Purpose: To evaluate to treatment consistency over the total number of fractions when treatment what HDR brachytherapy using the ML cylinders. At the same time the dosimetric impact on the critical organs is monitored over the total number of fractions. Methods: A retrospective analysis of 10 patients treated with Cylinder applicators, from 2015–2016 were considered for this study. The CT scans of these patients, taken before each treatment were separately imported in to the treatment planning system and paired with the initial CT scan after completing the contouring. Two sets of CT images were fused together with respective to the applicator, using landmark registration. The doses of each plan were imported as well and a cumulative dosimetric analysis was made for bladder, bowels, and rectum and PTV. Results: No contour of any of the OAR was exactly similar when CT images were fused on each other. The PTV volumes vary from fraction to fraction. There was always a difference between the doses received by the OARs between treatments. The maximum dose varied between 5% and 30% in rectum and bladder. The minimum dose varied between 5% and 8% in rectum and bladder. The average dose varied between 15% and 20% in rectum and bladder. Deviation in placement were noticed between fractions. Conclusion: The variation in volumes of OARs and isodoses near the OARs, indicate that the estimated doses to OARs on the planning system may not be the same dose delivered to the patient in all the fractions. There are no major differences between the prescribed dose and the delivered dose over the total number of fractions. In some cases the critical organs will benefit if the consecutive plans will made after the CT scans will be registered with the initial scan and then planned.

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Purpose: High dose rate (HDR) brachytherapy dose distribution is highly localized and has a very sharp fall‐off. Thus the one of the most important part of the treatment is the localization and immobilization of the applicator from the implantation to the setup verification to the treatment delivery. The smallest motions of the patient can induce a small rotation, tilt, or translational movement of the applicator that can convert into miss of a significant part of the tumor or to over irradiating a nearby critical organ. The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators. Methods: The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicator placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. Results: Many of the present immobilization devices produced for external radiotherapy can be used to improve the localization of HDR applicators during transportation of the patient and during treatment. Conclusion: This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended.

Purpose: The purpose of this study is to revise most of the HDR types of treatments with their applicators and their localization challenges. Since every millimeter of misplacement counts the study will look into the necessity of increasing the immobilization for several types of applicators Methods: The study took over 136 plans generated by the treatment planning system (TPS) looking into the applicator's placement in regard to the organs at risk (OR) and simulated the three possible displacements at the hottest dose point on the critical organ for several accessories to evaluate the variation of the delivered dose at the point due to the displacement. Results: Significant dose variation was obtained for the Contura, Savi, MLM and Prostate applicators. Conclusion: This study data indicates that an improvement of the immobilization devices for HDR is absolutely necessary. Better applicator fixation devices are required too. Developing new immobilization devices for all the applicators is recommended. Florida Atlantic University may provide Travel reimbursements.

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