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"ABSTRAKPenelitian ini diajukan dalam rangka melanjutkan penelitian sebelumnya oleh Wibowo (2015) tentang evaluasi Gamma Index (GI) untuk material homogen dan inhomogen dengan teknik IMRT. Penelitian ini dilakukan dengan menggunakan film gafchromic EBT3 sebagai detektornya. Kemudian, registrasi antara image dosis planar TPS dengan image hasil pengukuran menggunakan film dilakukan. Perencanaan radioterapi telah disiapkan sebanyak 5 pasien menggunakan modalitas FBCT, TPS Philips Pinnacle3, energi foton 6 MV, teknik IMRT 50 segment, dan CGR 0.2 cm. Evaluasi GI dilakukan dengan DD 2%, DTA 2 mm dan DD 5% DTA 3%, SAD 100 cm, dan kedalaman pengukuran pada phantom yaitu 5 cm dan 10 cm. Hasil penelitian menunjukkan GI pada material homogen lebih tinggi daripada material inhomogen. Selisih rata-rata hasil pengukuran GI terhadap penelitian sebelumnya untuk material homogen berkisar 1.98% (kedalaman 5 cm) dan 2.05% (kedalaman 10 cm) dan untuk material inhomogen sebesar 2.98% (kedalaman ekuivalen 5 cm) dan 4.59% (kedalaman ekuivalen 10 cm).

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ABSTRACTThis study was the extended work which has been done by Wibowo (2015) about Gamma Index (GI) evaluation for homogeneous and inhomogeneous material with IMRT techniques. This study was done to evaluate the gamma index for registering between the planar of dose planning and the measurement from EBT film. Treatment plan was simulated for 5 patients using FBCT modality, Philips Pinnacle3 planning system, 6 MV photon energy, 50 segments IMRT technique, and calculation grid resolution (CGR) of 0.2 cm. GI evaluation was done with criteria of dose difference (DD) of 2%, dose to agreement (DTA) of 2 mm and DD of 5% DTA of 3 mm, SAD 100 cm, depth of 5 cm and 10 cm of the phantom. The result shows that GI for homogeneous material is greater than for inhomogeneous material with discrepancy to previous work is about 1,98% for homogeneous material (depth 5 cm) and 2.05% (depth 10 cm) while it was found of 2,98% for inhomogeneous material (equivalent depth 5 cm) and 4.59% (equivalent depth 10 cm)."

"[Telah dilakukan penelitian dalam mengevaluasi pengaruh material homogen dan inhomogen pada teknik IMRT (Intensity Modulated Radiotherapy) menggunakan modalitas Fan Beam CT (FBCT) dan Cone Beam CT (CBCT) terhadap Gamma Index (GI). Perencanaan ulang dilakukan untuk 5 pasien kanker paru kanan pada modalitas FBCT dan CBCT menggunakan TPS Phillips Pinnacle energi foton 6 MV. Menggunakan Teknik IMRT 30 segmen, 50 segmen, dan 70 segmen untuk perencanan terapi. Calculation Grid Resolution (CGR) 0.2 cm dan 0.4 cm digunakan sebagai resolusi dalam perhitungan dosis. Serta kalibrasi bilangan CT (KBC) FBCT, CBCT, dan linear dipergunakan sebagai koreksi CT density number. Pengukuran plannar dose untuk evaluasi Gamma Index (DD 2% / DTA 2 mm, passing rate 90%) dilakukan pada SAD 100 cm dengan material homogen dan inhomogen pada kedalaman 1.5 cm, 5 cm, dan 10 cm. Didapatkan deviasi nilai rata-­‐rata GI antara CGR 0.2 cm dengan 0.4 cm material homogen modalitas FBCT dan CBCT berturut-­‐tutut ≤1.46% dan ≤ 1.13%. Serta deviasi pada material inhomogen sebesar ≤ 2.54% (FBCT) dan ≤ 1.74% (CBCT). Deviasi Nilai rata-­rata GI antara FBCT dengan CBCT dengan CGR 0.2 cm berturut-­turut ≤ 1.95% (homogen) dan ≤ 2.36% (inhomogen). Dan deviasi Nilai rata-­‐rata GI antara material homogen dan material ekuivalen homogen sebesar ≤ 0.80%. Dari hasil penelitian yang didapat, bahwa evaluasi Gamma Index dapat dipengaruhi oleh jumlah segmen, modalitas CT, kalibrasi bilangan CT, Calculation Grid Resolution, dan kedalaman material.

