1
|
Ji Z, Wang Z, Jiang Y, Sun H, Qiu B, Li C, Liu B, Li Q, Zhang L, Bai X, Wei Y, Li C, Wang R, Wang J. Experimental validation of the accuracy of robotic-assisted radioactive seed implantation for tumor treatment. J Robot Surg 2024; 18:219. [PMID: 38771389 DOI: 10.1007/s11701-024-01957-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
An experimental validation of a robotic system for radioactive iodine-125 seed implantation (RISI) in tumor treatment was conducted using customized phantom models and animal models simulating liver and lung lesions. The robotic system, consisting of planning, navigation, and implantation modules, was employed to implant dummy radioactive seeds into the models. Fiducial markers were used for target localization. In phantom experiments across 40 cases, the mean errors between planned and actual seed positions were 0.98 ± 1.05 mm, 1.14 ± 0.62 mm, and 0.90 ± 1.05 mm in the x, y, and z directions, respectively. The x, y, and z directions correspond to the left-right, anterior-posterior, and superior-inferior anatomical planes. Silicone phantoms exhibiting significantly smaller x-axis errors compared to liver and lung phantoms (p < 0.05). Template assistance significantly reduced errors in all axes (p < 0.05). No significant dosimetric deviations were observed in parameters such as D90, V100, and V150 between plans and post-implant doses (p > 0.05). In animal experiments across 23 liver and lung cases, the mean implantation errors were 1.28 ± 0.77 mm, 1.66 ± 0.69 mm, and 1.86 ± 0.93 mm in the x, y, and z directions, slightly higher than in phantoms (p < 0.05), with no significant differences between liver and lung models. The dosimetric results closely matched planned values, confirming the accuracy of the robotic system for RISI, offering new possibilities in clinical tumor treatment.
Collapse
Affiliation(s)
- Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Zhe Wang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Chuang Li
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Bo Liu
- Image Processing Center, Beihang University, Beijing, China
| | - Qianqian Li
- Hospital of Stomatological, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Leifeng Zhang
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Xiangzhi Bai
- Image Processing Center, Beihang University, Beijing, China
| | - Ying Wei
- School of Control Science and Engineering, Shandong University, Jinan, China
| | - Changle Li
- State Key Laboratory of Robotics and System, Harbin Institute of Technology, Harbin, China
| | - Ruoyu Wang
- Department of Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
| |
Collapse
|
2
|
Straathof R, Meijaard JP, van Vliet-Pérez SM, Kolkman-Deurloo IKK, Nout RA, Heijmen BJM, Wauben LSGL, Dankelman J, van de Berg NJ. Multibody dynamic modeling of the behavior of flexible instruments used in cervical cancer brachytherapy. Med Phys 2024; 51:3698-3710. [PMID: 38226798 DOI: 10.1002/mp.16934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 10/24/2023] [Accepted: 12/09/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND The steep radiation dose gradients in cervical cancer brachytherapy (BT) necessitate a thorough understanding of the behavior of afterloader source cables or needles in the curved channels of (patient-tailored) applicators. PURPOSE The purpose of this study is to develop and validate computer models to simulate: (1) BT source positions, and (2) insertion forces of needles in curved applicator channels. The methodology presented can be used to improve the knowledge of instrument behavior in current applicators and aid the development of novel (3D-printed) BT applicators. METHODS For the computer models, BT instruments were discretized in finite elements. Simulations were performed in SPACAR by formulating nodal contact force and motion input models and specifying the instruments' kinematic and dynamic properties. To evaluate the source cable model, simulated source paths in ring applicators were compared with manufacturer-measured source paths. The impact of discrepancies on the dosimetry was estimated for standard plans. To validate needle models, simulated needle insertion forces in curved channels with varying curvature, torsion, and clearance, were compared with force measurements in dedicated 3D-printed templates. RESULTS Comparison of simulated with manufacturer-measured source positions showed 0.5-1.2 mm median and <2.0 mm maximum differences, in all but one applicator geometry. The resulting maximum relative dose differences at the lateral surface and at 5 mm depth were 5.5% and 4.7%, respectively. Simulated insertion forces for BT needles in curved channels accurately resembled the forces experimentally obtained by including experimental uncertainties in the simulation. CONCLUSION The models developed can accurately predict source positions and insertion forces in BT applicators. Insights from these models can aid novel applicator design with improved motion and force transmission of BT instruments, and contribute to the estimation of overall treatment precision. The methodology presented can be extended to study other applicator geometries, flexible instruments, and afterloading systems.
Collapse
Affiliation(s)
- Robin Straathof
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jaap P Meijaard
- Department of Precision and Microsystems Engineering, Delft University of Technology, Delft, the Netherlands
| | - Sharline M van Vliet-Pérez
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Inger-Karine K Kolkman-Deurloo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Remi A Nout
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ben J M Heijmen
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Linda S G L Wauben
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Jenny Dankelman
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Nick J van de Berg
- Department of BioMechanical Engineering, Delft University of Technology, Delft, the Netherlands
- Department of Gynecological Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Holtman AL, DiCostanzo DJ, Zimmerman CA, Graeper G, Woollard J, Christ DF, Cetnar AJ. Comparison of failure modes and effects analyses and time for brachytherapy ring and tandem applicator digitization between manual and solid applicator source placement methods. J Appl Clin Med Phys 2024; 25:e14336. [PMID: 38664983 PMCID: PMC11087182 DOI: 10.1002/acm2.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/17/2024] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE Ring and tandem (R&T) applicator digitization is currently performed at our institution by manually defining the extent of the applicators. Digitization can also be achieved using solid applicators: predefined, 3D models with geometric constraints. This study compares R&T digitization using manual and solid applicator methods through Failure Modes and Effects Analyses (FMEAs) and comparative time studies. We aim to assess the suitability of solid applicator method implementation for R&T cases METHODS: Six qualified medical physicists (QMPs) and two medical physics residents scored potential modes of failure of manual digitization in an FMEA as recommended by TG-100. Occurrence, severity, and detectability (OSD) values were averaged across respondents and then multiplied to form combined Risk Priority Numbers (RPNs) for analysis. Participants were trained to perform treatment planning using a developed solid applicator protocol and asked to score a second FMEA on the distinct process steps from the manual method. For both methods, participant digitization was timed. FMEA and time data were analyzed across methods and participant samples RESULTS: QMPs rated the RPNs of the current, manual method of digitization statistically lower than residents did. When comparing the unique FMEA steps between the two digitization methods, QMP respondents found no significant difference in RPN means. Residents, however, rated the solid applicator method as higher risk. Further, after the solid applicator method was performed twice by participants, the time to digitize plans was not significantly different from manual digitization CONCLUSIONS: This study indicates the non-inferiority of the solid applicator method to manual digitization in terms of risk, according to QMPs, and time, across all participants. Differences were found in FMEA evaluation and solid applicator technique adoption based on years of brachytherapy experience. Further practice with the solid applicator protocol is recommended because familiarity is expected to lower FMEA occurrence ratings and further reduce digitization times.
Collapse
Affiliation(s)
- Adia L. Holtman
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| | | | | | - Gavin Graeper
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| | - Jeffrey Woollard
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| | - Daniel F. Christ
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| | - Ashley J. Cetnar
- Department of Radiation OncologyThe Ohio State UniversityColumbusOhioUSA
| |
Collapse
|
4
|
Gimeno-Morales M, Martínez-Monge R, Martinez-Lage A, Jablonska PA, Blanco J, Martínez-Regueira F, Rodriguez-Spiteri N, Olartecoechea B, Ramos L, Insausti LP, Elizalde A, Abengozar M, Cambeiro M. Long-term results of intraoperative multicatheter breast implant (IOMBI) for accelerated partial breast irradiation (APBI) on early breast cancer patients. Radiother Oncol 2024; 194:110193. [PMID: 38432310 DOI: 10.1016/j.radonc.2024.110193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Multicatheter breast brachytherapy is a standard technique for accelerated partial breast irradiation (APBI) in early breast cancer patients. Intraoperative multicatheter breast implant (IOMBI) followed by perioperative high-dose-rate brachytherapy (PHDRBT) offers a novel and advantageous approach. We present long-term oncological, toxicity, and cosmesis outcomes for a well-experienced single institution. MATERIALS AND METHODS Eligible women aged ≥ 40 years with clinically and radiologically confirmed unifocal invasive or in situ ≤ 3 cm breast tumors underwent IOMBI during breast-conserving surgery. Patients meeting APBI criteria by definitive pathologic results received 3.4 Gy × 10fx with PHDRBT. Patients not suitable for APBI received PHDRBT-boost followed by WBRT. RESULTS A total of 171 patients underwent IOMBI during BCS, 120 patients (70.1 %) were suitable for APBI and 51 (29.8 %) for anticipated PHDRBT-boost. The median age was 61 years (range: 40-78), the median tumor size was 1.1 cm (range: 0.2-3.5), with a histological diagnosis of invasive ductal carcinoma in 78.9 % and ductal in situ in 21.1 %. A median of 9 catheters (range: 4-14) were used. For APBI, the median CTV and V100 were 40.8 cc (range: 8.6-99) and 35.4 cc (range: 7.2-94). The median of healthy breast tissue irradiated represents 7.2 % (range: 2.3-28 %) and the median local treatment duration was 10 days (range: 7-16). With a median follow-up of 8.8 years (range: 0.3-16.25), the 8-year local, locoregional, and distant control rates were 99 %, 98.1 %, and 100 %. G1-G2 late-toxicity rate was 53.4 %. Long-term cosmetic evaluation was excellent-good in 90.8 %. CONCLUSION IOMBI&PHDRBT program reports excellent long-term oncological outcomes, with a reduction from unnecessary irradiation exposure which translates into low long-term toxicity and good cosmesis outcomes, especially on well-selected APBI patients.
Collapse
Affiliation(s)
- Marta Gimeno-Morales
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain.
| | - Rafael Martínez-Monge
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Adriana Martinez-Lage
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Paola Anna Jablonska
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Javier Blanco
- Medical Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Fernando Martínez-Regueira
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Natalia Rodriguez-Spiteri
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Begoña Olartecoechea
- Breast Surgical Oncology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Luis Ramos
- Departament of Medical Physic, Hospital Arnau de Villanova, Lleida, Spain
| | - Luis Pina Insausti
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Arlette Elizalde
- Radiology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Marta Abengozar
- Pathology Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| | - Mauricio Cambeiro
- Departments of Radiation Oncology, Cancer Center Clinica Universidad de Navarra. University of Navarre. Pamplona-Madrid, Spain
| |
Collapse
|
5
|
Dürrbeck C, Gomez-Sarmiento IN, Androulakis I, Sauer BC, Kolkman-Deurloo IK, Bert C, Beaulieu L. A comprehensive quality assurance protocol for electromagnetic tracking in brachytherapy. Med Phys 2024; 51:3184-3194. [PMID: 38456608 DOI: 10.1002/mp.17017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/31/2024] [Accepted: 02/24/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Electromagnetic tracking (EMT) systems have proven to be a valuable source of information regarding the location and geometry of applicators in patients undergoing brachytherapy (BT). As an important element of an enhanced and individualized pre-treatment verification, EMT can play a pivotal role in detecting treatment errors and uncertainties to increase patient safety. PURPOSE The purpose of this study is two-fold: to design, develop and test a dedicated measurement protocol for the use of EMT-enabled afterloaders in BT and to collect and compare the data acquired from three different radiation oncology centers in different clinical environments. METHODS A novel quality assurance (QA) phantom composed of a scaffold with supports to fix the field generator, different BT applicators, and reference sensors (sensor verification tools) was used to assess the precision (jitter error) and accuracy (relative distance errors and target registration error) of the EMT sensor integrated into an afterloader prototype. Measurements were repeated in different environments where EMT measurements are likely to be performed, namely an electromagnetically clean laboratory, a BT suite, an operating room, and, if available, a CT suite and an MRI suite dedicated to BT. RESULTS The mean positional jitter was consistently under 0.1 mm across all measurement points, with a slight trend of increased jitter at greater distances from the field generator. The mean variability of sensor positioning in the tested tandem and ring gynecological applicator was also below 0.1 mm. The tracking accuracy close to the center of the measurement volume was higher than at its edges. The relative distance error at the center was 0.2-0.3 mm with maximum values reaching 1.2-1.8 mm, but up to 5.5 mm for measurement points close to the edges. In general, similar accuracy results were obtained in the clinical environments and in all investigated institutions (median distance error 0.1-0.4 mm, maximum error 1.0-2.0 mm), however, errors were found to be larger in the CT suite (median distance error up to 1.0 mm, maximum error up to 3.6 mm). CONCLUSION The presented quality assessment protocol for EMT systems in BT has demonstrated that EMT offers a high-accuracy determination of the applicator/implant geometry even in clinical environments. In addition to that, it has provided valuable insights into the performance of EMT-enabled afterloaders across different radiation oncology centers.
