JOSR: Journal of Social Research

November 2022, 1 (12), 558-565

p-ISSN: 2827-9832 e-ISSN: xxxx-xxxx

Available online at http:// https://ijsr.internationaljournallabs.com/index.php/ijsr

http://ijsr.internationaljournallabs.com/index.php/ijsr

COMPARISON OF CONSISTENCY VALUE OF ABSORBENT

DOSE OF PLASTISIN AND SILICONE BOLUS USING

ELECTRON WITH 6 MEV ENERGY AT SANGLAH RSUP

DENPASAR

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia

Akademi Teknik Radiodiagnostik Dan Radioterapi Bali (Atro Bali)

12,3

dwipax@gmail.com

,ekaj.atro@gmail.com

,coryamelia999@gmail.com

Abstrak (indonesia)

Received:25

Oktober

2022

Revised :31

Oktober

2022

Accepted:04

November

2022

Latar Belakang: Radioterapi merupakan suatu

modalitas di bidang kedokteran yang berperan dalam

pengobatan penyakit keganasan dengan

memanfaatkan sinar pengion dengan memberikan

dosis letal ke sel kanker dengan memberikan

kerusakan yang seminimal mungkin pada sel normal.

Tujuan: dilakukan penelitian terkait adalah

mengetahui perbandingan konsistensi dosis serap

kedua bahan tersebut pada energi 6 MeV.

Metode: menggunakan penelitian dengan pengolahan

data kuantitatif deskriptif untuk mengetahui

perbandingan konsistensi nilai dosis serap bolus

berbahan plastisin dan bolus berbahan silikon pada

energi 6 MeV. Untuk mengetahui konsistensi nilai

dosis serap bolus berbahan plastisin dan berbahan

silikon dengan ketebalan masing masing 1 cm.

Hasil: didapatkan hasil nilai dosis serap yang nilainya

bervariasi setiap harinya. Dimana untuk nilai dosis

serap bolus berbahan plastisin rentang nilai dosis

serapnya adalah 1,390 Gy sampai dengan 1,413 Gy,

dengan persentase rata-rata deviasinya adalah 0,15%.

Kesimpulan: Nilai dosis serap yang diperoleh dengan

menggunakan elektron energi 6 MeV selama 25 fraksi

penyinaran didapatkan hasil nilai dosis serap yang

nilainya sedikit bervariasi setiap harinya, Dimana

untuk nilai dosis serap bolus berbahan plastisin

rentang nilai dosis serapnya adalah 1,390 Gy sampai

dengan 1,413 Gy, dengan persentase rata-rata

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 559

deviasinya adalah -0,38%, sedangkan untuk bolus

berbahan Silikon rentang nilai dosis serapnya adalah

1,749 Gy sampai dengan 1,777 Gy, dengan persentase

rata-rata deviasinya adalah 1,061. Rentang deviasi

konsistensi dosis serap dari bolus berbahan plastisin

adalah 0,002 dan rentang deviasi bolus berbahan

silikon adalah 0,009.

Kata kunci: Absorben bolus; Radioterapi; dosis

serap; konsistensi dosis serap

Abstract (English)

Background: Radiotherapy is a modality in the

medical field that plays a role in the treatment of

malignancy by utilizing ionizing rays by giving a

lethal dose to cancer cells by causing minimal

damage to normal cells.

Objective: related research is to know the

comparison of the consistency of the absorbed dose

of the two materials at an energy of 6 MeV.

Methods: used research with descriptive quantitative

data processing to compare the consistency of the

absorption dose values for boluses made from

plasticine and boluses made from silicon at 6 MeV

energy. To determine the consistency of the value of

the absorption dose of boluses made of plasticine

and silicone with a thickness of 1 cm each.

Results: The results obtained the value of the

absorbed dose which the value varies every day.

Where for the absorption dose of bolus made from

plasticine, the absorption dose ranges from 1.390 Gy

to 1.413 Gy, with the average deviation percentage

being 0.15%.

Conslusion: The absorbed dose value obtained by

using 6 MeV energy electrons for 25 irradiation

fractions resulted in the absorption dose value which

varies slightly every day, where for the absorption

dose value of plasticine-based bolus the absorption

dose value range is 1.390 Gy to 1.413 Gy, with an

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 560

average percentage The average deviation is -0.38%,

while for boluses made from Silicon, the absorption

dose ranges from 1.749 Gy to 1.777 Gy, with the

average deviation percentage being 1.061. The

deviation range of the consistency of the absorbed

dose from the plasticine-based bolus was 0.002 and

the deviation range of the silicone-based bolus was

0.009.

