Pub Date : 2025-07-01DOI: 10.1016/j.brachy.2025.06.069
Wenchao Cao PhD, Reza Taleei PhD, Firas Mourtada PhD, Jun Li PhD, Keita Okazaki PhD, Karen Mooney PhD, Pramila Rani Anne MD, Yingxuan Chen PhD
<div><h3>Purpose</h3><div>This study systematically evaluates the image quality of the Elekta ImagingRing CBCT system (version 2.11.6). The investigation focuses on the automatic exposure control (AEC) system's ability to optimize mA modulation across different patient size presets while maintaining consistent image quality under varying dose protocols.</div></div><div><h3>Materials and Methods</h3><div>CT images of a Catphan 500 phantom (Phantom Laboratory, Salem, NY) were acquired using the Elekta ImagingRing CBCT system with two layers of mAs modulation: the preset mA based on Body Mass Index (BMI) and real-time AEC adjustments. The preset mA adjusts the initial mA level according to four BMI size presets (20, 26, 34, and 40) to balance image quality and patient dose, while the AEC system dynamically modulates the mA during scanning to further optimize exposure based on real-time feedback. To evaluate the imaging performance, scans were conducted using two protocols: Medium Dose Limit and Ultra-High Dose Limit. To simulate larger patients, additional bolus material was wrapped around the phantom, increasing its effective size from 20 cm in diameter to 32 cm (AP) × 38 cm (lateral) elliptical dimensions. Real-time mA modulation was recorded and compared to the preset mA levels for both protocols. Image quality assessment focused on noise analysis using uniform regions of interest (ROIs) on the CTP486 Uniformity Module. Thirty-two ROIs were extracted along a radial distance of 42 mm from the phantom’s center, and the standard deviation (SD) of pixel values was calculated to quantify image noise. SD values were averaged across six adjacent slices for each scan.</div></div><div><h3>Results</h3><div>For the Ultra-High Dose protocol, the preset mA remained constant at 17.1 mA across all BMI levels, while real-time average mA values during scanning were 16.8, 17.6, 17.4, and 18.1 mA for BMI 20, 26, 34, and 40, respectively. For the Medium Dose protocol, preset mA values were 8.7, 15.8, 17.1, and 17.1 mA, whereas actual real-time mA values were significantly lower: 6.5, 6.8, 7.1, and 6.5 mA, respectively. When scanning the phantom with bolus under the Medium Dose protocol, the real-time mA values increased to 14.3, 14.3, 14.6, and 14.8 mA for BMI 20, 26, 34, and 40, respectively. These results indicate that in the Ultra-High Dose protocol, the AEC system closely follows the preset values to ensure stable dose delivery. However, in the Medium Dose protocol, the actual mA was significantly lower than the preset when scanning small phantom, reflecting the system’s ability to reduce exposure based on real-time attenuation feedback. In contrast, when scanning the phantom with bolus, the actual mA exceeded the preset values, as the AEC system detected higher attenuation and increased the dose to compensate.</div></div><div><h3>Conclusions</h3><div>While the Ultra-High Dose protocol achieves consistent mA delivery and noise reduction, the Medium Dose protocol
{"title":"PHSOP10 Presentation Time: 9:45 AM","authors":"Wenchao Cao PhD, Reza Taleei PhD, Firas Mourtada PhD, Jun Li PhD, Keita Okazaki PhD, Karen Mooney PhD, Pramila Rani Anne MD, Yingxuan Chen PhD","doi":"10.1016/j.brachy.2025.06.069","DOIUrl":"10.1016/j.brachy.2025.06.069","url":null,"abstract":"<div><h3>Purpose</h3><div>This study systematically evaluates the image quality of the Elekta ImagingRing CBCT system (version 2.11.6). The investigation focuses on the automatic exposure control (AEC) system's ability to optimize mA modulation across different patient size presets while maintaining consistent image quality under varying dose protocols.</div></div><div><h3>Materials and Methods</h3><div>CT images of a Catphan 500 phantom (Phantom Laboratory, Salem, NY) were acquired using the Elekta ImagingRing CBCT system with two layers of mAs modulation: the preset mA based on Body Mass Index (BMI) and real-time AEC adjustments. The preset mA adjusts the initial mA level according to four BMI size presets (20, 26, 34, and 40) to balance image quality and patient dose, while the AEC system dynamically modulates the mA during scanning to further optimize exposure based on real-time feedback. To evaluate the imaging performance, scans were conducted using two protocols: Medium Dose Limit and Ultra-High Dose Limit. To simulate larger patients, additional bolus material was wrapped around the phantom, increasing its effective size from 20 cm in diameter to 32 cm (AP) × 38 cm (lateral) elliptical dimensions. Real-time mA modulation was recorded and compared to the preset mA levels for both protocols. Image quality assessment focused on noise analysis using uniform regions of interest (ROIs) on the CTP486 Uniformity Module. Thirty-two ROIs were extracted along a radial distance of 42 mm from the phantom’s center, and the standard deviation (SD) of pixel values was calculated to quantify image noise. SD values were averaged across six adjacent slices for each scan.</div></div><div><h3>Results</h3><div>For the Ultra-High Dose protocol, the preset mA remained constant at 17.1 mA across all BMI levels, while real-time average mA values during scanning were 16.8, 17.6, 17.4, and 18.1 mA for BMI 20, 26, 34, and 40, respectively. For the Medium Dose protocol, preset mA values were 8.7, 15.8, 17.1, and 17.1 mA, whereas actual real-time mA values were significantly lower: 6.5, 6.8, 7.1, and 6.5 mA, respectively. When scanning the phantom with bolus under the Medium Dose protocol, the real-time mA values increased to 14.3, 14.3, 14.6, and 14.8 mA for BMI 20, 26, 34, and 40, respectively. These results indicate that in the Ultra-High Dose protocol, the AEC system closely follows the preset values to ensure stable dose delivery. However, in the Medium Dose protocol, the actual mA was significantly lower than the preset when scanning small phantom, reflecting the system’s ability to reduce exposure based on real-time attenuation feedback. In contrast, when scanning the phantom with bolus, the actual mA exceeded the preset values, as the AEC system detected higher attenuation and increased the dose to compensate.</div></div><div><h3>Conclusions</h3><div>While the Ultra-High Dose protocol achieves consistent mA delivery and noise reduction, the Medium Dose protocol","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S41"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889169","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.2025.05.001
Junzo Chino , Beth Erickson , David Gaffney , I-Chow Hsu , Mitchell Kamrava , Yongbok Kim , Thomas R. Niedermayr , Michael Roumeliotis , Jason Rownd , Dorin Todor , Akila Viswanathan , Elizabeth A Kidd
PURPOSE
The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize important considerations for adding interstitial needles to intracavitary implants for cervix cancer brachytherapy.
