CT-on-Rails-Guided HDR Brachytherapy: Single-Room, Rapid-Workflow Treatment Delivery with Integrated Image Guidance

Abstract

Brachytherapy is an important component of multidisciplinary cancer care for a variety of solid tumors. Most systems require moving the patient to multiple locations for treatment planning and delivery after the applicator is placed. A dedicated computed tomography (CT)-on-rails brachytherapy suite was installed at our institution to allow image-guided brachytherapy and a rapid scan-plan-treat workflow that is well suited to a busy quaternary care medical center. The suite consists of an OR couch with CT-compatible insert, a CT-on-rails imaging unit, a Varian Varisource iX HDR afterloader and full anesthesia capabilities. The explicit goal was to provide the ability to perform applicator placement, CT-guided treatment planning, and treatment delivery efficiently and without moving the patient. The dedicated CT-on-rails suite for high-dose-rate brachytherapy offers image-guided brachytherapy capabilities with a rapid workflow that lends itself well to efficient, high-quality care that can meet the demands of a large-volume referral center capable of high patient throughput.

A Novel Form of Breast Intraoperative Radiation Therapy With CT-Guided High-Dose-Rate Brachytherapy: Results of a Prospective Phase 1 Clinical Trial

“…All components of the CT-HDR-IORT procedures were performed in our institution's brachytherapy suite. This is a dedicated, shielded suite with full anesthesia and HDR brachytherapy capabilities [23]. Additionally the suite contains an integrated CT-on-rails unit (Siemens Medical Solutions USA, Inc.; Malvern, PA).…”

Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation

“…Intra-fractional organs deformations can be named as a major source of uncertainties during HDR 192 Ir intracavitary brachytherapy for cervical cancer patients [ 6 , 30 , 31 ]. Online treatment planning correction is reasonable based on these days’ improvements on image guidance in brachytherapy rooms [ 32 , 33 ]. Some fast intra/interorgan dose variations calculations methods were already proposed using radiotherapy research toolkits such as CERR and 3D Slicer [ 10 ].…”

The more IGRT systems, the merrier?

“…Recently, a more compact design of mobile CTs has emerged and implemented for proton therapy . CT‐on‐rails or mobile CTs can also be used with brachytherapy high‐dose rate (HDR) after‐loaders for image guidance brachytherapy …”