Comparison of simulator-CT versus simulator fluoroscopy versus surface marking based radiation treatment planning: A prospective study by three-dimensional evaluation

Background and purposeField placement for Radiation Treatment Planning can be done based on the surface markings or simulator fluoroscopy or simulator with CT facilities. A prospective study was carried out to compare these three techniques of radiation treatment planning to quantitatively find out the difference in normal tissue dosages and target volume coverage in the three groups after three-dimensional evaluation.Patients and methodsThe CT scans of 30 patients in the treatment position, taken on a Shimadzu SCT-3000 TF scanner at 1 cm intervals, were transferred to Theraplan-500 three-dimensional radiation treatment planning computer. The normal tissues and target volumes (GTV and CTV) were outlined on all the CT slices as per (ICRU) Report no. 50. Three types of radiation treatment planning was done sequentially: Plan I-based on the surface markings alone, Plan II-based on simulator-fluoroscopy, and Plan III-based on Simulator-CT.ResultsThe mean dose to 95% of the clinical target volume (D95) was increased by 4.4 and 6.4% by Plans II and III as compared with Plan I. The mean dose to 3/3rd (D3/3) to all the critical organs was decreased by 6.6 and 8.4% by Plans II and III as compared to Plan I. The mean time, in simulator room, for field placement for Plans I–III was 6.2, 14.6 and 44 min, respectively.ConclusionsThus for adequate coverage of target volumes and sparing normal tissues, Simulator-CT based radiation treatment planning is the best method of radiation treatment planning though it is more time consuming.