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"Telah dilakukan verifikasi dosis organ target dan jaringan sehat di sekitar target dengan menempatkan TLD Rod LiF100 dan film Gafchromic EBT2 di lubang slab bagian pelvis dari phantom Rando Alderson untuk simulasi kanker prostat. TLD dievaluasi menggunakan TLD Reader Harshaw, sementara Film Gafchromic EBT2 dipindai menggunakan scanner Epson Perfection V700 dengan mode transmisi, red channel dan resolusi 72 dpi. Pengukuran dosis titik dilakukan dengan membandingkan antara dosis yang direncanakan TPS Eclipse ver. 11 dan dosis yang diukur pada target organ target dan organ beresiko menggunakan teknik IMRT dan VMAT. Hasilnya adalah deviasi dosis pada organ target menggunakan teknik IMRT dan VMAT adalah kurang dari 5%. Demikian pula, deviasi dosis pada bladder dan rectum untuk kedua teknik juga kurang dari 5% karena posisinya sangat dekat dengan target volume. Di sisi lain, deviasi dosis di femoral head lebih dari 5% untuk kedua teknik karena lokasinya pada gradien dosis rendah. Selanjutnya, deviasi dosis organ target untuk teknik IMRT cenderung lebih kecil dari teknik VMAT baik untuk TLD dan Film. Perbedaan dosis pada dosis titik organ target antara IMRT dan VMAT kurang dari 1% tetapi terjadi pada dosis yang random untuk organ beresiko. Adapun dosis permukaan pada teknik IMRT cenderung lebih kecil dari teknik VMAT jika kita menggunakan TLD, tetapi dosis pada film EBT2 cenderung sama antara teknik IMRT dan VMAT.

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Have been done the dose verification of the target and healthy tissues around by placing the TLD Rod LiF100 and EBT2 Gafchromic film at slab hole of pelvic part of the Alderson Rando phantom for prostate cancer simulation. The Exposed TLDs was evaluated using the TLD Reader Harshaw, while Gafchromic Film EBT2 was scanned using Epson Perfection V700 scanner with transmission mode, red channel and resolution 72 dpi. The point dose measurements were compared between planned dose TPS Eclipse ver. 11 and measured dose at target volume organ and organ at risk for IMRT and VMAT techniques. The result is the dose difference at target volume for IMRT and VMAT are less than 5%. Similarly, the dose difference at Bladder and Rectum for both techniques are also less than 5% due to the position of OAR is very close to target volume. On the other hand, the dose difference at Femoral head are more than 5% for both techniques because the location of OAR already in low gradient dose. Furthermore, the difference dose of the target volume for IMRT technique is tends to be smaller than VMAT either for TLD and film detectors. The dose difference at point dose of target volume between IMRT and VMAT techniqe are less than 1% but it occur in random number for organ at risk. More over, the surface dose of IMRT tend to be smaller than VMAT dose if we are using TLDs, but the dose of EBT2 films tend to be similar between IMRT and VMAT techniques."

