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Aim:Radiation therapy has historically used margins for target volume to ensure dosimetric planning criteria. The size of margin for a given treatment site is still uncertain particularly for moving targets along with set-up variations leading to a fuzziness of target volume. In this study, we have estimated the dosimetric benefit of normal structures using biological-based optimal margins. The treatment margins are derived by knowledge-based fuzzy logic technique which is considering the radiotherapy uncertainties in treatment planning.Materials and methods:All treatment plans were performed using stepped increments of asymmetric margins to estimate prostate radiobiological indices such as tumour control probability (TCP) and normal tissue complication probability (NTCP). An absolute NTCP of 5% was considered to be the maximum acceptable value while TCP of 85% was considered to be the minimal acceptable limit for each volumetric modulated arc therapy (VMAT) plan of localised prostate cancer radiotherapy. Results were used to formulate rules and membership functions for Mamdani-type fuzzy inference system (FIS). In implementing the rules for the fuzzy system for ΔNTCP values above 10%, the PTV margin was not permitted to exceed 5 mm to avoid rectal complications due to margin selection. The new margins were applied in VMAT planning of prostate cancer for standard displacement errors. The dosimetric results of normal tissue predictors were estimated such as organ mean doses, rectum V60 (volume receiving 60 Gy), bladder V65 (volume receiving 65 Gy) and other clinically significant dose–volume indicators and compared with VMAT plans using current margin formulations.Results:Dosimetric results compared well to the results obtained by current techniques. Good agreement was obtained between proposed fuzzy model margins and currently used margins in lower error magnitude, but significant results were observed at higher error magnitude when organ toxicity concerned without compromising the target volumes.Findings:The new margins may be helpful to estimate possible outcomes of normal tissue complications and thus may improve complication free survival particularly when organ motion errors are inevitable, case by case.

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.

Start your abstract here…External beam radiation therapy (EBRT) is a process in which therapeutic radiation dose is delivered to targettissues whilst seeking the risk of healthynormal and critical organs is minimal. In case of Complex radiation therapy technique such as volumetric modulated arc radiotherapy (VMAT), there is requirement of precise and optimal treatment margin selection so that not only the resulting dose distributions gives high tumor control probability(TCP) but also dose close to critical organs will get minimal. A fuzzy logic application was used here to derive the optimal radiotherapy treatment margins to be used in radiation therapy treatment planning. Here major all possible radiotherapy uncertainties accounted such as translational set-up, organdelineation and organ motion-induced errors for calculating the quantitative variations in target volume radiobiological parameters for treatment plans using fixed step sized increments of treatment margins up to maximum possible variations of tumor volumes. Therules and membership functions were adopted from dosimetricresults of treatment planning for the fuzzy inference system. The imprecision and smoothness of the original fuzzy output was corrected with application of a convolution technique. The results demonstrate that performance of the applied fuzzy model margins against current used radiotherapy margins was consistent inlower range of error magnitude but beyond that a significant non-linearly margin performance was found when considering the normal tissue complication probability (NTCP) and constraint factors into account in the margin recipe formulation. With the new margins obtained then applied for the study of prostate cancer treatment planning and results were compared well with current volumetric modulated arc radiotherapy (VMAT)technique.

Background: Recently it was data wise established that there is a considerable dose difference due to source position from the surface of the patient, and due to the presence of inhomogeneities. Aim: It aims at to find out the dose difference due to source position, and inhomogenieties in water phantom of high dose rate (HDR) 192 Ir mHDR-v2 source by experiment and by Monte Carlo (MC) simulation GEANT4 code. Materials and Methods: The measured study of the source was done using an in-air ionization chamber, water phantom while the calculated study was done by modeling the water phantom and its water, inhomogeneities, position of source, and points of calculation. Results: The measured and calculated dose differences are 5.48 to 6.46% and 5.43 to 6.44% respectively higher in the presence of dry air and 4.40 to 4.90% and 4.38 to 4.88% respectively lower in the presence of cortical bone. However, for the study of the effect of source position on dose distribution, when the source was positioned at a 1 cm distance from the surface of water phantom, the near points between 1 cm and 2 cm are 2 to 3.5% and 2.1-3.7% underdose and for distant points from 3 cm to 8 cm from the source are 4 to 15% and 4.1 to 15.8% underdose for measured and calculated studies, respectively, to the dose when the source was positioned at midpoint of water phantom. Conclusion: These results can be used in the treatment planning system.