METHODS
A panel of experts in Gynecologic Brachytherapy, including both physicians and physicists completed surveys and met virtually on multiple occasions to discuss and define current practices and approaches in order to summarize these for the ABS community. This document was drafted, reviewed and approved by the full panel and the ABS Board of Directors.
RESULTS
Hybrid brachytherapy is increasingly being utilized in cervix brachytherapy. In incorporating supplementary interstitial needles there are numerous key considerations including resources for an emergency, planning considerations, applicator selection, and pre-, intra- and postprocedural imaging. Additionally, approaches to challenging cases that would often benefit from a hybrid approach are discussed.
CONCLUSIONS
While hybrid brachytherapy offers dosimetric advantages for cervix brachytherapy, it increases procedure complexity. Being aware of the necessary resources and defining considerations can help mitigate some of the challenges and improve procedural success.
{"title":"The American Brachytherapy Society (ABS) consensus guidance for hybrid intracavitary interstitial brachytherapy for locally advanced cervical cancer","authors":"Junzo Chino , Beth Erickson , David Gaffney , I-Chow Hsu , Mitchell Kamrava , Yongbok Kim , Thomas R. Niedermayr , Michael Roumeliotis , Jason Rownd , Dorin Todor , Akila Viswanathan , Elizabeth A Kidd","doi":"10.1016/j.brachy.2025.05.001","DOIUrl":"10.1016/j.brachy.2025.05.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The purpose of this consensus statement from the American Brachytherapy Society (ABS) is to summarize important considerations for adding interstitial needles to intracavitary implants for cervix cancer brachytherapy.</div></div><div><h3>METHODS</h3><div>A panel of experts in Gynecologic Brachytherapy, including both physicians and physicists completed surveys and met virtually on multiple occasions to discuss and define current practices and approaches in order to summarize these for the ABS community. This document was drafted, reviewed and approved by the full panel and the ABS Board of Directors.</div></div><div><h3>RESULTS</h3><div>Hybrid brachytherapy is increasingly being utilized in cervix brachytherapy. In incorporating supplementary interstitial needles there are numerous key considerations including resources for an emergency, planning considerations, applicator selection, and pre-, intra- and postprocedural imaging. Additionally, approaches to challenging cases that would often benefit from a hybrid approach are discussed.</div></div><div><h3>CONCLUSIONS</h3><div>While hybrid brachytherapy offers dosimetric advantages for cervix brachytherapy, it increases procedure complexity. Being aware of the necessary resources and defining considerations can help mitigate some of the challenges and improve procedural success.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 463-478"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188683","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.2025.06.007
{"title":"Listing of the Abstracts of the 2025 American Brachytherapy Society Annual Meeting","authors":"","doi":"10.1016/j.brachy.2025.06.007","DOIUrl":"10.1016/j.brachy.2025.06.007","url":null,"abstract":"","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S1-S7"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888836","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.2025.06.019
Alexander G. Goglia MD, PhD , Marissa A. Kollmeier MD , Sean M. McBride MD , Borys R. Mychalczak MD , Richard M. Gewanter MD , David M. Guttman MD , Daniel Shasha MD , Boris A. Mueller MD , Michael B. Bernstein MD , Dhwani R. Parikh MD , Michael J. Zelefsky MD , Himanshu Nagar MD , Daniel Gorovets MD
Purpose
We hypothesized that favorable genomic scores could identify patients with NCCN high-risk prostate cancer that are suitable for de-intensification of androgen deprivation therapy (ADT) and a compressed course of radiation therapy.
Methods
This single arm, phase II prospective study enrolled 50 patients with a Decipher genomic classifier (GC) score ≤0.6 and localized, high-risk prostate cancer defined as Gleason grade group 4 or 5, PSA > 20 ng/mL, or cT3-4N0M0. Patients were treated with 6 months of neoadjuvant/concurrent/adjuvant ADT (leuprolide + bicalutamide) combined with a single 15 Gy Ir-192 HDR brachytherapy implant followed by 25 Gy in 5 daily fractions whole pelvis SBRT. The primary endpoint was 3-year metastasis rate. Only early toxicity (CTCAE v5.0), International Prostate Symptom Score (IPSS), and biochemical recurrence rate (defined as PSA nadir + 2 ng/mL) are reported.
