Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.076
Sheridan Meltsner PhD, Diandra Ayala-Peacock MD, Junzo Chino MD, Oana Craciunescu PhD, Yang Sheng PhD, Julie Raffi PhD, Casey Lee PhD, Yongbok Kim PhD
Purpose
Varian (VMS, Palo Alto, CA) introduced the Universal Interstitial Cylinder (UIC) system to provide a hybrid solution for gynecological cancers. The UIC system includes an intracavitary cylinder, plastic interstitial needles, and a cervical probe (tandem) or rigid guide tube. After commissioning and subsequent clinical uses, three differences from regular hybrid applications (i.e., T&O+interstitial needles) were discovered for treatment planning utilizing both CT and MR images. 1. difficulties with plastic needle digitization due to the plastic material of the UIC components; 2. challenges of verifying rotation about cylinder axis on CT/MR registration; 3. issues using the combined solid applicator (SA) models of the cylinder and cervical probe. In this study, our treatment planning experiences are presented to address these issues.
Materials and Methods
As no radio-opaque marker is embedded in the tip of plastic needles, two types of radio opaque markers (VMS coded marker wires and nylon coated stainless steel leader wires), which were investigated during commissioning using an in-phantom setup to ensure the accurate definition of needle tip, were used clinically to determine which type of markers provided better visibility in vivo. To resolve any rotational misalignment of CT/MR registration, an MR marker was used. The coincidence between the physically implanted set of cylinder + cervical probe and the imported SA model was assessed.
Results
The image contrast from the leader wires was not always sufficient for digitization on CT images for clinical patients, and the artifact from the coded marker wires was not significant enough to preclude digitization. Hence, the coded marker wires were deemed superior for clinical use. To prevent the displacement of coded marker wires, the wires were secured to the plastic needles with tape. An MR marker provided enough signal to confirm applicator rotation for CT/MR registration but it is not required when the implant is asymmetric (e.g. when one or more needles are pushed outside of UIC cylinder into the surrounding tissue). Furthermore, the body fluid on the plastic needle tip on the level of end surface of the UIC cylinder provides MR signal and this MR signal can be used to verify rotation for CT/MR registration. When digitizing the plastic interstitial needles, the MR/CT registration provides suitable information to allow displacement of the marker wire to be identified and corrected for to correctly determine the tips of the needles. Measuring signal voids seen at the tips of the needles in the MR images allows any pull-back to be identified and accounted for. Clinical use of the UIC cylinder/tandem set demonstrated that using the combined UIC cylinder/tandem SA model was not always accurate, as the two components do not fit together in actual clinical use in the same manner in which they do in the SA model.
{"title":"GPP06 Presentation Time: 11:15 AM","authors":"Sheridan Meltsner PhD, Diandra Ayala-Peacock MD, Junzo Chino MD, Oana Craciunescu PhD, Yang Sheng PhD, Julie Raffi PhD, Casey Lee PhD, Yongbok Kim PhD","doi":"10.1016/j.brachy.2025.06.076","DOIUrl":"10.1016/j.brachy.2025.06.076","url":null,"abstract":"<div><h3>Purpose</h3><div>Varian (VMS, Palo Alto, CA) introduced the Universal Interstitial Cylinder (UIC) system to provide a hybrid solution for gynecological cancers. The UIC system includes an intracavitary cylinder, plastic interstitial needles, and a cervical probe (tandem) or rigid guide tube. After commissioning and subsequent clinical uses, three differences from regular hybrid applications (i.e., T&O+interstitial needles) were discovered for treatment planning utilizing both CT and MR images. 1. difficulties with plastic needle digitization due to the plastic material of the UIC components; 2. challenges of verifying rotation about cylinder axis on CT/MR registration; 3. issues using the combined solid applicator (SA) models of the cylinder and cervical probe. In this study, our treatment planning experiences are presented to address these issues.</div></div><div><h3>Materials and Methods</h3><div>As no radio-opaque marker is embedded in the tip of plastic needles, two types of radio opaque markers (VMS coded marker wires and nylon coated stainless steel leader wires), which were investigated during commissioning using an in-phantom setup to ensure the accurate definition of needle tip, were used clinically to determine which type of markers provided better visibility in vivo. To resolve any rotational misalignment of CT/MR registration, an MR marker was used. The coincidence between the physically implanted set of cylinder + cervical probe and the imported SA model was assessed.</div></div><div><h3>Results</h3><div>The image contrast from the leader wires was not always sufficient for digitization on CT images for clinical patients, and the artifact from the coded marker wires was not significant enough to preclude digitization. Hence, the coded marker wires were deemed superior for clinical use. To prevent the displacement of coded marker wires, the wires were secured to the plastic needles with tape. An MR marker provided enough signal to confirm applicator rotation for CT/MR registration but it is not required when the implant is asymmetric (e.g. when one or more needles are pushed outside of UIC cylinder into the surrounding tissue). Furthermore, the body fluid on the plastic needle tip on the level of end surface of the UIC cylinder provides MR signal and this MR signal can be used to verify rotation for CT/MR registration. When digitizing the plastic interstitial needles, the MR/CT registration provides suitable information to allow displacement of the marker wire to be identified and corrected for to correctly determine the tips of the needles. Measuring signal voids seen at the tips of the needles in the MR images allows any pull-back to be identified and accounted for. Clinical use of the UIC cylinder/tandem set demonstrated that using the combined UIC cylinder/tandem SA model was not always accurate, as the two components do not fit together in actual clinical use in the same manner in which they do in the SA model.</div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S45-S46"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889253","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.106
Nikhil Kotha MD, Santino Butler MD, Sara Richter MS, Thomas Niedermayr PhD, Elizabeth Kidd MD
Purpose
There is a range of acceptable high-dose rate (HDR) brachytherapy dose-fractionation regimens for locally advanced cervical cancer (LACC) based on meeting the recommended tumor and normal tissue dose constraints. While the most mature outcome data is for 28 Gy in 4 fractions, our institutional standard, growing data suggests that a less resource intensive 24 Gy in 3 fractions yields comparable outcomes. Selection criteria for patients suitable for a 3 fraction regimen remains to be adequately defined. We sought to analyze the feasibility of a 3 fraction regimen utilizing the first brachytherapy fraction target and organs at risk (OAR) dosimetry of historically treated LACC patients.
Materials and Methods
Patients with LACC treated with 28 Gy in 4 fractions HDR brachytherapy between December 2019 - October 2023 were identified. The first fraction of their 4 fraction plan was rescaled (without reoptimization) to 8 Gy in 1 fraction and then extrapolated to 3 identical fractions to determine tumor and OAR dosimetric metrics as a simple and efficient way to evaluate a more limited fraction regimen. We recognize this is a conservative approach as brachytherapy is an iterative process in which the knowledge from previous fractions is used to improve the subsequent dosimetry. Patients were deemed ‘eligible’ for a 3 fraction regimen if able to achieve D90 > 80Gy (given the lower equivalent dose in 2 Gy fractions [EQD2] of 24 Gy in 3 fractions compared to 28 Gy in 4 fractions) while respecting the EMBRACE 2 OAR constraints. Clinical variables analyzed included FIGO 2018 stage and tumor volume at brachytherapy. Multivariable logistic regression was used to assess factors associated with 3 fraction eligibility.
