simulator using adequate immobilization devices, fusion of simulation CT images with diagnostic CT/MRI/PET images, target volume delineation and organs at risk delineation. Treatment planning procedure uses VMAT/RapidArc: Eclipse TPS protocol for dose escalation in target volume with maximal protection of surrounding healthy tissue over steam dose gradient. That is accomplished by isocentric dose delivery from multiple narrow radiation beams with unequally weighted beam intensity (IMRT) or by Arc-technique with source of radiation rotating around the patient for 360o while the target volume is modulated by dynamic collimator leaf movement (VMAT, SRS/SRT, SBRT). Accuracy of dose delivery by checking the target position is provided by image guided radiotherapy during the treatment using OBI CBCT. Discussion: Implementation of modern radiotherapy techniques requires highly sophisticated facilities so the delivery of high doses to tumor is feasible. Sparing surrounding tissue is significant comparing to previous techniques but for the cost of irradiating greater volume of healthy tissue with lower doses of radiation. Conclusion: High-dose delivery to tumor tissue is in direct correlation with better tumor control with keeping the dose to healthy tissue below the limit that can cause significant organ dysfunction (less than 5% of complications). Completion of QA measures for assurance of high doses delivered to target and low doses to healthy tissue due to acute and late toxicity effects.