"Nilai indeks gamma yang dihasilkan antara satu perencanaan dengan perencanaan lainnya berbeda. Perbedaan ini mungkin dipengaruhi oleh banyak hal seperti detektor yang digunakan, kasus kanker yang berbeda, dll. Akan tetapi, terdapat passing criteria yang direkomendasikan oleh AAPM TG 119, sehingga seharusnya nilai indeks gamma tidak akan bernilai jauh dari passing criteria yang telah direkomendasikan. Oleh karena itu, pada penelitian ini akan dilakukan evaluasi konsistensi verifikasi yang dilakukan di RS MRCCC Siloam Hospital Semanggi dengan cara melihat perbedaan nilai rata-rata indeks gamma setiap tahunnya selama 8 tahun sejak tahun 2011-2018. Uji statistika juga dilakukan untuk menganalisis perbedaan dan pengaruh antara detektor yang berbeda, kasus kanker yang berbeda, serta teknik penyinaran yang berbeda terhadap nilai indeks gamma yang dihasilkan. Peralatan yang digunakan dalam penelitian ini adalah Pesawat LINAC Varian Clinac iX dengan TPS Eclipse versi 8.6-13, detektor 2D array bilik ionisasi MatriXXEvolution, EPID serta software Portal Dosimetry, Omni Pro I'mRT dan SPSS. Secara umum, metode penelitian dibagi menjadi beberapa tahap yaitu : pencatatan data pasien, verifikasi perencanaan, evaluasi indeks gamma, uji statistika dan analisis. Uji statistika yang digunakan merupakan uji Kruskal-Wallis, Mann-Whitney dan Wilcoxon. Uji Kruskal Wallis digunakan untuk melihat perbedaan rata-rata nilai indeks gamma setiap tahunnya. Uji Mann Whitney digunakan untuk melihat perbedaan rata-rata nilai indeks gamma antara kanker otak dan kanker prostat serta melihat perbedaan rata-rata nilai indeks gamma yang dihasilkan antara teknik IMRT dan VMAT. Uji Wilcoxon digunakan untuk melihat perbedaan rata-rata nilai indeks gamma detektor MatriXX dan EPID. Hasil penelitian menunjukkan perbedaan yang signifikan secara statistika pada nilai rata-rata indeks gamma antara dua detektor, dua teknik IMRT dan VMAT, serta antara dua kasus kanker yang berbeda, sedangkan nilai rata-rata indeks gamma per tahun tidak signifikan secara statistika. Secara keseluruhan, nilai rata-rata indeks gamma setiap tahunnya konsisten. Oleh karena itu, disimpulkan bahwa verifikasi yang dilakukan di RS MRCCC Siloam selama 8 tahun konsisten secara statistika.

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The gamma index value generated between one plan and another is normally different. This can be affected by many factors such as the usage of different detectors, different type of cancer cases, etc. However, there is certain passing criteria recommended by AAPM TG 119, thus the gamma index value ideally should not be much far from the recommended passing criteria. Therefore, this study will evaluate the verification consistency conducted at MRCCC Siloam Hospital Semanggi by looking at the difference between the mean value of gamma index every year for 8 years since 2011 2018. Statistical tests were also performed to analyze differences and effects between different detectors, different cancer cases, and different irradiation techniques on the resulting gamma index values. The equipment used in this research was LINAC Varian Clinac iX with TPS Eclipse version 8.6 13, 2D detector MatrixEvolution ionization array, EPID and Dosimetry Portal software, Omni Pro I'mRT and SPSS. In general, the study method is divided into several stages patient data recording, planning verification, gamma index evaluation, statistical test run, and analysis. The statistical test used is Kruskal Wallis, Mann Whitney and Wilcoxon test. The Kruskal Wallis test was used to see the average difference in the gamma index value annually. In addition, Mann Whitney test was used to see the difference in gamma index mean values between brain cancer and prostate cancer and to see the difference in gamma index mean values generated between IMRT and VMAT techniques. Furthermore, Wilcoxon test was used to see the difference in gamma index mean values of MatriXX and EPID detectors. The results showed statistically significant differences on the gamma index mean values between two detectors, two IMRT and VMAT techniques, and between two different cancer cases, while the difference between gamma index mean value per year was not statistically significant. Overall, the average value of the gamma index each year is consistent. Therefore, the verification performed at MRCCC Siloam Hospital for over 8 years is consistent statistically."

"Penelitian ini bertujuan untuk memverifikasi dosis radiasi radioterapi pada kasus kanker payudara dan kanker nasofaring (KNF). Percobaan dilakukan dengan menggunakan Linac Varian Trilogy radiasi foton berenergi 6 MV. Detektor yang digunakan dalam penelitian ini adalah film gafchromic, MatriXX 2D array, TLD, dan EPID. Film gafchromic dan TLD ditempatkan dalam phantom rando untuk mengevaluasi distribusi dosis pada volume target, sedangkan untuk mendapatkan hasil registrasi film gafchromic dan MatriXX 2D array ditempatkan dalam Multi Cube, dan dilakukan juga penyinaran pada EPID. Hasil perbedaan distribusi dosis teknik IMRT dan VMAT antara film dengan dosis preskripsi TPS pada KNF PTV70 adalah 6,87% dan 8,55%, pada KNF PTV50 adalah 14,43% dan 4,65%, sedangkan pada kanker payudara 11,98% dan 12,10%. Perbedaan nilai dosis antara TLD dengan dosis preskripsi TPS teknik IMRT dan VMAT pada KNF PTV50 sebesar 1,76% dan 1,60%, dan pada kanker payudara sebesar 7,06% dan 3,36%. Selisih perbedaan nilai gamma indeks teknik IMRT dan VMAT pada KNF sebesar -0,09% dan -1,65% antara film dan MatriXX, dan 5,13% dan 1,43% antara film dengan EPID. Pada kanker payudara selisih perbedaan nilai gamma indeks teknik IMRT dan VMAT sebesar 0,51% dan 0,19% antara film dengan MatriXX, dan 2,28% dan 4,38% antara film dengan EPID. Verifikasi dosis radioterapi dan registrasi citra pada kasus kanker payudara dan KNF dapat dilakukan menggunakan film gafchromic, TLD, MatriXX 2D array, dan EPID.