Collapse
Affiliation(s)
- Christopher Dürrbeck
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| | - Isaac Neri Gomez-Sarmiento
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| | - Ioannis Androulakis
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Birte Christina Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
| | - Inger-Karine Kolkman-Deurloo
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Bavaria, Germany
- Comprehensive Cancer Center, Erlangen-EMN (CCC ER-EMN), Erlangen, Bavaria, Germany
| | - Luc Beaulieu
- Service de physique médicale et radioprotection, et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
- Département de physique, de génie physique et d'optique, et Centre de recherche sur le cancer, Université Laval, Québec, Québec, Canada
| |
Collapse
|
6
|
Stenhouse K, Roumeliotis M, Ciunkiewicz P, Martell K, Quirk S, Banerjee R, Doll C, Phan T, Yanushkevich S, McGeachy P. Prospective validation of a machine learning model for applicator and hybrid interstitial needle selection in high-dose-rate (HDR) cervical brachytherapy. Brachytherapy 2024; 23:368-376. [PMID: 38538415 DOI: 10.1016/j.brachy.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE To Demonstrate the clinical validation of a machine learning (ML) model for applicator and interstitial needle prediction in gynecologic brachytherapy through a prospective clinical study in a single institution. METHODS The study included cervical cancer patients receiving high-dose-rate brachytherapy using intracavitary (IC) or hybrid interstitial (IC/IS) applicators. For each patient, the primary radiation oncologist contoured the high-risk clinical target volume on a pre-brachytherapy MRI, indicated the approximate applicator location, and made a clinical determination of the first fraction applicator. A pre-trained ML model predicted the applicator and IC/IS needle arrangement using tumor geometry. Following the first fraction, ML and radiation oncologist predictions were compared and a replanning study determined the applicator providing optimal organ-at-risk (OAR) dosimetry. The ML-predicted applicator and needle arrangement and the clinical determination were compared to this dosimetric ground truth. RESULTS Ten patients were accrued from December 2020 to October 2022. Compared to the dosimetrically optimal applicator, both the radiation oncologist and ML had an accuracy of 70%. ML demonstrated better identification of patients requiring IC/IS applicators and provided balanced IC and IC/IS predictions. The needle selection model achieved an average accuracy of 82.5%. ML-predicted needle arrangements matched or improved plan quality when compared to clinically selected arrangements. Overall, ML predictions led to an average total improvement of 2.0 Gy to OAR doses over three treatment fractions when compared to clinical predictions. CONCLUSION In the context of a single institution study, the presented ML model demonstrates valuable decision-support for the applicator and needle selection process with the potential to provide improved dosimetry. Future work will include a multi-center study to assess generalizability.
Collapse
Affiliation(s)
- Kailyn Stenhouse
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
| | - Michael Roumeliotis
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD.
| | - Philip Ciunkiewicz
- Department of Biomedical Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Quirk
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA
| | - Robyn Banerjee
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Corinne Doll
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Tien Phan
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Svetlana Yanushkevich
- Department of Electrical and Computer Engineering, University of Calgary, Calgary, Alberta, Canada
| | - Philip McGeachy
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta, Canada; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
7
|
Ewongwo A, Niedermayr T, Kidd EA. Design approach and benefits of the 3D-printed vaginal individualized applicator (VIA). Brachytherapy 2024; 23:282-289. [PMID: 38402047 DOI: 10.1016/j.brachy.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/26/2024]
Abstract
PURPOSE Interstitial gynecologic brachytherapy necessitates precise needle placement, requiring time and expertise. We aimed to simplify interstitial procedures and facilitate optimal needle distribution with individualized vaginal templates to guide interstitial needles. MATERIALS/METHODS We developed the 3D-printed vaginal individualized applicator (VIA), a cylindrical template containing individualized internal channels that guide interstitial needles to cover the tumor extent. Eight patients underwent VIA only interstitial implants (VIA only), and five intact cervical cases were treated using tandem and customized VIA (VIA + T). Procedure length, number of needles utilized and dosimetric measures were evaluated. RESULTS VIA was successfully designed and used clinically for 24 procedures (8 VIA only, 16 VIA + T). Average procedure needle insertion time reduced from 80.9 min for traditional interstitial to 42.9 min for VIA only, approximately 47% shorter with a similar mean high risk CTV volume (28.3 cc VIA only vs. 32.4 cc) and excellent dosimetry with average CTV V100% (94.3% and 94.4%). VIA + T was particularly useful in patients with small vaginal canals and large tumor size. For the five VIA + T patients average tumor size was 68.0cc (range 26.6-143.5 cc). VIA + T procedures were approximately 20% shorter than hybrid procedures with other applicators with mean length of 20.1 min and an average of 6.8 needles (range 3-12). CONCLUSION Our novel 3D-printed VIA facilitates gynecologic interstitial brachytherapy by simplifying needle placement, reducing procedure time, and maintaining excellent dosimetry. VIA can be customized for various clinical scenarios, particularly beneficial for large tumors or small vaginal canals.
Collapse
Affiliation(s)
- Agnes Ewongwo
- Department of Radiation Oncology, Stanford University, Stanford, CA
| | | | - Elizabeth A Kidd
- Department of Radiation Oncology, Stanford University, Stanford, CA.
| |
Collapse
|
8
|
Hong D, Zhou Y, Wan X, Su H, Shao H. Brachytherapy with Iodine-125 seeds for treatment of portal vein-branch tumor thrombus in patients with hepatocellular carcinoma. BMC Cancer 2021; 21:1020. [PMID: 34521375 PMCID: PMC8439081 DOI: 10.1186/s12885-021-08680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 08/13/2021] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There is currently no widely-accepted consensus for the management of hepatocellular carcinoma with portal vein tumor thrombus. We evaluate the safety and efficacy of ultrasound-guided percutaneous brachytherapy with iodine-125 seeds for the treatment of hepatocellular carcinoma with portal vein-branch tumor thrombus (PVBTT). METHODS Sixty-nine hepatocellular carcinoma patients with PVBTT were enrolled; 34 received transarterial chemoembolization (TACE) combined with iodine-125 seeds implanted in the PVBTT; 35 were treated with TACE alone. Adverse events, objective response rate, disease control rate, progression-free survival, and overall survival were compared between the two groups. Tumor responses of PVBTT and intrahepatic tumor were correlated. Multivariate and subgroup analyses were conducted for overall survival. RESULTS No grade 3 or 4 adverse events were recorded, and there was no difference in grade 1 or 2 adverse events between the two groups. Objective response rate and disease control rate for PVBTT were 58.9 and 91.2%, respectively, in the combined treatment group, which were significantly greater than the 5.7 and 54.3% rates, respectively, in the TACE-alone group (both p's ≤ 0.001). Intrahepatic tumor response was positively correlated with the PVBTT response (γ = 0.782, p < 0.01). Survival outcomes were better in the combined treatment group than in the TACE-alone group: the median progression-free survival for PVBTT was 9 months versus 3 months (HR = 0.187 [95% CI: 0.101, 0.345], p < 0.001), and the median overall survival was 11 months versus 7 months (HR = 0.448 [95% CI: 0.265, 0.758], p = 0.003). Multivariate analysis revealed that application of brachytherapy and lower grade PVBTT (Vp1 + Vp2 vs. Vp3) were protective predictors of overall survival. In stratified analysis, the benefit of overall survival was more significant in the subgroup of PVBTT Vp1 + Vp2 rather than in Vp3. CONCLUSIONS The combination of iodine-125 seed brachytherapy guided by ultrasound and TACE is a convenient, safe, and effective treatment for patients with HCC and PVBTT, conferring a better survival benefit than TACE alone.
Collapse
Affiliation(s)
- Duo Hong
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Yi Zhou
- Vascular Surgery and Interventional Department, Changzhou No.2 People’s Hospital, 29 Xinglong Lane, Tianning District, Changzhou, 213000 Jiangsu China
| | - Xiaoting Wan
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510000 China
| | - Hongying Su
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| | - Haibo Shao
- Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing Road, Heping District, Shenyang, 110000 Liaoning China
| |
Collapse
|
9
|
Ji Z, Sun H, Jiang Y, Chen Y, Guo F, Fan J, Wang J. Analysis on the accuracy of CT-guided radioactive I-125 seed implantation with 3D printing template assistance in the treatment of thoracic malignant tumors. J Radiat Res 2021; 62:910-917. [PMID: 34350955 PMCID: PMC8438469 DOI: 10.1093/jrr/rrab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/10/2021] [Indexed: 06/13/2023]
Abstract
This article analyzes the accuracy of needle track and dose of a 3-dimensional printing template (3DPT) in the treatment of thoracic tumor with radioactive I-125 seed implantation (RISI). A total of 28 patients were included. The technical process included: (i) preoperative CT positioning, (ii) preoperative planning design, (iii) 3DPT design and printing, (iv) 3DPT alignment, (v) puncture and seed implantation. The errors of needle position and dosimetric parameters were analyzed. A total of 318 needles were used. The mean errors in needle depth, needle insertion point, needle tip and needle angle were 0.52 ± 0.48 cm, 3.4 ± 1.7 mm, 4.4 ± 2.9 mm and 2.8 ± 1.7°, respectively. The differences between actual needle insertion angle and needle depth and those designed in the preoperative were statistically significant (p < 0.05). The mean values of all the errors of the chest wall cases were smaller than those of the lungs, and the differences were statistically significant (p < 0.05). There was no significant difference between the D90 calculated in the postoperative plan and those designed in the preoperative and intraoperative plans (p > 0.05). Some dosimetric parameters of preoperative plans such as V100, V200, CI and HI were not consistent with that of preoperative plans, and the difference was statistically significant (p < 0.05). However, there were no statistical difference in the dosimetric parameters between the postoperative plans and intraoperative plans (p > 0.05). We conclude that for thoracic tumors, even under the guidance of 3DPT, there will be errors. The plan should be optimized in real time during the operation.
Collapse
Affiliation(s)
- Zhe Ji
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Yi Chen
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Fuxin Guo
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jinghong Fan
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Junjie Wang
- Corresponding author. Department of Radiation Oncology, Peking University Third Hospital, Beijing 100191, China.
| |
Collapse
|
10
|
Jin J, Yu Y, Jia W, Li W. A novel 125I seeds fixed on gastric tube for treatment of inoperable esophageal carcinoma: A case report. Medicine (Baltimore) 2021; 100:e25410. [PMID: 33832137 PMCID: PMC8036097 DOI: 10.1097/md.0000000000025410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/12/2021] [Indexed: 01/05/2023] Open
Abstract
To explore the treatment benefit of 125I seeds fixed on a gastric tube in the early inoperable esophageal carcinoma (EC).Three senile patients with early inoperable EC who were treated with brachytherapy between October 2017 and February 2019 were included in this study. 125I seeds were fixed on the gastric tube, which was then inserted on the surface of the EC. One patient suffered from severe pulmonary insufficiency; 1 patient underwent colon cancer surgery one week before treatment and suffered from liver dysfunction and esophageal varices; 1 patient suffered from venous embolism of lower extremities and pulmonary artery embolism.All three patients were successfully operated and completed treatment. During the operation, no displacement and shedding of 125I seed gastric tube occurred. After surgery, the discomfort while swallowing and pain after eating were significantly improved. Moreover, dysphagia was relieved in patient 3. In addition, no complications, such as perforation or bleeding, occurred. Local lesions were effectively controlled.Gastric tube with 125I seeds provides a new treatment protocol for inoperable EC and malignant obstruction of esophageal carcinoma.
Collapse
Affiliation(s)
- Jing Jin
- Department of Geriatric Cardiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital
| | - Yang Yu
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Weikun Jia
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Wei Li
- Department of Cardiothoracic Surgery, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| |
Collapse
|
11
|
Masoudi SF, Baratian S, Asadi S, Rasouli FS. Dose reduction in HDR brachytherapy of esophageal cancer using gold and gold alloy plaques: a Monte Carlo study. Radiat Environ Biophys 2021; 60:115-124. [PMID: 33389051 DOI: 10.1007/s00411-020-00885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
In this work, the use of gold and gold alloy plaques is proposed for the first time, to reduce the dose to healthy organs in brachytherapy with Ir-192 sources. For dose simulations in tumour and healthy tissue, the MCNPX Monte Carlo code was used. The radiation source implemented in those simulations was benchmarked with well-known TG-43 criteria of dose rate constant, air-kerma strength, radial dose function, and 2D anisotropy function. For various arrangements of iridium sources and plaques of gold and gold alloy of various thicknesses, the dose distributions in an esophagus tumour and in surrounding healthy organs were simulated. The results showed that while the dose to the tumour is not much affected by the presence of gold plaques with a thickness of 3.5 mm in an optimized 192Ir sources' configuration, a relative reduction in average organ dose of 64%, 65%, 73%, 67%, and 35% was observed, for esophagus, thyroid, heart, stomach, and liver, respectively. Moreover, it was found that a gold plaque leads to smaller doses to healthy organs than a gold alloy plaque. It is concluded that gold plaques can be used to improve the treatment of esophageal cancer by HDR brachytherapy and to protect surrounding non-target organs.
Collapse
Affiliation(s)
- S Farhad Masoudi
- Department of Physics, K.N. Toosi University of Technology, P.O. Box 15875-4416, Tehran, Iran.
| | - Shokoufeh Baratian
- Department of Physics, K.N. Toosi University of Technology, P.O. Box 15875-4416, Tehran, Iran
| | - Somayeh Asadi
- Department of Mechanical Engineering, Politecnico Di Milano, Milan, Italy
| | - Fatemeh S Rasouli
- Department of Physics, K.N. Toosi University of Technology, P.O. Box 15875-4416, Tehran, Iran
| |
Collapse
|
12
|
Hall WA, Tree AC, Dearnaley D, Parker CC, Prasad V, Roach M, Lawton CAF. Considering benefit and risk before routinely recommending SpaceOAR. Lancet Oncol 2021; 22:11-13. [PMID: 33387489 PMCID: PMC8882263 DOI: 10.1016/s1470-2045(20)30639-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023]
Affiliation(s)
- William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, USA.
