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Lo S, Chao S, Harris E, Knisely J, Luh JY, Mohindra P, Quang TS, Ye J, Small W, Schechter NR. ACR-ARS Practice Parameter for Radiation Oncology. Am J Clin Oncol 2024; 47:201-209. [PMID: 38153244 DOI: 10.1097/coc.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND This practice parameter was revised collaboratively by the American College of Radiology (ACR), and the American Radium Society. This practice parameter provides updated reference literature regarding radiation oncology practice and its key personnel. METHODS This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website ( https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards ) by the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with the American Radium Society. RESULTS This practice parameter provides a comprehensive update to the reference literature regarding radiation oncology practice in general. The overall roles of the radiation oncologist, the Qualified Medical Physicist, and other specialized personnel involved in the delivery of external-beam radiation therapy are discussed. The use of radiation therapy requires detailed attention to equipment, patient and personnel safety, equipment maintenance and quality assurance, and continuing staff education. Because the practice of radiation oncology occurs in a variety of clinical environments, the judgment of a qualified radiation oncologist should be used to apply these practice parameters to individual practices. Radiation oncologists should follow the guiding principle of limiting radiation exposure to patients and personnel while accomplishing therapeutic goals. CONCLUSION This practice parameter can be used as an effective tool to guide radiation oncology practice by successfully incorporating the close interaction and coordination among radiation oncologists, medical physicists, dosimetrists, nurses, and radiation therapists.
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Affiliation(s)
- Simon Lo
- University of Washington Medical Center, Seattle, WA
| | | | | | | | | | - Pranshu Mohindra
- University Hospitals Seidman Cancer Center/Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Jason Ye
- Keck School of Medicine, Los Angeles, CA
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernardin Cancer Center, Loyola University Chicago, Chicago
- Department of Radiation Oncology, Maguire Center, Maywood, IL
| | - Naomi R Schechter
- Rakuten-Medical, South Florida Proton Therapy Institute, Delray Beach, FL
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2
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Grover S, Lichter KE, Likhacheva A, Jang JW, Ning MS, Robin TP, Small W, Kudchadker RJ, Swamidas J, Chopra S, Rai B, Sharma SD, Sharma DN, Kuppusamy T, Yang R, Berger D, Mendez LC, Glaser S, Erickson DL, Chino J, Mourtada F, Abdel-Wahab M, Jhingran A, Simonds H, Mahantshetty U. The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries. Brachytherapy 2023; 22:716-727. [PMID: 37704540 DOI: 10.1016/j.brachy.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/17/2023] [Accepted: 07/03/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE The global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. METHODS AND MATERIALS ABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. RESULTS The ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. CONCLUSIONS This ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| | - Katie E Lichter
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Anna Likhacheva
- Department of Radiation Oncology, Sutter Health Sacramento, Sacramento, CA
| | - Joanne W Jang
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Matthew S Ning
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tyler P Robin
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO
| | - William Small
- Department of Radiation Oncology, Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Chicago, Maywood, IL
| | - Rajat J Kudchadker
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bhavana Rai
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Dutt Sharma
- Department of Radiation Oncology, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
| | - Daya N Sharma
- Department of Radiation Oncology, Department of Radiation Oncology, National Cancer Institute, AIIMS, New Delhi, India
| | - Thayalan Kuppusamy
- Department of Radiation Oncology, Dr Kamakshi Memorial Hospital, Chennai, Tamil Nadu, India
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, China
| | - Daniel Berger
- Department of Nuclear Sciences and Division of Human Health, Section of Dosimetry and Medical Radiation Physics, International Atomic Energy Agency, Vienna, Austria
| | - Lisbeth Cordero Mendez
- Division of Human Health, Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Scott Glaser
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Delnora L Erickson
- Department of Radiation Oncology, Walter Reed National Military Center, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Junzo Chino
- Deptartment of Radiation Oncology, Duke Cancer Center, Durham, NC
| | - Firas Mourtada
- Department of Radiation Oncology, Helen F. Graham Cancer Center and Research Institute, Christiana Care Health System, Sidney Kimmel Cancer Center, Newark, DE
| | - May Abdel-Wahab
- Department of Nuclear Sciences and Division of Human Health, Section of Applied Radiation Biology and Radiotherapy, International Atomic Energy Agency, Vienna, Austria
| | - Anuja Jhingran
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Stellenbosch, South Africa
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Fahimian BP, Liu W, Skinner L, Yu AS, Phillips T, Steers JM, DeMarco J, Fraass BA, Kamrava M. 3D printing in brachytherapy: A systematic review of gynecological applications. Brachytherapy 2023; 22:446-460. [PMID: 37024350 DOI: 10.1016/j.brachy.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/27/2022] [Accepted: 02/02/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE To provide a systematic review of the applications of 3D printing in gynecological brachytherapy. METHODS Peer-reviewed articles relating to additive manufacturing (3D printing) from the 34 million plus biomedical citations in National Center for Biotechnology Information (NCBI/PubMed), and 53 million records in Web of Science (Clarivate) were queried for 3D printing applications. The results were narrowed sequentially to, (1) all literature in 3D printing with final publications prior to July 2022 (in English, and excluding books, proceedings, and reviews), and then to applications in, (2) radiotherapy, (3) brachytherapy, (4) gynecological brachytherapy. Brachytherapy applications were reviewed and grouped by disease site, with gynecological applications additionally grouped by study type, methodology, delivery modality, and device type. RESULTS From 47,541 3D printing citations, 96 publications met the inclusion criteria for brachytherapy, with gynecological clinical applications compromising the highest percentage (32%), followed by skin and surface (19%), and head and neck (9%). The distribution of delivery modalities was 58% for HDR (Ir-192), 35% for LDR (I-125), and 7% for other modalities. In gynecological brachytherapy, studies included design of patient specific applicators and templates, novel applicator designs, applicator additions, quality assurance and dosimetry devices, anthropomorphic gynecological applicators, and in-human clinical trials. Plots of year-to-year growth demonstrate a rapid nonlinear trend since 2014 due to the improving accessibility of low-cost 3D printers. Based on these publications, considerations for clinical use are provided. CONCLUSIONS 3D printing has emerged as an important clinical technology enabling customized applicator and template designs, representing a major advancement in the methodology for implantation and delivery in gynecological brachytherapy.
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Affiliation(s)
- Benjamin P Fahimian
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Wu Liu
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Lawrie Skinner
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Amy S Yu
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | - Tiffany Phillips
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jennifer M Steers
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - John DeMarco
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mitchell Kamrava
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
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Karaçam SÇ, Tunçman D, ALMisned G, Ene A, Tekin HO. Investigation of Radiochromic Film Use for Source Position Verification through a LINAC On-Board Imager (OBI). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030628. [PMID: 36984628 PMCID: PMC10053966 DOI: 10.3390/medicina59030628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: Quality assurance is an integral part of brachytherapy. Traditionally, radiographic films have been used for source position verification, however, in many clinics, computerized tomography simulators have replaced conventional simulators, and computerized radiography systems have replaced radiographic film processing units. With these advances, the problem of controlling source position verification without traditional radiographic films and conventional simulators has appeared. Materials and Methods: In this study, we investigated an alternative method for source position verification for brachytherapy applications. Source positions were evaluated using Gafchromic™ RTQA2 and EBT3 film and visually compared to exposed RTQA radiochromic film when using a Nucletron Oldelft Simulix HP conventional simulator and a Gammamed 12-i brachytherapy device for performance evaluation. Gafchromic film autoradiography was performed with a linear accelerator (LINAC) on-board imager (OBI). Radiochromic films are very suitable for evaluation by visual inspection with a LINAC OBI. Results: The results showed that this type of low-cost, easy-to-find material can be used for verification purposes under clinical conditions. Conclusions: It can be concluded that source-position quality assurance may be performed through a LINAC OBI device.
