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"[ABSTRAKTujuan dari penelitian ini adalah mengevaluasi akurasi perencanaan danpemberian perlakuan volumetric modulated arc therapy (VMAT) menggunakanrekomendasi AAPM Task Group (TG) 119 di Departemen Radioterapi MRCCCSiloam Hospitals Semanggi. TG 119 menetapkan dua tes pendahuluan dan limates menyerupai kondisi klinis, serta confidence limit (CL) sebagai nilai standarpengujian. Perencanaan intensity modulated radiation therapy (IMRT) danVMAT dibuat lokal mengikuti preskripsi dosis dan sasaran perencanaan yangditetapkan oleh TG 119, kemudian hasil perencanaan lokal dibandingkan denganhasil TG 119. Pengukuran dosis titik dari pemberian perlakuan IMRT dan VMATpada daerah dosis tinggi dan rendah diukur menggunakan tiga bilik ionisasidengan volume aktif yang berbeda, sedangkan pengukuran dosis penampangmenggunakan detektor 2D array, distribusi dosis penampang dianalisa dengankriteria indeks gamma 3 %, 3 mm dan 2 %, 2 mm. CL hasil pengukuran dosis titikIMRT pada daerah dosis tinggi dan rendah 1.06 % dan 0.82 % (CC01), 1.19 %dan 1.58 % (CC13), 1.37 % dan 3.02 % (FC65G). Untuk VMAT 1.47 % dan 1.17% (CC01), 1.71 % dan 1.95 % (CC13), 2.08 % dan 3.96 % (FC65G). Hasilpengukuran menggunakan bilik ionisasi CC01 dan CC13 mampu memenuhikriteria yang ditetapkan TG 119 dibawah 3 %, sedangkan bilik ioisasi FC65Gtidak memenuhi kriteria tersebut. Hasil CL analisa indeks gamma IMRT dengankriteria gamma 3 %, 3 mm dan 2 %, 2mm sebesar 3.68 dan 11.71 (96.32 % dan88.29 % pass), sedangkan untuk VMAT sebesar 1.44 dan 6.33 (98.56 % dan93.67 % pass), kedua hasil indeks gamma tersebut masuk dalam kriteria TG 119dibawah 12.4. Berdasarkan hasil tersebut, rekomendasi TG 119 dapatdiimplementasikan untuk menguji akurasi perencanaan dan pemberian perlakuanVMAT, hasil tersebut juga menunjukkan keakurasian yang cukup dariperencanaan dan pemberian perlakuan VMAT di institusi lokal.

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ABSTRACTThe purpose of this study was to evaluate the accuracy of treatment planning anddelivery of Volumetric Modulated Arc Therapy (VMAT) using recommendationof AAPM Task Group (TG) 119 in the Department of Radiotherapy MRCCCSiloam Hospitals Semanggi. TG 119 establishes two preliminary tests and fivetests resemble a clinical condition, as well as the confidence limit (CL) as abenchmark data. Dose prescriptions and planning objectives recommended by TG119 report were followed to generate Intensity Modulated Radiation Therapy(IMRT) and VMAT treatment planning, and then the local planning resultscompared with the results of TG 119. Point dose measurements were done usingthree ionization chambers with different active volume at high dose and low doseregions. The planar dose measurements were measured using a 2D detector arrayand the planar dose distribution was analyzed for percentage of points passing thegamma criteria of 3 %, 3 mm and 2 %, 2 mm. For IMRT plans, the CLs obtainedfor point dose measurement in areas of high and low doses were 1.06 % and 0.82% (CC01), 1.19 % and 1.58 % (CC13), 1.37 and 3.02 % (FC65G), whereas avalue of 1.47 and 1.17 % (CC01), 1.71 % and 1.95 % (CC13), 2.08 % and 3.96 %(FC65G) for CL VMAT. Point dose measurement results using ion chamberCC01 and CC13 were able to meet the criteria set by TG 119 below 3 %, whilefor ion chamber FC65G could not meet these criteria. From gamma analysis, CLIMRT for gamma criteria 3 %, 3 mm and 2 %, 2 mm were 3.68 and 11.71 (96.32% and 88.29 % pass), while for VMAT were 1.44 and 6.33 (98.56 % and 93.67 %pass), gamma index results falls within the criteria TG 119 under 12.4. Based onthe results, TG 119 recommendations can be implemented on commissioningVMAT treatment planning and delivery, these results also indicate adequateaccuracy of VMAT treatment planning and delivery in local institution, The purpose of this study was to evaluate the accuracy of treatment planning anddelivery of Volumetric Modulated Arc Therapy (VMAT) using recommendationof AAPM Task Group (TG) 119 in the Department of Radiotherapy MRCCCSiloam Hospitals Semanggi. TG 119 establishes two preliminary tests and fivetests resemble a clinical condition, as well as the confidence limit (CL) as abenchmark data. Dose prescriptions and planning objectives recommended by TG119 report were followed to generate Intensity Modulated Radiation Therapy(IMRT) and VMAT treatment planning, and then the local planning resultscompared with the results of TG 119. Point dose measurements were done usingthree ionization chambers with different active volume at high dose and low doseregions. The planar dose measurements were measured using a 2D detector arrayand the planar dose distribution was analyzed for percentage of points passing thegamma criteria of 3 %, 3 mm and 2 %, 2 mm. For IMRT plans, the CLs obtainedfor point dose measurement in areas of high and low doses were 1.06 % and 0.82% (CC01), 1.19 % and 1.58 % (CC13), 1.37 and 3.02 % (FC65G), whereas avalue of 1.47 and 1.17 % (CC01), 1.71 % and 1.95 % (CC13), 2.08 % and 3.96 %(FC65G) for CL VMAT. Point dose measurement results using ion chamberCC01 and CC13 were able to meet the criteria set by TG 119 below 3 %, whilefor ion chamber FC65G could not meet these criteria. From gamma analysis, CLIMRT for gamma criteria 3 %, 3 mm and 2 %, 2 mm were 3.68 and 11.71 (96.32% and 88.29 % pass), while for VMAT were 1.44 and 6.33 (98.56 % and 93.67 %pass), gamma index results falls within the criteria TG 119 under 12.4. Based onthe results, TG 119 recommendations can be implemented on commissioningVMAT treatment planning and delivery, these results also indicate adequateaccuracy of VMAT treatment planning and delivery in local institution]"