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This study was aimed to verify the radiation dose in the case of breast cancer and nasopharyngeal carcinoma (NPC). The experiments were performed using a Varian Trilogy Linac at 6 MV photon radiation and gafchromic films, Matrixx 2D Array, TLD, and EPID detectors. Gafchromic films and TLD were inserted into rando phantom to measures the dose on target volume and organ at risk. In order to evaluated the gamma index, gafchromic films and Matrixx 2D array were placed in the Multi Cube, and was irradiated with EPID in position. Results of the dose distribution differences on IMRT and VMAT between film and TPS on NPC PTV70 was 6.87% and 8.55%, the NPC PTV50 was 14.43% and 4.65%, and for breast cancer was 11,98% and 12,10%. The dose differences between TLD and TPS on IMRT and VMAT for NPC PTV50 was 1.76% and 1.60%, and the breast cancer was 7.06% and 3.36%. Gamma index differences on IMRT and VMAT technique on NPC was -0.09% and -1.65% between film and MatriXX, and 5.13% and 1.43% between films and EPID. In breast cancer the gamma index differences on IMRT and VMAT was 0.51% and 0.19% between films and MatriXX, and 2.28% and 4.38% between films and EPID. Radiotherapy dose verification and image registration for breast cancer and NPC was done using gafchromic film, TLD, MatriXX 2D array, and EPID."

"Dalam perencanaan terapi teknik lanjut telah diimplementasikan algoritma Anisotropic Analytical Algorithm AAA dan Acuros XB pada perencanaan terapi dengan teknik IMRT dan VMAT. Dalam penelitian ini dimaksudkan untuk memverifikasi simulasi perencanaan terapi dan pemberian dosis IMRT dan VMAT pada kasus kanker prostat dan kanker paru. Verifikasi dosis dilakukan dengan meletakkan TLD 100 LiF rod dan film Gafchromic EBT3 pada fantom Rando Alderson. Evaluasi dosis dilakukan dengan membandingkan analisis dosimetri PTV dan organ at risk menggunakan algoritma Anisotropic Analytical Algorithm AAA dan Acuros XB pada teknik IMRT dan VMAT. Dari hasil penelitian PTV pada kanker prostat algoritma Acuros XB memiliki kualitas perencanaan lebih baik dibandingkan Anisotropic Analytical Algorithm AAA sebesar 1. Pola yang sama juga diperoleh organ at risk dengan algoritma terbaik diperoleh Acuros XB dengan penyimpangan rata-rata terbesar pada OAR femoral head sebesar 6. Lebih lanjut PTV pada kanker paru kiri dan kanan memiliki penyimpangan rata-rata lebih kecil pada teknik VMAT. Sementara pada penggunaan algoritma Acuros XB memiliki kualitas perencanaan lebih baik dibandingkan Anisotropic Analytical Algorithm AAA sebesar 0,56 . Pada OAR kasus paru kiri dan kanan tidak terdapat perbedaan yang signifikan dari penggunaan algortima Acuros XB dan Anisotropic Analytical Algorithm AAA dengan rentang deviasi terbesar diperoleh jantung 9.