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Affiliation(s)
- Songül Çavdar Karaçam
- Department of Radiation Oncology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul 34303, Türkiye
| | - Duygu Tunçman
- Department of Radiotherapy, Vocational School of Health Services, Istanbul University-Cerrahpaşa, Istanbul 34265, Türkiye
| | - Ghada ALMisned
- Department of Physics, College of Science, Princess Nourah Bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Antoaneta Ene
- INPOLDE Research Center, Department of Chemistry, Physics and Environment, Faculty of Sciences and Environment, Dunarea de Jos University of Galati, 47 Domneasca Street, 800008 Galati, Romania
| | - Huseyin Ozan Tekin
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
- Faculty of Engineering and Natural Sciences, Computer Engineering Department, Istinye University, Istanbul 34396, Türkiye
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Richardson SL, Buzurovic IM, Cohen GN, Culberson WS, Dempsey C, Libby B, Melhus CS, Miller RA, Scanderbeg DJ, Simiele SJ. AAPM medical physics practice guideline 13.a: HDR brachytherapy, part A. J Appl Clin Med Phys 2023; 24:e13829. [PMID: 36808798 PMCID: PMC10018677 DOI: 10.1002/acm2.13829] [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: 05/09/2022] [Revised: 08/09/2022] [Accepted: 09/22/2022] [Indexed: 02/22/2023] Open
Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines (MPPGs) will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: (1) Must and must not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. (2) Should and should not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. Approved by AAPM's Executive Committee April 28, 2022.
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Affiliation(s)
| | - Ivan M Buzurovic
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gil'ad N Cohen
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | - Claire Dempsey
- Calvary Mater Newcastle Hospital University of Newcastle, Callaghan, Australia University of Washington, Seattle, USA
| | | | | | - Robin A Miller
- Multicare Regional Cancer Center, Northwest Medical Physics Center, Tacoma, WA, USA
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Poder J, Rivard MJ, Howie A, Carlsson Tedgren Å, Haworth A. Risk and Quality in Brachytherapy From a Technical Perspective. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00002-X. [PMID: 36682968 DOI: 10.1016/j.clon.2023.01.001] [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: 10/03/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
AIMS To provide an overview of the history of incidents in brachytherapy and to describe the pillars in place to ensure that medical physicists deliver high-quality brachytherapy. MATERIALS AND METHODS A review of the literature was carried out to identify reported incidents in brachytherapy, together with an evaluation of the structures and processes in place to ensure that medical physicists deliver high-quality brachytherapy. In particular, the role of education and training, the use of process and technical quality assurance and the role of international guidelines are discussed. RESULTS There are many human factors in brachytherapy procedures that introduce additional risks into the process. Most of the reported incidents in the literature are related to human factors. Brachytherapy-related education and training initiatives are in place at the societal and departmental level for medical physicists. Additionally, medical physicists have developed process and technical quality assurance procedures, together with international guidelines and protocols. Education and training initiatives, together with quality assurance procedures and international guidelines may reduce the risk of human factors in brachytherapy. CONCLUSION Through application of the three pillars (education and training; process control and technical quality assurance; international guidelines), medical physicists will continue to minimise risk and deliver high-quality brachytherapy treatments.
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Affiliation(s)
- J Poder
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Physics, University of Sydney, Camperdown, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
| | - M J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, RI, USA
| | - A Howie
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Å Carlsson Tedgren
- Department of Health, Medicine and Caring Sciences (HMV), Radiation Physics, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, The Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, The Karolinska Institute, Stockholm, Sweden
| | - A Haworth
- School of Physics, University of Sydney, Camperdown, New South Wales, Australia
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7
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Tachibana H, Watanabe Y, Kurokawa S, Maeyama T, Hiroki T, Ikoma H, Hirashima H, Kojima H, Shiinoki T, Tanimoto Y, Shimizu H, Shishido H, Oka Y, Hirose TA, Kinjo M, Morozumi T, Kurooka M, Suzuki H, Saito T, Fujita K, Shirata R, Inada R, Yada R, Yamashita M, Kondo K, Hanada T, Takenaka T, Usui K, Okamoto H, Asakura H, Notake R, Kojima T, Kumazaki Y, Hatanaka S, Kikumura R, Nakajima M, Nakada R, Suzuki R, Mizuno H, Kawamura S, Nakamura M, Akimoto T. Multi-Institutional Study of End-to-End Dose Delivery Quality Assurance Testing for Image-Guided Brachytherapy Using a Gel Dosimeter. Brachytherapy 2022; 21:956-967. [PMID: 35902335 DOI: 10.1016/j.brachy.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/15/2022] [Accepted: 06/19/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To quantify dose delivery errors for high-dose-rate image-guided brachytherapy (HDR-IGBT) using an independent end-to-end dose delivery quality assurance test at multiple institutions. The novelty of our study is that this is the first multi-institutional end-to-end dose delivery study in the world. MATERIALS AND METHODS The postal audit used a polymer gel dosimeter in a cylindrical acrylic container for the afterloading system. Image acquisition using computed tomography, treatment planning, and irradiation were performed at each institution. Dose distribution comparison between the plan and gel measurement was performed. The percentage of pixels satisfying the absolute-dose gamma criterion was reviewed. RESULTS Thirty-five institutions participated in this study. The dose uncertainty was 3.6% ± 2.3% (mean ± 1.96σ). The geometric uncertainty with a coverage factor of k = 2 was 3.5 mm. The tolerance level was set to the gamma passing rate of 95% with the agreement criterion of 5% (global)/3 mm, which was determined from the uncertainty estimation. The percentage of pixels satisfying the gamma criterion was 90.4% ± 32.2% (mean ± 1.96σ). Sixty-six percent (23/35) of the institutions passed the verification. Of the institutions that failed the verification, 75% (9/12) had incorrect inputs of the offset between the catheter tip and indexer length in treatment planning and 17% (2/12) had incorrect catheter reconstruction in treatment planning. CONCLUSIONS The methodology should be useful for comprehensively checking the accuracy of HDR-IGBT dose delivery and credentialing clinical studies. The results of our study highlight the high risk of large source positional errors while delivering dose for HDR-IGBT in clinical practices.