"Latar Belakang: Radiasi eksterna seringkali digunakan untuk mengurangi gejala dari metastasis otak. Teknik radiasi paliatif Whole Brain masih merupakan terapi standar bagi pasien kanker dengan metastasis otak, namun teknik radiasi ini dapat menyebabkan penurunan fungsi neurokognitif yang diakibatkan oleh inflamasi akibat radiasi pada daerah hipokampus. Hal ini memicu penggunaan Hippocampal Sparing Whole Brain Radiotherapy (HS-WBRT) untuk mengurangi efek samping penurunan neurokogntif yang terkait hipokampus. Thesis ini membahas perbandingan dosimetri teknik radiasi Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), dan Helical Tomotherapy (HT) pada Hippocampal Sparing Whole Brain Radiotherapy (HS-WBRT) untuk menilai apakah ada perbedaan parameter dosimetri dari ketiga teknik radiasi tersebut. Penelitian ini merupakan studi eksperimental eksploratif dengan melakukan intervensi pada data CT-plan pasien metastasis otak secara in silico. Parameter dosimetri yang dinilai adalah Conformity Index, Homogenity Index, Treatment Time, D98% PTV, D2% PTV, D50% PTV, D100% Hipokampus, dan Dmax Hipokampus. Hasil penelitian ini menunjukkan adanya perbedaan yang signifikan secara statistik dalam parameter Homogenity Index, D98% PTV, D2% PTV, dan D50% PTV pada semua kelompok data teknik radiasi, dimana Helical Tomotherapy (HT) memiliki nilai rerata yang paling baik dibandingkan kedua teknik radiasi lainnya. Untuk parameter yang lainnya baik Intensity Modulated Radiotherapy (IMRT) maupun Volumetric Modulated Arc Therapy (VMAT) memiliki nilai rerata yang tidak berbeda bermakna, kedua teknik radiasi tersebut masih memungkinkan sebagai tehnik pilihan dalam HSWBRT. Masih diperlukan penelitian lebih lanjut dengan jumlah sampel yang lebih besar guna menilai dengan baik teknik radiasi mana yang paling unggul untuk digunakan dalam perencanaan HS-WBRT serta menghasilkan perencanaan radiasi yang lebih baik.

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Background: Radiation therapy is still a standard treatment in brain metastases cases. Whole brain radiation therapy is widely used to reduce debilitating symptoms, on the other hand this treatment could decrease neurocognitif function due to radiationinduced inflammation of the hippocampus. This is the ground reason to apply Hippocampal Sparing Whole Brain Radiotherapy (HS-WBRT), in order to reduce hippocamus related side effects. The focus in this study is to analyze dosimetric parameter between Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc Therapy (VMAT), and Helical Tomotherapy (HT) in Hippocampal Sparing Whole Brain Radiotherapy (HS-WBRT) to asses any differences in dosimetric values. This study is an experimental study on CT and delivered treatment planing data, recalculated in silico as a hippocampal sparing treatment planning to be compared. The dosimetric parameter that were used in this study are Conformity Index, Homogenity Index, Treatment Time, D98% PTV, D2% PTV, D50% PTV, D100% Hippocampus, dan Dmax Hippocampus. The dosimetric comparisons between the three modalities resulted in statistically significant differences in Homogenity Index, D98% PTV, D2% PTV, D50% PTV, D100% where Helical Tomotherapy (HT) has a better mean value among the rest of the group. In other dosimetric comparisons, Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) does not have any significant differences, as such both modalities allows for sparing of the hippocampus with acceptable means value in many dosimetric parameters. Further research is nedeed, particularly with larger sample to assess superiority in HS-WBRT modalities, as such to increase efficacy in its treatment planning."

