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"[Studi ini telah dilakukan untuk mengetahui karakteristik dari EPID dosimetri yang digunakan sebagai verifikasi pasien IMRT dan VMAT. Penelitian ini dilakukan dengan membandingkan indeks gamma dari hasil verifikasi 5 pasien brain, 5 pasien cervix, 5 pasien kepala dan leher serta 5 pasien paru menggunakan EPID dosimetri dengan MatriXX 2D array pada dua Linac yang berbeda di instalasi radioterapi MRCCC SHS dan Siloam Hospital TBS. Dari penelitian ini dihasilkan nilai indeks gamma untuk kasus IMRT di MRCCC 99.59% ± 0.46 untuk EPID dosimetri dan 99.13% ± 0.75 untuk MatriXX 2D array, sedangkan di Siloam Hospital TBS 99.8% ± 0.20 untuk EPID dosimetri dan 99.71% ± 0.14 untuk MatriXX 2D array. Pada kasus VMAT di MRCCC 97.71% ± 1.27 untuk EPID dosimetri dan 99.50% ± 0.39 untuk MatriXX 2D array, sedangkan di SiloamHospital TBS 97.78% ± 1.45 untuk EPID dosimetri dan 98.66% ± 1.26 untuk MatriXX 2D array. Kesimpulan dari penelitian ini adalah perbedaan antara EPID dosimetri dan MatriXX 2D array di kedua rumah sakit menunjukan nilai kurang dari 1% untuk kasus IMRT dan kurang dari 2% untuk kasus VMAT.

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This work was aimed to study the characteristics of EPID dosimetry in use as patient specific QA for IMRT and VMAT. We compare result of gamma index from patient specific QA with each 5 cases of brain, cervix, head and neck, lung

using EPID dosimetry and MatriXX 2D array in two different linacs at MRCCC SHS and Siloam Hospital TBS. Calculated gamma index from IMRT case in MRCCC SHS ware 99.59% ± 0.46 for EPID dosimetry and 99.13% ± 0.75 for MatriXX 2D array, meanwhile at Siloam Hospital TBS the calculated gamma index were 99.8% ± 0.20 for EPID dosimetry and 99.71% ± 0.14 for MatriXX 2D array.Gamma index from VMAT cases in MRCCC were 97.71% ± 1.27 for EPID dosimetry and 99.50% ± 0.39 for MatriXX 2D array, and in Siloam Hospital TBS the value were 97.78% ± 1.45 for EPID dosimetry and 98.66% ± 1.26 for MatriXX 2D array. We conclude that the difference between EPID dosimetry and Matrixx 2D arrays at two hospitals were less than 1% and less than 2% for IMRT and VMAT cases, respectively. This work was aimed to study the characteristics of EPID dosimetry in use as patient specific QA for IMRT and VMAT. We compare result of gamma index from patient specific QA with each 5 cases of brain, cervix, head and neck, lung using EPID dosimetry and MatriXX 2D array in two different linacs at MRCCC SHS and Siloam Hospital TBS. Calculated gamma index from IMRT case in MRCCC SHS ware 99.59% ± 0.46 for EPID dosimetry and 99.13% ± 0.75 for

MatriXX 2D array, meanwhile at Siloam Hospital TBS the calculated gamma index were 99.8% ± 0.20 for EPID dosimetry and 99.71% ± 0.14 for MatriXX 2D array.Gamma index from VMAT cases in MRCCC were 97.71% ± 1.27 for EPID dosimetry and 99.50% ± 0.39 for MatriXX 2D array, and in Siloam Hospital TBS the value were 97.78% ± 1.45 for EPID dosimetry and 98.66% ± 1.26 for MatriXX 2D array. We conclude that the difference between EPID dosimetry and Matrixx 2D arrays at two hospitals were less than 1% and less than 2% for IMRT and VMAT cases, respectively.;This work was aimed to study the characteristics of EPID dosimetry in use as

