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Abstrak :
[ABSTRAK
Tujuan dari penelitian ini adalah mengevaluasi akurasi perencanaan dan pemberian perlakuan volumetric modulated arc therapy (VMAT) menggunakan rekomendasi AAPM Task Group (TG) 119 di Departemen Radioterapi MRCCC Siloam Hospitals Semanggi. TG 119 menetapkan dua tes pendahuluan dan lima tes menyerupai kondisi klinis, serta confidence limit (CL) sebagai nilai standar pengujian. Perencanaan intensity modulated radiation therapy (IMRT) dan VMAT dibuat lokal mengikuti preskripsi dosis dan sasaran perencanaan yang ditetapkan oleh TG 119, kemudian hasil perencanaan lokal dibandingkan dengan hasil TG 119. Pengukuran dosis titik dari pemberian perlakuan IMRT dan VMAT pada daerah dosis tinggi dan rendah diukur menggunakan tiga bilik ionisasi dengan volume aktif yang berbeda, sedangkan pengukuran dosis penampang menggunakan detektor 2D array, distribusi dosis penampang dianalisa dengan kriteria indeks gamma 3 %, 3 mm dan 2 %, 2 mm. CL hasil pengukuran dosis titik IMRT pada daerah dosis tinggi dan rendah 1.06 % dan 0.82 % (CC01), 1.19 % dan 1.58 % (CC13), 1.37 % dan 3.02 % (FC65G). Untuk VMAT 1.47 % dan 1.17 % (CC01), 1.71 % dan 1.95 % (CC13), 2.08 % dan 3.96 % (FC65G). Hasil pengukuran menggunakan bilik ionisasi CC01 dan CC13 mampu memenuhi kriteria yang ditetapkan TG 119 dibawah 3 %, sedangkan bilik ioisasi FC65G tidak memenuhi kriteria tersebut. Hasil CL analisa indeks gamma IMRT dengan kriteria gamma 3 %, 3 mm dan 2 %, 2mm sebesar 3.68 dan 11.71 (96.32 % dan 88.29 % pass), sedangkan untuk VMAT sebesar 1.44 dan 6.33 (98.56 % dan 93.67 % pass), kedua hasil indeks gamma tersebut masuk dalam kriteria TG 119 dibawah 12.4. Berdasarkan hasil tersebut, rekomendasi TG 119 dapat diimplementasikan untuk menguji akurasi perencanaan dan pemberian perlakuan VMAT, hasil tersebut juga menunjukkan keakurasian yang cukup dari perencanaan dan pemberian perlakuan VMAT di institusi lokal.

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ABSTRACT
The purpose of this study was to evaluate the accuracy of treatment planning and delivery of Volumetric Modulated Arc Therapy (VMAT) using recommendation of AAPM Task Group (TG) 119 in the Department of Radiotherapy MRCCC Siloam Hospitals Semanggi. TG 119 establishes two preliminary tests and five tests resemble a clinical condition, as well as the confidence limit (CL) as a benchmark data. Dose prescriptions and planning objectives recommended by TG 119 report were followed to generate Intensity Modulated Radiation Therapy (IMRT) and VMAT treatment planning, and then the local planning results compared with the results of TG 119. Point dose measurements were done using three ionization chambers with different active volume at high dose and low dose regions. The planar dose measurements were measured using a 2D detector array and the planar dose distribution was analyzed for percentage of points passing the gamma criteria of 3 %, 3 mm and 2 %, 2 mm. For IMRT plans, the CLs obtained for point dose measurement in areas of high and low doses were 1.06 % and 0.82 % (CC01), 1.19 % and 1.58 % (CC13), 1.37 and 3.02 % (FC65G), whereas a value of 1.47 and 1.17 % (CC01), 1.71 % and 1.95 % (CC13), 2.08 % and 3.96 % (FC65G) for CL VMAT. Point dose measurement results using ion chamber CC01 and CC13 were able to meet the criteria set by TG 119 below 3 %, while for ion chamber FC65G could not meet these criteria. From gamma analysis, CL IMRT for gamma criteria 3 %, 3 mm and 2 %, 2 mm were 3.68 and 11.71 (96.32 % and 88.29 % pass), while for VMAT were 1.44 and 6.33 (98.56 % and 93.67 % pass), gamma index results falls within the criteria TG 119 under 12.4. Based on the results, TG 119 recommendations can be implemented on commissioning VMAT treatment planning and delivery, these results also indicate adequate accuracy of VMAT treatment planning and delivery in local institution, The purpose of this study was to evaluate the accuracy of treatment planning and delivery of Volumetric Modulated Arc Therapy (VMAT) using recommendation of AAPM Task Group (TG) 119 in the Department of Radiotherapy MRCCC Siloam Hospitals Semanggi. TG 119 establishes two preliminary tests and five tests resemble a clinical condition, as well as the confidence limit (CL) as a benchmark data. Dose prescriptions and planning objectives recommended by TG 119 report were followed to generate Intensity Modulated Radiation Therapy (IMRT) and VMAT treatment planning, and then the local planning results compared with the results of TG 119. Point dose measurements were done using three ionization chambers with different active volume at high dose and low dose regions. The planar dose measurements were measured using a 2D detector array and the planar dose distribution was analyzed for percentage of points passing the gamma criteria of 3 %, 3 mm and 2 %, 2 mm. For IMRT plans, the CLs obtained for point dose measurement in areas of high and low doses were 1.06 % and 0.82 % (CC01), 1.19 % and 1.58 % (CC13), 1.37 and 3.02 % (FC65G), whereas a value of 1.47 and 1.17 % (CC01), 1.71 % and 1.95 % (CC13), 2.08 % and 3.96 % (FC65G) for CL VMAT. Point dose measurement results using ion chamber CC01 and CC13 were able to meet the criteria set by TG 119 below 3 %, while for ion chamber FC65G could not meet these criteria. From gamma analysis, CL IMRT for gamma criteria 3 %, 3 mm and 2 %, 2 mm were 3.68 and 11.71 (96.32 % and 88.29 % pass), while for VMAT were 1.44 and 6.33 (98.56 % and 93.67 % pass), gamma index results falls within the criteria TG 119 under 12.4. Based on the results, TG 119 recommendations can be implemented on commissioning VMAT treatment planning and delivery, these results also indicate adequate accuracy of VMAT treatment planning and delivery in local institution]

