EviGUIDE - a tool for evidence-based decision making in image-guided adaptive brachytherapy for cervical cancer

The clinical application of in vivo dosimetry for gynaecological brachytherapy: A scoping review

Brachytherapy is a key treatment for gynaecological malignancies, delivering high doses to the tumour volume whilst sparing nearby normal tissues due to its steep dose gradient. Accuracy is imperative as small shifts can lead to clinically significant under- or over-dosing of the target volume or organs at risk (OARs), respectively. Independent verification of dose delivered during brachytherapy is not routinely performed but it is important to identify gross errors and define action thresholds to guide inter-fraction treatment decisions. In vivo dosimetry (IVD) is one strategy for improving accuracy and identifying potential errors. Despite promising phantom work, clinical application of IVD is lacking. A literature search was performed using Medline and EMBASE without date limits and based on the PICO framework to evaluate the clinical application of IVD in gynaecological brachytherapy. After screening of titles and abstracts, full text papers were reviewed and 28 studies were identified. Several dosimeters were utilised and measurements were typically taken from the rectum, bladder, vagina and within interstitial catheters. Significant differences between calculated and measured dose were attributed to geometric shifts. The studies reviewed demonstrated the feasibility of IVD in brachytherapy for dose verification but further work is required before IVD can be used to optimise treatment. The purpose of this scoping review is to investigate the clinical application of IVD in gynaecological brachytherapy, understand its challenges and identify the steps required to facilitate integration into everyday clinical practice.

The Evolving Landscape of Cervical Cancer: Breakthroughs in Screening and Therapy Through Integrating Biotechnology and Artificial Intelligence

Cervical cancer (CC) continues to be a major worldwide health concern, profoundly impacting the lives of countless females worldwide. In low- and middle-income countries (LMICs), where CC prevalence is high, innovative, and cost-effective approaches for prevention, diagnosis, and treatment are vital. These approaches must ensure high response rates with minimal side effects to improve outcomes. The study aims to compile the latest developments in the field of CC, providing insights into the promising future of CC management along with the research gaps and challenges. Integrating biotechnology and artificial intelligence (AI) holds immense potential to revolutionize CC care, from MobileODT screening to precision medicine and innovative therapies. AI enhances healthcare accuracy and improves patient outcomes, especially in CC screening, where its use has increased over the years, showing promising results. Also, combining newly developed strategies with conventional treatment options presents an optimal approach to address the limitations associated with conventional methods. However, further clinical studies are essential for practically implementing these advancements in society. By leveraging these cutting-edge technologies and approaches, there is a substantial opportunity to reduce the global burden of this preventable malignancy, ultimately improving the lives of women in LMICs and beyond.

Initial needle tracking with the first standalone combined infrared camera - CT system for brachytherapy-analysis of tracking accuracy and uncertainties

PURPOSE

A prototype infrared camera - cone-beam computed tomography (CBCT) system for tracking in brachytherapy has recently been developed. We evaluated for the first time the corresponding tracking accuracy and uncertainties, and implemented a tracking-based prediction of needles on CBCT scans.

METHODS

A marker tool rigidly attached to needles was 3D printed. The precision and accuracy of tool tracking was then evaluated for both static and dynamic scenarios. Euclidean distances between the tracked and CBCT-derived markers were assessed as well. To implement needle tracking, ground truth models of the tool attached to 200 mm and 160 mm needles were matched to the tracked positions in order to project the needles into CBCT scans. Deviations between projected and actual needle tips were measured. Finally, we put our results into perspective with simulations of the system's tracking uncertainties.

RESULTS

For the stationary scenario and dynamic movements, we achieved tool-tracking precision and accuracy of 0.04 ± 0.06 mm and 0.16 ± 0.18 mm, respectively. The tracked marker positions differed by 0.52 ± 0.18 mm from the positions determined via CBCT. In addition, the predicted needle tips in air deviated from the actual tip positions by only 1.62 ± 0.68 mm (200 mm needle) and 1.49 ± 0.62 mm (160 mm needle). The simulated tracking uncertainties resulted in tip variations of 1.58 ± 0.91 mm and 1.31 ± 0.69 mm for the 200 mm and 160 mm needles, respectively.

CONCLUSION

With the innovative system it was possible to achieve a high tracking and prediction accuracy of marker tool and needles. The system shows high potential for applicator tracking in brachytherapy.