Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKPotensi induksi radiasi sekunder tidak hanya bergantung pada jumlah dosis penyerapan yang diberikan, tetapi juga pada karakteristik pasien. Selama perlakuan terapi menggunakan Gamma Knife Radiosurgery (GKRS), tubuh pasien menerima iradiasi akumulasi dosis hamburan dan kebocoran. Oleh karena itu, perlu untuk mengetahui dosis radiasi organ kritis pasien yang diterima selama perawatan Gamma Knife Radiosurgery dan membandingkan dengan batasan dosis masing-masing organ. Pengukuran dilakukan dengan menggunakan dosimeter film GafChromic XR-QA2 dan thermoluminescent dosimeter (TLD) yang diletakkan pada permukaan organ kritis fantom. Pemasangan head frame di fantom antropomorfik (Alderson Rando Phantom, Laboratorium Penelitian Alderson, Inc., Stamford, Connecticut) dan scalp measurement digunakan untuk mengukur geometri kepala fantom. Magnetic Resonance Imaging (MRI) digunakan untuk memperoleh citra fantom antropomorfik dan kemudian dipindahkan ke Leksell Gamma Planning (LGP) untuk menentukan perencanaan posisi target, distribusi dosis dan dosis preskripsi maksimum pada target 36 Gy. Unit LGK Perfexion (Elekta AB, Stockholm, Swedia) digunakan untuk menyinari fantom dengan target diposisikan di tengah, dan volume target divariasi dari 5 cc, 10 cc, 15, dan 20 cc serta ukuran kolimator dari 4 mm, 8 mm, dan 16 mm. Dosimeter diletakkan di permukaan lensa, tiroid, payudara, fundus uterus, ovarium, dan testis. Kemudian dosimeter dianalisa untuk memperoleh dosis pada organ kritis. Hasil pengukuran menunjukkan bahwa dosis yang terlihat pada lensa, tiroid, dan payudara dipengaruhi oleh jarak organ dari target, volume target, dan ukuran kolimator. Diperoleh bahwa dosis radiasi pada organ kritis berkontribusi kurang dari 3%, relatif terhadap dosis target maksimum. Dosis radiasi pada organ kritis yang diambil menggunakan film GafChromic XR-QA2 lebih tinggi dibandingkan TLD dengan diskrepansi mencapai 50%. Jika dibandingkan dengan referensi, pengukuran dosis XR-QA2 tidak jauh berbeda sehingga diketahui bahwa film XR-QA2 dapat digunakan untuk mengukur radiasi hambur. Namun, perhatian khusus dan optimisasi harus dilakukan untuk perencanaan perlakuan dengan mempertimbangkan ukuran kolimator yang digunakan dan meminimalkan waktu perlakuan.

---

ABSTRACTThe potential for secondary radiation induction depends not only on the amount of absorption dose received, but also on patient characteristics, such as age (in general, younger patients will be more vulnerable). During treatment using Gamma Knife Radiosurgery (GKRS), patient's body receives an dose accumulation from scattering and leakage. Therefore, it is necessary to know the dose of patient's organs at risk (OAR) received during Gamma Knife Radiosurgery treatment and compare it with the dose limit of each organs. Measurements obtained using a GafChromic XR-QA2 dosimeter and thermoluminescent dosimeter (TLD) placed on the surface of phantom critical organs. Installation of head frame in anthropomorphic phantom (Alderson Rando Phantom, Alderson Research Laboratory, Inc., Stamford, Connecticut) and scalp measurement used to measure phantom head geometry. Magnetic Resonance Imaging (MRI) used to obtain anthropomorphic phantom image and then transferred to the Leksell Gamma Planning (LGP) to determine the planning treatment planning such as target position, dose distribution and target maximum prescription dose at 36 Gy. The LGK Perfexion unit (Elekta AB, Stockholm, Sweden) used to illuminate the phantom with the target positioned in the middle, and the target volume varies from 5 cc, 10 cc, 15 and 20 cc and collimator sizes from 4 mm, 8 mm and 16 mm. The dosimeters placed on the surface of the lens, thyroid, breast, uterine fundus, ovaries and testes. Then the dosimeters analyzed to obtain the dose in OAR. The measurement results shows that the dose at lens, thyroid, and breast depend on the distance from the target, target volume, and collimator size. The radiation dose in OAR contributed less than 3%, relative to the maximum target dose. The radiation dose in critical organs taken using GafChromic XR-QA2 film is higher than TLD with a 50% discrepancy. When compared with the reference, the measurement of XR-QA2 dose is not much different so it is known that XR-QA2 film can be used to measure scattering radiation. However, special attention and optimization must be done for treatment planning by considering the size of the collimator used and minimizing the treatment time."