Results
The cohort included 76 patients, the median age was 49 years with the majority of patients identifying as White (46%) or Hispanic (44%) and presenting with FIGO IIIC1 disease (41%). Among the overall cohort, 28 patients (37%) met dosimetric eligibility criteria for the 3 fraction regimen while the ineligible cohort included 48 patients (63%). There were no significant differences between groups in ECOG performance status, smoking history, histology, concurrent chemotherapy. Tumor volume was significantly smaller in the eligible cohort (median 20.4 cc, 82% < 30 cc) compared to the ineligible cohort (median 35.6 cc, 52% < 30 cc) (p<0.01). The eligible cohort had more T2a-T2b (75% vs 58.4%, p=0.04) and N0 disease (46.4% vs 16.7%, p=0.02). For the rescaled first fraction dosimetry, the eligible cohort had a higher D90 (median 850.5 cGy vs 785.1 cGy, p<0.01), D98 (731.6 cGy vs 642.6 cGy, p<0.01), V100 (median 95% vs 88.6%, p<0.01), and lower D2cc bladder (median 580 cGy vs 641.3 cGy, p<0.01), D2cc bowel (median 429.1 cGy vs 459.9 cGy, p=0.03), and D2cc rectum (median 390.4 cGy vs 416.8 cGy, p=0.10). In multivariable analysis, tumor volume >
目的在满足肿瘤和正常组织推荐剂量限制的基础上，对局部晚期宫颈癌（LACC）进行可接受的高剂量率（HDR）近距离放疗剂量分级方案。虽然最成熟的结果数据是4份28 Gy，但我们的制度标准，不断增长的数据表明，资源密集度较低的3份24 Gy可产生可比的结果。适合3部分方案的患者的选择标准仍有待充分确定。我们试图分析三部分方案的可行性，利用第一个近距离治疗部分靶点和危险器官（OAR）剂量法对有治疗史的LACC患者进行治疗。材料与方法选取2019年12月至2023年10月期间接受28 Gy四段HDR近距离治疗的LACC患者。他们的4个部分计划的第一个部分被重新调整（没有重新优化）为1个部分的8 Gy，然后外推到3个相同的部分，以确定肿瘤和OAR剂量学指标，作为评估更有限部分方案的简单有效方法。我们认识到这是一种保守的方法，因为近距离放射治疗是一个迭代的过程，在这个过程中，从以前的分数中获得的知识被用来改进随后的剂量测定。如果患者能够达到D90 >； 80Gy，则认为患者“符合”3次治疗方案的条件（考虑到3次24 Gy的较低等效剂量[EQD2]，而4次28 Gy的较低等效剂量），同时尊重EMBRACE 2 OAR的限制。分析的临床变量包括FIGO 2018分期和近距离治疗时的肿瘤体积。采用多变量logistic回归评估与3分合格性相关的因素。结果该队列包括76例患者，中位年龄为49岁，大多数患者为白人（46%）或西班牙裔（44%），表现为FIGO IIIC1疾病（41%）。在整个队列中，28名患者（37%）符合3部分方案的剂量学合格标准，而不合格的队列包括48名患者（63%）。两组间在ECOG运动状态、吸烟史、组织学、同期化疗等方面无显著差异。符合条件的队列（中位20.4 cc, 82% < 30cc）的肿瘤体积明显小于不符合条件的队列（中位35.6 cc, 52% < 30cc） （p<0.01）。符合条件的队列有更多的T2a-T2b （75% vs 58.4%, p=0.04）和N0疾病（46.4% vs 16.7%, p=0.02）。对于重新校准的一阶剂量学，符合条件的队列具有较高的D90（中位数850.5 cGy vs 785.1 cGy, p=0.10）、D98（中位数731.6 cGy vs 642.6 cGy, p= 0.01）、V100（中位数95% vs 88.6%, p= 0.01）和较低的D2cc膀胱（中位数580 cGy vs 641.3 cGy, p= 0.01）、D2cc肠道（中位数429.1 cGy vs 459.9 cGy, p=0.03）和D2cc直肠（中位数390.4 cGy vs 416.8 cGy, p=0.10）。在多变量分析中，肿瘤体积>； 30cc（优势比0.19,95% CI 0.05-0.71, p=0.01）与三个部分的合格性降低相关。T3期与T2a期相比，适格性降低也有显著性趋势（OR 0.04, 95% CI 0.01-0.57, p=0.05）。近距离治疗期间补充间质针数量的增加与适格性的增加相关（OR 1.53, 95% CI 1.02-2.29, p=0.04）。结论：为了维持LACC近距离放疗所带来的改善的肿瘤预后，需要适当的患者选择标准来选择3段和4段HDR近距离放疗方案。在一项对4份28 Gy方案患者队列的回顾性分析中，37%的患者符合3份24 Gy方案所选择的剂量学合格标准。初始分数的重新缩放提供了一种简单有效的评估合格性的方法，并确定了较小的肿瘤体积、较低的T期和较多的间质针作为合格因素。将近距离治疗从4次减少到3次提供了几个潜在的社会心理和经济效益，本研究提供了初步的标准，可以考虑并可能进一步评估前瞻性研究。
{"title":"P0103","authors":"Nikhil Kotha MD, Santino Butler MD, Sara Richter MS, Thomas Niedermayr PhD, Elizabeth Kidd MD","doi":"10.1016/j.brachy.2025.06.106","DOIUrl":"10.1016/j.brachy.2025.06.106","url":null,"abstract":"<div><h3>Purpose</h3><div>There is a range of acceptable high-dose rate (HDR) brachytherapy dose-fractionation regimens for locally advanced cervical cancer (LACC) based on meeting the recommended tumor and normal tissue dose constraints. While the most mature outcome data is for 28 Gy in 4 fractions, our institutional standard, growing data suggests that a less resource intensive 24 Gy in 3 fractions yields comparable outcomes. Selection criteria for patients suitable for a 3 fraction regimen remains to be adequately defined. We sought to analyze the feasibility of a 3 fraction regimen utilizing the first brachytherapy fraction target and organs at risk (OAR) dosimetry of historically treated LACC patients.</div></div><div><h3>Materials and Methods</h3><div>Patients with LACC treated with 28 Gy in 4 fractions HDR brachytherapy between December 2019 - October 2023 were identified. The first fraction of their 4 fraction plan was rescaled (without reoptimization) to 8 Gy in 1 fraction and then extrapolated to 3 identical fractions to determine tumor and OAR dosimetric metrics as a simple and efficient way to evaluate a more limited fraction regimen. We recognize this is a conservative approach as brachytherapy is an iterative process in which the knowledge from previous fractions is used to improve the subsequent dosimetry. Patients were deemed ‘eligible’ for a 3 fraction regimen if able to achieve D90 > 80Gy (given the lower equivalent dose in 2 Gy fractions [EQD2] of 24 Gy in 3 fractions compared to 28 Gy in 4 fractions) while respecting the EMBRACE 2 OAR constraints. Clinical variables analyzed included FIGO 2018 stage and tumor volume at brachytherapy. Multivariable logistic regression was used to assess factors associated with 3 fraction eligibility.</div></div><div><h3>Results</h3><div>The cohort included 76 patients, the median age was 49 years with the majority of patients identifying as White (46%) or Hispanic (44%) and presenting with FIGO IIIC1 disease (41%). Among the overall cohort, 28 patients (37%) met dosimetric eligibility criteria for the 3 fraction regimen while the ineligible cohort included 48 patients (63%). There were no significant differences between groups in ECOG performance status, smoking history, histology, concurrent chemotherapy. Tumor volume was significantly smaller in the eligible cohort (median 20.4 cc, 82% < 30 cc) compared to the ineligible cohort (median 35.6 cc, 52% < 30 cc) (p<0.01). The eligible cohort had more T2a-T2b (75% vs 58.4%, p=0.04) and N0 disease (46.4% vs 16.7%, p=0.02). For the rescaled first fraction dosimetry, the eligible cohort had a higher D90 (median 850.5 cGy vs 785.1 cGy, p<0.01), D98 (731.6 cGy vs 642.6 cGy, p<0.01), V100 (median 95% vs 88.6%, p<0.01), and lower D2cc bladder (median 580 cGy vs 641.3 cGy, p<0.01), D2cc bowel (median 429.1 cGy vs 459.9 cGy, p=0.03), and D2cc rectum (median 390.4 cGy vs 416.8 cGy, p=0.10). In multivariable analysis, tumor volume >","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S62-S63"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889416","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.072
Darien N. Colson-Fearon M.D. M.P.H. , Khaled Aziz M.D., PhD , Ulysses Gardner M.D. M.B.A. , Xuguang Scott Chen M.D., PhD , Rashmi Prasad M.D. , Robert Thomsen M.D. , Rebecca Stone M.D. , Akila Viswanathan M.D., M.P.H.
Purpose
Given the predisposition of elderly patients to develop delirium, hypotension and other analgesia related toxicity, it is important to identify whether age can inform the approach to pain management. This study aims to investigate the relationship between age and post-operative pain in patients receiving interstitial brachytherapy.
