Journal of Medical Physics
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   2013| July-September  | Volume 38 | Issue 3  
    Online since August 12, 2013

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Forward-planned intensity modulated radiation therapy using a cobalt source: A dosimetric study in breast cancer
Savino Cilla, Joseph Kigula-Mugambe, Cinzia Digesł, Gabriella Macchia, Solomon Bogale, Mariangela Massaccesi, David Dawotola, Francesco Deodato, Milly Buwenge, Luciana Caravatta, Angelo Piermattei, Vincenzo Valentini, Alessio G Morganti
July-September 2013, 38(3):125-131
DOI:10.4103/0971-6203.116367  PMID:24049319
This analysis evaluates the feasibility and dosimetric results of a simplified intensity-modulated radiotherapy (IMRT) treatment using a cobalt-therapy unit for post-operative breast cancer. Fourteen patients were included. Three plans per patient were produced by a cobalt-60 source: A standard plan with two wedged tangential beams, a standard tangential plan optimized without the use of wedges and a plan based on the forward-planned "field-in-field" IMRT technique (Co-FinF) where the dose on each of the two tangential beams was split into two different segments and the two segments weight was determined with an iterative process. For comparison purposes, a 6-MV photon standard wedged tangential treatment plan was generated. D mean , D 98% , D 2% , V 95% , V 107%, homogeneity, and conformity indices were chosen as parameters for comparison. Co-FinF technique improved the planning target volume dose homogeneity compared to other cobalt-based techniques and reduced maximum doses (D 2% ) and high-dose volume (V 110% ). Moreover, it showed a better lung and heart dose sparing with respect to the standard approach. The higher dose homogeneity may encourage the adoption of accelerated-hypofractionated treatments also with the cobalt sources. This approach can promote the spread of breast conservative treatment in developing countries.
  1 2,458 148
The role of medical physicists in clinical trials: More than quality assurance
Tomas Kron
July-September 2013, 38(3):111-114
DOI:10.4103/0971-6203.116360  PMID:24049316
  - 1,655 121
Improvement of dose distribution with irregular surface compensator in whole breast radiotherapy
Fujita Hideki, Kuwahata Nao, Hattori Hiroyuki, Kinoshita Hiroshi, Fukuda Haruyuki
July-September 2013, 38(3):115-119
DOI:10.4103/0971-6203.116361  PMID:24049317
Aim of this study was to compare the dosimetric aspects of whole breast radiotherapy (WBRT) between an irregular surface compensator (ISC) and a conventional tangential field technique using physical wedges. Treatment plans were produced for 20 patients. The Eclipse treatment planning system (Varian Medical Systems) was used for the dose calculation: For the physical wedge technique, the wedge angle was selected to provide the best dose homogeneity; for the ISC technique, the fluence editor application was used to extend the optimal fluence. These two treatment plans were compared in terms of doses in the planning target volume, the dose homogeneity index, the maximum dose, ipsilateral lung and heart doses for left breast irradiation, and the monitor unit counts required for treatment. Compared with the physical wedge technique, the ISC technique significantly reduced the dose homogeneity index, the maximum dose, the volumes received at 105% of the prescription dose, as well as reducing both the ipsilateral lung and heart doses (P < 0.01 for all comparisons). However, the monitor unit counts were not significantly different between the techniques (P > 0.05). Thus, the ISC technique for WBRT enables significantly better dose distribution in the planning target volume.
  - 3,765 168
Comparative analysis between 5 mm and 7.5 mm collimators in CyberKnife radiosurgery for trigeminal neuralgia
H Sudahar, P.G.G. Kurup, V Murali, J Velmurugan
July-September 2013, 38(3):120-124
DOI:10.4103/0971-6203.116364  PMID:24049318
Trigeminal neuralgia (TN) is treated in CyberKnife (Accuray Inc, Sunnyvale, USA) with the 5 mm collimator whose dosimetric inaccuracy is higher than the other available collimators. The 7.5 mm collimator which is having less dosimetric uncertainty can be an alternative for 5 mm collimator provided the dose distribution with 7.5 mm collimator is acceptable. Aim of this study is to analyze the role of 7.5 mm collimator in CyberKnife treatment plans of TN. The treatment plans with 5 mm collimators were re-optimized with 7.5 mm collimator and a bi-collimator system (5 mm and 7.5 mm). The treatment plans were compared for target coverage, brainstem doses, and the dose to normal tissues. The target and brainstem doses were comparable. However, the conformity indices were 2.31 ± 0.52, 2.40 ± 0.87 and 2.82 ± 0.51 for 5 mm, bi-collimator (5mm and 7.5 mm), 7.5 mm collimator plans respectively. This shows the level of dose spillage in 7.5 mm collimator plans. The 6 Gy dose volumes in 7.5 mm plans were 1.53 and 1.34 times higher than the 5 mm plan and the bi-collimator plans respectively. The treatment time parameters were lesser for 7.5 mm collimators. Since, the normal tissue dose is pretty high in 7.5 mm collimator plans, the use of it in TN plans can be ruled out though the treatment time is lesser for these 7.5 mm collimator plans.