"Dosis pada LGK Perfexion dihitung untuk setiap tembakan dengan jumlahkan kontribusi dari 192 sumber radiasi yang dipancarkan dari cobalt-60. Secara umum, bentuk tengkorak pasien dimodelkan berdasarkan 24 skull measurement. Namun, karena keterbatasan pengukuran menggunakan 24 ukuran tengkorak, kontur yang dihasilkan perbedaan dari kepala pasien yang sebenarnya berdasarkan citra MRI. Penelitian ini dilakukan untuk distribusi dosis LGK Perfexion menggunakan kontur yang dihasilkan oleh pengukuran manual dan citra CT. Film GAFChromic EBT3 diletakan pada fantom anthropomorphik. Pemindai Epson 10000 XL dan ImageJ digunakan untuk menghasilkan hasil dari pengukuran. Hasil kalkulasi dosis titik menggunakan kontur dari citra CT menunjukan nilai yang lebih baik untuk semua kolimator dan bentuk target yang sama dengan nilai rata deviasi 1,3 ± 0,87, sedangkan jika menggunakan 24 ukuran tengkorak menunjukan nilai rata rata deviasi 4,03 ± 3,73.

---

The dose on LGK Perfexion is calculated for each shot by adding up the contributions of the 192 radiation sources emitted from the cobalt-60. In general, the patient's skull shape is modeled based on 24 skull sizes. However, due to the limitations of measurements using 24 skull sizes, the contours of the resulting differences from the actual patient's head based on the MRI images. This study was conducted for the dose distribution of LGK Perfexion using contours generated by manual measurements and CT images. The GAFChromic EBT3 film is set on an anthropomorphic ghost. An Epson 10000 XL and an ImageJ scanner were used to generate the measurement results. The result of point dose calculation using CT image contour shows a higher value good for all collimators and the same target shape with a mean deviation value of 1.3 ± 0.87, whereas if using 24 skull sizes it shows a mean deviation value of 4.03 ± 3.73."

"Latar Belakang: malformasi arteri-vena (MAV) adalah struktur abnormal yang menyebabkan fistula antara arteri dan vena tanpa perantara kapiler. MAV serebral memiliki risiko ruptur yang tinggi, dimana keadaan ruptur dapat menyebabkan kondisi katastrofik bagi pasien. Terdapat berbagai modalitas penatalaksanaan dalam manajemen MAV, seperti reseksi, embolisasi endovaskular, pembedahan stereotaktik, atau kombinasi tindakan-tindakan tersebut. Penelitian mengenai MAV sudah banyak dilakukan di luar negeri, namun masih sedikit dilakukan di Indonesia.Tujuan: memperoleh data profil klinis, manajemen, luaran, dan gambaran pembiayaan pasien MAV serebral di RSUPN Dr. Cipto Mangunkusumo, serta memperoleh hubungan antara variabel tersebut.Metode: penelitian ini merupakan penelitian observasional deskriptif dengan memperoleh data dari rekam medis pasien sejak tahun 2012 hingga 2021.Hasil: sebanyak 128 tindakan dilakukan pada pasien MAV serebral di RSCM. Jenis tindakan terbanyak adalah DSA diagnostik, disusul dengan GKRS dan embolisasi. Pada tindakan embolisasi,  luaran klinis yang memiliki perbedaan signifikan atara pra dan pasca operasi adalah kejang, nyeri kepala, dan penurunan kesadaran. Pada tindakan GKRS, luaran klinis yang memiliki perbedaan signifikan pra dan pasca operasi adalah kejang, nyeri kepala, mual muntah, penurunan kesadaran, hemiparesis, dan hemihipestesia. Median persentase obliterasi GKRS adalah 51,86%. Data tindakan reseksi tidak dianalisis karena jumlah sampel tidak mencukupi. Biaya tindakan paling tinggi adalah tindakan GKRS, dengan rerata pembiayaan tindakan sebesar Rp. 134.878.643,00.Kesimpulan: dibandingkan dengan embolisasi dan reseksi, tindakan GKRS menunjukkan luaran klinis yang lebih baik dengan nilai median obliterasi 51,86%, namun merupakan tindakan dengan pembiayaan paling tinggi dan tidak ditanggung oleh asuransi negara.

---

Backgrounds: Arteriovenous malformation (AVM) is an abnormal structure that causes fistulas between arteries and veins without capillary intermediaries. Cerebral AVM has a high risk of rupture, where the state of rupture can cause catastrophic conditions for the patient. There are various treatment modalities in the management of AVM, such as resection, endovascular embolization, stereotactic surgery, or a combination of the treatments above. Many researches on AVM have been carried out abroad, but little has been done in Indonesia.

Objective: to obtain data on clinical profiles, management, outcomes, and costs of cerebral AVM patients at Dr. Cipto Mangunkusumo, and to obtain the relationship between the variables.

Method: this study is a descriptive observational study by extracting data from patient medical records from 2012 to 2021.