"ABSTRAKPenelitian yang telah dilakukan ini bertujuan untuk mengevaluasi dan menganalisis kesesuaian dosis teknik IMRT dan VMAT antara distribusi dosis pada TPS dengan distribusi dosis yang terukur oleh dosimeter film gafchromic EBT2, MatriXXEvolution dan EPID pada kasus kanker KNF, paru dan prostat. Percobaan dilakukan menggunakan Pesawat Linac Varian Rapid Arc dengan TPS Eclips yang dimiliki oleh Rumah Sakit MRCCC SHS. Pengolahan data dari ketiga dosimeter tersebut menggunakan software MATLAB, Omni Pro IMRT dan portal dosimetry. Untuk perbandingan dilakukan analisis data sekunder yang telah dilakukan oleh pihak RS MRCCC SHS. Hasil penelitian menunjukkan indeks gamma rata-rata data sekunder pasien masih dalam toleransi dengan nilai >90%. Hasil pengukuran menggunakan film EBT2, MatriXXEvolution dan EPID dengan kriteria gamma 3% / 3mm pada kasus kanker KNF, paru dan prostat menunjukan bahwa indeks gamma yang diperoleh melewati batas toleransi yang diizinkan yaitu lebih dari 90%. Selisih indeks gamma antara dosimetri film gafchromic, MatriXXEvolution dan EPID pada teknik VMAT dan IMRT tidak terlalu jauh, dengan rentang 0,01 – 5,36%. Perbedaan indeks gamma menunjukkan bahwa direkomendasikan pengukuran menggunakan detektor MatriXXEvolution daripada menggunakan film dosimetri EBT2 dan EPID. Selisih persentase rata-rata indek gamma pada teknik IMRT dan VMAT berada pada rentang 0,02 – 5,31%. Selisih antara hasil pengukuran dan data sekunder menggunakan MatriXXEvolution dengan hasil penelitian Miura et al. diperoleh dengan rentang 0 – 6%. Data penelitian ini sangat mendukung penelitian yang telah dilakukan sebelumnya oleh Hussein et al., (2013), Nalbant et al., (2014), Elawady et al, (2014), Pham (2013), Miura et al., (2014).

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ABSTRACTThe purpose of this research was to evaluate and analyze the compatibility dose IMRT and VMAT technique between the dose distribution in the TPS and the dose distributions which measured by the film dosimeter gafchromic EBT2, MatriXXEvolution and EPID in the case of KNF cancer, lung and prostat. The experiments were done by using Varian linac Plane Rapid Arc with TPS Eclips owned by the MRCCC Siloam Hospital Semanggi. The data processed of the three dosimeters were using MATLAB software, Omni Pro IMRT and Dosimetry portal. For the comparative analysis of secondary data has been made by MRCCC SHS. The results showed an average gamma index of secondary data patients within tolerances with values > 90%. The measurement results EBT2 film, MatriXXEvolution and EPID of using criteria gamma 3% / 3mm in the case of NPC cancer, lung and prostate indicates that the gamma index gained over the limit allowed tolerance of more than 90%. Gamma index difference between the film dosimetry gafchromic, MatriXXEvolution and EPID on VMAT and IMRT techniques are not too far away, with a range of 0.01 to 5.36%. Differences show that the gamma index measurement using a MatriXXEvolution better than using EBT dosimetry film 2 and EPID. The difference in the average percentage of gamma index on IMRT and VMAT technique to be in the range of 0.02 to 5.31%. The difference between the measurement results and secondary data using MatriXXEvolution and the results Miura et al. Measurement in the range of 0-6%. Data from this study strongly support previous research by Hussein et al., (2013), Nalbant et al., (2014), Elawady et al, (2014), Pham (2013), Miura et al., (2014)"

"ABSTRAKTujuan dari penelitian ini adalah untuk membuat dasar perencanaan teknik 3D-CRT dan IMRT lapangan kecil berdasarkan acuan AAPM TG-119. Pada penelitian ini dilakukan perencanaan teknik 3D-CRT dan IMRT di fantom homogen dan inhomogen pada dua geometri target berbeda. Perencanaan pada geometri target C-shape dan circular dilakukan dengan 7 arah berkas MLC statik untuk teknik 3D-CRT, dan dMLC untuk teknik IMRT pada dua kedalaman berbeda yaitu 5 g/cm² dan 10 g/cm². Optimisasi dan kalkulasi dosis menggunakan TPS Pinnacle³ untuk berkas foton 6MV. Parameter perencanaan digunakan acuan AAPM TG-119 dengan membandingkan indeks konformalitas (CI), homogenitas (HI), dan capaian dosis. Pengukuran dilakukan dengan menggunakan PTW Semiflex 0.125 cc, Exradin A16, dan Film Gafchromic EBT3. Hasil penelitian menunjukan CI untuk geometri target C-shape berkisar antara 0.710-0.999 pada kedalaman 10 g/cm² dan 0.691-1.613 pada kedalaman 5 g/cm². Sedangkan untuk geometri circular CI berkisar antara 0.334-1.122 dan 0.729-1.165 masing-masing untuk kedalaman 10 g/cm² dan 5 g/cm². Nilai HI untuk target C-shape dan circular berkisar 6.3%-58.7% dan 5.4%-87.1% untuk kedalaman 10 g/cm² serta 7.0%-80.4% dan 5.9-67.5% untuk kedalaman 5 g/cm². Hasil menunjukan sebagian besar pengukuran dosis mengalami penurunan dibandingkan nilai dosis perhitungan TPS. Penurunan tersebut semakin besar dampaknya pada medium inhomogen dibandingkan pada pengukuran di medium homogen