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These Studies have been carried out to evaluate the effect of a homogeneous and inhomogeneous material on IMRT Technique (Intensity Modulated Radiotherapy) using Fan Beam CT (FBCT) and Cone Beam CT (CBCT) for the Gamma Index (GI). The Phillips Pinnacle treatment plan was used to replan 5 patients on right side of lung cancer. Photon 6 MV was applied to this technique with 30 segments, 50 segments, and 70 segments, repectively. Using Calculation Grid Resolution (CGR) 0.2 cm and 0.4 cm for resolution in the calculation of the dose. As well as the calibration of CT numbers (CCN) FBCT, CBCT, and the linear density are used as a correction CT number. The planar measurement for the evaluation of Gamma Index (DD 2% / DTA 2 mm, the passing rate of 90%) carried out at 100 cm SAD with the homogeneous and inhomogeneous material at a depth of 1.5 cm, 5 cm, and 10 cm, respectively. We obtained deviation average value of GI between CGR 0.2 cm and 0.4 cm using the homogeneous material on FBCT and CBCT modality ≤1.46% and ≤ 1:13%, respectively. As well as the material inhomogeneous deviation of ≤ 2.54% (FBCT) and ≤ 1.74% (CBCT). The deviation of the average GI value between FBCT with CBCT with CGR 0.2 cm respectively ≤ 1.95% (homogeneous) and ≤ 2.36% (inhomogeneous). Finally, the deviation of the average GI value between homogeneous and equivalent of homogeneous material is ≤ 0.80%. From the results obtained, that the Gamma Index can be influenced by the number of segments, modalities of CT, calibration of CT numbers, calculation grid resolution and depth of material.

, These

Studies

have

been

carried

out

to

evaluate

the

effect

of

a

homogeneous

and

inhomogeneous

material

on

IMRT

Technique

(Intensity

Modulated

Radiotherapy)

using

Fan

Beam

CT

(FBCT)

and

Cone

Beam

CT

(CBCT)

for

the

Gamma

Index

(GI).

The

Phillips

Pinnacle

treatment

plan

was

used

to

replan

5

patients

on

right

side

of

lung

cancer.

Photon

6

MV

was

applied

to

this

technique

with

30

segments,

50

segments,

and

70

segments,

repectively.

Using

Calculation

Grid

Resolution

(CGR)

0.2

cm

and

0.4

cm

for

resolution

in

the

calculation

of

the

dose.

As

well

as

the

calibration

of

CT

numbers

(CCN)

FBCT,

CBCT,

and

the

linear

density

are

used

as

a

correction

CT

number.

The

planar

measurement

for

the

evaluation

of

Gamma

Index

(DD

2%

/

DTA

2

mm,

the

passing

rate

of

90%)

carried

out

at

100

cm

SAD

with

the

homogeneous

and

inhomogeneous

material

at

a

depth

of

1.5

cm,

5

cm,

and

10

cm,

respectively.

We

obtained

deviation

average

value

of

GI

between

CGR

0.2

cm

and

0.4

cm

using

the

homogeneous

material

on

FBCT

and

CBCT

modality

≤1.46%

and

≤

1:13%,

respectively.

As

well

as

the

material

inhomogeneous

deviation

of

≤

2.54%

(FBCT)

and

≤

1.74%

(CBCT).

The

deviation

of

the

average

GI

value

between

FBCT

with

CBCT

with

CGR

0.2

cm

respectively

≤

1.95%

(homogeneous)

and

≤

2.36%

(inhomogeneous).

Finally,

the

deviation

of

the

average

GI

value

between

homogeneous

and

equivalent

of

homogeneous

material

is

≤

0.80%.

From

the

results

obtained,

that

the

Gamma

Index

can

be

influenced

by

the

number

of

segments,

modalities

of

CT,

calibration

of

CT

numbers,

calculation

grid

resolution

and

depth

of

material.

Key

words

:

Calculation

Grid

Resolution,

Calibration

of

CT

Numbers,

Cone]"