Materials and Methods
This study retrospectively analyzed patients with cervical, endometrial, and vaginal cancers treated with MRI-guided brachytherapy at the Johns Hopkins Hospital between January 2019 and July 2022. All patients had either epidural catheter or peripheral intravenous patient-controlled opioid analgesia. Details of use of analgesics and pain scores throughout admission were compiled. Age was analyzed as a categorical variable divided into 5-year intervals on linear regression to explore whether the relationship changed at a certain cutoff. Age was also analyzed as a continuous variable with the inclusion of a spline term to model a piecewise linear relationship. Model fit was assessed using Likelihood Ratio Test and Akaike Information Criterion (AIC). Other potential factors associated with poor pain control on post-operative day 0 were identified and included in multivariate linear regression to control for potential confounding, including number of catheters, length of anesthesia, preoperative opioid requirement, and ECOG score.
Results
A total of 146 patients with 177 brachytherapy admissions were identified for inclusion in the analysis. Of those, 115 patients had tandem ± interstitial insertions and 62 had interstitial alone. The average number of catheters inserted was 9 (range 2 - 25). Average dose of radiation administered via brachytherapy was 25.0 Gy (range 10-42) in 4 fractions (range 1-7). Average pain score on post-operative day 0 by age category is reported below (Table). When analyzed as a categorical variable, only age > 70 years was associated with significantly reduced self-reported pain by 2.5 [95% CI: 1.0 - 4.0] when compared to those < 40 years. When assessed with a spline term at 70, age less than 70 was not found to have a significant relationship with pain, but every year increase after 70 was associated with a significant reduction in pain score by 0.2 [95% CI: 0.1 - 0.3]. Of the models assessed, the model including the spline term was found to have significantly improved fit.
Conclusion
This study identified advanced age (>70 years) as a predictor of reduced pain experienced during brachytherapy treatment in patients with gynecologic malignancies. Additionally, each year of age over 70 progressively reduced pain. The findings inform consideration of analgesic de-escalation in this patient population who are disproportionally vulnerable to opioid side effects. Further studies are warranted to advance evidence-based guidelines for analgesia in gynecologic br
{"title":"GPP02 Presentation Time: 10:39 AM","authors":"Darien N. Colson-Fearon M.D. M.P.H. , Khaled Aziz M.D., PhD , Ulysses Gardner M.D. M.B.A. , Xuguang Scott Chen M.D., PhD , Rashmi Prasad M.D. , Robert Thomsen M.D. , Rebecca Stone M.D. , Akila Viswanathan M.D., M.P.H.","doi":"10.1016/j.brachy.2025.06.072","DOIUrl":"10.1016/j.brachy.2025.06.072","url":null,"abstract":"<div><h3>Purpose</h3><div>Given the predisposition of elderly patients to develop delirium, hypotension and other analgesia related toxicity, it is important to identify whether age can inform the approach to pain management. This study aims to investigate the relationship between age and post-operative pain in patients receiving interstitial brachytherapy.</div></div><div><h3>Materials and Methods</h3><div>This study retrospectively analyzed patients with cervical, endometrial, and vaginal cancers treated with MRI-guided brachytherapy at the Johns Hopkins Hospital between January 2019 and July 2022. All patients had either epidural catheter or peripheral intravenous patient-controlled opioid analgesia. Details of use of analgesics and pain scores throughout admission were compiled. Age was analyzed as a categorical variable divided into 5-year intervals on linear regression to explore whether the relationship changed at a certain cutoff. Age was also analyzed as a continuous variable with the inclusion of a spline term to model a piecewise linear relationship. Model fit was assessed using Likelihood Ratio Test and Akaike Information Criterion (AIC). Other potential factors associated with poor pain control on post-operative day 0 were identified and included in multivariate linear regression to control for potential confounding, including number of catheters, length of anesthesia, preoperative opioid requirement, and ECOG score.</div></div><div><h3>Results</h3><div>A total of 146 patients with 177 brachytherapy admissions were identified for inclusion in the analysis. Of those, 115 patients had tandem ± interstitial insertions and 62 had interstitial alone. The average number of catheters inserted was 9 (range 2 - 25). Average dose of radiation administered via brachytherapy was 25.0 Gy (range 10-42) in 4 fractions (range 1-7). Average pain score on post-operative day 0 by age category is reported below (Table). When analyzed as a categorical variable, only age > 70 years was associated with significantly reduced self-reported pain by 2.5 [95% CI: 1.0 - 4.0] when compared to those < 40 years. When assessed with a spline term at 70, age less than 70 was not found to have a significant relationship with pain, but every year increase after 70 was associated with a significant reduction in pain score by 0.2 [95% CI: 0.1 - 0.3]. Of the models assessed, the model including the spline term was found to have significantly improved fit.</div></div><div><h3>Conclusion</h3><div>This study identified advanced age (>70 years) as a predictor of reduced pain experienced during brachytherapy treatment in patients with gynecologic malignancies. Additionally, each year of age over 70 progressively reduced pain. The findings inform consideration of analgesic de-escalation in this patient population who are disproportionally vulnerable to opioid side effects. Further studies are warranted to advance evidence-based guidelines for analgesia in gynecologic br","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S43"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889172","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.030
Maria diMayorca MS, Christian Velten MS, Ravindra Yaparpalvi MS, Ping Yan PhD, Lee Goddard PhD, Amar Basavatia MS, Wolfgang A. Tomé PhD
Purpose
High dose rate (HDR) brachytherapy planning is a high-risk process performed under considerable time pressure, with human failure being the leading cause of error. To elevate training for medical physics residents in brachytherapy planning, we developed a learning exercise and evaluation metric in human error detection.