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ABSTRACTThe purpose of this study was to create benchmark plan for smallfield IMRT based on AAPM TG-119. In this study we created 3D-CRT and IMRT treatment plans for homogen and inhomogeneous medium for two geometrical targets. C-shape and circular target were simulated using 7 static MLC for 3D-CRT and 7 static dMLC IMRT field at two different depths, 5 g/cm² and 10 g/cm². Dose optimization and calculation were done using Pinnacle³ treatment planning system for 6 MV photons beam. Planning objectives were set according to the AAPM TG-119 goals and compared conformity index (CI), homogeneity index (HI) and also dose goals. The measurement were done with PTW Semiflex 0.125 cc, Exradin A16, and Gafchromic EBT3. The results shows, the conformity index for C-shape target was in range of 0.710-0.999 at 10 g/cm² depth and 0.691-1.613 at 5 g/cm² whereas CI for circular target was in range 0.334-1.122 and 0.729-1.165 for 10 and 5 g/cm² depths respectly. In addition, the homogeneity index for C-shape and circular were in the range of 6.3%-58.7% and 5.4%-87.1% for 10 g/cm² depth whereas it was found at 7.0%-80.4% and 5.9-67.5% for 5 g/cm². The results showed that the most of measured dose are underestimate dose-compared to the dose plan. Moreover, the measurement dose at inhomogeneous medium is much lower difference compared to planning dose."

"This paper describes how supplier evaluation used multi criteria and Confidence Interval Approach at Flavor Company in order to purchase cardboard material supplier. The result of design supplier evaluation six criterion that is seen significant to evaluate supplier by PT MW such: Quality, Delivery, Responsiveness, Flexibility, Relationship, and Cost. The scoring is filled up by the active participant and it is proceed using confidence interval approach method, which is involved purchasing, PPIC, QC, and Packing (warehouse) department. Generally, the best performance supplier are KS and STG. The result of this supplier evaluation can be used as consideration in deciding the order space policies in the supplier for the next period."

"Peningkatan keakuratan dan kepresisian dalam pengobatan radioterapi dapat dilakukan menggunakan teknologi lanjut radioterapi seperti Volumetric Modulation Arc Therapy (VMAT). Pemanfaatan teknik VMAT terhadap pemilihan orientasi gantri arc yang bersamaan dengan pergerakan multileaf collimator (MLC) perlu dilakukan verifikasi untuk memastikan ketepatan distribusi dosis pada saat perencanaan dan pengukuran. Tujuan dari penelitian ini adalah mengevaluasi dosis radioterapi teknik VMAT partial arc dan full arc berdasarkan struktur target yang disediakan oleh protokol AAPM TG 119 dan diverifikasi menggunakan protokol AAPM TG 218. Phantom dipindai menggunakan CT Simulator, hasil pemindaian dikirim ke Treatment Planning System (TPS) untuk dilakukan perencanaan teknik VMAT dengan variasi gantri arc. Penyinaran pada saat pengukuran dilakukan dengan metode true composite, dengan pengukuran dosis titik menggunakan bilik ionisasi CC13, pengukuran dosis planar field by field menggunakan EPID dan dosis planar composite menggunakan detektor 2D array MatriXXFFF. Kriteria gamma index yang digunakan 3%/2mm dan 2%/2mm. Hasil perencanaan teknik double arc menghasilkan distribusi dosis lebih baik dibandingkan dengan single arc, karena terjadi peningkatan modulasi selama optimasi. Hasil data pengukuran dosis titik lebih tinggi dibandingkan nilai perencanaan di TPS, hal ini karena adanya kebocoran efek tongue and groove pada saat pengukuran. Tingkat kelulusan gamma secara field by field mampu memenuhi kriteri 3%/2mm, namun tidak untuk penyinaran secara composite. Kemudian terjadi penurunan tingkat kelulusan gamma pada kriteria 2%/2mm. Confidence limit yang diperoleh secara universal tidak memenuhi kriteria yang diberikan artinya dosis perencanaan dengan dosis hasil pengukuran tidak konsisten seperti yang direkomendasikan oleh AAPM TG 119 dan AAPM TG 218. Evaluasi dosis VMAT dengan variasi gantri arc secara true composite pada penelitian ini menunjukkan bahwa terdapat metode pengukuran yang tidak sesuai dengan alat ukur yang digunakan dan kriteria gamma index yang terlalu ketat, sehingga diperlukan penggunaan alat ukur yang tepat dan parameter verifikasi yang sesuai.

