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Li X, Su FC, Sarkar V, Zhao H, Ibanez S, Kunz JN, Nelson G, Jessica Huang Y. Impact of detector selection on commissioning of Leipzig surface applicators with improving immobilization in high-dose-rate brachytherapy. Brachytherapy 2022; 21:511-519. [PMID: 35256286 DOI: 10.1016/j.brachy.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE Commission and treatment setup of Leipzig surface applicators, because of the steep dose gradient and lack of robust immobilization, is challenging. We aim to improve commissioning reliability by investigating the impact of detector choice on percentage depth dose (PDD) verifications, and to enhance accuracy and reproducibility in calibration/treatment setup through a simple and novel immobilization device. METHODS AND MATERIALS PDD distributions were measured with radiochromic films, optically stimulated luminescent dosimeters (OSLDs), a diode detector, and both cylindrical and parallel plate ionization chambers. The films were aligned to the applicators in parallel and transverse orientations. PDD data from a benchmarking Monte Carlo (MC) study were compared with the measured results, where surface doses were acquired from extrapolation. To improve setup accuracy and reproducibility, a custom-designed immobilization prototype device was made with cost-effective materials using a 3D printer. RESULTS The measured PDD data with different detectors had an overall good agreement (<±10%). The parallel plate ionization chamber reported unreliable doses for the smallest applicator. There was no remarkable dose difference between the two film setups. The two-in-one prototype device provided a rigid immobilization and a flexible positioning of the applicator. It enhanced accuracy and reproducibility in calibration and treatment setup. CONCLUSION We recommend using radiochromic films in the transverse orientation for a reliable and efficient PDD verification. The applicator's clinical applicability has been limited by a lack of robust immobilization. We expect this economical, easy-to-use prototype device can promote the use of Leipzig applicators in surface brachytherapy.
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Affiliation(s)
- Xing Li
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT.
| | - Fan-Chi Su
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Vikren Sarkar
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Sergio Ibanez
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Jeremy N Kunz
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Geoff Nelson
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Y Jessica Huang
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
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Tagliaferri L, Ciardo FG, Fionda B, Casà C, DI Stefani A, Lancellotta V, Placidi E, Macchia G, Capocchiano ND, Morganti AG, Kovács G, Bussu F, Peris K, Valentini V. Non-melanoma Skin Cancer Treated by Contact High-dose-rate Radiotherapy (Brachytherapy): A Mono-institutional Series and Literature Review. In Vivo 2021; 35:2313-2319. [PMID: 34182511 PMCID: PMC8286496 DOI: 10.21873/invivo.12505] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/11/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM Non-melanoma skin cancers (NMSC) are the most common neoplasms worldwide and their incidence has been proven to increase in recent years and their treatment should aim at cancer cure as well as cosmetic and functional results. The aim of the study was to report the results of our mono-institutional series of high-dose-rate radiotherapy (cHDR-RT) in NMSC, based on a homogenous technique and two different treatment schedules. PATIENTS AND METHODS All patients affected by NMSC who were consecutively evaluated and treated at our Interventional Oncology Center from October 2018 to August 2020, were included. Patients underwent cHDR-RT using flap applicators and remotely afterloaded Ir-192 sources. RESULTS Overall, 51 patients were treated for a total of 67 lesions. Local control (LC) and disease-specific survival (DSS) were 94.0% and 100%, respectively. Grade 1, grade 2, grade 3 and grade 4 acute toxicity rates were 24.6%, 3.5%, 3.5%, and 0.0%, respectively. The cosmetic results were graded as excellent/good, fair, and poor in 73.7%, 19.3%, and 7.0%. CONCLUSION cHDR-RT of NMSC is an effective alternative to surgery due to excellent outcomes both in terms of local control and aesthetic results especially in the face.
