Brachytherapy最新文献

{"title":"Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience","authors":"Elena Dizendorf ,&nbsp;Supriya Chopra ,&nbsp;Prachi Mittal ,&nbsp;Ankita Gupta ,&nbsp;Remi Nout ,&nbsp;Alina Sturdza ,&nbsp;Cyrus Chargari ,&nbsp;Kari Tanderup ,&nbsp;Ekkasit Tharavichitkul ,&nbsp;Hamza Tatli ,&nbsp;Meenakshi Jeeva ,&nbsp;Jeevanshu Jain ,&nbsp;Subhajit Panda ,&nbsp;Ritu Raj Upreti ,&nbsp;Yogesh Ghadi ,&nbsp;Akshay Bhavke ,&nbsp;Satish Kohle ,&nbsp;Rajesh Bhajbhuje ,&nbsp;Jai Prakash Agarwal","doi":"10.1016/j.brachy.2024.07.002","DOIUrl":"10.1016/j.brachy.2024.07.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022–2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Participants were radiation oncologists (RO) and medical physicists (MP) with experience in gynecological BT aiming to transition to image-guided brachytherapy (IGBT). The training covered cervical, endometrial, vaginal, vulvar, periurethral cancers, and pelvic reirradiation. The hybrid course included online pre and postcourse homework assignments, a live workshop with hands-on training, a 6-month online follow-up, and a 12-month opportunity to share the transition experience.</div></div><div><h3>RESULTS</h3><div>The December 2022 Mumbai live workshop spanned 2.5 days, attracting 39 participants from 8 countries (Asia, Africa, Australia/Oceania). Feedback rated the course 9/10, with 78% fully meeting expectations. Forty-four percent suggested extending hands-on training. At the 6-month follow-up, response rates were low (33% RO, 11% MP). Among responding RO, 70% reported practice changes after attending the course, 40% implemented IGBT concepts in clinical practice, and 50% increased confidence in image-guided procedures. Overall, 45% of respondent sites could strengthen their intracavitary/interstitial program, while others faced limitations due to lack of access to advanced BT applicators.</div></div><div><h3>CONCLUSION</h3><div>The hybrid gynecological BT training concept was successfully executed. Areas for improvement include extending hands-on training and enhancing participant engagement postcourse. Structured steps beyond training may be needed to improve the utilization of advanced brachytherapy for gynecological cancers.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 648-659"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GF479-Elsevier-www.theclinics.com-Our Issues Can Help You Manage…-BW","authors":"","doi":"10.1016/S1538-4721(24)00435-5","DOIUrl":"10.1016/S1538-4721(24)00435-5","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page I"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric evaluation of adaptive planning for five-fraction gynecologic template-based interstitial brachytherapy","authors":"Steven Blum ,&nbsp;Jessica R. Miller ,&nbsp;Kristin A. Bradley ,&nbsp;Bethany Anderson ,&nbsp;Hari Menon ,&nbsp;Bradley Eckelmann ,&nbsp;Charles Wallace ,&nbsp;Abby Besemer ,&nbsp;Michael Lawless ,&nbsp;Jordan M. Slagowski","doi":"10.1016/j.brachy.2024.07.007","DOIUrl":"10.1016/j.brachy.2024.07.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this work was to evaluate whether inter-fraction imaging and replanning enhance treatment delivery adherence to clinical planning objectives in the context of a 5-fraction template-based interstitial brachytherapy (TISB) approach for gynecologic cancer treatment.</div></div><div><h3>METHODS AND MATERIALS</h3><div>This retrospective study analyzed nineteen patients who underwent 5 fractions of interstitial brachytherapy over 3 days using the Syed–Neblett template. A verification CT scan was acquired for applicator assessment and reviewed by a radiation oncologist and medical physicist before each fraction. Eleven patients required replanning at least once during the treatment course. Replanning on the verification CT scan consisted of generating new target and organ-at-risk contours, digitizing catheter positions, and optimizing source dwell times to meet planning objectives. Dwell times and positions from the initial treatment plan were evaluated on the new contours to assess the dose that would have been delivered without replanning (nonadapted). Significance of nonadapted versus adapted dose differences were evaluated using a 2-sided Wilcoxon sum rank test.