Results
The median age of enrolled patients was 68.5 years old, with a median Decipher GC score of 0.405 [95%CI 0.361 - 0.433], and median baseline PSA of 6.83 [95%CI 5.98 - 8.77]. Pre-treatment MR imaging showed PIRADS 4 or 5 lesions in 84% (42/50) of enrolled patients and pre-treatment biopsies showed Gleason grade group 4 or 5 disease in 64% (32/50) of patients. The median follow-up across all enrolled patients was 22 months [95%CI 19.69 - 23.55], and thus only early secondary endpoint outcomes are reported. Median baseline IPSS was 4 [95%CI 3.93 - 6.15], while median IPSS at first follow up was 9.54 [95%CI 7.73 - 11.35] and at most recent follow up was 6.62 [95%CI 5.09 - 8.14]. Grade 2 GU toxicity was seen in 32% (16/50) patients, while grade 2 GI toxicity was seen in 14% of patients (7/50). No grade 3 or higher toxicities were seen. Median time to testosterone recovery was 10 months [95%CI 9.34 - 11.03]. The rate of biochemical recurrence was 2% (1/50).
Conclusions
Thus far, we have observed low GU/GI toxicity, preserved GU quality of life, and encouraging early oncological outcomes with a shorter course of ADT and RT for genomically lower risk, NCCN high-risk prostate cancer patients. Longer follow-up is needed to report the primary endpoint of 3-year metastasis-free survival.
{"title":"PRPP02 Presentation Time: 10:39 AM","authors":"Alexander G. Goglia MD, PhD , Marissa A. Kollmeier MD , Sean M. McBride MD , Borys R. Mychalczak MD , Richard M. Gewanter MD , David M. Guttman MD , Daniel Shasha MD , Boris A. Mueller MD , Michael B. Bernstein MD , Dhwani R. Parikh MD , Michael J. Zelefsky MD , Himanshu Nagar MD , Daniel Gorovets MD","doi":"10.1016/j.brachy.2025.06.019","DOIUrl":"10.1016/j.brachy.2025.06.019","url":null,"abstract":"<div><h3>Purpose</h3><div>We hypothesized that favorable genomic scores could identify patients with NCCN high-risk prostate cancer that are suitable for de-intensification of androgen deprivation therapy (ADT) and a compressed course of radiation therapy.</div></div><div><h3>Methods</h3><div>This single arm, phase II prospective study enrolled 50 patients with a Decipher genomic classifier (GC) score ≤0.6 and localized, high-risk prostate cancer defined as Gleason grade group 4 or 5, PSA > 20 ng/mL, or cT3-4N0M0. Patients were treated with 6 months of neoadjuvant/concurrent/adjuvant ADT (leuprolide + bicalutamide) combined with a single 15 Gy Ir-192 HDR brachytherapy implant followed by 25 Gy in 5 daily fractions whole pelvis SBRT. The primary endpoint was 3-year metastasis rate. Only early toxicity (CTCAE v5.0), International Prostate Symptom Score (IPSS), and biochemical recurrence rate (defined as PSA nadir + 2 ng/mL) are reported.</div></div><div><h3>Results</h3><div>The median age of enrolled patients was 68.5 years old, with a median Decipher GC score of 0.405 [95%CI 0.361 - 0.433], and median baseline PSA of 6.83 [95%CI 5.98 - 8.77]. Pre-treatment MR imaging showed PIRADS 4 or 5 lesions in 84% (42/50) of enrolled patients and pre-treatment biopsies showed Gleason grade group 4 or 5 disease in 64% (32/50) of patients. The median follow-up across all enrolled patients was 22 months [95%CI 19.69 - 23.55], and thus only early secondary endpoint outcomes are reported. Median baseline IPSS was 4 [95%CI 3.93 - 6.15], while median IPSS at first follow up was 9.54 [95%CI 7.73 - 11.35] and at most recent follow up was 6.62 [95%CI 5.09 - 8.14]. Grade 2 GU toxicity was seen in 32% (16/50) patients, while grade 2 GI toxicity was seen in 14% of patients (7/50). No grade 3 or higher toxicities were seen. Median time to testosterone recovery was 10 months [95%CI 9.34 - 11.03]. The rate of biochemical recurrence was 2% (1/50).</div></div><div><h3>Conclusions</h3><div>Thus far, we have observed low GU/GI toxicity, preserved GU quality of life, and encouraging early oncological outcomes with a shorter course of ADT and RT for genomically lower risk, NCCN high-risk prostate cancer patients. Longer follow-up is needed to report the primary endpoint of 3-year metastasis-free survival.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S13"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888851","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.2025.06.079
Evrosina Isaac MD , Mustafa Basree DO, MS , Peter F. Orio III DO, MS , Catheryn M. Yashar MD , Mitchell Kamrava MD
Purpose
Brachytherapy is an established evidence-based treatment for prostate cancer. Resident surveys demonstrate both LDR and HDR prostate brachytherapy are skills that most are not comfortable performing at the completion of training. One reason for this is low case volume. This analysis aims to evaluate prostate brachytherapy utilization trends in the United States amongst Medicare providers to better understand how these trends may be impacting training opportunities.