Results: a total of 128 procedures were performed on cerebral AVM patients at RSCM. The most common type of procedure was diagnostic DSA, followed by GKRS and embolization. In the embolization procedure, the clinical outcomes that had a significant difference between pre and post-procedure were seizures, headache, and decreased consciousness. In the GKRS procedure, the clinical outcomes that had significant differences before and after the procedure were seizures, headache, nausea and vomiting, decreased consciousness, hemiparesis, and hemihypesthesia. The median percentage of GKRS obliteration was 51.86%. Resection data were not analyzed because the number of samples was insufficient. The highest cost of procedure is GKRS, with an average cost of action of Rp. 134,878,643.00.

Conclusion: compared to embolization and resection, the GKRS procedure showed a better clinical outcome with a median obliteration value of 51.86%, but it was the procedure with the highest cost and was not covered by national health coverage."

"Compensating for quasi-periodic motion in robotic radiosurgery outlines the techniques needed to accurately track and compensate for respiratory and pulsatory motion during robotic radiosurgery. The algorithms presented within the book aid in the treatment of tumors that move during respiration. In Chapters 1 and 2, the book introduces the concept of stereotactic body radiation therapy, motion compensation strategies and the clinical state-of-the-art. In Chapters 3 through 5, the author describes and evaluates new methods for motion prediction, for correlating external motion to internal organ motion, and for the evaluation of these algorithms’ output based on an unprecedented amount of real clinical data. Finally, Chapter 6 provides a brief introduction into currently investigated, open questions and further fields of research. "

"Stereotactic body radiation therapy (SBRT) has emerged as an important innovative treatment for various primary and metastatic cancers. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists."

"The treatment of prostate cancer continues to be problematic owing to serious side-effects, including erectile dysfunction and urinary incontinence. Robotic radiosurgery offers a novel, rapid, non-invasive outpatient treatment option that combines robotics, advanced image-guided spatial positioning, and motion detection with submillimeter precision. This book examines all aspects of the treatment of prostate cancer with robotic radiosurgery. It explains how image-guided robotic radiosurgery overcomes the problem of patient motion during radiation therapy by continuously identifying the precise location of the prostate tumor throughout the course of treatment. Hypofractionated radiation delivery by means of robotic radiosurgery systems is also discussed in detail. The book closes by examining other emerging genitourinary applications of robotic radiosurgery. All of the authors are experts in their field who present a persuasive case for this fascinating technique."

"Karakteristik dari berkas proton secara teori lebih menguntungkan untuk jaringan normal dibanding dengan berkas foton. Karakteristik bragg peak dari berkas proton memungkinkan untuk mereduksi distribusi dosis pada jaringan normal. Oleh karena itu, penggunaan berkas proton mampu mengurangi kemungkinan terjadinya efek samping pada jaringan normal. Penggunaan Intensity Modulated Proton Therapy (IMPT) memungkinkan untuk memberikan dosis optimal pada PTV dengan tetap memberikan distribusi dosis yang baik, sehingga tujuan penelitian ini untuk mengetahui kemungkinan penggunaan IMPT untuk kasus vestibular schwannoma serta membandingkan kualitas pencitraan IMPT dengan IMRT, VMAT, dan TOMO. Setiap perencanaan dilakukan dengan menggunakan teknik stereotactic radiosurgery (SRS), perencanaan IMPT dilakukan dengan multifield optimizatin (MFO) dan single field optimization (SFO). Hasil perencanaan didapat nilai conformity indeks (CI) dari tertinggi ke terendah adalah 3MFO-NC, 5MFO-NC, 3MFO, 5MFO, IMRT, 3SFO-NC, VMAT, 3SFO, dan TOMO. Perencanaan proton memiliki gradient indeks lebih baik dari foton. Equivalent Unoform Dose (EUD) berkas proton lebih rendah dibandingkan dengan foton. Nilai Normal Tissue Complication Probability perencaan proton lebih rendah dari foton. Selain itu, perencanaan proton memiliki dosis pada OAR yang lebih rendah dibanding foton.

---

The characteristics of the proton beam are theoretically more favorable for normal tissues than the photon beam. The characteristic of the proton beam Bragg Peak can provide minimum dose distribution in normal tissues. Therefore, the use of proton beams can reduce the possibility of side effects in normal tissues. In addition, Intensity Modulated Proton Therapy (IMPT) produces an optimal dose for PTV while still providing a good dose distribution. In this study, the purpose was to determine the quality of planning IMPT for cases of Vestibular Schwannoma and compare with planning with IMRT, VMAT, and TOMO. The stereotactic Radiosurgery (SRS) technique was employed for all treatment planning. Furthermore, IMPT planning was performed using Multifield Optimization (MFO) and Single Field Optimization (SFO). The study described Conformity Index (CI) values from the highest to the lowest are 3MFO-NC, 5MFO-NC, 3MFO, 5MFO, IMRT, 3SFO-NC, VMAT, 3SFO, and TOMO. Additionally, the Gradient Index (GI) of the proton beam is better than photons planning. However, the Equivalent Uniform Dose (EUD) and Normal Tissue Complication Probability (NTCP) of the proton beam are lower than that of the photon. In addition, proton plans have a lower OAR dose than photons."