</div></div><div><h3>RESULTS</h3><div>The average (min, max) change in dose (Gy) between the clinically delivered plans and the nonadapted plans were HR-CTV D_90%: −6.5 (−0.6, −15.1), HR-CTV D_98%: −6.5 (−0.4, −12.6), Bladder D_2cc: −0.5 (0.0, −2.8), Bowel D_2cc: −0.8 (0.0, −3.2), Rectum D_2cc: −1.1 (0.0, −11.5), Sigmoid D_2cc: −1.4 (−0.1, −5.4). Dosimetric changes in HR-CTV coverage were significantly improved with replanning while organ-at-risk differences were nonsignificant (<em>p</em> &gt; 0.05). Fraction 3 was the most common fraction indicated for replanning.</div></div><div><h3>CONCLUSIONS</h3><div>Replanning template-based interstitial brachytherapy can improve target coverage and adherence to planning goals.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 668-675"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142115896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgically targeted radiation therapy versus stereotactic radiation therapy: A dosimetric comparison for brain metastasis resection cavities","authors":"Tugce Kutuk ,&nbsp;Rupesh Kotecha ,&nbsp;Roberto Herrera ,&nbsp;D Jay J. Wieczorek ,&nbsp;Zachary W. Fellows ,&nbsp;Vibha Chaswal ,&nbsp;Alonso La Rosa ,&nbsp;Vivek Mishra ,&nbsp;Michael W. McDermott ,&nbsp;Vitaly Siomin ,&nbsp;Minesh P. Mehta ,&nbsp;Alonso N. Gutierrez ,&nbsp;Ranjini Tolakanahalli","doi":"10.1016/j.brachy.2024.06.007","DOIUrl":"10.1016/j.brachy.2024.06.007","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Surgically targeted radiation therapy (STaRT) with Cesium-131 seeds embedded in a collagen tile is a promising treatment for recurrent brain metastasis. In this study, the biological effective doses (BED) for normal and target tissues from STaRT plans were compared with those of external beam radiotherapy (EBRT) modalities.</div></div><div><h3>METHODS</h3><div>Nine patients (n = 9) with 12 resection cavities (RCs) who underwent STaRT (cumulative physical dose of 60 Gy to a depth of 5 mm from the RC edge) were replanned with CyberKnife^Ⓡ (CK), Gamma Knife^Ⓡ (GK), and intensity modulated proton therapy (IMPT) using an SRT approach (30 Gy in 5 fractions). Statistical significance comparing D95% and D90% in BED_10Gy (BED_10Gy95% and BED_10Gy90%) and to RC + 0 to + 5 mm expansion margins, and parameters associated with radiation necrosis risk (V8_3Gy, V10_3Gy, V12_3Gy and V24_3Gy) to the normal brain were evaluated by a Wilcoxon-signed rank test.</div></div><div><h3>RESULTS</h3><div>For RC + 0 mm, median BED_10Gy 90% for STaRT (90.1 Gy₁₀, range: 64.1–140.9 Gy₁₀) was significantly higher than CK (74.3 Gy₁₀, range:59.3–80.4 Gy₁₀, <em>p =</em> 0.04), GK (69.4 Gy₁₀, range: 59.8–77.1 Gy₁₀, <em>p =</em> 0.005), and IMPT (49.3 Gy₁₀, range: 49.0–49.7 Gy₁₀, <em>p =</em> 0.003), respectively. However, for the RC + 5 mm, the median BED_10Gy 90% for STaRT (34.1 Gy₁₀, range: 22.2–59.7 Gy₁₀) was significantly lower than CK (44.3 Gy₁₀, range: 37.8–52.4 Gy₁₀), and IMPT (46.6 Gy₁₀, range: 45.1–48.5 Gy₁₀), respectively, but not significantly different from GK (34.1 Gy₁₀, range: 22.8–47.0 Gy₁₀). The median V24_3Gy was significantly higher in CK (11.7 cc, range: 4.7–20.1 cc), GK(6.2 cc, range: 2.3–11.9 cc) and IMPT (19.9 cc, range: 11.1–36.6 cc) compared to STaRT (1.1 cc, range: 0.0–7.8 cc) (<em>p</em> &lt; 0.01).</div></div><div><h3>CONCLUSIONS</h3><div>This comparative analysis suggests a STaRT approach may treat recurrent brain tumors effectively via delivery of higher radiation doses with equivalent or greater BED up to at least 3 mm from the RC edge as compared to EBRT approaches.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 751-760"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality and postinterventional complications after ablative treatment of liver malignancies: A cohort study of 4374 patients","authors":"Christine March ,&nbsp;Maximilian Thormann ,&nbsp;Peter Hass ,&nbsp;Marilena Georgiades ,&nbsp;Maximilian Sensse ,&nbsp;Tim Herrmann ,&nbsp;Jazan Omari ,&nbsp;Maciej Pech ,&nbsp;Robert Damm","doi":"10.1016/j.brachy.2024.07.001","DOIUrl":"10.1016/j.brachy.2024.07.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Ablative therapies for primary and secondary liver malignancies are increasingly adopted in current guidelines. Nevertheless, surgical resection remains the gold standard in most curative therapy settings.</div><div>Extensive studies on mortality and morbidity after ablative treatment of the liver are missing. We investigated complications and mortality after ablative treatment in a large, unselected study cohort.