Materials/Methods
The Medicare Provider and Other Supplier Public Use File database by provider and state was queried for code 55875 (transperineal placement of needles or catheters into prostate for interstitial radio element application, with or without cystoscopy) for years 2013-2022. Radiation oncology resident brachytherapy case log information was accessed from the Accreditation Council for Graduate Medical Education database. SPSS version 29.0.0 was used for all data analysis.
Results
Between 2013 to 2022, there was a decrease by 50% in total providers, decrease by 31% in distinct patients, and decrease by 32% in total services. State-by-state analysis revealed that 38 states experienced decreases, seven states had increases, and one state had no change in providers. The top 10 states contributed to over 56% of total providers, benefactors, and services during each year analyzed. California, Georgia, Florida, and Maryland were all in the top 10 for providers, benefactors, and services in each of the 10 years. Among the top 10 organizations/individuals by total services provided per year, 29 organizations and individuals were in the top 10 at least once. These top 10 organizations/individuals had significant contributions to the total services done yearly with a minimum of 21% contributed. Since 2013, at least 65% of the top 10 individuals/organizations were in the private setting with three years where all of the top 10 were in private practice. In parallel since the 2017/2018 academic year, there has been continued decrease in median LDR cases logged by residents (down from 4 to 1 in 2023/2024) while median HDR cases increased from 0 to 1.
Conclusions
While indications for prostate brachytherapy are established, there has been a steady decline in number of providers and total cases done over the last 10 years. A select few states and organizations/individuals account for a significant volume of cases. The highest volume of cases is being done in private practice with little changes being seen in the median number of cases residents are performing. Opportunities for resident training with private practice and/or understanding declines in academic practices are needed in order to improve case volume exposure for resident training.
{"title":"PPP03 Presentation Time: 10:48 AM","authors":"Evrosina Isaac MD , Mustafa Basree DO, MS , Peter F. Orio III DO, MS , Catheryn M. Yashar MD , Mitchell Kamrava MD","doi":"10.1016/j.brachy.2025.06.079","DOIUrl":"10.1016/j.brachy.2025.06.079","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy is an established evidence-based treatment for prostate cancer. Resident surveys demonstrate both LDR and HDR prostate brachytherapy are skills that most are not comfortable performing at the completion of training. One reason for this is low case volume. This analysis aims to evaluate prostate brachytherapy utilization trends in the United States amongst Medicare providers to better understand how these trends may be impacting training opportunities.</div></div><div><h3>Materials/Methods</h3><div>The Medicare Provider and Other Supplier Public Use File database by provider and state was queried for code 55875 (transperineal placement of needles or catheters into prostate for interstitial radio element application, with or without cystoscopy) for years 2013-2022. Radiation oncology resident brachytherapy case log information was accessed from the Accreditation Council for Graduate Medical Education database. SPSS version 29.0.0 was used for all data analysis.</div></div><div><h3>Results</h3><div>Between 2013 to 2022, there was a decrease by 50% in total providers, decrease by 31% in distinct patients, and decrease by 32% in total services. State-by-state analysis revealed that 38 states experienced decreases, seven states had increases, and one state had no change in providers. The top 10 states contributed to over 56% of total providers, benefactors, and services during each year analyzed. California, Georgia, Florida, and Maryland were all in the top 10 for providers, benefactors, and services in each of the 10 years. Among the top 10 organizations/individuals by total services provided per year, 29 organizations and individuals were in the top 10 at least once. These top 10 organizations/individuals had significant contributions to the total services done yearly with a minimum of 21% contributed. Since 2013, at least 65% of the top 10 individuals/organizations were in the private setting with three years where all of the top 10 were in private practice. In parallel since the 2017/2018 academic year, there has been continued decrease in median LDR cases logged by residents (down from 4 to 1 in 2023/2024) while median HDR cases increased from 0 to 1.</div></div><div><h3>Conclusions</h3><div>While indications for prostate brachytherapy are established, there has been a steady decline in number of providers and total cases done over the last 10 years. A select few states and organizations/individuals account for a significant volume of cases. The highest volume of cases is being done in private practice with little changes being seen in the median number of cases residents are performing. Opportunities for resident training with private practice and/or understanding declines in academic practices are needed in order to improve case volume exposure for resident training.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S47-S48"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889555","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.2025.06.017
Michelle Ann Eala MD , John Charters MS, PhD , Rojine T. Ariani MD, MS , Edward Christopher Dee MD , Puja Venkat MD , Alan Lee MD , Albert Chang MD, PhD