patient specific QA for IMRT and VMAT. We compare result of gamma index

from patient specific QA with each 5 cases of brain, cervix, head and neck, lung

using EPID dosimetry and MatriXX 2D array in two different linacs at MRCCC

SHS and Siloam Hospital TBS. Calculated gamma index from IMRT case in

MRCCC SHS ware 99.59% ± 0.46 for EPID dosimetry and 99.13% ± 0.75 for

MatriXX 2D array, meanwhile at Siloam Hospital TBS the calculated gamma

index were 99.8% ± 0.20 for EPID dosimetry and 99.71% ± 0.14 for MatriXX 2D

array.Gamma index from VMAT cases in MRCCC were 97.71% ± 1.27 for EPID

dosimetry and 99.50% ± 0.39 for MatriXX 2D array, and in Siloam Hospital TBS

the value were 97.78% ± 1.45 for EPID dosimetry and 98.66% ± 1.26 forMatriXX

2D array. We conclude that the difference between EPID dosimetry and Matrixx

2D arrays at two hospitals were less than 1% and less than 2% for IMRT and

VMAT cases, respectively., This work was aimed to study the characteristics of EPID dosimetry in use as

patient specific QA for IMRT and VMAT. We compare result of gamma index

from patient specific QA with each 5 cases of brain, cervix, head and neck, lung

using EPID dosimetry and MatriXX 2D array in two different linacs at MRCCC

SHS and Siloam Hospital TBS. Calculated gamma index from IMRT case in

MRCCC SHS ware 99.59% ± 0.46 for EPID dosimetry and 99.13% ± 0.75 for

MatriXX 2D array, meanwhile at Siloam Hospital TBS the calculated gamma

index were 99.8% ± 0.20 for EPID dosimetry and 99.71% ± 0.14 for MatriXX 2D

array.Gamma index from VMAT cases in MRCCC were 97.71% ± 1.27 for EPID

dosimetry and 99.50% ± 0.39 for MatriXX 2D array, and in Siloam Hospital TBS

the value were 97.78% ± 1.45 for EPID dosimetry and 98.66% ± 1.26 forMatriXX

2D array. We conclude that the difference between EPID dosimetry and Matrixx

2D arrays at two hospitals were less than 1% and less than 2% for IMRT and

VMAT cases, respectively.]"

"Penggunaan kecerdasan buatan berbasis Deep Learning untuk mendukung prediksi dan pengambilan keputusan sangat populer di banyak bidang. Salah satu bidang tersebut adalah di sektor kesehatan, terutama dalam pengobatan kanker. Banyak ahli onkologi radiasi dan fisikawan medis sedang melakukan penelitian yang menjanjikan dalam histologi dan stadium kanker, prediksi hasil, segmentasi otomatis, perencanaan perawatan, dan jaminan kualitas. Penelitian ini merupakan studi pendahuluan pengembangan dan perbandingan model deep learning yang berfungsi sebagai alat konversi dari nilai piksel citra Electronic Portal Imaging Device (EPID) ke dosis. Data diambil dari dua bidang radioterapi dengan teknik yang berbeda, yang pertama dosimetri transit pada Varian Unique 6MV foton dan dosimetri non-transit pada Varian Halcyon. Selanjutnya karena data yang tersedia hanya sedikit, data tersebut direproduksi dengan teknik augmentasi sehingga data tersebut cukup untuk menjadi data latih pada berbagai model deep learning, hasilnya divalidasi menggunakan indeks gamma 3%/3mm terhadap citra dosis hasil perencanaan dari TPS. Beberapa model deep learning telah berhasil dibuat yang dapat mengubah nilai piksel EPID menjadi distribusi dosis. Pada dosimetri transit telah berhasil dibuat model Convolutional Neural Network (CNN) dengan 6 layer dengan hasil validasi terbaik mencapai 92,40% ± 28,14%. sedangkan pada dosimetri non-transit, model terbaik mencapai tingkat kelulusan gamma indeks rata-rata 90,07 ± 4,96%. Validasi lebih lanjut dalam banyak kasus dan perbaikan perlu dilakukan untuk meningkatkan akurasi kemiripan dengan citra acuan dengan mempertimbangkan karakteristik yang terkandung dalam gambar EPID dan jumlah dataset.

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The use of deep learning to support prediction and decision making is very popular in many areas. Many radiations oncologist and medical physicists are conducting promising research in cancer histology and staging, outcome prediction, automated segmentation, treatment planning, and quality assurance. This research is a preliminary study of the development and comparison of deep learning model that work as a conversion tool from the pixel value of Electronic Portal Imaging Device (EPID) images to dose. Data were taken from two radiotherapy plane with different techniques, the first was transit dosimetry on the Varian Unique 6MV Photon and the second non-transit dosimetry on the Varian Halcyon. Furthermore, due to limited of data source, the data was reproduced by augmentation techniques so that the data was sufficient to become training data on various deep learning models, the results were validated using a gamma index of 3%/3mm compared to the planned dose image from TPS. Several deep learning models has been successfully created that can convert the EPID pixel value into a dose distribution. In transit dosimetry, a Convolutional Neural Network (CNN) model with 6 layers has been successfully created with the best results from the validation reaching 92.40% ± 28.14%. while in non-transit dosimetry, the best model achieves an average gamma passing rate of 90.07 ± 4.96%. Further validation in many cases and improvements need to be made to increase the accuracy of similarity by considering the characteristics contained in the EPID image and the number of datasets."

