Radiotherapy Simulation

1. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬1
‫ﻤﺤﺎﻜﺎة‬
‫اﻹﺸﻌﺎﻋﻴﺔ‬ ‫اﻠﻣﻌﺎﻠﺟﺔ‬
Radiotherapy Simulation
‫ـﻖ‬‫ﺟ‬‫ﻧ‬
ٔ
‫ا‬‫ﺴﺎﻤﺔ‬
ٔ
‫ا‬
‫اﻠﺳﻮرﻳﺔ‬‫اﻠﺬرﻳﺔ‬‫اﻠﻄﺎﻘﺔ‬‫ﻫﻴﺌﺔ‬
‫اﻠﺜﺎﻧﻴﺔ‬‫اﻠﺳﻨﺔ‬
‫اﻠﻄﺒﻴﺔ‬‫اﻠﻔﻴﺰﻳﺎء‬‫ﻤﺎﺠﺳﺘﻴﺮ‬
‫اﻠﻌﻟﻮم‬‫ﻜﻟﻴﺔ‬–‫دﻤﺷﻖ‬ ‫ﺠﺎﻤﻌﺔ‬
2015/2014
13/12/14Ossama aNJaK2
IAEA
InternationalAtomic Energy Agency
‫اﻹﺸﻌﺎﻋﻴﺔ‬ ‫اﻠﻣﻌﺎﻠﺟﺔ‬‫ﻤﻦ‬ ‫اﻠﻐﺎﻳﺔ‬
•‫اﻟﺳرطﺎﻧﯾﺔ‬ ‫اﻟﺧﻼﯾﺎ‬ ‫ﻛﺎﻓﺔ‬ ‫ﻗﺗل‬.
•‫اﻟﮭدف‬ ‫ﺗﻌرﯾض‬)‫اﻟورم‬(‫إﻟﻰ‬
‫ﯾﻣﻛن‬ ‫إﺷﻌﺎﻋﯾﺔ‬ ‫ﺟرﻋﺔ‬ ‫أﻋﻠﻰ‬
‫إﻟﯾﮭﺎ‬ ‫اﻟوﺻول‬.
•‫اﻟﻧﺳﺞ‬ ‫إﻟﻰ‬ ‫اﻟﺟرﻋﺔ‬ ‫ﺗﺧﻔﯾض‬
‫ﻣﻣﻛن‬ ‫ﺣد‬ ‫أدﻧﻰ‬ ‫إﻟﻰ‬ ‫اﻟﻣﺣﯾطﺔ‬.
13/12/14 OSSAMA ANJAK 5
‫ﻣﻘدﻣﺔ‬
•‫اﻟﻌﺎﻣﺔ‬ ‫اﻻﻋﺘﺒﺎرات‬General considerations‫اﻟﻔﻮﺗﻮﻧﺎت‬ ‫ﻟﺤﺰم‬:
–‫ھﻮ‬ ‫ﺧﺎرﺟﯿﺔ‬ ‫ﺣﺰم‬ ‫ﺑﺎﺳﺘﻌﻤﺎل‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﻣﺒﺪأ‬:‫ﺗﺘﻄﻠﺐ‬
‫إﺷﻌﺎﻋﯿﺔ‬ ‫ﺟﺮﻋﺔ‬ ‫اﻟﻨﺎﺟﺤﺔ‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬‫ﻣﻮزﻋﺔ‬‫ﻣﺘﺠﺎﻧﺲ‬ ‫ﺑﺸﻜﻞ‬
‫اﻟﮭﺪف‬ ‫ﻓﻲ‬)‫اﻟﻮرم‬tumour.(
–‫ﺑﺎﺳﺘﺨﺪام‬ ‫ﻋﺎدة‬ ‫اﻟﺨﺎرﺟﯿﺔ‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺗﺘﻢ‬‫اﻟﺤﺰم‬ ‫ﻣﻦ‬ ‫ﻋﺪد‬
‫اﻹﺷﻌﺎﻋﯿﺔ‬multiple radiation beams‫إﻟﻰ‬ ‫اﻟﻮﺻﻮل‬ ‫أﺟﻞ‬ ‫ﻣﻦ‬
‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫ﻟﻠﺠﺮﻋﺔ‬ ‫ﻣﺘﺠﺎﻧﺲ‬ ‫ﺗﻮزع‬uniform dose distribution
‫اﻟﮭﺪف‬ ‫ﺣﺠﻢ‬ ‫داﺧﻞ‬target volume‫وإﻟﻰ‬‫ﻣﻤﻜﻦ‬ ‫ﺟﺮﻋﺔ‬ ‫أﻗﻞ‬
‫ﺑﺎﻟﮭﺪف‬ ‫اﻟﻤﺤﯿﻄﺔ‬ ‫اﻟﺴﻠﯿﻤﺔ‬ ‫اﻟﻨﺴﺞ‬ ‫ﻓﻲ‬ ‫ﺑﻠﻮﻏﮭﺎ‬.
13/12/14 6OSSAMA ANJAK

2. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬2
‫ﻣﻘدﻣﺔ‬:
•‫اﻟﮭﺪف‬ ‫ﺿﻤﻦ‬ ‫ﻟﻠﺠﺮﻋﺔ‬ ‫اﻟﻤﺘﺠﺎﻧﺲ‬ ‫اﻟﺘﻮزع‬ ‫ﻣﻌﺎﯾﯿﺮ‬:
–‫ﻟوﺣدات‬ ‫اﻟدوﻟﯾﺔ‬ ‫اﻟﮭﯾﺋﺔ‬ ‫وﺿﻌت‬‫اﻹﺷﻌﺎع‬‫واﻟﻘﯾﺎﺳﺎت‬International
Commission on Radiation Units and
Measurements (ICRU)‫ﺑﺗﺟﺎﻧس‬ ‫ﺗﺗﻌﻠق‬ ‫اﻟﺗﻲ‬ ‫اﻟﺗوﺻﯾﺎت‬ ‫ﺑﻌض‬
‫ﺑﺎﻟﻣﻌﺎﻟﺟﺔ‬ ‫اﻟﺧﺎﺻﺔ‬ ‫اﻟﺗﻘﺎرﯾر‬ ‫وﻛﺗﺎﺑﺔ‬ ‫ﺗﺳﺟﯾﻠﮭﺎ‬ ،‫اﻟﺟرﻋﺔ‬ ‫وﺻف‬ ،‫اﻟﺟرﻋﺔ‬
‫اﻟﻔوﺗوﻧﺎت‬ ‫ﺑﺣزم‬ ‫اﻹﺷﻌﺎﻋﯾﺔ‬.
–‫ﻣﺗﺟﺎﻧﺳﺔ‬ ‫ﺗﻛون‬ ‫أن‬ ‫ﯾﺟب‬ ‫اﻟﺟرﻋﺔ‬ ‫أن‬ ‫ﺗﺑﯾن‬ ‫اﻟﺗﻘرﯾر‬ ‫ﻓﻲ‬ ‫اﻟواردة‬ ‫اﻟﺗوﺻﯾﺎت‬
‫اﻟﻣﺟﺎل‬ ‫ﺿﻣن‬ ‫اﻟﮭدف‬ ‫ﺿﻣن‬–5%‫و‬+7%‫اﻟﻣﻘدﻣﺔ‬ ‫ﻟﻠﺟرﻋﺔ‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬
‫اﻟﮭدف‬ ‫ﺿﻣن‬ ‫ﺑدﻗﺔ‬ ‫ﻣﺣدد‬ ‫ﻣوﺿﻊ‬ ‫إﻟﻰ‬ ‫ﻟﻠﻣرﯾض‬.
13/12/14 7OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
•‫ﻗﺑل‬ ‫ﻣن‬ ‫اﻟﻣﺣددة‬ ‫اﻷھداف‬ ‫ﺗﻠك‬ ‫إﻟﻰ‬ ‫ﻟﻠوﺻول‬ICRU‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﺈن‬
‫ﺗﻐﯾﯾر‬ ‫ﻋﻠﻰ‬ ‫ﺗﻌﺗﻣد‬ ‫اﻟﺣدﯾﺛﺔ‬ ‫اﻹﺷﻌﺎﻋﯾﺔ‬:
–‫اﻟﻔوﺗوﻧﺎت‬ ‫ﺣزم‬ ‫طﺎﻗﺔ‬.
–‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺣزم‬ ‫ﻧﻣط‬.
–‫أﺑﻌﺎد‬)‫ﻣﺳﺎﺣﺔ‬(‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺳﺎﺣﺔ‬.
13/12/14 8OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
•‫اﻟﺣزم‬ ‫طﺎﻗﺔ‬‫ﺧﺎرﺟﯾﺔ‬ ‫ﻓوﺗوﻧﺎت‬ ‫ﺑﺣزم‬ ‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻣﺳﺗﺧدﻣﺔ‬:
‫اﻟﺳطﺣﯾﺔ‬ ‫اﻷﺷﻌﺔ‬Superficial
(30 kVp to 80 kVp)
‫اﻟﻌﻣﯾﻘﺔ‬ ‫اﻷﺷﻌﺔ‬Orthovoltage
(100 kVp to 300 kVp)
‫اﻟﻌﺎﻟﯾﺔ‬ ‫اﻟطﺎﻗﺎت‬‫ﻣﯾﻐﺎ‬‫ﻓوﻟت‬
(Co-60 to 25 MV)
13/12/14 9OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
•‫ﻣﺟﺎل‬)‫ﻣﺳﺎﺣﺔ‬(‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺳﺎﺣﺔ‬:
‫اﻟﺷﻛل‬ ‫داﺋرﯾﺔ‬ ‫ﺻﻐﯾرة‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫ﺳﺎﺣﺔ‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺟراﺣﺔ‬ ‫ﻓﻲ‬ ‫ﺗﺳﺗﺧدم‬.
‫اﻟﺷﻛل‬ ‫ﻣﺳﺗطﯾﻠﺔ‬ ‫إﺷﻌﺎﻋﯾﺔ‬ ‫ﺳﺎﺣﺔ‬
‫ﻧظﺎﻣﯾﺔ‬ ‫ﻏﯾر‬ ‫ﺣواف‬ ‫ذات‬ ‫أو‬
)‫ﺷﺎذة‬(IRReGulaR
fIelDs
ً‫ا‬‫ﺟﺪ‬ ‫واﺳﻌﺔ‬ ‫إﺷﻌﺎﻋﯿﺔ‬ ‫ﺳﺎﺣﺔ‬
‫ﻓﻲ‬ ‫ﺗﺴﺘﺨﺪم‬‫ﺗﺸﻌﯿﻊ‬‫اﻟﺠﺴﻢ‬ ‫ﻛﺎﻣﻞ‬
total body irradiations
13/12/14 10OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
‫ﺑوﺿﻊ‬ ‫اﻟﺧﺎرﺟﯾﺔ‬ ‫اﻟﻔوﺗوﻧﺎت‬ ‫ﺑﺣزم‬ ‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﻧﻔذ‬)‫ﺑﺈﻋداد‬(
‫اﻟطرﯾﻘﺗﯾن‬ ‫ﺑﺈﺣدى‬ ‫اﻟﻣرﯾض‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻼل‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬
‫ﺛﺎﺑﺗﺔ‬ ‫اﻟﺟﻠد‬ ‫وﺳطﺢ‬ ‫اﻟﻣﺻدر‬ ‫ﺑﯾن‬ ‫اﻟﻣﺳﺎﻓﺔ‬
Constant
Source-SurfaceDistance
‫دوران‬ ‫وﻣﺣور‬ ‫اﻟﻣﺻدر‬ ‫ﺑﯾن‬ ‫اﻟﻣﺳﺎﻓﺔ‬
‫ﺛﺎﺑﺗﺔ‬ ‫اﻟﺟﮭﺎز‬
Isocentric setup with a constant Source-Axis
Distance
(SSD technique)
(SAD technique).
13/12/14 11OSSAMA ANJAK
‫واﻟﺟﻠد‬ ‫اﻟﻣﻧﺑﻊ‬ ‫ﺑﯾن‬ ‫ﻣﺎ‬ ‫اﻟﻣﺳﺎﻓﺔ‬
Source to Skin Distance
ssD=80Cm
13/12/14 12OSSAMA ANJAK

3. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬3
‫ﻣﻘدﻣﺔ‬:
•‫ﺑﺗﻘﻧﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬SSD
–‫إﻟﻰ‬ ‫اﻟﻣﺻدر‬ ‫ﻣن‬ ‫اﻟﻣﺳﺎﻓﺔ‬ ‫ﺗﺑﻘﻰ‬
‫ﻷﺟل‬ ‫ﺛﺎﺑﺗﺔ‬ ‫اﻟﻣرﯾض‬ ‫ﺳطﺢ‬
‫ﻛﺎﻓﺔ‬ ‫ﻣن‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺣزم‬ ‫ﻛﺎﻓﺔ‬
‫اﻟﺟﮭﺎت‬
–‫ﺗﻌدﯾل‬ ‫ﯾﺗم‬ ‫اﻟﺣﺎﻟﺔ‬ ‫ھذه‬ ‫ﻓﻲ‬
‫ﺣزﻣﺔ‬ ‫ﻟﻛل‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬
‫ﻋﻠﻰ‬ ‫ﻟﻠﻣﺣﺎﻓظﺔ‬ ‫ﻣﻌﺎﻟﺟﺔ‬
‫اﻟﻣﺳﺎﻓﺔ‬SSD
ssD
13/12/14 13OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
•‫ﺑﺗﻘﻧﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬SAD
–‫اﻟﮭدف‬ ‫ﻣرﻛز‬ ‫وﺿﻊ‬ ‫ﯾﺟرى‬
‫ﺗﺑﻘﻰ‬ ‫أي‬ ‫اﻟﺟﮭﺎز‬ ‫دوران‬ ‫ﺑﻣرﻛز‬
‫ﻣرﻛز‬ ‫إﻟﻰ‬ ‫اﻟﻣﺻدر‬ ‫ﻣن‬ ‫اﻟﻣﺳﺎﻓﺔ‬
‫ﺣزم‬ ‫ﻛﺎﻓﺔ‬ ‫ﻷﺟل‬ ‫ﺛﺎﺑﺗﺔ‬ ‫اﻟﮭدف‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬
–‫ﺗﻐﯾر‬ ‫ﯾﺗم‬ ‫ﻓﻘط‬ ‫اﻟﺣﺎﻟﺔ‬ ‫ھذه‬ ‫ﻓﻲ‬
‫دون‬ ‫اﻟذراع‬ ‫دوران‬ ‫زاوﯾﺔ‬
‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬ ‫ﺗﻌدﯾل‬.
saD
saD
13/12/14 14OSSAMA ANJAK
‫ﻣﻘدﻣﺔ‬:
•‫ﺗﻘﻨﯿﺔ‬ ‫ﺑﻤﻘﺎرﻧﺔ‬SSD‫ﺗﻘﻨﯿﺔ‬ ‫ﻣﻊ‬
SAD‫إﻟﻰ‬ ‫ﻧﺤﺘﺎج‬ ‫ﻻ‬ ‫أﻧﻨﺎ‬ ‫ﻧﺠﺪ‬
‫ﻋﻨﺪ‬ ‫اﻟﻤﺮﯾﺾ‬ ‫وﺿﻌﯿﺔ‬ ‫ﺗﻌﺪﯾﻞ‬
‫إﻟﻰ‬ ‫ﻣﻌﺎﻟﺠﺔ‬ ‫ﺳﺎﺣﺔ‬ ‫ﻣﻦ‬ ‫اﻻﻧﺘﻘﺎل‬
‫أﺧﺮى‬ ‫ﺳﺎﺣﺔ‬.‫ﯾﻤﻜﻦ‬ ‫ﺣﯿﺚ‬
‫ﻓﻘﻂ‬ ‫ﻷﺧﺮ‬ ‫ﺳﺎﺣﺔ‬ ‫ﻣﻦ‬ ‫اﻻﻧﺘﻘﺎل‬
‫اﻟﻤﺮﯾﺾ‬ ‫ﺣﻮل‬ ‫اﻟﺬراع‬ ‫ﺑﺪوران‬.
13/12/14 15OSSAMA ANJAK
‫اﻟﮭﺪف‬)‫اﻟﻮرم‬(
I
S
O
C
E
N
T
R
I
C
T
R
E
A
T
M
E
N
T
‫اﻟﻤﺮﻛﺰ‬Isocenter ‫اﻟﮭﺪف‬+‫اﻟﻤﺮﻛﺰ‬
13/12/14 16OSSAMA ANJAK
7.2‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬VOLUMEDEFINITION
•‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫اﻟﺣﺟم‬ ‫ﺗﺣدﯾد‬ ‫آﻟﯾﺔ‬ ‫إن‬volume for the treatment
‫اﻟﻣﺗﻣﯾزة‬ ‫ﻣراﺣل‬ ‫ﻣن‬ ‫ﻋدد‬ ‫ﻋﻠﻰ‬ ‫ﺗﺟري‬ ‫اﻟﺧﺑﯾث‬ ‫اﻟورم‬ ‫ﻟﻣوﺿﻊ‬:
•‫ّة‬‫د‬‫ﻋ‬ ‫ﺗﻌﯾﯾن‬ ‫إﻟﻰ‬ ‫ﻧﺣﺗﺎج‬ ‫أن‬ ‫ﯾﻣﻛن‬ ‫اﻟﻌﻣﻠﯾﺎت‬ ‫ھذه‬ ‫ﺧﻼل‬‫ﺣﺟوم‬
different volumes‫ﯾﻠﻲ‬ ‫ﻟﻣﺎ‬ ‫ذﻟك‬ ‫وﯾﻌود‬:
–‫ﺗﺠﻤﻊ‬‫ا‬ِ‫ﺔ‬‫اﻟﺨﺒﯿﺜ‬ ‫ﻟﺨﻼﯾﺎ‬‫ﻣﺨﺘﻠﻔﺔ‬ ‫ﻣﻮاﺿﻊ‬ ‫ﻓﻲ‬.
–‫واﻟ‬ ِ‫اﻟﺤﺠﻢ‬ ‫ﺑﯿﻦ‬ ِ‫ﺔ‬‫اﻟﻤﻜﺎﻧﯿ‬ ِ‫ﺔ‬‫اﻟﻌﻼﻗ‬ ‫ﻓﻲ‬ ‫اﻟﻤﺤﺘﻤﻠﺔ‬ ‫اﻟﺘﻐﯿﯿﺮات‬‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫ﺤﺰﻣﺔ‬
‫أﺛﻨﺎء‬‫اﻟﻤ‬‫ﻌ‬‫ﺎ‬ِ‫ﻟﺠ‬‫ﺔ‬.
–ِ‫اﻟﻤﺮﯾﺾ‬ ‫ﺣﺮﻛﺔ‬.
–‫ﻓﻲ‬ ‫اﻟﻤﺤﺘﻤﻠﺔ‬ ‫اﻷﺧﻄﺎء‬‫اﻹﻋﺪاد‬ ‫ﻣﺮاﺣﻞ‬‫ﻟ‬َ‫ﺔ‬‫ﻠﻤﻌﺎﻟﺠ‬
13/12/14 17OSSAMA ANJAK
7.2‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬VOLUMEDEFINITION
•‫ﻋرف‬‫اﻟـ‬ICRU‫اﻟﺗﻘرﯾر‬ ‫ﻓﻲ‬50
‫واﻟ‬‫ﺗﻘرﯾر‬62‫اﻟﮭدف‬ ‫ﻣﻧﺎطق‬ ‫ﻣن‬ ‫دد‬ِ‫ﻋ‬
‫واﻟﺣﺟوم‬‫اﻟﺗﻲ‬‫وﺗﺣﯾد‬ ‫ﻟﻺﺷﻌﺎع‬ ‫ﺳﺗﺗﻌرض‬
‫اﻟﺣﺳﺎﺳﺔ‬ ‫اﻷﻋﺿﺎء‬Critical organs
‫أﺟل‬ ‫ﻣن‬:
–ِ‫ﺔ‬‫اﻟﻣﻌﺎﻟﺟ‬ ‫ﺗﺧطﯾط‬ ِ‫ﺔ‬‫ﻋﻣﻠﯾ‬ ‫ﻓﻲ‬ ‫اﻟﻣﺳﺎﻋدة‬
–ِ‫ﻧﺗﺎﺋﺞ‬ ِ‫ﺔ‬‫ﻟﻣﻘﺎرﻧ‬ ‫ﻣﺣددة‬ ‫أﺳس‬ ‫ﻟﻧﺎ‬ْ‫ر‬ ّ‫ﻓ‬‫ﺗو‬
ِ‫ﺔ‬‫اﻟﻣﻌﺎﻟﺟ‬.
13/12/14 18OSSAMA ANJAK

4. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬4
PTV
ITV
CTV
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬VOLUME DEFINITION
•‫ﺳوف‬ ‫اﻟﺗﺎﻟﯾﺔ‬ ‫اﻟﺷراﺋﺢ‬ ‫ﻓﻲ‬
‫اﻟﺣﺟوم‬ ‫ﺑﺎﻟﺗﻔﺻﯾل‬ ‫ﻧﺳﺗﻌرض‬
‫ﻗﺑل‬ ‫ﻣن‬ ‫اﻟﻣﺣددة‬‫اﻟـ‬ICRU
‫اﻷﺳﺎس‬ ‫ﺗﻌد‬ ‫اﻟﺗﻲ‬
(principal volumes)
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬ ‫ﻓﻲ‬
‫اﻷﺑﻌﺎد‬ ‫ﺛﻼﺛﯾﺔ‬ ‫اﻹﺷﻌﺎﻋﯾﺔ‬.
OaR
13/12/14 19OSSAMA ANJAK
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫اﻟﺣﺟم‬‫اﻟﻛﻠﻲ‬‫ﻟﻠورم‬Gross Tumor Volume (GTV)
•‫ﻟﻠورم‬ ‫اﻟﻛﻠﻲ‬ ‫اﻟﺣﺟم‬Gross Tumor Volume (GTV)‫ھو‬
‫اﻟﻣﻼﺣظ‬ ‫اﻟﻛﻠﻲ‬ ‫اﻟﺣﺟم‬)‫اﻟﻣرﺋﻲ‬(‫اﻟورم‬ ‫ﻧﻣو‬ ‫ﻣوﺿﻊ‬ ‫إﻟﻰ‬ ‫ﺑﺎﻹﺿﺎﻓﺔ‬
‫اﻟﺣﺟم‬ ‫ﻫذا‬ ‫ﺗﺣدﯾد‬ ‫ى‬‫ﯾﺟر‬ ‫ﻋﺎدة‬GTV
‫ﻧﺣﺻل‬ ‫اﻟﺗﻲ‬ ‫اﻟﻣﻌﻠوﻣﺎت‬ ‫ﻋﻠﻰ‬ ‫اﻋﺗﻣﺎدا‬
‫ﻣن‬ ‫ﻋﻠﯾﻬﺎ‬:
‫اﻟﻣﺧﺗﻠﻔﺔ‬ ‫اﻟطﺑﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺗﻘﻧﯾﺎت‬(CT,
MRI, ultrasound, etc.).
‫ﺗﻘﻧﺎت‬‫اﻟطﺑﻲ‬ ‫اﻟﺗﺷﺧﯾص‬)‫ﯾﺢ‬‫ر‬‫اﻟﺗﺷ‬
‫اﻟﻧﺳﯾﺟﻲ‬‫و‬ ‫اﻟﻣرﺿﻲ‬.(
‫ي‬‫ﯾر‬‫ر‬‫اﻟﺳ‬ ‫اﻟﻔﺣص‬.
GTV
13/12/14 20OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬:‫اﻟﺣﺟم‬‫اﻟﻛﻠﻲ‬‫ﻟﻠورم‬Gross Tumor Volume(GTV)
13/12/14 21OSSAMA ANJAK
GTV
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫ﻟﻠﮭدف‬ ‫اﻟﺳرﯾري‬ ‫اﻟﺣﺟم‬Clinical Tumor Volume (CTV)
•‫ﻟﻠﮭدف‬ ‫اﻟﺳرﯾري‬ ‫اﻟﺣﺟم‬Clinical Tumor Volume (CTV):‫ﺣﺟم‬ ‫ھو‬
‫اﻟورم‬ ‫ﻋﻠﻰ‬ ‫ﺗﺣوي‬ ‫اﻟﺗﻲ‬ ‫اﻟﻧﺳﺞ‬‫و‬‫ﻋﻠﻰ‬‫أ‬‫ﯾﺔ‬‫ارﺗﺷﺎح‬‫ﻣﻛروي‬‫ﻟﻠﻧﺳﺞ‬
‫اﻟﺧﺑﯾﺛﺔ‬sub-clinical microscopic malignant disease‫ﻻ‬ ‫اﻟﺗﻲ‬
‫ﯾﻣﻛن‬‫إزاﻟﺗﮭﺎ‬.
‫اﻟﻘدر‬ ‫اﻟﺣﺟم‬ ‫ﻫذا‬ ‫ﯾﻧﺎل‬ ‫أن‬ ‫ﯾﺟب‬
‫غ‬‫ﻟﺑﻠو‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣن‬ ‫اﻟﻛﺎﻓﻲ‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣن‬ ‫اﻟﻛﻠﻲ‬ ‫اﻟﻬدف‬
‫ﺷﺎﻓﯾﺔ‬ ‫أو‬ ‫ﺗﻠطﯾﻔﯾﺔ‬ ‫ﻛﺎﻧت‬ ً‫اء‬‫و‬‫ﺳ‬
CTV
13/12/14 22OSSAMA ANJAK
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫اﻟﺣﺟم‬‫ﻟﻠﮭدف‬ ‫اﻟﺳرﯾري‬Clinical Target Volume (CTV)
•‫اﻟﺣﺟم‬ َ◌CTV‫ﻣﺑﺎﺷرة‬ ُ‫ﺣﯾط‬ُ‫ﺗ‬ ‫اﻟﺗﻲ‬ ‫اﻟﻣﻧطﻘﺔ‬ ُ‫ّن‬‫ﻣ‬‫ﯾﺗﺿ‬‫ﺑـ‬GTV‫ﻓﻲ‬
‫َﺣﺗوي‬‫ﯾ‬ ْ‫َد‬‫ﻗ‬ ‫اﻟذي‬ ‫اﻷﺣﯾﺎن‬ ‫أﻏﻠب‬‫اﻻرﺗﺷﺎﺣﺎت‬َ‫اﻟﻣﺟﮭري‬‫أﺧرى‬ َ‫وﻣﻧﺎطق‬
ً‫ﻣﻌﺎﻟﺟﺔ‬ ‫إﻟﻰ‬ ‫وﺗﺣﺗﺎج‬ ‫اﻷذى‬ ‫داﺋرة‬ ‫ﻓﻲ‬ ‫أﻧﮭﺎ‬ ‫ﻋﻠﻰ‬ ‫اﻻﻋﺗﺑﺎر‬ ‫ﺑﻌﯾن‬ ‫ﺗؤﺧذ‬.
•‫ﻣﺛﺎل‬:‫اﻹﯾﺟﺎﺑﯾﺔ‬ ‫اﻟﻠﻣﻔﺎوﯾﺔ‬ ‫د‬َ‫ﻘ‬ُ‫اﻟﻌ‬ ‫ﺣﺎﻟﺔ‬positive lymph nodes.
–‫اﻟـ‬CTV‫اﻟﺳرﯾري‬ ‫اﻟﺗﺷرﯾﺣﻲ‬ ‫اﻟﺣﺟم‬ ‫ﯾﻛون‬anatomical-clinical
volume.
–‫ﻗﺑل‬ ‫ﻣن‬ ‫اﻟﻣﻧطﻘﺔ‬ ‫ھذه‬ ‫ﺗﻌﯾﯾن‬ ‫ﯾﺟري‬ ‫ﻋﺎدة‬‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ِ‫ب‬‫طﺑﯾ‬‫وﻓﻲ‬ ،
‫أﺧﺻﺎﺋﯾﻲ‬ ‫ﻣﺛل‬ ِ‫اﻵﺧرﯾن‬ ِ‫اﻟﻣﻌﻧﯾﯾن‬ ‫اﻻﺧﺗﺻﺎﺻﯾﯾن‬ ‫اﺳﺗﺷﺎرة‬ ‫ﺑﻌد‬ ‫اﻷﺣﯾﺎن‬ ‫أﻏﻠب‬
‫ﺔ‬ّ‫اﻷﺷﻌ‬ ‫أﺧﺻﺎﺋﯾﻲ‬ ‫و‬ َ‫أ‬ ‫اﻟﻣرﺿﻲ‬ ‫اﻟﺗﺷرﯾﺢ‬.
13/12/14 23OSSAMA ANJAK
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬:‫اﻟﺣﺟم‬‫ﻟﻠﮭدف‬ ‫اﻟﺳرﯾري‬(CTV)
CTV GTV
13/12/14 24OSSAMA ANJAK

5. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬5
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫ﻟﻠﮭدف‬ ‫اﻟﺳرﯾري‬ ‫اﻟﺣﺟم‬(CTV)
•‫اﻟﺣﺟم‬ ‫ﺗﻌﯾﯾن‬ ‫ﯾﺟري‬ ‫ﻋﺎدة‬CTV‫ھﺎﻣش‬ ‫ﺑﺈﺿﺎﻓﺔ‬ ‫وذﻟك‬ ‫ﺛﺎﺑت‬ ‫ﺑﺷﻛل‬
‫اﻟﺣﺟم‬ ‫ﺣول‬ ‫ﻣﺗﻐﯾر‬GTV:
Example: CTV = GTV + 1 cm margin
•‫اﻟﺣﺟم‬ ‫ﯾﻛون‬ ‫اﻟﺣﺎﻻت‬ ‫ﺑﻌض‬ ‫ﻓﻲ‬CTV‫ﻟﻠﺣﺟم‬ ‫ﻣطﺎﺑق‬GTV.‫ﻋﻠﻰ‬
‫ﻓﻘط‬ ‫اﻟﺑروﺳﺗﺎت‬ ‫ﻏدة‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫اﻟﻣﺛﺎل‬ ‫ﺳﺑﯾل‬.
•‫إﻟﻰ‬ ‫ﺗﺣﺗﺎج‬ ‫اﻟﺗﻲ‬ ‫اﻟﺣﺟوم‬ ‫ﻣن‬ ‫ﻋدد‬ ‫ﻟدﯾﻧﺎ‬ ‫ﯾﻛون‬ ‫أن‬ ‫اﻟﻣﺣﺗﻣل‬ ‫ﻣن‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣن‬ ‫اﻟﮭدف‬ ‫ﻟﺑﻠوغ‬ ‫ﻣﺧﺗﻠﻔﺔ‬ ‫ﺟرﻋﺎت‬)‫اﻟﺛدي‬ ‫ﻣﻌﺎﻟﺟﺔ‬.(
13/12/14 25OSSAMA ANJAK
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫اﻟﺣﺟم‬‫ﻟﻠورم‬ ‫اﻟداﺧﻠﻲ‬Internal Tumor Volume (ITV)
‫اﻟﮭﺎﻣش‬ ‫ﺣول‬ ‫ﻋﺎﻣﺔ‬ ‫ﻣﻼﺣظﺎت‬Margins‫ﺑﺎﻟﮭدف‬ ‫اﻟﻣﺣﯾط‬:
•‫ﻋرض‬ ‫وﯾﻌﺗﻣد‬ ‫ﻟﻠﻣﻌﺎﻟﺟﺔ‬ ‫اﻟﺳرﯾرﯾﺔ‬ ‫اﻟﻧﺎﺣﯾﺔ‬ ‫ﻣن‬ ً‫ا‬‫ﺟد‬ ‫ھﺎم‬ ‫اﻟﮭﺎﻣش‬
‫ﻋﻠﻰ‬ ‫اﻟﮭﺎﻣش‬:
–‫اﻟﻌﺿو‬ ‫ﺣرﻛﺔ‬)‫داﺧﻠﻲ‬ ‫ھﺎﻣش‬(
–‫اﻟﺣزﻣﺔ‬ ‫وأﺑﻌﺎد‬ ‫اﺗﺟﺎه‬ ،‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬)‫ﺧﺎرﺟﻲ‬ ‫ھﺎﻣش‬(
•‫ﻣﻧﺗظم‬ ‫ﻏﯾر‬ ‫اﻟﮭﺎﻣش‬ ‫ﯾﻛون‬ ‫أن‬ ‫ﯾﻣﻛن‬non-uniform‫أن‬ ‫ﯾﺟب‬ ‫وﻟﻛن‬
‫اﻷﺑﻌﺎد‬ ‫ﺛﻼﺛﻲ‬ ‫ﯾﻛون‬3D.
•‫ﺑﺎﺧﺗﯾﺎر‬ ‫ﯾﺗم‬ ‫أن‬ ‫ﯾﻣﻛن‬ ‫اﻟﻣﻌﻘول‬ ‫اﻻﺧﺗﯾﺎر‬‫اﻟﮭﺎﻣش‬‫اﻟﮭدف‬ ‫ﯾﻛون‬ ‫ﺑﺣﯾث‬
‫ﺑﺣدود‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫اﻟﻣﻧطﻘﺔ‬ ‫ﻓﻲ‬95%‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣدة‬ ‫ﻣن‬.
13/12/14 26OSSAMA ANJAK
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﻼل‬ ‫اﻟﺣرﻛﺔ‬Motion in Radiotherapy
13/12/14 OSSAMA ANJAK 27
‫اﻟﻄﺒﯿﻌﻲ‬ ‫اﻟﺘﻨﻔﺲ‬ ‫ﻧﺘﯿﺠﺔ‬ ‫اﻟﺤﺮﻛﺔ‬Breathing motion
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬:‫اﻟﺣﺟم‬‫ﻟﻠورم‬ ‫اﻟداﺧﻠﻲ‬(ITV)
•‫ﻟﻠورم‬ ‫اﻟداﺧﻠﻲ‬ ‫اﻟﺣﺟم‬ ‫ﯾﺗﺄﻟف‬Internal Target Volume (ITV)‫اﻟﺣﺟم‬ ‫ﻣن‬CTV+
‫اﻟداﺧﻠﻲ‬ ‫اﻟﮭﺎﻣش‬.
‫اﻟداﺧﻠﻲ‬ ‫اﻟﻬﺎﻣش‬ ‫ﺗﺣدﯾد‬ ‫ي‬‫ﯾﺟر‬‫اﻷ‬ ‫أﺟل‬ ‫ﻣن‬‫ﺧذ‬
‫ات‬‫ر‬‫اﻟﺗﻐﯾ‬ ‫اﻻﻋﺗﺑﺎر‬ ‫ﺑﻌﯾن‬‫ﺗﺣدث‬ ‫ﻗد‬ ‫اﻟﺗﻲ‬‫ﻓﻲ‬
‫اﻷﺳﺎﺳﻲ‬ ‫ﻟﻠﺷﻛل‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫اﻟﺣﺟم‬ ‫وﻣوﺿﻊ‬ ‫ﺣﺟم‬
‫ﻟﻠﻣرﯾض‬)‫اﻟﻌظﻣﻲ‬ ‫ﯾﺢ‬‫ر‬‫ﺑﺎﻟﺗﺷ‬ ‫ﯾﻌرف‬ ‫اﻟذي‬‫و‬
bony anatomy(،
‫ا‬‫ﻟﺗﻐﯾر‬‫ﻛﺎﻟﺣرﻛﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﺣرﻛﺔ‬ ‫ﺑﺳﺑب‬
‫ﻣﺣﺗوﯾﺎت‬ ‫ﻓﻲ‬ ‫اﻟﺗﻐﯾر‬ ،‫اﻟﺗﻧﻔس‬ ‫ﺧﻼل‬
‫اﻟﻣﺳﺗﻘﯾم‬ ‫أو‬ ‫اﻟﻣﺛﺎﻧﺔ‬...‫إﻟﺦ‬.
CTV
ITV
CTV
13/12/14 28OSSAMA ANJAK
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬
‫ﺣﺟم‬‫اﻟورم‬ ‫ﻣﺧطط‬Planning Tumor Volume (PTV)
•‫اﻟﺣﺟم‬ ‫ﻣﻊ‬ ‫ﺑﺎﻟﻣﻘﺎرﻧﺔ‬CTV‫اﻟﺣﺟم‬ ‫ﻓﺈن‬Planning Target Volume
(PTV)‫ھﻧدﺳﻲ‬ ‫ﻣﻔﮭوم‬ ‫ﻋن‬ ‫ﻋﺑﺎرة‬ ‫ھو‬.
‫اﺧﺗﯾﺎر‬ ‫أﺟل‬ ‫ﻣن‬ ‫اﻟﺣﺟم‬ ‫ﻫذا‬ ‫ﯾف‬‫ر‬‫ﺗﻌ‬ ‫ﯾﺗم‬
‫آﺧذﯾن‬ ،‫ﻟﻠﺣزﻣﺔ‬ ‫اﻟﻣﻧﺎﺳﺑﺔ‬ ‫اﻷﺑﻌﺎد‬‫و‬ ‫اﻻﺗﺟﺎﻩ‬
‫ﻛﺎﻓﺔ‬ ‫ﻋﻠﻰ‬ ‫ات‬‫ر‬‫اﻟﺗﺄﺛﯾ‬ ‫ﻛل‬ ‫ﺑﺎﻻﻋﺗﺑﺎر‬
‫ﻟﻠﺗﺄﻛد‬ ‫وذﻟك‬ ‫اﻟﻣﺣﺗﻣﻠﺔ‬ ‫ى‬‫اﻷﺧر‬ ‫ات‬‫ر‬‫اﻟﺧﯾ‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫ﻋﺔ‬‫اﻟﺟر‬ ‫ﻫذا‬ ‫أن‬ ‫ﻣن‬
‫ﻓﻲ‬ ُ‫ﺎ‬‫ﻓﻌﻠﯾ‬ ‫ﺗﻣﺗص‬ ‫ﺳوف‬ ‫اﻟﻣوﺻوﻓﺔ‬
‫اﻟﺣﺟم‬CTV.
PTV
ITV
CTV
13/12/14 29OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬:‫ﺣﺟم‬‫اﻟورم‬ ‫ﻣﺧطط‬Planning Tumor Volume (PTV)
PTV
13/12/14 30OSSAMA ANJAK

6. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬6
(IEC 1217: "Fixed System").
‫ﺗﻌرﯾف‬‫اﻟﺣﺟم‬:‫اﻟورم‬ ‫ﻣﺧطط‬ ‫ﺣﺟم‬Planning Tumor Volume (PTV)
•‫اﻟﺣﺟم‬ ‫ﯾﺿﻣن‬PTV‫أﺟل‬ ‫ﻣن‬ ‫أﺧرى‬ ‫وھواﻣش‬ ‫اﻟداﺧﻠﻲ‬ ‫اﻟﮭدف‬ ‫ھﺎﻣش‬:
–‫اﻻرﺗﯾﺎﺑﺎت‬‫ﻓﻲ‬‫اﻻﻋداد‬‫واﻟﺗﮭﯾﺋﺔ‬Set-up uncertainties.
–‫اﻟﺳﻣﺎﺣﯾﺔ‬‫اﻟﺟﮭﺎز‬ ‫ﻓﻲ‬Machine tolerances
–‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﻧطﻘﺔ‬ ‫داﺧل‬ ‫اﻟﺗﻐﯾرات‬Intra-treatment variations.
‫اﻟﺣﺟم‬ ‫ﺗﺑط‬‫ر‬‫ﯾ‬PTV‫ﺟﻌﻲ‬‫اﻟﻣر‬ ‫ﺑﺎﻟﺷﻛل‬
‫ﺑﺎﻟﺗوﺻﯾﺎت‬ ‫اﻟﻣﺣدد‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺟﻬﺎز‬
‫ﻋن‬ ‫ة‬‫ر‬‫اﻟﺻﺎد‬IEC(IEC 1217: "Fixed
System").
13/12/14 31OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬:‫اﻟورم‬ ‫ﻣﺧطط‬ ‫ﺣﺟم‬Planning Tumor Volume (PTV)
•‫اﻟﺤﺠﻢ‬ ‫ﯾﺤﺪد‬ ‫ﻣﺎ‬ ً‫ﺎ‬‫ﻏﺎﻟﺒ‬PTV‫ﻟﻠﺤﺠﻢ‬ ‫اﻟﺤﺎل‬ ‫ھﻮ‬ ‫ﻛﻤﺎ‬CTVً‫ﺎ‬‫ﻣﻀﺎﻓ‬
‫ﻣﺘﻐﯿﺮ‬ ‫أو‬ ‫ﺛﺎﺑﺖ‬ ‫ھﺎﻣﺶ‬ ‫إﻟﯿﮫ‬.
Typical example: PTV = CTV + 1 cm
•‫ﯾﺳﺗﻌﻣل‬‫ﺣﺟم‬ ‫ﻋﺎدة‬PTV‫ّة‬‫د‬‫ﻋ‬ ‫أو‬ ‫ﺣﺟم‬ ‫ﻹﺣﺎطﺔ‬ ‫واﺣد‬‫ﺣﺟوم‬‫ﻣن‬
‫اﻟـ‬CTV‫ﻧﺣوھﺎ‬ ‫ﺗوﺟﮫ‬ ‫ﻛﻲ‬ ً‫ﺎ‬‫ﻣﻌ‬ ‫ﻟﺗﺟﺗﻣﻊ‬‫اﻷﺷﻌﺔ‬ ‫ﺣزم‬
13/12/14 32OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬:‫اﻟورم‬ ‫ﻣﺧطط‬ ‫ﺣﺟم‬Planning Tumor Volume (PTV)
•‫اﻟﺤﺠﻢ‬ ‫ﺗﻌﺘﻤﺪ‬PTV‫ﻣﺜﻞ‬ ‫اﻟﻤﺴﺘﺨﺪﻣﺔ‬ ‫اﻷدوات‬ ‫ﻓﻲ‬ ‫اﻟﺪﻗﺔ‬ ‫ﻋﻠﻰ‬:
–‫أدوات‬‫اﻟﻤﺮﯾﺾ‬ ‫ﺗﺜﺒﯿﺖ‬Immobilization devices.
–‫ﻟﻠﻤﻌﺎﻟﺠﺔ‬ ‫اﻟﻤﺮﯾﺾ‬ ‫إﻋﺪاد‬ ‫ﻓﻲ‬ ‫اﻟﻤﺴﺘﺨﺪﻣﺔ‬ ‫اﻟﻠﯿﺰر‬ ‫ﺧﻄﻮط‬.
•‫ﻻ‬‫ﻟﻠﺤﺰﻣﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﺑﺘﻮزﯾﻊ‬ ‫ﺧﺎﺻﺔ‬ ‫ھﻮاﻣﺶ‬ ‫أي‬ ‫اﻟﺤﺠﻢ‬ ‫ﯾﺘﻀﻤﻦ‬
‫اﻟﺘﺨﻄﯿﻂ‬ ‫ﻣﺮﺣﻠﺔ‬ ‫ﺧﻼل‬ ‫ﯾﻀﺎف‬ ‫ھﺎﻣﺶ‬ ‫إﻟﻰ‬ ‫ﺗﺤﺘﺎج‬ ‫واﻟﺘﻲ‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬
‫وﺗﺼﻤﯿﻢ‬‫اﻟﺤﻤﺎﯾﺎت‬
•‫ﯾﺘﻀﻤﻦ‬ ‫ﻻ‬ ‫اﻟﻤﺜﺎل‬ ‫ﺳﺒﯿﻞ‬ ‫ﻋﻠﻰ‬:
–‫اﻟﻈﻠﯿﻞ‬ ‫ﻣﻨﺎطﻖ‬Penumbral areas.
–‫اﻟﺘﻌﺰﯾﺰ‬ ‫ﻗﻄﺎع‬Build-up region.
13/12/14 33OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬‫اﻟﺧطر‬ ‫ذات‬ ‫اﻷﻋﺿﺎء‬Organ at Risk (OAR)
•‫اﻟﺧطر‬ ‫ذات‬ ‫اﻷﻋﺿﺎء‬Organ at Risk (OAR)‫ﺑﺤﯿﺚ‬ ‫ﻟﻺﺷﻌﺎع‬ ‫اﻟﺤﺴﺎﺳﯿﺔ‬ ‫ذات‬ ‫اﻷﻋﻀﺎء‬ ‫ھﻲ‬
‫اﻟﺘﻲ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﻣﻘﺎرﻧﺔ‬ ‫اﻟﻀﺮوري‬ ‫وﻣﻦ‬ ‫ﺗﺘﻠﻘﺎھﺎ‬ ‫اﻟﺘﻲ‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫ﺑﺎﻟﺠﺮﻋﺔ‬ ‫ﺗﺘﺄﺛﺮ‬ ‫أن‬ ‫ﯾﻤﻜﻦ‬
‫اﻟﺤﺰﻣﺔ‬ ‫اﺗﺠﺎه‬ ‫ﺗﻌﺪﯾﻞ‬ ‫ﯾﺠﺐ‬ ‫وﺑﺎﻟﺘﺎﻟﻲ‬ ‫ﺗﺘﺤﻤﻠﮭﺎ‬ ‫اﻟﺘﻲ‬ ‫اﻟﺠﺮع‬ ‫ﻣﻘﺪار‬ ‫ﻣﻊ‬ ‫ﻟﮭﺎ‬ ‫ﺗﺘﻌﺮض‬ ‫ﺳﻮف‬
‫اﻹﺷﻌﺎﻋﯿﺔ‬ ‫اﻟﺠﺮﻋﺔ‬ ‫ﺗﻌﺪﯾﻞ‬ ‫أو‬ ‫أﺑﻌﺎدھﺎ‬ ‫أو‬ ‫اﻹﺷﻌﺎﻋﯿﺔ‬.
PTV
ITV
CTV
OAR
13/12/14 34OSSAMA ANJAK
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬‫اﻟﺧطر‬ ‫ذات‬ ‫اﻷﻋﺿﺎء‬Organ at Risk (OAR)
•‫ﯾﺟب‬‫إﺣﺎطﺔ‬ً‫ة‬‫ﻣﺑﺎﺷر‬ ‫ﺗﻘﻊ‬ ‫ﻻ‬ ‫ﺑﺣﯾث‬ ‫ﺧﺎﺻﺔ‬ ‫ﺑﻌﻧﺎﯾﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﺗﻠك‬
‫اﻟﺣﺟم‬ ‫ﺿﻣن‬CTV‫ﻣﻘدار‬ ‫ﻣن‬ ‫ﯾﻣﻛن‬ ‫ﻣﺎ‬ ‫أﻗل‬ ‫إﻟﻰ‬ ‫ﺗﺗﻌرض‬ ‫وأن‬
‫ﺑﮭﺎ‬ ‫اﻟﻣﺳﻣوح‬ ‫اﻟﺟرﻋﺔ‬.
•‫ﻣن‬‫اﻷﻣﺛﻠﺔ‬‫اﻷﻋﺿﺎء‬ ‫ﺗﻠك‬ ‫ﻋﻠﻰ‬:
–‫اﻟدﻣﺎغ‬ ‫أورام‬ ‫أو‬ ‫اﻷﻧﻔﻲ‬ ‫اﻟﺑﻠﻌوم‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫أﺛﻧﺎء‬ ‫اﻟﻌﯾن‬ ‫ﻋدﺳﺔ‬.
–‫اﻟﻧﺧﺎع‬‫اﻟﺷوﻛﻲ‬
–‫اﻟﻣﺳﺗﻘﯾم‬
13/12/14 35OSSAMA ANJAK13/12/14 OSSAMA ANJAK 36

7. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬7
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﺣﺎﻛﺎة‬
13/12/14 OSSAMA ANJAK 38
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬
‫اﻠﻣﻌﺎﻠﺟﺔ‬‫اﻟﺗﺣﻘق‬‫و‬ ‫اﻟﺗﺳﺟﯾل‬
‫ﺗﻬﯾﺋﺔ‬‫اﻟﻣرﯾض‬‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬‫اﻟﻣﺣﺎﻛﺎة‬
‫اف‬‫و‬‫ﺣ‬ ‫ﺗﺣدﯾد‬
‫اﻟﻬدف‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ار‬‫ر‬‫ﻗ‬
‫اﻟﺗﺷﺧﯾﺻﯾﺔ‬ ‫اﻟﺻور‬
‫اﻟﯾدوي‬ ‫اﻟﺣﺳﺎب‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟزﻣن‬
Qa
‫أﺟل‬ ‫ﻣن‬ ‫ﯾض‬‫ر‬‫اﻟﻣ‬ ‫ﺗﻬﯾﺋﺔ‬
‫اﻟﻣﺣﺎﻛﺎة‬
‫اء‬‫ر‬‫إﺟ‬ ‫ﻗﺑل‬ ‫ﺗﻣﻸ‬ ‫ة‬‫ر‬‫اﺳﺗﻣﺎ‬
‫ﻋﻠﻰ‬ ‫ﻟﻠﺣﺻول‬ ‫اﻟﺗﺧطﯾط‬
‫ﺣول‬ ‫اﻟﻼزﻣﺔ‬ ‫اﻟﻣﻌﻠوﻣﺎت‬
‫اﻟﺗﺧطﯾط‬ ‫اءات‬‫ر‬‫إﺟ‬
13/12/14 OSSAMA ANJAK 39
‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﮭﺎز‬
RadiotherapySimulator
13/12/14 OSSAMA ANJAK 40
‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﮭﺎز‬
•‫أﺷﻌﺔ‬ ‫ﺟﮭﺎز‬-X‫اﻟﺗﺻوﯾر‬ ‫أﺟل‬ ‫ﻣن‬
‫ﺧﺎﺻﺔ‬ ‫ﻣﯾزات‬ ‫ذو‬ ‫واﻟﺗﻧظﯾر‬:
–‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫أﺟﮭزة‬ ‫ﻣﺣﺎﻛﺎة‬:
•‫اﻟﻣﯾﻛﺎﻧﯾﻛﯾﺔ‬ ‫اﻟﺣرﻛﺎت‬ ‫ﻛﺎﻓﺔ‬ ‫ﺗﺄﻣﯾن‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﮭﺎز‬ ‫ﻓﻲ‬ ‫اﻟﻣﺗوﻓرة‬.
•‫ﻟطﺎوﻟﺔ‬ ‫ﻣطﺎﺑﻘﺔ‬ ‫ﺑطﺎوﻟﺔ‬ ‫ﻣزود‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬.
13/12/14 OSSAMA ANJAK 41
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﺣﺎﻛﻲ‬
1.‫اﻟرأس‬:
–‫أﺷﻌﺔ‬ ‫أﻧﺑوب‬-X.
–‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺣزﻣﺔ‬ ‫ﻣﺣددات‬
–‫ﺳﺎﺣﺔ‬ ‫ﺗﺣدﯾد‬ ‫ﺧطوط‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬.
–‫اﻟﺣﻣﺎﯾﺎت‬ ‫ﺣﺎﻣل‬.
13/12/14 OSSAMA ANJAK 42
2.‫اع‬‫ر‬‫اﻟذ‬
3.‫اﻷﺷﻌﺔ‬ ‫ﻣﺳﺗﻘﺑل‬:
‫اﻟﺗﻧظﯾر‬ ‫ﻧظﺎم‬
‫اﻟﻔﻠم‬
4.‫اﻟطﺎوﻟﺔ‬
5.‫اﻟﺗﺣﻛم‬ ‫وﺣدة‬
‫اﻟﺗﺷﻐﯾل‬‫و‬

8. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬8
‫اﻟﻣﺣﺎﻛﻲ‬Simulator
•‫اﻠﻣﻴﻛﺎﻧﻴﻛﻴﺔ‬‫اﻠﺤﺮﻜﺎت‬:
–‫اﻟذراع‬ ‫ﺣرﻛﺔ‬
–‫اﻟﻣﺣددات‬ ‫ﺣرﻛﺎت‬
–‫اﻟطﺎوﻟﺔ‬ ‫ﺣرﻛﺎت‬.
–‫اﻟﺻورة‬ ‫ﻣﺳﺗﻘﺑل‬ ‫ﺣﺎﻣل‬ ‫ﺣرﻛﺎت‬
13/12/14 OSSAMA ANJAK 43
‫اﻟﻣﺣﺎﻛـﻲ‬
Simulator
13/12/14 OSSAMA ANJAK 44
‫اﻠﻣﻌﺎﻠﺟﺔ‬ ‫ﺠﻬﺎز‬
‫اﻠﻣﺤﺎﻜﻲ‬Simulator
‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﮭﺎز‬ ‫ﻋﻠﻰ‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬
•‫ظﮭري‬ ‫اﺳﺗﻠﻘﺎء‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬ ‫ﺗﻛون‬ ‫اﻟﺣﺎﻻت‬ ‫ﻣﻌظم‬ ‫ﻓﻲ‬
13/12/14 OSSAMA ANJAK 45
‫اﻟﻣﺣﺎﻛﺎة‬ ‫أﺛﻧﺎء‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬
•‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﮭﺎز‬ ‫ﻋﻠﻰ‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬ ‫ﺗﻛون‬ ‫أن‬ ‫ﯾﺟب‬:
–‫ﻟﻠﻣرﯾض‬ ‫ﺑﺎﻟﻧﺳﺑﺔ‬ ‫ﻣرﯾﺣﺔ‬.
–‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﮭﺎز‬ ‫ﻋﻠﻰ‬ ‫ﺗﻧﻔﯾذھﺎ‬ ‫ﯾﻣﻛن‬.
–‫ﻟﻠﺗﻛرار‬ ‫ﻗﺎﺑﻠﺔ‬.
13/12/14 OSSAMA ANJAK 46
13/12/14 OSSAMA ANJAK 47
‫اﻟﻣﺣﺎﻛﺎة‬
‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﻬﺎز‬ ‫وﺿﻌﯾﺔ‬ ‫ﻋن‬ ‫اﻟﻣﻌﻠوﻣﺎت‬ ‫ﻛﺎﻓﺔ‬ ‫ﺗﺳﺟﯾل‬ ‫ﯾﺟب‬:
‫اﻟﺳﺎﺣﺔ‬ ‫أﺑﻌﺎد‬
‫اﻟﻣﺳﺎﻓﺔ‬SSD.
‫اﻟورم‬ ‫ﻋﻣق‬.
‫ان‬‫ر‬‫اﻟدو‬ ‫اﯾﺎ‬‫و‬‫ز‬)،‫اﻟطﺎوﻟﺔ‬ ،‫اع‬‫ر‬‫اﻟذ‬ ،‫اﻟﻣﺣددات‬.(......
‫اﻟطﺎوﻟﺔ‬ ‫ﺳطﺢ‬ ‫ﻋن‬ ‫اﻟﻣرﻛز‬ ‫ﺗﻔﺎع‬‫ر‬‫ا‬.
‫اﻟﻣرﻛز‬.
.........
13/12/14
OSSAMA ANJAK 48
‫اﻟﻣﺣﺎﻛﺎة‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫وﺟﻬﺎز‬ ‫اﻟﻣﺣﺎﻛﺎة‬ ‫ﺟﻬﺎز‬ ‫ﺑﯾن‬ ‫اﻟﺗطﺎﺑق‬
‫اﻟﺳﺎﺣﺔ‬ ‫أﺑﻌﺎد‬
‫اﻟﻣﺳﺎﻓﺔ‬SSD/SAD.
s1
s2
saD
saD2
saD1
10x10 at SAD=80cm
12.5x12.5 at SAD=100cm
‫اﻟﻤﺤﺎﻛﻲ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺟﮭﺎز‬
‫اﻟﻤﺤﺎﻛﻲ‬
‫اﻟﻤﻌﺎﻟﺠﺔ‬ ‫ﺟﮭﺎز‬
s

9. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬9
13/12/14 OSSAMA ANJAK 49
‫ﻣرﺟﻌﯾﺔ‬ ‫ﻧﻘﺎط‬
‫وﺿﻌﯾﺔ‬ ‫ﻋن‬ ‫اﻟﻣﻌﻠوﻣﺎت‬ ‫ﻛﺎﻓﺔ‬ ‫ﺗﺳﺟﯾل‬ ‫ﯾﺟب‬
‫اﻟﻣﺣﺎﻛﻲ‬ ‫ﺟﮭﺎز‬ ‫ﻋﻠﻰ‬ ‫اﻟﻣرﯾض‬
‫اﻟﻣﺳﺗﺧدﻣﺔ‬ ‫اﻟﻣﺳﺎﻋدة‬ ‫اﻷدوات‬.
‫اﻟﻣرﺟﻌﯾﺔ‬ ‫اﻟﻧﻘﺎط‬.
........
13/12/14 OSSAMA ANJAK 50
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﺣﺎﻛﺎة‬)‫اﻟﺗﺧطﯾط‬.(
‫اﻟﺗوﺛﯾق‬:
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺳﺎﺣﺔ‬ ‫ة‬‫ر‬‫ﺻو‬)،‫ﺗﺻوﯾر‬ ‫ﻓﻠم‬
.(......
‫ﺑطﺎﻗﺔ‬)‫ة‬‫ر‬‫اﺳﺗﻣﺎ‬(‫ﺑﺎﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺧﺎﺻﺔ‬
‫اﻟﻣﻌﻠوﻣﺎت‬ ‫ﻛﺎﻓﺔ‬ ‫ﻋﻠﯾﻬﺎ‬ ‫ﺗدون‬.
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺑطﺎﻗﺔ‬ ‫ﻋﻠﻰ‬ ‫ﺗوﺿﯾﺣﻲ‬ ‫رﺳم‬
R
‫اﻟﺘﺼﻮﯾﺮ‬ ‫وﺿﻌﯿﺔ‬‫اﻟﺘﺼﻮﯾﺮ‬ ‫وﺿﻌﯿﺔ‬
13/12/14OSSAMA ANJAK53
‫اﻟﺘﺼﻮﯾﺮ‬ ‫وﺿﻌﯿﺔ‬
13/12/14OSSAMA ANJAK54
‫اﻟﺘﺼﻮﯾﺮ‬ ‫وﺿﻌﯿﺔ‬‫اﻟﻄﺒﻘﻲ‬CT
Sagital Plan
Horizantal Plan
Veirtcal Plan

10. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬10
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬ ‫ﻧظﺎم‬
(Treatment planning System, TPS)
13/12/14 OSSAMA ANJAK 56
‫ﻣﻧظوﻣﺔ‬‫اﻟﺣﺎﺳوﺑﻲ‬ ‫اﻟﺗﺧطﯾط‬)‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬ ‫ﻧظﺎم‬(
‫ﺣﺎﺳ‬‫و‬‫ب‬
‫اﻟﺗﺧطﯾط‬
‫ات‬‫ر‬‫اﻣﺗ‬‫ر‬‫ﺑﺎ‬‫اﻟﺣزﻣﺔ‬
‫اﻟﺗﺷﺧﯾﺻﯾﺔ‬ ‫اﻟوﺳﺎﺋل‬:CT,
MRI, PET, SPECT
‫اﻟﺗﺳﺟﯾل‬
‫اﻟﺗﺣﻘق‬‫و‬
‫اﻟﺷﺎﺷﺔ‬
‫اﻟطﺎﺑﻌﺔ‬
‫اﺳﻣﺔ‬‫ر‬‫اﻟ‬‫و‬
‫اﻟﺗﺧزﯾن‬ ‫ات‬‫و‬‫أد‬
‫ﻗرص‬ ،‫ﻣﻣﻐﻧط‬ ‫ﺷرﯾط‬
‫اﻟﺣﻣﺎﯾﺎت‬ ‫ﺗﺻﻧﯾﻊ‬
‫اﻟﻣﻔﺎﺗﯾﺢ‬ ‫ﻟوﺣﺔ‬ ‫اﻷﻓﻼم‬
‫اﻟﻣ‬‫ﻧظ‬‫و‬‫ﻣ‬‫ﻟﺗﺣﺻﯾل‬ ‫اﻟﻣﺣوﺳﺑﺔ‬ ‫ﺔ‬
‫اﻟﺣزﻣﺔ‬ ‫ﺑﯾﺎﻧﺎت‬
‫ﻣﻧظوﻣﺔ‬‫اﻟﻣرﯾض‬ ‫ﺑﯾﺎﻧﺎت‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ات‬‫و‬‫أد‬:MLC,‫اﻟﻣرﺷﺣﺎت‬
،‫اﻟدﯾﻧﺎﻣﯾﻛﯾﺔ‬ ‫اﻹﺳﻔﯾﻧﯾﺔ‬IMRT
13/12/14OSSAMA ANJAK57
‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫اﻟﻣﺣﺎﻛﺎة‬
CT Simulator
‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫اﻟﻣﺣﺎﻛﺎة‬
13/12/14 OSSAMA ANJAK 59
‫اﻷﺑﻌﺎد‬ ‫ﺛﻼﺛﻲ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬3D treatment planning:
–‫ـ‬‫ﻟ‬‫ا‬ ‫ﺻور‬ ‫ﺑﯾﺎﻧﺎت‬ ‫ﻗﺎﻋدة‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫ي‬‫ﺗﺟر‬CT dataset‫ﻓﺎﺻل‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫ﻟﻠﻣﻧطﻘﺔ‬
‫اﻟﻣﻘﺎطﻊ‬ ‫ﺑﯾن‬ ‫ﻣﻧﺎﺳب‬)0.5 cm - 1 cm‫و‬ ‫اﻟﺻدر‬ ‫أﺟل‬ ‫ﻣن‬0.5 cm‫أﺟل‬ ‫ﻣن‬
‫و‬ ‫اﻟﺣوض‬0.3 cm‫اﻟﻌﻧق‬‫و‬ ‫أس‬‫ر‬‫اﻟ‬ ‫أﺟل‬ ‫ﻣن‬.(
–‫ﺟﻲ‬‫اﻟﺧﺎر‬ ‫اﻟﻣﺣﯾط‬ ‫رﺳم‬ ‫ﯾﺟب‬)‫اﻟﺗﺛﺑﯾت‬ ‫ﻗﻧﺎع‬ ‫أو‬ ‫اﻟﺟﻠد‬ ‫ﯾظﻬر‬immobilization
mask(‫ـ‬‫ﻟ‬‫ا‬ ‫ﻣﻘﺎطﻊ‬ ‫ﻣن‬ ‫ﻣﻘطﻊ‬ ‫ﻛل‬ ‫ﻋﻠﻰ‬CT‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬ ‫ﻓﻲ‬ ‫اﻟﻣﺳﺗﺧدﻣﺔ‬.
–‫ـ‬‫ﻟ‬‫ا‬ ‫ﻣﻘﺎطﻊ‬ ‫ﻋﻠﻰ‬ ‫اﻟﻬدف‬ ‫وﺣﺟم‬ ‫اﻟورم‬ ‫رﺳم‬ ‫ﯾﺗم‬ ً‫ﺎ‬‫أﯾﺿ‬CT.
–‫اﻟﻬﺎﻣﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﺗرﺳم‬ ‫وﻛذﻟك‬ ‫ﺑﺎﻹﺷﻌﺎع‬ ‫ﺗﺿرر‬ ‫اﻟﺗﻲ‬ ‫اﻷﻋﺿﺎء‬ ‫رﺳم‬ ‫ﯾﺟب‬ ‫أﯾﺿﺎ‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫ﻋﺔ‬‫اﻟﺟر‬ ‫ع‬‫ﻟﺗوز‬ ‫اﻹﺣﺻﺎﺋﻲ‬ ‫اﻟﻣﺧطط‬ ‫رﺳم‬ ‫اﻟﻣطﻠوب‬ ‫ﻛﺎن‬ ‫إذا‬ ‫ى‬‫اﻷﺧر‬
dose-volume histograms
13/12/14 OSSAMA ANJAK 60
‫ﻣﺘﺤﺮﻛﺔ‬ ‫ﻟﯿﺰرات‬
‫اﻟﻤﺮﻛﺰ‬ ‫ﻣﺴﻘﻂ‬CT ‫ﺻﻮر‬
‫اﻟـ‬ ‫ﺑﺠﮭﺎز‬ ‫اﻟﻤﺤﺎﻛﺎة‬CT)CT Simulation(
‫اﻠﻣﺮﻜﺰ‬‫ﻤﻮﺿﻊ‬

11. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬11
13/12/14 OSSAMA ANJAK 61
‫ﺑﺎﻟﻤﺤﺎﻛﺎة‬ ‫ﺧﺎﺻﺔ‬ ‫ﻣﺘﺤﺮﻛﺔ‬ ‫ﻟﯿﺰرات‬
‫اﻟطﺑﻘﻲ‬ ‫ﺑﺎﻟﺗﺻوﯾر‬ ‫اﻟﻣﺣﺎﻛﺎة‬ ‫ﺧﻼل‬ ‫اﻟﻣرﯾض‬ ‫وﺿﻌﯾﺔ‬
13/12/14 OSSAMA ANJAK 62
‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫اﻟﻣﺣﺎﻛﺎة‬
•‫اﻟﺗﺻوﯾر‬ ‫وﺿﻌﯾﺔ‬ ‫اﺧﺗﻼف‬
13/12/14 OSSAMA ANJAK 63
‫ﻣﺳﺗوي‬ ‫ﺳطﺢ‬)‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﮭﺎز‬( ‫ﻋﺎدي‬ ‫ﺳطﺢ‬
‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫اﻟﻣﺣﺎﻛﺎة‬
•‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﻟﺟﮭﺎز‬ ‫اﻟطﺎوﻟﺔ‬ ‫ﺳطﺢ‬ ‫ﺗﻌدﯾل‬
13/12/14 OSSAMA ANJAK 64
‫اﻟطﺑﻘﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺑﺎﺳﺗﺧدام‬ ‫اﻟﻣﺣﺎﻛﺎة‬
•ٍ‫اﻟﺣﻠزوﻧﻲ‬ ‫اﻟﺗﺻوﯾر‬ ‫ﺗﻘﻧﯾﺔ‬ ‫اﺳﺗﺧدام‬Spiral CT Scan
13/12/14 OSSAMA ANJAK 65
3D Simulation & Planning
•‫ﻣن‬ ‫ﻟﻌدد‬ ‫ﻣﺧطط‬ ‫ﺗﻌﯾﯾن‬ ‫ﯾﺟرى‬
‫ﻣﻘطﻊ‬ ‫ﻋﻠﻰ‬ ‫اﻟﺣﺟوم‬CT‫ﻣن‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺣﺎﻟﺔ‬ ‫أﺟل‬:
–GTV
–CTV
–PTV
–organs at risk
(bladder and
rectum).
13/12/14 OSSAMA ANJAK 66

12. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬12
13/12/14 OSSAMA ANJAK 67
‫اﻟﺣﺟم‬ ‫ﺗﻌﯾﯾن‬VOLUME DEFINITION
‫ﻋرﻓ‬‫ت‬‫ـ‬‫ﻟ‬‫ا‬ICRU‫ﯾر‬‫ر‬‫اﻟﺗﻘ‬ ‫ﻓﻲ‬50‫و‬
‫اﻟ‬‫ﯾر‬‫ر‬‫ﺗﻘ‬62‫اﻟﻬدف‬ ‫ﻣﻧﺎطق‬ ‫ﻣن‬ ‫دد‬ِ‫ﻋ‬
‫أﺟل‬ ‫ﻣن‬ ‫اﻟﺣرﺟﺔ‬ ‫ﻟﻠﺑﻧﯾﺔ‬ ‫اﻟﺣﺟوم‬‫و‬:
ِ‫ﺔ‬‫اﻟﻣﻌﺎﻟﺟ‬ ‫ﺗﺧطﯾط‬ ِ‫ﺔ‬‫ﻋﻣﻠﯾ‬ ‫ﻓﻲ‬ ‫اﻟﻣﺳﺎﻋدة‬
ِ‫ﺞ‬‫ﻧﺗﺎﺋ‬ ِ‫ﺔ‬‫ﻟﻣﻘﺎرﻧ‬ ‫ﻣﺣددة‬ ‫أﺳس‬ ‫ﻟﻧﺎ‬ ْ‫ر‬ّ‫ﻓ‬‫ﺗو‬
ِ‫ﺔ‬‫اﻟﻣﻌﺎﻟﺟ‬.
13/12/14 OSSAMA ANJAK 68
PTV
ITV
CTV
‫اﻟﺣﺟم‬ ‫ﺗﻌﯾﯾن‬VOLUME DEFINITION
‫ـ‬‫ﻟ‬‫ا‬ ‫ﻗﺑل‬ ‫ﻣن‬ ‫اﻟﻣﺣددة‬ ‫اﻟﺣﺟوم‬
ICRU‫اﻷﺳﺎس‬ ‫ﺗﻌد‬ ‫اﻟﺗﻲ‬
(principal volumes)‫ﻓﻲ‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺗﺧطﯾط‬
‫اﻷﺑﻌﺎد‬ ‫ﺛﻼﺛﯾﺔ‬.
OAR
13/12/14 OSSAMA ANJAK 69
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬
‫ﻟﻠﻬدف‬ ‫ي‬‫اﻟﺳرﯾر‬ ‫اﻟﺣﺟم‬(CTV)
CTV
GTV
13/12/14 OSSAMA ANJAK 70
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬
‫اﻟورم‬ ‫ﻣﺧطط‬ ‫ﺣﺟم‬Planning Tumor Volume (PTV)
PTV
13/12/14 OSSAMA ANJAK 71
‫اﻟﺣﺟم‬ ‫ﺗﻌرﯾف‬
‫اﻟﺧطر‬ ‫ذات‬ ‫اﻷﻋﺿﺎء‬Organ at Risk (OAR)
‫ﺿﻣن‬ ً‫ة‬‫ر‬‫ﻣﺑﺎﺷ‬ ‫ﺗﻘﻊ‬ ‫ﻻ‬ ‫ﺑﺣﯾث‬ ‫ﺧﺎﺻﺔ‬ ‫ﺑﻌﻧﺎﯾﺔ‬ ‫اﻷﻋﺿﺎء‬ ‫ﺗﻠك‬ ‫اﺣﺎطﺔ‬ ‫ﯾﺟب‬
‫اﻟﺣﺟم‬CTV‫ح‬‫اﻟﻣﺳﻣو‬ ‫ﻋﺔ‬‫اﻟﺟر‬ ‫ﻣﻘدار‬ ‫ﻣن‬ ‫ﯾﻣﻛن‬ ‫ﻣﺎ‬ ‫أﻗل‬ ‫إﻟﻰ‬ ‫ﺗﺗﻌرض‬ ‫أن‬‫و‬
‫ﺑﻬﺎ‬.
‫ﻣن‬‫اﻷﻣﺛﻠﺔ‬‫اﻷﻋﺿﺎء‬ ‫ﺗﻠك‬ ‫ﻋﻠﻰ‬:
‫اﻟدﻣﺎغ‬ ‫ام‬‫ر‬‫أو‬ ‫أو‬ ‫اﻷﻧﻔﻲ‬ ‫اﻟﺑﻠﻌوم‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫أﺛﻧﺎء‬ ‫اﻟﻌﯾن‬ ‫ﻋدﺳﺔ‬.
‫اﻟﺛدي‬ ‫ام‬‫ر‬‫أو‬ ‫ﻣﻌﺎﻟﺟﺔ‬ ‫ﻋﻧد‬ ‫اﻟرﺋﺔ‬
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺟرﻋﺔ‬ ‫ﺗوزع‬ ‫دراﺳﺔ‬
13/12/14 OSSAMA ANJAK 72

13. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬13
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻣﺧطط‬ ‫ﺗﻘﯾﯾم‬
•‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﺟرﻋﺔ‬ ‫ﺗوزع‬ ‫دراﺳﺔ‬:
–‫اﻟﺟرﻋﺔ‬ ‫ﺗوزع‬ ‫ﻣﻧﺣﻧﯾﺎت‬
–Dose Volume Histogram DVH
13/12/14 OSSAMA ANJAK 73
‫اﻟﻣﺣﺎور‬ ‫ﻓﻲ‬ ‫اﻟﺗواﻓق‬OXYZ
13/12/14 OSSAMA ANJAK 74
‫اﻟﻣﺣﺎور‬ ‫ﻓﻲ‬ ‫اﻟﺗواﻓق‬OXYZ
13/12/14 OSSAMA ANJAK 75
IAEA: Lessons Learned from Accidental...
• Describes 92 accidental exposures
– 26 relate to radiation treatment planning
• 16 external beam therapy
• 10 brachytherapy
13/12/14 OSSAMA ANJAK 76
13/12/14 OSSAMAANJAK 77
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻣﺗﻣﻣﺔ‬ ‫اﻟﺗﺟﮭﯾزات‬
‫اﻹﺳﻔﯾﻧﻲ‬ ‫اﻟﻣرﺷﺢ‬
Wedge Filter
13/12/14 77OSSAMAANJAK
‫اﻹﺳﻔﯾﻧﻲ‬ ‫اﻟﻣرﺷﺢ‬Wedge Filter
13/12/14 OSSAMA ANJAK 78
Physical Wedge
Dynamic Wedge

14. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬14
‫اﻹﺳﻔﯾﻧﻲ‬ ‫اﻟﻣرﺷﺢ‬Wedge Filter
13/12/14 OSSAMA ANJAK 7913/12/14 OSSAMAANJAK 80
‫اﻹﺷﻌﺎﻋﯾﺔ‬ ‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫اﻟﻣﺗﻣﻣﺔ‬ ‫اﻟﺗﺟﮭﯾزات‬
‫اﻟﺣﻣﺎﯾﺎت‬ ‫ﺻب‬ ‫ﻏرﻓﺔ‬
Molding Room
13/12/14 80OSSAMA ANJAK
‫اﻟﺣﻣﺎﯾﺎت‬
•‫ﻋدم‬ ‫ﯾﺟب‬ ‫اﻟﺗﻲ‬ ‫اﻟﻣﻧﺎطق‬ ‫وﻗﺎﯾﺔ‬
‫ﻟﻺﺷﻌﺎع‬ ‫ﺗﻌرﯾﺿﮭﺎ‬.
•‫ﺣﻣﺎﯾﺎت‬ ‫أو‬ ‫ﻗواﻟب‬ ‫إﻣﺎ‬ ‫ﯾﺳﺗﻌﻣل‬
‫ﻋﻠﻰ‬ ‫ﻣرﯾض‬ ‫ﻟﻛل‬ ً‫ﺎ‬‫ﻣﺣﻠﯾ‬ ‫ﻣﺻﻧﻌﺔ‬
‫ّة‬‫ﺣد‬
13/12/14 OSSAMA ANJAK 81
‫اﻟﺣﻣﺎﯾﺎت‬ ‫ﺗﺻﻧﯾﻊ‬
•‫ﺑﺟﮭﺎز‬ ‫اﻟﻣﻠﺗﻘطﺔ‬ ‫اﻟﻣرﯾض‬ ‫ﺻورة‬ ‫ﺗﺳﺗﻌﻣل‬
‫اﻟﻘﺎﻟب‬ ‫وﻗص‬ ‫اﻟﺣﻣﺎﯾﺔ‬ ‫ﺣواف‬ ‫ﻟﺗﺣدﯾد‬ ‫اﻟﻣﺣﺎﻛﻲ‬
‫اﻟﻣطﻠوب‬ ‫اﻟﺷﻛل‬ ‫إﻟﻰ‬ ‫ﻟﻠوﺻول‬.
13/12/14 OSSAMA ANJAK 82
‫اﻟﻘواﻟب‬ ‫ﻗص‬ ‫أﺟﮭزة‬
13/12/14 OSSAMA ANJAK 83
‫اﻟﺣﻣﺎﯾﺎت‬ ‫ﺗﺻﻧﯾﻊ‬
•‫اﻟﻘﺎﻟب‬ ‫ﻓﻲ‬ ‫اﻟﺧﻠﯾطﺔ‬ ‫ﺳﻛب‬.
•‫اﻟﺣﻣﺎﯾﺔ‬ ‫ﺗﺻﻧﯾﻊ‬
•‫اﻟﻠوﺣﺔ‬ ‫ﻋﻠﻰ‬ ‫اﻟﺣﻣﺎﯾﺔ‬ ‫ﺗﺛﺑﯾت‬
‫اﻟﺧﺎﺻﺔ‬.
13/12/14 OSSAMA ANJAK 84

15. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬15
‫اﻟورﯾﻘﺎت‬ ‫اﻟﻣﺗﻌدد‬ ‫اﻟﻣﺣدد‬MLC
13/12/14 OSSAMA ANJAK 85
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﺧﻼل‬ ‫ﺛﺎﺑﺗﺔ‬
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﺟﻠﺳﺔ‬ ‫ﺧﻼل‬ ‫ﻣﺗﺣرﻛﺔ‬
Dynamic Treatment
‫ﺑﺎﻹﻟﻛﺗروﻧﺎت‬ ‫اﻟﺧﺎﺻﺔ‬ ‫اﻟﺣﻣﺎﯾﺎت‬
13/12/14 OSSAMA ANJAK 86
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻟﺗﺟﮭﯾزات‬ ‫اﻟﻣﺗﻣﻣﺔ‬ ‫اﻷدوات‬
‫اﻟﻣرﯾض‬ ‫ﺗﺛﺑﯾت‬ ‫أدوات‬
13/12/14 OSSAMA ANJAK 88
‫واﻟﻌﻧق‬ ‫اﻟرأس‬ ‫ﻣﺛﺑﺗﺎت‬
‫اﻟﻣرﯾض‬ ‫ﻣﺛﺑﺗﺎت‬ ‫ﺗﺳﺗﻌﻣل‬:
‫اﻟﻣﻌﺎﻟﺟﺔ‬ ‫ﻓﻲ‬ ‫اﻟدﻗﺔ‬ ‫ﻟزﯾﺎدة‬.
‫اﻟﺣﺎﻻت‬ ‫ﺑﻌض‬ ‫ﻓﻲ‬ ‫اﻟﻣرﺿﻰ‬ ‫ﺗﺛﺑﯾت‬)‫دﻣﺎﻏﯾﺔ‬ ‫أورام‬ ،‫أطﻔﺎل‬(...
13/12/14 OSSAMA ANJAK 89
‫اﻟﻣﺳﺎﻋدة‬ ‫اﻷدوات‬
13/12/14 OSSAMA ANJAK 90
‫اﻟﻣﺳﺎﻋدة‬ ‫اﻷدوات‬

16. ‫أﻧﺟـق‬ ‫أﺳﺎﻣﺔ‬/‫اﻟﺳورﯾﺔ‬ ‫اﻟذرﯾﺔ‬ ‫اﻟطﺎﻗﺔ‬ ‫ھﯾﺋﺔ‬16
13/12/14 OSSAMA ANJAK 91
‫اﻟﺟﺳم‬ ‫ﻣﺛﺑﺗﺎت‬
13/12/14OSSAMA ANJAK92
‫وﻣﻨﺎﻗﺸـــــﺔ‬ ‫أﺳـــــﺌﻠﺔ‬
13/12/14OSSAMA ANJAK93