La problématique et l'évolution du contrôle de qualité pour la mise en oeuvre de la radiothérapie conformationnelle avec modulation d'intensité

Abstract : Intensity-modulated radiation therapy (IMRT) is the latest evolution of conforma! radiotherapy, made possible by recent developments in imaging, software and treatment technologies. IMRT, using an inverse optimization algorithm to modizy the bearn fluence, allows better conformity of the treatment isodoses to the target volumes while sparing organs at risk. Our work was to define a comprehensive quality assurance program in order to use with optimal safety conditions IMRT for both prostate and head and neck cancers. After having defined the most adapted material and the methods for the measurements of intensity-modulated beams, we found it necessary to elaborate new original measurement phantoms to simulate both treatment locations. These new phantoms demonstrated their efficacy despite a very low cost. These works have subsequently been used to validate the treatment chain consisting of the optimization algorithm, the leaf-sequencing algorithm and the multileaf collimator / accelerator. We developed tests designed to evaluate the capability of these elements and to maintain their performance at an optimal level. Hence, we proposed a quality control protocol of the IMRT treatment chain. In order to make the control of intensity-modulated beams simpler and faster, we studied the use of a liquid-filled electronic portal imaging deviee. This deviee combined ali the qualities required for efficient measuring such beams. These preliminary works allowed us to start treating patients with IMRT using the dynamic collimation method rather than the segmented method since a comparative study had been made on simple then clinical beams. From July 2000 to October 2003, 40 patients were treated with this technique. Our quality control protocol allowed to validate predictive calculations and to demonstrate the reliability of the technique (daily reproducibility higher than 99%).
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Vincent Marchesi. La problématique et l'évolution du contrôle de qualité pour la mise en oeuvre de la radiothérapie conformationnelle avec modulation d'intensité. Médecine humaine et pathologie. Institut National Polytechnique de Lorraine, 2003. Français. ⟨NNT : 2003INPL096N⟩. ⟨tel-01749711⟩

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