"Pendahuluan : Radioterapi kanker serviks uteri dalam pelaksanaannya memerlukan verifikasi geometri sebagai salah satu rantai prosedur radioterapi. Prosedur ini dilakukan untuk mengetahui kesalahan set-up yang terdiri dari kesalahan sistematik dan acak yang nantinya digunakan untuk menentukan margin PTV yang sesuai untuk radioterapi kanker serviks uteri di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Metode : Penelitian ini merupakan studi potong lintang terhadap data verifikasi dengan Electronic Portal Imaging Devices (EPID) dari 9 pasien kanker serviks uteri yang mendapatkan radioterapi dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM antara bulan Oktober 2013 hingga Desember 2013. Pergeseran pada lapangan radiasi yang didapatkan dari hasil verifikasi dalam tiga fraksi awal dianalisis untuk memperoleh kesalahan sistematik dan acak, yang selanjutnya dihitung untuk mendapatkan margin PTV. Hasil : Sebanyak 72 data verifikasi EPID dianalisis. Didapatkan kesalahan sistematik dan kesalahan acak pada pelaksanaan radiasi (radioterapi) kanker serviks uteri di Departemen Radioterapi RSCM, berturut-turut sebesar 3.8 dan 3.0mm pada sumbu laterolateral, 5.9 dan 2.6mm pada sumbu kraniokaudal, serta 4.3 dan 3.5mm pada sumbu anteroposterior. Margin PTV yang diperoleh sebesar 9.8mm, 13.5mm dan 11,0 mm untuk masing-masing sumbu laterolateral, kraniokaudal, dan anteroposterior. Kesimpulan : Hasil penelitian ini mendapatkan kesalahan sistematik dan acak menggunakan verifikasi dengan EPID yang digunakan sebagai rekomendasi pemberian margin PTV sebesar 13.5mm dalam pelaksanaan radioterapi kanker serviks uteri dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM. Diperlukan alat imobilisasi khusus regio pelvis untuk meningkatkan akurasi penyinaran.

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Introduction : Geometric verification is needed as a part of chain of radiotherapy procedures in cervical cancer irradiation. This procedure used to detect set-up erros contains sistematic and random errors for the next step use to formulating adequate PTV margin for cervical cancer irradiation in Cipto Mangunkusumo Hospital.

Methods : This is a cross-sectional study using Electronic Portal Imaging Devices (EPID) verification data of 9 cervical cancer patients treated with 3DCRT/IMRT in Department of Radiotherapy, Cipto Mangunkusumo Hospital between October 2013 and December 2013. Translation errors from the first three fractions were analyzed to count for systematic and random errors. These errors were then calculated to acquire PTV margin.

Results : A total of 72 EPID data were analyzed. Systematic and random errors for cervical cancer irradiation in this study were respectively 3.8mm and 3.0mm in laterolateral direction, 5.9mm and 2.6mm in craniocaudal direction, and 4.3mm and 3.5mm in anteroposterior direction. PTV margin were 9.8mm, 13.5mm and 11.0mm in laterolateral, craniocaudal and anteroposterior direction, respectively.

Conclusions : The result in this study acquire systematic and random errors with verificaton by EPID gave PTV margin recommendation and showed that 13.5mm margin was adequate in planning 3DCRT/IMRT technique for cervical cancer in Department of Radiotherapy, Cipto Mangunkusumo Hospital. Immobilisation devices for pelvic region might be needed to improve the accuration of radiotherapy."

