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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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Quantifying clinical severity of physics errors in high-dose rate prostate brachytherapy using simulations. Brachytherapy 2021; 20:1062-1069. [PMID: 34193362 DOI: 10.1016/j.brachy.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE To quantitatively evaluate through automated simulations the clinical significance of potential high-dose rate (HDR) prostate brachytherapy (HDRPB) physics errors selected from our internal failure-modes and effect analysis (FMEA). METHODS AND MATERIALS A list of failure modes was compiled and scored independently by 8 brachytherapy physicists on a one-to-ten scale for severity (S), occurrence (O), and detectability (D), with risk priority number (RPN) = SxOxD. Variability of RPNs across observers (standard deviation/average) was calculated. Six idealized HDRPB plans were generated, and error simulations were performed: single (N = 1722) and systematic (N = 126) catheter shifts (craniocaudal; -1cm:1 cm); single catheter digitization errors (tip and connector needle-tips displaced independently in random directions; 0.1 cm:0.5 cm; N = 44,318); and swaps (two catheters swapped during digitization or connection; N = 528). The deviations due to each error in prostate D90%, urethra D20%, and rectum D1cm3 were analyzed using two thresholds: 5-20% (possible clinical impact) and >20% (potentially reportable events). RESULTS Twenty-nine relevant failure modes were described. Overall, RPNs ranged from 6 to 108 (average ± 1 standard deviation, 46 ± 23), with responder variability ranging from 19% to 184% (average 75% ± 30%). Potentially reportable events were observed in the simulations for systematic shifts >0.4 cm for prostate and digitization errors >0.3 cm for the urethra and >0.4 cm for rectum. Possible clinical impact was observed for catheter swaps (all organs), systematic shifts >0.2 cm for prostate and >0.4 cm for rectum, and digitization errors >0.2 cm for prostate and >0.1 cm for urethra and rectum. CONCLUSIONS A high variability in RPN scores was observed. Systematic simulations can provide insight in the severity scoring of multiple failure modes, supplementing typical FMEA approaches.
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Simiele SJ, Chen X, Lee C, Rosen BS, Mikell JK, Moran JM, Prisciandaro JI. Development and comprehensive commissioning of an automated brachytherapy plan checker. Brachytherapy 2020; 19:355-361. [DOI: 10.1016/j.brachy.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
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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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Luk SMH, Meyer J, Young LA, Cao N, Ford EC, Phillips MH, Kalet AM. Characterization of a Bayesian network‐based radiotherapy plan verification model. Med Phys 2019; 46:2006-2014. [DOI: 10.1002/mp.13515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 02/02/2023] Open
Affiliation(s)
- Samuel M. H. Luk
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
| | - Juergen Meyer
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
| | - Lori A. Young
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
| | - Ning Cao
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
| | - Eric C. Ford
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
| | - Mark H. Phillips
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
- Department of Biomedical Informatics and Medical Education University of Washington Seattle WA 98019‐4714 USA
| | - Alan M. Kalet
- Department of Radiation Oncology University of Washington Medical Center Seattle WA 98195‐6043USA
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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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Lack D, Liang J, Benedetti L, Knill C, Yan D. Early detection of potential errors during patient treatment planning. J Appl Clin Med Phys 2018; 19:724-732. [PMID: 29978546 PMCID: PMC6123146 DOI: 10.1002/acm2.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 03/30/2018] [Accepted: 05/24/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose Data errors caught late in treatment planning require time to correct, resulting in delays up to 1 week. In this work, we identify causes of data errors in treatment planning and develop a software tool that detects them early in the planning workflow. Methods Two categories of errors were studied: data transfer errors and TPS errors. Using root cause analysis, the causes of these errors were determined. This information was incorporated into a software tool which uses ODBC‐SQL service to access TPS's Postgres and Mosaiq MSSQL databases for our clinic. The tool then uses a read‐only FTP service to scan the TPS unix file system for errors. Detected errors are reviewed by a physicist. Once confirmed, clinicians are notified to correct the error and educated to prevent errors in the future. Time‐cost analysis was performed to estimate the time savings of implementing this software clinically. Results The main errors identified were incorrect patient entry, missing image slice, and incorrect DICOM tag for data transfer errors and incorrect CT‐density table application, incorrect image as reference CT, and secondary image imported to incorrect patient for TPS errors. The software has been running automatically since 2015. In 2016, 84 errors were detected with the most frequent errors being incorrect patient entry (35), incorrect CT‐density table (17), and missing image slice (16). After clinical interventions to our planning workflow, the number of errors in 2017 decreased to 44. Time savings in 2016 with the software is estimated to be 795 h. This is attributed to catching errors early and eliminating the need to replan cases. Conclusions New QA software detects errors during planning, improving the accuracy and efficiency of the planning process. This important QA tool focused our efforts on the data communication processes in our planning workflow that need the most improvement.
