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

Abstract

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.

In silico dosimetry of low-dose rate brachytherapy using radioactive nanoparticles

“…For solid tumors such as prostate cancer, localized within the organ, seed based BT is a preferred treatment modality (Meyer et al 2020). Radioactive seeds of I-125/Pd-103 are permanently implanted within the prostate gland and low doses of radiation are delivered to the tumor volume for several months (Katti et al 2018).…”