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Affiliation(s)
- Hidenobu Tachibana
- Radiation Safety and Quality Assurance division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Yusuke Watanabe
- School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Shogo Kurokawa
- Radiation Safety and Quality Assurance division, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takuya Maeyama
- School of Science, Kitasato University, Sagamihara, Kanagawa, Japan
| | - Tomoyuki Hiroki
- Department of Radiology, Tokai University Hospital, Isehara, Kanagawa, Japan
| | - Hideaki Ikoma
- Department of Radiation Technology, Ibaraki Prefectual Central Hospital, Kasama, Ibaraki, Japan
| | - Hideaki Hirashima
- Deparment of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Hironori Kojima
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yuuki Tanimoto
- Department of Radiology, Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan
| | - Hiroki Shishido
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yoshitaka Oka
- Department of Radiology, Fukushima Medical University Hospital, Fukushima, Fukushima, Japan
| | - Taka-Aki Hirose
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Fukuoka, Fukuoka, Japan
| | - Masashi Kinjo
- Department of Radiology, University of the Ryukyus Graduate School of Medical Science, Nishihara, Okinawa, Japan
| | - Takuya Morozumi
- Department of Radiology, Nagano Municipal Hospital, Nagano, Nagano, Japan
| | - Masahiko Kurooka
- Department of Radiation Therapy, Tokyo Medical University Hospital, Shinjuku, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi Hospital, Chuo, Yamanashi, Japan
| | - Tomohiko Saito
- Central Division of Radiology, Akita University Hospital, Akita, Akita, Japan
| | - Keiichi Fujita
- Department of Radiology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Ryosuke Shirata
- Department of Radiation Oncology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Ryuji Inada
- Department of Radiology, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Ryuichi Yada
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Mikiko Yamashita
- Department of Radiological Technology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Kazuto Kondo
- Department of Radiological Technology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takashi Hanada
- Department of Radiology, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Tadashi Takenaka
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Kyoto, Japan
| | - Keisuke Usui
- Department of Radiological Technology, Juntendo University, Faculty of Health Science, Bunkyo, Tokyo, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Chuo, Tokyo, Japan
| | - Hiroshi Asakura
- Radiation Oncology Center, Dokkyo Medical University Hospital, Shimotsuga, Tochigi, Japan
| | - Ryoichi Notake
- Department of Radiology, Tokyo Medical And Dental University, Medical Hospital, Bunkyo, Tokyo, Japan
| | - Toru Kojima
- Department of Radiation Oncology, Saitama Cancer Center, Ina, Saitama, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Shogo Hatanaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Riki Kikumura
- Department of Radiology, National Hospital Organization, Tokyo Medical Center, Meguro, Tokyo, Japan
| | - Masaru Nakajima
- Department of Radiation Oncology, The Cancer Institute Hospital Of JFCR, Koto, Tokyo, Japan
| | - Ryosei Nakada
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Shizuoka, Japan
| | - Ryusuke Suzuki
- Department of Medical physics, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Hideyuki Mizuno
- Quality control section, QST hospital, National Institutes for Quantum Science and Technology, Chiba, Chiba, Japan
| | - Shinji Kawamura
- Division of Radiological Sciences, Teikyo University Graduate School of Health Sciences, Omuta, Fukuoka, Japan
| | - Mistuhiro Nakamura
- Division of Medical Physics, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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9
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Prisciandaro J, Zoberi JE, Cohen G, Kim Y, Johnson P, Paulson E, Song W, Hwang KP, Erickson B, Beriwal S, Kirisits C, Mourtada F. AAPM Task Group Report 303 endorsed by the ABS: MRI Implementation in HDR Brachytherapy-Considerations from Simulation to Treatment. Med Phys 2022; 49:e983-e1023. [PMID: 35662032 DOI: 10.1002/mp.15713] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/05/2022] Open
Abstract
The Task Group (TG) on Magnetic Resonance Imaging (MRI) Implementation in High Dose Rate (HDR) Brachytherapy - Considerations from Simulation to Treatment, TG 303, was constituted by the American Association of Physicists in Medicine's (AAPM's) Science Council under the direction of the Therapy Physics Committee, the Brachytherapy Subcommittee, and the Working Group on Brachytherapy Clinical Applications. The TG was charged with developing recommendations for commissioning, clinical implementation, and on-going quality assurance (QA). Additionally, the TG was charged with describing HDR brachytherapy (BT) workflows and evaluating practical consideration that arise when implementing MR imaging. For brevity, the report is focused on the treatment of gynecologic and prostate cancer. The TG report provides an introduction and rationale for MRI implementation in BT, a review of previous publications on topics including available applicators, clinical trials, previously published BT related TG reports, and new image guided recommendations beyond CT based practices. The report describes MRI protocols and methodologies, including recommendations for the clinical implementation and logical considerations for MR imaging for HDR BT. Given the evolution from prescriptive to risk-based QA,1 an example of a risk-based analysis using MRI-based, prostate HDR BT is presented. In summary, the TG report is intended to provide clear and comprehensive guidelines and recommendations for commissioning, clinical implementation, and QA for MRI-based HDR BT that may be utilized by the medical physics community to streamline this process. This report is endorsed by the American Brachytherapy Society (ABS). This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | | | - Gil'ad Cohen
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | - Perry Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL
| | | | | | - Ken-Pin Hwang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Sushil Beriwal
- Allegheny Health Network Cancer Institute, Pittsburgh, PA
| | | | - Firas Mourtada
- Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Chang D, Moore A, van Dyk S, Khaw P. Why quality assurance is necessary in gynecologic radiation oncology. Int J Gynecol Cancer 2022; 32:402-406. [DOI: 10.1136/ijgc-2021-002534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/16/2021] [Indexed: 11/03/2022] Open
Abstract
Quality assurance (QA) in radiation oncology involves all checks and processes that ensure that radiotherapy is delivered in an optimal and intended manner. QA is essential for the accurate delivery of brachytherapy and external beam radiotherapy in patients diagnosed with gynecologic malignancies. Inadequate QA can adversely impact clinical outcomes and reduce the reliability of clinical trials. This review highlights the importance of QA in gynecologic radiation oncology and explores the pertinent issues related to its implementation.
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11
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The Efficacy of Photobiomodulation Therapy in Improving Tissue Resilience and Healing of Radiation Skin Damage. PHOTONICS 2021. [DOI: 10.3390/photonics9010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The increased precision, efficacy, and safety of radiation brachytherapy has tremendously improved its popularity in cancer care. However, an unfortunate side effect of this therapy involves localized skin damage and breakdown that are managed palliatively currently. This study was motivated by prior reports on the efficacy of photobiomodulation (PBM) therapy in improving tissue resilience and wound healing. We evaluated the efficacy of PBM therapy on 36 athymic mice with 125I seed (0.42 mCi) implantation over 60 days. PBM treatments were performed with either red (660 nm) or near-infrared (880 nm, NIR) LEDs irradiance of 40 mW/cm2, continuous wave, fluence of 20 J/cm2 once per week. Animals were evaluated every 7 days with digital imaging, laser Doppler flowmetry, thermal imaging, µPET-CT imaging using 18F-FDG, and histology. We observed that both PBM treatments—red and NIR—demonstrated significantly less incidence and severity and improved healing with skin radionecrosis. Radiation exposed tissues had improved functional parameters such as vascular perfusion, reduced inflammation, and metabolic derangement following PBM therapy. Histological analysis confirmed these observations with minimal damage and resolution in tissues exposed to radiation. To our knowledge, this is the first report on the successful use of PBM therapy for brachytherapy. The results from this study support future mechanistic lab studies and controlled human clinical studies to utilize this innovative therapy in managing side effects from radiation cancer treatments.
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12
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Song WY, Robar JL, Morén B, Larsson T, Carlsson Tedgren Å, Jia X. Emerging technologies in brachytherapy. Phys Med Biol 2021; 66. [PMID: 34710856 DOI: 10.1088/1361-6560/ac344d] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 01/15/2023]
Abstract
Brachytherapy is a mature treatment modality. The literature is abundant in terms of review articles and comprehensive books on the latest established as well as evolving clinical practices. The intent of this article is to part ways and look beyond the current state-of-the-art and review emerging technologies that are noteworthy and perhaps may drive the future innovations in the field. There are plenty of candidate topics that deserve a deeper look, of course, but with practical limits in this communicative platform, we explore four topics that perhaps is worthwhile to review in detail at this time. First, intensity modulated brachytherapy (IMBT) is reviewed. The IMBT takes advantage ofanisotropicradiation profile generated through intelligent high-density shielding designs incorporated onto sources and applicators such to achieve high quality plans. Second, emerging applications of 3D printing (i.e. additive manufacturing) in brachytherapy are reviewed. With the advent of 3D printing, interest in this technology in brachytherapy has been immense and translation swift due to their potential to tailor applicators and treatments customizable to each individual patient. This is followed by, in third, innovations in treatment planning concerning catheter placement and dwell times where new modelling approaches, solution algorithms, and technological advances are reviewed. And, fourth and lastly, applications of a new machine learning technique, called deep learning, which has the potential to improve and automate all aspects of brachytherapy workflow, are reviewed. We do not expect that all ideas and innovations reviewed in this article will ultimately reach clinic but, nonetheless, this review provides a decent glimpse of what is to come. It would be exciting to monitor as IMBT, 3D printing, novel optimization algorithms, and deep learning technologies evolve over time and translate into pilot testing and sensibly phased clinical trials, and ultimately make a difference for cancer patients. Today's fancy is tomorrow's reality. The future is bright for brachytherapy.