Keywords: Bolus absorbent; Radiotherapy; absorbed

dose; absorption dose consistency

*Correspondent Author : Made Dwipa Nararta

Email : dwipax@gmail.com

BACKGROUND

Cancer is one of the leading causes of death and an important barrier to

increasing life expectancy in every country in the world. According to estimates

from the World Health Organization (WHO) in 2019, cancer is the first or second

cause of death before the age of 70 in 112 of 183 countries and ranks third or

fourth in 23 other countries (Beyzadeoglu, Ozyigit, & Ebruli, 2010). The

increasing prominence of cancer as the leading cause of death in part reflects the

sharp decline in mortality from stroke and coronary heart disease when compared

with cancer in many countries. Of all types of cancer, breast cancer in women

showed the highest percentage of new cases when compared to 36 other types of

cancer, which was recorded in GLOBOCAN 2020 as many as 2,261,419 new

cases (11.7%) (Huq, 2006).

Based on Basic Health Research (Riskesdas) data in 2018, the prevalence

of tumors/cancer in Indonesia showed an increase from 1.4/1,000 population in

2013 to 1.79/1,000 population in 2018, where the highest incidence of cancer in

women is cancer. breast, which is 42.1% / 100,000 population with an average

mortality of 17% (Kemenkes RI, 2018). The reported province of Bali has a fairly

high prevalence of cancer/tumor, namely 2.27% with 16,481 million cases

(RISKESDAS, 2018). It is also supported by data taken at the Dharmais Cancer

Hospital in 2018 showing that the highest cancer cases in Indonesia are breast

cancer at 19.18%, followed by cervical cancer at 10.69%, and lung cancer at

9.89% (Kemenkes RI). , 2019). With a high prevalence, the role of curative

modalities is in the spotlight to increase the life expectancy of these cancer

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 561

patients. One of the modalities that has become the gold standard as a curative

effort for cancer cases is radiotherapy.

Radiotherapy is a modality in the field of medicine that plays a role in the

treatment of malignancy by utilizing ionizing rays by giving a lethal dose to cancer

cells by causing minimal damage to normal cells. These ionizing rays can be

electrons, X-rays, and gamma rays. In principle, the treatment method of

radiotherapy with ionizing rays is to expose it to cancer tissue with external

radiation (Beyzadeoglu et al., 2010).

Effective dosing is still a challenge in the application of radiotherapy in

cancer patients. Giving a wide and excessive radiation field has the risk that too

many healthy organs are involved in the radiation so that it will damage normal

tissue, and cause tissue death, while a dose that is insufficient/inadequate to kill

cancer cells will cause relapse/residence. It is endeavored that the radiation dose

given to the tumor must be uniformly or homogeneously distributed in accordance

with the International Commission on Radiation Units and Measurements (ICRU)

guidelines, namely the maximum dose in the 95%-107% range. By planning

therapy and giving the right dose of cancer will get the optimum dose and will

determine the therapy. In its development, Linear Accelerator (LINAC) is present

as an effective radiotherapy modality in carrying out more accurate radiation.

LINAC is a radiotherapy device that uses high-frequency electromagnetic

waves by accelerating electron-charged particles so that they can irradiate tumor

targets both superficially and at depth (Mirul, 1930). In irradiating breast cancer in

mastectomy conditions or cancer cells located in the superficial area, electron

beams from the LINAC and Bolus are usually used as tools (Wong et al., 2020).

Bolus is a material whose attenuation coefficient and attenuation is equivalent to

that of human body tissue which is placed directly on the body surface which

serves to increase the dose on the skin surface, even out uneven body contours,

and as compensation for the removed body tissue. The ideal bolus material is one

that has the same attenuity coefficient as human tissue, is able to stop light

scattering and must be flexible and easy to shape according to the patient's various

body surfaces, and most importantly not harmful to the patient's skin (Wong et al. ,

2020).

The most frequently used bolus material today is a plasticine-based bolus.

However, plasticine is very flexible and when pressed it cannot return to its

original shape. This of course can reduce the optimization of the bolus in terms of

the consistency of the absorbed dose from the beginning of the fraction to the end.

