Une approche pour augmenter le débit par longueur d'onde, est d'utiliser la modulation DMT (Discrete Multitone) à haute efficacité spectrale. Le travail présenté dans cette thèse se focalise principalement sur l'optimisation de la consommation en puissance et le coût de la DMT, qui présentent des obstacles majeurs à son industrialisation. Dans ce cadre, nous avons tout d'abord développé des nouvelles techniques permettant d'exclure la symétrie Hermitienne des modulations DMT, réduisant ainsi considérablement la consommation en puissance et le coût du système. Nous avons ensuite proposé un algorithme de compression linéaire asymétrique permettant de réduire la puissance optique de la modulation DMT avec une complexité modérée. Un nouveau modèle comportemental du VCSEL basé sur la caractéristique quasi-statique a été également développé. Nous avons enfin validé expérimentalement les techniques que nous avons proposées. Plusieurs résultats de simulations et de mesures sont ainsi présentés. / A possible approach to maximize the data rate per wavelength, is to employ the high spectral efficiency discrete multitone (DMT) modulation. The work presented in this thesis mainly focuses on optimizing the power consumption and cost of DMT, that are the major obstacles to its market development. Within this context, we have first developed novel techniques permitting to discard the use of Hermitian symmetry in DMT modulations, thus significantly reducing the power consumption and the system cost. We have next proposed an asymmetric linear companding algorithm permitting to reduce the optical power of conventional DCO-OFDM modulation with a moderate complexity. A new VCSEL behavioural model based on the use of the VCSEL quasi-static characteristic was also developed to accurately evaluate the VCSEL impact on DMT modulations. Finally, we have built an experimental system to experimentally validate our proposed techniques. Several simulations and measurement results are then provided.

Submitted by ISABELLA PAZIAM FERNANDES NUNES null (ipaziam@me.com) on 2018-03-14T12:47:35Z No. of bitstreams: 1 dissertacao - nunes ipf.pdf: 3167962 bytes, checksum: bd9df494a7b84197900f4be8d90cd090 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-19T11:47:25Z (GMT) No. of bitstreams: 1 nunes_ipf_me_bot.pdf: 3167962 bytes, checksum: bd9df494a7b84197900f4be8d90cd090 (MD5) / Made available in DSpace on 2018-03-19T11:47:25Z (GMT). No. of bitstreams: 1 nunes_ipf_me_bot.pdf: 3167962 bytes, checksum: bd9df494a7b84197900f4be8d90cd090 (MD5) Previous issue date: 2018-02-23 / O presente estudo consiste na análise da viabilidade econômica e financeira da implantação da radioterapia de intensidade modulada (IMRT) no tratamento do câncer de próstata e comparar seus benefícios clínicos frente aos procedimentos similares custeados pelos sistemas de saúde públicos e privados. Para tanto, foram analisadas as distribuições de dose de radiação preconizadas nos planejamentos radioterápicos com as técnicas de radioterapia conformacional tridimensional (3D-CRT) e de intensidade modulada (IMRT), prescrita para 20 pacientes com câncer de próstata tratados em um serviço de radioterapia privado. Para verificação da qualidade da distribuição de dose de radiação no volume de tratamento, foram analisados os índices de homogeneidade (IH) e de conformidade (IC) de cada um dos planos radioterápicos estudados. Em comparação com a técnica 3D-CRT, a técnica de IMRT permitiu uma melhor cobertura e conformação da dose prescrita no volume alvo de planejamento (PTV), porém distribuída de forma mais heterogênea. Além disso, avaliou-se os custos financeiros para aquisição dos equipamentos de irradiação e manutenção dos tratamentos, bem como os valores de repasses feitos pelos sistemas de saúde para os procedimentos de radioterapia em próstata. / The present study consists in analyzing the economic and financial viability to establish the intensity modulated radiotherapy (IMRT) in the treatment for prostate cancer and compare its clinical benefits to similar procedures funded by public and private health systems. In order to do so, the radiation absorbed-dose distributions recommended in the radiotherapy plans with three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques, prescribed for 20 patients with prostate cancer treated in a private radiotherapy clinic, were evaluated. To verify the quality of the radiation dose distribution in the treatment volume, the homogeneity index (HI) and the conformity index (CI) of each radiotherapy plans studied were analyzed. In contrast to the 3D-CRT technique, the IMRT technique allowed a better coverage and conformation of the radiation dose prescribed in the planning target volume (PTV), but distributed in a more heterogeneous way. It was also evaluated the financial costs for the acquisition of the irradiation equipment and for the maintenance of the treatments, as well as the values of the on-lending made by the health systems for the radiotherapy procedures for the prostate.

