Does the fluence map editing in electronic tissue compensator improve dose homogeneity in bilateral field plan of head and neck patients?

The purpose of this study was to evaluate the effect of fluence map editing in electronic tissue compensator (ETC) on the dose homogeneity for head and neck cancer patients. Treatment planning using 6-MV X-rays and bilateral field arrangement employing ETC was carried out on the computed tomography (CT) datasets of 20 patients with head and neck cancer. All the patients were planned in Varian Eclipse three-dimensional treatment planning system (3DTPS) with dynamic multileaf collimator (DMLC). The treatment plans, with and without fluence editing, was compared and the effect of pre-editing and post-editing the fluence maps in the treatment field was evaluated. The skin dose was measured with thermoluminescent dosimeters (TLDs) and was compared with the skin dose estimated by TPS. The mean percentage volume of the tissue receiving at least 107% of the prescription dose was 5.4 (range 1.5-10; SD 2.4). Post-editing fluence map showed that the mean percentage volume of the tissue receiving at least 107% of the prescription dose was 0.47 (range 0.1-0.9; SD 0.3). The mean skin dose measured with TLD was found to be 74% (range 71-80%) of the prescribed dose while the TPS showed the mean skin dose as 85% (range 80-90%). The TPS overestimated the skin dose by 11%. Fluence map editing thus proved to be a potential tool for improving dose homogeneity in head and neck cancer patients planned with ETC, thus reducing the hot spots in the treatment region as well. The treatment with ETC is feasible with DMLC and does not take any additional time for setup or delivery. The method used to edit the fluence maps is simple and time efficient. Manual control over a plan is essential to create the best treatment plan possible.