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - David Dearnaley
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Christopher C Parker
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, UK
| | - Vinay Prasad
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Mack Roach
- Department of Radiation Oncology and Urology, University of California San Francisco, San Francisco, CA, USA
| | - Colleen A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, USA
| |
Collapse
|
13
|
Samper Ots PM, Rovirosa Casino A, Herreros Martínez A, Rodriguez Villalba S, Pérez Calatayud J, Polo Cezón R, Gutiérrez Miguélez C, Anchuelo Latorre J, Rodríguez Rodríguez I, Córdoba Largo S, Pérez Echagüen S, Sanz Freire CJ, Clemente Gutiérrez F, De Las Peñas Cabrera D, Villafranca Iturre E. Consensus and recommendations on vaginal-cuff Brachytherapy of the Spanish Brachytherapy Groups of SEOR and SEFM. Clin Transl Oncol 2020; 23:1193-1200. [PMID: 33237447 DOI: 10.1007/s12094-020-02510-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE/OBJECTIVE(S) On October 5, 2018, a meeting of the Spanish Society of Radiation Oncology (SEOR) Brachytherapy Group was held, in collaboration with the Spanish Society of Medical Physics (SEFM), with the aim of preparing a consensus document on postoperative vaginal-cuff brachytherapy (VCBT). MATERIALS/METHODS A survey including 42 questions was sent to Spanish Radiation Oncology Centres before the meeting. The survey items included: experience in VCBT, technique indications, previous patient preparation, applicator type, implant procedure, computerized tomography (CT) simulation, definition of target volumes and organs at risk (OAR), dose prescription, fractionation, treatment planning, dosimetric parameters and constraints to OAR. Thirty-three centres answered the survey. Statistical analysis of the survey considered that there was consensus when there was ≥ 85% of agreement related to a survey item, otherwise an item with < 85% of agreement would be discussed during the meeting to reach consensus. RESULTS The results of the survey are reported here. The mean number of patients treated per centre in 2017 was 52 ± 41 (range 7-175), and the mean number of procedures per centre was 175 ± 150 (range 24-701).There was consensus on: the indications, applicator type, the OAR to be considered, the prescription point, standardisation and dosimetric quality parameters. There was no consensus on: patient preparation for the implant, the need for performing CT simulation and the frequency, the length of the vagina to be treated, if CTV should be delimited, the definition of the clinical target volume, fractionation, overall EQD2, active source length, separation between dwelling stepping source positions, if considering the uniformity/maximum values for dwelling stepping sources, the optimization mode, and the limiting doses to the OAR. After presenting the results of the survey, the consensus meeting discussion focused on the issues for which there was no consensus. CONCLUSION A consensus document on postoperative VCBT of the Spanish Brachytherapy Groups of SEOR-SEFM was elaborated.
Collapse
Affiliation(s)
- P M Samper Ots
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - A Rovirosa Casino
- Departament de Fonaments Clínics, Universitat de Barcelona, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | - A Herreros Martínez
- Departament de Fonaments Clínics, Universitat de Barcelona, Hospital Clínic Universitari de Barcelona, Barcelona, Spain
| | | | | | - R Polo Cezón
- Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Garty G, Xu Y, Johnson GW, Smilenov LB, Joseph SK, Pujol-Canadell M, Turner HC, Ghandhi SA, Wang Q, Shih R, Morton RC, Cuniberti DE, Morton SR, Bueno-Beti C, Morgan TL, Caracappa PF, Laiakis EC, Fornace AJ, Amundson SA, Brenner DJ. VADER: a variable dose-rate external 137Cs irradiator for internal emitter and low dose rate studies. Sci Rep 2020; 10:19899. [PMID: 33199728 PMCID: PMC7670416 DOI: 10.1038/s41598-020-76941-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/03/2020] [Indexed: 11/08/2022] Open
Abstract
In the long term, 137Cs is probably the most biologically important agent released in many accidental (or malicious) radiation disasters. It can enter the food chain, and be consumed, or, if present in the environment (e.g. from fallout), can provide external irradiation over prolonged times. In either case, due to the high penetration of the energetic γ rays emitted by 137Cs, the individual will be exposed to a low dose rate, uniform, whole body, irradiation. The VADER (VAriable Dose-rate External 137Cs irradiatoR) allows modeling these exposures, bypassing many of the problems inherent in internal emitter studies. Making use of discarded 137Cs brachytherapy seeds, the VADER can provide varying low dose rate irradiations at dose rates of 0.1 to 1.2 Gy/day. The VADER includes a mouse "hotel", designed to allow long term simultaneous residency of up to 15 mice. Two source platters containing ~ 250 mCi each of 137Cs brachytherapy seeds are mounted above and below the "hotel" and can be moved under computer control to provide constant low dose rate or a varying dose rate mimicking 137Cs biokinetics in mouse or man. We present the VADER design and characterization of its performance over 18 months of use.
Collapse
Affiliation(s)
- Guy Garty
- Radiological Research Accelerator Facility, Columbia University, 136 S. Broadway, Box 21, Irvington, NY, 10533, USA.
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA.
| | - Yanping Xu
- Radiological Research Accelerator Facility, Columbia University, 136 S. Broadway, Box 21, Irvington, NY, 10533, USA
| | - Gary W Johnson
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Lubomir B Smilenov
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Simon K Joseph
- David A. Gardner PET Imaging Research Center, Columbia University, New York, NY, 10032, USA
| | | | - Helen C Turner
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Shanaz A Ghandhi
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Qi Wang
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Rompin Shih
- Department of Radiation Oncology, Columbia University, New York, NY, 10032, USA
| | - Robert C Morton
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - David E Cuniberti
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Shad R Morton
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Carlos Bueno-Beti
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - Thomas L Morgan
- Environmental Health and Safety, Columbia University, New York, NY, 10032, USA
| | - Peter F Caracappa
- Environmental Health and Safety, Columbia University, New York, NY, 10032, USA
| | - Evagelia C Laiakis
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, 20057, USA
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington DC, 20057, USA
| | - Albert J Fornace
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, 20057, USA
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University, Washington DC, 20057, USA
| | - Sally A Amundson
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| | - David J Brenner
- Center for Radiological Research, Columbia University, New York, NY, 10032, USA
| |
Collapse
|
15
|
Scanderbeg DJ, Yashar C, Ouhib Z, Jhingran A, Einck J. Development, implementation, and associated challenges of a new HDR brachytherapy program. Brachytherapy 2020; 19:874-880. [PMID: 32950407 PMCID: PMC7495265 DOI: 10.1016/j.brachy.2020.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 12/24/2022]
Abstract
Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting. The sections include feasibility of a program, starting cases, machine and equipment selection, and quality and safety.
Collapse
Affiliation(s)
- Daniel J Scanderbeg
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA.
| | - Catheryn Yashar
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| | - Zoubir Ouhib
- Radiation Oncology, Lynn Regional Cancer Center, Delray Beach, FL
| | - Anuja Jhingran
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Einck
- Radiation Medicine and Applied Sciences, University of California, San Diego, CA
| |
Collapse
|
16
|
van den Ende RPJ, Ercan E, Keesman R, Kerkhof EM, Marijnen CAM, van der Heide UA. Applicator visualization using ultrashort echo time MRI for high-dose-rate endorectal brachytherapy. Brachytherapy 2020; 19:618-623. [PMID: 32747144 DOI: 10.1016/j.brachy.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The individual channels in an endorectal applicator for high-dose-rate endorectal brachytherapy are not visible on standard MRI sequences. The aim of this study was to test whether an ultrashort echo time (UTE) MRI sequence could be used to visualize the individual channels to enable MR-only treatment planning for rectal cancer. METHODS AND MATERIALS We used a radial three-dimensional (3D) UTE pulse sequence and acquired images of phantoms and two patients with rectal cancer. We rigidly registered a UTE image and CT scan of an applicator phantom, based on the outline of the applicator. One observer compared channel positions on the UTE image and CT scan in five slices spaced 25 mm apart. To quantify geometric distortions, we scanned a commercial 3D geometric quality assurance phantom and calculated the difference between detected marker positions on the UTE image and corresponding marker positions on two 3D T1-weighted images with opposing readout directions. RESULTS On the UTE images, there is sufficient contrast to discern the individual channels. The difference in channel positions on the UTE image compared with the CT was on average -0.1 ± 0.1 mm (left-right) and 0.1 ± 0.3 mm (anteroposterior). After rigid registration to the 3D T1-weighted sequences, the residual 95th percentile of the geometric distortion inside a 550-mm-diameter sphere was 1.0 mm (left-right), 0.9 mm (anteroposterior), and 0.9 mm (craniocaudal). CONCLUSIONS With a UTE sequence, the endorectal applicator and individual channels can be adequately visualized in both phantom and patients. The geometrical fidelity is within an acceptable range.
Collapse
Affiliation(s)
- Roy P J van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Ece Ercan
- C.J. Gorter Center for High Field MRI, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rick Keesman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| |
Collapse
|
17
|
Malajovich I, Anamalayil S, Dolney OV, Kevin Teo BK, Arscott WT, Taunk NK. Techniques for and uncertainties of MRI-based reconstruction of titanium tandem and ring brachytherapy applicators. Brachytherapy 2020; 19:651-658. [PMID: 32624406 DOI: 10.1016/j.brachy.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Eliminating patient computed tomography (CT) scans for tandem and ring (T&R) brachytherapy can reduce overall procedure time and eliminates imaging dose. However, reconstructing titanium applicators in magnetic resonance imaging (MRI) is challenging. We evaluated the uncertainty of different applicator reconstruction workflows in MR-guided brachytherapy, and assessed the clinical impact of reconstruction uncertainties. METHODS AND MATERIALS Titanium MRI-compatible T&Rs with aqueous gel in the buildup cap were reconstructed on CTs and MRIs to assess the uncertainties of four different workflows. Reconstruction was performed using (1) proton density-weighted MRIs with solid applicator from a library, (2) applicator-only reference CT fused with MRIs, (3) T2-weighted (T2W) MRIs following GEC-ESTRO guidelines, and (4) patient CTs fused with patient MRIs with in situ applicators. We evaluated dwell positions and plan quality differences using high-risk clinical target volume coverage, and EQD2 D2cc of rectum, sigmoid, bladder, and small bowel. RESULTS The 2σ uncertainty for dwell positions for each workflow were (1) 2.7 mm for both ring and tandem, (2) 1.4 mm ring and 0.8 mm tandem, (3) 0.2 mm ring and 0.8 mm tandem, and (4) 1.9 mm ring and 0.4 mm tandem. Reconstruction uncertainties resulted in dose variations within acceptable levels (below 10%) except for (1) which resulted in larger dose to the rectum (20%). Dose uncertainties were similar between reference CT and patient CT. CONCLUSIONS Reconstruction with a reference CT results in similar uncertainty to a patient CT. T2W MRI plans have acceptable uncertainty levels for the applicator reconstruction and resulting dose distributions.
Collapse
Affiliation(s)
- Irina Malajovich
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; MD Anderson Cancer Center at Cooper, Camden, NJ
| | - Shibu Anamalayil
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | | | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - William Tristram Arscott
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA; Compass Oncology, Trigard, OR
| | - Neil K Taunk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA.
| |
Collapse
|
18
|
Bajwa HK, Singareddy R, Talluri AK, Guntupalli R, Raju AK, Sresty M, Ahmed A. Development of an indigenous low-cost multichannel cylinder applicator for vaginal tumors. Brachytherapy 2020; 19:674-678. [PMID: 32540330 DOI: 10.1016/j.brachy.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 03/08/2020] [Accepted: 05/01/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to report our experience regarding the development of a low-cost multichannel vaginal cylinder applicator for superficial and recurrent vaginal tumors. METHODS AND MATERIALS The applicator mold was created by applying heated wax sheets in layers around a plastic tube. Interstitial stainless-steel needles were placed at equal distance around the mold surface to create multiple channels for treatment. Two plans were created using CT images for a patient with a recurrent tumor over the posterior vaginal wall for comparing single-channel and multichannel cylinder dosimetry. The doses received by the target (high risk clinical target volume) and organs at risk (OARs) were computed using dose-volume histograms. RESULTS There was no significant difference in terms of the prescribed dose delivered to high risk clinical target volume between the two plans. The volume of the target receiving 150 and 200 percent (V150 and V200) dose was higher in the multichannel cylinder plan than the single-channel cylinder plan. In terms of doses to the OARs, there was no significant difference between the rectum doses (D2cc rectum). There was a significant reduction in the dose to the bladder (D2cc bladder), urethra (D0.1cc urethra), and uninvolved vagina (D2cc uninvolved vagina). CONCLUSIONS Multichannel vaginal cylinders reduce doses to the OARs as compared with the single-channel vaginal cylinder in superficial vaginal lesions limited to the wall of the vagina. Their use is limited by the cost of the applicator. Our low-cost multichannel vaginal cylinder can be used as a reliable alternative in such situations.
Collapse
Affiliation(s)
- Harjot Kaur Bajwa
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rohith Singareddy
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India.
| | - Anil Kumar Talluri
- Department of Radiation Physics, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Rajeev Guntupalli
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Alluri Krishnam Raju
- Department of Radiation Oncology, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Madhusudhana Sresty
- Department of Radiation Physics, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Ameer Ahmed
- Department of Radiation Therapy, Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| |
Collapse
|
19
|
Masui K, Yamazaki H, Suzuki G, Shimizu D, Kawabata K, Noguchi N, Takenaka T, Yoshida K, Murakami N, Naito M, Yamamoto T, Kanamura N, Komori S, Oshita A, Asai J, Yamada K. High dose rate interstitial brachytherapy for early stage lip cancer using customized dental spacer. J Radiat Res 2020; 61:506-510. [PMID: 32266411 PMCID: PMC7299259 DOI: 10.1093/jrr/rraa019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/22/2019] [Indexed: 06/11/2023]
Abstract
The present study aimed to report the efficacy and toxicity of our high-dose-rate (HDR) brachytherapy for early stage lip cancer (LC) using customized dental spacers. A retrospective analysis was performed among six patients with early stage LC treated with HDR interstitial brachytherapy between April 2015 and August 2019 using customized dental spacers. The total treatment dose was 49 Gy/7 fractions or 54 Gy/9 fractions. The median follow-up duration for the patients was 13 (range: 2-52) months. All patients completed the entire brachytherapy protocol safely and have experienced no local recurrence thus far. The CTV D100 and D90 values per fraction were median 100 (range: 98.3-100) % prescribed dose (PD) and median 133.4 (range: 129.3-138.9) % PD, respectively. The D2cc and D0.1cc values per fraction for the mandible were median 1.07 (range, 0.79-1.88) Gy and median 1.65 (range: 1.21-2.83) Gy, D2cc and D0.1cc values per fraction for oral cavity were median 1.48 (range, 1.31-1.72) Gy and median 2.73 (range: 1.79-2.88) Gy, respectively. Acute toxicities encountered were mucositis and lip edema limited to the irradiated area; none of them was beyond grade 2 and all were resolved within 1-2 months after treatment. We did not observe any late grade 2 adverse events or worse. This study shows that the adverse effects of HDR brachytherapy for early stage LC can be minimized using a dental spacer. Cooperation with the dentistry department is essential to make spacers that are individually customized for each patient.