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Standardized patient and treatment data in 4374 percutaneous and angiographic ablative procedures of the liver from the DRG-based hospital reimbursement system (diagnosis-related groups) of an academic hospital in Germany were retrospectively evaluated. We analyzed descriptive patient data, length of stay (LOS), pre-existing medical conditions, previous gastrointestinal surgeries, severe complications, and occurrence of death.</div></div><div><h3>RESULTS</h3><div>Treatment of secondary liver malignancies constituted over two-thirds of all procedures (71%, n = 3053). The mean LOS was 4.1 ± 3.5 days. Severe complications were documented in 1.4% and in-house death in 0.2% of cases, significantly more often after treatment with chemoembolization of primary liver malignancies (<em>p</em> = 0.003; <em>p</em> = 0.0001).</div><div>Previous partial liver resection, partial bowel resection, and chronic renal failure were independent risk factors for the occurrence of severe complications.</div></div><div><h3>CONCLUSION</h3><div>Severe complications and in-hospital death are rare in the treatment of primary and secondary liver malignancies with percutaneous and angiographic procedures.</div><div>They are a viable alternative or addition to a surgical approach in treating liver lesions.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 743-750"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142047582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D-printed individual template brachytherapy for the treatment of intractable central pelvic recurrent cervical cancer: A single institution experience","authors":"Xiaolu Zhu ,&nbsp;Manting Zeng ,&nbsp;Youyi Dai ,&nbsp;Weilu Kuang ,&nbsp;Zijian Zhang ,&nbsp;Shan Li ,&nbsp;Hong Zhu","doi":"10.1016/j.brachy.2024.05.004","DOIUrl":"10.1016/j.brachy.2024.05.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The prognosis of recurrent cervical cancer tends to be poor and there are limited effective treatments currently available for these patients. This study was developed to find a safe and effective treatment for patients with central pelvic recurrent cervical cancer.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective study analyzed patients with central pelvic recurrent cervical cancer who received 3D-printed individual template (3D-PIT) brachytherapy between February 2019 and June 2023. Analyses of dosimetric parameters, toxicity-related complications, and survival were conducted based on the data of these patients.</div></div><div><h3>RESULTS</h3><div>Twenty-one patients with central pelvic recurrent cervical cancer patients were enrolled. All of them received 3D-printed individual template (3D-PIT) brachytherapy. The mean respective adjusted cumulative HRCTV-D90 and HRCTV-D98 values for these patients were 86.9 Gy and 75.4 Gy. And the local control (LC) rate of these patients was 57.1%. In these 21 patients, only 2 (9.5%) of them experienced grade 3–4 rectal adverse reactions, while 7 (33.3%) patients experienced grade 3–4 bladder adverse reactions. 5(23.8%) patients had fistula, while 3 of these 5 patients had undergone prior anti-VEGF targeted drug treatment which is a risk factor of fistula. The respective 2-year rates of overall and progression-free survival (OS and PFS) for these patients were 72.9% and 57.4%, with a 26-month median PFS.</div></div><div><h3>CONCLUSIONS</h3><div>These single-institution data highlight the potential viability of 3D-PIT brachytherapy as an approach to managing intractable central pelvic recurrent cervical cancer following first-line treatment.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 634-640"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142147112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commissioning considerations for the Bravos high-dose-rate afterloader: Towards improving treatment delivery accuracy","authors":"Gil'ad N. Cohen ,&nbsp;Xiuxiu He ,&nbsp;Michael Trager ,&nbsp;Maria F. Chan ,&nbsp;Jeonghoon Park ,&nbsp;Antonio L. Damato ,&nbsp;David Aramburu Nunez","doi":"10.1016/j.brachy.2024.06.010","DOIUrl":"10.1016/j.brachy.2024.06.010","url":null,"abstract":"<div><h3>BACKGROUND And PURPOSE</h3><div>The upgrade of major equipment can be disruptive to clinical operations and introduce risk as policy and procedures need to adapt to new technical possibilities and constraints. We describe here the transition from GammaMed<em>Plus</em>-iX to Bravos in a busy brachytherapy clinic, involving four afterloaders across two sites.