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Affiliation(s)
- Luca Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Bruno Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy;
| | - Calogero Casà
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandro DI Stefani
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Lancellotta
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Elisa Placidi
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Nikola Dino Capocchiano
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - György Kovács
- Educational Program Director Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Bussu
- Divisione di Otorinolaringoiatria, Azienda Ospedaliero Universitaria, Sassari, Italy
- Department of Otorinolaringoiatria, Università degli studi di Sassari, Sassari, Italy
| | - Ketty Peris
- U.O.C. Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
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Draeger E, Pinkham DW, Chen ZJ, Tien CJ. Clinically-implementable template plans for multidwell treatments using Leipzig-style applicators in 192Ir surface brachytherapy. Brachytherapy 2020; 20:401-409. [PMID: 33288488 DOI: 10.1016/j.brachy.2020.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/16/2020] [Accepted: 09/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Multiple dwell positions ("multidwell") within a Leipzig-style applicator can be used to increase dose uniformity and treatment area. Model-based dose calculation algorithms (MBDCAs) are necessary for accurate calculations involving these applicators because of their nonwater equivalency and complex geometry. The purpose of this work was to create template plans from MBDCA calculations and present their dwell times and positions for users of these applicators without access to MBDCAs. METHODS AND MATERIALS The Leipzig-style solid applicator model within our treatment planning system was used to design template plans. Five template plans, normalized to 0.3 cm depth within a water phantom, were optimized using the treatment planning system MBDCA. Each template plan contained unique dwell positions, times, and active lengths (0.5-1.5 cm). A single-dwell distribution was optimized for comparison. The stem of this applicator stops within the shell; therefore, one template plan contained an intrafraction rotation to determine the largest dose distribution achievable. Effects of imperfect applicator rotation were quantified by inserting rotational offsets and comparing the V100%, D95%, and minimum dose coverage for planning target volumes created from 80%/90% isodose lines. RESULTS The 90% (80%) isodose line dimensions at 0.3 cm depth for single-dwell increased from 0.94 × 0.97 (1.53 × 1.57) cm2 to 2.09 × 1.24 (2.75 × 1.88) cm2 in the largest template plan. Manually inserted angular offsets up to ±10° for the template plan requiring rotation preserved V100%, D95%, and minimum dose within 2.0%, 1.9%, and 8.0%, respectively. CONCLUSION A set of template plans was created to provide accessibility to the multidwell methodology, even for users without access to MBDCAs. Each template plan should be reviewed before clinical implementation.
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Affiliation(s)
- Emily Draeger
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
| | - Daniel W Pinkham
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Christopher J Tien
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Tien CJ, Pinkham DW, Chen ZJ. Feasibility of using multiple-dwell positions in 192Ir Leipzig-style brachytherapy surface applicators to expand target coverage and clinical application. Brachytherapy 2020; 19:532-543. [PMID: 32327342 DOI: 10.1016/j.brachy.2020.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Leipzig-style applicators for surface brachytherapy are traditionally used with a single-source dwell position. This study explores the feasibility of using multiple-source dwell positions ("multidwell") to improve the dose coverage and applicability of Leipzig-style applicators. METHODS AND MATERIALS A virtual model of the Leipzig-style applicator was commissioned for a model-based dose calculation algorithm (MBDCA) and compared against American Association of Physicists in Medicine working group 186 benchmarking data sets and ionization chamber point measurements. An absolute dosimetry technique based on radiochromic film was used to validate both single-dwell and multidwell plans. RESULTS Dose distributions generated from the MBDCA-based virtual model were consistent with working group data sets, ion chamber measurements, and radiochromic film analysis. In one multidwell configuration, at 3 mm prescription depth, the 80% isodose width was increased to 25 mm, compared with 15 mm in the same dimension for a single-dwell delivery. In the same multidwell configuration, the flatness, measured as >98% isodose line, was more than doubled to 8 mm, compared with 3 mm in the same dimension. For multidwell plans, 2-D planar agreement between radiochromic film and MBDCA exceeded 93% in gamma analysis (3%/1 mm criteria). Submillimeter positional agreement was found, with a total dosimetric uncertainty of 4.5% estimated for the entire system. CONCLUSIONS Leipzig-style surface applicators with multiple-source dwell positions have been benchmarked against radiochromic film dosimetry. Results show that the clinically viable coverage area can be increased significantly.
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Affiliation(s)
- Christopher J Tien
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
| | - Daniel W Pinkham
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Independent assessment of source transit time for the BEBIG SagiNova® cobalt-60 high dose rate brachytherapy afterloader. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:913-919. [PMID: 31452058 DOI: 10.1007/s13246-019-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
Independent verification of transit time and the methodology employed in commercial high dose rate (HDR) afterloaders to compensate its effect is an important part of their commissioning and quality assurance. This study aimed to independently evaluate the Co-60 source transit time of the new BEBIG SagiNova® HDR afterloader unit by employing a dosimetric approach using a well-type ionization chamber. The source was placed at three dwell positions (DPs) to mimic a variety of clinical situations with different distances from the afterloader unit. The distances of the DPs to the afterloader were 129.37 cm, 124.50 cm and 118.57 cm. Plans were generated using the SagiPlan® treatment planning system to produce 3, 5, 10, 15, 20, 30, 40, 60 and 120 s dwell times (DTs). The residual transit times (following any possible system compensation) were assessed using the ESTRO-recommended approach of obtaining transit time compensation factors and another strategy established for teletherapy sources. The mean residual transit time depended on the distance between the afterloader and the DP, ranging from 0.43 to 1.10 s. The transit dose contribution was case-specific, ranging from 0.4% for a 60 s DT at the nearest DP to the afterloader up to 15.6% for a 3 s DT at the furthest DP from the unit. The results show that currently SagiNova® afterloader does not apply transit time compensation and suggest a 0.2-0.5 s compensation for each arrival and departure DP from/to the afterloader, depending on position in an 11 cm active length.