Collapse
Affiliation(s)
- Koji Masui
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Hideya Yamazaki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Gen Suzuki
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Daisuke Shimizu
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Kanako Kawabata
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Naoki Noguchi
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Tadashi Takenaka
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Ken Yoshida
- Department of Radiation Oncology, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masayuki Naito
- Department of Dental Medicine, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Toshiro Yamamoto
- Department of Dental Medicine, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Narisato Kanamura
- Department of Dental Medicine, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Satoshi Komori
- Department of Dermatology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Akifumi Oshita
- Department of Dermatology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Kyoto Prefectural University Graduate School of Medical Science, Kyoto, Japan
| |
Collapse
|
20
|
Serban M, Kirisits C, de Leeuw A, Pötter R, Jürgenliemk-Schulz I, Nesvacil N, Swamidas J, Hudej R, Lowe G, Hellebust TP, Menon G, Oinam A, Bownes P, Oosterveld B, De Brabandere M, Koedooder K, Langeland Marthinsen AB, Whitney D, Lindegaard J, Tanderup K. Ring Versus Ovoids and Intracavitary Versus Intracavitary-Interstitial Applicators in Cervical Cancer Brachytherapy: Results From the EMBRACE I Study. Int J Radiat Oncol Biol Phys 2020; 106:1052-1062. [PMID: 32007365 DOI: 10.1016/j.ijrobp.2019.12.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/13/2019] [Accepted: 12/16/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE The aim of this study was to investigate the influence of brachytherapy technique and applicator type on target dose, isodose surface volumes, and organ-at-risk (OAR) dose. METHODS AND MATERIALS Nine hundred two patients treated with tandem/ovoids (T&O) (n = 299) and tandem/ring (T&R) (n = 603) applicators from 16 EMBRACE centers were analyzed. Patients received external beam radiation therapy and magnetic resonance imaging guided brachytherapy with dose prescription according to departmental practice. Centers were divided into 4 groups, according to applicator/technique: Ovoids and ring centers treating mainly with the intracavitary (IC) technique and ovoids and ring centers treating routinely with the intracavitary/interstitial (IC/IS) technique. V85Gy EQD210, CTVHR D90% (EQD210), and bladder, rectum, sigmoid, and vaginal 5-mm lateral-point doses (EQD23) were evaluated among center groups. Differences between T&O and T&R were tested with multivariable analysis. RESULTS For similar point A doses, mean CTVHR D90% was 3.3 Gy higher and V85Gy was 23% lower for ring-IC compared with ovoids-IC centers (at median target volumes). Mean bladder/rectum doses (D2cm3 and ICRU-point) were 3.2 to 7.7 Gy smaller and vaginal 5-mm lateral-point was 19.6 Gy higher for ring-IC centers. Routine use of IC/IS technique resulted in increased target dose, whereas V85Gy was stable (T&R) or decreased (T&O); reduced bladder and rectum D2cm3 and bladder ICRU-point by 3.5 to 5.0 Gy for ovoids centers; and similar OAR doses for ring centers. CTVHR D90% was 2.8 Gy higher, bladder D2cm3 4.3 Gy lower, rectovaginal ICRU-point 4.8 Gy lower, and vagina 5-mm lateral-point 22.4 Gy higher for ring-IC/IS versus ovoids-IC/IS centers. The P values were <.002 for all comparisons. Equivalently, significant differences were derived from the multivariable analysis. CONCLUSIONS T&R-IC applicators have better target dose and dose conformity than T&O-IC in this representative patient cohort. IC applicators fail to cover large target volumes, whereas routine application of IC/IS improves target and OAR dose considerably. Patients treated with T&R show a more favorable therapeutic ratio when evaluating target, bladder/rectum doses, and V85Gy. A comprehensive view on technique/applicators should furthermore include practical considerations and clinical outcome.
Collapse
Affiliation(s)
- Monica Serban
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Medical Physics, McGill University Health Centre, Montreal, Canada
| | - Christian Kirisits
- Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna/General Hospital of Vienna, Vienna, Austria.
| | - Astrid de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, The Netherlands
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna/General Hospital of Vienna, Vienna, Austria
| | | | - Nicole Nesvacil
- Department of Radiation Oncology, Comprehensive Cancer Centre, Medical University of Vienna/General Hospital of Vienna, Vienna, Austria
| | - Jamema Swamidas
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Robert Hudej
- Department of Radiotherapy, Institute of Oncology Ljubljana, Slovenia
| | - Gerry Lowe
- Cancer Centre, Mount Vernon Hospital, London, United Kingdom
| | - Taran Paulsen Hellebust
- Department of Medical Physics, Oslo University Hospital - The Radium Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | - Geetha Menon
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Arun Oinam
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Peter Bownes
- Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom
| | | | | | - Kees Koedooder
- Department of Radiation Oncology Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Diane Whitney
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Jacob Lindegaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
21
|
Jreij M, Al Kattar Z, Charara J. [Comparison between Stump Cylinder and custom mold, effect of the shape of the applicator on the dose distribution]. Cancer Radiother 2020; 24:106-113. [PMID: 32063417 DOI: 10.1016/j.canrad.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to compare the efficacy of two applicators used in high dose rate vaginal brachytherapy. The first is the Stump Cylinder used in the "brachycenter" department at the Middle East Institute of Health in Lebanon and the second is the custom mold used in the radiotherapy department at Tenon Hospital in France. MATERIALS AND METHOD A comparison of the clinical target volume and the doses received by the rectum and bladder was performed in order to determine the best method of treatment and to optimize the dose distribution. 95 patients were treated in both departments. RESULTS The average values of the D95% dose received by the CTV were respectively 89.43% for the Stump Cylinder and 110.16% for the custom mold. The conformity index was 0.84 for the Stump Cylinder while it was 0.97 for the custom mold, which ensures a better dose distribution. For the rectum, the maximum dose D2cc taken by volume was 71.23% for the Stump Cylinder and 79.51% for the custom mold. The bladder was better protected with Stump Cylinder with a D2cc value of 65.81% against 94.88% for the custom mold. CONCLUSION The underdosing obtained using the Stump Cylinder was due to the shape of upper part of the cylinder which was not conform with the shape of the vaginal vault in women. A better protection of the organs at risk was observed with the Stump Cylinder since the dose taken by the rectum and bladder using a custom mold can reach the tolerance limits.
Collapse
Affiliation(s)
- M Jreij
- École doctorale des sciences et technologies, campus Rafik Hariri, université Libanaise, Hadat, Liban
| | - Z Al Kattar
- École doctorale des sciences et technologies, campus Rafik Hariri, université Libanaise, Hadat, Liban
| | - J Charara
- École doctorale des sciences et technologies, campus Rafik Hariri, université Libanaise, Hadat, Liban.
| |
Collapse
|
22
|
Gérard JP, Dejean C, Montagne L, Benezery K, Doyen J, Hannoun Levi JM. A brief history of contact X-ray brachytherapy 50 kVp. Cancer Radiother 2020; 24:222-225. [PMID: 32171676 DOI: 10.1016/j.canrad.2020.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/25/2020] [Indexed: 11/18/2022]
Abstract
Contact X ray brachytherapy 50 kVp was initiated in the 1930s with the Siemens unit and popularized with the Philips unit in the 1950s. A renaissance was seen in the early 2000s with the Intrabeam™ unit for breast IORT. Presently the Papillon™ systems thanks to its high dose rate (>10Gy/mn) can be used to treat breast (IORT), skin, eyelid and rectal cancers. Future developments are expected to consolidate the place of contact radiotherapy as a safe and efficient treatment for accessible early tumors.
Collapse
Affiliation(s)
- J P Gérard
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France.
| | - C Dejean
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - L Montagne
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - K Benezery
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J Doyen
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - J M Hannoun Levi
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| |
Collapse
|
23
|
Chattaraj A, Selvam TP, Datta D. MONTE CARLO-BASED INVESTIGATION OF MICRODOSIMETRIC DISTRIBUTION OF HIGH ENERGY BRACHYTHERAPY SOURCES. Radiat Prot Dosimetry 2019; 187:115-128. [PMID: 31165891 DOI: 10.1093/rpd/ncz148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/26/2019] [Accepted: 05/09/2019] [Indexed: 06/09/2023]
Abstract
FLUKA-based Monte Carlo calculations were carried out to study microdosimetric distributions in air and in water for encapsulated high energy brachytherapy sources (60Co, 137Cs, 192Ir and 169Yb) by simulating a Tissue Equivalent Proportional Counter (Model LET1/2) having sensitive diameter of 1. 27 cm for a site size of 1 μm. The study also included microdosimetric distributions of bare sources. When the sources are in air, for a given source, the source geometry does not affect the y¯F and y¯D values significantly. When the encapsulated 192Ir, 137Cs and 60Co sources are in water, y¯F and y¯D values increase with distance in water which is due to degradation in the energy of photons. Using the calculated values of y¯D, relative biological effectiveness (RBE) was obtained for the investigated sources. When 60Co, 137Cs and 192Ir sources are in water, RBE increases from 1.03 ± 0.01 to 1.17 ± 0.01, 1.24 ± 0.01 to 1.46 ± 0.02 and 1.50 ± 0.01 to 1.75 ± 0.03, respectively, when the distance was increased from 3-15 cm, whereas for 169Yb, RBE is about 2, independent of distance in water.
Collapse
Affiliation(s)
- Arghya Chattaraj
- Radiological Physics & Advisory Division, Health, Safety & Environment Group, Bhabha Atomic Research Centre, Trombay, Mumbai
- Homi Bhabha National Institute, Anushaktinagar, Mumbai
| | - T Palani Selvam
- Radiological Physics & Advisory Division, Health, Safety & Environment Group, Bhabha Atomic Research Centre, Trombay, Mumbai
- Homi Bhabha National Institute, Anushaktinagar, Mumbai
| | - D Datta
- Radiological Physics & Advisory Division, Health, Safety & Environment Group, Bhabha Atomic Research Centre, Trombay, Mumbai
- Homi Bhabha National Institute, Anushaktinagar, Mumbai
| |
Collapse
|
24
|
Jamalludin Z, Jong WL, Ho GF, Rosenfeld AB, Ung NM. In vivo dosimetry using MOSkin detector during Cobalt-60 high-dose-rate (HDR) brachytherapy of skin cancer. Australas Phys Eng Sci Med 2019. [PMID: 31650362 DOI: 10.1007/s13246-019-00809-7/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The MOSkin, a metal-oxide semiconductor field-effect transistor based detector, is suitable for evaluating skin dose due to its water equivalent depth (WED) of 0.07 mm. This study evaluates doses received by target area and unavoidable normal skin during a the case of skin brachytherapy. The MOSkin was evaluated for its feasibility as detector of choice for in vivo dosimetry during skin brachytherapy. A high-dose rate Cobalt-60 brachytherapy source was administered to the tumour located at the medial aspect of the right arm, complicated with huge lymphedema thus limiting the arm motion. The source was positioned in the middle of patients' right arm with supine, hands down position. A 5 mm lead and 5 mm bolus were sandwiched between the medial aspect of the arm and lateral chest to reduce skin dose to the chest. Two calibrated MOSkin detectors were placed on the target and normal skin area for five treatment sessions for in vivo dose monitoring. The mean dose to the target area ranged between 19.9 and 21.1 Gy and was higher in comparison with the calculated dose due to contribution of backscattered dose from lead. The mean measured dose at normal skin chest area was 1.6 Gy (1.3-1.9 Gy), less than 2 Gy per fraction. Total dose in EQD2 received by chest skin was much lower than the recommended skin tolerance. The MOSkin detector presents a reliable real-time dose measurement. This study has confirmed the applicability of the MOSkin detector in monitoring skin dose during brachytherapy treatment due to its small sensitive volume and WED 0.07 mm.
Collapse
Affiliation(s)
- Z Jamalludin
- Medical Physics Unit, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - W L Jong
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - G F Ho
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - A B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - N M Ung
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| |
Collapse
|
25
|
Abstract
BACKGROUND The occurrence of retained surgical instruments in vaginal surgery, although low, carries unique complications. Appropriate imaging to find retained surgical instruments allows for timely diagnosis and retrieval of the vaginal foreign body. CASE The patient is a 33-year-old woman with recurrent cervical cancer who was undergoing radiation therapy. During interstitial implantation, a reverse cutting needle was broken into the anterior vaginal wall. Three-dimensional endoluminal ultrasonography allowed for timely retrieval with minimal surgical exploration in the operating room. CONCLUSION Intraoperative three-dimensional endoluminal ultrasonography allows for accurate visualization and mapping of a vaginal foreign body. This highlights an innovative and highly useful feature of this imaging technique.