  - 1,963 107
A study on rectal dose measurement in phantom and in vivo using Gafchromic EBT3 film in IMRT and CyberKnife treatments of carcinoma of prostate
K Ganapathy, P.G.G. Kurup, V Murali, M Muthukumaran, S Balaji Subramanian, J Velmurugan
July-September 2013, 38(3):132-138
DOI:10.4103/0971-6203.116372  PMID:24049320
The objective of this study is to check the feasibility of in vivo rectal dose measurement in intensity-modulated radiotherapy (IMRT) and CyberKnife treatments for carcinoma prostate. An in-house pelvis phantom made with bee's wax was used in this study. Two cylindrical bone equivalent materials were used to simulate the femur. Target and other critical structures associated with carcinoma prostate were delineated on the treatment planning images by the radiation oncologist. IMRT treatment plan was generated in Oncentra Master Plan treatment planning system and CyberKnife treatment plan was generated in Multiplan treatment planning system. Dose measurements were carried out in phantom and in patient using Gafchromic EBT3 films. RIT software was used to analyze the dose measured by EBT3 films. The measured doses using EBT3 films were compared with the TPS-calculated dose along the anterior rectal wall at multiple points. From the in-phantom measurements, it is observed that the difference between calculated and measured dose was mostly within 5%, except for a few measurement points. The difference between calculated and measured dose in the in-patient measurements was higher than 5% in regions which were away from the target. Gafchromic EBT3 film is a suitable detector for in vivo rectal dose measurements as it offers the possibility of analyzing the dose at multiple points. In addition, the method of extending this in vivo rectal dose measurement technique as a tool for patient-specific quality assurance check is also analyzed.
  - 2,097 134
Investigation on the effect of sharp phantom edges on point dose measurement during patient-specific dosimetry with Rapid Arc
RA Kinhikar, VP Pandey, Rojas K Jose, U Mahantshetty, DS Dhote, DD Deshpande, SK Shrivastava
July-September 2013, 38(3):139-142
DOI:10.4103/0971-6203.116373  PMID:24049321
The objective of this work was to investigate and quantify the effect of sharp edges of the phantom on the point dose measurement during patient-specific dosimetry with Rapid Arc (RA). Ten patients with carcinoma of prostate were randomly selected for this dosimetric study. Rapid Arc plans were generated with 6 MV X-rays in the Eclipse (v 8.6.14) with single arc (clockwise). Dosimetry verification plans were generated for two phantoms (cylindrical and rectangular). The cylindrical phantom was solid water (diameter 34 cm) and the rectangular phantom was a water phantom (25 cm × 25 cm × 10 cm). These phantoms were pre-scanned in computed tomography (CT) machine with cylindrical ionization chamber (FC65) in place. The plans were delivered with Novalis Tx linear accelerator with 6 MV X-rays for both the phantoms separately. The measured dose was compared with the planned dose for both the phantoms. Mean percentage deviation between measured and planned doses was found to be 4.19 (SD 0.82) and 3.63 (SD 0.89) for cylindrical and rectangular phantoms, respectively. No significant dosimetric variation was found due to the geometry (sharp edges) of the phantom. The sharp edges of the phantom do not perturb the patient specific Rapid Arc dosimetry significantly.
  - 1,401 120
Commissioning and quality assurance of Calypso four-dimensional target localization system in linear accelerator facility
KR Muralidhar, Krishna Komanduri, Birendra Kumar Rout, K.K.D. Ramesh
July-September 2013, 38(3):143-147
DOI:10.4103/0971-6203.116376  PMID:24049322
Four dimensional (4D) target localization system (Calypso System) was installed at our hospital, which is equipped with Beacon Transponders, Console, Electromagnetic Array, Optical System, Tracking Station, Treatment table overlay, and Calypso kVue Couch top. The objective of this presentation is to describe the results of commissioning measurements carried out on the Calypso System to verify the manufacturer specifications and also to evolve a quality assurance (QA) procedure which can be used to test its performance routinely. The QA program consists of a series of tests (QA for checking the calibration or system accuracy, Camera Calibration with L-frame fixture, Camera Calibration with T-frame fixture, System calibration Fixture targets test, Localization, and Tracking). These tests were found to be useful to assess the performance of the Calypso System.
  - 1,972 95
Role of step size and max dwell time in anatomy based inverse optimization for prostate implants
Arjunan Manikandan, Biplab Sarkar, Vivek Thirupathur Rajendran, Paul R King, N.V. Madhusudhana Sresty, Ragavendra Holla, Sachin Kotur, Sujatha Nadendla
July-September 2013, 38(3):148-154
In high dose rate (HDR) brachytherapy, the source dwell times and dwell positions are vital parameters in achieving a desirable implant dose distribution. Inverse treatment planning requires an optimal choice of these parameters to achieve the desired target coverage with the lowest achievable dose to the organs at risk (OAR). This study was designed to evaluate the optimum source step size and maximum source dwell time for prostate brachytherapy implants using an Ir-192 source. In total, one hundred inverse treatment plans were generated for the four patients included in this study. Twenty-five treatment plans were created for each patient by varying the step size and maximum source dwell time during anatomy-based, inverse-planned optimization. Other relevant treatment planning parameters were kept constant, including the dose constraints and source dwell positions. Each plan was evaluated for target coverage, urethral and rectal dose sparing, treatment time, relative target dose homogeneity, and nonuniformity ratio. The plans with 0.5 cm step size were seen to have clinically acceptable tumor coverage, minimal normal structure doses, and minimum treatment time as compared with the other step sizes. The target coverage for this step size is 87% of the prescription dose, while the urethral and maximum rectal doses were 107.3 and 68.7%, respectively. No appreciable difference in plan quality was observed with variation in maximum source dwell time. The step size plays a significant role in plan optimization for prostate implants. Our study supports use of a 0.5 cm step size for prostate implants.
  - 1,631 78
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