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Purpose: The purpose of present study is to estimate asymmetric margins of prostate target volume based on biological limitations with help of knowledge based fuzzy logic considering the effect of organ motion and setup errors. Materials and Methods: A novel application of fuzzy logic modelling technique considering radiotherapy uncertainties including setup, delineation and organ motion was used in this study to derive margins. The new margin was applied in prostate cancer treatment planning and the results compared very well to current techniques Here volumetric modulated arc therapy treatment plans using stepped increments of asymmetric margins of planning target volume (PTV) were performed to calculate the changes in prostate radiobiological indices and results were used to formulate the rule based and membership function for Mamdani-type fuzzy inference system. The optimum fuzzy rules derived from input data, the clinical goals and knowledge-based conditions imposed on the margin limits. The PTV margin obtained using the fuzzy model was compared to the commonly used margin recipe. Results: For total displacement standard errors ranging from 0 to 5 mm the fuzzy PTV margin was found to be up to 0.5 mm bigger than the vanHerk derived margin, however taking the modelling uncertainty into account results in a good match between the PTV margin calculated using our model and the one based on van Herk et al. formulation for equivalent errors of up to 5 mm standard deviation (s. d.) at this range. When the total displacement standard errors exceed 5 mm s. d., the fuzzy margin remained smaller than the van Herk margin. Conclusion: The advantage of using knowledge based fuzzy logic is that a practical limitation on the margin size is included in the model for limiting the dose received by the critical organs. It uses both physical and radiobiological data to optimize the required margin as per clinical requirement in real time or adaptive planning, which is an improvement on most margin models which mainly rely on physical data only.

Plasmablastic lymphoma (PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma which is associated with HIV infection. Recently, it has also been reported in immunocompetent and solid organ transplant patients. PBL commonly presents in extranodal regions such as oral cavity, digestive tract, and skin. Orbital involvement by PBL is extremely rare with only few reports in the literature. We present a case of PBL involving the bilateral orbits in an immunocompetent patient with 1-year follow-up on 18F-FDG PET/CT scan.

Introduction: Volumetric Arc Radiotherapy (VMAT) is an advanced technique. Calculations of VMATplans are not so accurate even with State-of-Art dose calculation algorithms due to their complexity.Hence pre-treatment patient specific Quality Assurance (QA) of each VMAT plan is required. In thepresent study Electronic Portal Imaging Device (EPID) based portal dosimetry system was used forpre-treatment patient specific QA. Material and Methods: A total of 50 patients were chosen inthis study. Verification plans of each patient were calculated for portal dosimetry then executed onthe EPID system to measure the spatial distribution of radiation dose. Calculated and measured dosedistribution were compared to evaluate Gamma Index (GI) passing criteria of Dose Difference (DD)of 3% and Distance–to-Agreement (DTA) of 3mm, Area Gamma (γ% ≤1) >95%, Average Gamma(gAve) <0.5% and Maximum Gamma (gMax) <3.5%. Results: The mean values of Area Gamma (γ%≤1) were observed to be varied from 99.14±0.23% to 99.87±0.18%. The Mean Values of AverageGamma (gAve) are found to vary from 0.19±0.05% to 0.15±0.04% and the mean values ofMaximum Gamma (gMax) found to be varied from 1.94±0.37% to 1.59±0.41%. All the plans werepassed the gamma index criteria with very good agreement. Thus the use of Portal Dosimetry forpre-treatment patient QA is found to be a very useful, quick, precise, efficient and effective pre-treatment patient specific QA tool for VMAT treatment. Conclusion: Portal Dosimetry can be utilizedfor routine use for patient specific quality assurance for Volumetric Arc Radiotherapy treatment.

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