Collapse
Affiliation(s)
- Halei Wong
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, and the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Missouri School of Medicine, Columbia, Missouri
| | | | | |
Collapse
|
26
|
Roumeliotis M, Quirk S, Husain S, Guebert A, Watt E, Frederick A, Martell K, Hilts M, Crook J, Batchelar D, Ma I, Meyer T. Establishing a simulation-based education program for radiation oncology learners in permanent seed implant brachytherapy: Building validation evidence. Brachytherapy 2019; 19:812-819. [PMID: 31786168 DOI: 10.1016/j.brachy.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/12/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to establish a simulation-based education program for radiation oncology learners in permanent seed implant brachytherapy. The first step in formalizing any education program is a validation process that builds evidence-based verification that the learning environment is appropriate. METHODS AND MATERIALS The primary education task allowed practitioners to use an anthropomorphic breast phantom to simulate a permanent seed implant brachytherapy delivery. Validation evidence is built by generating data to assess learner and expert cohorts according to their proficiency. Each practitioner's performance during the simulation was evaluated by seed placement accuracy, procedural time-to-complete, and two qualitative evaluation tools-a global rating scale and procedural checklist. RESULTS The average seed placement accuracy (±SD) was 8.1 ± 3.5 mm compared to 6.1 ± 2.6 mm for the learner and expert cohort, respectively. The median (range) procedural time-to-complete was 64 (60-77) minutes and 43 (41-50) minutes for the learner and expert cohort, respectively. Seed placement accuracy (student t-test, p < 0.05) and procedural time-to-complete (Mann-Whitney U-test, p < 0.05) were statistically different between the cohorts. In both the global rating scale and procedural checklist, the expert cohort demonstrated improved proficiency compared to the learner cohort. CONCLUSIONS This validation evidence supports the utilization of this simulation environment toward appropriately capturing the delivery experience of practitioners. The results demonstrate that, in all areas of evaluation, expert cohort proficiency was superior to learner cohort proficiency. This methodology will be used to establish a simulation-based education program for radiation oncology learners in permanent seed implant brachytherapy.
Collapse
Affiliation(s)
- Michael Roumeliotis
- Department of Oncology, University of Calgary, Calgary, Alberta; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta.
| | - Sarah Quirk
- Department of Oncology, University of Calgary, Calgary, Alberta; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta
| | - Siraj Husain
- Department of Oncology, University of Calgary, Calgary, Alberta
| | - Alexandra Guebert
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta
| | - Elizabeth Watt
- Department of Oncology, University of Calgary, Calgary, Alberta
| | - Amy Frederick
- Department of Physics and Astronomy, University of Calgary, Calgary, Alberta
| | - Kevin Martell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Michelle Hilts
- Department of Medical Physics, BC Cancer - Kelowna, Kelowna, British Columbia
| | - Juanita Crook
- Department of Radiation Oncology, BC Cancer - Kelowna, Kelowna, British Columbia
| | - Deidre Batchelar
- Department of Medical Physics, BC Cancer - Kelowna, Kelowna, British Columbia
| | - Irene Ma
- Department of Medicine, University of Calgary, Calgary, Alberta
| | - Tyler Meyer
- Department of Oncology, University of Calgary, Calgary, Alberta; Department of Physics and Astronomy, University of Calgary, Calgary, Alberta
| |
Collapse
|
27
|
Jamalludin Z, Jong WL, Ho GF, Rosenfeld AB, Ung NM. In vivo dosimetry using MOSkin detector during Cobalt-60 high-dose-rate (HDR) brachytherapy of skin cancer. Australas Phys Eng Sci Med 2019; 42:1099-1107. [PMID: 31650362 DOI: 10.1007/s13246-019-00809-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
The MOSkin, a metal-oxide semiconductor field-effect transistor based detector, is suitable for evaluating skin dose due to its water equivalent depth (WED) of 0.07 mm. This study evaluates doses received by target area and unavoidable normal skin during a the case of skin brachytherapy. The MOSkin was evaluated for its feasibility as detector of choice for in vivo dosimetry during skin brachytherapy. A high-dose rate Cobalt-60 brachytherapy source was administered to the tumour located at the medial aspect of the right arm, complicated with huge lymphedema thus limiting the arm motion. The source was positioned in the middle of patients' right arm with supine, hands down position. A 5 mm lead and 5 mm bolus were sandwiched between the medial aspect of the arm and lateral chest to reduce skin dose to the chest. Two calibrated MOSkin detectors were placed on the target and normal skin area for five treatment sessions for in vivo dose monitoring. The mean dose to the target area ranged between 19.9 and 21.1 Gy and was higher in comparison with the calculated dose due to contribution of backscattered dose from lead. The mean measured dose at normal skin chest area was 1.6 Gy (1.3-1.9 Gy), less than 2 Gy per fraction. Total dose in EQD2 received by chest skin was much lower than the recommended skin tolerance. The MOSkin detector presents a reliable real-time dose measurement. This study has confirmed the applicability of the MOSkin detector in monitoring skin dose during brachytherapy treatment due to its small sensitive volume and WED 0.07 mm.
Collapse
Affiliation(s)
- Z Jamalludin
- Medical Physics Unit, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - W L Jong
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - G F Ho
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - A B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - N M Ung
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| |
Collapse
|
28
|
Chernavsky NE, Morcos M, Wu P, Viswanathan AN, Siewerdsen JH. Technical assessment of a mobile CT scanner for image-guided brachytherapy. J Appl Clin Med Phys 2019; 20:187-200. [PMID: 31578811 PMCID: PMC6806478 DOI: 10.1002/acm2.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The imaging performance and dose of a mobile CT scanner (Brainlab Airo®, Munich, Germany) is evaluated, with particular consideration to assessment of technique protocols for image-guided brachytherapy. METHOD Dose measurements were performed using a 100-mm-length pencil chamber at the center and periphery of 16- and 32-cm-diameter CTDI phantoms. Hounsfield unit (HU) accuracy and linearity were assessed using materials of specified electron density (Gammex RMI, Madison, WI), and image uniformity, noise, and noise-power spectrum (NPS) were evaluated in a 20-cm-diameter water phantom as well as an American College of Radiology (ACR) CT accreditation phantom (Model 464, Sun Nuclear, Melbourne, FL). Spatial resolution (modulation transfer function, MTF) was assessed with an edge-spread phantom and visually assessed with respect to line-pair patterns in the ACR phantom and in structures of interest in anthropomorphic phantoms. Images were also obtained on a diagnostic CT scanner (Big Bore CT simulator, Philips, Amsterdam, Netherlands) for qualitative and quantitative comparison. The manufacturer's metal artifact reduction (MAR) algorithm was assessed in an anthropomorphic body phantom containing surgical instrumentation. Performance in application to brachytherapy was assessed with a set of anthropomorphic brachytherapy phantoms - for example, a vaginal cylinder and interstitial ring and tandem. RESULT Nominal dose for helical and axial modes, respectively, was 56.4 and 78.9 mGy for the head protocol and 17.8 and 24.9 mGy for the body protocol. A high degree of HU accuracy and linearity was observed for both axial and helical scan modes. Image nonuniformity (e.g., cupping artifact) in the transverse (x,y) plane was less than 5 HU, but stitching artifacts (~5 HU) in the longitudinal (z) direction were observed in axial scan mode. Helical and axial modes demonstrated comparable spatial resolution of ~5 lp/cm, with the MTF reduced to 10% at ~0.38 mm-1 . Contrast-to-noise ratio was suitable to soft-tissue visualization (e.g., fat and muscle), but windmill artifacts were observed in helical mode in relation to high-frequency bone and metal. The MAR algorithm provided modest improvement to image quality. Overall, image quality appeared suitable to relevant clinical tasks in intracavitary and interstitial (e.g., gynecological) brachytherapy, including visualization of soft-tissue structures in proximity to the applicators. CONCLUSION The technical assessment highlighted key characteristics of dose and imaging performance pertinent to incorporation of the mobile CT scanner in clinical procedures, helping to inform clinical deployment and technique protocol selection in brachytherapy. For this and other possible applications, the work helps to identify protocols that could reduce radiation dose and/or improve image quality. The work also identified areas for future improvement, including reduction of stitching, windmill, and metal artifacts.
Collapse
Affiliation(s)
| | - Marc Morcos
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Pengwei Wu
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | | |
Collapse
|
29
|
Gessert N, Priegnitz T, Saathoff T, Antoni ST, Meyer D, Hamann MF, Jünemann KP, Otte C, Schlaefer A. Spatio-temporal deep learning models for tip force estimation during needle insertion. Int J Comput Assist Radiol Surg 2019; 14:1485-1493. [PMID: 31147818 PMCID: PMC6785597 DOI: 10.1007/s11548-019-02006-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 05/23/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Precise placement of needles is a challenge in a number of clinical applications such as brachytherapy or biopsy. Forces acting at the needle cause tissue deformation and needle deflection which in turn may lead to misplacement or injury. Hence, a number of approaches to estimate the forces at the needle have been proposed. Yet, integrating sensors into the needle tip is challenging and a careful calibration is required to obtain good force estimates. METHODS We describe a fiber-optic needle tip force sensor design using a single OCT fiber for measurement. The fiber images the deformation of an epoxy layer placed below the needle tip which results in a stream of 1D depth profiles. We study different deep learning approaches to facilitate calibration between this spatio-temporal image data and the related forces. In particular, we propose a novel convGRU-CNN architecture for simultaneous spatial and temporal data processing. RESULTS The needle can be adapted to different operating ranges by changing the stiffness of the epoxy layer. Likewise, calibration can be adapted by training the deep learning models. Our novel convGRU-CNN architecture results in the lowest mean absolute error of [Formula: see text] and a cross-correlation coefficient of 0.9997 and clearly outperforms the other methods. Ex vivo experiments in human prostate tissue demonstrate the needle's application. CONCLUSIONS Our OCT-based fiber-optic sensor presents a viable alternative for needle tip force estimation. The results indicate that the rich spatio-temporal information included in the stream of images showing the deformation throughout the epoxy layer can be effectively used by deep learning models. Particularly, we demonstrate that the convGRU-CNN architecture performs favorably, making it a promising approach for other spatio-temporal learning problems.
Collapse
Affiliation(s)
- Nils Gessert
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany.
| | - Torben Priegnitz
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - Thore Saathoff
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - Sven-Thomas Antoni
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - David Meyer
- Department of Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Moritz Franz Hamann
- Department of Urology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Christoph Otte
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| | - Alexander Schlaefer
- Institute of Medical Technology, Hamburg University of Technology, Hamburg, Germany
| |
Collapse
|
30
|
Tien CJ, Chen ZJ. Deployment and performance of model-based dose calculation algorithm in 192Ir shielded cylinder brachytherapy. Brachytherapy 2019; 18:883-889. [PMID: 31444132 DOI: 10.1016/j.brachy.2019.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of the study was to integrate model-based dose calculation algorithm (MBDCA) and 3-D planning into our institutional capabilities for clinical cases with inherent heterogeneities, namely shielded cylinder cases, which were previously performed using templates. METHODS AND MATERIALS AcurosBV (Varian Medical Systems) was selected as MBDCA, and we compared results against the American Association of Physicists in Medicine working group (WG) reference Test Case #4, which contains a 36-mm-diameter 180-degree shielded cylinder. The last five clinically used template plans, as generated with ABACUS (Varian Medical Systems), were compared against MBDCA results. Clinical plans used 20-, 23-, and 26-mm-diameter cylinders, prescribed from 5 to 7 Gy, 50- to 110-mm active length, 7 to 21 dwell positions, with 5- or 10-mm spacing. RESULTS Compared with the WG reference plan, AcurosBV produced excellent agreement, within 1% at reference points. Larger deviations arose only within the applicator itself. Historical plans generated using ABACUS had higher point dose than AcurosBV by 3-4% or 2-3% using transport within medium at prescription points, with dose to medium or water, respectively. CONCLUSIONS To verify the accuracy of our MBDCA algorithm, we benchmarked against the WG data set available for shielded cylinders. We discovered a 3-4% difference in dose from our established historical templates, which is easily outweighed by daily positioning uncertainties. Dose distributions from MBDCA were used to assess and validate existing historical templates.
Collapse
Affiliation(s)
- Christopher J Tien
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
31
|
Bellezzo M, Baeza JA, Voncken R, Reniers B, Verhaegen F, Fonseca GP. Mechanical evaluation of the Bravos afterloader system for HDR brachytherapy. Brachytherapy 2019; 18:852-862. [PMID: 31327634 DOI: 10.1016/j.brachy.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE The Bravos afterloader system was released by Varian Medical Systems in October of 2018 for high-dose-rate brachytherapy with 192Ir sources, containing new features such as the CamScale (a new device for daily quality assurance and system recalibration), channel length verification, and different settings for rigid and flexible applicators. This study mechanically evaluated the Bravos system precision and accuracy for clinically relevant scenarios, using dummy sources. METHODS AND MATERIALS The system was evaluated after three sets of experiments: (1) The CamScale was used to verify inter- and intra-channel dwelling variability and system calibration; (2) A high-speed camera was used to verify the source simulation cable movement inside a transparent quality assurance device, where dwell positions, dwell times, transit times, speed profiles, and accelerations were measured; (3) The source movement inside clinical applicators was captured with an imaging panel while being exposed to an external kV source. Measured and planned dwell positions and times were compared. RESULTS Maximum deviations between planned and measured dwell positions and times for the source cable were 0.4 mm for the CamScale measurements and 0.07 seconds for the high-speed camera measurements. Mean dwell position deviations inside clinical applicators were below 1.2 mm for all applicators except the ring that required an offset correction of 1 mm to achieve a mean deviation of 0.4 mm. CONCLUSIONS Features of the Bravos afterloader system provide a robust and precise treatment delivery. All measurements were within manufacturer specifications.