<div><h3>Purpose</h3><div>Asia comprises 60% of the world’s population, and cervical cancer remains one of the most prevalent cancers affecting women in the region despite being largely preventable. Brachytherapy (BT) is an essential component of cervical cancer treatment, with guidelines recommending at least one BT machine per 100 cervical cancer cases. This study aims to assess the current burden of cervical cancer in Asia and evaluate the availability of BT machines relative to disease burden to determine BT machine shortfall.</div></div><div><h3>Materials and Methods</h3><div>We queried the International Agency for Research on Cancer (IARC) GLOBOCAN 2022 database to extract age-standardized incidence and mortality rates of cervical cancer in Asia per 100,000 person-years, calculating mortality-to-incidence ratios (MIR) as a crude measure of survival outcomes. Data on BT machine availability across Asia were obtained from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres.</div></div><div><h3>Results</h3><div>Data on cervical cancer burden and BT machine availability were available for 42 out of 47 countries in Asia. The highest MIRs, indicating worse survival outcomes, were observed in Western Asian countries: Yemen (0.75), Iraq (0.73), and Oman (0.70). In contrast, the lowest MIRs, suggesting better survival, were found in Eastern Asian countries: Japan (0.20), South Korea (0.23), and China (0.33). A significant disparity in BT access was observed, with 70% of Asian countries having fewer than one BT machine per 100 cervical cancer cases. Notably, five countries—Yemen, Bahrain, North Korea, Lao PDR, and Brunei Darussalam—had no available BT machines. On average, high-income countries had 3.6 times more BT machines per 100 cervical cancer cases than non-high-income countries, aligning with a moderate and statistically significant correlation between income level and BT machine availability per 100 cases (r = 0.52, p = 0.0006). Moreover, we observed a statistically significant moderate negative correlation between income level and MIR (r = -0.40, p = 0.009), suggesting that wealthier countries generally achieve better cervical cancer survival outcomes, likely due to improved screening, treatment, and healthcare infrastructure (Figure 1A). We found a weak but statistically significant correlation between the number of BT machines and MIR (r = -0.39, p = 0.0116), indicating that countries with more BT machines tend to have better survival rates for cervical cancer. Importantly, a moderate and statistically significant negative correlation was observed between ASIR and BT machine shortfall (r = -0.43, p = 0.0052), indicating that countries with a higher cervical cancer burden tend to experience greater shortages in BT resources (Figure 1B).</div></div><div><h3>Conclusions</h3><div>Substantial disparities in access to BT persist across Asia, with low- and middle-income countries facing significant shortages. The lack
{"title":"GPP06 Presentation Time: 10:00 AM","authors":"Michelle Ann Eala MD , John Charters MS, PhD , Rojine T. Ariani MD, MS , Edward Christopher Dee MD , Puja Venkat MD , Alan Lee MD , Albert Chang MD, PhD","doi":"10.1016/j.brachy.2025.06.017","DOIUrl":"10.1016/j.brachy.2025.06.017","url":null,"abstract":"<div><h3>Purpose</h3><div>Asia comprises 60% of the world’s population, and cervical cancer remains one of the most prevalent cancers affecting women in the region despite being largely preventable. Brachytherapy (BT) is an essential component of cervical cancer treatment, with guidelines recommending at least one BT machine per 100 cervical cancer cases. This study aims to assess the current burden of cervical cancer in Asia and evaluate the availability of BT machines relative to disease burden to determine BT machine shortfall.</div></div><div><h3>Materials and Methods</h3><div>We queried the International Agency for Research on Cancer (IARC) GLOBOCAN 2022 database to extract age-standardized incidence and mortality rates of cervical cancer in Asia per 100,000 person-years, calculating mortality-to-incidence ratios (MIR) as a crude measure of survival outcomes. Data on BT machine availability across Asia were obtained from the International Atomic Energy Agency (IAEA) Directory of Radiotherapy Centres.</div></div><div><h3>Results</h3><div>Data on cervical cancer burden and BT machine availability were available for 42 out of 47 countries in Asia. The highest MIRs, indicating worse survival outcomes, were observed in Western Asian countries: Yemen (0.75), Iraq (0.73), and Oman (0.70). In contrast, the lowest MIRs, suggesting better survival, were found in Eastern Asian countries: Japan (0.20), South Korea (0.23), and China (0.33). A significant disparity in BT access was observed, with 70% of Asian countries having fewer than one BT machine per 100 cervical cancer cases. Notably, five countries—Yemen, Bahrain, North Korea, Lao PDR, and Brunei Darussalam—had no available BT machines. On average, high-income countries had 3.6 times more BT machines per 100 cervical cancer cases than non-high-income countries, aligning with a moderate and statistically significant correlation between income level and BT machine availability per 100 cases (r = 0.52, p = 0.0006). Moreover, we observed a statistically significant moderate negative correlation between income level and MIR (r = -0.40, p = 0.009), suggesting that wealthier countries generally achieve better cervical cancer survival outcomes, likely due to improved screening, treatment, and healthcare infrastructure (Figure 1A). We found a weak but statistically significant correlation between the number of BT machines and MIR (r = -0.39, p = 0.0116), indicating that countries with more BT machines tend to have better survival rates for cervical cancer. Importantly, a moderate and statistically significant negative correlation was observed between ASIR and BT machine shortfall (r = -0.43, p = 0.0052), indicating that countries with a higher cervical cancer burden tend to experience greater shortages in BT resources (Figure 1B).</div></div><div><h3>Conclusions</h3><div>Substantial disparities in access to BT persist across Asia, with low- and middle-income countries facing significant shortages. The lack ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S11-S12"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888839","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.2025.06.065
