Md. Motiur Rahman1*, Rubel Ahmed2, MMH Bhuiyan3, K.A. Khan1
1 Department of Physics, Jagannath University, Dhaka, Bangladesh
2 Department of Neurosurgery, TMSS Medical College, Gokul, Bangladesh
3 Department of Nuclear Medicine, Bangladesh Atomic Energy Commission, Dhaka, Bangladesh
Received: 16-May-2022, Manuscript No. RCT -22-63916; Editor assigned: 19- May -2022, PreQC No. RCT-22-63916 (PQ); Reviewed: 02-Jun-2022, QC No. RCT-22-63916; Revised: 09-Jun-2022, Manuscript No. RCT-22-63916 (R); Published: 16-Jun-2022, DOI: 10.4172/Rep cancer Treat.6.3.001
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The main concern and goal for oncologists and physicists in cancer treatments is accurate radiation therapy, dosage calculation, and quality control. Where Treatment Planning Systems (TPS) are not accessible, the global usage of Radiation Therapy Machines such as 60 Co and LINAC (Old) necessitates an accurate and quick External Beam Radiation Therapy (EBRT) machine dose evaluation. A medical physicist or dosimeters are not always available at cancer treatment centers. For this, we created the "Mithu" spreadsheet, which allows Radiation Oncologists, Physicists, and Radiotherapy Technologists to easily calculate Treatment Time (TT) or Monitor Unit (MU) using simple Microsoft Excel spreadsheets.
Treatment planning system; Spread sheets; Physicist; Oncologist
For dosimetry purpose most of the radiotherapy center follows IAEA Code of Practice based on standards of absorbed dose to water called TRS-398. IAEA developed Worksheets in MS Excel for the Codes of Practice for dose determination with therapeutic beams TRS-398. The "Mithu" spreadsheet was made for a radiation facility that didn't have a treatment planning system. In crowded government and private radiotherapy centres in South Asia and Africa, Medical Physicists can save patients dose calculation time. Another purpose is that in some Asian and African countries, medical physicists are not recruited in government hospitals that are why radiation oncologists and Radiotherapy technologists calculate treatment doses manually. As a result, there is a probability to increase treatment dose calculation error. Spreadsheet "Mithu" will be the best option for calculating treatment doses quickly [1]. The manual dose calculation is based on the treatment machine’s PDD, TMR, Output factor, and so on. For manual dose calculation and equipment acceptance most of the physicist follow British Journal of Radiology (BJR-25). Another benefit of these Mithu spreadsheets is that they can display the 25 days treatment dose schedule, which is the same as the LINAC plan for all days, but 60 Co is different due to its decay activity. One physicist must know how much dosage exits from the machine at a specified distance called the source to surface distance before applying the dose to the cancer patient. The majority of linear accelerators have SSD 100 cm, whereas the majority of 60 Co machines use SSD 80 cm, but SSD 100 60 Co machines are available on the market. D-Max is the amount of surface dose accumulated after a hit (ó-ray or X-ray) at a point inward from the surface. Spreadsheet "Mithu" will be useful in verifying the TPS System. We know 6 MV photon beam has 67% dose and 60 Co has 56% dose at 10 cm depth for 10 × 10 cm collimator jaw setup, according to BJR Suplimentary-25 data table. So, if we want to deliver a dose of 200 cGy at a depth of 10 cm, we'll need to deliver 298.5 cGy (Beam is calibrated at 1 MU=1 cGy). So, in TPS, we can expect the same dose in a same depth. If the TPS dose differs by more than 2% from our Spreadsheet "Mithu," then commissioning must be reviewed again. Photon (X-ray) and Electron (e-) therapy treatment options are available on the majority of dual energy Linacs. So, for electron therapy, we'll need to know the cutout factor, energy verses collimator jaw setting, output factor, and % depth dose, all of which will be determined during commissioning. This option is available in the spreadsheet "Mithu" for calculating dose for electron treatment [2]. In a radiotherapy centre, the patient database is recorded for the future. So physicists can readily say how many patients will be treated per year or month. It is possible to determine which organs (sites) are treated the most and which patients are treated the most on a demographic basis. The heart of this Spreadsheet "Mithu" is the admin panel. After commissioning, every date for Cobalt-60, LINAC, and Electron dose calculation must be entered into the admin panel.
Microsoft Excel and Visual Basic software, machine specific data for absolute dosimetry, output factor, wedge factor, tray factor, etc. are vital instruments in the current study and development. PDD and TMR tables for 60 Co and Linac (6 and 10 MV) beams were taken from BJR Suppl. 25 (1996). Some crucial and most commonly used functions are HLOOKUP, VLOOKUP, Exact, and the logical functions IF, OR, AND. We utilize HLOOKUP () and VLOOKUP to extract data from the table. HLOOKUP looks for values in table rows, while VLOOKUP looks for values in table columns. The results of HLOOKUP and VLOOKUP are same, but the table is arranged differently. EXACT function is used to compare two strings [3-5]. The IF function allows you to compare two values, such as =IF (Something is True, then do something, otherwise do something else). Although AND, OR, and NOT are independent functions, they are combined in this IF statement=IF (OR (Something is True, Something is False), Value if True, Value if False) Microsoft Visual Basic is a set of tools included in Microsoft Office. Simply turn on the developer option from the file options menu in Microsoft Excel. Absolute dosimetry also uses TRS-398 data and formula. As a result, the goal of this work can be used as a guide for any user who wants to construct spreadsheets in their own way for machine treatment time/MU verification of quality performance when utilizing it at any Cancer Treatment Center (CTC) [6].
