Development and characterization of an anthropomorphic breast phantom for permanent breast seed implant brachytherapy credentialing

Roumeliotis, Michael; Quirk, Sarah; Skarsgard, Matthew; Trumpour, Tiana; Watt, Elizabeth; Meyer, Tyler

doi:10.1016/j.brachy.2017.11.009

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…Clinical outcomes published at a median follow-up of 63 months found a local recurrence rate of 1.2 ± 1.2%, comparable to nomogram-based estimates for whole breast irradiation [8]. As the PBSI technique matures, numerous studies in recent literature have investigated how to optimize aspects of the treatment process, including treatment planning [9,10,11,12], training [13,14], clinical practice [15,16], and post-implant analysis [17,18,19,20,21].…”

Section: Purposementioning

confidence: 75%

Post-implant analysis in permanent breast seed implant: automated plan reconstruction using simulated annealing

Watt¹,

Skarsgard²,

Roumeliotis³

et al. 2019

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PurposePost-implant analysis in permanent breast seed implant (PBSI) brachytherapy is an important component of the quality assurance process that indicates dosimetric quality relevant to patient outcome, indicating salvage therapy if inadequate, as well as providing feedback to the brachytherapy team to improve future treatments. To measure geometric indices on implant quality, plan reconstruction must be performed to correlate each planned and post-implant seed location. In this work, a simulated-annealing-based algorithm is developed to perform this plan reconstruction automatically.Material and methodsThe plan reconstruction algorithm was developed in MATLAB, taking the patient pre-treatment and post-implant (Day 0) plan and associated contours as inputs. For 19 treated patients, a reconstruction was obtained that defined the correspondence between each planned and post-implant seed. The simulated-annealing algorithm was used to reconstruct each patient 10 times to assess the variability in convergence. Manual reconstructions performed by at least two independent observers to obtain consensus were defined as the ground truth; these were compared to the automatic reconstructions obtained by the algorithm. Metrics on seed placement accuracy and needle strand angulation were calculated for the patients.ResultsThe algorithm performed reconstructions on 19 patients (1235 seeds) with ground-truth reconstructions, obtaining 97 ± 8% correct matches. This strong performance indicates the ability to incorporate this algorithm into the clinical quality assurance workflow.ConclusionsThe plan reconstruction algorithm developed herein performed very well in a 19-patient cohort. This algorithm can be incorporated into the clinical process to assist in the assessment of center-specific seed placement accuracy and can be used to gather implant metrics in an automated, standardized fashion for future PBSI trials.

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Section: Purposementioning

confidence: 75%

Post-implant analysis in permanent breast seed implant: automated plan reconstruction using simulated annealing

Watt¹,

Skarsgard²,

Roumeliotis³

et al. 2019

jcb

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“…This is the first necessary step in designing an education program that establishes the simulation tool and evaluation metrics appropriate for simulating the clinical environment. The education program and assessment tools (12,24) used in this study will form the foundation of a Validation evidence is widely used in medical simulation to measure the appropriateness of a given instrument for use in an education program (1,37,38). Validation evidence is formally built on five key sources of evidence: content, response process, internal structure, relationship between variables, and outcome (3,39).…”

Section: Discussionmentioning

confidence: 99%

“…An implantable anthropomorphic breast phantom was previously designed and characterized for use in a simulation-based brachytherapy environment (24). The breast phantom is composed of a gelatin that allows a user to implant brachytherapy seeds in a fixed location according to the brachytherapy plan.…”

Section: Overviewmentioning

confidence: 99%

Establishing a simulation-based education program for radiation oncology learners in permanent seed implant brachytherapy: Building validation evidence

et al. 2020

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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 toolsda global rating scale and procedural checklist. RESULTS: The average seed placement accuracy (AESD) was 8.1 AE 3.5 mm compared to 6.1 AE 2.6 mm for the learner and expert cohort, respectively. The median (range) procedural time-to-complete was 64 (60e77) minutes and 43 (41e50) minutes for the learner and expert cohort, respectively. Seed placement accuracy (student t-test, p ! 0.05) and procedural time-tocomplete (ManneWhitney 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.

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“…Each seed displacement is reported in directional (signed) coordinates and a total distance (unsigned). The reported seed displacements are quoted with a per implant uncertainty, which is calculated from the per seed uncertainty, determined to be 2.6 mm in the simulation phantoms used for this study (23), divided by the square root of the number of seeds implanted in the simulation.…”

Section: Seed Placement Accuracy and Uncertaintymentioning

confidence: 99%

“…The purpose of this study was to outline and demonstrate a permanent seed implant credentialing workflow by performing simulated brachytherapy implants. Anthropomorphic breast phantoms (23) and postplan reconstruction software (14) were used as tools to perform end-to-end testing to assess institutional seed placement accuracy. The methodology is illustrated by two experienced permanent breast seed implant centers participating in a peerbased credentialing framework.…”

Section: Introductionmentioning

confidence: 99%

Peer-based credentialing for brachytherapy: Application in permanent seed implant

et al. 2020

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The purpose of the study was to establish a quantitative method for implant quality evaluation in permanent seed implant brachytherapy for credentialing. Delivery-based credentialing will promote consistency in brachytherapy seed delivery and improve patient outcomes. METHODS: A workflow for delivery-based credentialing was outlined and applied to permanent breast seed implant brachytherapy. Delivery simulations were performed on implantable anthropomorphic breast phantoms. Two institutions experienced in permanent seed implant brachytherapy demonstrated the peer credentialing process. Each delivery was evaluated for seed placement accuracy as the measure of implant quality, both for implant accuracy and across five simulations to assess implant variation. Initial credentialing criteria are set based on two factors; the mean seed placement accuracy (implant accuracy) and the mean standard deviation (seed variation) with the threshold for each set with the addition of two standard deviations. RESULTS: Across two institutions, seed placement accuracy (AEstandard deviation) was calculated for all five delivery simulations to yield 6.1 (AE2.6) mm. To set credentialing criteria, the implant accuracy (6.1 mm) plus two standard deviations (2.0 mm) and the seed variation (2.6 mm) plus two standard deviations (0.8) mm yield a threshold of 8.1 AE 3.4 mm. It is expected that 95% of experienced institutions would perform the phantom simulation within this threshold. CONCLUSION: Brachytherapy programs should validate delivery accuracy by formal credentialing, which is standard in external beam programs. This quantitative implant evaluation should be combined with current credentialing standards for permanent seed brachytherapy to form a comprehensive validation of institutional brachytherapy program quality.

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Development and characterization of an anthropomorphic breast phantom for permanent breast seed implant brachytherapy credentialing

Cited by 4 publications

References 19 publications

Post-implant analysis in permanent breast seed implant: automated plan reconstruction using simulated annealing

Post-implant analysis in permanent breast seed implant: automated plan reconstruction using simulated annealing

Establishing a simulation-based education program for radiation oncology learners in permanent seed implant brachytherapy: Building validation evidence

Peer-based credentialing for brachytherapy: Application in permanent seed implant

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