Virtual simulation and treatment verification–merits and demerits: experience at Sindh Institute of Urology and Transplantation (SIUT), Pakistan

Abstract

Background: The rapid changes in practice of radiotherapy have taken place over the past 5 years in Pakistan. With advent of computed tomography simulator, and multileaf collimators–assisted linear accelerators and electronic portal imaging system, few centres in Pakistan have switched from conventional radiotherapy to modern computer-based technology. Our hospital is first centre in Pakistan which is using virtual simulation since March 2006. We present our experience with list of merits and demerits.Design: Retrospective study.Patient collection: Medical records of all patients who received radiotherapy in our centre were reviewed. Parameters included were type of malignancy, type radiotherapy (curative/palliative), simulation and planning process time and the displacement of the beam-axis from the planning isocentre in clinical situations during three-dimensional conformal radiotherapy using electronic portal imaging device (EPID). Data were collected on written proforma. Percentages, frequencies, measures of central tendency and dispersion were calculated using SPSS version 17.0.Results: A total of 289 patients were treated from March 2006 to November 2008. Transitional cell carcinoma of urinary bladder was most common malignancy seen (42.4%) followed by prostate (28.62%) and renal cell carcinoma (14.14%). Of these 34.26% patients were treated on curative basis. The virtual simulation process could be completed in an average time of 5 min (SD 3.5). Under many cases, the treatment portals could be designed and the patient marked in one session. The displacements were recorded for 43 portals for early prostate cancer using an EPID system. The mean displacement was found 2.44 ± 0.8 mm in x (transverse), y (craniocaudal), and z (anteroposterior) directions during treatment. Standard deviation (SD) was 0.87 (90% CI 2.21–2.66). Average number of portals taken was 10 (6–27) per treatment session.Conclusion: Computer-based simulation and treatment over conventional methods is appropriate for curative patients, achieving more accurate tumour localisation, sparing normal organs at risk, reduced field sizes and a film free environment; however efforts are required to achieve maximum immobilisation during treatment.