title: Comparison of manual and inverse optimisation techniques in high dose rate intracavitary brachytherapy of cervical cancer: A dosimetric study.
abstract: OBJECTIVE
  To compare dosimetrically the manual optimisation with IPSA using dose volume histograms (DVH) among patients treated for carcinoma of cervix with intracavitary brachytherapy.
  
  
  BACKGROUND
  With the advent of advanced imaging modalities, there has been a shift from conventional X-ray based planning to three-dimensional planning. Manual optimisation is widely used across various institutions but it is time consuming and operator dependant. Inverse planning simulated annealing (IPSA) is now available in various brachytherapy planning systems. But there is a paucity of studies comparing manual optimisation and IPSA in treatment of carcinoma cervix with intracavitary brachytherapy and hence this study.
  
  
  METHODS
  Fifteen consecutive patients treated between December 2013 and March 2014 with intracavitary brachytherapy for carcinoma of cervix were selected for this study. All patients were initially treated with external beam radiotherapy followed by intracavitary brachytherapy. The DVH was evaluated and compared between manually optimised plans and IPSA in the same set of patients.
  
  
  RESULTS
  There was a significant improvement in the HRCTV coverage, mean V100 of 87.75% and 82.37% (p = 0.001) and conformity index 0.67 and 0.6 (p = 0.007) for plans generated using IPSA and manual optimisation, respectively. Homogeneity index and dose to the OARs remained similar between the two groups.
  
  
  CONCLUSIONS
  The use of inverse planning in intracavitary brachytherapy of cervix has shown a significant improvement in the target volume coverage when compared with manual planning.
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Ram Abhinav
authors.initials: RA
authors.lastname: Kannan
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Janaki Manur
authors.initials: JM
authors.lastname: Gururajachar
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Arul
authors.initials: A
authors.lastname: Ponni
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Kirthi
authors.initials: K
authors.lastname: Koushik
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Kumar
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Ram Charith
authors.initials: RC
authors.lastname: Alva
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Ritika
authors.initials: R
authors.lastname: Harjani
authors.affiliation: Department of Radiation Oncology, M.S. Ramaiah Medical College, Bangalore 54, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Murthy
keywords: Carcinoma cervix; High dose rate; Inverse planning; Manual Optimisation