Le présent travail de thèse décrit le développement d'un protocole d'irradiation stéréotaxique combinée à une radiothérapie conformationnelle avec modulation d'intensité. Ce projet a été initiée dans le service de radiothérapie-oncologie du Centre Hospitalier Lyon Sud. La première partie de ce travail fait état d'une revue de littérature sur les techniques d'irradiation du cancer de la prostate. Trois grands thèmes de recherche ont été identifiés et developpés : un premier thèse de recherche portant sur la définition optimale des volumes à irradier lors d'une irradiation stéréotaxique de la prostate et la fiabilité d'uin repérage de l'oragane par des marqueurs intra-prostatiques. La deuxième thématique de recherche était dédiée à la planification du traitement stéréotaxique de la prostate avec pour principal objectif une protection optimale de la paroi rectale avec deux approches différentes : a) une augmentation focalisée de la dose d'irradiation uniquement sur la tumeur macroscopiquement visible, ou b) l'utilisation d'un gel injecté entre la paroi du rectum et la prostate. Le nombre optimal de faisceaux à utiliser ainsi que l'énergie la mieux adaptée ont été évalués dans le cadre de la première approche avec uin boost intégré.. La trosième thématique portait sur les contrôles qualité à réaliser dans le cadre de la mise en route de cette technique d'irradiation. Trois détecteur dédiés aux contrôles de la distribution de dose sous l'accélarateur ont été évalués. L'ensemble de ces travaux serviront de supports à la réalisation d'une étude de phase II intégrant une irradiation stéréotaxique des cancers de la prostate avec injection de gel d'acide hyaluronique entre le rectum et la prostate / The current work decribes the implementation of a protocol for stereotactic body radiotherapy (SBRT) combined with an intensity-modulated radiation therapy technique (IMRT). the project was initiated in the Department of Radiation-Oncology from Lyon Sud Hospital. The first part summarizes the state of the art of prostate cancer with a literature review on irradiation techniques. Three research themes were described and developped : The first theme discusses the optimal definition of the volumes to be irradiated during a prostate SBRT and the accuracy of the target localization using intraprostatic markers. The second theme of research describes the treatment planning for prostate SBRT having as main purpose an optimal protection of the rectal-wall with two different approaches: a) an augmentation of the dose with simultaneous integrated boost only into visible macroscopic tumor, or b) the use of a gel injected between the rectal-wall and the prostate. The optimal number of fields, as well as the most favorable energy, was evaluated in the context of the first approach with a simultaneous integrated boost. The third theme discusses the quality assurance (QA) that needs to be performed for an IMRT-SBRT technique. Three detectors that ara dedicated to the QA of dose distribution under accelerator were evaluated. The results of all these studies will be used for the implementation of a phase II study for prostate SBRT with an injection of hyaluronic acid between the rectum and the prostate.