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Affiliation(s)
- Danielle Lack
- Department of Radiation Oncology, Beaumont Health System - Troy, Troy, MI, USA
| | - Jian Liang
- Department of Radiation Oncology, Beaumont Health System - Royal Oak, Royal Oak, MI, USA
| | - Lisa Benedetti
- Department of Radiation Oncology, Beaumont Health System - Royal Oak, Royal Oak, MI, USA
| | - Cory Knill
- Department of Radiation Oncology, Beaumont Health System - Dearborn, Dearborn, MI, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System - Royal Oak, Royal Oak, MI, USA
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Automated calculation of point A coordinates for CT-based high-dose-rate brachytherapy of cervical cancer. J Contemp Brachytherapy 2017; 9:354-358. [PMID: 28951755 PMCID: PMC5611457 DOI: 10.5114/jcb.2017.69397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022] Open
Abstract
Purpose The goal is to develop a stand-alone application, which automatically and consistently computes the coordinates of the dose calculation point recommended by the American Brachytherapy Society (i.e., point A) based solely on the implanted applicator geometry for cervical cancer brachytherapy. Material and methods The application calculates point A coordinates from the source dwell geometries in the computed tomography (CT) scans, and outputs the 3D coordinates in the left and right directions. The algorithm was tested on 34 CT scans of 7 patients treated with high-dose-rate (HDR) brachytherapy using tandem and ovoid applicators. A single experienced user retrospectively and manually inserted point A into each CT scan, whose coordinates were used as the “gold standard” for all comparisons. The gold standard was subtracted from the automatically calculated points, a second manual placement by the same experienced user, and the clinically used point coordinates inserted by multiple planners. Coordinate differences and corresponding variances were compared using nonparametric tests. Results Automatically calculated, manually placed, and clinically used points agree with the gold standard to < 1 mm, 1 mm, 2 mm, respectively. When compared to the gold standard, the average and standard deviation of the 3D coordinate differences were 0.35 ± 0.14 mm from automatically calculated points, 0.38 ± 0.21 mm from the second manual placement, and 0.71 ± 0.44 mm from the clinically used point coordinates. Both the mean and standard deviations of the 3D coordinate differences were statistically significantly different from the gold standard, when point A was placed by multiple users (p < 0.05) but not when placed repeatedly by a single user or when calculated automatically. There were no statistical differences in doses, which agree to within 1-2% on average for all three groups. Conclusions The study demonstrates that the automated algorithm calculates point A coordinates consistently, while reducing inter-user variability. Point placement using the algorithm expedites the planning process and minimizes associated potential human errors.