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In the planning of advanced engineering therapy has been implemented Anisotropic Analytical Algorithm AAA and Acuros XB algorithms on therapy planning with IMRT and VMAT techniques. In this study intended to verify the simulation of therapy planning and dosage of IMRT and VMAT in cases of prostate cancer and lung cancer. Dose verification is done by placing TLD 100 LiF rod and Gafchromic EBT3 film on fantom Rando Alderson. Dose evaluation was done by comparing dosimetry analysis of PTV and organ at risk using Anisotropic Analytical Algorithm AAA and Acuros XB algorithm on IMRT and VMAT techniques. From the results of research PTV on prostate cancer algorithm Acuros XB has better planning quality than Anisotropic Analytical Algorithm AAA of 1. The same pattern is also obtained by the organ at risk with the best algorithm obtained by Acuros XB with the largest mean deviation on femoral head OAR of 6. Furthermore, PTV in left and right lung cancer has a smaller mean deviation in VMAT technique. While the use of Acuros XB algorithm has better planning quality than Anisotropic Analytical Algorithm AAA of 0.56. In the left and right lung OAR cases there was no significant difference from the use of the Acuros XB algorithm and the Anisotropic Analytical Algorithm AAA with the largest deviation range obtained by heart 9."

"Gerak tumor akibat pernapasan pasien merupakan masalah yang signifikan dalam pengobatan radioterapi kanker paru-paru, khususnya teknik radioterapi modern Intensity Modulated Radiotherapy (IMRT) dan Volumetric Modulated Arc Therapy (VMAT). Interaksi gerakan antara gerak target tumor dan MLC (interplay effect) memiliki keterbatasan dalam hal modulasi intensitas radiasi, probabilitasnya hanya sebagian kecil Planning Target Volume (PTV) menerima dosis radiasi sesuai perencanaan dosis Treatment Planning System (TPS) pada waktu tertentu.Penelitian ini melakukan verifikasi dosimetri antara dosis yang direncanakan TPS dan dosis yang diterima volume tumor, akibat adanya interplay effect pada teknik IMRT dan VMAT. Penelitian menggunakan fantom toraks dinamik in-house dengan target tumor bergerak translasi arah superior-inferior dengan variasi amplitudo dan periode gerak tumor sebesar 9,3 mm dan 2,3 sekon, 20 mm dan 3,44 sekon, 30 mm dan 4,22 sekon. Pengukuran dosis titik dengan meletakkan dosimeter TLD-100 LiF:Mg,Ti dan Film Gafchromic EBT2 pada titik tengah target tumor dan organ at risk spinal cord. Penyinaran teknik IMRT menggunakan 7-field dan teknik VMAT menggunakan Rapidarc partial double arc dengan dosis preskripsi (95%) sebesar 200 cGy per fraksi.Hasil penelitian menunjukkan bahwa kehadiran gerak target tumor paru-paru menyebabkan efek dosimetri yang tidak diinginkan berupa underdosage dalam volume tumor. Deviasi dosis rata-rata pada target tumor antara perencanaan dosis TPS dan hasil pengukuran pada teknik IMRT dengan target tumor bergerak statis, bergerak 9,3 mm, bergerak 20 mm, bergerak 30 mm berturut-turut sebesar 0,3% sampai 0,5%, -2,7% sampai -3,0%, -3,7% sampai -4,6%, dan -6,0% sampai -6,6%, sedangkan deviasi dosis pada teknik VMAT berturut-turut sebesar 0,2% sampai 0,9%, -1,6% sampai -1,9%, -2,9% sampai -3,1%, dan -5,0% sampai -5,3%. Hal berbeda, deviasi dosis untuk organ at risk spinal cord pada teknik IMRT berturutturut sebesar -5,6% sampai -1,0%, -6,8% sampai -6,9%, -3,7% sampai -5,9%, dan 0,7% sampai 1,0%, sedangkan deviasi dosis pada teknik VMAT berturut-turut sebesar -1,4% sampai -3,1%, -3,0% sampai -6,3%, -1,6% sampai -4,2%, dan 0,1% sampai 0,9%. Kenaikan amplitudo gerak target tumor menyebabkan dosis yang diterima volume tumor menurun. Namun sebaliknya, adanya kenaikan amplitudo gerak target tumor menyebabkan dosis yang diterima organ at risk spinal cord meningkat.

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Tumor motion due to patient's respiratory is a significant problem in radiotherapy treatment of lung cancer, especially in modern radiotherapy treatment of Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT). The interplay effect is the effect that may occur as the motion of Linac (primarily the MLC) and motion of the tumor target interferes. At delivery dose treatment, a small part of Planning Target Volume (PTV) does not recover dose according to Treatment Planning System (TPS) Prescription.