Background: The conventional treatment planning system (TPS) gives analytical calculations with approximately ±15?20% dose uncertainty, which may lead to over exposure of critical organs or under dose of target as well as the presence of inhomogeneities, and the position of source affects the exact dose calculation like in breast and intraluminal brachytherapy. Aim: To obtain dose distribution parameters of GammaMed Plus high dose rate (HDR) 192 Ir source using Monte Carlo (MC) EGSnrc and GEANT4 codes as well as to find the effect on dose distribution due to source position, and due to presence of air and cortical bone by using MC GEANT4 code, and to find the similarity of both studies with any past study of any HDR brachytherapy source for either as input to TPS or verification of TPS calculations. Settings and Design: It is done using different software of the computer, e.g., excel, MS word, etc. Materials and Methods: The source, source position for different studies, water phantom, water characteristics, points of measurements, air and cortical bone inhomogeneities, and position of inhomogeneities were simulated. Statistical Analysis Used: For uncertainties calculation, mean and probability are used. Results: The calculated dose rate constant, radial dose function, and 2D anisotropy function of the source show similarity with published data. Calculated dose distribution differences due to presence of air and cortical bone, and position of source in water phantom also show similarity with published data. Conclusion: These results can either be implemented in TPS or can be used for verification of TPS calculations.

The conventional treatment planning system (TPS) gives analytical calculations with ± 15 to 20% dose, which may lead to over exposure of critical organs or under dose of target. It is to obtain dose distribution parameters of nucletron high dose rate (HDR) microselectron v2 (mHDR-v2) 192 Ir brachytherapy source by experiment and by calculated study using Monte Carlo (MC) EGSnrc code, and to find the similarity between them, and with any past study. To validate data, another MC GEANT4 study done in this work on the same source is also presented. Different software of the computer e.g. paint, excel, etc are employed for preparation of figures and graphs. The measured study of the source was done using an in-air ionization chamber, water phantom, and measurement set-up, while the calculated study was done by modeling the set up of the measured study by using the MC EGSnrc and GEANT4. Mean and probability are used in calculation of average values, and calculation of the uncertainties in result and discussion. The measured and calculated values of dose rate constant, radial dose function, and 2D anisotropy function were found to be in agreement with each other as well as with published data. The results of this study can be used as input to TPS.

Background: The presence of least dense dry air and highly dense cortical bone in the path of radiation and the position of source, near or far from the surface of patient, affects the exact dose delivery like in breast brachytherapy. Aim: This study aims to find out the dose difference in the presence of inhomogenieties like cortical bone and dry air as well as to find out difference of dose due to position of source in water phantom of high dose rate (HDR) 192 Ir nucletron microselectron v2 (mHDRv2) brachytherapy source using Monte Carlo (MC) simulation EGSnrc code, so that the results could be used in Treatment Planning System (TPS) for more precise brachytherapy treatment. Settings and Design: The settings and design are done using different software of the computer. Methods and Materials: For this study, the said source, water phantom of volume 30 x 30 x 30 cm 3 , inhomogeneities each of volume 1 x 2 x 2 cm 3 with their position, water of water phantom and position of source are modeled using three-dimensional MC EGSnrc code. Statistical Analysis Used: Mean and probability are used for results and discussion. Results : The % relative dose difference is calculated here as 5.5 to 6.5% higher and 4.5 to 5% lower in the presence of air and cortical bone respectively at transverse axis of the source, which may be due to difference of linear attenuation coefficients of the inhomogeneities. However, when the source was positioned at 1 cm distance from the surface of water phantom, the near points between 1 to 2 cm and 3 to 8 cm. from the source, at its transverse axis, were 2 to 3.5% and 4 to 16% underdose to the dose when the source was positioned at mid-point of water phantom. This may be due to lack of back scatter material when the source was positioned very near to the surface of said water phantom and overlap of the additional cause of missing scatter component with the primary dose for near points from the source. These results were found in good agreement with literature data. Conclusion: The results can be used in TPS.