"ABSTRAKPenelitian ini bertujuan untuk memverifikasi distribusi dosis pada teknik 3D-CRT dan IMRT dengan menggunakan dosimeter TLD rod dan film gafchromic EBT3 pada kasus payudara yang telah dibuat di TPS berdasarkan data klinis di Siloam Hospital TB Simatupang. Penelitian ini dilakukan menggunakan Linac Trilogy dengan TPS menggunakan modul Eclipse versi 11 yang memproduksi berkas foton dengan radiasi 6 dan 10 MV. Film EBT3 dengan ukuran 4 4 cm2 diiradiasi menggunakan energi 6 MV dalam variasi dosis 0 - 260 cGy. Penelitian ini menggunakan lapangan radiasi 10 10 cm2. Film dipindai menggunakan flatbed scanner Epson V700 dalam evaluasi pixel value. Perhitungan dan plot antara netOD dan dosis untuk mendapatkan kurva kalibrasi yang digunakan untuk memperoleh dosis pengukuran pada pasien. TLD rod dengan ukuran 3 mm diiradiasi dengan energi 6 MV dalam dosis 200 cGy. TLD dibaca menggunakan TLD reader Harshaw dalam bentuk muatan coulomb. Perhitungan dan plot antara muatan dan dosis akan mendapatkan faktor kalibrasi yang digunakan untuk memperoleh dosis pengukuran pada pasien. TLD dan film EBT3 ditempelkan pada 5 titik di masker yang digunakan pasien dimana titik 1 daerah trakea, titik 2 daerah aksila, titik 3 daerah mammaria interna, titik 4 daerah nipple, dan titik 5 mammae inferior. Hasil perbedaan dosis menunjukkan penggunaan film gafchromic EBT3 pada verifikasi dosis titik kasus kanker payudara lebih baik daripada TLD rod pada teknik 3D-CRT dan teknik IMRT. Perbedaan dosis antara TPS dan film EBT3 dalam rentang 0,66 sampai dengan 5,67 teknik 3D-CRT dan -0,67 sampai dengan -7,57 teknik IMRT . Perbedaan dosis antara TPS dan TLD rod dalam rentang -2,63 sampai dengan 29,14 teknik 3D-CRT dan -16,41 sampai dengan -46,84 teknik IMRT . Uji statistika menunjukkan korelasi kuat 1,00 tetapi tidak signifikan sig < 0,05 serta terdapat perbedaan dosis titik rata-rata yang signifikan antara film EBT3 dan TLD rod pada kelompok pasien sebelum dan setelah dilakukan operasi. Tidak terdapat perbedaan dosis titik rata-rata antara kelompok sebelum dan setelah dilakukan operasi baik teknik 3D-CRT maupun IMRT dan tidak terdapat perbedaan dosis titik rata-rata antara teknik 3D-CRT dan IMRT.

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ABSTRACTThe aim of thisresearch is to verify dose distribution in 3D CRT and IMRT by using TLD rod dosimeter and Gafchromic EBT3 films on breast cases that have been made in TPS based on clinical data at Siloam Hospital TB Simatupang.This research was conducted using Linac Trilogy with TPS using Eclipse module version 11 which produces photon beam with radiation of 6 and 10 MV.EBT3 films of size 4 4 cm2 were irradiated using 6MV photon beams in dose variation of 0 260 cGy. Radiation field of size 10 10 cm2 was used in this research. The irradiated EBT3 film was scanned using Epson V700 flatbed scanner to evaluate the pixel value. The calculation and plot between netOD and dose was used to get the calibration curve which will be used to obtain dose measurement for patients. TLD rod of size 3 mm was irradiated using 6 MV in dose variation of 200 cGy. TLD was read by using HarshawTLD reader in coulomb. The calculation and plot between netOD and dose will generate calibration factor used to get dose measurement for patients. TLD and EBT3 film were taped to 5 points in the mask used by patients where 1 point is the OAR trachea and 4 points is the PTV50. The results of dose difference at PTV50 with point orientation.TLD and EBT3 film were taped to 5 points in the mask used by patients wherethe first point is in the OAR trachea , the second point is in the axilla, the third point is in the mammaria interna, the fourth point is in the nipple, and the fifth point is in the mammae inferior. The result of differences in dose shows the use of gafchromic EBT3 film in dose verification on breast cancer is better than TLD rod in 3D CRT technique and IMRT technique. The dose difference between TPS and EBT3 film ranged from 0.66 to 5.67 3D CRT technique and 0.67 to 7.57 IMRT technique . The dose difference between TPS and TLD rod is in the range 2.63 to 29.14 3D CRT technique and 16.41 up to 46.84 IMRT technique . The statistical test showed a strong correlation 1.00 but insignificant sig "