Collapse
Affiliation(s)
- Murillo Bellezzo
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Centro de Engenharia Nuclear, Instituto de Pesquisas Energéticas e Nucleares IPEN-CNEN/SP, São Paulo, Brazil
| | - José A Baeza
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriel P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| |
Collapse
|
32
|
Balsdon A, Timotin E, Hunter R, Diamond K. Stability of Intracavitary Applicator Placement for HDR Brachytherapy of Cervix Cancer. J Med Imaging Radiat Sci 2019; 50:441-448. [PMID: 31311722 DOI: 10.1016/j.jmir.2019.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/13/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION/BACKGROUND Cervical cancer is often treated with a combination of external beam radiation therapy and high-dose-rate intracavitary brachytherapy. An intrauterine ring and tandem applicator is used for intracavitary brachytherapy. The dose is prescribed to the high-risk clinical target volume. The goals of this study were to investigate the stability of intracavitary applicator placement during patient transfer and to evaluate the dosimetric impact of displacement. METHODS Fourteen patients with cervical cancer were analyzed. Three sets of orthogonal fluoroscopic radiographs were obtained in the high-dose-rate suite after the insertion and before treatment: pre-computed tomography (CT) fluoroscopic radiograph with patient in the lithotomy position, pre-CT fluoroscopic radiograph with patient in the legs down position, and post-CT fluoroscopic radiograph with patient in the legs down position. Applicator position after CT was compared with the pre-CT radiographs to determine if the position changed during patient transfer. The displacement was measured in the anterior-posterior, medio-lateral, and superior-inferior directions, as well as the degree of pitch, roll, and yaw. To study the impact of applicator shifts on dose to organs at risk (OARs), the ring and tandem applicator was shifted virtually in the BrachyVision treatment planning system. The OARs studied included the small bowel, sigmoid colon, rectum, and bladder. Five millimeter shifts were made in the superior-inferior, medio-lateral, and anterior-posterior direction. Three degree rotations were made in the pitch, yaw, and roll directions. Applicator shifts were analyzed in only one direction at a time. The dosimetric impact on OARs was evaluated by comparing the original and shifted/rotated plans to dose-volume histogram-based criteria. RESULTS The average displacements were 1.9 ± 0.5 mm laterally, 3.0 ± 0.6 mm longitudinally, and 9.5 ± 1.5 mm anterior-posterior. The average applicator rotation on the posterior-anterior radiograph was 1.0 ± 0.2° and 2.6 ± 0.6° on the lateral radiograph. Five millimeter anterior-posterior shifts had the greatest effect on dose to OARs. On average, 5 mm anterior shifts had the greatest effect on the small bowel dose, where there was a 13.7% (79.6 cGy) increase in D2cc. Five millimeter anterior shifts also affected bladder dose, with a 36.5% (141.1 cGy) increase in D2cc. Five millimeter POST shifts increased the rectal D2cc by 28.6% (168.7 cGy). Other directional shifts had negligible effects on dose. The largest effect on OAR dose arising from rotations was to the sigmoid colon, when the applicator rotated in the POST pitch direction. As a result, the dose increased by 4.7% (7.6 cGy). All other rotations had minimal impact on OAR doses. CONCLUSION Patient transfer resulted in applicator shifts and rotations that had a measurable effect on dose to OARs. The displacements were the result of either a direct shift or rotation of the applicator. Additional tracking of these shifts and rotations may clarify the sources of these unwanted motions and suggest possible mitigation strategies.
Collapse
Affiliation(s)
- Alexandra Balsdon
- McMaster University, Faculty of Science, Hamilton, Ontario, Canada; Tom Baker Cancer Centre, Radiation Therapy Department, Calgary, Alberta, Canada.
| | - Emilia Timotin
- Juravinski Cancer Centre, Radiation Therapy/Medical Physics Department, Hamilton, Ontario, Canada
| | - Robert Hunter
- McMaster University, Faculty of Science, Hamilton, Ontario, Canada; Juravinski Cancer Centre, Radiation Therapy/Medical Physics Department, Hamilton, Ontario, Canada
| | - Kevin Diamond
- McMaster University, Faculty of Science, Hamilton, Ontario, Canada; Juravinski Cancer Centre, Radiation Therapy/Medical Physics Department, Hamilton, Ontario, Canada
| |
Collapse
|
33
|
Nose T, Masui K, Takenaka T, Yamazaki H, Nakata K, Otani Y, Kumita S. An easy and novel method for safer brachytherapy: real-time fluoroscopic verification of high-dose-rate 192Ir source position using a flat-panel detector. J Radiat Res 2019; 60:412-415. [PMID: 31116853 PMCID: PMC6530625 DOI: 10.1093/jrr/rrz013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/17/2019] [Indexed: 06/09/2023]
Abstract
Real-time fluoroscopic verification of the active source position during actual treatment is the only established method to prevent high-dose-rate (HDR) brachytherapy events. The challenge is spurious signals from an HDR 192Ir source that result in image halation, making source positions indiscernible when using a non-modified image intensifier fluoroscope. We have previously reported a method for observing an HDR 192Ir source by using an elaborately modified image intensifier system. The newly developed flat-panel detector fluoroscope is, by contrast, inherently halation-free thanks to the wider dynamic range (12-14 bits), compared with image intensifier fluoroscopes (8 bits). To explore the feasibility, we applied a commercially available flat-panel detector fluoroscope without modification to actual treatment. We successfully observed source positions without halation for all 107 patients, with a total of 522 HDR treatment sessions during a 3-year period from 2014 to 2017. Actual source positions were compared with planned positions on the planning hard copy. With this method, we detected a total of 1 error (0.2%) among the 522 sessions, at a similar detection rate of 0.1% with our previous experience using a modified image intensifier fluoroscope. We found that a commercially available flat-panel detector fluoroscope is ready for use for real-time verification and outweighs the need for elaborate modifications of an image intensifier fluoroscope. A flat-panel detector fluoroscope will help the global radiation oncology community promote real-time verification programs, leading to safer HDR brachytherapy.
Collapse
Affiliation(s)
- Takayuki Nose
- Department of Radiation Oncology, Nippon Medical School, Tamanagayama Hospital, Nagayama, Tama, Tokyo, Japan
| | - Koji Masui
- Department of Radiation Oncology, University Hospital, Kyoto Prefectural University of Medicine, Kajii-cho,Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto, Japan
| | - Tadashi Takenaka
- Department of Radiation Oncology, University Hospital, Kyoto Prefectural University of Medicine, Kajii-cho,Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto, Japan
| | - Hideya Yamazaki
- Department of Radiation Oncology, University Hospital, Kyoto Prefectural University of Medicine, Kajii-cho,Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto, Japan
| | - Katsuya Nakata
- Department of Radiation Oncology, University Hospital, Kyoto Prefectural University of Medicine, Kajii-cho,Kawaramachi-Hirokoji, Kamigyo, Kyoto, Kyoto, Japan
| | - Yuki Otani
- Department of Radiology, Kaizuka City Hospital, Hori, Kaizuka, Osaka, Japan
| | - Shinichiro Kumita
- Department of Radiology, Nippon Medical School Hospital, Sendagi,Bunkyo, Tokyo, Japan
| |
Collapse
|
34
|
Lv Y, He L, Wang C, Zhang L, Zhang B, Song Y. A systematic review of clinical outcomes and radiotherapy-associated toxicity in multicatheter accelerated partial breast irradiation. Medicine (Baltimore) 2019; 98:e14407. [PMID: 30732191 PMCID: PMC6380720 DOI: 10.1097/md.0000000000014407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To integrate relevant clinical data of multicatheter accelerated partial breast irradiation (mAPBI) for reaching a comprehensive conclusion. METHODS We did 3 meta-analyses for clinical outcomes including 1740 women from 4 articles, for acute radiotherapy (RT)-associated toxicity including 1255 patients from 5 articles, and for late RT-related toxicity involving 1565 patients from 9 papers. Clinical outcomes analyses were stratified by molecular subtypes, lymph nodes status, receptor status, and human epidermal growth factor receptor 2 (HER2) status. RESULTS For the Luminal A/B phenotypes, the disease relapse and failure in survival significantly decreased when compared with triple negative (TN)/HER2-amplified subtypes (P < .00001). The 5-year regional nodal recurrence (RNR), 5-year distant metastasis-free survival (DMFS) and 5-year disease free-survival (DFS) of TN patients were significantly superior to HER2-overexpression patients (P < .00001). The 5-year cause-specific survival (CSS), 5-year DMFS and 5-year overall survival (OS) in women with lymph nodes-negative were significantly improved versus patients with lymph nodes-positive (P = .0001). Conversely, the positive status of HER2 compared with negative one significantly increased the rate of local recurrence (LR) (P = .02). For acute toxicity, the morbidity of dermatitis was significantly higher than hematoma and implant infection (P = .01, P < .0001, respectively). For late toxicity, the occurrences of fibrosis (32%) and telangiectasia (14%) were significantly higher than other complications (P < .0001). CONCLUSION HER2-enriched subtype compared with other subtypes has significantly increased disease relapse and failure in survival. HER2-positive status is positively associated with an increased incidence of LR. Dermatitis is the most common acute RT-related toxicity and fibrosis is the first rife late RT-related toxicity.
Collapse
Affiliation(s)
- Yang Lv
- Department of Oncology, The PLA Navy Anqing Hospital, Anqing, Anhui Province
| | - Lin He
- Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
| | - Chao Wang
- The Second Hospital of Anhui Medical University, Hefei, Anhui
| | - Lijiu Zhang
- The Second Hospital of Anhui Medical University, Hefei, Anhui
| | - Biyuan Zhang
- Department of Radiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, People's Republic of China
| | - Yuhua Song
- Breast Center B ward, The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province
| |
Collapse
|
35
|
Steward PG. Radiation Field Strengths Near Cylindrical Volume Sources Via Point-source Correction Factors. Health Phys 2019; 116:60-68. [PMID: 30489367 DOI: 10.1097/hp.0000000000000952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Due to the ease with which the radiation field strength is determined for a point source, the field strength emanating from radiopharmaceutical therapy patients is sometimes estimated by using the point source approximation with a correction factor. It is inevitable that the correction factor will occasionally be used under conditions that do not precisely match those for which the factor was originally derived. The difficulty is that the boundary of the correction factor's domain of acceptability is usually unclear. The purpose of this paper is to address this issue. The patient is modeled as a cylinder containing the radionuclide administered to the patient. From first principles, the expression for converting the radiation field strength of an unshielded point source to that of the extended cylindrical volume source is derived. This expression is analytically separated into the component depicting geometric dispersion of the source material into the volume and the component depicting self-absorption (absorption characteristics of I in water are used). These components, along with their composite, are presented showing their dependence on patient size, distance from the patient, and various dispersion patterns of the source material within the patient. Correlation of theory and measurement is demonstrated, and a conceptual grasp is conveyed regarding field strength variations around volume sources with changes in shape, size, distance, and other parameters. Using data presented, the radiation field strength emanating from a radiopharmaceutical therapy patient can be estimated from the point source approximation and customized for patient size and presumed internal radionuclide distribution.
Collapse
|
36
|
Huang W, Lu J, Chen KM, Wu ZY, Wang QB, Liu JJ, Gong J, Chen ZJ, Ding XY, Wang ZM. Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer. World J Gastroenterol 2018; 24:5280-5287. [PMID: 30581276 PMCID: PMC6295836 DOI: 10.3748/wjg.v24.i46.5280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate a 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with pancreatic cancer.
METHODS A retrospective analysis of our database was performed, and a total of 25 patients with pancreatic cancer who underwent iodine-125 seed implantation between January 2014 and November 2017 were analyzed. Of these, 12 implantations were assisted by a 3D-printed coplanar template (group A), and 13 implantations performed freehand were selected as a control group (group B). A 3D coplanar template was designed and printed according to a preoperative CT scan and treatment planning system. The iodine-125 seeds were then implanted using the template as a guide. Dosimetric verification was performed after implantation. Pre- and postoperative D90, V100, and V150 were calculated. The success rate of iodine-125 seed implantation, dosimetric parameters, and complications were analyzed and compared between the two groups.
RESULTS Iodine-125 seed implantation was successfully performed in both groups. In group A, the median pre- and postoperative D90 values were 155.32 ± 8.05 Gy and 154.82 ± 16.43 Gy, respectively; the difference between these values was minimal and not statistically significant (P > 0.05). Postoperative V100 and V150 were 91.05% ± 4.06% and 64.54% ± 13.40%, respectively, which met the treatment requirement. A better dosimetric parameter was observed in group A than in group B, and the difference was statistically significant (V100: 91.05% ± 4.06% vs 72.91% ± 13.78%, P < 0.05). No major procedure-related complications were observed in either group. For group A, mild hemorrhage was observed in 1 patient with a peritoneal local hematoma due to mesenteric vein damage from the iodine-125 seed implantation needle. The hematoma resolved spontaneously without treatment. Postoperative blood amylase levels remained within the normal range for all patients.
CONCLUSION A 3D-printed coplanar template appears to be a safe and effective iodine-125 seed implantation guidance tool to improve implantation accuracy and optimize dosimetric distribution.