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Advanced technology, such as Volumetric Modulation Arc Therapy (VMAT), can enhance the precision and accuracy of radiotherapy treatment. However, the reliability of the dose distribution during planning and measurement, the VMAT technique's gantry arc orientation selection, and multileaf collimator (MLC) movement need to be verified. This study aims to evaluate partial arc and full arc VMAT radiotherapy doses, utilizing the target structure provided by the American Association of Physicists in Medicine (AAPM) TG 119 protocol and verified using the AAPM TG 218 protocol. A CT Simulator scanned the phantom, and the scan results were integrated into the Treatment Planning System (TPS) for VMAT technique planning with varied gantry arc settings. During irradiation and measurement, the true composite method was employed, with point dose measurements using a CC13 ionization chamber, field-by-field planar dose measurements using EPID, and planar composite doses using a 2D array detector MatriXXFFF. The gamma index criteria employed were 3%/2mm and 2%/2mm. The results indicated that planning a double arc technique yielded superior dose distribution compared to a single arc, owing to increased modulation during optimization. Nevertheless, point dose measurement data exceeded the TPS planning values due to the leakage of the tongue and groove effect during measurement. While the field-by-field gamma pass rate met the 3%/2mm criteria, it did not suffice for composite irradiation. Furthermore, there was a further decrease in the gamma pass rate for the 2%/2mm criterion. The universally obtained confidence limit failed to meet the criteria, revealing inconsistencies between the planning dose and the dose measurement results, as recommended by AAPM TG 119 and AAPM TG 218. The evaluation of VMAT doses with gantry arc variations using true composite demonstrated that certain measurement methods did not align with the chosen measuring instrument, and the gamma index criteria proved excessively stringent. Therefore, using appropriate measuring instruments and verification parameters is crucial."

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Salah satu kekurangan teknik Intensity Modulated Radiation Therapy (IMRT) adalah dosis serap di jaringan sehat yang cukup tinggi. Berkas proton memiliki karakteristik yang mampu mengkompensasi kekurangan tersebut. Karakteristik bragg peak yang dimiliki berkas proton memungkinkan dosis tinggi hanya pada target. Kasus Non-Small Cell Lung Cancer (NSCLC) terletak di sekitar banyak organ vital, sehingga deposisi dosis yang melebihi batas akan berdampak signifikan. Proton juga merupakan partikel bermassa yang menunjukkan pola interaksi dengan heterogenitas jaringan yang berbeda dengan foton. Penelitian ini bertujuan untuk mengetahui distribusi dosis perencanaan berkas proton pada kasus NSCLC dengan teknik IMPT serta membandingkan efektivitasnya dengan teknik IMRT. Perencanaan dilakukan menggunakan TPS Eclipse pada fantom air dan citra fantom in-house thorax dynamic. Perencanaan pada fantom air menggunakan 1 lapangan pada 0^o dan 3 lapangan pada 45^o, 135^o, dan 225^o. Perencanaan pada fantom in-house thorax dynamic dilakukan menggunakan single field, sum-field, dan multiple field. Nilai Conformity Index (CI) dan Homogeneity Index (HI) antara perencanaan IMPT dan IMRT tidak menunjukkan perbedaan yang signifikan. Gradient Index (GI) perencanaan IMPT berkisar antara 4,15-4,53, sedangkan nilai GI perencanan IMRT sebesar 7,89. Terdapat perbedaan yang cukup signifikan antara keduanya. Histogram distribusi dosis planar menunjukkan bahwa hasil perencanaan IMPT memberikan dosis rendah di luar target lebih sedikit dibandingkan hasil perencanaan IMRT. Selain itu dilakukan juga pengukuran dosis hasil perencanaan IMPT pada lima posisi target, serta empat posisi OAR. Hasilnya dibandingkan dengan data pengukuran IMRT. Nilai dosis titik pada target tidak berbeda secara signifikan, namun nilai dosis empat posisi OAR adalah nol, yang menunjukkan reduksi signifikan dibandingkan teknik IMRT.

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One deficiency of the Intensity Modulated Radiation Therapy (IMRT) technique is that the absorbed dose in healthy tissue is quite high. Proton beams has characteristics that can compensate for these deficiencies. The bragg peak characteristic of a proton beam allows high doses only to the target. Non-Small Cell Lung Cancer (NSCLC) cases are located around many vital organs, so the doses that exceed the limit will has a significant impact. Protons are also heavy particles that show patterns of interaction with tissue heterogeneity, which is different with photons. This study aims to determine the dose distribution of proton beam planning in the NSCLC case with the IMPT technique and to compare its effectiveness with the IMRT technique. Planning was done by using TPS Eclipse on the water phantom and in-house thorax dynamic phantom. Planning parameter on the water phantom used 1 field at 0o and 3 fields at 45o, 135o, and 225o. Moreover, we used single field, sum-field, and multiple fields techniques on the in-house thorax dynamic phantom. Conformity Index (CI) and Homogeneity Index (HI) showed a bit differences between IMPT and IMRT planning. The Gradient Index (GI) of IMPT planning ranges between 4.15-4.53, while the GI value of IMRT is 7.89. The planar dose distribution histogram showed that the results of IMPT planning gave fewer out of target doses than IMRT planning results. In addition, evaluation was also made on the target of IMPT planning at five area of interest, as well as four OAR positions. The results are compared with IMRT measurement data. The point dose value at the target did not differ significantly, however the absorbed dose of the four OAR positions are zero which had a large deviation compared to the IMRT technique.