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Bellezzo M, Baeza JA, Voncken R, Reniers B, Verhaegen F, Fonseca GP. Mechanical evaluation of the Bravos afterloader system for HDR brachytherapy. Brachytherapy 2019; 18:852-862. [PMID: 31327634 DOI: 10.1016/j.brachy.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The Bravos afterloader system was released by Varian Medical Systems in October of 2018 for high-dose-rate brachytherapy with 192Ir sources, containing new features such as the CamScale (a new device for daily quality assurance and system recalibration), channel length verification, and different settings for rigid and flexible applicators. This study mechanically evaluated the Bravos system precision and accuracy for clinically relevant scenarios, using dummy sources. METHODS AND MATERIALS The system was evaluated after three sets of experiments: (1) The CamScale was used to verify inter- and intra-channel dwelling variability and system calibration; (2) A high-speed camera was used to verify the source simulation cable movement inside a transparent quality assurance device, where dwell positions, dwell times, transit times, speed profiles, and accelerations were measured; (3) The source movement inside clinical applicators was captured with an imaging panel while being exposed to an external kV source. Measured and planned dwell positions and times were compared. RESULTS Maximum deviations between planned and measured dwell positions and times for the source cable were 0.4 mm for the CamScale measurements and 0.07 seconds for the high-speed camera measurements. Mean dwell position deviations inside clinical applicators were below 1.2 mm for all applicators except the ring that required an offset correction of 1 mm to achieve a mean deviation of 0.4 mm. CONCLUSIONS Features of the Bravos afterloader system provide a robust and precise treatment delivery. All measurements were within manufacturer specifications.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - José A Baeza
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Bellezzo M, Fonseca GP, Verrijssen AS, Voncken R, Van den Bosch MR, Yoriyaz H, Reniers B, Berbée M, Van Limbergen EJ, Verhaegen F. A novel rectal applicator for contact radiotherapy with HDR 192Ir sources. Brachytherapy 2018; 17:1037-1044. [PMID: 30122346 DOI: 10.1016/j.brachy.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE Dose escalation to rectal tumors leads to higher complete response rates and may thereby enable omission of surgery. Important advantages of endoluminal boosting techniques include the possibility to apply a more selective/localized boost than using external beam radiotherapy. A novel brachytherapy (BT) rectal applicator with lateral shielding was designed to be used with a rectoscope for eye-guided positioning to deliver a dose distribution similar to the one of contact x-ray radiotherapy devices, using commonly available high-dose-rate 192Ir BT sources. METHODS AND MATERIALS A cylindrical multichannel BT applicator with lateral shielding was designed by Monte Carlo modeling, validated experimentally with film dosimetry and compared with results found in the literature for the Papillon 50 (P50) contact x-ray radiotherapy device regarding rectoscope dimensions, radiation beam shape, dose fall-off, and treatment time. RESULTS The multichannel applicator designed is able to deliver 30 Gy under 13 min with a 20350 U (5 Ci) source. The use of multiple channels and lateral shielding provide a uniform circular treatment surface with 22 mm in diameter. The resulting dose fall-off is slightly steeper (maximum difference of 5%) than the one generated by the P50 device with the 22 mm applicator. CONCLUSIONS A novel multichannel rectal applicator for contact radiotherapy with high-dose-rate 192Ir sources that can be integrated with commercially available treatment planning systems was designed to produce a dose distribution similar to the one obtained by the P50 device.
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Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - An-Sofie Verrijssen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel R Van den Bosch
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hélio Yoriyaz
- Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Maaike Berbée
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
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Anagnostopoulos G, Andrássy M, Baltas D. The Bebig Valencia-type skin applicators: Dosimetric study and implementation of a dosimetric hybrid technique. Brachytherapy 2017. [DOI: 10.1016/j.brachy.2017.04.243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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