Materials and Methods
HDR brachytherapy plans for five gynecological applicators were generated with various combinations of mistakes (or none). Experienced brachytherapy physicists scored twenty unique errors for Occurrence (O), Severity (S), and Detectability (D) scores per AAPM TG100 guidance. Residents were asked to review twenty plans, identify any errors, and score each for O, S, and D. This exercise was provided to residents after their first and second (last) brachytherapy rotations, with each rotation being three months long.
Results
Residents who completed their second brachytherapy rotation identified more of the planning errors than those half-way through their training. Residents who completed both rotations also identified all ten of the highest risk planning errors (the five errors with the highest RPN scores and the five errors with the highest Severity scores as ranked by brachytherapy physicists). After the first brachytherapy rotation, residents missed an average of two of the five errors with highest RPN scores and two of five errors with the highest Severity scores. Residents who completed six months of brachytherapy rotations provided O, S, and D scores that agreed more closely with those from experienced brachytherapy physicists.
Conclusions
This training exercise can be used to guided residents beyond following internal procedures and planning guides, teaching them to independently evaluate brachytherapy plans for quality and accuracy. Attending physicists can identify weaknesses in resident understanding of the brachytherapy planning process where resident O, S, and D scores differ significantly from attending physicist scores. This training exercise can be easily expanded to include more applicators, treatment sites, and error modes. Training plans can be shared between institutions to increase access to well-rounded brachytherapy training.
{"title":"PPP01 Presentation Time: 4:00 PM","authors":"Maria diMayorca MS, Christian Velten MS, Ravindra Yaparpalvi MS, Ping Yan PhD, Lee Goddard PhD, Amar Basavatia MS, Wolfgang A. Tomé PhD","doi":"10.1016/j.brachy.2025.06.030","DOIUrl":"10.1016/j.brachy.2025.06.030","url":null,"abstract":"<div><h3>Purpose</h3><div>High dose rate (HDR) brachytherapy planning is a high-risk process performed under considerable time pressure, with human failure being the leading cause of error. To elevate training for medical physics residents in brachytherapy planning, we developed a learning exercise and evaluation metric in human error detection.</div></div><div><h3>Materials and Methods</h3><div>HDR brachytherapy plans for five gynecological applicators were generated with various combinations of mistakes (or none). Experienced brachytherapy physicists scored twenty unique errors for Occurrence (O), Severity (S), and Detectability (D) scores per AAPM TG100 guidance. Residents were asked to review twenty plans, identify any errors, and score each for O, S, and D. This exercise was provided to residents after their first and second (last) brachytherapy rotations, with each rotation being three months long.</div></div><div><h3>Results</h3><div>Residents who completed their second brachytherapy rotation identified more of the planning errors than those half-way through their training. Residents who completed both rotations also identified all ten of the highest risk planning errors (the five errors with the highest RPN scores and the five errors with the highest Severity scores as ranked by brachytherapy physicists). After the first brachytherapy rotation, residents missed an average of two of the five errors with highest RPN scores and two of five errors with the highest Severity scores. Residents who completed six months of brachytherapy rotations provided O, S, and D scores that agreed more closely with those from experienced brachytherapy physicists.</div></div><div><h3>Conclusions</h3><div>This training exercise can be used to guided residents beyond following internal procedures and planning guides, teaching them to independently evaluate brachytherapy plans for quality and accuracy. Attending physicists can identify weaknesses in resident understanding of the brachytherapy planning process where resident O, S, and D scores differ significantly from attending physicist scores. This training exercise can be easily expanded to include more applicators, treatment sites, and error modes. Training plans can be shared between institutions to increase access to well-rounded brachytherapy training.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S19"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889337","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.032
Davide Brivio PhD, Ivan Buzurovic Ph.D, Thomas Harris Ph.D, Desmond O'Farrell M.Sc, Martin King MD, Aiven Dyer MD, Alicia Smart MD, Phillip Devlin MD, Piotr Zygmanski Ph.D
Purpose
Several risks for brachytherapy misadministration are associated with the chain of manual procedures prior or during delivery of the therapeutic dose using an HDR afterloader. Interchanged transfer guide tubes have been indicated as a major source of error as it may have significant impact on the delivered dose distribution. We aim to develop a dual-function sensor for pre-treatment-QA of brachytherapy applicators including verification of proper connection to the corresponding transfer tubes, catheter lengths and verification of Ir-192 activity and location during treatment delivery.
Materials and Methods
BrachySafe Dual-Function Sensor (DFS) is self-powered (does not require battery) and comprised two coaxial metallic micro-tubes with inner diameter encompassing the HDR brachytherapy needle. The internal tube of inner diameter ϕ =2.4mm, thickness Δϕ=0.7mm and length L=5mm, is connected to an external data acquisition system DAQ to measure signal as a function of time. The external tube with diameter ϕ=6.2mm, L=1cm provides shielding and is grounded. Sensing of the dummy source during pre-treatment checks utilizes electromagnetically motion induced currents inside the internal micro-tube encompassing the catheters at the entrance of the applicator. This dummy source moves inside the plastic transfer tubes and applicators accumulating charges by friction with the walls and when entering the sensor induces electrical current in the DAQ circuit. When the dummy source passes through the micro-tube the induced current increases to a maximum value marking the moment of entrance, or exit (upon retraction). In this way both the entrance/retraction times and active catheter can be identified for the dummy source. Simultaneously, the same micro-tube is surrounded by a larger diameter tube creating a miniaturized well-type ionization chamber, which detects ionization from the hot HDR source during treatment. For the dummy source detection of current does not require any radiation, and it is purely based on the motion and electrodynamic effects. For the hot source signal formation is via collection of ionized charges due to contact potential (different work functions) between internal and external micro-tubes. These BrachySafe DFSs were connected at the entrance of 6F ProGuide plastic needles and Freiburg Flap applicators which were connected via transfer tubes to a Flexitron afterloader (Elekta). The dummy source always precedes the active Ir-192 HDR source (8.5Ci) at the treatment delivery. A plan with 50 dwells, 1mm step size and 0.1s dwell was delivered at the around the detector location.
