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Nuklearmedizin 2022; 61(01): 49-57
DOI: 10.1055/a-1650-9428
Original Article

Bestrahlungsplanung und Dosisverifikation für die kombinierte interne und externe Strahlentherapie (CIERT)

Treatment Planning and Dose Verification for Combined Internal and External Radiotherapy (CIERT)
Robert Freudenberg
1   Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
,
Holger Hartmann
1   Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
,
Michael Andreeff
1   Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
,
Liane Oehme
1   Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
,
Thomas Leichtner
2   Department of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
,
Alexander Fischer
3   Philips Technologie GmbH Innovative Technologies, Aachen, Germany
,
Timo Paulus
3   Philips Technologie GmbH Innovative Technologies, Aachen, Germany
,
Mechthild Krause
2   Department of Radiation Oncology, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
4   OncoRay – National Center for Radiation Research in Oncology, Technische Universität Dresden, Dresden, Germany (Ringgold ID: RIN9169)
5   partner site Dresden, German Cancer Consortium, Dresden, Germany (Ringgold ID: RIN553465)
6   partner site Dresden, National Center for Tumor Diseases Dresden, Dresden, Germany (Ringgold ID: RIN557202)
7   German Cancer Research Center (DKFZ), Heidelberg, Germany
8   Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
,
Jörg Kotzerke
1   Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Dresden, Germany (Ringgold ID: RIN39063)
5   partner site Dresden, German Cancer Consortium, Dresden, Germany (Ringgold ID: RIN553465)
6   partner site Dresden, National Center for Tumor Diseases Dresden, Dresden, Germany (Ringgold ID: RIN557202)
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Zusammenfassung

Ziel Die kombinierte interne und externe Radiotherapie (CIERT) mittels offenen Radionukliden und externer Bestrahlung ermöglicht die Ausnutzung der Vorteile beider Bestrahlungsansätze. Hierzu zählen steile Dosisgradienten und eine geringe Normalgewebstoxizität durch die Bestrahlung mit offenen Radionukliden sowie die homogene Dosisdeposition innerhalb des Tumors durch externe Bestrahlung. Für eine kombinierte Bestrahlungsplanung soll eine Infrastruktur zur Berücksichtigung der Dosisbeiträge aus beiden Modalitäten geschaffen werden. Anschließend soll die physikalische Verifikation der Dosisverteilung messtechnisch mittels OSL-Detektoren erfolgen.

Methode Die interne Bestrahlung erfolgte durch Re-188 in einem Zylinderphantom mit drei zylindrischen Einsätzen. Nach Akquisition von SPECT-Aufnahmen wurde die interne Dosis mittels der Software STRATOS berechnet und als DICOM-RT-Datensatz exportiert. Mittels der Planungssoftware Pinnacle wurde diese Dosisverteilung als Vorbestrahlung berücksichtigt und die externe Bestrahlung mit 6 MV Photonen geplant. Die Messung der Dosisbeiträge erfolgte mittels OSL-Detektoren aus Berylliumoxid für die kombinierte Bestrahlung und für beide Modalitäten getrennt.

Ergebnisse Die geplante Kombinationsbestrahlung mit 1 Gy, 2 Gy und 4 Gy konnte innerhalb der Messunsicherheit der Detektoren sowohl für die getrennten als auch die kombinierte interne und externe Bestrahlung verifiziert werden. Das mittlere Ansprechvermögen der Detektoren bei der internen Bestrahlung mit Re-188 betrug dabei (88,6 ± 2,4) % gegenüber der Kalibrierung mit 200 kV Röntgenstrahlen, wogegen das Ansprechvermögen für 6 MV Photonen bei (146,0 ± 4,9) % lag.

Schlussfolgerung Es wurde ein Ablaufschema für die Bestrahlungsplanung bei der kombinierten internen und externen Radiotherapie entwickelt und erfolgreich getestet. Messtechnisch konnte die Dosisverifikation mittels OSL-Detektoren erfolgreich umgesetzt werden, so dass die physikalisch-technischen Grundlagen für die Dosimetrie bei Kombinationsbestrahlungen gelegt sind.

Abstract

Aim The combined internal and external radiotherapy (CIERT) take advantage of the benefits from radionuclide therapy and external beam irradiation. These include steep dose gradients and a low toxicity to normal tissue due to the use of unsealed radioisotopes as well as homogeneous dose distribution within the tumor due to external beam irradiation. For a combined irradiation planning, an infrastructure has to be developed that takes into account the dose contributions from both modalities. A physical verification of the absorbed dose distribution should follow by measurements using OSL detectors.

Method Internal irradiation was performed using Re-188 in a cylindrical phantom with three inserts. SPECT images were acquired to calculate the internal dose using the software STRATOS. The dose distribution was exported as DICOM-RT data and imported in the software Pinnacle. Based on the internal dose distribution the external irradiation using 6 MV photons was planned. The dose contributions of both modalities separately as well as for combined irradiation was measured using OSL detectors made out of Beryllium oxide.

Results The planed doses of combined irradiation (1 Gy, 2 Gy, 4 Gy) could be verified within the uncertainty of the detectors. The mean energy response to Re-188 was (88.6 ± 2.4) % with respect to the calibration with 200 kV X-ray irradiation. The energy response to 6 MV photons was (146.0 ± 4.9) %.

Conclusion A workflow for the treatment planning of combined internal and external radiotherapy has been developed and tested. Measurements verified the calculated doses. Therefore, the physical and technical basis for the dosimetry of combined irradiation were worked out.

Schlüsselwörter

CIERT - kombinierte Bestrahlung - OSL - Dosimetrie

Keywords

CIERT - combined radiation - OSL - dosimetry


Publikationsverlauf

Eingereicht: 19. Januar 2021

Angenommen nach Revision: 14. September 2021

Artikel online veröffentlicht:
29. November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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