Based on the coefficient and attenuation values equivalent to human body tissue,

Silicone Rubber is an alternative to be used as a bolus material to replace

plasticine. To ensure the consistency of the absorption dose values for boluses

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 562

made of plasticine and silicone, further research is needed that compares boluses

made of plasticine with other materials, namely Silicon Ruber which is another

material for making boluses. (Purba, 2018)("View of Study of the Use of Silicone

Rubber Boluses on Surface Dosing in Electron Beam Radiotherapy," 2020) Based

on this background the authors are interested in conducting research to test and

compare the consistency of the absorbed dose values of the two materials and raise

them to a in a study entitled "Comparison of Absorbed Dose Consistency of Bolus

Made of Plasticine and Silicon on Electrons with 6 MeV Energy at Sanglah

Hospital Denpasar".

METODE PENELITIAN

In this study, the authors used research with descriptive quantitative data

processing to compare the consistency of the absorption dose values for boluses

made from plasticine and boluses made from silicon at 6 MeV energy.

Independent Variables; The independent variable is the variable that causes

changes in the dependent variable. The independent variables in this study were

boluses made of plasticine, boluses made of silicone. Dependent variable; The

dependent variable (bound) is the variable that is affected. The dependent variable

(bound) in this study was the reading of the absorbed dose of a bolus of 1 cm

thickness at a depth of 2 cm (with phantom). Control Variables; The control

variable (constant) is a variable that is controlled or fixed so that the relationship

of the independent variable (free) to the dependent variable (constant) in this

study, namely electrons with an energy of 6 MeV, 25 radiation fractions, slab

phantom, ionization chamber, electrometer, temperature and humidity storage

space.

Data analysis begins with obtaining the results obtained from the

electrometer as many as 25 fractions. From the data and information obtained

through recording the value of the absorbed dose reading on the electrometer, it

will be analyzed further by calculating the deviation from the absorbed dose

received per day. From the results of the data that has been processed, it will be

obtained the consistency of the absorption dose of plasticine and silicon bolus

doses with an energy of 6 MeV. The difference will be seen by using SPSS by

applying the difference test of 2 variables. With the Independent T Test Difference

Test if it is normally distributed or Mann-Whitney if the distribution of the data to

be obtained is not normal with reference to the value of 0.05, so that conclusions

can be drawn based on the hypothesis: The hypothesis is rejected (H0) if the

significance value of p value < 0 0.05 means that there is a significant difference

between the consistency of the two boluses.

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 563

RESULTS AND DISCUSSION

The results of the measurement of the absorbed dose of the two bolus

materials The process of evaluating the consistency of the value of the absorbed

bolus dose at the radiotherapy installation of the Sanglah Central General

Hospital, measurements were made on the phantom without using a bolus once as

a comparison for the value of the absorbed dose using a detector at a depth of 2

cm with a field area of 10 x 10 cm and SSD 100 cm. From this measurement, the

absorbed dose from the phantom slab was 1.818 Gy. Subsequent measurements

for 25 fractions with the same treatment were added using both bolus materials.

The results obtained from measurements of room temperature and pressure and

electrometer readings are the absorbed dose value in Gy units for 25 fractions

(attachment 1) whose characteristics can be seen in Table 4.1 as follows.

On the first day, the result was 1,409 Gy for plasticine bolus and 1,749 Gy

for Silicone bolus, these results were then used as a reference for calculating the

consistency of the absorbed dose. To measure the average percentage deviation

from the consistency of the absorbed dose, the following equation is used:

Percentage Deviation = (absorbed dose value-consistency reference)/(consistency

reference) x 100 Reference value: plasticine bolus 1.409 Gy Silicone Bolus 1.749

Statistical Test Results Absorb Dose Value Consistency

Based on the data obtained in the form of dose values and characteristics of

dose deviations in both types of boluses, the researchers conducted statistical tests

to be able to see the significance of differences in the distribution of absorbed dose

values and their deviations. Before carrying out the different test, the researchers

tested the normality of the data obtained with the following results: By using 6

MeV energy for 25 fractions of irradiation, it was obtained that the absorbed dose

value varied slightly every day. 1.390 Gy to 1.413 Gy, with an average deviation

percentage of -0.38%, while for boluses made from Silicon, the absorption dose

ranges from 1.749 Gy to 1.777 Gy, with an average deviation percentage of

1.061%,

From the measurement results described in Tables 4.1 and 4.2, it can be

seen that there is a difference in the value of the consistency of the two bolus

materials where the average value of the absorbed dose of plasticine is 1.404 Gy

and the average value of deviation of the absorbed dose is 0.002 Gy for 25

irradiation fractions. bolus made of silicon, the average value of the absorbed dose

was 1.767 Gy and the deviation value was 0.09 Gy for 25 fractions. The results of

the MannWhitney Statistical Test showed that there was no significant difference

in the absorbed dose produced in the two types of boluses. This is due to several