Orientador: Marco Antônio Rodrigues Fernandes / Resumo: Os modernos sistemas de planejamentos de tratamento (Treatment Planning System - TPS) computadorizados possibilitam a análise de parâmetros que informam sobre a homogeneidade (Índice de Homogeneidade - IH) e a conformidade (Índice de Conformidade - IC) da distribuição de dose de radiação em todo o volume irradiado. O IH é determinado verificando o gradiente de dose de radiação em todo o volume de tratamento planejado (PTV), uma distribuição de dose perfeitamente homogênea implica em IH igual a zero. O IC representa o grau de conformidade entre a região do PTV coberta pela dose prescrita e o volume total do PTV, quanto mais próximo do valor 1,0 melhor a conformidade do tratamento. Nesta pesquisa foram analisados os índices IH e IC para 82 casos clínicos de pacientes anteriormente submetidos à radioterapia, comparando os valores calculados destes parâmetros em planejamentos realizados com a técnica radioterápica tridimensional conformacional (3D-CRT) com a técnica de radioterapia de intensidade modulada (IMRT), e correlacionando estes índices com a dose de radiação preconizada em cada um dos casos clínicos estudados. Os planejamentos radioterápicos foram efetuados em dois diferentes Sistemas de Planejamento de Tratamento (TPS), o TPS Eclipse e o TPS XiO. Os resultados apontam que os planejamentos feitos com a técnica de IMRT apresentam valores de IC e IH levemente melhores do que os obtidos com a técnica 3D-CRT. / Abstract: Modern Treatment Planning System (TPS) computerized allows the analysis of parameters that report on the homogeneity index (HI) and conformity index (CI) of radiation dose distribution throughout the irradiated volume. IH is determined by checking the radiation dose gradient across the PTV (planned treatment volume), a perfectly homogeneous dose distribution implies IH = zero. The IC represents the degree of conformity between the PTV region covered by the prescribed dose and the total PTV volume, the closer to 1.0 the better the treatment compliance. In this research IH and IC indices were analyzed for 82 clinical cases previously submitted to radiotherapy, comparing the calculated values of these parameters in three-dimensional conformal radiation therapy (3D-CRT) planning with the intensity modulated radiation therapy (IMRT) technique, and correlating these indices with radiation dose recommended in each of the clinical cases studied. Radiotherapy planning was carried out in two different treatment planning system (TPS): TPS Eclipse and TPS XiO. The results indicated that the plans made with the IMRT technique present slightly better IC and IH values than those obtained by 3DCRT technique. / Mestre

A radioterapia de intensidade modulada (IMRT) é uma das mais modernas técnicas radioterapêuticas que permite a entrega de elevadas e complexas distribuição de doses ao volume tumoral, que necessita de novos métodos para o controle de qualidade dos procedimentos efetuados. Nos serviços de radioterapia costuma-se usar para o controle de qualidade do sistema de planejamento, a câmara de ionização para verificação pontual da dose e um dispositivo com diodos semicondutores (MapCHECK2) para a verificação bidimensional em um plano da fluência planejada, entretanto, para a verificação tridimensional dessas distribuições de doses ainda não há um dosímetro consolidado na rotina clínica. Nesse contexto, para a dosimetria tridimensional se destacam os géis poliméricos. Neste trabalho foram feitas a dosimetria convencional, pontual e bidimensional como se faz na rotina clínica e a dosimetria tridimensional utilizando o gel polimérico Magic-f, que apresenta a distribuição de dose volumétrica. Para este trabalho foi escolhido o tratamento de câncer de próstata, pois na atualidade é um dos tipos de cânceres mais comuns entre os homens. No contexto da dosimetria gel, para se obter a informação volumétrica é necessária uma técnica de imagem, no presente caso foram utilizadas imagens por ressonância magnética (magnetic resonance imaging, MRI). A partir dessas imagens é possível determinar as distribuições de doses processando-as em um software desenvolvido pelo grupo que determina as taxas de relaxação R2 associada à dose absorvida e posteriormente comparar as imagens obtidas com as imagens do sistema de planejamento. Para isso, se obteve dez cortes ao longo de cada simulador físico ou fantom em que sua comparação foi feita com a respectiva fatia do sistema de planejamento, na