Lee Goddard PhD, William Martin MS, Travis Lambert MD, Wolfgang Tomé PhD
<div><h3>Purpose</h3><div>Polyethylene terephthalate glycol (PETG) plastic filament containing powdered Tungsten (W) has recently been made available for use in Fused Filament Fabrication (FFF) 3D printing. FFF printing allows for fabrication of custom 3D printed objects at a lower cost than custom metal fabrication or Selective Laser Melting (SLM) 3D printing technologies. This material has been characterized for shielding Technetium 99m (Tc99m) sources by the manufacturer, but not for use with other radiation sources. The Half Value Layer (HVL) was calculated for the material for an Iridium 192 (Ir192) high dose rate (HDR) brachytherapy source for use in shielding calculations.</div></div><div><h3>Materials and Methods</h3><div>35 mm square sheets of various thicknesses (1, 2, 3, 4, 5 and 10 mm) were printed using a Prusa XL printer and Prusament PETG Tungsten 75% filament (PETG-W). This filament is reported as having a density of 4.0 gcm<sup>-3</sup>. An Elekta Flexitron HDR afterloader was used for radiation delivery. A single dwell point was utilized to deliver a dose of 4 Gy at a distance of 30 mm from the center of the Ir192 source. EBT4 Gafchromic film and a PTW Markus parallel plate (PP) ion chamber were placed in solid water at the prescribed depth and measurements taken replacing solid water with PETG-W sheets adjacent to the source. For film measurements measured optical densities were converted to dose and the average dose of an ∼1cm square region of interest was measured, centered on the highest dose measured on each film. Relative dose was calculated based on measurements utilizing solid water phantoms only, with no PETG-W shielding.</div></div><div><h3>Results</h3><div>Variations in 3D printing can lead to differences between the planned and actual dimensions and density of the PETG-W sheets. The width and height of each sheet was measured using calibrated Vernier calipers and found to be within 0.05 mm of the expected value. The thickness of each sheet was measured using a calibrated micrometer at 10 points for each printed sheet and averaged. The average ratio of the measured to expected thickness was found to be 0.99 (0.98-1.00). There was also some variation between the expected and measured mass of the sheets with the average ratio of measured to expected mass found to be 0.98 (0.97-1.00). This led to an average effective density of the sheets to be 3.94 gcm<sup>-3</sup> (3.89-3.99). An exponential decay curve was calculated based on measured transmission data and utilized to calculate the HVL for both PP chamber and film measurements. The relative dose (y) can then be calculated as a function of PETG-W thickness in mm(x). Eqn 1 shows the results for the PP ion chamber, and Eqn 2 film results. PP ion chamber measurements give a HVL of 13.3 mm and film measurements give a HVL of 14.7 mm.</div><div>Eqn 1 y=e<sup>-0.052x</sup></div><div>Eqn 2 y=e<sup>-0.047x</sup></div></div><div><h3>Conclusions</h3><div>Excellent agreement was
{"title":"PHSOP6 Presentation Time: 9:25 AM","authors":"Lee Goddard PhD, William Martin MS, Travis Lambert MD, Wolfgang Tomé PhD","doi":"10.1016/j.brachy.2025.06.065","DOIUrl":"10.1016/j.brachy.2025.06.065","url":null,"abstract":"<div><h3>Purpose</h3><div>Polyethylene terephthalate glycol (PETG) plastic filament containing powdered Tungsten (W) has recently been made available for use in Fused Filament Fabrication (FFF) 3D printing. FFF printing allows for fabrication of custom 3D printed objects at a lower cost than custom metal fabrication or Selective Laser Melting (SLM) 3D printing technologies. This material has been characterized for shielding Technetium 99m (Tc99m) sources by the manufacturer, but not for use with other radiation sources. The Half Value Layer (HVL) was calculated for the material for an Iridium 192 (Ir192) high dose rate (HDR) brachytherapy source for use in shielding calculations.</div></div><div><h3>Materials and Methods</h3><div>35 mm square sheets of various thicknesses (1, 2, 3, 4, 5 and 10 mm) were printed using a Prusa XL printer and Prusament PETG Tungsten 75% filament (PETG-W). This filament is reported as having a density of 4.0 gcm<sup>-3</sup>. An Elekta Flexitron HDR afterloader was used for radiation delivery. A single dwell point was utilized to deliver a dose of 4 Gy at a distance of 30 mm from the center of the Ir192 source. EBT4 Gafchromic film and a PTW Markus parallel plate (PP) ion chamber were placed in solid water at the prescribed depth and measurements taken replacing solid water with PETG-W sheets adjacent to the source. For film measurements measured optical densities were converted to dose and the average dose of an ∼1cm square region of interest was measured, centered on the highest dose measured on each film. Relative dose was calculated based on measurements utilizing solid water phantoms only, with no PETG-W shielding.</div></div><div><h3>Results</h3><div>Variations in 3D printing can lead to differences between the planned and actual dimensions and density of the PETG-W sheets. The width and height of each sheet was measured using calibrated Vernier calipers and found to be within 0.05 mm of the expected value. The thickness of each sheet was measured using a calibrated micrometer at 10 points for each printed sheet and averaged. The average ratio of the measured to expected thickness was found to be 0.99 (0.98-1.00). There was also some variation between the expected and measured mass of the sheets with the average ratio of measured to expected mass found to be 0.98 (0.97-1.00). This led to an average effective density of the sheets to be 3.94 gcm<sup>-3</sup> (3.89-3.99). An exponential decay curve was calculated based on measured transmission data and utilized to calculate the HVL for both PP chamber and film measurements. The relative dose (y) can then be calculated as a function of PETG-W thickness in mm(x). Eqn 1 shows the results for the PP ion chamber, and Eqn 2 film results. PP ion chamber measurements give a HVL of 13.3 mm and film measurements give a HVL of 14.7 mm.</div><div>Eqn 1 y=e<sup>-0.052x</sup></div><div>Eqn 2 y=e<sup>-0.047x</sup></div></div><div><h3>Conclusions</h3><div>Excellent agreement was ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S38-S39"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888859","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.2025.06.096