The admin panel (also known as the Administration Panel) is the most important tool in any radiotherapy program. Though "Mithu" is an excel spreadsheet, we created a separate sheet within "Mithu" that can be referred to as an admin panel for entering fundamental machine-specific data prior to employing these spreadsheets in their cancer therapy center. This admin sheet will serve as a hub for all other user sheets. So, if you only enter the basic data once, like output factor, wedge factor, machine calibration value (1 MU=?) or 60 Co dosage rate input, it will be quite simple to use these spreadsheets. For the 60 Co time calculations worksheet, computer date and time is a highly significant and sensitive topic. Because the activity of radioactive sources decreases with the passage of time (Figures 1 and 2).
Figure 1: Main panel of Spreadsheet “Mithu”.
Figure 2: Admin panel arrangement for the “Mithu” software.
Radiotherapy treatment plan
In-house radiotherapy treatment planning system "Mithu" has been developed for Linac 6 MV and 10 MV photon energy emergency radiotherapy plan MU calculations, as well as 60 Co radiation therapy 2D treatment plan treatment time calculations. Commercial treatment planning systems can also be easily cross-checked. For selected data, the "List" function from the Data Menu was used inside the treatment planning excel spreadsheets [7-10].
For example, in our Linac Spreadsheets, we can alter the energy and method by pressing on the energy cell and selecting energy; similarly, we can change the treatment technique, Tx Area, Machine, Physicist, and oncologist by pressing on the energy cell and selecting energy.
Figures 3 and 4 demonstrate the applications of in-house Spreadsheets that have been used for radiotherapy patient treatment plan dose computation since 2012. The man-made hand calculation inaccuracy was reduced by 99 percent using this spreadsheet. This "Mithu" program has been used to calculate around 2000 patients' 60 Co Machine based Radiotherapy treatment plans at Rajshahi Medical College and Hospital, Rajshahi, National Institute of Cancer Research Hospital, Dhaka, Dhaka Medical College and Hospital, Dhaka, and Delta Hospital Ltd., Dhaka. An equivalent Square of rectangular fields table was released by the Hospital Physicist Association1 Central Axis Depth dosage data for radiotherapy (BJR Suppliment-11) for exact treatment. (Tables 1 and 2) demonstrate that the computed MU divergence between the Commercial TPS and the Commercial TPS is less than 1.5 percent for 6 and 10 MV photon beams [11-14].
| Treatment Depth (cm) | Eclipse Planning System Data | “Mithu” Planning System Data and Result | Deviation ± âÂÂ% | ||
|---|---|---|---|---|---|
| % DD | Calculated MU | % DD | Calculated MU | ||
| 5 | 86.55 | 231 | 86.9 | 230 | 0.41 |
| 10 | 67 | 299 | 67.5 | 296 | 0.85 |
| 15 | 51.2 | 391 | 51.7 | 387 | 0.94 |
| 20 | 38.9 | 514 | 39.3 | 509 | 1.01 |
Table 1. 6 MV, 10 × 10 cm field size has been calculated at various depths using Commercial TPS system and “Mithu” spreadsheet and their deviation.
| Treatment Depth (cm) | Eclipse Planning System Data | “Mithu” Planning System Data and Result | Deviation ± âÂÂ% | ||
|---|---|---|---|---|---|
| % DD | Calculated MU | % DD | Calculated MU | ||
| 5 | 91.6 | 218 | 91.4 | 219 | 0.30 |
| 10 | 73.5 | 272 | 73 | 274 | 0.69 |
| 15 | 58.2 | 344 | 57.8 | 346 | 0.68 |
| 20 | 46 | 435 | 45.6 | 439 | 0.96 |
Table 2. 10 MV, 10 × 10 cm field size has been calculated at various depths using Commercial TPS system and “Mithu” spreadsheet and their deviation.
Figure 3: Linac 2D treatment planning Spreadsheets which can be used for 6 and 10 MV photon dose calculation both for SSD and SAD method.
Figure 4: 60 Co treatments planning Spread sn can perform treatment time or dose calculation.
On the market are modern radiation therapy Quality Assurance (QA) devices and treatment planning systems. However, where TPS is not available and a Medical Physicist is not appointed for quality treatment that center can use this for reference. Some government hospitals or radiation therapy clinics in South Asia and Africa use 60 Co and Linac machines but physicist is not appointed Like Bangladesh. In addition to QA, an in-house radiotherapy treatment planning system has been developed for quality and accurate dose delivery in radiation therapy. This section discusses how to ensure high-quality radiation therapy. When physicists and dosimetrists are not available, this will be a valid solution. So that treatment can be delivered without errors. It will be helpful in some busy centers for saving physicist time and patients waiting for radiation card calculation and preparation.
Our sincere thanks to Rajshahi Medical College and Hospital, Delta Hospital limited, in providing the Machine-specific data and use these spreadsheets for their clinical use purpose. Thanks to Professor. Dr. Sadiq R Malik, Radiation Oncology Physicist from USA for his encouragement and association respectively, to work on 60 Co and Linac machines described here. Thanks are also due to Professor Dr. AKM Ahsan Habib, DMRT, Head of the Oncology Department, Dr. Md. Matiur Rahman, DED-2, TMSS and TMSS Medical College and Hospital, for their support in the clinical use of the Teletherapy Units, for cancer treatments.
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