Conception et validation d'un système pour la planification et le guidage en temps réel des traitements de curiethérapie à haut débit de dose du sein
|Abstract:||This thesis focuses on the development and validation of different tools to increase the efficacy of high dose rate (HDR) breast brachytherapy treatments. The project goal aim at designing and validating a new system for real-time guidance and planning of HDR breast brachytherapy treatments, based mainly on 3D ultrasound (3DUS). As a first step, a clinical study was performed using the first linear 3DUS prototype developed by our group. This study has shown the limitations of the current system (ex : small acquisition volume, no catheter tracking possibility) and that 3DUS volumes are three times smaller than computed tomography volumes. As a second step, a catheter optimization algorithm was developed. The algorithm was shown to be robust to catheter implantation errors and it was possible to reduce significantly the number of catheters without having a significant negative impact on the dosimetry. As a third step, a study was designed to compare the present catheter optimization algorithm to the only commercially available algorithm, HIPO. The results demonstrated that the HIPO algorithm produce significantly worse plan, in term of dosimetry, than the algorithm that was developed in the present thesis. As a fourth step, two methods were developed for personalized, real-time planning of breast HDR brachytherapy treatments. The two methods were efficient and they were able to reduce the number of catheters. A proof-of-concept was validated and it demonstrated the potential of a personalized, real-time planning approach for breast HDR brachytherapy. Using the experience acquired during the clinical study, a new 3DUS system was developed. The system includes a new hybrid acquisition approach and a module for catheter tracking. The results presented in this study have shown the ability of the hybrid 3DUS system to accurately measure linear dimensions and volumes. Furthermore, it allows the reconstruction of the catheters trajectory with accuracy as well as track them in real-time. Finally, in order to dynamically reconstruct catheters, an electromagnetic tracking system was validated. This study has shown that the reconstruction of catheters, in HDR brachytherapy, is significantly more accurate and precise with an electromagnetic tracking system than with the conventional methods.|
|Document Type:||Thèse de doctorat|
|Open Access Date:||23 April 2018|
|Collection:||Thèses et mémoires|
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