"ABSTRAKPelaksanaan kontrol kualitas peralatan yang merupakan komponen jaminan kualitas (QA) termasuk audit eksternal independen sangat esensial dalam menjamin ketelitian radioterapi. Prosedur sebuah program QA tergantung pada keadaan masing-masing pelaksana radioterapi. Penelitian dilakukan menggunakan on site audit dengan detektor matriks dan film gafchromic untuk beberapa simulasi penyinaran meliputi fantom homogen dan inhomogen serta variasi lapangan dan wedge. Dari 39 titik pada central axis yang diuji menggunakan detektor matriks, 37 titik dikategorikan Pass dengan Optimal Level (σ < 3.3%) dan 2 titik Pass dengan Action Level (σ= 3.3%- 5%). Sedangkan hasil uji dengan detektor film gafchromic, 24 titik dikategorikan Pass dengan Optimal Level dan 11 titik Pass dengan Action Level sedangkan 4 titik Fail. Hasil audit keseluruhan didapatkan dengan memasukkan nilai deviasi maksimum hasil pengukuran 80% lapangan dengan detektor matriks. Dari 39 bidang yang diuji, 28 dikategorikan Pass dengan Optimal Level dan 6 bidang Pass dengan Action Level. 5 Bidang Fail dengan nilai deviasi mencapai 6.11%; 5,26%;7.51%; 5.16%; dan 5.26%. Nilai deviasi tersebut tidak memenuhi batas yang direkomendasikan. Laporan audit disusun berdasarkan kasus yang diuji. Dari 16 kasus, menurut hasil pengukuran detektor matriks 3 kasus dinyatakan Fail. Dari 16 kasus, menurut hasil pengukuran detektor film gafchromic, 4 kasus dinyatakan Fail.

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ABSTRACTExternal dosimetry audit of radiotherapy equipment as a part of Quality Assurance (QA) is recognized as best practice to help avoiding and identifying dosimetric errors as well as to ensure accurate dosimetry of radiotherapy facilities. Procedures on QA Program might differ between radiotherapy facilities and units. This experiment was carried out as an on site audit using matrix detector and gafchromic film on several irradiation simulations including homogenous and inhomogenous phantom, field variations, and wedge factors. Dose in 39 central axis points were measured by using matrix detector; 37 points were categorized as Pass with Optimal Level (σ < 3.3%) and 2 points were categorized as Pass with Action Level (σ= 3.3%- 5%). Measurement result of gafchromic film shown that 24 points were categorized Pass with Optimal Level, 11 points Pass with Action Level, and 4 points were Fail. The whole audit results were determined also by maximum deviation of 80% field measured using matrix detector. From 39 planes measured, 28 planes were categorized Pass with Optimal Level and 6 planes were Pass with Action Level. 5 planes were categorized Fail because its maximum deviation reached 6.11%; 5.26%; 7.51%, 5.16%, and 5.26%, exceeding the recommended limit. Audit reports were determined by case. From 16 cases that had been audited using matrix detector, 3 cases were considered Fail. From 16 cases that had been audited using gafchromic film, 4 cases were considered Fail.inhomogenous phantom field variations and wedge factors Dose in 39 central axis points were measured by using matrix detector 37 points were categorized as Pass with Optimal Level 3 3 and 2 points were categorized as Pass with Action Level 3 3 5 Measurement result of gafchromic film shown that 24 points were categorized Pass with Optimal Level 11 points Pass with Action Level and 4 points were Fail The whole audit results were determined also by maximum deviation of 80 field measured using matrix detector From 39 planes measured 28 planes were categorized Pass with Optimal Level and 6 planes were Pass with Action Level 5 planes were categorized Fail because its maximum deviation reached 6 11 5 26 7 51 5 16 and 5 26 exceeding the recommended limit Audit reports were determined by case From 16 cases that had been audited using matrix detector 3 cases were considered Fail From 16 cases that had been audited using gafchromic film 4 cases were considered Fail."

"ABSTRAKLeksell gamma knife (LGK) adalah salah satu modalitas terapi radiasi yang bersumber dari radioaktif Co-60. Teknik lapangan kecil dengan pemberian dosis radiasi tinggi kepada pasien dalam satu sesi harus dihitung secara akurat dan diverifikasi dengan cermat. Penelitian ini menggambarkan prosedur untuk memverifikasi keakuratan distribusi dosis pada Leksell Gamma Plan (LGP) menggunakan fantom RANDO dan film gafchromic EBT3. Pertama, dilakukan verifikasi berkas profil pada fantom standar LGK dan RANDO menggunakan ukuran kolimator 4 mm, 8 mm dan 16 mm untuk memperoleh nilai full width half maximum (FWHM), penumbra dan beam-symmetry, nilai FWHM yang diperoleh dibandingkan dengan nilai pada LGP. Selanjutnya verifikasi nilai dosis serap pada RANDO dengan vasiasi ukuran kolimator, jumlah shoot, volume dan lokasi tumor, diverifikasi mengggunakan film EBT3. Perhitungan distribusi dosis dilakukan menggunakan perangkat lunak ImageJ dan program MATLAB. Penelitian ini menunjukkan perbedaan nilai FWHM dan beam-symmetry terkecil antara LGP ​​dan fantom standar LGK terjadi pada ukuran kolimator 16 mm sebesar 0.42 mm dan 1.58% sedangkan perbedaan pada fantom RANDO adalah 0.45 mm dan 1.64%. Verifikasi dosis maksimum menunjukkan pada variasi jumlah shoot, kolimator 16 mm memiliki nilai deviasi yang paling stabil. Kesimpulannya, kolimator ukuran 16 mm memiliki akurasi nilai dosis, FWHM dan beam-symmetry sangat baik. Namun, pada volume tumor yang lebih kecil, kolimator 16 mm dengan single shoot memberikan nilai deviasi yang lebih tinggi.