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Affiliation(s)
- William Y Song
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - James L Robar
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Björn Morén
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Torbjörn Larsson
- Department of Mathematics, Linköping University, Linköping, Sweden
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | - Xun Jia
- Innovative Technology Of Radiotherapy Computations and Hardware (iTORCH) Laboratory, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
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13
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Interstitial brachytherapy for gynecologic malignancies: Complications, toxicities, and management. Brachytherapy 2021; 20:995-1004. [PMID: 33789823 DOI: 10.1016/j.brachy.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/21/2022]
Abstract
From both a disease and management perspective, locally advanced gynecologic cancers present a significant challenge. Dose escalation with brachytherapy serves as a key treatment, providing conformal radiation while sparing at-risk organs. Intracavitary brachytherapy techniques have been shown to be effective, with improving tumor control and toxicity profiles with the advent of three-dimensional image planning. Despite this, the variations in tumor size, location, and pelvic anatomy may lead to suboptimal dosimetry with standard intracavitary applicators in some clinical scenarios. The addition of interstitial needles (interstitial brachytherapy (ISBT)) can improve the conformality of brachytherapy treatments by adding needles to peripheral (and central) regions of the target volume, improving the ability to escalate doses in these undercovered regions while sparing organs at risk. Interstitial brachytherapy can be delivered by intracavitary and interstitial hybrid applicators (ICBT/ISBT), perineal template (P-ISBT), or by free-hand technique. ISBT has however yet to be widely available because of concerns of complications and toxicities from this specialized treatment. However, with the increasing use of three-dimensional image-guided brachytherapy, there is an opportunity to increase the level of expertise in the gynecologic radiation oncology community with an improved understanding of the potential complications and morbidity. In this article, we review the acute and long-term toxicity in both ICBT/ISBT and P-ISBT using image-guided brachytherapy.
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14
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Addressing the burden of cervical cancer through IAEA global brachytherapy initiatives. Brachytherapy 2020; 19:850-856. [PMID: 32928684 PMCID: PMC7895316 DOI: 10.1016/j.brachy.2020.07.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/29/2020] [Accepted: 07/29/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE: Brachytherapy (BT) is an essential component of definitive therapy for locally advanced cervical cancer. Despite the advantages of the dose distribution with BT in cervical cancer, there is paucity of specific skills required for good-quality BT applications. Furthermore, replacing BT with other modern external beam techniques as a boost can lead to suboptimal results in cervix cancer. METHODS AND MATERIALS: Review of available IAEA resources, research and cooperation programs available from the IAEA was completed. These opportunities can be used to address challenges in Brachytherapy. The International Atomic Energy Agency (IAEA) provides support for BT through various means that includes education and training, both long term, short term and continuing medical education of professionals, providing expert visits to support implementation, development of curricula for professionals, e-learning through the human health campus, contouring workshops, 2D to 3D BT training, and virtual tumor boards. In addition, the IAEA provides support for implementing quality assurance in radiotherapy to its member states and provides guidelines for comprehensive audits in radiation therapy (QUATRO), and produces safety standards and training in radiation safety. In addition, mapping BT resources, making the case for investment and support for setting up BT services and radiotherapy centers are also available. The IAEA Dosimetry Laboratory provides calibration services to Secondary Standards Dosimetry Laboratories for well chambers used to confirm the reference air kerma rate of Co60 and Ir192 high-dose-rate BT sources, as well as for Cs137 low-dose-rate sources. Furthermore, the IAEA supports research and development in radiotherapy (and BT) through coordinated research activities that include controlled randomized clinical trials, Patterns of Care studies among others. Partnerships with professional organizations and funding bodies, as well as through the United Nations Joint Global Programme on Cervical Cancer Prevention and Control support radiotherapy activities, including BT in countries worldwide. CONCLUSION: The IAEA supports brachytherapy implementation, training and research and provides resources to professionals in the area.
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Fulkerson RK, Perez‐Calatayud J, Ballester F, Buzurovic I, Kim Y, Niatsetski Y, Ouhib Z, Pai S, Rivard MJ, Rong Y, Siebert F, Thomadsen BR, Weigand F. Surface brachytherapy: Joint report of the AAPM and the GEC‐ESTRO Task Group No. 253. Med Phys 2020; 47:e951-e987. [DOI: 10.1002/mp.14436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Regina K. Fulkerson
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Jose Perez‐Calatayud
- Radiotherapy Department La Fe Hospital Valencia46026 Spain
- Radiotherapy Department Clinica Benidorm Alicante03501 Spain
| | - Facundo Ballester
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot46100 Spain
| | - Ivan Buzurovic
- Dana‐Farber/Brigham and Women’s Cancer Center Harvard Medical School Boston MA02115 USA
| | - Yongbok Kim
- Department of Radiation Oncology University of Arizona Tucson AZ85724 USA
| | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1 Veenendaal3903 DD Netherlands
| | - Zoubir Ouhib
- Radiation Oncology Department Lynn Regional Cancer CenterBoca Raton Community Hospital Boca Raton FL33486 USA
| | - Sujatha Pai
- Radion Inc. 20380 Town Center Lane, Suite 135 Cupertino CA95014 USA
| | - Mark J. Rivard
- Department of Radiation Oncology Alpert Medical School Brown University Providence RI02903 USA
| | - Yi Rong
- Department of Radiation Oncology University of California Davis Comprehensive Cancer Center Sacramento CA95817 USA
| | - Frank‐André Siebert
- UK S‐HCampus Kiel, Klinik fur Strahlentherapie (Radioonkologie) Arnold‐Heller‐Str. 3Haus 50 KielD‐24105 Germany
| | - Bruce R. Thomadsen
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Frank Weigand
- Carl Zeiss Meditec AG Rudolf‐Eber‐Straße 11 Oberkochen73447 Germany
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16
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First experience of 192Ir source stuck event during high-dose-rate brachytherapy in Japan. J Contemp Brachytherapy 2020; 12:53-60. [PMID: 32190071 PMCID: PMC7073345 DOI: 10.5114/jcb.2020.92401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/09/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To share the experience of an iridium-192 (192Ir) source stuck event during high-dose-rate (HDR) brachytherapy for cervical cancer. Material and methods In 2014, we experienced the first source stuck event in Japan when treating cervical cancer with HDR brachytherapy. The cause of the event was a loose screw in the treatment device that interfered with the gear reeling the source. This event had minimal clinical effects on the patient and staff; however, after the event, we created a normal treatment process and an emergency process. In the emergency processes, each staff member is given an appropriate role. The dose rate distribution calculated by the new Monte Carlo simulation system was used as a reference to create the process. Results According to the calculated dose rate distribution, the dose rates inside the maze, near the treatment room door, and near the console room were ≅ 10-2 [cGy · h-1], 10-3 [cGy · h-1], and << 10-3 [cGy · h-1], respectively. Based on these findings, in the emergency process, the recorder was evacuated to the console room, and the rescuer waited inside the maze until the radiation source was recovered. This emergency response manual is currently a critical workflow once a year with vendors. Conclusions We reported our experience of the source stuck event. Details of the event and proposed emergency process will be helpful in managing a patient safety program for other HDR brachytherapy users.
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Prisciandaro JI, Zhao X, Dieterich S, Hasan Y, Jolly S, Al-Hallaq HA. Interstitial High-Dose-Rate Gynecologic Brachytherapy: Clinical Workflow Experience From Three Academic Institutions. Semin Radiat Oncol 2019; 30:29-38. [PMID: 31727297 DOI: 10.1016/j.semradonc.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
An interstitial brachytherapy approach for gynecologic cancers is typically considered for patients with lesions exceeding 5 mm within tissue or that are not easily accessible for intracavitary applications. Recommendations for treating gynecologic malignancies with this approach are available through the American Brachytherapy Society, but vary based on available resources, staffing, and logistics. The intent of this manuscript is to share the collective experience of 3 academic centers that routinely perform interstitial gynecologic brachytherapy. Discussion points include indications for interstitial implants, procedural preparations, applicator selection, anesthetic options, imaging, treatment planning objectives, clinical workflows, timelines, safety, and potential challenges. Interstitial brachytherapy is a complex, high-skill procedure requiring routine practice to optimize patient safety and treatment efficacy. Clinics planning to implement this approach into their brachytherapy practice may benefit from considering the discussion points shared in this manuscript.