Results
Measured signals in the 1nA range were detected by DFS at each needle when the dummy source was entering/exiting with characteristic spiky shape. The pulse full width at half maximum was 0.1s±0.01s allowing for accurate detection of time. When the active Ir-192 source was deplo
{"title":"PPP03 Presentation Time: 4:18 PM","authors":"Davide Brivio PhD, Ivan Buzurovic Ph.D, Thomas Harris Ph.D, Desmond O'Farrell M.Sc, Martin King MD, Aiven Dyer MD, Alicia Smart MD, Phillip Devlin MD, Piotr Zygmanski Ph.D","doi":"10.1016/j.brachy.2025.06.032","DOIUrl":"10.1016/j.brachy.2025.06.032","url":null,"abstract":"<div><h3>Purpose</h3><div>Several risks for brachytherapy misadministration are associated with the chain of manual procedures prior or during delivery of the therapeutic dose using an HDR afterloader. Interchanged transfer guide tubes have been indicated as a major source of error as it may have significant impact on the delivered dose distribution. We aim to develop a dual-function sensor for pre-treatment-QA of brachytherapy applicators including verification of proper connection to the corresponding transfer tubes, catheter lengths and verification of Ir-192 activity and location during treatment delivery.</div></div><div><h3>Materials and Methods</h3><div>BrachySafe Dual-Function Sensor (DFS) is self-powered (does not require battery) and comprised two coaxial metallic micro-tubes with inner diameter encompassing the HDR brachytherapy needle. The internal tube of inner diameter ϕ =2.4mm, thickness Δϕ=0.7mm and length L=5mm, is connected to an external data acquisition system DAQ to measure signal as a function of time. The external tube with diameter ϕ=6.2mm, L=1cm provides shielding and is grounded. Sensing of the dummy source during pre-treatment checks utilizes electromagnetically motion induced currents inside the internal micro-tube encompassing the catheters at the entrance of the applicator. This dummy source moves inside the plastic transfer tubes and applicators accumulating charges by friction with the walls and when entering the sensor induces electrical current in the DAQ circuit. When the dummy source passes through the micro-tube the induced current increases to a maximum value marking the moment of entrance, or exit (upon retraction). In this way both the entrance/retraction times and active catheter can be identified for the dummy source. Simultaneously, the same micro-tube is surrounded by a larger diameter tube creating a miniaturized well-type ionization chamber, which detects ionization from the hot HDR source during treatment. For the dummy source detection of current does not require any radiation, and it is purely based on the motion and electrodynamic effects. For the hot source signal formation is via collection of ionized charges due to contact potential (different work functions) between internal and external micro-tubes. These BrachySafe DFSs were connected at the entrance of 6F ProGuide plastic needles and Freiburg Flap applicators which were connected via transfer tubes to a Flexitron afterloader (Elekta). The dummy source always precedes the active Ir-192 HDR source (8.5Ci) at the treatment delivery. A plan with 50 dwells, 1mm step size and 0.1s dwell was delivered at the around the detector location.</div></div><div><h3>Results</h3><div>Measured signals in the 1nA range were detected by DFS at each needle when the dummy source was entering/exiting with characteristic spiky shape. The pulse full width at half maximum was 0.1s±0.01s allowing for accurate detection of time. When the active Ir-192 source was deplo","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S20"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889339","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.091
Ulysses Grant Gardner MD, Gayoung Kim PhD, Khadija Sheikh PhD, Majd Antaki BS/BE, Ehud Schmidt PhD, Michael Roumeliotis PhD, Junghoon Lee PhD, Akila Viswanathan MD
Purpose
This study quantitatively evaluates high-risk clinical target volume (HR-CTV) deformation using magnetic resonance imaging (MRI) done before and after applicator placement, in order to consider the reliability of pre-brachytherapy MR imaging to reflect tumor volume and shape at the time of treatment.
Materials & Methods
A retrospective analysis of 54 cervical cancer patients who underwent MRI-guided HDR brachytherapy between January 2019 and December 2023 was conducted under an institutional review board-approved protocol. All patients received tandem/ring or tandem/ring/interstitial applicator insertions and underwent same-day pre- and post-applicator placement T2-weighted MRI in a dedicated 1.5T MR simulator (Siemens Sola). HR-CTVs were segmented, and quantitative shape descriptors—including elongation, flatness and roundness—were analyzed using 3D Slicer (v5.6.2). Paired Student’s t-tests (α < 0.05) were performed to assess statistically significant changes in tumor morphology.
Results
Analysis revealed a significant increase in MR HR-CTV volume from 53.1 cm³ pre-insertion to 62.8 cm³ post-insertion (p=0.048), with a Pearson correlation coefficient (r=0.72) indicating a strong volumetric relationship. However, shape descriptor analysis demonstrated statistically significant geometric changes, including differences in roundness (p=0.002), flatness (p=0.047), and elongation (p=0.002), suggesting that applicator placement induces substantial tumor deformation beyond simple volumetric expansion.
Conclusion
This study provides the first quantitative evidence that pre-brachytherapy MRI alone may not adequately represent HR-CTV geometry at the time of treatment. The significant post-insertion deformation underscores the critical need for post-applicator insertion MRI to ensure accurate target delineation and optimal dose delivery. These findings challenge conventional imaging workflows and highlight the necessity of adaptive treatment planning strategies in MRI-guided brachytherapy to improve clinical outcomes for cervical cancer patients.