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ABSTRACTLeksell gamma knife (LGK) is an advanced modality of radiation therapy sourced Co-60 radioactive for treating patient with intracranial lesion. Small field techniques with highly integrated radiation delivering to patients in single session must be calculated accurately and verified carefully. This study illustrates a procedure to verify the accuracy of dose distribution associated with Leksell Gamma Plan (LGP) using RANDO phantom and gafchromic EBT3 film dosimetry. First, we assessed the profile dose on LGK standard phantom with collimators size 4,8 and 16 mm and compared the results with the profile dose based on RANDO to obtained Full Width Half Maximum (FWHM), penumbra and beam-symmetry. Absorbed-dose distributions on RANDO with various combinations of lesion volume, collimator size, location and number of shots assessed by EBT3 film using LGK Perfexion. Scanned images of the measured films were processed following standard EBT3 film-handling procedures. Dose value calculation were performed using ImageJ software and MATLAB in-house software. The study shows samallest difference of FWHM and beam symmetry occurs at collimator size 16 mm, whereas discrepancy in standard phantom between LGP and measurement is 1.83 % and 1.58 % respectively and the discrepancy in RANDO phantom is 2.15 %, and 1.64 % respectively. Verification of max dose shows, colimator size 16 mm has the most stable deviation value in variation of number of shoots. In conclusion, collimator size 16 mm have a highest accuracy of dose value, FWHM and beam-symmetry value. However, on smaller lesion volume, collimator 16 mm with single shot give higher deviation dose value."

"ABSTRAKTPS merupakan modalitas penting dalam perlakuan terapi karena salah satu fungsinya sebagai penyedia informasi dosis yang akan diterima target. Oleh karena itu jaminan kualitas TPS harus dilakukan untuk menjamin akurasi perhitungan dosis sehingga perlakuan terapi dapat bersifat optimal. Tujuan penelitian ini adalah melakukan verifikasi dosis kalkulasi TPS sebagai salah satu prosedur jaminan kualitas serta untuk mengetahui rentang deviasi jika terdapat perbedaan antara dosis kalkulasi dengan dosis pengukuran. Penelitian dilakukan menggunakan fantom CIRS 002LFC model toraks di dua center radioterapi dengan tahapan penelitian berdasarkan publikasi IAEA melalui TECDOC-1583. Pengukuran dosis titik menggunakan dosimeter bilik ionisasi 0.6 cm3, film gafchromic EBT3, dan TLD kemudian dosis pengukuran dibandingkan dengan dosis kalkulasi TPS. Hasil penelitian menunjukkan deviasi dosis pada seluruh kasus uji untuk kedua center radioterapi masih berada di dalam rentang tolerasi. Deviasi dosis di center radioterapi 1 bernilai 0.272.00% untuk bilik ionisasi 0.6 cm3, -0.081.79% untuk film gafchromic EBT3, dan -0.214.93% untuk TLD. Deviasi dosis di center radioterapi 2 bernilai -0.602.68% untuk bilik ionisasi 0.6 cm3, 0.151.75% untuk film EBT3, dan -3.906.30% untuk TLD. Nilai deviasi dosis yang tinggi umumnya diperoleh pada pengukuran dengan geometri kompleks seperti penggunaan blok, berkas tangensial, dan perputaran kolimator serta pengukuran pada material inhomogen (paru-paru dan tulang). Pengukuran di titik dengan perluasan penumbra (titik 10 kasus uji 6) gagal dilakukan menggunakan dosimeter bilik ionisasi namun menghasilkan deviasi yang rendah pada dua dosimeter lainnya. Kesimpulan dari penelitian in adalah semua unit TPS menunjukkan performa yang baik. Hasil pengukuran menunjukkan TLD merupakan dosimeter dengan akurasi dan presisi yang paling buruk. Tingkat akurasi keseluruhan dosimeter yang digunakan adalah film EBT3 dengan -0.05%, bilik ionisasi dengan -0.23%, dan TLD dengan -2.24%.