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"Latar Belakang: Radioterapi baik sebagai terapi tunggal maupun sebagai terapi kombinasi, memegang peranan yang penting dalam penatalaksanaan kanker payudara kiri. Eskalasi dosis dikatakan mampu meningkatkan kontrol dan menurunkan angka kekambuhan namun di sisi lain dapat meningkatkan angka toksisitas. Hingga saat ini masih terus dilakukan studi untuk menganalisis parameter dosimetri diantara teknik Three Dimensional Conformal Radiotherapy-Field and Field, Volumetric Modulated Arc Therapy, dan Helical Tomotherapy pada kanker payudara di departemen Radioterapi RSUPN-CM. Metode: Studi eksperimental eksploratorik dengan melakukan intervensi pada 10 data CT plan pasien kanker payudara kiri yang diradiasi di Departemen Radioterapi RSUPN-CM. Dosis 50 Gy diberikan pada PTV dalam 25 fraksi. Cakupan PTV dievaluasi menggunakan Indeks konformitas CI dan indeks homogenitas HI. Menilai perbandingan PTV lokal D98, D95, D2, D50 dan supraklavikula dan menilai organ kritis sekitar target seperti paru kiri ipsilateral V20 le; 30, paru kanan contralateral V5 le; 50, jantung V25 le;10, payudara kanan contralateral Dmean < 5Gy. Hasil: Dari hasil analisis statistik tidak ditemukan adanya perbedaan yang bermakna antara 3DCRT-FIF, VMAT maupun HT dalam mencapai dosis D98 dan D95, pada D50 terdapat perbedaan yang bermakna antara 3DCRT-FIF dengan VMAT p=0,000, 3DCRT-FIF dengan HT p=0,000, namun tidak terdapat perbedaan yang bermakna antara VMAT dengan HT p=0,508. Dalam hal ini, ketiga teknik mampu memberikan cakupan dosis minimal yang baik pada volume target, meskipun begitu dari hasil penelitian ini teknik HT mampu memberikan nilai rerata D95 yang superior. Untuk D50 lokal ditemukan adanya perbedaan yang bermakna di 3 kelompok yang ada yaitu antara 3DCRT-FIF dengan VMAT p=0,000, 3DCRT-FIF dengan HT p=0,000, maupun VMAT dengan HT p=0,005. Didapat teknik HT memiliki nilai rerata D50 yang paling baik 50.01 0.25. Untuk D2 dari hasil analisis statistik ditemukan adanya perbedaan yang bermakna di 3 kelompok yang ada yaitu antara 3DCRT-FIF dengan VMAT p=0,005, 3DCRT-FIF dengan HT p=0,005, maupun VMAT dengan HT p=0,005.Kesimpulan: Tidak terdapat perbedaan bermakna rerata D98 dan D95, namun terdapat perbedaan bermakna pada cakupan dosis D2 dan D50 antara teknik 3DCRT-FIF vs VMAT, 3DCRT-FIF vs HT, dan VMAT vs HT, seluruhnya memperlihatkan perbedaan yang bermakna p < 0,05 . Rerata durasi penyinaran paling tinggi didapatkan dengan teknik HT dan paling rendah pada 3DCRT-FIF.

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Background: Radiotherapy as a main or combination therapy, holds an important role in the management of left breast cancer. Dose escalation is said to increase control and lower recurrence rate. On the other hand, dose escalation increases toxicity. Until now there is many study comparing dosimetry parameters between three different techniques; Three Dimensional Conformal Radiotherapy ndash; Field and Field 3DCRT-FIF, Volumetric Modulated Arc Therapy VMAT and Helical Tomotherapy HT and in relation to left breast cancer in radiotherapy department RSUPN-CM. Method: This is an experimental study with intervention on 10 left breast cancer patients, CT planning data. All the subjects underwent radiation in radiotherapy department RSUPN-CM. 50 Gy dose in 25 fractions was given for PTV. Afterwards, PTV coverage was evaluated using conformity index CI and homogeneity index HI . Comparison of critical organs was evaluated using Dmax le; 50 Gy spinal cord, V25 le; 10 heart, V20 le; 30 lung ipsilateral and V5 le; 30 lung contraleteral and Dmean < 5 Gy right breast. Results: From the statistical analysis there is no difference between 3DCRT-FIF, VMAT and HT in achieving D98 in local PTV. At the D95 value there is a difference between 3DCRT- and VMAT p = 0.022, 3DCRT-FIF with HT p = 0.005, but no value exists between VMAT and HT p = 0.508. In this case, one of the techniques employed gives a good minimum amount of volume targets, although the results of this technique HT are able to provide a superior D95% average. For D50% locally found, there are three groups that exist between 3DCRT-FIF with VMAT p = 0,000, 3DCRT-FIF with HT p = 0,000, and VMAT with HT p = 0,005. HT technique has the highest mean D50 50.01 0.25. For D2 of the analysis results found there were significant differences in 3 groups that existed between 3DCRT-FIF with VMAT p = 0,005, 3DCRT-FIF with HT p = 0,005, and VMAT with HT p = 0,005.Conclusion: There is no D98% and D95%, but there is still a difference with D2% and D50% between 3DCRT-FIF vs VMAT, 3DCRT-FIF vs HT, and VMAT vs HT, all significant differences (p <0.05). The highest average duration of exposure with HT and lowest on 3DCRT-FIF."