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Affiliation(s)
- Joann I Prisciandaro
- Department of Radiation Oncology, University of Michigan/Michigan Medicine, Ann Arbor, MI.
| | - Xiao Zhao
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA
| | - Sonja Dieterich
- Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, CA
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan/Michigan Medicine, Ann Arbor, MI
| | - Hania A Al-Hallaq
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL
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18
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Abstract
Radiation protection in brachytherapy entails protecting members of the public, radiation professionals, and the patient from unnecessary radiation, as well as making sure that the radiation used in the patient's treatment is placed correctly with the correct dose distribution. Protecting members of the public from radiation emanating from brachytherapy sources implanted in a patient was an issue several decades ago, but with modern brachytherapy, the problem has mostly disappeared. The most frequent treatments are either low-dose-rate permanent implants for prostate cancer, or high-dose-rate procedures for gynecological, breast, or skin cancers. Almost all current permanent implants use low-energy photon sources that are shielded by the patient. Similarly, some temporary implants, such as eye plaques that also use low-energy photon sources, incorporate a metallic shield into the applicator. All high-dose-rate brachytherapy takes place in a treatment vault, in a manner similar to external-beam radiotherapy, thus eliminating exposure to members of the public, in the absence of some terrible error or mistake. Modern brachytherapy techniques either eliminate or greatly reduce radiation exposures to the brachytherapy staff also. As noted above, high-dose-rate treatments take place in a heavily shielded vault, and staff remain outside the vault when the source is out of its shielded housing. For low-energy permanent implants, facilities often order the sources loaded into the implant needles by the vendor, reducing the time the procedure staff is exposed to the source. Often, the loaded needles can be shielded while awaiting implantation. Alternatively, individual sources may be placed using a special applicator that shields the staff. Radiation protection of the patient in many respects differs little from how it was decades ago except for greatly increased precision. Assaying the strength of a source of any kind is still essential. As important as verifying the source strength is ensuring that the source will be in the correct location for the desired time. Imaging serves as the main mechanism to guide the implantation and verify source or applicator position. Modern imaging has unveiled anatomy exquisitely and often permits definition of target disease and neighboring normal structures sufficiently to allow very conformal dose distributions. Despite these great advances and capabilities, errors and mistakes (together called failures) still occur. Failures in health care overall are the third leading cause of death in the United States. Most treatment failures result not from equipment problems but from procedures gone wrong. Attention to comprehensive commissioning of both equipment and procedures and risk-based development of quality management procedures helps protect the patient. Patient safety organizations, established by the Agency for Healthcare Research and Quality, work with client facilities to help identify weaknesses in both treatment procedures and quality management and to develop improvements to enhance protection.
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Affiliation(s)
- Bruce Thomadsen
- Department of Medical Physics, University of Wisconsin-Madison, 1005 Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705
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19
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Kumar M, Pandey U, Yadav Y, Gandhi SS, Saxena SK, Kumar Y, Nuwad J, Dash A. Utilization of Chemical Deposition Technique for Preparation of Miniature 170Tm Sources and Preliminary Quality Assessment for Potential Use in Brachytherapy. Cancer Biother Radiopharm 2019; 34:24-32. [DOI: 10.1089/cbr.2018.2524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Manoj Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Usha Pandey
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
| | - Yugandhara Yadav
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
| | - Shyamala S. Gandhi
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
| | | | - Yogendra Kumar
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
| | - Jitendra Nuwad
- Chemistry Division, Bhabha Atomic Research Center, Mumbai, India
| | - Ashutosh Dash
- Radiopharmaceuticals Division, Bhabha Atomic Research Center, Mumbai, India
- Homi Bhabha National Institute, Mumbai, India
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20
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Cai B, Altman MB, Reynoso F, Garcia-Ramirez J, He A, Edward SS, Zoberi I, Thomas MA, Gay H, Mutic S, Zoberi JE. Standardization and automation of quality assurance for high-dose-rate brachytherapy planning with application programming interface. Brachytherapy 2018; 18:108-114.e1. [PMID: 30385115 DOI: 10.1016/j.brachy.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/01/2018] [Accepted: 09/06/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To standardize and automate the high-dose-rate (HDR) brachytherapy planning quality assurance (QA) process utilizing scripting with application programming interface (API) in a commercially available treatment planning system (TPS). METHODS AND MATERIALS Site- and applicator-dependent plan quality (PQ) evaluation criteria and plan integrity (PI) checklists were established based on published guidelines, clinical protocols, and institutional experience. User designed C# programs ("scripts") were created and executed through the API to access planning information in TPS. A set of standardized quality control reports, focusing on PQ evaluations and PI checks, were automatically generated. Information derived from the TPS was compared against predetermined QA metrics with color-coded pass/fail indicators to aid and enhance the efficiency of plan evaluation. Five independent, blinded observers reviewed mock plans with simulated errors to validate the scripts and to quantify the improvement of plan review efficiency. RESULTS Scripts were developed for HDR prostate and breast. Forty-one parameters were reported/checked in the PI report; the PQ report returned dose-volume indices and an independent check of dwell time. All simulated errors were detected by the PI scripts with appropriate warning messages displayed, and any values failing to meet the planning constraints were red-flagged successfully in the PQ report. An average time reduction of 16 min for plan review was observed when using the scripts. CONCLUSIONS API scripting-based automated planning QA for HDR brachytherapy including PI checks and PQ evaluations was designed and implemented. The simulated error study showed promising results in terms of error catching and efficiency improvement.
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Affiliation(s)
- Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO.
| | - Michael B Altman
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Francisco Reynoso
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jose Garcia-Ramirez
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Angell He
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Sharbacha S Edward
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Maria A Thomas
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
| | - Jacqueline E Zoberi
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MO
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Verification of high-dose-rate brachytherapy treatment planning dose distribution using liquid-filled ionization chamber array. J Contemp Brachytherapy 2018; 10:142-154. [PMID: 29789763 PMCID: PMC5961529 DOI: 10.5114/jcb.2018.75599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/23/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to investigate the dosimetric performance of a liquid-filled ionization chamber array in high-dose-rate (HDR) brachytherapy dosimetry. A comparative study was carried out with air-filled ionization chamber array and EBT3 Gafchromic films to demonstrate its suitability in brachytherapy. Material and methods The PTW OCTAVIUS detector 1000 SRS (IA 2.5-5 mm) is a liquid-filled ionization chamber array of area 11 x 11 cm2 and chamber spacing of 2.5-5 mm, whereas the PTW OCTAVIUS detector 729 (IA 10 mm) is an air vented ionization chamber array of area 27 x 27 cm2 and chamber spacing of 10 mm. EBT3 films were exposed to doses up to a maximum of 6 Gy and evaluated using multi-channel analysis. The detectors were evaluated using test plans to mimic a HDR intracavitary gynecological treatment. The plan was calculated and delivered with the applicator plane placed 20 mm from the detector plane. The acquired measurements were compared to the treatment plan. In addition to point dose measurement, profile/isodose, gamma analysis, and uncertainty analysis were performed. Detector sensitivity was evaluated by introducing simulated errors to the test plans. Results The mean point dose differences between measured and calculated plans were 0.2% ± 1.6%, 1.8% ± 1.0%, and 1.5% ± 0.81% for film, IA 10 mm, and IA 2.5-5 mm, respectively. The average percentage of passed gamma (global/local) values using 3%/3 mm criteria was above 99.8% for all three detectors on the original plan. For IA 2.5-5 mm, local gamma criteria of 2%/1 mm with a passing rate of at least 95% was found to be sensitive when simulated positional errors of 1 mm was introduced. Conclusion The dosimetric properties of IA 2.5-5 mm showed the applicability of liquid-filled ionization chamber array as a potential QA device for HDR brachytherapy treatment planning systems.