{"title":"GSOR10 Presentation Time: 12:15 PM","authors":"Ulysses Grant Gardner MD, Gayoung Kim PhD, Khadija Sheikh PhD, Majd Antaki BS/BE, Ehud Schmidt PhD, Michael Roumeliotis PhD, Junghoon Lee PhD, Akila Viswanathan MD","doi":"10.1016/j.brachy.2025.06.091","DOIUrl":"10.1016/j.brachy.2025.06.091","url":null,"abstract":"<div><h3>Purpose</h3><div>This study quantitatively evaluates high-risk clinical target volume (HR-CTV) deformation using magnetic resonance imaging (MRI) done before and after applicator placement, in order to consider the reliability of pre-brachytherapy MR imaging to reflect tumor volume and shape at the time of treatment.</div></div><div><h3>Materials & Methods</h3><div>A retrospective analysis of 54 cervical cancer patients who underwent MRI-guided HDR brachytherapy between January 2019 and December 2023 was conducted under an institutional review board-approved protocol. All patients received tandem/ring or tandem/ring/interstitial applicator insertions and underwent same-day pre- and post-applicator placement T2-weighted MRI in a dedicated 1.5T MR simulator (Siemens Sola). HR-CTVs were segmented, and quantitative shape descriptors—including elongation, flatness and roundness—were analyzed using 3D Slicer (v5.6.2). Paired Student’s t-tests (α < 0.05) were performed to assess statistically significant changes in tumor morphology.</div></div><div><h3>Results</h3><div>Analysis revealed a significant increase in MR HR-CTV volume from 53.1 cm³ pre-insertion to 62.8 cm³ post-insertion (p=0.048), with a Pearson correlation coefficient (r=0.72) indicating a strong volumetric relationship. However, shape descriptor analysis demonstrated statistically significant geometric changes, including differences in roundness (p=0.002), flatness (p=0.047), and elongation (p=0.002), suggesting that applicator placement induces substantial tumor deformation beyond simple volumetric expansion.</div></div><div><h3>Conclusion</h3><div>This study provides the first quantitative evidence that pre-brachytherapy MRI alone may not adequately represent HR-CTV geometry at the time of treatment. The significant post-insertion deformation underscores the critical need for post-applicator insertion MRI to ensure accurate target delineation and optimal dose delivery. These findings challenge conventional imaging workflows and highlight the necessity of adaptive treatment planning strategies in MRI-guided brachytherapy to improve clinical outcomes for cervical cancer patients.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S54-S55"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888810","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.087
Stella C. Lymberis MD , Juhi Purswani MD , Pooja Venkatesh MD , Tamara L. Duckworth MS , Gil'ad N. Cohen MPH , Nicole Hindman MD
Purpose
Anatomic and dosimetric evaluation of the bulboclitoris (BC) among patients with primary gynecologic malignancies has not been previously investigated. This retrospective cohort study aims to clarify guidelines for contouring the bulboclitoris (BC) and to report bulboclitoral dosimetric data among women with gynecologic malignancies who underwent interstitial brachytherapy for tumors involving the lower vagina and periurethral region.
Materials and Methods
40 patients diagnosed with a gynecologic malignancy treated with external beam radiotherapy (EBRT) and high dose rate (HDR) interstitial brachytherapy from 2017-2023 were retrospectively identified. The BC was contoured retrospectively by radiation oncologists (SL,JP) and a pelvic radiologist (NH) on CT simulation images for EBRT planning, and on CT simulation images with interstitial brachytherapy applicator with needles in situ. CT images were fused to T2 and VIBE MRI sequences acquired pre-treatment and post-operatively at time of brachytherapy. Bulboclitoris delineation: BC is made up of the body, crura and vestibular bulbs. Superiorly, is caudal to the pubic symphysis ligament. Laterally, on either side of the corpus, extend the crura. The crura posteriorly are continuous with the ischiocavernosus muscle and terminate inferiorly at the adipose tissue of labium majus, caudal to the ischiopubic rami. The vestibular bulbs (erectile tissue) are inferior and medial to the crura, and anterolaterally flank the urethra and vagina, terminating at the midpoint of the ischial spine. Inferiorly, the body terminates at the glans, composed of non-erectile tissue, projecting anteriorly into the adipose tissue of the mons pubis. Patients were divided into 3 groups based on overlap of the BC volume within the external beam EB-CTV and brachytherapy high risk CTV (HR-CTV): 1) no overlap, 2) EB-CTV overlap, and 3) EB-CTV+HR-CTV overlap. Cumulative dose volume histograms for the BC were extracted for each group for the total EBRT and brachytherapy treatment course in equivalent dose in 2Gy fractions (EQD2).
Results
All patients underwent IMRT EBRT to the pelvis and bilateral inguinal region (45-50.4 Gy) followed by HDR brachytherapy using the M.A.C. Interstitial GYN template for a median total dose of 25.5 Gy (22-28 Gy). Median total dose to the HR-CTV D90 from EBRT and brachytherapy was 82.5 Gy (58.6-96.8). At the time of brachytherapy, 58% (33% - 77%) of total interstitial needles were placed within the BC, within the bulbs. The mean pre-treatment volume of the BC was 16.6 cc (11.9 - 20.9 cc) and at the time of the first brachytherapy treatment was 12.66 cc (7.3 - 22.1 cc), (p=NS). Median volume of the BC was 17.6cc (6.4-35.1). 12.5% of patients were in the no overlap group, 62.5% in the EB-CTV group and 16.7% in the EB-CTV+HR-CTV group. D0.1cc to the BC was 16.2 Gy ± 10.4 (7.2-29.1) in the no overlap group, 56.4Gy ±
{"title":"GSOR06 Presentation Time: 11:55 AM","authors":"Stella C. Lymberis MD , Juhi Purswani MD , Pooja Venkatesh MD , Tamara L. Duckworth MS , Gil'ad N. Cohen MPH , Nicole Hindman MD","doi":"10.1016/j.brachy.2025.06.087","DOIUrl":"10.1016/j.brachy.2025.06.087","url":null,"abstract":"<div><h3>Purpose</h3><div>Anatomic and dosimetric evaluation of the bulboclitoris (BC) among patients with primary gynecologic malignancies has not been previously investigated. This retrospective cohort study aims to clarify guidelines for contouring the bulboclitoris (BC) and to report bulboclitoral dosimetric data among women with gynecologic malignancies who underwent interstitial brachytherapy for tumors involving the lower vagina and periurethral region.</div></div><div><h3>Materials and Methods</h3><div>40 patients diagnosed with a gynecologic malignancy treated with external beam radiotherapy (EBRT) and high dose rate (HDR) interstitial brachytherapy from 2017-2023 were retrospectively identified. The BC was contoured retrospectively by radiation oncologists (SL,JP) and a pelvic radiologist (NH) on CT simulation images for EBRT planning, and on CT simulation images with interstitial brachytherapy applicator with needles in situ. CT images were fused to T2 and VIBE MRI sequences acquired pre-treatment and post-operatively at time of brachytherapy. <em>Bulboclitoris delineation: BC is made up of the body, crura and vestibular bulbs. Superiorly, is caudal to the pubic symphysis ligament. Laterally, on either side of the corpus, extend the crura. The crura posteriorly are continuous with the ischiocavernosus muscle and terminate inferiorly at the adipose tissue of labium majus, caudal to the ischiopubic rami. The vestibular bulbs (erectile tissue) are inferior and medial to the crura, and anterolaterally flank the urethra and vagina, terminating at the midpoint of the ischial spine. Inferiorly, the body terminates at the glans, composed of non-erectile tissue, projecting anteriorly into the adipose tissue of the mons pubis.</em> Patients were divided into 3 groups based on overlap of the BC volume within the external beam EB-CTV and brachytherapy high risk CTV (HR-CTV): 1) no overlap, 2) EB-CTV overlap, and 3) EB-CTV+HR-CTV overlap. Cumulative dose volume histograms for the BC were extracted for each group for the total EBRT and brachytherapy treatment course in equivalent dose in 2Gy fractions (EQD2).</div></div><div><h3>Results</h3><div>All patients underwent IMRT EBRT to the pelvis and bilateral inguinal region (45-50.4 Gy) followed by HDR brachytherapy using the M.A.C. Interstitial GYN template for a median total dose of 25.5 Gy (22-28 Gy). Median total dose to the HR-CTV D90 from EBRT and brachytherapy was 82.5 Gy (58.6-96.8). At the time of brachytherapy, 58% (33% - 77%) of total interstitial needles were placed within the BC, within the bulbs. The mean pre-treatment volume of the BC was 16.6 cc (11.9 - 20.9 cc) and at the time of the first brachytherapy treatment was 12.66 cc (7.3 - 22.1 cc), (p=NS). Median volume of the BC was 17.6cc (6.4-35.1). 12.5% of patients were in the no overlap group, 62.5% in the EB-CTV group and 16.7% in the EB-CTV+HR-CTV group. D0.1cc to the BC was 16.2 Gy ± 10.4 (7.2-29.1) in the no overlap group, 56.4Gy ±","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S52"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889069","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.04.001
Diane Park , Sayeh Fattahi , Yoshie Sawin , Andrzej Niemierko , Fantine Giap , Colleen M. Foote , Kelly E. Irwin , Andrea L. Russo
PURPOSE
Vaginal brachytherapy (VBT) is a standard treatment after hysterectomy for early-stage endometrial cancer. Despite only requiring a few treatments with minimal toxicity, many women have significant anxiety regarding VBT. This study was to assess and quantify anxiety in early-stage endometrial cancer patients receiving VBT and to evaluate correlations with clinicopathologic and demographic variables.