Shalini Moningi MD , Grgur Mirić MD , Robert Galbreath PhD , Ryan Fiano PhD , Kent Wallner MD , Martin King MD, PhD , Peter F. Orio DO, MS
<div><h3>Purpose</h3><div>The successful treatment of high risk (HR) prostate cancer is essential because of the attendant risk of local and distant progression with ultimate death. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements in overall survival have been hampered by a plethora of non-cancer deaths. In this HR study, we report biochemical failure (BF), prostate cancer specific mortality (PCSM), overall mortality (OM) & patterns of death (POD) with recommendations for mitigation of non-prostate cancer deaths.</div></div><div><h3>Materials and Methods</h3><div>From April 1995 to November 2018, 577 HR patients were treated with LDR BT(97.9% Pd-103). Patients were stratified into 3 age cohorts:≤59, 60-69 & ≥70 years. The BT prescription dose was prescribed to the prostate gland with generous periprostatic margins & the proximal 10-12mm of the seminal vesicles. 94.6% received supplemental EBRT (45-50.4Gy) & 63.3% received androgen deprivation therapy (ADT) (median duration 12 months). Post-implant CT-based dosimetry was performed on day 0. BF was defined as a PSA>0.40ng/ml after nadir. Cause of death was determined for each patient. Patients with metastatic prostate cancer or non-metastatic castrate resistant prostate cancer who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause. Multiple clinical, pathologic & treatment parameters were evaluated for impact on patient outcomes. Pearson’s Chi-square was used across all age groups. Overall mortalities were compared across the three categories of age groups using Cox regression analysis. Univariate analyses were used to determine the hazard ratios of select variables with overall mortality.</div></div><div><h3>Results</h3><div>87.5% of the patients (median follow-up 8.9 years) presented with a single HR factor. The day 0 D90 was 122.5%. Overall, the 15-year BF, PCSM and OM were 12.4%, 5.6% and 51.7%. When stratified by age, there was no significant difference in BF or PCSM despite the ≤59 cohort presenting with a higher PSA(p<0.001) & greater percent positive biopsies(p=0.040). The median post-treatment PSA in biochemically controlled patients was <0.01ng/ml. In all 3 cohorts, OM steadily increased for the first 10 years, followed by an approximate doubling of OM from years 10 to 15 (Figure 1). 239 patients died with 10.9% due to prostate cancer, 38.1% from cardiovascular disease & 28.4% from other malignancies (1 rectal cancer & 3 bladder cancers). In MVA, BF was most closely related to percent positive biopsies(p<0.001,SHR 1.019), PCSM to Gleason score(p=0.004,SHR 2.884) & percent positive biopsies(p=0.005,SHR 1.021) & OM to age(p<0.001,SHR 1.077) & tobacco(p<0.001,SHR 2.282).</div></div><div><h3>Conclusions</h3><div>Despite high cancer control rates, overall survival was limited by
{"title":"PRSOP02 Presentation Time: 11:35 AM","authors":"Shalini Moningi MD , Grgur Mirić MD , Robert Galbreath PhD , Ryan Fiano PhD , Kent Wallner MD , Martin King MD, PhD , Peter F. Orio DO, MS","doi":"10.1016/j.brachy.2025.06.096","DOIUrl":"10.1016/j.brachy.2025.06.096","url":null,"abstract":"<div><h3>Purpose</h3><div>The successful treatment of high risk (HR) prostate cancer is essential because of the attendant risk of local and distant progression with ultimate death. Although brachytherapy (BT) with supplemental therapies has demonstrated favorable biochemical and quality of life outcomes, improvements in overall survival have been hampered by a plethora of non-cancer deaths. In this HR study, we report biochemical failure (BF), prostate cancer specific mortality (PCSM), overall mortality (OM) & patterns of death (POD) with recommendations for mitigation of non-prostate cancer deaths.</div></div><div><h3>Materials and Methods</h3><div>From April 1995 to November 2018, 577 HR patients were treated with LDR BT(97.9% Pd-103). Patients were stratified into 3 age cohorts:≤59, 60-69 & ≥70 years. The BT prescription dose was prescribed to the prostate gland with generous periprostatic margins & the proximal 10-12mm of the seminal vesicles. 94.6% received supplemental EBRT (45-50.4Gy) & 63.3% received androgen deprivation therapy (ADT) (median duration 12 months). Post-implant CT-based dosimetry was performed on day 0. BF was defined as a PSA>0.40ng/ml after nadir. Cause of death was determined for each patient. Patients with metastatic prostate cancer or non-metastatic castrate resistant prostate cancer who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause. Multiple clinical, pathologic & treatment parameters were evaluated for impact on patient outcomes. Pearson’s Chi-square was used across all age groups. Overall mortalities were compared across the three categories of age groups using Cox regression analysis. Univariate analyses were used to determine the hazard ratios of select variables with overall mortality.</div></div><div><h3>Results</h3><div>87.5% of the patients (median follow-up 8.9 years) presented with a single HR factor. The day 0 D90 was 122.5%. Overall, the 15-year BF, PCSM and OM were 12.4%, 5.6% and 51.7%. When stratified by age, there was no significant difference in BF or PCSM despite the ≤59 cohort presenting with a higher PSA(p<0.001) & greater percent positive biopsies(p=0.040). The median post-treatment PSA in biochemically controlled patients was <0.01ng/ml. In all 3 cohorts, OM steadily increased for the first 10 years, followed by an approximate doubling of OM from years 10 to 15 (Figure 1). 239 patients died with 10.9% due to prostate cancer, 38.1% from cardiovascular disease & 28.4% from other malignancies (1 rectal cancer & 3 bladder cancers). In MVA, BF was most closely related to percent positive biopsies(p<0.001,SHR 1.019), PCSM to Gleason score(p=0.004,SHR 2.884) & percent positive biopsies(p=0.005,SHR 1.021) & OM to age(p<0.001,SHR 1.077) & tobacco(p<0.001,SHR 2.282).</div></div><div><h3>Conclusions</h3><div>Despite high cancer control rates, overall survival was limited by ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S57"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888862","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.2025.06.052