"Pendahuluan : Radioterapi kanker serviks uteri dalam pelaksanaannya memerlukan verifikasi geometri sebagai salah satu rantai prosedur radioterapi. Prosedur ini dilakukan untuk mengetahui kesalahan set-up yang terdiri dari kesalahan sistematik dan acak yang nantinya digunakan untuk menentukan margin PTV yang sesuai untuk radioterapi kanker serviks uteri di Departemen Radioterapi Rumah Sakit dr. Cipto Mangunkusumo (RSCM)Metode : Penelitian ini merupakan studi potong lintang terhadap data verifikasi dengan Electronic Portal Imaging Devices (EPID) dari 9 pasien kanker serviks uteri yang mendapatkan radioterapi dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM antara bulan Oktober 2013 hingga Desember 2013. Pergeseran pada lapangan radiasi yang didapatkan dari hasil verifikasi dalam tiga fraksi awal dianalisis untuk memperoleh kesalahan sistematik dan acak, yang selanjutnya dihitung untuk mendapatkan margin PTV.Hasil : Sebanyak 72 data verifikasi EPID dianalisis. Didapatkan kesalahan sistematik dan kesalahan acak pada pelaksanaan radiasi (radioterapi) kanker serviks uteri di Departemen Radioterapi RSCM, berturut-turut sebesar 3.8 dan 3.0mm pada sumbu laterolateral, 5.9 dan 2.6mm pada sumbu kraniokaudal, serta 4.3 dan 3.5mm pada sumbu anteroposterior. Margin PTV yang diperoleh sebesar 9.8mm, 13.5mm dan 11,0 mm untuk masing-masing sumbu laterolateral, kraniokaudal, dan anteroposterior.Kesimpulan : Hasil penelitian ini mendapatkan kesalahan sistematik dan acak menggunakan verifikasi dengan EPID yang digunakan sebagai rekomendasi pemberian margin PTV sebesar 13.5mm dalam pelaksanaan radioterapi kanker serviks uteri dengan teknik 3DCRT/IMRT di Departemen Radioterapi RSCM. Diperlukan alat imobilisasi khusus regio pelvis untuk meningkatkan akurasi penyinaran.

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Introduction : Geometric verification is needed as a part of chain of radiotherapy procedures in cervical cancer irradiation. This procedure used to detect set-up erros contains sistematic and random errors for the next step use to formulating adequate PTV margin for cervical cancer irradiation in Cipto Mangunkusumo Hospital

Methods : This is a cross-sectional study using Electronic Portal Imaging Devices (EPID) verification data of 9 cervical cancer patients treated with 3DCRT/IMRT in Department of Radiotherapy, Cipto Mangunkusumo Hospital between October 2013 and December 2013. Translation errors from the first three fractions were analyzed to count for systematic and random errors. These errors were then calculated to acquire PTV margin.

Results : A total of 72 EPID data were analyzed. Systematic and random errors for cervical cancer irradiation in this study were respectively 3.8mm and 3.0mm in laterolateral direction, 5.9mm and 2.6mm in craniocaudal direction, and 4.3mm and 3.5mm in anteroposterior direction. PTV margin were 9.8mm, 13.5mm and 11.0mm in laterolateral, craniocaudal and anteroposterior direction, respectively.

Conclusions : The result in this study acquire systematic and random errors with verificaton by EPID gave PTV margin recommendation and showed that 13.5mm margin was adequate in planning 3DCRT/IMRT technique for cervical cancer in Department of Radiotherapy, Cipto Mangunkusumo Hospital. Immobilisation devices for pelvic region might be needed to improve the accuration of radiotherapy."

"Halcyon 2.0 memiliki EPID yang dapat digunakan untuk Patient-Specific Quality Assurance (PSQA) dan selalu merekam dosis transit selama penyinaran. PSQA merupakan metode untuk menilai kesesuaian hasil perencanaan radioterapi dengan pengukuran, sedangkan dosis transit memiliki kaitan terhadap distribusi dosis pasien. Penelitian ini menganalisis hasil PSQA pada Halcyon 2.0 dan dosis transit setiap fraksi pada kasus nasofaring, servik, dan payudara. Analisis dilakukan berdasarkan metode pengukuran dan evaluasi yang direkomendasikan TG-218. Selain itu, analisis dosis transit dilakukan pada setiap fraksi dan fluence map fraksi pertama dijadikan sebagai baseline. Nilai tolerance limit dan action limit Halcyon 2.0 memenuhi kriteria dari TG-218. Metode dan kriteria gamma index yang direkomendasikan TG-218 memiliki performa baik. Berbeda hal, nilai GPR dosis transit kasus nasofaring terjadi penurunan lebih curam dibandingkan kasus servik dan payudara, hal yang sama untuk korelasi berat badan dengan GPR. Penurunan GPR dari memiliki korelasi dengan berat badan, terutama untuk kasus nasofaring. Selain itu, kasus payudara tidak memiliki subjek dengan korelasi signifikan (p < 0,05) antara GPR dengan berat badan. Kesimpulan dari penelitian ini, berdasarkan metode TG-218 Halcyon 2.0 memiliki hasil PSQA yang baik. Nilai GPR untuk ketiga kasus mengalami penurunan seiring bertambahnya waktu dan memiliki kaitan terhadap berat badan.