</div></div><div><h3>MATERIAL And METHODS</h3><div>Our clinic employs three high-dose-rate remote afterloaders in four dedicated treatment vaults at the main site and a fourth afterloader at a regional location. Of more than 600 new HDR treatment plans performed annually, most are planned and treated intraoperatively. Most treatments are for prostate cancer, followed by GYN, intraoperative brachytherapy, GI, and other sites. Applicators used include vendor-provided applicators as well as third party applicators and in-house 3D-printed devices to provide interstitial, intracavitary, intraluminal, and surface treatments. All applicators were commissioned according to recommended guidelines. The choice of tolerances and the design of new procedures were informed by current guidelines and leveraged new HDR afterloader functionalities. A review of clinical operations in the 4 months postupgrade was conducted to evaluate the feasibility of new tolerances and the effectiveness of new procedures.</div></div><div><h3>RESULTS</h3><div>The procedures outlined improved and standardized afterloader QA and treatment protocols with clear actionable steps for staff to follow to ensure treatments are delivered as planned. Re-commissioning of applicators yielded results similar to those previously reported by other investigators. A review of initial treatment data revealed that in one case, due to the implementation of tight tolerances, obstruction near the tip of the channel was detected and corrected prior to treatment. It confirms that the implementation of the tolerances adopted is feasible and effective in flagging treatment deviations.</div></div><div><h3>CONCLUSION</h3><div>Enhanced procedures and QA processes were implemented successfully. We established clear actionable steps to follow by staff to ensure that treatments are delivered accurately.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 705-711"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive commissioning of a cone beam CT imaging ring for treatment of HDR GYN patients","authors":"Cullen Boyle,&nbsp;Firas Mourtada,&nbsp;Rani Anne,&nbsp;Shuying Wan,&nbsp;Yingxuan Chen,&nbsp;Yevgeniy Vinogradskiy,&nbsp;Reza Taleei","doi":"10.1016/j.brachy.2024.07.008","DOIUrl":"10.1016/j.brachy.2024.07.008","url":null,"abstract":"<div><h3>PURPOSE</h3><div>A new mobile cone beam computed tomography (CBCT) imaging ring (IRm, Elekta, v2.10.6, Veenendaal, Netherlands) has recently been proposed for brachytherapy to improve procedure efficiency. We describe the commissioning process and end-to-end tests for GYN HDR brachytherapy employing IRm CBCT imaging.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Commissioning included imaging isocenter test, 3D image quality, 2D imaging quality, image dose, and tube characteristics. CIRS HDR GYN phantom and Venezia CT/MR gynecological applicator were used to perform end-to-end (E2E) tests and optimize workflow. Venezia applicator and four interstitial needles were inserted into the phantom and IRm CBCT images were acquired. Phantom and applicator were scanned with CT scanner (Siemens SOMATOM go.Open Pro) using department's pelvis imaging protocol. MR imaging was performed using 0.35T MR Linac TRUFI pulse sequence. CBCT images were registered to CT and MR using rigid registration to assess image quality and applicator geometry fidelity.</div></div><div><h3>RESULTS</h3><div>All physics tests passed within acceptance tolerances. Registration of CBCT images to MR and CT scans was acceptable for applicator placement. Applicator registration of CBCT images to CT demonstrated excellent agreement of most distal source dwell position (&lt;1 mm). Slice thickness was also measured to be 1.25 mm, within 0.5 mm of its nominal value.</div></div><div><h3>CONCLUSION</h3><div>Based on E2E and commissioning results, IRm is an appropriate tool for brachytherapy treatment planning. This study demonstrated good image quality in GYN phantom and Venezia applicator using the IRm. Distal source dwell position agreement between CBCT and CT was acceptable for clinical use.