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 564

factors, namely differences in temperature, air pressure, humidity, and the

calibration factor of the electrometer. (IAEA, 2000) The two bolus materials have

very good consistency values, there is no significant difference in consistency, it

can also be considered from several factors, namely the absorption capacity of the

silicone bolus is better than plasticine where the average absorption dose of the

two bolus materials is closest to the measurement results. slab phantom without

using a bolus material with an absorption dose of 1.818 Gy, where the average

absorption dose of plasticine bolus is 1.404 Gy and a bolus made of silicon with an

average absorption dose of 1.767 Gy not much different. It can also be seen in

terms of efficiency and economy of the two bolus materials, where plasticine is

easier to obtain, the manufacturing process is short, and the price of the material is

cheap compared to silicone boluses.

CONCLUSION

Based on the description of the results and discussion in the research that

has been carried out, the following conclusions are obtained; The absorbed dose

value obtained by using 6 MeV energy electrons for 25 irradiation fractions

resulted in the absorption dose value which varies slightly every day, where for the

absorption dose value of bolus made of plasticine, the absorption dose value range

is 1.390 Gy to 1.413 Gy, with an average percentage The average deviation is -

0.38%, while for boluses made from Silicon, the absorption dose ranges from

1.749 Gy to 1.777 Gy, with the average deviation percentage being 1.061. The

deviation range of the consistency of the absorbed dose from the plasticine-based

bolus was 0.002 and the deviation range of the silicone-based bolus was 0.009.

There was no significant difference in the deviation value of the absorbed

dose in the plasticine and silicon bolus referring to the Mann-Whitney test results

which showed a p-Value of 0.133 or > 0.05, which means that there was no

significant difference in the consistency of the absorbed dose shown by the two

bolus materials. Based on the average value of the absorbed dose and the deviation

range value of the absorbed dose of the two bolus materials in the statistical test

using SPSS, the plasticine-based bolus showed a higher deviation value than the

silicone-based bolus. Plasticine-based bolus showed better consistency in the

application of 25 times fractionation.

BIBLIOGRAFI

Beyzadeoglu, Murat, Ozyigit, Gokhan, & Ebruli, Cuneyt. (2010). Basic radiation

oncology. In Basic Radiation Oncology. https://doi.org/10.1007/978-3-642-

11666-7

Huq, M. Saiful. (2006). Absorbed dose determination in external beam

Made Dwipa Nararta1,Putu Eka Juliantara

,Cory Amelia/ JOSR: Journal of Social Research,

1(12), 558-565

comparison of consistency value of absorbent dose of plastisin and silicone

bolus using electron with 6 mev energy at sanglah rsup denpasar 565

radiotherapy: an international code of practice for dosimetry based on

standards of absorbed dose to water.

IAEA. (2000). IAEA TRS 398:Absorbed Dose Determination in External Beam

Radiotherapy: An International Code of Practice for Dosimetry based on

Standards of Absorbed Dose to Water. 12(June), 183.

Kemenkes RI. (2018). Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian

Kesehatan RI, 53(9), 1689–1699.

Kemenkes RI. (2019). Infodatin-cancer burden 2019. Jakarta: Ministry of Health

RI., 3–6.

Mirul, Ka. (1930). Prinsip Kerja Akselerator Linier (LINAC).

Purba, marintan handayani. (2018). Konsistensi Nilai Dosis Serap Bolus Plastisin

Dengan Energi 9 MeV dI Rumah Sakit Pusat Pertamina.

RISKESDAS. (2018). Laporan Provinsi Bali RISKESDAS 2018. In Badan

Penelitian dan Pengembangan Kesehatan.

View of Studi Penggunaan Bolus Berbahan Silicone Rubber terhadap Dosis

Permukaan pada Radioterapi Berkas Elektron. (2020).

Wong, Gina, Lam, Emily, Bosnic, Sandi, Karam, Irene, Drost, Leah, Yee, Caitlin,

Ariello, Krista, Chow, Edward, & Wronski, Matt. (2020). Quantitative Effect

of Bolus on Skin Dose in Postmastectomy Radiation Therapy Journal of

Medical Imaging and Radiation Sciences. Journal of Medical Imaging and

Radiation Sciences, 51, 462–469.

the terms and conditions of the Creative Commons Attribution (CC BY SA)

license (https://creativecommons.org/licenses/by-sa/4.0/).