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PURPOSE: We aimed to study the long-term efficacy, prognostic factors and complications associated with the GKRS for trigeminal neuralgia. METHODS AND MATERIALS: Prospectively created database was analyzed for these patients. We created an Artificial neural Network - using Multilayer perceptron model in SPSS 23 by including all variables whose p value were<0.5 in univariate analysis. RESULTS: A total of 36 patients were included in the study. Patients pain free at 6 months were 25(69.44%), which reduced to 6(40 %) at 6 years. Median time to pain relief was 18.5 days. Only 5(13.88%) of them developed new onset or worsened numbness post Gamma Knife radio surgery. Median radiation dose was 80 Gy (prescribed at 100 percent isodose line). 1st GKT (P value < 0.05) and post GKT numbness (P value < 0.05) were the only factors favouring good outcome. Prior history of MVD was associated with poor pain relief post GKRS although p value was not significant (p = 0.136). ANN model could predict with 90.0 percent accuracy the favourable or unfavourable response on 11 Tested cases. In ANN model, a greater number of Pre GKT medications, previous MVD history, V2 dermatome involvement and negative history of post GKT numbness were negative prognostic factors. CONCLUSIONS: Lesser number of pre GKRS drugs used, involvement of V1 dermatome, post GKT numbness are favourable prognostic factors. Also, history of failed MVD for trigeminal neuralgia is associated with poor outcome. Repeat GKRS failed to show improvement in BNI grades.

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The purpose of this study was to validate the newly designed acrylic phantom for routine dosimetric purpose in radiotherapy. The phantom can be used to evaluate and compare the calculated dose and measured dose using film and gel dosimetric methods. In this study, a doughnut-shaped planning target volume (8.54 cm3) and inner organ at risk (0.353 cm3) were delineated for an IMRT test plan using the X-ray CT image of the phantom. The phantom consists of acrylic slabs which are integrated to form a human head with a hole in the middle where several dosimetric inserts can be positioned for measurement. An inverse planning with nine coplanar intensity-modulated fields was created using Pinnacle TPS. For the film analysis, EBT2 film, flatbed scanner, in-house developed MATLAB codes and ImageJ software were used. The 3D dose distribution recorded in the MAGAT gel dosimeter was read using a 1.5 T MRI scanner. Scanning parameters were CPMG pulse sequence with 8 equidistant echoes, TR = 5600, echo step = 22 ms, pixel size = 0.5 × 0.5, slice thickness = 2 mm. Using a calibration relationship between absorbed dose and spin-spin relaxation rate (R2), R2 images were converted to dose images. The dose comparison was accomplished using in-house MATLAB-based graphical user interface named "IMRT3DCMP". For gel measurement dose grid from the TPS was extracted and compared with the measured dose grid of the gel. Gamma index analysis of film measurement for the tolerance criteria of 2%/2mm, 1%/1 mm showed more than 90% voxels pass rate. Gamma index analysis of 3D gel measurement data showed more than 90% voxels pass rate for different tolerance criteria of 2%/2 mm and 1%/1 mm. Overall both 2D and 3D measurement were in close agreement with the Pinnacle TPS calculated dose. The phantom designed is cost-effective and the results are promising, but further investigation is required to validate the phantom with other 3D conformal techniques for dosimetric purpose.

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PURPOSE: To present EBT2 film verification of treatment planning with the eXtend System, a relocatable frame system for multiple-fraction or serial multiple-session radiosurgery. METHODS: A human head shaped phantom simulated the verification process for fractionated Gamma Knife (GK) treatment. Phantom preparation for eXtend Frame based treatment planning involved creating a dental impression, fitting the phantom to the frame system, acquiring a stereotactic computed tomography (CT) scan. A CT scan (Siemens, Emotion6) of the phantom was obtained with following parameters: Tube Voltage - 110 kV, Tube Current - 280 mA, pixel size - 0.5 mm × 0.5 mm and 1 mm slice thickness. A treatment plan with two 8 mm collimator shots and three sector blocking in each shot was made. Dose prescription of 4.0 Gy at 100% was delivered for the first fraction out of the two fractions planned. Gafchromic EBT2 film (ISP Wayne, NJ) was used as 2D verification dosimeter in this process. Films were cut and placed inside the film insert of the phantom for treatment dose delivery. Meanwhile a set of films from the same batch were exposed from 0 Gy to 12 Gy doses for calibration purpose. EPSON (Expression 10000XL) scanner was used for scanning the exposed films in transparency mode. Scanned films were analyzed with in-house made Matlab codes. RESULTS: Gamma index analysis of film measurement in comparison with TPS calculated dose resulted in high pass rates >90% for different tolerance criteria of 2%/2mm, 1%/1mm, and 0.5%/0.5mm. The isodose overlay and linear dose profiles of film measured and computed dose distribution on sagittal and coronal plane was in close agreement. CONCLUSIONS: Through this study we propose a treatment verification QA method for eXtend frame based fractionated Gamma Knife radiosurgery using EBT2 film. Acknowledgement: Authors acknowledge the help of Andre Micke, ISP for sharing his expertise on EBT2 film.

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Cardiac toxicity is an important concern in tangential field breast radiotherapy. In this study, the impact of three different breathing conditions on the dose to surrounding normal structures such as heart, ipsilateral lung, liver and contralateral breast has been assessed. Thirteen patients with early breast cancer who underwent conservative surgery (nine left-sided and four right-sided breast cancer patients) were selected in this study. Spiral CT scans were performed for all the three breathing conditions, viz., deep inspiration breath-hold (DIBH), normal breathing phase (NB) and deep expiration breath-hold (DEBH). Conventional tangential fields were placed on the 3D-CT dataset, and the parameters such as V30 (volume covered by dose >30 Gy) for heart, V20 (volume covered by dose >20 Gy) for ipsilateral lung and V(50) (volume receiving >50% of the prescription dose) for heart and liver were studied. The average reduction in cardiac dose due to DIBH was 64% (range: 26.5-100%) and 74% (range: 37-100%) as compared to NB and DEBH respectively. For right breast cancer, DIBH resulted in excellent liver sparing. Our results indicate that in patients with breast cancer, delivering radiation in deep inspiration breath-hold condition can considerably reduce the dose to the surrounding normal structures, particularly heart and liver.