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ABSTRAKTPS is an important modality in therapy planning since it provides calculated dose information that will be received by target. Thus TPS quality assurance must be conducted to ensure the accuracy of dose calculation hence optimal therapy treatment could be achieved. The aim of this study is to verify TPS calculated dose as one of quality assurance procedures and also to know the deviation range if there are differences between calculated and measured dose. This study was performed using phantom CIRS thorax model 002LFC on 2 radiotherapy centers. The method of this study is based on IAEA TECDOC-1583. Point dose measurement was accomplished using 0.6 cm3 ionization chamber, gafchromic EBT3 film, and TLD then the measured dose was compared to calculated dose. The result of this study showed that the dose deviation of entire test cases on both radiotherapy centers are still below agreement criterion. Dose deviations on first radiotherapy center are 0.272.00% for 0.6 cm3 ionization chamber, -0.081.79% for gafchromic EBT3 film, and -0.214.93% for TLD. Meanwhile, dose deviations on second radiotherapy center are -0.602.68% for 0.6 cm3 ionization chamber, 0.151.75% for gafchromic EBT3 film, and -3.906.30% for TLD. Dose deviation out of agreement criterion generally discovered on measurement with complex geometry such as blocked field, tangential field, collimator rotation and measurement on inhomogen materials (lungs and bone equivalent) as well. Measurement on widening penumbra (point 10 test case 6) was failed to be conducted using ionization chamber yet yield dose deviation below agreement criterion with two others dosimeters. The conclusion of this study is all TPS units that were involved showed good performance of dose calculation. Measurement results also conclude that TLD is a dosimeter with the worst accuracy and precision. The accuracy order of dosimeters used in this study is gafchromic EBT3 film with -0.05%, ionization chamber with -0.23%, and TLD with -2.24%."

"ABSTRAKTindakan terapi bertujuan untuk memperoleh hasil yang optimal berupakematian jaringan kanker sebanyak mungkin dan kerusakan minimal padajaringan sehat sehingga dilakukan upaya untuk mengoptimalkan hasil pengobatanradiasi. Dengan perkembangan teknologi, teknik radioterapi juga berkembangdari konvesional, 3D conformal ke Intensity Modulated Radiotherapy (IMRT).IMRT merupakan teknik meggunakan banyak lapangan radiasi dalampenyinarannya dengan intensitas yang tidak seragam pada setiap arah lapanganradiasi. Sebelum dilakukan penyinaran pada pasien perlu dilakukan verifikasipenyinaran IMRT antara perhitungan pada TPS dan pada keadaan sebenarnyadilapangan. Verifikasi dilakukan dengan mengguunakan film gafchromic EBT2.Pada penelitian ini dilakukan verifikasi penyinaran IMRT dengan klinisGlioblastoma Multiforme pada 5 pasien distribusi dosis akumulasi dan 3 pasienuntuk distribusi dosis per lapangan penyinaran menggunakan film gafchromicEBT2. Didapatkan kesesuaian piksel untuk semua pasien dengan kriteria gamma≤ 1 dengan 3% dose different dan 3 mm DTA. Hasil verifikasi untuk distribusidosis akumulasi pada 5 pasien didapat kesesuaian piksel 100% pada 4 pasien danhanya 1 pasien yang mempunyai kesesuaian 99,8%. Kesesuaian piksel gammauntuk verifikasi setiap lapangan penyinaran pasien pada pasien 1, 87%; 85,4%;85,9%; 80,5%; 92,3%; 100%; pasien 2; 91,1%; 89,9%; 89,4%; 87,8%; 80,5%;100%; pasien 3; 79,3%; 88,5%; 77,5%; 84,9%; 83,1%; 99,8%. Hasil kesesuaianpiksel pada distribusi dosis perlapangan penyinaran kurang baik karena dosisperlapangan penyinaran rendah maka tingkat kehitaman film gafchromic EBT2rendah. Film gafchromic EBT2 memberikan hasil yang baik pada lapanganpenyinaran akumulasi. Evaluasi dose difference dengan kriteria 3% memberikanhasil banyak daerah yang tidak cocok (tidak lolos) sehingga kesesuaian pikselrendah karena dosis pada film disetiap piksel cukup fluktuatif dan adanyaperbedaan resolusi film dengan dose matrix. Evaluasi menggunakan DTA sajatidak dapat digunakan untuk mengevaluasi verifikasi IMRT karena pada tiappikselnya mempunyai kecocokan (lolos) pada kriteria 3mm sehingga mempunyaikesesuaian pixel yang baik. Sehingga untuk mengevaluasi verifikasi IMRT harusmenggunakan gabungan DTA dan dose difference yaitu menggunakan evaluasinilai gamma.

