Pengaruh volume Vesica Urinaria terhadap paparan dosis radiasi organ kritis pada perhitungan komputer Treatment Planning System pre Brachytherapy Carcinoma Cervix Uteri
SUPRIONO, Paulus, Prof.Dr.dr. H. Salugu Maesadjie TJ., SpRad.(K)Onk
2005 | Tesis | PPDS I RadiologiBerbagai prosedur dilakukan untuk mengurangi paparan dosis radiasi pada organ kritis (usus halus, vesica urinaria dan rectum) selama brachytherapy Carcinoma Cervix Uteri, salah satunya adalah dengan memperbesar volume vesica urinaria dengan cara mengisi cairan kedalam vesica urina ria. Prosedur ini pada beberapa penelitian terbukti mampu mengurangi paparan dosis pada usus halus dan membuat area dinding vesica urinaria (bladder high) bertambah sehingga paparan dosis vesica urinaria total (terutama pada dinding anterior) berkurang; tetapi penelitian lain melaporkan tindakan mengisi cairan pada vesica urinaria membuat dinding posterior vesica urinaria mendekati sumber radiasi sehingga paparan dosis pada tempat itu menjadi besar (dosis vesica urinaria maksimum). Penelitian ini bertujuan untuk membuktikan bahwa prosedur mengisi vesica urinaria pada brachytherapy Carcinoma Cervix Uteri berdaya guna untuk mengurangi paparan radiasi dosis total vesica urinaria dan tidak berpengaruh terhadap paparan dosis vesica urinaria maksimumnya. Penelitian ini menggunakan desain uji klinis acak parallel terkendali secara terbuka, dilakukan pada Instalasi Radiologi pelayanan Radiotherapy RS Dr.Sardjito selama 21 bulan, perlakuan memberi cairan pada vesica urinaria dilakukan setelah pemasangan aplikator brachytherapy Carcinoma Cervix Uteri yaitu memasukkan cairan kontras Urogrfin 38% sebanyak 35 ml via kateter, kemudian dilakukan x-foto simulator posisi AP dan lateral, dari hasil foto simulator- paparan dosis pada organ kritis dihitung menggunakan komputer Treatment Planning System Nucletron Plato, luaran berupa nilai paparan dosisi radiasi ini, dianalisa pada kelompok vesica urinaria yang diisi dibandingkan dengan vesica urinaria kosong. Karakteristik demografi dan klinis kedua kelompok hampir sama (p>0,05) dan sample berdistribusi normal (Q-Q plotting). Rerata paparan dosis radiasi vesica urinaria maksimum pada kelompok vesica urinaria diisi cairan 35 ml lebih besar dibanding vesica urinaria kosong (p=0,009). Rerata jarak dinding anteroposterior vesica urinaria (bladder high) kelompok yang diisi cairan 35ml lebih besar dibanding vesica urinaria kosong (p>0,05) dan paparan dosis vesica urinaria minimum pada vesica urinaria yang diisi cairan lebih kecil dibanding vesica urinaria kosong (p=0,002). Kesimpulan dari penelitian ini adalah, prosedur mengisi cairan 35 ml pada brachytherapy Carcinoma Cervix Uteri akan meningkatkan paparan dosis vesica urinaria maksimum, tetapi memperluas area dinding vesica urinaria (bladder high) sehingga mengurangi paparan dosis dinding vesica urinaria secara keseluruhan.
As We know, many procedures must be done to decrease dose of the radiation exposure to critical organ (small bowel, bladder and rectum) during brachythrapy Carcinoma Cervix Uteri, one of them is to increasing the bladder volume by filling fluid into the bladder. This procedure have been proven by many studies can reduce dose of radiation exposure to small bowel and it cause the bladder wall area (bladder high) extended so that the total dose radiation to the bladder decreased, but in the other studies report that filling procedure can cause the posterior wall of bladder closer to the source of radiation, so that the dose of exposure to that area become greater (maximum dose of bladder). This study was to proved that those procedures by filling the bladder during brachytherapy Carcinoma Cervix Uteri benifical to reduce the total dose of radiation exposure to the bladder and not have being affected to the maximum dose exposure of the bladder. This design of this study was Paraller Randomized Control Trial, that been done in Radiology instalation in Radiotherapy centre of Dr. Sardjito General Hospital within 21 mont, after the applicator brachythrapy Carcinoma Cervix Uteri has been plugged on; the bladder filled by Urografin contrast agent 38%, 35ml, after that the xray foto simulator with AP and lateral view have been done. From the radiograph, the dose exposure in critical organ calculated by using Treatment Planning System Nucletrron Plato computer, the output of the value dose exposure in the group of filling bladder was been analyzed compared with the empty bladder. Demographic and clinical characteristic in both group were equal (p>0,05), those samp le was distributed normally (Q-Q plotting). The mean maximal dose of radiation exposure in the group of filling bladder more than the empty bladder (p>0,05). Otherwise, the mean of the anteroposterior wall distance (bladder high) in the filling bladder group greatr than the empty bladder (p>0,05) The conclution of this study were that the procedure by filling 35 ml fluid to brachytherapy Carcinoma Cervix Uteri will increased the maximum dose of radiation exposure of bladder, but extended the bladder wall area (bladder high) so that can reduced the total dose of radiation exposure of the bladder’s wall.
Kata Kunci : Carcinoma Cervix Uteri,Radioterapi EBRT,Brachytherapy, Volume of bladder about 35 ml, Empty bladder volume, Carcinoma Cervix Uteri, Clinical Trial