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Steinberg I, Tamir G, Gannot I. A Reconstruction Method for the Estimation of Temperatures of Multiple Sources Applied for Nanoparticle-Mediated Hyperthermia. Molecules 2018; 23:molecules23030670. [PMID: 29547502 PMCID: PMC6017713 DOI: 10.3390/molecules23030670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/06/2018] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Solid malignant tumors are one of the leading causes of death worldwide. Many times complete removal is not possible and alternative methods such as focused hyperthermia are used. Precise control of the hyperthermia process is imperative for the successful application of such treatment. To that end, this research presents a fast method that enables the estimation of deep tissue heat distribution by capturing and processing the transient temperature at the boundary based on a bio-heat transfer model. The theoretical model is rigorously developed and thoroughly validated by a series of experiments. A 10-fold improvement is demonstrated in resolution and visibility on tissue mimicking phantoms. The inverse problem is demonstrated as well with a successful application of the model for imaging deep-tissue embedded heat sources. Thereby, allowing the physician then ability to dynamically evaluate the hyperthermia treatment efficiency in real time.
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Affiliation(s)
- Idan Steinberg
- Multimodality Molecular Imaging Lab (MMIL), Department of Radiology, School of Medicine, Stanford University, Stanford, CA 94305-5427, USA.
| | - Gil Tamir
- The Laboratory for Optics and Lasers in Medicine , Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv 6997801, Israel.
| | - Israel Gannot
- The Laboratory for Optics and Lasers in Medicine , Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv 6997801, Israel.
- Department of Electrical and Computer Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD 21218-2608, USA.
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23
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Okamoto H, Nakamura S, Nishioka S, Iijima K, Wakita A, Abe Y, Tohyama N, Kawamura S, Minemura T, Itami J. Independent assessment of source position for gynecological applicator in high-dose-rate brachytherapy. J Contemp Brachytherapy 2017; 9:477-486. [PMID: 29204169 PMCID: PMC5705831 DOI: 10.5114/jcb.2017.70952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 09/05/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The aim of this study is to describe a phantom designed for independent examination of a source position in brachytherapy that is suitable for inclusion in an external auditing program. MATERIAL AND METHODS We developed a phantom that has a special design and a simple mechanism, capable of firmly fixing a radiochromic film and tandem-ovoid applicators to assess discrepancies in source positions between the measurements and treatment planning system (TPS). Three tests were conducted: 1) reproducibility of the source positions (n = 5); 2) source movements inside the applicator tube; 3) changing source position by changing curvature of the transfer tubes. In addition, as a trial study, the phantom was mailed to 12 institutions, and 23 trial data sets were examined. The source displacement ΔX and ΔY (reference = TPS) were expressed according to the coordinates, in which the positive direction on the X-axis corresponds to the external side of the applicator perpendicular to source transfer direction Y-axis. RESULTS Test 1: The 1σ fell within 1 mm irrespective of the dwell positions. Test 2: ΔX were greater around the tip of the applicator owing to the source cable. Test 3: All of the source position changes fell within 1 mm. For postal audit, the mean and 1.96σ in ΔX were 0.8 and 0.8 mm, respectively. Almost all data were located within a positive region along the X-axis due to the source cable. The mean and 1.96σ in ΔY were 0.3 and 1.6 mm, respectively. The variance in ΔY was greater than that in ΔX, and large uncertainties exist in the determination of the first dwell position. The 95% confidence limit was 2.1 mm. CONCLUSIONS In HDR brachytherapy, an effectiveness of independent source position assessment could be demonstrated. The 95% confidence limit was 2.1 mm for a tandem-ovoids applicator.
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Affiliation(s)
- Hiroyuki Okamoto
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
| | - Satoshi Nakamura
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
| | - Shie Nishioka
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
| | - Kotaro Iijima
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
| | - Akihisa Wakita
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
| | - Yukinao Abe
- Department of Radiology, Chiba University Hospital, Chiba
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Advanced Imaging & Radiation Oncology Clinic, Chiba
| | - Shinji Kawamura
- Department of Radiological Technology, Faculty of Fukuoka Medical Technology, Teikyo University, Fukuoka
| | - Toshiyuki Minemura
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo
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Brusadin G, Bour MS, Deutsch E, Kouchit N, Corbin S, Lefkopoulos D. [Implementation of "never events" checklists in a radiotherapy information system]. Cancer Radiother 2017; 21:665-669. [PMID: 28826696 DOI: 10.1016/j.canrad.2017.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 07/18/2017] [Indexed: 12/31/2022]
Abstract
In order to reduce the incidence of major accidents during external radiotherapy treatment, "never events" checklists have been incorporated into the "record and verify" system. This article details this process. Prospects for improvement are also proposed, including a peer-to-peer audit on the use of checklists and the availability of the radiotherapy information system manufacturer to collaborate in this process to secure the patients' journey.
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Affiliation(s)
- G Brusadin
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France.
| | - M S Bour
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - E Deutsch
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - N Kouchit
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - S Corbin
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - D Lefkopoulos
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
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Brachytherapy patient safety events in an academic radiation medicine program. Brachytherapy 2017; 17:16-23. [PMID: 28757402 DOI: 10.1016/j.brachy.2017.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 06/22/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To describe the incidence and type of brachytherapy patient safety events over 10 years in an academic brachytherapy program. METHODS AND MATERIALS Brachytherapy patient safety events reported between January 2007 and August 2016 were retrieved from the incident reporting system and reclassified using the recently developed National System for Incident Reporting in Radiation Treatment taxonomy. A multi-incident analysis was conducted to identify common themes and key learning points. RESULTS During the study period, 3095 patients received 4967 brachytherapy fractions. An additional 179 patients had MR-guided prostate biopsies without treatment as part of an interventional research program. A total of 94 brachytherapy- or biopsy-related safety events (incidents, near misses, or programmatic hazards) were identified, corresponding to a rate of 2.8% of brachytherapy patients, 1.7% of brachytherapy fractions, and 3.4% of patients undergoing MR-guided prostate biopsy. Fifty-one (54%) events were classified as actual incidents, 29 (31%) as near misses, and 14 (15%) as programmatic hazards. Two events were associated with moderate acute medical harm or dosimetric severity, and two were associated with high dosimetric severity. Multi-incident analysis identified five high-risk activities or clinical scenarios as follows: (1) uncommon, low-volume or newly implemented brachytherapy procedures, (2) real-time MR-guided brachytherapy or biopsy procedures, (3) use of in-house devices or software, (4) manual data entry, and (5) patient scheduling and handoffs. CONCLUSIONS Brachytherapy is a safe treatment and associated with a low rate of patient safety events. Effective incident management is a key element of continuous quality improvement and patient safety in brachytherapy.
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Shi C, Wang B. Preliminary Monte Carlo Investigation of Using Ir-192 as the Source for Real Time Imaging Purpose. INTERNATIONAL JOURNAL OF MEDICAL PHYSICS, CLINICAL ENGINEERING AND RADIATION ONCOLOGY 2017; 6:21-30. [PMID: 28824832 PMCID: PMC5562365 DOI: 10.4236/ijmpcero.2017.61003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The purpose of this study is to investigate the potential use of Ir-192 as the source for real time imaging during HDR (High Dose Rate) brachytherapy treatment. Phantom measurement was performed to determine outside of the body dose. Monte Carlo code, EGSnrcMP egs_inprz, was used for the simulation to calculate the outside of the body x-ray signal for CT reconstruction. Matlab code was developed to reconstruct the Ir-192 source and for 3D visualization in order to assess reconstructed CT resolution, signal-to-noise ratio, and imaging dose information. The measured dose was 0.67 ± 0.04 cGy, which was comparable to the Monte Carlo simulation result 0.71 ± 0.20 cGy. The reconstructed source diameter dimension was 1.3 mm compared with 1.1 mm for the real source dimension. The signal-to-noise ratio was 19.91 db following de-noising. Source position was within a 1 mm difference between programmed and simulated results. Although the Ir-192 signal is weak for CT imaging, it is possible to use it as a CT imaging x-ray source for HDR treatment localization, verification and dosimetry purposes. Further study is needed for the detailed design of an outside of the body CT-like device for use in brachytherapy imaging.