This investigation was carried out through dosimetry verification between TPS and actual dose by tumor volume due to the interplay effect in IMRT and VMAT treatment. Tumor target of in-house dynamic thorax phantom was designed in linier sinusoidal motion toward superior-inferior direction with amplitude and period variation of tumor motion of 9,3 mm and 2,3s, 20 mm and 3,44s, 30 mm and 4,22s respectively. For point dose measurement, TLD-100 LiF:Mg,Ti and gafchromic EBT2 film detectors were took placed at midpoint of tumor target and spinal cord. IMRT treatment irradiation was applied by 7-fields and VMAT treatment by partial double arc, with prescription dose (95%) of 200 cGy per fraction.

The results showed that the occurrence of lung tumor target motion causes underdosage dosimetry effect in tumor volume. Mean dose deviation of tumor target between TPS and measurement in IMRT treatment by tumor target moves at condition of static, 9,3 mm, 20 mm and 30 mm were 0,3% to 0,5%, -2,7% to -3,0%, -3,7% to -4,6%, and -6,0% to -6,6% respectively while dose deviation in VMAT treatment were 0,2% to 0,9%, -1,6% to -1,9%, -2,9% to -3,1%, and -5,0% to -5,3% respectively. On the other hand, mean dose deviation of spinal cord in IMRT treatment were -5,6% to -1,0%, -6,8% to -6,9%, -3,7% to -5,9%, and 0,7% to 1,0% respectively and in VMAT treatment were -1,4% to -3,1%, -3,0% to -6,3%, -1,6% to -4,2%, and 0,1% to 0,9% respectively. The increment amplitude of tumor target motion reduced dose received by tumor volume and conversely, increased dose received by spinal cord."

"[ABSTRAKFilm gafchromic EBT2 dan EBT3 cocok digunakan untuk jaminan kualitas (QA) pada treatment planning systems (TPS) dan linear accelerator (LINAC) serta verifikasi radioterapi teknik IMRT dan VMAT. Namun generasi selanjutnya dari film gafchromic EBT yaitu EBT2 dan EBT3 ketika dilakukan scanning (pemindaian) menggunakan scanner flatbed masih terdapat artefak geometris yang dahulunya juga ditemukan pada film EBT sehingga memerlukan penanggulangan dan koreksi yang sesuai. Pada penelitian ini menggunakan scanner flatbed Epson expression 10000XL, Epson perfection V700 dan Mikrotek 1000XL plus yang dapat menangkap warna dengan rinci dan presisi. Perangkat lunak yang digunakan dalam koreksi ini adalah FilmQA Pro 2015. Hasil yang diperoleh yaitu Koefisien A dan B diterapkan untuk variasi posisi lateral terhadap nilai tanggapan di lokasi yang bersamaan, sehingga pengkoreksian tanggapan artifak lateral dapat dilakukan. Pada dosis maksimum nilai koreksinya <0,5% dan pada kasus <0.2%. Pada pengukuran ulang untuk setiap film, standar deviasi yang diperoleh untuk setiap film sekitar 0.19%. Pengujian dosimetri channel tunggal (merah) sebelum dan sesudah koreksi pada kasus IMRT didapatkan hampir 91% dari piksel memenuhi 3% / 3mm kriteria gamma keseluruhan dengan ambang batas dosis > 10%. Untuk pengujian kasus VMAT, film di scan dengan posisi di pusat scanner dan posisi ektrim tepi scanner, maka pengukuran di channel warna merah 4% lebih tinggi dibandingkan channel warna hijau dan biru. Rata-rata konsistensi pengukuran dosis selama daerah terkena dosis > 100 cGy adalah sekitar 21,8 cGy dan di daerah yang paling dekat dengan tepi scan window sekitar 10 mm dengan perbedaan dosis 35 cGy. Setelah dilakukan koreksi, rata-rata konsistensi dosis pada tiga channel di sekitar daerah terpapar sekitar 5,1 cGy. Perbedaan dosis antar channel sekitar 9 cGy. Hasil ini menunjukkan koreksi respon artefak lateral memang perlu dilakukan. Respon yang diukur tergantung pada posisi film pada pemindai dan dosis yang diberikan. Pengukuran pada channel warna merah menunjukkan sensitivitas yang lebih besar pada dosis rendah, sedangkan respon pada channel hijau atau biru memberikan perpanjangan jangkauan dinamis dari film ke dosis tinggi. Metode triple-channel dosimetri telah terbukti memiliki keuntungan signifikan atas single channel dosimetry dengan akurasi dosimetri yang baik.