posição correspondente. Para uma avaliação quantitativa foi utilizado o conceito de índice gama, no critério padrão da radioterapia, 3% da dose e 3mm de distância de concordância. Os resultados obtidos com a dosimetria gel se mostram de acordo com os controles de qualidade convencionais e oferecem uma visão global da distribuição de dose no volume alvo. / The intensity modulated radiotherapy (IMRT) is one of the most modern radiotherapeutic technique that enables the delivery of high and complexes conformational doses to the tumor volume, that requires new methods for the quality assurance of the procedures performed. Radiotherapy services usually perform quality assurance of the planning system with the ionization chamber for spot-checking and an array of semiconductor diodes (MapCHECK2) to check on a two-dimensional plane, however for tridimensional dose verification does not exist an established dosimeter in the clinical routine. In this context, for three-dimensional dosimetry the polymeric gels were used. In This work the conventional one and two-dimensional dosimetry as employed in the clinical routine, and the three-dimensional dosimetry using polymer gel MAGIC- f, which provide the volumetric dose distribution. Prostate cancer clinical cases were chosen for this work because this kind of tumor is one of the most common cases in male individuals. In the context of dosimetry gel to obtain volumetric information an imaging technique is necessary, in this case the magnetic resonance imaging (MRI), was used to measure the dose. From these images it is possible to determine the distributions of doses processing them in a software developed by our research group that determines R2 relaxation rates associated with the absorbed dose and subsequently compare the images obtained with the images of the planning system. For this, ten slices were obtained along each phantom, and comparisons were made with the respective slice of the treatment planning system, in the corresponding position. For a quantitative evaluation of the gamma index , in the standard criterion in radiotherapy, 3 % dose and 3 mm distance to agreement was used. The results obtained shown that gel dosimetry agrees with the conventional quality controls and provide an overview of dose distribution in the target volume.

As técnicas de radioterapia vem sendo constantemente modificadas com a implementação de novas tecnologias visando aumentar a eficiência e diminuir a toxicidade dos tratamentos com radiação ionizante. Esse trabalho visa comparar as técnicas de radioterapia de intensidade modulada (IMRT) e a radioterapia em arco modulada volumetricamente (VMAT) em termos dosimétricos para o alvo e órgãos em risco além de avaliar a diferença do tempo de tratamento utilizando cada técnica. Para assegurar que os planejamentos seguiriam um padrão aceitável para ambas as técnicas, realizou-se primeiramente os planejamentos sugeridos pelo TG 119 da Associação Americana de Física Médica e compatibilidade dos resultados obtidos comparados com os dados da literatura. Tal comparação permitiu prosseguir para uma próxima etapa que consistiu da utilização de imagens de pacientes reais que foram submetidos a tratamentos de próstata e cabeça e pescoço, para a realização dos planejamentos utilizando as técnicas de IMRT e VMAT. A qualidade dosimétrica dos planejamentos utilizando ambas as técnicas foi avaliada em termos de conformidade e homogeneidade da dose no alvo e para os casos de pacientes com câncer de próstata, foram investigados os limites de dose em reto, bexiga e cabeça de fêmur, sendo avaliada a associação entre o volume de intersecção de reto e bexiga com o alvo. Para os   casos de pacientes com câncer de cabeça e pescoço, em termos dos limites de dose em medula, tronco cerebral e parótidas. Os planejamentos nos quais fez se uso da técnica de VMAT apresentaram valores semelhantes aos dos planos de IMRT. A análise dos tempos de tratamento para cada técnica avaliada mostrou que a VMAT reduz significativamente o tempo, até 67% para os casos de pacientes com câncer de próstata e até 36% para os casos de pacientes com câncer de cabeça e pescoço / The goal of this study was to compare the dosimetric aspects of volumetric-modulated arc therapy (VMAT) with those of intensity-modulated radiotherapy (IMRT) and to evaluate the delivery time and monitor unit differences between the two techniques, for applications in prostate and head and neck cancer treatment. First of all, to