Collapse
Affiliation(s)
- Wei Huang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jian Lu
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Ke-Min Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhi-Yuan Wu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qing-Bin Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Jing-Jing Liu
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Ju Gong
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Zhi-Jin Chen
- Department of Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai 200020, China
| | - Xiao-Yi Ding
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhong-Min Wang
- Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| |
Collapse
|
37
|
Heesch D, Rogalla D, Lenders T, Meijer J, Happel P. Implantation of defined activities of phosphorus 32 with reduced target damage. Rev Sci Instrum 2018; 89:113304. [PMID: 30501334 DOI: 10.1063/1.5019014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 10/11/2018] [Indexed: 06/09/2023]
Abstract
Materials doped with the unstable isotope phosphorus 32 are promising candidates for use in brachytherapeutic applications. One way to dope a material with 32P is by ion implantation. However, the bombardment of the target with ions other than 32P due to impurities of the ion beam leads to unnecessary damages of the target, which might reduce its potential for medical applications. Furthermore, implanting a pre-selected activity of an unstable isotope into a target requires the repeated determination of the target's activity, which requires removing the target from the implantation chamber. This prolongs the total implantation time and requires handling the radioactive target multiple times, which in turn increases the risk of accidental exposure. We have incorporated an online-detector system into the implantation chamber of a 60 kV ion implanter that allowed us to determine the activity of the target without removing the target from the implantation chamber. We then used this system to investigate the implantation of ions with m = 38 u-instead of ions with m = 32 u-to reduce the fraction of other ions than 32P implanted into the target to reduce the induced damages.
Collapse
Affiliation(s)
- Daniel Heesch
- Central Unit for Ionbeams and Radionuclides (RUBION), Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
| | - Detlef Rogalla
- Central Unit for Ionbeams and Radionuclides (RUBION), Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
| | - Thomas Lenders
- Central Unit for Ionbeams and Radionuclides (RUBION), Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
| | - Jan Meijer
- Faculty of Physics and Earth Sciences, Felix Bloch Institute for Solid State Physics, Leipzig University, Linnéstraße 5, D-04103 Leipzig, Germany
| | - Patrick Happel
- Central Unit for Ionbeams and Radionuclides (RUBION), Ruhr-University Bochum, Universitätsstraße 150, D-44801 Bochum, Germany
| |
Collapse
|
38
|
Sapienza LG, Jhingran A, Kollmeier MA, Lin LL, Calsavara VF, Gomes MJL, Baiocchi G. Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis. Gynecol Oncol 2018; 151:573-578. [PMID: 30333082 DOI: 10.1016/j.ygyno.2018.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance. MATERIALS AND METHODS A systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance. RESULTS A total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35-8.67) and per patient was 7.39% (95%CI: 3.92-13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12-17.57) versus 1.06% (95%CI: 0.41-2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01-26.45) versus 2.54% (95%CI: 1.21-5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management. CONCLUSION Using postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.
Collapse
Affiliation(s)
- Lucas Gomes Sapienza
- Department of Radiation Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil; Department of Radiation Oncology, Hospital Central do Exército do Rio de Janeiro (HCE-RJ), Rio de Janeiro, RJ, Brazil.
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maria José Leite Gomes
- Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil
| | - Glauco Baiocchi
- Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil
| |
Collapse
|
39
|
Upreti RR, Budrukkar A, Upreti U, Wadasadawala T, Misra S, Gurram L, Pathak R, Deshpande DD. Impact of inter-observer variations in target volume delineation on dose volume indices for accelerated partial breast irradiation with multi-catheter interstitial brachytherapy. Radiother Oncol 2018; 129:173-179. [PMID: 30318170 DOI: 10.1016/j.radonc.2018.06.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate dosimetric impact of inter-observer variation in clinical target volume(CTV) delineation for patients undergoing interstitial partial breast brachytherapy. METHODS Five radiation oncologists delineated CTV in twenty patients who underwent multi-catheter partial breast brachytherapy. Five treatment plans for each patient were graphically optimized for CTV of all observers and evaluated using coverage index(CI), external volume index(EI), overdose volume index(OI) and conformal index(COIN). In addition, volume enclosed by prescription isodose(V100), its spatial concordance(CIcommon), mean coverage of all CTVs with common volume of prescription dose(V100_common) and mean CTV coverage for all pairs of observer with common prescription volume of respective pairs(V100_pair) were also computed. RESULTS The mean ± standard deviation(SD) of CI and COIN ranged from 0.756 ± 0.076 to 0.840 ± 0.070 and 0.591 ± 0.090 to 0.673 ± 0.06 respectively. When a plan made for CTV of individual observer was evaluated on CTV of all observers, the maximum variations(ρ < 0.05) in the mean CI,COIN,OI and EI were 10.6%,11.4%,10.6% and 72.7% respectively. The observed mean ± SD of V100, CIcommon of V100, CTV coverage with V100_common and V100_pair was 160.7 ± 52.1, 0.70 ± 0.09, 73.1 ± 8.1% and 77.9 ± 7.3% respectively. CONCLUSION Inter-observer variation in delineation of CTV showed significant dosimetric impact with mean CTV coverage of 73.1% and 77.9% by common and paired prescription dose volume respectively among all observers.
Collapse
Affiliation(s)
- Ritu Raj Upreti
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Mumbai, India.
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Udita Upreti
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer, Mumbai, India
| | - Shagun Misra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Deepak D Deshpande
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Mumbai, India
| |
Collapse
|
40
|
Karagiannis E, Leczynski A, Tselis N, Psanis E, Steckenreiter O, Milickovic N, Bon D, Strouthos I, Ferentinos K, Hass P, Gademann G, Baltas D, Zamboglou N. Inverse planning and inverse implanting for breast interstitial brachytherapy. Introducing a new anatomy specific breast interstitial template (ASBIT). Radiother Oncol 2018; 128:421-427. [PMID: 29934109 DOI: 10.1016/j.radonc.2018.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 04/30/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
An innovative template, based on thoracic cage surface reconstructions for breast interstitial brachytherapy was developed. Hybrid-inverse-planning-optimisation-based implantations and brachytherapy plans, using three custom anthropomorphic breast phantoms, were utilised for its validation. A user independent, inverse planning and inverse implanting technique is proposed.
Collapse
Affiliation(s)
| | - Agnes Leczynski
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Tselis
- Department of Radiation Oncology, Radiotherapy and Oncology, J. W. Goethe University, Frankfurt am Main, Germany
| | - Emmanouil Psanis
- Department of Electrical Engineering and Computer Science, University of Liege, Montefiore Institute, Belgium
| | | | - Natasa Milickovic
- Department of Radiation Oncology, Sana Klinikum Offenbach, Offenbach am Main, Germany
| | - Dimitra Bon
- Institute of Biostatistic and Mathematical Modeling, J. W. Goethe University, Frankfurt am Main, Germany
| | - Iosif Strouthos
- Department of Radiation Oncology, Medical Center, University of Freiburg, Germany
| | | | - Peter Hass
- Department of Radiation Oncology, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Günther Gademann
- Department of Radiation Oncology, Otto-von-Guericke University Medical School, Magdeburg, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, University of Freiburg, Faculty of Medicine and German Cancer Consortium (DKTK), Partner Site, Freiburg, Germany
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, Limassol, Cyprus; Department of Radiation Oncology, Radiotherapy and Oncology, J. W. Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
41
|
Warrell GR, Xing Y, Podder TK, Traughber BJ, Ellis RJ. Reduction of seed motion using a bio-absorbable polymer coating during permanent prostate brachytherapy using a mick applicator technique. J Appl Clin Med Phys 2018; 19:44-51. [PMID: 29667307 PMCID: PMC5978941 DOI: 10.1002/acm2.12254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The addition of a braided bio-absorbable vicryl coating to the surface of radioactive seeds used for low dose rate (LDR) prostate brachytherapy is intended to reduce the incidence of seed movement and migration. Here, we present a single-institution study of the frequency and severity of seed slippage (initial seed movement) of coated seeds in comparison with uncoated seeds. METHODS Forty-seven patients received permanent prostate brachytherapy, with either coated (n = 26) or uncoated (n = 21) seeds. AgX100 125 I seeds, coated or uncoated, and uncoated Model 200 103 Pd seeds were used. During the ultrasound-guided implantation procedure, each implanted seed was categorized as having remained in the implanted position after being placed, having moved slightly, or having left the ultrasound field of view. RESULTS 3.1% of the coated seeds (AgX100 seeds, n = 70) and 6.9% of the uncoated seeds (AgX100 and Model 200 seeds, n = 128) were observed to have moved at least 2 mm from their initial implant positions, respectively. The difference in incidence of this movement was 54.4% (P = 0.0026). Coated AgX100 seeds demonstrated a 66.7% lower rate of movement of at least 2 mm than that for uncoated AgX100 seeds (P = 0.038), and a 49.0% lower rate than that for Model 200 seeds (P = 0.021). While no significant differences were noted in prescription dose coverage of the prostate or the studied dosimetric parameters for the organs at risk between the coated and uncoated seeds (P > 0.05) in the CT-based Day-0 postoperative plans, the limited sample size and differences in energies between the 125 I and 103 Pd seeds make further analysis of postoperative dosimetric coverage difficult without additional data directly comparing the coated and uncoated 125 I seeds. CONCLUSION When the vicryl coating is used, seeds have a significantly lower propensity to slip from their initial implant locations. This may help maintain dosimetric integrity, warranting further study of postoperative dosimetry.
Collapse
Affiliation(s)
- Gregory R. Warrell
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Yan Xing
- Case Western Reserve UniversityClevelandOHUSA
| | - Tarun K. Podder
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Bryan J. Traughber
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| | - Rodney J. Ellis
- Department of Radiation OncologyUniversity Hospitals Cleveland Medical CenterClevelandOHUSA
| |
Collapse
|
42
|
Chen W, Fang XM, Wang X, Sudarshan SKP, Hu XY, Chen HW. Preliminary clinical application of integrated 125I seeds stents in the therapy of malignant lower biliary tract obstruction. J Xray Sci Technol 2018; 26:865-875. [PMID: 30040791 DOI: 10.3233/xst-180403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the clinical efficacy of percutaneous trans-hepatic integrated 125I seed stents implantation for malignant lower biliary tract obstruction. METHODS Thirty-two patients with malignant lower biliary obstruction were randomly divided into two groups. One group underwent the therapy with integrated 125I seed stents (Test group, n = 13), and another group received conventional metal stents implantation for treatment (Control group, n = 19). The pre- and post-operative changes in biochemical indices, white blood cell count, IgG level, stent patency, survival time, tumor size and complications were compared between the two groups. RECIST 1.1 (Response Evaluation Criteria In Solid Tumors) was used to evaluate therapeutic effects. The average follow-up time was 12.3 months. RESULTS The differences between pre- and post-operative (30 days) intragroup biochemical indices had statistically significant difference (P < 0.05), but there were no significant differences (P > 0.05) in leukocyte counts and IgG levels. As to the median time of stent patency and patients' survival, there were significant differences (P < 0.05) between Control and Test groups (3.9 months vs. 8.1 months, 139 days vs. 298 days, respectively). Three months after the operation, the average tumor size was reduced in the Test group, but was increased in the Control group (P < 0.05). There was no significant difference in the incidence of complications between the two groups. The evaluation results using RECIST 1.1 showed that there were statistically significant differences between the two groups in terms of the rates of remission, control, and progression (χ2 = 17.5, P < 0.05). CONCLUSIONS The study indicates that integrated 125I seed stents are effective in reducing jaundice symptoms, inhibiting tumor growth, improving stent patency and prolonging patient survival, which may serve as a safer and more feasible method in treating malignant lower biliary obstruction with minimal invasiveness.
Collapse
Affiliation(s)
- Wei Chen
- Department of Intervention Radiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Xiang-Ming Fang
- Imaging Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Xuan Wang
- Department of Intervention Radiology, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | | | - Xiao-Yun Hu
- Imaging Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| | - Hong-Wei Chen
- Imaging Center, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu Province, China
| |
Collapse
|
43
|
Smolic M, Sombroek C, Bloemers MCWM, van Triest B, Nowee ME, Mans A. Needle use and dosimetric evaluation in cervical cancer brachytherapy using the Utrecht applicator. Radiother Oncol 2017; 126:411-416. [PMID: 29198407 DOI: 10.1016/j.radonc.2017.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE To analyse the clinical use of needles and examine the feasibility to meet the planning criteria in three fractions of cervical cancer brachytherapy. Furthermore, to investigate whether the needles with the largest discrepancy between application and loading are essential to treatment planning. MATERIALS AND METHODS For 22 patients we analysed the applied and loaded needle patterns, and examined the dosimetric results for small (<30 cm3) and large (≥30 cm3) CTVHR. We removed from the clinical plans (CP) the needles applied most, but with the lowest loading frequency and intensity and re-optimized these plans (RP). RESULTS On average 5.8 needles were applied and 4.8 loaded per fraction, with average intensity 22% (17% for small, 29% for large CTVHR). Mid-lateral needles were applied and loaded most frequently and intensely. The average CTVHR D90% prescribed dose was 88.8 Gy (SD 4.2) EQD210, the average OAR [Formula: see text] limit was respected. Omitting the mid-ventral needles, minimal statistically significant differences were found in dose distributions between RP and CP. CONCLUSIONS Applying on average 5.8 needles per fraction it was possible to meet the planning criteria for targets and OARs in three BT fractions for both small and large CTVHR. The mid-ventral needles were not essential in treatment planning, unless situated in the vicinity of the GTVres.
