Emerging technologies in brachytherapy

Abstract

Brachytherapy is a mature treatment modality. The literature is abundant in terms of review articles and comprehensive books on the latest established as well as evolving clinical practices. The intent of this article is to part ways and look beyond the current state-of-the-art and review emerging technologies that are noteworthy and perhaps may drive the future innovations in the field. There are plenty of candidate topics that deserve a deeper look, of course, but with practical limits in this communicative platform, we explore four topics that perhaps is worthwhile to review in detail at this time. First, intensity modulated brachytherapy (IMBT) is reviewed. The IMBT takes advantage of anisotropic radiation profile generated through intelligent high-density shielding designs incorporated onto sources and applicators such to achieve high quality plans. Second, emerging applications of 3D printing (i.e. additive manufacturing) in brachytherapy are reviewed. With the advent of 3D printing, interest in this technology in brachytherapy has been immense and translation swift due to their potential to tailor applicators and treatments customizable to each individual patient. This is followed by, in third, innovations in treatment planning concerning catheter placement and dwell times where new modelling approaches, solution algorithms, and technological advances are reviewed. And, fourth and lastly, applications of a new machine learning technique, called deep learning, which has the potential to improve and automate all aspects of brachytherapy workflow, are reviewed. We do not expect that all ideas and innovations reviewed in this article will ultimately reach clinic but, nonetheless, this review provides a decent glimpse of what is to come. It would be exciting to monitor as IMBT, 3D printing, novel optimization algorithms, and deep learning technologies evolve over time and translate into pilot testing and sensibly phased clinical trials, and ultimately make a difference for cancer patients. Today’s fancy is tomorrow’s reality. The future is bright for brachytherapy.

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

“…As a result, they either administered insufficient radiation to a portion of the target volume or placed a greater burden on the surrounding organs at risk [32,33]. Despite their limits, these advancements in brachytherapy treatments represent significant progress towards standardisation and provide a means of verifying the effectiveness of new developments in radiation therapy [34,35]. Historical dosimetry systems have validated several technologies that greatly improved the treatment of tumours that require high doses of radiation, such as cervical or prostate cancers.…”

On the potential of 2D ion chamber arrays for high-dose rate remote afterloading brachytherapy quality assurance

“…The successful simulation of PixSIC response in the 192 Ir energy range, performed in this work for the purpose of verification of source air kerma strength, is encouraging with respect to its potential use for treatment planning QA and dosimetric verification in 192 Ir HDR brachytherapy. A PixSIC could be useful in source characterization for intensity modulated brachytherapy (Song et al 2021) or in phantom studies for the Pappas et al 2017Pappas et al , 2018. PixSICs could also be used for direct comparison to model based dose calculation algorithm results in real time dose verification provided that: (1) they feature adequate sensitivity or a PixSIC finetuned for such applications is designed and developed, (2) they are coupled with an accurate method for the co-registration of patient and PixSIC in the same coordinate system, and, of course, (3) the model based dose calculation algorithm is accurate enough to support such an application.…”

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

“…First proposed in the 1980s, 3D printing is a technology that creates entities by printing layer by layer. With the help of 3D-printing technology, individualized applicators and interstitial implant templates of specific shapes can be prepared according to the individual anatomical structure to help optimize the needle path, achieve accurate dose coverage, and improve security and efficiency [99,100]. Jiang et al [101] summarized the advantages of the 3D template as follows: it can decrease setup and mobilization errors, and minimize differences between therapists.…”