METHODS
A survey-based cohort study of patients ages 18–99 with stage I-II endometrioid endometrial cancer treated with adjuvant VBT after hysterectomy between 2014 and 2020 was performed to assess experience with VBT and related anxiety. Patients with recurrent disease were excluded. Assessments included: (1) qualitative questionnaire measuring anxiety and mood pre- and post-VBT, (2) clinical factors questionnaire measuring health status, (3) Hospital and Anxiety Depression Scale (HADS), and (4) demographics questionnaire. Pearson’s chi-squared test was used to correlate demographics with anxiety.
RESULTS
About 185 patients met inclusion criteria and of those, 75 completed all 4 surveys. Forty-nine patients (65%) reported anxiety or fear prior to receiving VBT, related to concerns of pain (40%), quality of life (27%), bladder/bowel function (24%). On univariate analysis, patients with a college degree or higher, income of ≥ $80,000, and HADS-Anxiety ≥ 8 were significantly more likely to experience anxiety with X2 values of 4.64 (p = 0.03), 5.79 (p = 0.02), and 6.49 (p = 0.01), respectively. Only income ≥ $80,000 approached significance on multivariable analysis (p = 0.07).
CONCLUSION
A majority of patients experience anxiety prior to treatment with adjuvant VBT. It is important to increase the general knowledge surrounding VBT and to establish educational tools to reduce VBT related anxiety and fear.
{"title":"Understanding anxiety in patients receiving vaginal brachytherapy for low-grade early-stage endometrial cancer","authors":"Diane Park , Sayeh Fattahi , Yoshie Sawin , Andrzej Niemierko , Fantine Giap , Colleen M. Foote , Kelly E. Irwin , Andrea L. Russo","doi":"10.1016/j.brachy.2025.04.001","DOIUrl":"10.1016/j.brachy.2025.04.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Vaginal brachytherapy (VBT) is a standard treatment after hysterectomy for early-stage endometrial cancer. Despite only requiring a few treatments with minimal toxicity, many women have significant anxiety regarding VBT. This study was to assess and quantify anxiety in early-stage endometrial cancer patients receiving VBT and to evaluate correlations with clinicopathologic and demographic variables.</div></div><div><h3>METHODS</h3><div>A survey-based cohort study of patients ages 18–99 with stage I-II endometrioid endometrial cancer treated with adjuvant VBT after hysterectomy between 2014 and 2020 was performed to assess experience with VBT and related anxiety. Patients with recurrent disease were excluded. Assessments included: (<em>1</em>) qualitative questionnaire measuring anxiety and mood pre- and post-VBT, (<em>2</em>) clinical factors questionnaire measuring health status, (<em>3</em>) Hospital and Anxiety Depression Scale (HADS), and (<em>4</em>) demographics questionnaire. Pearson’s chi-squared test was used to correlate demographics with anxiety.</div></div><div><h3>RESULTS</h3><div>About 185 patients met inclusion criteria and of those, 75 completed all 4 surveys. Forty-nine patients (65%) reported anxiety or fear prior to receiving VBT, related to concerns of pain (40%), quality of life (27%), bladder/bowel function (24%). On univariate analysis, patients with a college degree or higher, income of ≥ $80,000, and HADS-Anxiety ≥ 8 were significantly more likely to experience anxiety with X<sup>2</sup> values of 4.64 (<em>p</em> = 0.03), 5.79 (<em>p</em> = 0.02), and 6.49 (<em>p</em> = 0.01), respectively. Only income ≥ $80,000 approached significance on multivariable analysis (<em>p</em> = 0.07).</div></div><div><h3>CONCLUSION</h3><div>A majority of patients experience anxiety prior to treatment with adjuvant VBT. It is important to increase the general knowledge surrounding VBT and to establish educational tools to reduce VBT related anxiety and fear.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 510-514"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144925","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.02.006
Tirthraj Adhikari , Tomas Montenegro , Jae Won Jung , Courtney Oare , Gabriel Fonseca , Luc Beaulieu , Abdullah Alshreef , Clara Ferreira
Monte Carlo techniques have become crucial in brachytherapy since their introduction in the early 1980s, offering significant improvements in source parameter characterizations, and dose calculations. It provides precise dose distributions by modeling complex radiation interactions and can be determine doses in nonhomogeneous detailed cases. They are not affected by experimental artifacts, unlike traditional detectors, and can distinguish between primary and scatter dose components. However, MC techniques have limitations. They are susceptible to systematic errors and require thorough validation against experimental data, despite generally showing smaller standard deviations. Additionally, MC simulations can be computationally intensive and depend heavily on accurate input data and models. Recent research, including 1433 publications identified up to October 2024, highlights the ongoing development and application of MC techniques in brachytherapy. Of these, 426 articles met the inclusion criteria for relevance. This comprehensive review aims to help brachytherapy researchers to identify the appropriate MC code depending on the application in BT research. Of the forty-five MC codes used in BT, MCNP is noted as the most widely used MC code due to its robust modeling capabilities in various materials and geometries. AAPM TG-186 and TG-372 reports have recommended the use of model base dose calculation algorithms, since it can offer more accurate dose calculations over TG-43 formalism, particularly in heterogeneous tissues. Despite these recommendations, further research is needed to refine dosimetry for various isotopes, geometry and media. In essence, MC techniques have greatly enhanced the accuracy, precision and flexibility of brachytherapy techniques, though challenges such as systematic errors, heterogeneities corrections, and high computational demands remain. Continued research and development of MC codes and algorithms are essential for advancing the field and improving clinical outcomes.