Collapse
Affiliation(s)
- Milena Smolic
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Chèrita Sombroek
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Monique C W M Bloemers
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marlies E Nowee
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anton Mans
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
44
|
Elzibak AH, Kager PM, Soliman A, Paudel MR, Safigholi H, Han DY, Karotki A, Ravi A, Song WY. Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator. Brachytherapy 2017; 17:465-475. [PMID: 29174936 DOI: 10.1016/j.brachy.2017.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to quantitatively assess the CT metal-induced artifacts from a novel direction-modulated brachytherapy (DMBT) tandem applicator prototype, recently designed for cervical cancer treatments. METHODS AND MATERIALS A water-based pelvic phantom was constructed for CT scanning. The DMBT applicator was imaged using our institutional protocol, one with higher kVp and mAs settings, and repetition of these protocols using 3-mm slices. A conventional stainless steel applicator was also scanned. In addition to the standard reconstructed images, applicator images were reconstructed using a commercial metal artifact-reduction (MAR) algorithm and an in-house-developed research algorithm. Subsequently, image quality and artifact severity were evaluated. RESULTS Artifact severity, measured in terms of SDs in CT numbers, decreased asymptotically to background water levels with the distance away from the applicator. Artifact-reduction algorithms lead to significant and visible improvements in image quality, with >50% and >20% decrease in artifact severity achieved at a 10-mm distance for the DMBT and stainless steel applicators, respectively. Differences in artifact severity were minimal between the four imaging protocols. DMBT dimensions were the same on images with and without the commercial MAR algorithm, within <1 mm of the theoretical value. Both the commercial and in-house algorithms restored the CT numbers outside the applicator, albeit a better performance was achieved by the in-house algorithm. CONCLUSIONS The artifacts produced by both applicators were minimized with the use of MAR algorithms. Adoption of the DMBT and stainless steel applicators for CT-guided brachytherapy is anticipated as MAR algorithms are widely available on CT scanners.
Collapse
Affiliation(s)
- Alyaa H Elzibak
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.
| | - Petronella M Kager
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Abraam Soliman
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Physical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Moti R Paudel
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Habib Safigholi
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Electrical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Dae Yup Han
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Aliaksandr Karotki
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Ananth Ravi
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - William Y Song
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| |
Collapse
|
45
|
Zhang ZH, Liu QX, Zhang W, Ma JQ, Wang JH, Luo JJ, Liu LX, Yan ZP. Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus. World J Gastroenterol 2017; 23:7735-7745. [PMID: 29209114 PMCID: PMC5703933 DOI: 10.3748/wjg.v23.i43.7735] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/18/2017] [Accepted: 10/17/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the safety and efficacy of combined endovascular brachytherapy (EVBT), transarterial chemoembolization (TACE), and sorafenib to treat hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT).
METHODS This single-center retrospective study involved 68 patients with unresectable HCC or those who were unfit for liver transplantation and percutaneous frequency ablation according to the BCLC classification. All patients had Child-Pugh classification grade A or B, Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, and MPVTT. The patients received either EVBT with stent placement, TACE, and sorafenib (group A, n = 37), or TACE with sorafenib (group B, n = 31). The time to progression (TTP) and overall survival (OS) were evaluated by propensity score analysis.
RESULTS In the entire cohort, the 6-, 12-, and 24-mo survival rates were 88.9%, 54.3%, and 14.1% in group A, and 45.8%, 0%, and 0% in group B, respectively (P < 0.001). The median TTP and OS were significantly longer in group A than group B (TTP: 9.0 mo vs 3.4 mo, P < 0.001; OS: 12.3 mo vs 5.2 mo, P < 0.001). In the propensity score-matched cohort, the median OS was longer in group A than in group B (10.3 mo vs 6.0 mo, P < 0.001). Similarly, the median TTP was longer in group A than in group B (9.0 mo vs 3.4 mo, P < 0.001). Multivariate Cox analysis revealed that the EVBT combined with stent placement, TACE, and sorafenib strategy was an independent predictor of favorable OS (HR = 0.18, P < 0.001).
CONCLUSION EVBT combined with stent placement, TACE, and sorafenib might be a safe and effective palliative treatment option for MPVTT.
Collapse
Affiliation(s)
- Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Qing-Xin Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Jing-Qin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Jian-Hua Wang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Jian-Jun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Ling-Xiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University and Shanghai Institute of Medical Imaging, Shanghai 20032, China
| |
Collapse
|
46
|
Liang LH, Tomic N, Vuong T, Aldelaijan S, Bekerat H, DeBlois F, Seuntjens J, Devic S. Physics aspects of the Papillon technique-Five decades later. Brachytherapy 2017; 17:234-243. [PMID: 29102741 DOI: 10.1016/j.brachy.2017.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The Papillon technique using 50-kVp soft X-rays to treat rectal adenocarcinomas was developed and clinically implemented in the 1960s. We describe differences between accurate dosimetry and clinical implementation of this technique that is extending from its very inception to date. METHODS AND MATERIALS A renaissance of the Papillon technique occurred with two recently introduced 50-kVp systems: Papillon+ by Ariane and a custom-made rectal applicator (consisting of a surface applicator inserted into a proctoscope) by iCAD's Xoft Axxent Electronic Brachytherapy (eBT) System (iCad, Inc., Sunnyvale, CA). In contrast to the initial design, we investigated the impact of introducing a plastic lid, which would provide more reproducible and more accurate dose delivery across the rectal adenocarcinoma patient population. We use both parallel-plate chamber and radiochromic film dosimeters to determine differences in basic dosimetry characteristics (beam half-value layers, outputs, percent depth doses, and profiles) between the Xoft Electronic Brachytherapy rectal applicator system with and without the plastic lid in place. RESULTS Compared to the open-cone applicator, the proposed applicator with the plastic lid produces a slightly harder (more penetrating) beam quality (half-value layer of 1.4 vs. 1.3-mm Al), but with reduced output (by 33%), and a slightly broader beam with flatness not worse than 3% and symmetry not worse than 2%. CONCLUSIONS In addition to characterizing beam properties modified by the possible introduction of the plastic cap, we also pointed out and addressed misconceptions in the use of radiochromic films for dose measurements at low-energy photon beams.
Collapse
Affiliation(s)
- Li Heng Liang
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Nada Tomic
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Te Vuong
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Oncology Department, McGill University, Montreal, Quebec, Canada
| | - Saad Aldelaijan
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Biological & Biomedical Engineering Department, Montreal Neurological Institute, Montréal, Québec, Canada; Biomedical Physics Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hamed Bekerat
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Francois DeBlois
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Oncology Department, McGill University, Montreal, Quebec, Canada
| | - Slobodan Devic
- Radiation Oncology Department, Jewish General Hospital, Montreal, Quebec, Canada; Medical Physics Unit, McGill University, Montreal, Quebec, Canada; Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, Québec, Canada.
| |
Collapse
|
47
|
Boman EL, Satherley TWS, Schleich N, Paterson DB, Greig L, Louwe RJW. The validity of Acuros BV and TG-43 for high-dose-rate brachytherapy superficial mold treatments. Brachytherapy 2017; 16:1280-1288. [PMID: 28967561 DOI: 10.1016/j.brachy.2017.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this work is to validate the Acuros BV dose calculation algorithm for high-dose-rate (HDR) brachytherapy superficial mold treatments in the absence of full scatter conditions and compare this with TG-43 dose calculations. We also investigate the impact of additional back scatter material (bolus) applied above surface molds to the dose distributions under the mold. METHODS AND MATERIALS The absorbed dose at various depths was compared for simulations performed using either TG-43 or Acuros BV dose calculations. Parameter variations included treatment area, thickness of the bolus, and surface shape (flat or spherical). Film measurements were carried out in a flat phantom. RESULTS Acuros BV calculations and film measurements agreed within 1.5% but were up to 15% lower than TG-43 dose calculations when no bolus was applied above the treatment catheters. The difference in dose at the prescription depth (1 cm below the central catheter) increased with increasing treatment area: 3.3% difference for a 3 × 3.5 cm2 source loading area, 7.4% for 8 × 9 cm2, and 13.4% for 18 × 19 cm2. The dose overestimation of the TG-43 model decreased when bolus was added above the treatment catheters. CONCLUSIONS The TG-43 dosimetry formalism cannot model surface mold treatments in the absence of full scatter conditions within 5% for loading areas larger than approximately 5 × 5 cm2. The TG-43 model results in an overestimation of the delivered dose, which increases with treatment area. This confirms the need for model-based dose calculation algorithms as discussed in TG-186.
Collapse
Affiliation(s)
- Eeva L Boman
- Blood & Cancer Centre, Wellington Hospital, Wellington, NZ; Department of Oncology, Tampere University Hospital, Tampere, Finland; Department of Medical Physics, Tampere University Hospital, Tampere, Finland.
| | | | | | | | - Lynne Greig
- Blood & Cancer Centre, Wellington Hospital, Wellington, NZ
| | - Rob J W Louwe
- Blood & Cancer Centre, Wellington Hospital, Wellington, NZ
| |
Collapse
|
48
|
Wang K, Ferenci MS, de la Zerda A, Padgett KR, Bossart EL, Chao M, Shao H, Zhang M. A review of nonstandardized applicators digitization in Nucletron™ HDR procedures. J Appl Clin Med Phys 2017; 18:89-96. [PMID: 28857433 PMCID: PMC5875818 DOI: 10.1002/acm2.12156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/04/2017] [Accepted: 06/01/2017] [Indexed: 11/07/2022] Open
Abstract
The major errors in HDR procedures were failures to enter the correct treatment distance, which could be caused by either entering wrong transmission lengths or imprecisely digitizing the dwelling positions. Most of those errors were not easily avoidable by enhancing the HDR management level because they were caused by implementations of nonstandardized applicators utilizing transmission tubes of different lengths in standard HDR procedures. We performed this comprehensive study to include all possible situations with different nonstandardized applicators that frequently occurred in HDR procedures, provide corresponding situations with standard applicator as comparisons, list all possible errors and in planning, clarify the confusions in offsets setting, and provide mathematical and quantitative solutions for each given scenarios. Training on HDR procedures with nonstandardized applicators are normally not included in most residential program for medical physics, thus this study could be meaningful in both clinical and educational purpose. At precision of 1 mm, our study could be used as the essential and practical reference for finding the correct treatment length as well as locating the accurate dwelling positions in any HDR procedure with nonstandardized applicators.
Collapse
Affiliation(s)
- Kelin Wang
- Department of RadiologyRadiation OncologyPenn State Milton S. Hershey Medical CenterHersheyPAUSA
| | - Michele S. Ferenci
- Department of RadiologyRadiation OncologyPenn State Milton S. Hershey Medical CenterHersheyPAUSA
| | - Alberto de la Zerda
- Department of Radiation OncologySylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFLUSA
| | - Kyle R. Padgett
- Department of Radiation OncologySylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFLUSA
| | - Elizabeth L. Bossart
- Department of Radiation OncologySylvester Comprehensive Cancer CenterUniversity of MiamiMiamiFLUSA
| | - Ming Chao
- Department of Radiation OncologyIcahn School of Medicine at Mont SinaiNew YorkNYUSA
| | - Hua Shao
- 21st Century OncologyKendall Oncology CenterMiamiFLUSA
| | - Mutain Zhang
- Department of Radiation OncologyUniversity of Nebraska Medical CenterOmahaNEUSA
| |
Collapse
|
49
|
Paterson DB, Pearson SM, Wilson AN. Intracavitary vaginal brachytherapy using a custom balloon applicator. J Med Radiat Sci 2017; 64:310-314. [PMID: 28661036 PMCID: PMC5715253 DOI: 10.1002/jmrs.235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/11/2017] [Accepted: 05/26/2017] [Indexed: 11/07/2022] Open
Abstract
A custom balloon applicator was created to deliver intracavitary high-dose-rate brachytherapy to a patient with a superficial vaginal cancer. The patient was unable to be treated conventionally due to an extremely narrow introitus that prevented the introduction of a conventional cylinder applicator. The custom applicator was constructed by inserting a straight titanium tandem applicator through the drainage lumen of a Foley catheter. The applicator was inserted and the catheter balloon was inflated when positioned at the vaginal apex. Three brachytherapy treatments were performed using this technique. Individual balloon eccentricities resulted in small radial tandem offsets within the balloon. This phenomenon was exploited by orientating the tandem offset in the direction of the target volume. Acceptable dosimetry was achieved for all fractions and the procedure was very well tolerated. The custom applicator was a viable solution that was safely developed in a short time frame using equipment readily available in our department.
Collapse
Affiliation(s)
- Dean B. Paterson
- Radiation Treatment DepartmentBlood and Cancer CentreWellington Regional HospitalWellingtonNew Zealand
| | - Shelley M. Pearson
- Radiation Treatment DepartmentBlood and Cancer CentreWellington Regional HospitalWellingtonNew Zealand
| | - Andrew N. Wilson
- Radiation Treatment DepartmentBlood and Cancer CentreWellington Regional HospitalWellingtonNew Zealand
| |
Collapse
|
50
|
Ibanez-Rosello B, Bautista-Ballesteros JA, Candela-Juan C, Villaescusa JI, Ballester F, Vijande J, Perez-Calatayud J. Evaluation of the shielding in a treatment room with an electronic brachytherapy unit. J Radiol Prot 2017; 37:N5-N12. [PMID: 28253202 DOI: 10.1088/1361-6498/aa56cf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Esteya® (Elekta Brachytherapy, Veenendaal, The Netherlands) is an electronic brachytherapy (eBT) system based on a 69.5 kVp x-ray source and a set of collimators of 1 to 3 cm in diameter, used for treating non-melanoma skin cancer lesions. This study aims to estimate room shielding requirements for this unit. The non-primary (scattered and leakage) ambient dose equivalent rates were measured with a Berthold LB-133 monitor (Berthold Technologies, Bad Wildbad, Germany). The latter ranges from 17 mSv h-1 at 0.25 m distance from the x-ray source to 0.1 mSv h-1 at 2.5 m. The necessary room shielding was then estimated following US and some European guidelines. The room shielding for all barriers considered was below 2 mmPb. The dose to a companion who, exceptionally, would stay with the patient during all treatment was estimated to be below 1 mSv if a leaded apron is used. In conclusion, Esteya shielding requirements are minimal.
Collapse
Affiliation(s)
- Blanca Ibanez-Rosello
- Radioprotection Department, La Fe University and Polytechnic Hospital, Valencia E-46026, Spain
| | | | | | | | | | | | | |
Collapse
|