Clinical Efficacy of an Electronic Portal Imaging Device versus a Physical Phantom Tool for Patient-Specific Quality Assurance.

Pre-treatment patient-specific quality assurance (QA) is critical to prevent radiation accidents. The electronic portal imaging device (EPID) is a dose measurement tool with good resolution and a low volume-averaging effect. EPIbeam­an EPID-based portal dosimetry software­has been newly installed in three institutions in Korea. This study evaluated the efficacy of the EPID-based patient-specific QA tool versus the PTW729 detector (a previously used QA tool) based on gamma criteria and planning target volume (PTV). A significant difference was confirmed through the R statistical analysis software. The average gamma passing rates of PTW729 and EPIbeam were 98.73% and 99.60% on 3 mm/3% (local), 96.66% and 97.91% on 2 mm/2% (local), and 88.41% and 74.87% on 1 mm/1% (local), respectively. The p-values between them were 0.015 (3 mm/3%, local), 0.084 (2 mm/2%, local), and less than 0.01 (1 mm/1%, local). Further, the average gamma passing rates of PTW 729 and EPIbeam according to PTV size were 99.55% and 99.91% (PTV < 150 cm3) and 97.91% and 99.28% (PTV > 150 cm3), respectively. The p-values between them were 0.087 (PTV < 150 cm3) and 0.036 (PTV > 150 cm3). These results confirm that EPIbeam can be an effective patient-specific QA tool.

Customized 3D Bolus Applied to the Oral Cavity and Supraclavicular Area for Head and Neck Cancer.

BACKGROUND/AIM: In this study, a new method to create a customized three-dimensional (3D) bolus by accurately considering the anatomy of an individual patient is demonstrated. PATIENTS AND METHODS: A 3D bolus structure was created from an extended planning target volume (PTV) to reduce an inevitable skin reaction. In addition, during computed tomography simulation in patients with oral cavity cancers, a balloon was inserted into the mouth of a patient to secure space, and then the area surrounding the balloon was designed into a 3D bolus structure. RESULTS: For patients with head and neck cancers, a customized 3D bolus can reduce the unnecessary skin dose by 14.4% compared to a commercial bolus. For patients with oral cavity cancer, the PTV and tongue doses were 93.8% and 8% of the prescribed dose, respectively. CONCLUSION: The customized 3D bolus enables effective skin sparing and full coverage of the target area.