title: Dosimetric verification of a high dose rate brachytherapy treatment planning system in homogeneous and heterogeneous media.
abstract: OBJECTIVE
  To verify the dosimetric accuracy of treatment plans in high dose rate (HDR) brachytherapy by using Gafchromic EBT2 film and to demonstrate the adequacy of dose calculations of a commercial treatment planning system (TPS) in a heterogeneous medium.
  
  
  METHODS
  Absorbed doses at chosen points in anatomically different tissue equivalent phantoms were measured using Gafchromic EBT2 film. In one case, tandem ovoid brachytherapy was performed in a homogeneous cervix phantom, whereas in the other, organ heterogeneities were introduced in a phantom to replicate the upper thorax for esophageal brachytherapy treatment. A commercially available TPS was used to perform treatment planning in each case and the EBT2 films were irradiated with the HDR Ir-192 brachytherapy source.
  
  
  RESULTS
  Film measurements in the cervix phantom were found to agree with the TPS calculated values within 3% in the clinically relevant volume. In the thorax phantom, the presence of surrounding heterogeneities was not seen to affect the dose distribution in the volume being treated, whereas, a little dose perturbation was observed at the lung surface. Doses to the spinal cord and to the sternum bone were overestimated and underestimated by 14.6% and 16.5% respectively by the TPS relative to the film measurements. At the trachea wall facing the esophagus, a dose reduction of 10% was noticed in the measurements.
  
  
  CONCLUSIONS
  The dose calculation accuracy of the TPS was confirmed in homogeneous medium, whereas, it was proved inadequate to produce correct dosimetric results in conditions of tissue heterogeneity.
authors.affiliation: Department of Radiology, Himalayan Institute of Medical Sciences, HIHT University, C-I-5, HIHT Campus, Swami Ram Nagar, P.O. Doiwala, Jolly Grant, Dehradun, Uttarakhand 248140, India. uniyal.satish@rediffmail.com
authors.forename: S C
authors.initials: SC
authors.lastname: Uniyal
authors.forename: S D
authors.initials: SD
authors.lastname: Sharma
authors.forename: U C
authors.initials: UC
authors.lastname: Naithani
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D002138:Calibration; D002584:Cervix Uteri / Q000528:radiation effects; D005260:Female; D006801:Humans; D019047:Phantoms, Imaging; D011829:Radiation Dosage; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D013909:Thorax / Q000528:radiation effects