title: Comparison of two planning systems for HDR brachytherapy gynecological application.
abstract: OBJECTIVE
  This report compares the Nucletron NPS and PLATO planning system for patients treated for cervix cancer.
  
  
  METHODS
  This study compares calculations generated using the older NPS (version 11.43) planning system and the more recent PLATO (version 14.1) system for two cases: 1) a single dwell position and 2) an actual patient application using a tandem and ovoid.
  
  
  RESULTS
  For one dwell position: for NPS planning the dose for points along the source axis forward of the cable was 9.85% more than for symmetrically placed points in the cable direction. For PLATO, the same test gave rise to a difference of 10.2%. Comparing the two systems, NPS calculated doses for points in the forward direction 14% greater than those calculated by PLATO. The entry of points using the digitizer accounted for less than 1% of any difference. For the patient case: the dose difference between NPS and PLATO planning for all patient reference points entered from films ranged from 1 to 4%. The difference in dose between optimized and nonoptimized planning was approximately 0.5% for prescription points (points A), while for the bladder and rectum the differences were 6% and 20%, respectively with NPS, and with PLATO, 8% and 22%, respectively.
  
  
  CONCLUSIONS
  This study highlighted the effects of the differences in the calculational algorithm between the older and newer planning systems from Nucletron. While the differences were minimal on the perpendicular bisector of the source, along the axis they become considerable. In a practical gynecological case, these differences mostly affect the dose to the rectum, since that organ receives the greatest proportion of its dose from rays near the same axis. Overall, the PLATO system plan required about 2.5% less integrated reference air kerma than the NPS plan for the same dose to point A. For either planning system, optimization is crucial in decreasing dose to bladder and rectal points.
authors.affiliation: Department of Human Oncology, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: O A
authors.initials: OA
authors.lastname: Elhanafy
authors.forename: M D
authors.initials: MD
authors.lastname: Migahed
authors.forename: H A
authors.initials: HA
authors.lastname: Sakr
authors.forename: M
authors.initials: M
authors.lastname: Ellithy
authors.forename: R K
authors.initials: RK
authors.lastname: Das
authors.forename: H J
authors.initials: HJ
authors.lastname: Odau
authors.forename: B R
authors.initials: BR
authors.lastname: Thomadsen
mesh_terms: D000465:Algorithms; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D006801:Humans; D011829:Radiation Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*