assure an acceptable pattern of treatment planning using both techniques, the TG119 of American Association of Medical Physics instructions were followed and the results of plans were compared to TG119 published data. The next step consisted of using real patients\' images, whose underwent prostate radiotherapy or head and neck radiotherapy, to planning IMRT and VMAT. The dosimetric quality of plans using both techniques was evaluated in terms of target dose conformity and target dose homogeneity The dose constraints for rectum, bladder and femoral head were analyzed and the association between the rectum intersection volume and bladder intersection volume to the target volume were evaluated for the prostate cases. The dose constraints for spinal cord, brainstem and parotids were investigated for the head and neck cases. Best or similar values were obtained for the VMAT plans in relation to IMRT plans. The analysis of treatment time indicated a significant reduction using VMAT, until 67% to the prostate cases and 36% to the head and neck cases

At the BC Cancer Agency (BCCA), Vancouver Island Centre (VIC), the clinical verification of Intensity Modulated Radiation Therapy (IMRT) treatment plans involves comparing Portal Image (PI) -based three-dimensionally reconstructed (EPIDose) dose distributions to planned doses calculated using the Pencil Beam Convolution (PBC) algorithm. Discrepancies surpassing established action levels constitute failure. Since 2007, the failure rate of IMRT verification process had been increasing, reaching as high as 18.5% in 2009. A retrospective evaluation of clinical IMRT verification failures was conducted to identify causes and possible resolutions. Thirty clinical verification failures were identified. An equipment malfunction was discovered and subsequently repaired, and several failures were resolved in the process. Statistical uncertainty in measurement outcome was small in comparison to action levels and not considered significant to the production of failures. Still, over 50% of the redelivered plans were shown to consistently fail. A subgroup of consistent verification plans were compared to ion chamber point dose measurements. Relative to ion chamber measurements, EPIDose underestimated the dose while the dose calculation algorithm (PBC, Eclipse version 8.1.18) overestimated the same point dose. Comparisons of individual fields demonstrated that none were identifiably problematic; dose discrepancies were the result of minor but accumulating dose differences. Consistent verification failures were recalculated using two advanced dose calculation engines (the Anisotropic Analytical Algorithm and Monte Carlo). In general, verification metrics improved, and all failures were resolved. Three distinct indices of fluence modulation (or complexity) were shown to correlate with verification metrics. This indicated that deficiencies in both the leaf motion calculator and the PBC (Eclipse version 8.1.18) had likely contributed to the production of failures. In conclusion, clinical verification failures were resolved retrospectively by replacing faulty equipment and using more advanced methods of planned dose calculation, supporting the efficacy and continued use of PI-based three dimensional dose reconstruction for IMRT verification.

A radioterapia de intensidade modulada (IMRT) é uma das mais modernas técnicas radioterapêuticas que permite a entrega de elevadas e complexas distribuição de doses ao volume tumoral, que necessita de novos métodos para o controle de qualidade dos procedimentos efetuados. Nos serviços de radioterapia costuma-se usar para o controle de qualidade do sistema de planejamento, a câmara de ionização para verificação pontual da dose e um dispositivo com diodos semicondutores (MapCHECK2) para a verificação bidimensional em um plano da fluência planejada, entretanto, para a verificação tridimensional dessas distribuições de doses ainda não há um dosímetro consolidado na rotina clínica. Nesse contexto, para a dosimetria tridimensional se destacam os géis poliméricos. Neste trabalho foram feitas a dosimetria convencional, pontual e bidimensional como se faz na rotina clínica e a dosimetria tridimensional utilizando o gel polimérico Magic-f, que apresenta a distribuição de dose volumétrica. Para este trabalho foi escolhido o tratamento de câncer de próstata, pois na atualidade é um dos tipos de cânceres mais comuns entre os homens. No contexto da dosimetria gel, para se obter a