VERIFICATION OF THE TREATMENT PLANNING

SYSTEM (TPS) USING THE PHANTOM SLAB

Presented by : Nisa’ul Sholihah

Masgister of Biomedical Engineering

Faculty of Science and Technology
Airlangga University
Content

01 Introduction

02 Methods

03 Result And Discussion

04 Conclusions
Introduction
 According to the Data and Information Center of the Ministry of
Health of the Republic of Indonesia, cancer is one of the leading
causes of death worldwide.

 In 2012, cancer caused an estimated 8.2 million deaths. The biggest

causes of death from cancer each year are lung, liver, stomach,
colorectal, and breast cancers.
 Some of the therapies used for cancer
treatment include immunotherapy,
chemotherapy, and radiation therapy.

 One of the radiation therapy tools is Linac

(Linear Accelerator).

 Linear accelerator (Linac) is a high-

frequency electromagnetic wave device
for accelerating charged particles such as
high-energy electrons through a linear
tube
 Utilization of linear accelerator (Linac) radiation
sources in radiotherapy is about more than 70%
for cancer treatment which is carried out with
external radiation techniques.

 Linear accelerator (Linac) has advantages,

among others, a higher level of efficiency and
accuracy factor, and the radiation time required
is relatively more stable so that more people will
be served.
 The calculation of the dose distribution of the
target organs and the time of therapy was
carried out using the Treatment Planning System
(TPS) software.

 Treatment Planning System (TPS) is an

important component of the complex
radiotherapy treatment planning process by
generating images based on 3D Conformal
Radiotherapy (3DCRT) and Intensity Modulated
Radiotherapy Tomography (IMRT).
 Treatment Planning System (TPS) have
limitations or can experience errors because no
computer program system is perfect.
 Therefore, it is necessary to verify the data from
TPS calculation results to minimize accidents due
to radiation.
 Verification was carried out between the TPS
calculation and the measurement of the
radiation output of the linear accelerator (Linac)
machine on the phantom slab using the
International Atomic Energy Agency (IAEA)
dosimetry protocol contained in the Technical
Report Series No. 398 (TRS-398).
 Previous Research

 It was found that the high absorption dose value corresponded to the difference in
the absorbed dose value between water medium and virtual water phantom for
a 6 MV X-ray beam of 0.002 cGy/MU and for a 10 MV X-ray beam of 0.008
cGy/MU, where aims to verify the In Vivo Method of External Radiotherapy on
Phantom (Suharsono, 2012).

 It can be seen that for simple geometric shapes and homogeneous materials, the
deviation range is between -2.682% - 1.918%, for complex geometric shapes (one-
way radiation beam) the deviation range is between -5.278% - 4.990%, and for
more complex geometric shapes (two directions). radiation beam) the deviation
range is between -3.202% - 2.090%, which aims to verify the Dosimetry Treatment
Planning System (TPS) on the Main Axis of the Co-60 Teletherapy Beam (Nunung
et al., 2001).
Methods
 This research was conducted at the Radiotherapy Installation
at RSUD Dr Soetomo Surabaya using Linac (linear accelerator)
brand Varian Medical System USA type 2300 iX. Verification of
the Therapy Planning System (TPS) in this study used a
phantom slab measuring 30x30x30 cm³, exposed to X-ray
radiation with a photon beam energy of 6 MV. Before
conducting TPS, the gantry on the Linac was set to 0 °, the
collimator was adjusted according to the desired field size, and
the distance between the Linac and the phantom slab was
established as far as 100 cm. In addition, the phantom slab is
arranged so that the isocenter point is precisely in the middle.
Then, the ionization chamber detector is inserted into the hole
in the phantom slab and connected to a digital electrometer
using a coaxial cable. After the radiation exposure process to
the phantom, the next step is to enter the data that has been
obtained and perform calculations using TRS-398.
Result And Discussion
Calculation of Dose
Output at TPS
 Treatment Planning System (TPS) is
a computerized-based software to
perform dose calculations in external
beam radiotherapy.