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Halcyon 2.0 has an EPID that can be used for Patient-Specific Quality Assurance (PSQA) and continuously records transit doses during irradiation. PSQA is a method for assessing the suitability of the results of radiotherapy planning with measurements, while the transit dose has a bearing on the patient's dose distribution. This study analyzed PSQA results on Halcyon 2.0 and transit doses for each fraction in the nasopharynx, cervix, and breast cases. The analysis was carried out based on the measurement and evaluation methods recommended by TG-218. In addition, transit dose analysis was carried out for each fraction, and the fluence map of the first fraction was used as a baseline. The tolerance limit and action limit values of Halcyon 2.0 meet the criteria of TG-218. The method and gamma index criteria recommended by TG-218 have good performance. In contrast, the transit dose GPR values for nasopharyngeal cases decreased more steeply than cervical and breast cases, the same for the correlation of body weight with GPR. The decrease in GPR correlates with body weight, especially for nasopharyngeal cases. In addition, no breast cases had a significant correlation (p <0.05) between GPR and body weight. The conclusion of this study, based on the TG-218 Halcyon 2.0 method, has good PSQA results. The GPR values for the three cases decreased over time and were related to body weight."

"Penelitian ini dilakukan untuk mengevaluasi distribusi dosis radioterapi pada kasus kanker payudara, dengan menyelidiki dampak dosimetrik dari kesalahan pemosisian leaf MLC pada Varian Halcyon untuk kesalahan acak, dan untuk mengevaluasi keefektifan jaminan kualitas portal dosimetri dalam menangkap perubahan signifikan secara klinis yang disebabkan oleh kesalahan-kesalahan ini. Kesalahan acak secara sengaja dibuat pada leaf MLC sebesar 5%, 10%, 15%, 20%, 50%, 80%, dan 100% dari total keseluruhan distal MLC Halcyon yang berjumlah 28 pasang, dengan pergeseran daun MLC sejauh 1 mm yang mengacu pada batas nilai toleransi AAPM TG 142. Modifikasi pergeseran leaf MLC memanfaatkan Python, Python dapat membaca file dicom yang dieksport dari TPS eclipse, modifikasi ini dilakukan untuk mengetahui besarnya dosis yang diterima pasien dan menentukan apakah pergeseran leaf MLC tersebut masih dalam rentang yang dapat ditoleransi. Rencana kemudian diberikan pada Linac Varian Halcyon dan fluence ditangkap oleh Electronic Portal Imaging Device (EPID). Distribusi dosis yang diperoleh dievaluasi dengan metode gamma indeks. Hasil evaluasi dan analisis menunjukkan bahwa peningkatan error posisi MLC menyebabkan distribusi dosis yang semakin tidak sesuai dengan batasan dosis, dengan dosis yang diterima oleh PTV semakin menurun yang mempengaruhi kualitas dan efektivitas treatment radioterapi.

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The research was conducted to evaluate the radiation dose distribution in breast cancer cases, By investigate the dosimetric impact of multi-leaf collimator positioning errors on Varian Halcyon for random errors, and to evaluate the effectiveness of portal dosimetry quality assurance in capturing clinically significant changes caused by these errors. Random errors were intentionally created in the MLC leaves at 5%, 10%, 15%, 20%, 50%, 80%, and 100% of Halcyon's total of 28 distal MLC pairs, with a 1 mm MLC leaf shift in reference to the AAPM TG 142 tolerance limit values. The modification of the MLC leaf shift utilizes Python, Python can read the dicom file exported from TPS eclipse, this modification is done to determine the amount of dose received by the patient and determine whether the MLC leaf shift is still within the tolerable range. The plan was then administered on a Varian Halcyon linear accelerator and the fluence was captured by an Electronic Portal Imaging Device (EPID). The obtained dose distribution was evaluated by the gamma index method. The results of the evaluation and analysis showed that increasing the MLC position error led to dose distributions that were increasingly out of dose constraint, with the dose received by the PTV decreasing which affected the quality and effectiveness of the radiotherapy treatment."