informação volumétrica é necessária uma técnica de imagem, no presente caso foram utilizadas imagens por ressonância magnética (magnetic resonance imaging, MRI). A partir dessas imagens é possível determinar as distribuições de doses processando-as em um software desenvolvido pelo grupo que determina as taxas de relaxação R2 associada à dose absorvida e posteriormente comparar as imagens obtidas com as imagens do sistema de planejamento. Para isso, se obteve dez cortes ao longo de cada simulador físico ou fantom em que sua comparação foi feita com a respectiva fatia do sistema de planejamento, na posição correspondente. Para uma avaliação quantitativa foi utilizado o conceito de índice gama, no critério padrão da radioterapia, 3% da dose e 3mm de distância de concordância. Os resultados obtidos com a dosimetria gel se mostram de acordo com os controles de qualidade convencionais e oferecem uma visão global da distribuição de dose no volume alvo. / The intensity modulated radiotherapy (IMRT) is one of the most modern radiotherapeutic technique that enables the delivery of high and complexes conformational doses to the tumor volume, that requires new methods for the quality assurance of the procedures performed. Radiotherapy services usually perform quality assurance of the planning system with the ionization chamber for spot-checking and an array of semiconductor diodes (MapCHECK2) to check on a two-dimensional plane, however for tridimensional dose verification does not exist an established dosimeter in the clinical routine. In this context, for three-dimensional dosimetry the polymeric gels were used. In This work the conventional one and two-dimensional dosimetry as employed in the clinical routine, and the three-dimensional dosimetry using polymer gel MAGIC- f, which provide the volumetric dose distribution. Prostate cancer clinical cases were chosen for this work because this kind of tumor is one of the most common cases in male individuals. In the context of dosimetry gel to obtain volumetric information an imaging technique is necessary, in this case the magnetic resonance imaging (MRI), was used to measure the dose. From these images it is possible to determine the distributions of doses processing them in a software developed by our research group that determines R2 relaxation rates associated with the absorbed dose and subsequently compare the images obtained with the images of the planning system. For this, ten slices were obtained along each phantom, and comparisons were made with the respective slice of the treatment planning system, in the corresponding position. For a quantitative evaluation of the gamma index , in the standard criterion in radiotherapy, 3 % dose and 3 mm distance to agreement was used. The results obtained shown that gel dosimetry agrees with the conventional quality controls and provide an overview of dose distribution in the target volume.

As técnicas de radioterapia vem sendo constantemente modificadas com a implementação de novas tecnologias visando aumentar a eficiência e diminuir a toxicidade dos tratamentos com radiação ionizante. Esse trabalho visa comparar as técnicas de radioterapia de intensidade modulada (IMRT) e a radioterapia em arco modulada volumetricamente (VMAT) em termos dosimétricos para o alvo e órgãos em risco além de avaliar a diferença do tempo de tratamento utilizando cada técnica. Para assegurar que os planejamentos seguiriam um padrão aceitável para ambas as técnicas, realizou-se primeiramente os planejamentos sugeridos pelo TG 119 da Associação Americana de Física Médica e compatibilidade dos resultados obtidos comparados com os dados da literatura. Tal comparação permitiu prosseguir para uma próxima etapa que consistiu da utilização de imagens de pacientes reais que foram submetidos a tratamentos de próstata e cabeça e pescoço, para a realização dos planejamentos utilizando as técnicas de IMRT e VMAT. A qualidade dosimétrica dos planejamentos utilizando ambas as técnicas foi avaliada em termos de conformidade e homogeneidade da dose no alvo e para os casos de pacientes com câncer de próstata, foram investigados os limites de dose em reto, bexiga e cabeça de fêmur, sendo avaliada a associação entre o volume de intersecção de reto e bexiga com o alvo. Para os   casos de pacientes com câncer de cabeça e pescoço, em termos dos limites de dose em medula, tronco cerebral e parótidas. Os planejamentos nos quais fez se uso da técnica de VMAT apresentaram valores semelhantes