La dosimétrie in vivo en curiethérapie à haut débit

Les chapitres 2, 3 et 6 ont démontré la possible utilisation des détecteurs à scintillateurs plastiques comme dosimètres in vivo en temps réel pour la curiethérapie à haut débit. La capacité de mesurer la dose déposée par la source d’Ir-192 pour le traitement en entier, à l’intérieur de chacun des cathéters et à chaque position de source a été vérifiée pour une simulation de traitement de prostate dans un fantôme d’eau, au chapitre 3, avec le détecteur à un point. La justesse et la précision du détecteur se sont avérées être des plus importantes lorsque la vérification de la dose à chaque position de source est désirée. Celles-ci se sont montrées dépendantes du temps d’intégration de sorte que plus l’acquisition est longue, plus la mesure est précise. Toutefois, une résolution temporelle moindre mène à un plus petit nombre de position de sources pour lesquelles on peut vérifier le dépôt de dose. Le détecteur utilisé ici avait une résolution temporelle se limitant à 5 secondes, une limite imposée par l’électronique composant l’électromètre utilisé pour la lecture du signal. Nous avons aussi démontré que les détecteurs à scintillation peuvent permettre de détecter les possibles erreurs de positionnement de la source et des cathéters, l’inversion des cathéters ainsi que les erreurs dans la dynamique du traitement.

Les résultats que nous avons obtenus au chapitre 6 démontraient une amélioration de la résolution temporelle pour le détecteur multi-point grâce à l’approche spectrale. Les acquisitions de 3 s se sont avérées être un bon compromis entre résolution temporelle et précision. La moyenne des justesses et la précision de mesures effectuées avec ce détecteur étaient respectivement de (3,4 ± 2,1)%, (3,0 ± 0,7)% et (4,5 ± 1,0)% pour respectivement les éléments distal, médian et proximal. L’utilisation d’une moyenne de la justesse pondérée par la dose au carré à chaque détecteur a permis d’améliorer considérablement la justesse du détecteur, passant de 2,7% à 0,6% pour une distance radiale fixée à 3 cm.

Si le premier détecteur développé pour la curiethérapie à haut débit était viable, le détecteur multi-point l’est d’autant plus, en plus de donner accès à plus de points de mesure. C’est donc le détecteur qui serait à préconiser pour une implémentation lors d’une étude clinique. Le détecteur développé au chapitre 6 donnant des résultats très encourageants, il serait effectivement intéressant que ce type de détecteur soit utilisé lors

125 d’une étude clinique afin de mesurer la dose à la tumeur et aux organes environnants en curiethérapie de prostate. Il sera important de développer des procédures permettant de localiser le mieux possible le détecteur et la source radioactive dans l’espace, car l’incertitude sur la position a été démontrée comme étant l’aspect critique sur la précision, tel que montré dans cette étude et par Andersen et al.41 Le gabarit de positionnement des cathéters que nous avons développé au chapitre 2 et utilisé aux chapitres 3 et 6 pourraient aussi être utilisé pour la calibration du détecteur en suivant les étapes établies au chapitre 6. À plus grande échelle, lorsque le détecteur aura été validé cliniquement, il pourra permettre d’effectuer les vérifications de dose et positions de source en temps réel et le traitement pourrait se voir modifié, ou complètement arrêté, en fonction des mesures effectuées.

Les résultats présentés dans les chapitres 2 à 6 de cette thèse démontrent que d’importantes améliorations ont été effectuées et pourraient être utilisées en curiethérapie à haut débit de dose. On peut s’attendre dans les prochaines années à voir les détecteurs à scintillateurs plastiques être implantés en clinique et les domaines d’application se multiplier vu les nombreux avantages associés à ce type de détecteur.

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