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Affiliation(s)
- Chengyu Shi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brian Wang
- Department of Radiation Oncology, James Brown Cancer Center, The University of Louisville, Louisville, KY, USA
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Huq MS, Fraass BA, Dunscombe PB, Gibbons JP, Ibbott GS, Mundt AJ, Mutic S, Palta JR, Rath F, Thomadsen BR, Williamson JF, Yorke ED. The report of Task Group 100 of the AAPM: Application of risk analysis methods to radiation therapy quality management. Med Phys 2016; 43:4209. [PMID: 27370140 PMCID: PMC4985013 DOI: 10.1118/1.4947547] [Citation(s) in RCA: 303] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 03/13/2016] [Accepted: 03/14/2016] [Indexed: 12/25/2022] Open
Abstract
The increasing complexity of modern radiation therapy planning and delivery challenges traditional prescriptive quality management (QM) methods, such as many of those included in guidelines published by organizations such as the AAPM, ASTRO, ACR, ESTRO, and IAEA. These prescriptive guidelines have traditionally focused on monitoring all aspects of the functional performance of radiotherapy (RT) equipment by comparing parameters against tolerances set at strict but achievable values. Many errors that occur in radiation oncology are not due to failures in devices and software; rather they are failures in workflow and process. A systematic understanding of the likelihood and clinical impact of possible failures throughout a course of radiotherapy is needed to direct limit QM resources efficiently to produce maximum safety and quality of patient care. Task Group 100 of the AAPM has taken a broad view of these issues and has developed a framework for designing QM activities, based on estimates of the probability of identified failures and their clinical outcome through the RT planning and delivery process. The Task Group has chosen a specific radiotherapy process required for "intensity modulated radiation therapy (IMRT)" as a case study. The goal of this work is to apply modern risk-based analysis techniques to this complex RT process in order to demonstrate to the RT community that such techniques may help identify more effective and efficient ways to enhance the safety and quality of our treatment processes. The task group generated by consensus an example quality management program strategy for the IMRT process performed at the institution of one of the authors. This report describes the methodology and nomenclature developed, presents the process maps, FMEAs, fault trees, and QM programs developed, and makes suggestions on how this information could be used in the clinic. The development and implementation of risk-assessment techniques will make radiation therapy safer and more efficient.
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Affiliation(s)
- M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute and UPMC CancerCenter, Pittsburgh, Pennsylvania 15232
| | - Benedick A Fraass
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048
| | - Peter B Dunscombe
- Department of Oncology, University of Calgary, Calgary T2N 1N4, Canada
| | | | - Geoffrey S Ibbott
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, Texas 77030
| | - Arno J Mundt
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, California 92093-0843
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110
| | - Jatinder R Palta
- Department of Radiation Oncology, Virginia Commonwealth University, P.O. Box 980058, Richmond, Virginia 23298
| | - Frank Rath
- Department of Engineering Professional Development, University of Wisconsin, Madison, Wisconsin 53706
| | - Bruce R Thomadsen
- Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705-2275
| | - Jeffrey F Williamson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia 23298-0058
| | - Ellen D Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Center, New York, New York 10065
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Brown DW, Damato AL, Sutlief S, Morcovescu S, Park SJ, Reiff J, Shih A, Scanderbeg DJ. A consensus-based, process commissioning template for high-dose-rate gynecologic treatments. Brachytherapy 2016; 15:570-7. [PMID: 27364873 DOI: 10.1016/j.brachy.2016.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE There is a lack of prescriptive, practical information for those doing the work of commissioning high-dose-rate (HDR) gynecologic (GYN) treatment equipment. The purpose of this work is to develop a vendor-neutral, consensus-based, commissioning template to improve standardization of the commissioning process. METHODS AND MATERIALS A series of commissioning procedures and tests specific to HDR GYN treatments were compiled within one institution. The list of procedures and tests was then sent to five external reviewers at clinics engaged in HDR GYN treatments. External reviewers were asked to (1) suggest deletions, additions, and improvements/modifications to descriptions, (2) link the procedures and tests to common, severe failure modes based on their effectiveness at mitigating those failure modes, and (3) rank the procedures and tests based on perceived level of importance. RESULTS External reviewers suggested the addition of 14 procedures and tests. The final template consists of 67 procedures and tests. "Treatment process" and "staff training" sections were identified as mitigating the highest number of commonly reported failure modes. The mean perceived importance for all procedures and tests was 4.4 of 5, and the mean for each section ranged from 3.6 to 4.8. Sections of the template that were identified as mitigating the highest number of commonly reported failure modes were not assigned the highest perceived importance. CONCLUSION The commissioning template developed here provides a standardized approach to process and equipment commissioning. The discord between perceived importance and mitigation of the highest number of failure modes suggests that increased focus should be placed on procedures and tests in "treatment process" and "staff training" sections.
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Affiliation(s)
- Derek W Brown
- Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA.
| | - Antonio L Damato
- Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA
| | - Steven Sutlief
- Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA
| | | | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Jay Reiff
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, PA
| | - Allen Shih
- Cancer Treatment Center, Kaiser Permanente Santa Clara, Santa Clara, CA
| | - Daniel J Scanderbeg
- Deparment of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA
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Vargo JA, Viswanathan AN, Erickson BA, Beriwal S. Gynecologic Brachytherapy: Cervical Cancer. Brachytherapy 2016. [DOI: 10.1007/978-3-319-26791-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee WR. Six-Year Checkup: Narrowing the Scope of Practical Radiation Oncology. Pract Radiat Oncol 2015; 6:1-2. [PMID: 26679423 DOI: 10.1016/j.prro.2015.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/12/2015] [Indexed: 11/18/2022]
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A framework for quality improvement and patient safety education in radiation oncology residency programs. Pract Radiat Oncol 2015; 5:423-6. [DOI: 10.1016/j.prro.2015.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/27/2015] [Indexed: 12/26/2022]
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Prisciandaro J, Hadley S, Jolly S, Lee C, Roberson P, Roberts D, Ritter T. Development of a brachytherapy audit checklist tool. Brachytherapy 2015; 14:963-9. [PMID: 26439623 DOI: 10.1016/j.brachy.2015.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/04/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To develop a brachytherapy audit checklist that could be used to prepare for Nuclear Regulatory Commission or agreement state inspections, to aid in readiness for a practice accreditation visit, or to be used as an annual internal audit tool. METHODS AND MATERIALS Six board-certified medical physicists and one radiation oncologist conducted a thorough review of brachytherapy-related literature and practice guidelines published by professional organizations and federal regulations. The team members worked at two facilities that are part of a large, academic health care center. Checklist items were given a score based on their judged importance. Four clinical sites performed an audit of their program using the checklist. The sites were asked to score each item based on a defined severity scale for their noncompliance, and final audit scores were tallied by summing the products of importance score and severity score for each item. RESULTS The final audit checklist, which is available online, contains 83 items. The audit scores from the beta sites ranged from 17 to 71 (out of 690) and identified a total of 7-16 noncompliance items. The total time to conduct the audit ranged from 1.5 to 5 hours. CONCLUSIONS A comprehensive audit checklist was developed which can be implemented by any facility that wishes to perform a program audit in support of their own brachytherapy program. The checklist is designed to allow users to identify areas of noncompliance and to prioritize how these items are addressed to minimize deviations from nationally-recognized standards.