"Latar Belakang: Belum tersedia penelitian yang membandingkan teknik radiasikonvensional dengan teknik bone marrow sparing (BMS) di Indonesia. Penelitian inibertujuan mengetahui teknik yang paling superior secara dosimetri dan akan menjadi data dasar untuk studi-studi klinis berikutnya. Metode: Sepuluh data Digital Imaging and Communications in Medicine (DICOM) Computed Tomography (CT) simulasi pasien kanker serviks stadium IB2 - IVA di Rumah Sakit Umum Pusat Nasional CiptoMangunkusumo pada studi eksperimental eksploratorik ini menjalani proses perencanaan radiasi teknik 3D konformal dengan 4 lapangan dan teknik BMS menggunakan intensity-modulated radiation therapy (IMRT) step-and-shoot (SS) dengan 7 lapangan, volumetric modulated arc therapy (VMAT) dengan full 2-arc dan tomoterapi spiral. Dosis 50 Gy dipreskripsikan terhadap planning target volume (PTV) dalam 25 fraksi. Parameter dosimetri pada target dan organ kritis, jumlah monitor units (MU) dan lama waktu radiasi dibandingkan melalui analisis statistik dan sistem skor keunggulan. Hasil: Seluruh teknik memberi cakupan PTV yang sangat baik. Perbedaan statistik terlihat pada rerata D98%; D95%; dan homogeneity index (HI), dengan IMRT SS dan tomoterapi merupakan teknik yang paling superior (D98% = 48 Gy; D95% = 48,98 Gy dan 48,97 Gy; HI = 0,06). VMAT memberi rerata terendah pada V40 (22,2%), Dmean (26,45 Gy) dan D2% (50,42 Gy) usus halus, namun IMRT SS paling mudah mencapai batasan dosis-volume V45 < 195 cc untuk volume usus halus yang luas. IMRT SS juga memberi rerata terendah pada V30 (86,93% dan 92,55%), V40 (65,92% dan 70,81%), Dmean (42,05 Gy dan 43,03 Gy) dan D2% (50,51 Gy dan 50,91 Gy) rektum dan buli, secara berurutan. Tomoterapi memberi rerata terendah pada V10 (83,31%), V20 (67,5%), V30 (46,04%), V40 (27,38%) dan Dmean (28,43 Gy) bone marrow, namun dengan rerata kedua tertinggi pada D2% (50,82 Gy) bone marrow. Teknik 3D konformal memberi rerata terendah pada V5 RVR (43,8%), jumlah MU (275,3) dan lama waktu radiasi (0,46 menit). Total skor keunggulan yang tertinggi diperoleh pada teknik IMRT SS (80), diikuti dengan VMAT (68), tomoterapi (65) dan terendah pada 3D konformal (43). Kesimpulan: Teknik IMRT SS, VMAT dan tomoterapi mampu menyelamatkan bone marrow pelvis dengan cakupan dosis PTV adekuat, homogenitas dan konformitas yang baik, serta memberi dosis radiasi yang aman terhadap organ-organ kritis. Secara keseluruhan, IMRT SS paling superiordibanding ketiga teknik lainnya, terutama terlihat pada dosis rektum, buli dan usus halus yang luas. VMAT paling superior menurunkan dosis usus halus secara umum.Tomoterapi paling superior menurunkan dosis bone marrow kecuali untuk parameterD2%, sedangkan 3D konformal paling superior menurunkan dosis RVR, jumlah MU dan lama waktu radiasi.

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Background: Currently there is no research that compares conventional radiotherapy

technique with bone marrow sparing (BMS) techniques in Indonesia. The aim of this

research was to discover the most superior technique dosimetrically and will be the basic data for further clinical studies. Method: Ten Digital Imaging and Communications in Medicine (DICOM) images of simulation Computed Tomography from stage IB2 - IVA cervical cancer patients at Cipto Mangunkusumo National Center General Hospital were enrolled in this experimental exploratory study and planned for four-field three-dimensional (3D) conformal radiotherapy and BMS technique using seven-field step-andshoot intensity-modulated radiation therapy (SS IMRT), full 2-arc volumetric modulated arc therapy (VMAT), and helical tomotherapy. A dose of 50 Gy was prescribed to the planning target volume (PTV) in 25 fractions. Dosimetric parameters of the target and critical organs, total monitor units (MU), and beam-on time were compared by means of statistical analysis and superiority score system. Result: All techniques provided excellent PTV coverage. Statistical difference was seen in the average of D98%; D95%; and homogeneity index (HI), with SS IMRT and tomotherapy were the most superior techniques (D98% = 48 Gy; D95% = 48.98 Gy and 48.97 Gy; HI = 0.06). VMAT delivered the lowest average of small bowel V40 (22.2%), Dmean (26.45 Gy), and D2% (50.42 Gy), but SS IMRT was the easiest to achieve V45 < 195 cc dose-volume constraint for a large volume of the small bowel. SS IMRT also delivered the lowest average of rectum and bladder V30 (86.93% and 92.55%), V40 (65.92% and 70.81%),Dmean (42.05 Gy and 43.04 Gy), and D2% (50.51 Gy and 50.91 Gy), respectively. Tomotherapy delivered the lowest average of bone marrow V10 (83.31%), V20 (67.5%), V30 (46.04%), V40 (27.38%) and Dmean (28.43 Gy), although with second-highest average of D2% (50.82 Gy). Three-dimensional conformal radiotherapy delivered the lowest average of Remaining Volume at Risk (RVR) V5 (43.8%), total MU (275.3), and beam-on time (0.46 minutes). The highest total superiority score was obtained by SS IMRT (80), followed by VMAT (68), tomotherapy (65), and 3D conformal (43). Conclusion: SS IMRT, VMAT, and tomotherapy techniques were able to spare pelvic bone marrow with adequate PTV dose coverage, good homogeneity and conformity, and

provided safe radiation dose to critical organs. Overall, SS IMRT was the most superior technique compared to the other three techniques, particularly seen in the dose of rectum, bladder and a large volume of the small bowel. VMAT was most superior to decrease the dose of the general small bowel. Tomotherapy was most superior to decrease the dose of bone marrow except for the D2% parameter, while 3D conformal was most superior to decrease the dose of RVR, total MU, and beam-on time."

