Minimizing Targeting Error in High-Dose-Rate Brachytherapy with an End-to-End Source Positioning Test

Gao, Wanbao

doi:10.1016/j.brachy.2016.04.310

Cited by 2 publications

(4 citation statements)

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“…There are few concepts published in the literature related to end-to-end tests in HDR-BT. The published studies either focus only on displacement effects [14], or while delivering more precise results with regard to the combined standard uncertainty (3.2%) [16], which due to the size and construction of the used phantoms are not suitable for periodic in-house test procedures to check the entire treatment planning chain in clinical practice. Another system check shown [15], based on a PMMA-phantom, provides a system check for the planning chain without inclusion of the imaging system.…”

Section: Discussionmentioning

confidence: 99%

“…In accordance with the recommendation of the German radiation-protection-commission [6], an end-to-end test procedure for CT-based BT using an HDR afterloading device is described in this study. In contrast to other system test procedures already published [7,8,9,10,11,12,13,14,15], the presented end-to-end test allows a check of the entire treatment planning chain, including the imaging system. The described system is easy to handle [16], given its compact size.…”

Section: Purposementioning

confidence: 99%

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End-to-end test for computed tomography-based high-dose-rate brachytherapy

Krause

Risske

Bohn

et al. 2018

jcb

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PurposeOne of the important developments in brachytherapy in recent years has been the clinical implementation of complex modern technical procedures. Today, 3D-imaging has become the standard procedure and it is used for contouring and precise position determination and reconstruction of used brachytherapy applicators. Treatment planning is performed on the basis of these imaging methods, followed by data transfer to the afterloading device. Therefore, checking the entire treatment chain is of high importance. In this work, we describe an end-to-end test for computed tomography (CT)-based brachytherapy with an high-dose-rate (HDR) afterloading device, which fulfills the recommendation of the German radiation-protection-commission.Material and methodsThe treatment chain consists of a SOMATOM S64 CT scanner (Siemens Medical), the treatment planning system (TPS) BrachyVision v.13.7 (VMS), which utilizes the calculation formalism TG-43 and the Acuros algorithm v. 1.5.0 (VMS) as well as GammaMedplus HDR afterloader (VMS) using an Ir-192 source. Measurement setups for common brachytherapy applicators are defined in a water phantom, and the required PMMA applicator holders are developed. These setups are scanned with the CT and the data is imported into the TPS. Computed TPS reference dose values for significant points located on the side of the applicator are compared with dose measurements performed with a PinPoint 3D chamber 31016 (PTW Freiburg).ResultsThe deviations for the end-to-end test between computed and measured values are shown to be ≤ 5%, when using an implant needle or vaginal cylinder. Furthermore, it can be demonstrated that the test procedure provides reproducible results, while repositioning the applicators without carrying out a new CT-scan.ConclusionsThe end-to-end test presented allows a practice-oriented realization for checking the whole treatment chain for HDR afterloading technique and CT-imaging. The presented phantom seems feasible for performing periodic system checks as well as to verify newly introduced brachytherapy techniques with sufficient accuracy.

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Section: Discussionmentioning

confidence: 99%

Section: Purposementioning

confidence: 99%

End-to-end test for computed tomography-based high-dose-rate brachytherapy

Krause

Risske

Bohn

et al. 2018

jcb

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“…2 More recent analysis of HDR treatment errors reported to the NRC between 1999 and 2015 found that~63% were due to either mislabeling of catheters or the specification of the wrong treatment length in the TPS, resulting in treatment targets being missed by 0.4-30 cm. [2][3][4] Surface applicators are customized to the shape and size of the lesion. Custom-made applicators have variability in treatment length of catheters.…”

Section: Introductionmentioning

confidence: 99%

“…Incorrect manual entry into the treatment planning system (TPS) of the treatment distance was found to be a major source of HDR treatment errors reported to the NRC and International Atomic Energy Agency between 1980 and 2001 2 . More recent analysis of HDR treatment errors reported to the NRC between 1999 and 2015 found that ~63% were due to either mislabeling of catheters or the specification of the wrong treatment length in the TPS, resulting in treatment targets being missed by 0.4–30 cm 2–4 …”

Section: Introductionmentioning

confidence: 99%

Technical Note: Scintillation markers for real‐time visual source tracking during skin high dose rate brachytherapy

Huynh

Bhagwat

2020

Medical Physics

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Background Treatment misadministration during high dose rate (HDR) brachytherapy is mainly caused due to gross errors in incorrect manual entry of catheter length and manual connection of hardware. The probability of these errors increases with increasing complexity of a surface applicator. A simple, real‐time visual verification method was developed using a scintillator to enhance quality assurance (QA) measures for HDR surface brachytherapy and thus reduce manual errors and improve patient safety. Materials and methods Scintillation markers were fabricated from cerium‐doped lutetium yttrium orthosilicate (LYSO) embedded in a polymer compound to form 5‐mm diameter markers. To verify catheter‐transfer tube connections, markers were attached to each channel of a Freiburg flap and irradiated with an 192Ir source. To determine if the source reached the edge of a target, markers were placed along the periphery. The HDR source was visually tracked by following the illumination from the markers. The response of the markers was also verified in the presence of thermoplastic material overlaid on the Freiburg applicator. Results Scintillation markers emitted intense blue visible light upon irradiation when the HDR source was beneath the marker, verifying the source’s presence in the correct catheter. The signal was clearly visible even when the marker was placed on top of the thermoplastic material covering the Freiburg Flap. Crosstalk from adjacent catheters was <50% of the maximum light intensity. Conclusion Scintillation markers and paint were developed to successfully meet the challenge of visually tracking of HDR source during brachytherapy by surface applicators. This direct visualization of source allows real‐time catheter verification during treatment, and correct superficial target coverage, thus preventing a medical event. It can easily be integrated into pre‐existing QA program.

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Minimizing Targeting Error in High-Dose-Rate Brachytherapy with an End-to-End Source Positioning Test

Cited by 2 publications

References 0 publications

End-to-end test for computed tomography-based high-dose-rate brachytherapy

End-to-end test for computed tomography-based high-dose-rate brachytherapy

Technical Note: Scintillation markers for real‐time visual source tracking during skin high dose rate brachytherapy

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