Author(s)

Seenisamy Ramapandian¹, Vivekanandan Nagarajan², Ashutosh Mukherji¹, Parthasarathy Vedasoundaram¹, K. S. Reddy³, Vivekanandam Singhavajala¹, Vijayaprabhu Neelakandan¹

¹Department of Radiotherapy, RCC, JIPMER, Pondicherry, India.
²Department of Medical Physics, Cancer Institute, Chennai, India.
³Department of Oncology, MGMC & RI, Puducherry, India.

Background: The delivered dose has to be checked and verified with planned dose since precise and accurate dose delivery is essential in Brachytherapy. Sources of uncertainty during Brachytherapy are intra-fraction, inter-fraction and inter-application variations. In-vivo dosimetry is the direct method to monitor the radiation dose delivered to a patient during radiotherapy. In this study, assessment of the inter-fraction and intra-fraction variations in the interstitial Brachytherapy was done with microMOSFET. Aim: To analyze the inter-fraction variations in dose delivery during interstitial HDR Brachytherapy and to compare the measured point dose with the TPS-calculated point dose, intra-fraction variation, using the microMOSFET in-vivo dosimeter. Materials and Methods: From May 2014 to February 2016, 22 patients with Head and Neck cancers and 8 patients with Soft-Tissue Sarcomas (STS) were selected for this study. All these patients underwent CT imaging more than 24 hours after the application. Brachyvision 3DTPS and GammaMed Plus iX HDR unit were used for treatments. MicroMOSFET in-vivo dosimeter after calibration was used for the measurements of dose inside the treated volume. Intra & Inter-fraction variations were analyzed and reported. Results: The SD of inter-fraction variation among 22 Head & Neck patients ranges from 2.14% to 14.26%. Minimum & maximum dose variation with first fraction dose of patients ranged from -22.33% to +26.71% and the mean doses were -6.42% to +19.76%. Differences of TPS dose and microMOSFET measured first fraction dose, intra-fraction variation, ranged from -12.36% to +5.05%. The SD of inter-fraction variation for 8 STS patients was from 2.81% to 14.43%. Minimum and maximum doses vary from -38.72% to +25.74% and mean dose varies from -21.5% to +12.53%. Differences of point doses of TPS and measured, intra-fraction variation, were from -5.86% to 4.88%. Conclusions: MicroMOSFET has the potential to minimize the gross errors during multi-fractionated Interstitial Brachytherapy. Edema, applicator displacements and placement of microMOSFET are the main influencing factors for inter-fraction uncertainty in dose delivery. Re-planning with re-simulated images should be considered whenever the microMOSFET readings vary more than ±10% of the planned dose inside the CTV measured in two successive fractions.

MicroMOSFET, Interstitial Brachytherapy, MicroMOSFET in Brachytherapy, In-Vivo Dosimetry in Brachytherapy, Dose Verification in Brachytherapy

Ramapandian, S. , Nagarajan, V. , Mukherji, A. , Vedasoundaram, P. , Reddy, K. , Singhavajala, V. and Neelakandan, V. (2017) Inter-Fraction and Intra-Fraction Variation in the Absorbed-Dose Delivery during Interstitial High Dose Rate Brachytherapy—A Study Using MicroMOSFET In-Vivo Dosimeter. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 6, 445-456. doi: 10.4236/ijmpcero.2017.64040.