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The objective of the study is to examine the variation in doses to, Bladder, pelvic wall and Rectal Points when a patient is simulated in Supine (S Position) and Lithotomy M shaped positions (LM Position), respectively as part of Intracavitary Brachytherapy in Cervical Cancer patients. Patients (n = 19) were simulated and orthogonal images were taken in S Position and LM Positions on a physical simulator. Digital orthogonal X-ray images were transferred to Brachyvision Treatment Planning System via Dicom to generate treatment plans. Radio opaque dye of 7 ml was injected into the Foley bulb for identification and digitization of International Commission on Radiological Units and Measurements (ICRU) Bladder point. Pelvic side wall points were marked in accordance with ICRU 38 recommendations. A Rectal tube containing dummy source marker wire was used to identify Rectal Point. Students’t-test was used to analyze the results. Doses in LM Position were lower and statistically significant when compared to S Position for ICRU Bladder Point, pelvic walls and Rectal Point. It was observed that movement of applicator could be the reason for the variations in doses between the two positions. Bladder, pelvic wall and rectal points systematically registered lower doses in LM Position as compared to S Position.

It has been seen that there is a clinically significant variation in the volume calculated across different planning systems for the same digital imaging and communication (DICOM) contours. Aim: The purpose of this study is to investigate the difference in volumes of organs at risk when the structure sets were exported from the Eclipse ((Palo Alto, USA Version 10.0) to XIO CMS (Electa, Crawley, UK Version 4.40.00) treatment planning system (TPS) and identify how the differences occur. Methods: We prospectively analyzed the volumes of organs at risk from computerized tomography (CT) data of 54 patients. Head and neck and brain tumors were taken for this study and contoured on Eclipse treatment planning system (TPS) after importing images from CT. These contoured images were then exported using radiotherapy DICOM transfer facility to XIO CMS planning system and compared the contoured volumes with Eclipse TPS structured volumes. Results: Our analysis showed that the differences in calculated volumes of the contours for the patients between the two planning systems can be large. Mixed results are shown for different organs with the absolute volume difference ranging from-0.25 cc to 319.73 cc. These results clearly shown that the two TPS interprets the contours differently when calculating the volume, and there is a closer match with the theoretical calculated volumes with XIO CMS calculated volumes. Conclusion: Observed discrepancies were consistent between the two planning systems. This impact of contouring variability could play a role on plan quality metrics which is used as criteria for clinical trial protocol compliance.

Technical ReportAbstract Purpose: To find methods for optimal usage of XVI (X-ray volume imaging) system in Elekta synergy linear accelerator with different field of views for same lesion in order to minimize patient dose due to imaging. Methods: 20 scans of 2 individual patients with ca sigmoid colon and ca lung were used in this study. Kilo voltage collimators with medium field of view were used as per the preset information. Images were reconstructed for another collimator with small field of view. The set up errors were evaluated with XVI software. Shift results of both methods were compared. Results: Variation in treatment set up errors with M20 and S20 collimators were ≤ 0.2 mm in translational and 0.3 0 in rotational shifts. Results showed almost equal translational and rotational shifts in both medium and small field of views with different collimators in all the scans. Visualization of target and surrounding structures were good enough and sufficient for XVI auto matching. Conclusion: Imaging with small field of view results less patient dose compared with medium or large field of views. It is Suggestible to use collimators with small field of view wherever possible. In this study, collimators with small field of view were sufficient for both patients though the preset information indicated medium field of view. But, it always depends on the area required for matching purpose. So, individual selection is important than preset information in the XVI system.