 Computerized TPS is used in

external beam radiotherapy to
generate beam shape and dose
distribution with a view to TPS process using software
maximizing tumor control and
minimizing normal tissue
complications.
 TABLE 1. Output calculation results dose output (MU) at Treatment Planning System (TPS)
Depth Field Area (cm2))
(cm) 5x5 8x8 10x10 15x15
1,5 99,8 99,9 99,9 99,9
5 84,6 86,0 86,6 85,7
10 62,7 62,3 66,7 64,9
15 46,4 49,4 51,0 49,0

From Table 1, it can be seen that the overall dose distribution in different fields did not
show a significant difference. Ideally, with the same amount of energy, the wider the
irradiation field, the smaller the dose distribution received by the target because the
beam spread is large. But in practice this is very difficult to achieve. According to the
American Academy of Project Management (AAPM), recommends that the
magnitude of the photon radiation beam should not be more than 3%. If viewed from
the depth variation, the greater the depth or the farther the distance from the source
to the target, the smaller the dose received by the target. This is in accordance with
Newton's inverse square law which states that the photon intensity is inversely
proportional to the square of the distance .
Phantom Slab Exposure
Using Linac
 TABLE 2. Linac dose output measurement results (nC) on phantom slabs
Depth Field Area (cm2))
(cm) 5x5 8x8 10x10 15x15
1,5 19,36 20,17 20,58 21,29
5 16,43 17,38 17,82 18,57
10 12,15 13,19 13,69 14,56
15 8,99 9,91 10,38 11,26
 Table 2 it can be seen that the larger the irradiation field, the greater the linear
accelerator (Linac) dose output. However, it is different when viewed from the
depth, the greater the depth or the farther the distance from the source to the
target, the lower the dose of Linac.
Dose Output Calculation
on TRS-398
TRS-398 is a Microsoft Excel-based dose calculation method. TRS-398
based on Microsoft Excel is used to convert units from nC to cGy/MU
as the absorbed dose with various components that must be entered.
These components include the specifications of the equipment used,
namely Linac, ionization chamber detector, and electrometer,
dosimetry readings and their corrections.
 TABLE 3. Calculation of the absorbed dose (cGy/MU) using the TRS-398 method

Depth Field Area (cm2)

(cm) 5x5 8x8 10x10 15x15
1,5 0,94555 0,98386 1,0025 1,0341
5 0,96362 0,99998 1,0203 1,0479
10 0,95654 0,99373 1,0158 1,0408
15 0,95432 0,99427 1,0169 1,0432

From the results of the study using TRS-398, shown in Table 3 on the field's variation of
depth and area, the absorbed dose values ranged from 0.94555 to 1.0479 nC. This
shows that the absorbed dose value is still within the allowable range to be treated by
the patient. The unit for TPS dose output is MU. So to be able to verify the dose output
of TPS and Linac, both must be in the same unit. To produce a Linac dose output with
the same units as the dose output at the TPS, namely MU.
 TABLE 4. Results of calculation of dose output (MU) on Linac

Depth Field Area (cm2)

(cm) 5x5 8x8 10x10 15x15
1,5 94,36589 98,28761 100,1498 103,3066
5 81,52225 85,99828 88,35798 89,80503
10 59,97506 61,90938 67,75386 67,54792
15 44,28045 49,11694 51,8619 51,1168

The Linac dose output results in Table 4. have been adjusted to what the target should
have received. Based on table 4, it can be seen that the larger the field area, the
higher the dose required. From this difference, it will be known the percentage
deviation value between the TPS dose output that the target will receive and the
Linac dose output that the target should receive.
 TABLE 5. Two independent sample T test results for TPS dose output and Linac . dose output

deviation Ket.
Depth percentage Hasil
Factor N
(cm)
Average Dosis (MU) STD Sig. (p) Conclusion
1,5 8 99,451 2,4869 0,681 No Difference
5 8 86,073 2,4628 0,721 No Difference
Luas Lapangan
10 8 64,226 2,9200 0,949 No Difference
15 8 49,022 2,5600 0,944 No Difference

In the results from table 5, it is analyzed that there is no difference between the output
of the Treatment Planning System (TPS) dose and the linear accelerator (Linac) dose.
The deviation value between Treatment Planning System (TPS) dose output and
linear accelerator (Linac) dose output reviewed based on depth ranged from 2.4628%
- 2.900%, which means it is still within the recommended tolerance limit of ±5%.
Conclusions
 The results of the A Maximum Dose Depth
computerized treatment Of 1.5 Cm At Percentage
planning system (TPS) Depth Dose (PDD) 99.8%
are in accordance with - 99.9% And 94.3% -
the radiation output of 103.3% And In Both
the linear accelerator Cases There Was A
(linac) machine using a Decrease In Dose Along
slab phantom With Increasing Depth
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