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Affiliation(s)
- Joann Prisciandaro
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.
| | - Scott Hadley
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Shruti Jolly
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Peter Roberson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Donald Roberts
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Timothy Ritter
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI; Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
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Practical implementation of quality improvement for high-dose-rate brachytherapy. Pract Radiat Oncol 2015; 6:34-43. [PMID: 26577008 DOI: 10.1016/j.prro.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/30/2015] [Accepted: 09/12/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE High-dose-rate (HDR) brachytherapy is a high-risk procedure with serious errors reported in the medical literature. Our goal was to develop a quality improvement framework for HDR brachytherapy using a multidisciplinary approach. This work describes the time, personnel, and materials involved in implementation as well as staff-reported safety benefits of quality improvement checklists. METHODS AND MATERIALS Quality improvement was achieved using a department-wide multidisciplinary approach. Process mapping of the entire HDR program, from initial scheduling through follow-up, was performed. The scope of the project was narrowed to the point of treatment delivery. Two types of multidisciplinary checklists were created: a safety-timeout checklist to ensure safety-critical actions were performed before treatment initiation; and detailed procedure checklists that served as written procedures for physicians, physicists, dosimetrists, and nurses. Implementation was carried out through initial training led by various staff members, creation of visual training guides, piloting and use of checklists for all treatments, and auditing of checklist compliance. RESULTS Process maps of the entire HDR program were generated and used to guide subsequent changes in the treatment delivery process. A single safety-timeout checklist and the individual procedure checklists were created and used at the time of treatment delivery. The 3-month audit showed that the safety-timeout checklist was used for 100% of treatment fractions. Individual procedure checklists were used for 85% of fractions. All cross-covering physicians and physicists continued to use these checklists 100% of the time. Staff survey results indicated improvements in safety and increased benefits for cross-covering staff. CONCLUSIONS In using a multidisciplinary approach to quality improvement, process mapping and comprehensive checklists for HDR treatment delivery have been implemented. This has resulted in improved practices that are optimal in our department. This experience can provide others with practical strategies toward implementing such changes in their own facilities.
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Espinoza A, Petasecca M, Fuduli I, Howie A, Bucci J, Corde S, Jackson M, Lerch MLF, Rosenfelda AB. The evaluation of a 2D diode array in “magic phantom” for use in high dose rate brachytherapy pretreatment quality assurance. Med Phys 2015; 42:663-673. [PMID: 25771556 DOI: 10.1118/1.4905233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High dose rate (HDR) brachytherapy is a treatment method that is used increasingly worldwide. The development of a sound quality assurance program for the verification of treatment deliveries can be challenging due to the high source activity utilized and the need for precise measurements of dwell positions and times. This paper describes the application of a novel phantom, based on a 2D 11 × 11 diode array detection system, named “magic phantom” (MPh), to accurately measure plan dwell positions and times, compare them directly to the treatment plan, determine errors in treatment delivery, and calculate absorbed dose. METHODS The magic phantom system was CT scanned and a 20 catheter plan was generated to simulate a nonspecific treatment scenario. This plan was delivered to the MPh and, using a custom developed software suite, the dwell positions and times were measured and compared to the plan. The original plan was also modified, with changes not disclosed to the primary authors, and measured again using the device and software to determine the modifications. A new metric, the “position–time gamma index,” was developed to quantify the quality of a treatment delivery when compared to the treatment plan. The MPh was evaluated to determine the minimum measurable dwell time and step size. The incorporation of the TG-43U1 formalism directly into the software allows for dose calculations to be made based on the measured plan. The estimated dose distributions calculated by the software were compared to the treatment plan and to calibrated EBT3 film, using the 2D gamma analysis method. RESULTS For the original plan, the magic phantom system was capable of measuring all dwell points and dwell times and the majority were found to be within 0.93 mm and 0.25 s, respectively, from the plan. By measuring the altered plan and comparing it to the unmodified treatment plan, the use of the position–time gamma index showed that all modifications made could be readily detected. The MPh was able to measure dwell times down to 0.067 ± 0.001 s and planned dwell positions separated by 1 mm. The dose calculation carried out by the MPh software was found to be in agreement with values calculated by the treatment planning system within 0.75%. Using the 2D gamma index, the dose map of the MPh plane and measured EBT3 were found to have a pass rate of over 95% when compared to the original plan. CONCLUSIONS The application of this magic phantom quality assurance system to HDR brachytherapy has demonstrated promising ability to perform the verification of treatment plans, based upon the measured dwell positions and times. The introduction of the quantitative position–time gamma index allows for direct comparison of measured parameters against the plan and could be used prior to patient treatment to ensure accurate delivery.
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Kim T, Showalter TN, Watkins WT, Trifiletti DM, Libby B. Parallelized patient-specific quality assurance for high-dose-rate image-guided brachytherapy in an integrated computed tomography-on-rails brachytherapy suite. Brachytherapy 2015; 14:834-9. [PMID: 26356642 DOI: 10.1016/j.brachy.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/20/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe a parallelized patient-specific quality assurance (QA) program designed to ensure safety and quality in image-guided high-dose-rate brachytherapy in an integrated computed tomography (CT)-on-rails brachytherapy suite. MATERIALS AND METHODS A patient-specific QA program has been modified for the image-guided brachytherapy (IGBT) program in an integrated CT-on-rails brachytherapy suite. In the modification of the QA procedures of Task Group-59, the additional patient-specific QA procedures are included to improve rapid IGBT workflow with applicator placement, imaging, planning, treatment, and applicator removal taking place in one room. RESULTS The IGBT workflow is partitioned into two groups of tasks that can be performed in parallel by two or more staff members. One of the unique components of our implemented workflow is that groups work together to perform QA steps in parallel and in series during treatment planning and contouring. Coordinating efforts in this systematic way enable rapid and safe brachytherapy treatment while incorporating 3-dimensional anatomic variations between treatment days. CONCLUSIONS Implementation of these patient-specific QA procedures in an integrated CT-on-rails brachytherapy suite ensures confidence that a rapid workflow IGBT program can be implemented without sacrificing patient safety or quality and deliver highly-conformal dose to target volumes. These patient-specific QA components may be adapted to other IGBT environments that seek to provide rapid workflow while ensuring quality.
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Affiliation(s)
- Taeho Kim
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - W Tyler Watkins
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA
| | - Bruce Libby
- Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA.
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Espinoza A, Petasecca M, Cutajar D, Fuduli I, Howie A, Bucci J, Corde S, Jackson M, Zaider M, Lerch MLF, Rosenfeld AB. Pretreatment verification of high dose rate brachytherapy plans using the ‘magic phantom’ system. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/2/025201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Marks LB, Pawlicki TA, Hayman JA. Learning to Appreciate Swiss Cheese and Other Industrial Engineering Concepts. Pract Radiat Oncol 2015; 5:277-281. [PMID: 26362704 DOI: 10.1016/j.prro.2015.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/21/2015] [Indexed: 12/26/2022]
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Adlienė D, Jakštas K, Urbonavičius BG. In vivo TLD dose measurements in catheter-based high-dose-rate brachytherapy. RADIATION PROTECTION DOSIMETRY 2015; 165:477-481. [PMID: 25809111 DOI: 10.1093/rpd/ncv054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Routine in vivo dosimetry is well established in external beam radiotherapy; however, it is restricted mainly to detection of gross errors in high-dose-rate (HDR) brachytherapy due to complicated measurements in the field of steep dose gradients in the vicinity of radioactive source and high uncertainties. The results of in vivo dose measurements using TLD 100 mini rods and TLD 'pin worms' in catheter-based HDR brachytherapy are provided in this paper alongside with their comparison with corresponding dose values obtained using calculation algorithm of the treatment planning system. Possibility to perform independent verification of treatment delivery in HDR brachytherapy using TLDs is discussed.
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Affiliation(s)
- Diana Adlienė
- Physics Department, Kaunas University of Technology, Studentų g. 50, LT-51368 Kaunas, Lithuania
| | - Karolis Jakštas
- Šiauliai County Hospital, V.Kudirkos g. 99, LT-76231 Šiauliai, Lithuania
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