In-house quality check of external beam plans using 3D treatment planning systems - a DVH comparison.

This paper presents a new approach towards the quality assurance of external beam plans using in-house-developed DICOM import and export software in a clinical setup. The new approach is different from what is currently used in most clinics, viz., only MU and point dose are verified. The DICOM-RT software generates ASCII files to import/export structure sets, treatment beam data, and dose-volume histo-grams (DVH) from one treatment planning system (TPS) to the other. An efficient and reliable 3D planning system, ROPS, was used for verifying the accuracy of treatment plans and treatment plan parameters. With the use of this new approach, treatment plans planned using Varian Eclipse planning system were exported to ROPS planning system. Important treatment and dosimetrical data, such as the beam setup accuracy, target dose coverage, and dose to critical structures, were also quantitatively verified using DVH comparisons. Two external beam plans with diverse photon energies were selected to test the new approach. The satisfactory results show that the new approach is feasible, easy to use, and can be used as an adjunct test for patient treatment quality check.

Implementing high-dose rate surface mould brachytherapy for carcinoma of eyelid: a practical approach and weekly review.

Surface mould brachytherapy is a conformal radiotherapy technique that can deliver high dose to the target while sparing nearby normal structures, Here, we aim to describe the procedurals details for high-dose rate (HDR) surface mould brachytherapy in sebaceous carcinoma of eyelid in a 54-year old lady. She was hesitant for surgery and any form of invasive intervention like interstitial brachytherapy. So, she was treated with surface mould HDR brachytherapy to a total dose of 52 Gy in 13 fractions at a dose of 4 Gy per fraction delivered twice daily using Iridium-192 isotope with no acute side effects. She was evaluated on a weekly basis for any radiation side effects and now she is disease-free for 6 months post-treatment with only mild dry eye. A detailed step-by-step procedure of surface mould technique, simulation procedure, dose prescription, planning, plan evaluation and treatment has been described in this paper. Surface mould HDR brachytherapy can be safely used as organ preserving modality of treatment for eyelid carcinoma.

Validation of Leaf Design Characteristics of an Add-on Automated Multi Leaf Collimator for Telecobalt Therapy Machine.

BACKGROUND: In developing countries like India, cobalt-60 machines still find their applicability, considering the cost and maintenance issues. With a view to deliver conformal treatment plans using teletherapy machines, an automated Multi-Leaf Collimator (MLC) was developed for the existing machines as a retrofit attachment to the collimator assembly without any modifications to the unit. OBJECTIVE: This study aims to investigate the radiation characteristics of leaf designs incorporated in two add-on prototype MLC systems with respect to the shape of leaf projected at the isocenter plane and the isodose distribution around the target. Besides, the dosimetric characteristics of prototype MLC with divergent leaf design are validated through simulation and experimental measurements. MATERIAL AND METHODS: In this experimental study, two add-on prototype MLC systems were designed and fabricated. The characteristic measurements of leaf designs incorporated in both the prototypes were carried out using Gafchromic films (GAF) and compared with Monte Carlo (MC) simulations. For divergent leaf design, beam profiles were obtained using Monte Carlo simulations which are complemented with the results obtained from measurements of radiochromic films and ionization chamber (IC) profiler. Dosimetric characteristics like radiation field width and beam penumbra were evaluated. RESULTS: The Monte Carlo simulated data are in agreement with experimental data from IC profiler as well as from Radiochromic films. The results of this study are well within acceptable tolerance limits. CONCLUSION: The prototype MLC system designed for existing telecobalt machines supports its clinical applicability for conformal therapy to better manage treatment in rural areas, which can provide superior cost effective treatments.

Efficacy of MLC based cobalt-60 plans: A DVH comparison and analysis with 6 MV plans.

The purpose of this study was to compare 3D treatment plans implemented using 6 MV Linac with a retrofitted multileaf collimator (MLC) based cobalt-60 plans. In this retrospective study, DVH analysis was used to compare homogeneity of dose within the target and the dose received by critical organs. A prototype MLC designed and developed as a retrofit to current cobalt-60 teletherapy machines with a dedicated 3D treatment planning system was used. Cases representing 5 tumor sites like head & neck, glottis, lung, gall bladder, stomach were taken for the study, which were planned using Eclipse treatment planning system and treated with 6 MV photon beams. The plans were re-planned using the retrofit cobalt-60 MLC with same beam arrangement and dose prescription in Radiation Oncology planning system (ROPS). For each case, DVH data was evaluated for both types of beam energies. Conformity index (CI) and homogeneity index (HI) for target were calculated and compared. The conformal plans created using cobalt MLC for five sites were found to be similar to those planned using 6 MV photon beams. CI values close to unity reflected dose uniformity in the target volume while HI evaluated the hotspots in the target volume. It was concluded that plans created using retrofit prototype MLC developed for cobalt-60 teletherapy machines can provide dose distributions comparable to 6 MV photon beams. The prototype MLC developed can provide a promising treatment option for existing telecobalt machines in implementing conformal therapy in developing countries.

Estimation of Skin doses for Retrofit Prototype Multileaf Collimators Designed for Telecobalt Therapy Machine.

AIM: The objective of this study was to evaluate skin dose based on retrofit prototype multileaf collimators (MLCs), designed for cobalt-60 teletherapy machine. Since patient's skin is sensitive to radiation, evaluation of skin dose is of utmost importance for investigating the risk of late effects. MATERIALS AND METHODS: Measurements were performed with a Phoenix cobalt-60 teletherapy machine and the detector used was EBT3 radiochromic film. The experiments were performed in a solid water phantom with two prototype MLCs mounted to the machine. Dose readings were taken by placing the films at source-to-surface distance (SSD) of 60 cm, 65 cm, 70 cm, 75 cm, 80 cm, 85 cm, and 90 cm for various MLC-generated field sizes starting from 2 cm × 2 cm to 14 cm × 14 cm. The films were analyzed using custom made programs. The measured doses were normalized to the dose at dmax for that particular measurement of SSD. RESULTS: The skin dose is expressed as a percentage of dose at dose maximum. In general, the skin dose increases with field size and decreases with SSD. The measurements indicate surface doses within 20%-60% for the investigated SSD range. Furthermore, there is no significant difference between the surface doses of two prototype MLCs studied. CONCLUSIONS: From the measurements, it can be concluded that there is good skin sparing even at close distance to the MLCs. The skin dose is <50% for SSDs >65 cm. A minimum gap of 5 cm is required to produce acceptable skin dose.