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ABSTRACT

The film of gafchromic EBT2 and EBT3 are appropriate for quality assurance (QA) to the radiotherapy technics verification of IMRT and VMAT. In the next generations of EBT which are EBT2 and EBT3, are still attained the geometrical artifacts once scanning by flatbed scanner which is used to be found on EBT film in order to need an overcome ways and an appropriate correction. This research used a flatbed scanner EPSON expression 10000XL, EPSON perfection V700 and Microtech 1000XL plus and FilmQA Pro 2015 as a software for correcting it. The result shows that coefficient A and B were applied for lateral correction artifacts responses can be made. On the maximum dose, it has correction value as much as <0,5% and in case was <0.2%. The deviation standard was approximately 0,19% on re-measure for each film. Prior to the dosimetry measurement of single channel (red) and subsequent to the correction IMRT has got almost 91% of pixel which met with gamma criteria, 3% / 3mm, with dose threshold 10% TH. In the measurement of VMAT‟s case, film scanned on the center of scanner and the extreme position of the scanner edge. Thus, measurement in the red channel was 4% higher than green and blue channel. The average of dose measurement consistency during area exposed to doses > 100 cGy is approximately 21,8 cGy and the closest area with the edge of scan window is around 10 mm at difference doses 35 cGy. After correction, the average of doses consistency was 5,1 cGy on the three channel where exposed. The distinction of doses was approximately 9 cGy among channels. This result stated that the correction of artifacts lateral response is needed to carry on. The method of triple-channel dosimetry has the significant advantage on single-channel dosimetry with a good consistency. Through escalation dose and variation of lateral position, the distinct response would be increased on single-channel which is red channel. The measurement on red channel reveals the highest sensitivity on the slight dose. Whereas, a green or blue channel response provides a dynamic range extension of film to a high dose. Thus, the method of dosimetry triple-channel has the significant contribution of single-channel evidently with a good dosimetric accuracy., The film of gafchromic EBT2 and EBT3 are appropriate for quality assurance (QA) to the radiotherapy technics verification of IMRT and VMAT. In the next generations of EBT which are EBT2 and EBT3, are still attained the geometrical artifacts once scanning by flatbed scanner which is used to be found on EBT film in order to need an overcome ways and an appropriate correction. This research used a flatbed scanner EPSON expression 10000XL, EPSON perfection V700 and Microtech 1000XL plus and FilmQA Pro 2015 as a software for correcting it. The result shows that coefficient A and B were applied for lateral correction artifacts responses can be made. On the maximum dose, it has correction value as much as <0,5% and in case was <0.2%. The deviation standard was approximately 0,19% on re-measure for each film. Prior to the dosimetry measurement of single channel (red) and subsequent to the correction IMRT has got almost 91% of pixel which met with gamma criteria, 3% / 3mm, with dose threshold 10% TH. In the measurement of VMAT‟s case, film scanned on the center of scanner and the extreme position of the scanner edge. Thus, measurement in the red channel was 4% higher than green and blue channel. The average of dose measurement consistency during area exposed to doses > 100 cGy is approximately 21,8 cGy and the closest area with the edge of scan window is around 10 mm at difference doses 35 cGy. After correction, the average of doses consistency was 5,1 cGy on the three channel where exposed. The distinction of doses was approximately 9 cGy among channels. This result stated that the correction of artifacts lateral response is needed to carry on. The method of triple-channel dosimetry has the significant advantage on single-channel dosimetry with a good consistency. Through escalation dose and variation of lateral position, the distinct response would be increased on single-channel which is red channel. The measurement on red channel reveals the highest sensitivity on the slight dose. Whereas, a green or blue channel response provides a dynamic range extension of film to a high dose. Thus, the method of dosimetry triple-channel has the significant contribution of single-channel evidently with a good dosimetric accuracy.]"