Abstrak :
Peningkatan keakuratan dan kepresisian dalam pengobatan radioterapi dapat dilakukan menggunakan teknologi lanjut radioterapi seperti Volumetric Modulation Arc Therapy (VMAT). Pemanfaatan teknik VMAT terhadap pemilihan orientasi gantri arc yang bersamaan dengan pergerakan multileaf collimator (MLC) perlu dilakukan verifikasi untuk memastikan ketepatan distribusi dosis pada saat perencanaan dan pengukuran. Tujuan dari penelitian ini adalah mengevaluasi dosis radioterapi teknik VMAT partial arc dan full arc berdasarkan struktur target yang disediakan oleh protokol AAPM TG 119 dan diverifikasi menggunakan protokol AAPM TG 218. Phantom dipindai menggunakan CT Simulator, hasil pemindaian dikirim ke Treatment Planning System (TPS) untuk dilakukan perencanaan teknik VMAT dengan variasi gantri arc. Penyinaran pada saat pengukuran dilakukan dengan metode true composite, dengan pengukuran dosis titik menggunakan bilik ionisasi CC13, pengukuran dosis planar field by field menggunakan EPID dan dosis planar composite menggunakan detektor 2D array MatriXXFFF. Kriteria gamma index yang digunakan 3%/2mm dan 2%/2mm. Hasil perencanaan teknik double arc menghasilkan distribusi dosis lebih baik dibandingkan dengan single arc, karena terjadi peningkatan modulasi selama optimasi. Hasil data pengukuran dosis titik lebih tinggi dibandingkan nilai perencanaan di TPS, hal ini karena adanya kebocoran efek tongue and groove pada saat pengukuran. Tingkat kelulusan gamma secara field by field mampu memenuhi kriteri 3%/2mm, namun tidak untuk penyinaran secara composite. Kemudian terjadi penurunan tingkat kelulusan gamma pada kriteria 2%/2mm. Confidence limit yang diperoleh secara universal tidak memenuhi kriteria yang diberikan artinya dosis perencanaan dengan dosis hasil pengukuran tidak konsisten seperti yang direkomendasikan oleh AAPM TG 119 dan AAPM TG 218. Evaluasi dosis VMAT dengan variasi gantri arc secara true composite pada penelitian ini menunjukkan bahwa terdapat metode pengukuran yang tidak sesuai dengan alat ukur yang digunakan dan kriteria gamma index yang terlalu ketat, sehingga diperlukan penggunaan alat ukur yang tepat dan parameter verifikasi yang sesuai. ......Advanced technology, such as Volumetric Modulation Arc Therapy (VMAT), can enhance the precision and accuracy of radiotherapy treatment. However, the reliability of the dose distribution during planning and measurement, the VMAT technique's gantry arc orientation selection, and multileaf collimator (MLC) movement need to be verified. This study aims to evaluate partial arc and full arc VMAT radiotherapy doses, utilizing the target structure provided by the American Association of Physicists in Medicine (AAPM) TG 119 protocol and verified using the AAPM TG 218 protocol. A CT Simulator scanned the phantom, and the scan results were integrated into the Treatment Planning System (TPS) for VMAT technique planning with varied gantry arc settings. During irradiation and measurement, the true composite method was employed, with point dose measurements using a CC13 ionization chamber, field-by-field planar dose measurements using EPID, and planar composite doses using a 2D array detector MatriXXFFF. The gamma index criteria employed were 3%/2mm and 2%/2mm. The results indicated that planning a double arc technique yielded superior dose distribution compared to a single arc, owing to increased modulation during optimization. Nevertheless, point dose measurement data exceeded the TPS planning values due to the leakage of the tongue and groove effect during measurement. While the field-by-field gamma pass rate met the 3%/2mm criteria, it did not suffice for composite irradiation. Furthermore, there was a further decrease in the gamma pass rate for the 2%/2mm criterion. The universally obtained confidence limit failed to meet the criteria, revealing inconsistencies between the planning dose and the dose measurement results, as recommended by AAPM TG 119 and AAPM TG 218. The evaluation of VMAT doses with gantry arc variations using true composite demonstrated that certain measurement methods did not align with the chosen measuring instrument, and the gamma index criteria proved excessively stringent. Therefore, using appropriate measuring instruments and verification parameters is crucial.