A consensus-based, process commissioning template for high-dose-rate gynecologic treatments

Brown, Derek; Damato, Antonio L.; Sutlief, Steven; Morcovescu, Serban; Park, Sang-June; Reiff, Jay E.; Shih, Allen; Scanderbeg, Daniel J.

doi:10.1016/j.brachy.2016.05.003

Cited by 10 publications

(28 citation statements)

References 15 publications

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“…Some researchers have reported that failure modes in HDR brachytherapy tend to occur because of human error during treatment planning and delivery rather than because of malfunctions of the treatment machine 10, 11, 24. Failures frequently result because of lack of training or experience.…”

Section: Discussionmentioning

confidence: 99%

High‐dose rate intracavitary brachytherapy pretreatment dwell position verification using a transparent applicator

Otani

Sumida

Nose

et al. 2018

J Applied Clin Med Phys

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PurposeThe major errors in HDR brachytherapy are related to treatment distance, almost all of which are caused by incorrect applicator information. The aim of this study is to propose a quick pretreatment verification method to evaluate channel length and dwell position with a transparent applicator, which, in addition, is suitable as an education tool to assist in the understanding of the applicator structure.MethodsA transparent applicator model was fabricated using a three‐dimensional printer and transparent resin. Its aim is to be a replica of a real gynecological applicator. The pretreatment verification is performed by observing the planned dwell positions of a check cable inside a transparent applicator. A digital camera acquired images and the dwell positions of the radioactive source and check cable were evaluated by comparing them with respect to the theoretical dwell positions marked by the proper x‐ray marker. The potential effectiveness of verification using a transparent applicator was also evaluated using brachytherapy events reported in the literature.ResultsThe transparent applicator closely resembles the real applicator in shape and had an error of less than 0.2 mm. The average dwell position displacement between the radioactive source and check cable was 0.4 mm. The analysis of brachytherapy events showed that channel‐length, dwell‐position, and step‐size errors made up 50% of all events, but affected 64% of all patients.ConclusionsThe transparent applicator model enables a noninvasive, repeatable verification of the channel length and dwell positions to be performed before treatment. This verification has the potential to help prevent common errors in treatment delivery. In addition, the transparent applicator model can be used as a teaching tool to help clinicians understand the operation of the applicator, lowering the risk of events.

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Section: Discussionmentioning

confidence: 99%

High‐dose rate intracavitary brachytherapy pretreatment dwell position verification using a transparent applicator

Otani

Sumida

Nose

et al. 2018

J Applied Clin Med Phys

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“…Before the implementation of a new brachytherapy program, or using a new device, applicator, or software, commissioning is essential to ensure safe introduction into the clinic. While most publications regard commissioning as key to safe implementation, many are nondescript in their approach, and some offer more prescriptive processes (15). Every center performs commissioning after acceptance of a new treatment device, so there is ample knowledge on how to perform this task.…”

Section: Commissioning Calibration and Quality Assurancementioning

confidence: 99%

Development, implementation, and associated challenges of a new HDR brachytherapy program

et al. 2020

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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.

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“…These fractions are delivered a minimum of six hours apart, with the total treatment time spanning multiple, consecutive days. To aid in the safe adoption of complex high-dose-rate (HDR) brachytherapy gynecologic treatments, consensus-based commissioning guidelines provide a standardized approach to minimize treatment errors [4]; however, the availability of institutional resources create differences in practical clinical implementation, which often impacts the possibility of creating treatment plans on a per fraction basis. Institutional resources are tied to the availability of radiation oncologists, dosimetrists, radiation therapists, and medical physicists, collectively working to treat the patient.…”

Section: Purposementioning

confidence: 99%

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

Belliveau¹,

Thind²,

Banerjee³

et al. 2019

jcb

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Purpose Perineal template-based interstitial gynecologic brachytherapy (ISBT) treatments are evaluated to determine whether adaptive inter-fraction re-planning is beneficial and necessary to meet the treatment aims of the American Brachytherapy Society (ABS) consensus guidelines for interstitial brachytherapy. Adherence to the EMBRACE II protocol is also assessed. Material and methods Ten patients receiving radical intent treatment for locally advanced or recurrent gynecologic malignancies underwent a three-fraction ISBT treatment with an ABS-recommended prescription regimen of 21 to 24 Gy. Clinical treatment plans were created according to a computed tomography (CT) acquired immediately post-implant. The first fraction was delivered on the same day as the implant (Day 1). The remaining two fractions were delivered on the next day (Day 2), at least six hours apart. Prior to treating on Day 2, a verification CT was acquired, permitting assessment of over-night changes. The Day 2 CT was used to evaluate deviations in 2-Gy-per-fraction equivalent dose (EQD 2 ) from the clinically intended dosimetry for clinical target volume (CTV), bladder, rectum, and sigmoid. Results For all patients, the median (range) difference between the intended and the delivered dosimetry for the CTV D90% was 1.4 Gy 10 (0.3-4.4 Gy 10 ). For all normal tissues, the median (range) difference from the intended normal tissue dose was 2.6 Gy 3 (0.1-15.5 Gy 3 ). In all cases, the deviation from clinically intended dosimetry did not lead to a violation of recommended normal tissue dose guidelines. For two of 10 patients with large normal tissue differences (> 10 Gy 3 from the intended dose), inter-fraction adaptive planning did improve the plan quality, but was not strictly required to meet the normal tissue dose planning aims. Conclusions The implementation of perineal template-based ISBT treatment without inter-fraction adaptive planning can be delivered to comply with the ABS normal tissue dose guidelines and EMBRACE II limits for prescribed dose.

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A consensus-based, process commissioning template for high-dose-rate gynecologic treatments

Cited by 10 publications

References 15 publications

High‐dose rate intracavitary brachytherapy pretreatment dwell position verification using a transparent applicator

High‐dose rate intracavitary brachytherapy pretreatment dwell position verification using a transparent applicator

Development, implementation, and associated challenges of a new HDR brachytherapy program

The impact of inter-fraction changes for perineal template-based interstitial gynecologic brachytherapy implants

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