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ABSTRACTTherapy aims is to obtain optimal results to kill cancer tissue with minimaldamage in healthy tissue, so we need to optimize the radiation treatment.Technology has developed from conventional radiotherapy, 3D conformal toIntensity Modulated Radiotherapy (IMRT). IMRT is a technique which has manyradiation field with non uniform intensity in every from many directions. Beforethe irradiation done in patients we need to verify the IMRT delivery between TPSand the calculations on the actual conditions the field using gafchromic EBT2film. In this study IMRT verification were done on glioblastoma multiforme on 5patients verification with are 2 patient verified using composite field 3 patientswere verificed using per-field radiation using film gafchromic EBT2. Pixelpassing level criteria for all patients using gamma criteria of 3% ≤ 1 with adifferent dose and 3 mm DTA. Verification for the distribution of the accumulateddose on 5 patients are 100% pixel passing on 4 patients and 1 patient 99.8%.Verification of each pixel passing gamma radiation field in patients 1 patient,87%, 85.4%, 85.9%, 80.5%, 92.3%; patient 2; 91.1%, 89.9 %, 89.4%, 87.8%,80.5%; patient 3; 79.3%, 88.5%, 77.5%, 84.9%, 83.1%. The results of passingpixel per field radiation distributions is not good because of low radiation dosesper field. Gafchromic EBT2 film give good results in the accumulation ofradiation field. Evaluation of dose difference with the criteria of 3% give theresults of many areas that do not pass resolution between with the dose matrixfrom TPS. Evaluation using DTA can not be used to evaluate IMRT verificationbecause at each pixel a pass on 3mm criteria so as to have a good fit pixel. So theevaluation should IMRT verification using a combined DTA and dose differenceis using the evaluation value of gamma."

"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)"

"Telah dilakukan pengukuran dosis titik dan distribusi dosis menggunakan film gafchromic EBT3 pada HDR brakhiterapi dengan aplikator silinder. Adapun tujuan utama dilakukannya penelitian ini yaitu mengetahui karakteristik film gafchromic EBT3 dalam pengukuran brakhiterapi, mengevaluasi dosis pengukuran dengan dosis TPS melalui pengukuran dosis titik, serta mengetahui distribusi dosis di sepanjang sumber brakhiterapi. Evaluasi dosis titik dilakukan dengan mengevaluasi nilai dosis di titik pengukuran A1, A2, A3, dan A4 dengan dosis kalkulasi TPS. Titik A1 dan A2 merupakan titik preskripsi yang berada di sisi kanan dan kiri aplikator silinder. Pengukuran dosis titik dilakukan dengan variasi 13 mm, 14 mm, dan 15 mm dari sumber. Sedangkan, titik A3 dan A4 merupakan titik yang berada di atas A2 dan A1 dengan jarak 1.5 cm. Pengukuran distribusi dosis dilakukan pada jarak 10 mm dan 15 mm dari sumber. Hasil pengukuran menunjukkan bahwa kalibrasi film gafchromic EBT3 yang paling baik yaitu kalibrasi 13 mm dengan nilai diskrepansi untuk titik A1, A2, A3, dan A4 berturut-turut adalah -0.37 , -3.40 , -1.39 , dan -1.54 . Nilai diskrepansi pada jarak 10 mm dari sumber sebesar -0.26 dan pada jarak 15 mm dari sumber sebesar 7.5 .

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Point dose measurements and dose distributions have been conducted in HDR brachytherapy with cylinder applicator using EBT3 gafchromic film. The main objective of this study was to know the characteristics of EBT3 gafchromic film, to evaluate doses between measurements and brachytherapy treatment planning, and to know dose distribution along the source rsquo s main axis. The evaluation of point dose have been performed by comparing dose value in point A1, A2, A3, and A4 of the measurements with dose in treatment planning. Point A1 and A2 are prescription point at the right side and the left side of cylinder applicator. Measurement of point dose have been varied by distance of 13 mm, 14 mm, and 15 mm from brachytherapy source. Point A3 and A4 are located at distance of 1.5 cm above point A2 and A1. Dose distribution was measured at distance of 10 mm and 15 mm from brachytherapy source. The most suitable calibration for point dose measurements is calibration 13 mm which discrepancy values for point A1, A2, A3, and A4 were 0.37 , 3.40 , 1.39 , and 1.54 . The discrepancy value for dose distribution measurements at distance of 10 mm and 15 mm from the source was 0.26 and 7.5 , respectively."