{"title":"The use of Monte Carlo simulation techniques in brachytherapy: A comprehensive literature review","authors":"Tirthraj Adhikari , Tomas Montenegro , Jae Won Jung , Courtney Oare , Gabriel Fonseca , Luc Beaulieu , Abdullah Alshreef , Clara Ferreira","doi":"10.1016/j.brachy.2025.02.006","DOIUrl":"10.1016/j.brachy.2025.02.006","url":null,"abstract":"<div><div>Monte Carlo techniques have become crucial in brachytherapy since their introduction in the early 1980s, offering significant improvements in source parameter characterizations, and dose calculations. It provides precise dose distributions by modeling complex radiation interactions and can be determine doses in nonhomogeneous detailed cases. They are not affected by experimental artifacts, unlike traditional detectors, and can distinguish between primary and scatter dose components. However, MC techniques have limitations. They are susceptible to systematic errors and require thorough validation against experimental data, despite generally showing smaller standard deviations. Additionally, MC simulations can be computationally intensive and depend heavily on accurate input data and models. Recent research, including 1433 publications identified up to October 2024, highlights the ongoing development and application of MC techniques in brachytherapy. Of these, 426 articles met the inclusion criteria for relevance. This comprehensive review aims to help brachytherapy researchers to identify the appropriate MC code depending on the application in BT research. Of the forty-five MC codes used in BT, MCNP is noted as the most widely used MC code due to its robust modeling capabilities in various materials and geometries. AAPM TG-186 and TG-372 reports have recommended the use of model base dose calculation algorithms, since it can offer more accurate dose calculations over TG-43 formalism, particularly in heterogeneous tissues. Despite these recommendations, further research is needed to refine dosimetry for various isotopes, geometry and media. In essence, MC techniques have greatly enhanced the accuracy, precision and flexibility of brachytherapy techniques, though challenges such as systematic errors, heterogeneities corrections, and high computational demands remain. Continued research and development of MC codes and algorithms are essential for advancing the field and improving clinical outcomes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 564-621"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775173","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}
Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.025
Jay Hou Ph.D. , Andrew Kopecky M.D., Ph.D. , Brijal Desai M.D. , Clara Ferreira Ph.D. , Mark Rivard PhD , Clark Chen M.D., Ph.D.
Purpose
Migration of tumor cells away from the focal source of radiation may facilitate resistance to brachytherapy. While the mechanisms mediating chemotaxis from noxious stimuli are well-established, it remains unclear whether tumor cells harbor intrinsic molecular circuits that mediate migration away from focal radiation sources. Here, we examined this question using real-time imaging of glioblastoma cells.
Materials and Methods
Green fluorescent protein-labeled U251MG (GFP-U251MG) cells were plated on 2.5-dimensional collagen gel at fixed distances relative to cesium-131 brachytherapy seeds (Fig. 1a). The proliferation and migration of these cells were monitored using time-lapse microscopy at a single-cell level as a function of the cumulative radiation dose of brachytherapy.
Results
Cell death was observed for GFP-U251MG cells exposed to >30 Gy (Fig. 1b). For cells receiving sub-lethal dose radiation, cell migration speed (∼1 µm/min in the absence of radiation) decreased exponentially with increasing radiation exposure (reduced to ∼0.3 µm/min at the cumulative dose of 20 Gy) (Fig. 1c). About 75% of viable cells migrated away from the Cs-131 seeds with the mean forward migration indices of 0.1 (p = 0.0017) (Fig. 1d) relative to the expected migration pattern predicted based on non-directional, random migration. Single-cell tracking showed cells migrated toward the radiation source and were more likely to undergo cell death (Fig. 1e), while those that migrated away from the radiation source were more likely to proliferate (Fig. 1f).
Conclusions
These findings suggest a previously undescribed cellular behavior that we termed radiotaxis, defined as migration away from a focal source of radiation, which confers radio-resistance to brachytherapy. The conceptual framework of radiotaxis predicts synergy between brachytherapy and tumor migration inhibitors, a hypothesis that awaits validation.
{"title":"MPP03 Presentation Time: 4:18 PM","authors":"Jay Hou Ph.D. , Andrew Kopecky M.D., Ph.D. , Brijal Desai M.D. , Clara Ferreira Ph.D. , Mark Rivard PhD , Clark Chen M.D., Ph.D.","doi":"10.1016/j.brachy.2025.06.025","DOIUrl":"10.1016/j.brachy.2025.06.025","url":null,"abstract":"<div><h3>Purpose</h3><div>Migration of tumor cells away from the focal source of radiation may facilitate resistance to brachytherapy. While the mechanisms mediating chemotaxis from noxious stimuli are well-established, it remains unclear whether tumor cells harbor intrinsic molecular circuits that mediate migration away from focal radiation sources. Here, we examined this question using real-time imaging of glioblastoma cells.</div></div><div><h3>Materials and Methods</h3><div>Green fluorescent protein-labeled U251MG (GFP-U251MG) cells were plated on 2.5-dimensional collagen gel at fixed distances relative to cesium-131 brachytherapy seeds (Fig. 1a). The proliferation and migration of these cells were monitored using time-lapse microscopy at a single-cell level as a function of the cumulative radiation dose of brachytherapy.</div></div><div><h3>Results</h3><div>Cell death was observed for GFP-U251MG cells exposed to >30 Gy (Fig. 1b). For cells receiving sub-lethal dose radiation, cell migration speed (∼1 µm/min in the absence of radiation) decreased exponentially with increasing radiation exposure (reduced to ∼0.3 µm/min at the cumulative dose of 20 Gy) (Fig. 1c). About 75% of viable cells migrated away from the Cs-131 seeds with the mean forward migration indices of 0.1 (p = 0.0017) (Fig. 1d) relative to the expected migration pattern predicted based on non-directional, random migration. Single-cell tracking showed cells migrated toward the radiation source and were more likely to undergo cell death (Fig. 1e), while those that migrated away from the radiation source were more likely to proliferate (Fig. 1f).</div></div><div><h3>Conclusions</h3><div>These findings suggest a previously undescribed cellular behavior that we termed radiotaxis, defined as migration away from a focal source of radiation, which confers radio-resistance to brachytherapy. The conceptual framework of radiotaxis predicts synergy between brachytherapy and tumor migration inhibitors, a hypothesis that awaits validation.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S16"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889333","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}
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