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 687-697"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142303356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overview of treatment plan quality in a high dose rate prostate brachytherapy workflow","authors":"J.V. Panetta,&nbsp;I. Veltchev,&nbsp;E. Horwitz,&nbsp;M. Hallman,&nbsp;K. Wong,&nbsp;R.A. Price,&nbsp;C.M.C. Ma","doi":"10.1016/j.brachy.2024.08.255","DOIUrl":"10.1016/j.brachy.2024.08.255","url":null,"abstract":"<div><h3>PURPOSE</h3><div>High dose rate brachytherapy (HDR-BT) has been shown to be an effective treatment for prostate cancer, with treatment plan quality dependent on a number of factors. In this work, we report on the overall performance of our ultrasound (US)-based workflow and the impact of several treatment-specific variables.</div></div><div><h3>METHODS AND MATERIALS</h3><div>Patients who underwent HDR-BT (boost, monotherapy, and retreatment) using Varian Bravos/US from 2021 to 2023 were sampled for this study. Treatment plan quality was analyzed and plans were categorized with regard to a number of metrics, including: prostate volume, treating physician, planning physicist, number of needles included, estimated planning time, rectum-prostate separation, and bladder-prostate separation. The performance of this program was compared to the performance of our program using previously used modality combinations: Varian Varisource/US, Elekta microSelectron/CT.</div></div><div><h3>RESULTS</h3><div>Plan quality for our Bravos/US workflow was shown to be consistently above acceptability criteria for all personnel involved; on average: prostate V100%: 98.9% ± 0.1%, rectum V75%: 0.04 ± 0.01 cc, bladder V75%: 0.06 ± 0.01cc, urethra V125%: 0.00 ± 0.00 cc. Prostate coverage was statistically improved with this workflow compared to that using our previous modalities. There was a statistical correlation between organ-at-risk sparing/prostate coverage ratio and prostate volume, number of needles/prostate volume, bladder-prostate separation, and rectum-prostate separation. There was no correlation between plan quality and planning time.</div></div><div><h3>CONCLUSIONS</h3><div>Our US-based HDR-BT program led to target coverage and organ-at-risk sparing that exceeded department thresholds. Results were acceptable regardless of the personnel involved and improved plan quality was obtained using more needles/prostate volume and increased spacing between the prostate and the rectum and bladder.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 698-704"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142334337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel 3D-printed brachytherapy applicator and Monte Carlo model for the treatment of conjunctival tumors","authors":"C.K. Matrosic ,&nbsp;S. Kronenberg ,&nbsp;H. Demirci ,&nbsp;J.A. Hayman ,&nbsp;H. Han ,&nbsp;C. Lee","doi":"10.1016/j.brachy.2024.07.004","DOIUrl":"10.1016/j.brachy.2024.07.004","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To develop a custom low dose rate brachytherapy applicator for the treatment of conjunctival malignancies which leverages 3D-printing technology to provide enhanced design flexibility and availability.</div></div><div><h3>METHODS</h3><div>An elliptical shell applicator inspired by ocular surgery postoperation conformer shells was developed for the placement of the applicator around the cornea of the eye, with a central hole to provide patient comfort. The applicator featured 2 concentric circles of slots for iodine-125 seeds, providing customization of the dose distribution depending on the location of the target. The applicator was modeled using computer-aided design software. The resultant model STL file was used for 3D printing of the applicator and the development of a Monte Carlo model of the applicator and its dose distribution.</div></div><div><h3>RESULTS</h3><div>The applicator was successfully 3D printed using biocompatible resin, which could be sterilized for treatment after manual source loading. A Geant4 model of the applicator was created directly from the STL model and was applied to a phantom to estimate the dose distribution delivered by the applicator. The toroidal dose distribution allowed for treatment of the conjunctiva while reducing dose to the cornea compared to traditional eye plaque designs.</div></div><div><h3>CONCLUSIONS</h3><div>A custom 3D-printed applicator was successfully developed and modeled for the treatment of conjunctival malignancies. This novel applicator design potentially provides higher quality, more customizable dose distributions for patients and the simplicity of the design makes it accessible for any clinic with 3D-printing technology.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages 712-718"},"PeriodicalIF":1.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}