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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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Computerized System for Safety Verification of External Beam Radiation Therapy Planning. Int J Radiat Oncol Biol Phys 2017; 98:691-698. [DOI: 10.1016/j.ijrobp.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 02/25/2017] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
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Custom-made micro applicators for high-dose-rate brachytherapy treatment of chronic psoriasis. J Contemp Brachytherapy 2017; 9:263-269. [PMID: 28725251 PMCID: PMC5509984 DOI: 10.5114/jcb.2017.68304] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 05/14/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose In this study, we present the treatment of the psoriatic nail beds of patients refractory to standard therapies using high-dose-rate (HDR) brachytherapy. The custom-made micro applicators (CMMA) were designed and constructed for radiation dose delivery to small curvy targets with complicated topology. The role of the HDR brachytherapy treatment was to stimulate the T cells for an increased immune response. Material and methods The patient diagnosed with psoriatic nail beds refractory to standard therapies received monthly subunguinal injections that caused significant pain and discomfort in both hands. The clinical target was defined as the length from the fingertip to the distal interphalangeal joint. For the accurate and reproducible setup in the multi-fractional treatment delivery, the CMMAs were designed. Five needles were embedded into the dense plastic mesh and covered with 5 mm bolus material for each micro applicator. Five CMMAs were designed, resulting in the usage of 25 catheters in total. Results The prescription dose was planned to the depth of the anterior surface of the distal phalanx, allowing for the sparing of the surrounding tissue. The total number of the active dwell positions was 145 with step size of 5 mm. The total treatment time was 115 seconds with a 7.36 Ci activity of the 192Ir source. The treatment resulted in good pain control. The patient did not require further injections to the nail bed. After this initial treatment, additional two patients with similar symptoms received HDR brachytherapy. The treatment outcome was favorable in all cases. Conclusions The first HDR brachytherapy treatment of psoriasis of the nail bed is presented. The initial experience revealed that brachytherapy treatment was well-tolerated and resulted in adequate control of the disease. A larger cohort of patients will be required for additional conclusions related to the long-term clinical benefits.
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Tanderup K, Lindegaard JC, Kirisits C, Haie-Meder C, Kirchheiner K, de Leeuw A, Jürgenliemk-Schulz I, Van Limbergen E, Pötter R. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome. Radiother Oncol 2016; 120:365-369. [PMID: 27555228 DOI: 10.1016/j.radonc.2016.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Denmark
| | | | - Christian Kirisits
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Christine Haie-Meder
- Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France
| | - Kathrin Kirchheiner
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Astrid de Leeuw
- University Medical Center Utrecht, Department of Radiotherapy, The Netherlands
| | | | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Richard Pötter
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
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Halabi T, Lu HM, Bernard DA, Chu JCH, Kirk MC, Hamilton RJ, Lei Y, Driewer J. Automated survey of 8000 plan checks at eight facilities. Med Phys 2016; 43:4966. [DOI: 10.1118/1.4959999] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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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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Redesign of process map to increase efficiency: Reducing procedure time in cervical cancer brachytherapy. Brachytherapy 2015; 14:471-80. [PMID: 25572438 DOI: 10.1016/j.brachy.2014.11.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/13/2014] [Accepted: 11/18/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE To increase intraprocedural efficiency in the use of clinical resources and to decrease planning time for cervical cancer brachytherapy treatments through redesign of the procedure's process map. METHODS AND MATERIALS A multidisciplinary team identified all tasks and associated resources involved in cervical cancer brachytherapy in our institution and arranged them in a process map. A redesign of the treatment planning component of the process map was conducted with the goal of minimizing planning time. Planning time was measured on 20 consecutive insertions, of which 10 were performed with standard procedures and 10 with the redesigned process map, and results were compared. Statistical significance (p < 0.05) was measured with a two-tailed t test. RESULTS Twelve tasks involved in cervical cancer brachytherapy treatments were identified. The process map showed that in standard procedures, the treatment planning tasks were performed sequentially. The process map was redesigned to specify that contouring and some planning tasks are performed concomitantly. Some quality assurance tasks were reorganized to minimize adverse effects of a possible error on procedure time. Test dry runs followed by live implementation confirmed the applicability of the new process map to clinical conditions. A 29% reduction in planning time (p < 0.01) was observed with the introduction of the redesigned process map. CONCLUSIONS A process map for cervical cancer brachytherapy was generated. The treatment planning component of the process map was redesigned, resulting in a 29% decrease in planning time and a streamlining of the quality assurance process.
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