"[ABSTRAKVolumetric Modulation Arc Therapy (VMAT) merupakan salah satu modalitas untukpengobatan kanker yang mempunyai beberapa teknik penyinaran. Dalam penelitiandilakukan karakteristik dosimetri dan dosimetri invivo menggunakan TLD-100 roddan film gafchromic EBT3 dengan teknik full arc dan half arc VMAT pada fantomrando kasus kanker parotid kiri dan kanker paru ? paru apeks kiri yang masing -masing memiliki empat target dengan volume yang berbeda. Evaluasi yang dilakukanmeliputi parameter penyinaran, Homogeneity Index (HI), Conformity Index (CI) dandeviasi pengukuran dosis menggunakan TLD dan film dengan TPS. Total MU yangdigunakan dan waktu penyinaran, teknik full arc lebih besar dibandingkan teknik halfarc. Selain itu, laju dosis yang diperlukan untuk VMAT teknik full-arc lebih rendahdibandingkan dengan teknik half arc,Teknik full arc lebih homogen dan konformitasdibandingkan pada teknik half arc. Pada pengukuran dosis titik menunjukkan bahwateknik full-arc dan half-arc mempunyai nilai deviasi yang tidak besar, danpenggunaan TLD lebih efektif jika dibandingkan dengan film, dimana rata ? ratadeviasi dosis penggunaan TLD antara 3,79 ? 5,76 % untuk target dan 6,38 ? 9,3 %untuk organ at risk (OAR), dan pada penggunaan film antara 5,69 ? 11,85 % untuktarget dan 34,40 ? 215,76 % untuk OAR.

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ABSTRACT

Volumetric Modulation Arc Therapy (VMAT) is one of the modalities for cancer

treatment that have some technique. This study conducted, dosimetry

characterizations and determination dose by TLD and gafchromic EBT3 film with

full arc and half arc VMAT technique at rando phantom for left parotid cancer and

left apex lung cancer case, which each case have four target different volumes.

Evaluation was conducted on the irradiation parameters, homogeneity index (HI),

Conformity Index (CI) and the deviation of dose measurement using TLD and films

with TPS. On VMAT, the total MU which used and the total of delivery treatment

time, on full arc technique is greater than the half arc technique. Results of the study

the dose rate necessary for VMAT technique of full arc lower than the technique of

half arc, VMAT technique full arc more homogeneous and conformity compared to

the technique of half arc. The measurement of the dose point of use TLD is more

effective than the use of the film, where deviations dose average using TLD between

3.79 to 5.76 % for target and 6.36 to 9.3 % for organ at risk (OAR), and the use of

film between 5.69 to 11.85 % for target and 34.4 to 215.76 % for OAR.;Volumetric Modulation Arc Therapy (VMAT) is one of the modalities for cancer

treatment that have some technique. This study conducted, dosimetry

characterizations and determination dose by TLD and gafchromic EBT3 film with

full arc and half arc VMAT technique at rando phantom for left parotid cancer and

left apex lung cancer case, which each case have four target different volumes.

Evaluation was conducted on the irradiation parameters, homogeneity index (HI),

Conformity Index (CI) and the deviation of dose measurement using TLD and films

with TPS. On VMAT, the total MU which used and the total of delivery treatment

time, on full arc technique is greater than the half arc technique. Results of the study

the dose rate necessary for VMAT technique of full arc lower than the technique of

half arc, VMAT technique full arc more homogeneous and conformity compared to

the technique of half arc. The measurement of the dose point of use TLD is more

effective than the use of the film, where deviations dose average using TLD between

3.79 to 5.76 % for target and 6.36 to 9.3 % for organ at risk (OAR), and the use of

film between 5.69 to 11.85 % for target and 34.4 to 215.76 % for OAR., Volumetric Modulation Arc Therapy (VMAT) is one of the modalities for cancer

treatment that have some technique. This study conducted, dosimetry

characterizations and determination dose by TLD and gafchromic EBT3 film with

full arc and half arc VMAT technique at rando phantom for left parotid cancer and

left apex lung cancer case, which each case have four target different volumes.

Evaluation was conducted on the irradiation parameters, homogeneity index (HI),

Conformity Index (CI) and the deviation of dose measurement using TLD and films

with TPS. On VMAT, the total MU which used and the total of delivery treatment

time, on full arc technique is greater than the half arc technique. Results of the study

the dose rate necessary for VMAT technique of full arc lower than the technique of

half arc, VMAT technique full arc more homogeneous and conformity compared to

the technique of half arc. The measurement of the dose point of use TLD is more

effective than the use of the film, where deviations dose average using TLD between

3.79 to 5.76 % for target and 6.36 to 9.3 % for organ at risk (OAR), and the use of

film between 5.69 to 11.85 % for target and 34.4 to 215.76 % for OAR.]"