"ABSTRAKPotensi induksi radiasi sekunder tidak hanya bergantung pada jumlah dosis penyerapan yang diberikan, tetapi juga pada karakteristik pasien. Selama perlakuan terapi menggunakan Gamma Knife Radiosurgery (GKRS), tubuh pasien menerima iradiasi akumulasi dosis hamburan dan kebocoran. Oleh karena itu, perlu untuk mengetahui dosis radiasi organ kritis pasien yang diterima selama perawatan Gamma Knife Radiosurgery dan membandingkan dengan batasan dosis masing-masing organ. Pengukuran dilakukan dengan menggunakan dosimeter film GafChromic XR-QA2 dan thermoluminescent dosimeter (TLD) yang diletakkan pada permukaan organ kritis fantom. Pemasangan head frame di fantom antropomorfik (Alderson Rando Phantom, Laboratorium Penelitian Alderson, Inc., Stamford, Connecticut) dan scalp measurement digunakan untuk mengukur geometri kepala fantom. Magnetic Resonance Imaging (MRI) digunakan untuk memperoleh citra fantom antropomorfik dan kemudian dipindahkan ke Leksell Gamma Planning (LGP) untuk menentukan perencanaan posisi target, distribusi dosis dan dosis preskripsi maksimum pada target 36 Gy. Unit LGK Perfexion (Elekta AB, Stockholm, Swedia) digunakan untuk menyinari fantom dengan target diposisikan di tengah, dan volume target divariasi dari 5 cc, 10 cc, 15, dan 20 cc serta ukuran kolimator dari 4 mm, 8 mm, dan 16 mm. Dosimeter diletakkan di permukaan lensa, tiroid, payudara, fundus uterus, ovarium, dan testis. Kemudian dosimeter dianalisa untuk memperoleh dosis pada organ kritis. Hasil pengukuran menunjukkan bahwa dosis yang terlihat pada lensa, tiroid, dan payudara dipengaruhi oleh jarak organ dari target, volume target, dan ukuran kolimator. Diperoleh bahwa dosis radiasi pada organ kritis berkontribusi kurang dari 3%, relatif terhadap dosis target maksimum. Dosis radiasi pada organ kritis yang diambil menggunakan film GafChromic XR-QA2 lebih tinggi dibandingkan TLD dengan diskrepansi mencapai 50%. Jika dibandingkan dengan referensi, pengukuran dosis XR-QA2 tidak jauh berbeda sehingga diketahui bahwa film XR-QA2 dapat digunakan untuk mengukur radiasi hambur. Namun, perhatian khusus dan optimisasi harus dilakukan untuk perencanaan perlakuan dengan mempertimbangkan ukuran kolimator yang digunakan dan meminimalkan waktu perlakuan.

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ABSTRACTThe potential for secondary radiation induction depends not only on the amount of absorption dose received, but also on patient characteristics, such as age (in general, younger patients will be more vulnerable). During treatment using Gamma Knife Radiosurgery (GKRS), patient's body receives an dose accumulation from scattering and leakage. Therefore, it is necessary to know the dose of patient's organs at risk (OAR) received during Gamma Knife Radiosurgery treatment and compare it with the dose limit of each organs. Measurements obtained using a GafChromic XR-QA2 dosimeter and thermoluminescent dosimeter (TLD) placed on the surface of phantom critical organs. Installation of head frame in anthropomorphic phantom (Alderson Rando Phantom, Alderson Research Laboratory, Inc., Stamford, Connecticut) and scalp measurement used to measure phantom head geometry. Magnetic Resonance Imaging (MRI) used to obtain anthropomorphic phantom image and then transferred to the Leksell Gamma Planning (LGP) to determine the planning treatment planning such as target position, dose distribution and target maximum prescription dose at 36 Gy. The LGK Perfexion unit (Elekta AB, Stockholm, Sweden) used to illuminate the phantom with the target positioned in the middle, and the target volume varies from 5 cc, 10 cc, 15 and 20 cc and collimator sizes from 4 mm, 8 mm and 16 mm. The dosimeters placed on the surface of the lens, thyroid, breast, uterine fundus, ovaries and testes. Then the dosimeters analyzed to obtain the dose in OAR. The measurement results shows that the dose at lens, thyroid, and breast depend on the distance from the target, target volume, and collimator size. The radiation dose in OAR contributed less than 3%, relative to the maximum target dose. The radiation dose in critical organs taken using GafChromic XR-QA2 film is higher than TLD with a 50% discrepancy. When compared with the reference, the measurement of XR-QA2 dose is not much different so it is known that XR-QA2 film can be used to measure scattering radiation. However, special attention and optimization must be done for treatment planning by considering the size of the collimator used and minimizing the treatment time."