aos dos planos de IMRT. A análise dos tempos de tratamento para cada técnica avaliada mostrou que a VMAT reduz significativamente o tempo, até 67% para os casos de pacientes com câncer de próstata e até 36% para os casos de pacientes com câncer de cabeça e pescoço / The goal of this study was to compare the dosimetric aspects of volumetric-modulated arc therapy (VMAT) with those of intensity-modulated radiotherapy (IMRT) and to evaluate the delivery time and monitor unit differences between the two techniques, for applications in prostate and head and neck cancer treatment. First of all, to assure an acceptable pattern of treatment planning using both techniques, the TG119 of American Association of Medical Physics instructions were followed and the results of plans were compared to TG119 published data. The next step consisted of using real patients\' images, whose underwent prostate radiotherapy or head and neck radiotherapy, to planning IMRT and VMAT. The dosimetric quality of plans using both techniques was evaluated in terms of target dose conformity and target dose homogeneity The dose constraints for rectum, bladder and femoral head were analyzed and the association between the rectum intersection volume and bladder intersection volume to the target volume were evaluated for the prostate cases. The dose constraints for spinal cord, brainstem and parotids were investigated for the head and neck cases. Best or similar values were obtained for the VMAT plans in relation to IMRT plans. The analysis of treatment time indicated a significant reduction using VMAT, until 67% to the prostate cases and 36% to the head and neck cases

Depuis quelques années, il y a un intérêt de la communauté en dosimétrie d'actualiser les protocoles de dosimétrie des faisceaux larges tels que le TG-51 (AAPM) et le TRS-398 (IAEA) aux champs non standard qui requièrent un facteur de correction additionnel. Or, ces facteurs de correction sont difficiles à déterminer précisément dans un temps acceptable. Pour les petits champs, ces facteurs augmentent rapidement avec la taille de champ tandis que pour les champs d'IMRT, les incertitudes de positionnement du détecteur rendent une correction cas par cas impraticable. Dans cette étude, un critère théorique basé sur la fonction de réponse dosimétrique des détecteurs est développé pour déterminer dans quelles situations les dosimètres peuvent être utilisés sans correction. Les réponses de quatre chambres à ionisation, d'une chambre liquide, d'un détecteur au diamant, d'une diode, d'un détecteur à l'alanine et d'un détecteur à scintillation sont caractérisées à 6 MV et 25 MV. Plusieurs stratégies sont également suggérées pour diminuer/éliminer les facteurs de correction telles que de rapporter la dose absorbée à un volume et de modifier les matériaux non sensibles du détecteur pour pallier l'effet de densité massique. Une nouvelle méthode de compensation de la densité basée sur une fonction de perturbation est présentée. Finalement, les résultats démontrent que le détecteur à scintillation peut mesurer les champs non standard utilisés en clinique avec une correction inférieure à 1%. / In recent years, the radiation dosimetry community has shown a keen interest in extending broad beam dosimetry protocols such as AAPM's TG-51 and IAEA's TRS-398 to nonstandard fields which involve the use of an additional correction factor. Yet, these correction factors are difficult to determine precisely in a time frame that is acceptable. For small fields, these factors increase rapidly with field size, whereas for composite IMRT fields, detector positioning uncertainties render a case-by-case correction impractical. In this study, a theoretical criterion based on radiation detectors' dose response functions is used to determine in which situations a given dosimeter can be used without correction. The responses of four ionization chambers, a liquid-filled chamber, a diamond detector, an unshieded diode, an alanine dosimeter and a plastic scintillator detector are characterized at 6 MV and 25 MV. Several strategies are also suggested to reduce/eliminate correction factors such as reporting the absorbed dose to a volume and modifying the non-sensitive components of a detector to compensate for mass density effects. A new method of density compensation based on a perturbation function is presented. Finally, results show that the scintillator detector can measure nonstandard fields used in the clinic with corrections under 1%.