Surendra Kumar Saini MD, DPH, D.N. Sharma MD
<div><h3>Purpose</h3><div>Locally advanced carcinoma of the tongue (stage IVA) presents a significant therapeutic challenge, with surgery leading to functional impairment, affecting speech and swallowing. While external beam radiotherapy (EBRT) plays a crucial role, interstitial brachytherapy (BT) provides highly conformal dose delivery, minimizing radiation exposure to surrounding normal tissues. With the advancements in 3D imaging and treatment planning, the precision of brachytherapy has improved significantly. However, its use has declined over time. This case highlights the importance of regaining the art of brachytherapy in the modern era, demonstrating its role in achieving tumour control while preserving organ function.</div></div><div><h3>Materials and Methods</h3><div>A 41-year-old male presented with biopsy-proven squamous cell carcinoma of the left posterior tongue (T4aN0M0). Surgery was deemed unsuitable due to deep extension of the disease. High-dose-rate (HDR) interstitial brachytherapy was performed first, delivering a total dose of 28 Gy in seven fractions, with two fractions per day at six-hours intervals, using interstitial catheter implantation technique. The treatment was planned with 3D image guidance using CT and MRI, optimizing dose distribution while minimizing toxicity to critical structures. This was followed by EBRT to a total dose of 50 Gy in 25 fractions, ensuring microscopic tumour coverage with concurrent chemotherapy. Treatment response, acute toxicity, and functional outcomes were assessed.</div></div><div><h3>Results</h3><div>The patient achieved complete clinical tumour regression upon treatment completion. Acute toxicities included grade 2 mucositis and grade 1 dysphagia, both of which resolved within week. Patient maintained weight throughout treatment . Importantly, the patient maintained near-normal speech and swallowing function without requiring enteral feeding. The precise dose escalation achieved through brachytherapy contributed to effective tumour eradication while preserving organ function. Patient is due for first follow up imaging at three months post completion of treatment.</div></div><div><h3>Conclusions</h3><div>This case underscores the critical role of brachytherapy, particularly in the era of advanced 3D imaging, in the management of locally advanced tongue cancer. Modern imaging techniques enhance the accuracy and safety of brachytherapy, making it a viable alternative to surgery in select patients who prioritize organ preservation. The decline in brachytherapy utilization over the years calls for renewed clinical interest and training to re-establish its role in contemporary oncologic practice. For stage IVA tongue cancer, interstitial brachytherapy, when combined with EBRT, can offer excellent oncologic outcomes while maintaining quality of life. Further clinical trials and research are needed to further identify technological and training gaps in providing optimal tumour control in oral
{"title":"MSOP03 Presentation Time: 8:10 AM","authors":"Surendra Kumar Saini MD, DPH, D.N. Sharma MD","doi":"10.1016/j.brachy.2025.06.052","DOIUrl":"10.1016/j.brachy.2025.06.052","url":null,"abstract":"<div><h3>Purpose</h3><div>Locally advanced carcinoma of the tongue (stage IVA) presents a significant therapeutic challenge, with surgery leading to functional impairment, affecting speech and swallowing. While external beam radiotherapy (EBRT) plays a crucial role, interstitial brachytherapy (BT) provides highly conformal dose delivery, minimizing radiation exposure to surrounding normal tissues. With the advancements in 3D imaging and treatment planning, the precision of brachytherapy has improved significantly. However, its use has declined over time. This case highlights the importance of regaining the art of brachytherapy in the modern era, demonstrating its role in achieving tumour control while preserving organ function.</div></div><div><h3>Materials and Methods</h3><div>A 41-year-old male presented with biopsy-proven squamous cell carcinoma of the left posterior tongue (T4aN0M0). Surgery was deemed unsuitable due to deep extension of the disease. High-dose-rate (HDR) interstitial brachytherapy was performed first, delivering a total dose of 28 Gy in seven fractions, with two fractions per day at six-hours intervals, using interstitial catheter implantation technique. The treatment was planned with 3D image guidance using CT and MRI, optimizing dose distribution while minimizing toxicity to critical structures. This was followed by EBRT to a total dose of 50 Gy in 25 fractions, ensuring microscopic tumour coverage with concurrent chemotherapy. Treatment response, acute toxicity, and functional outcomes were assessed.</div></div><div><h3>Results</h3><div>The patient achieved complete clinical tumour regression upon treatment completion. Acute toxicities included grade 2 mucositis and grade 1 dysphagia, both of which resolved within week. Patient maintained weight throughout treatment . Importantly, the patient maintained near-normal speech and swallowing function without requiring enteral feeding. The precise dose escalation achieved through brachytherapy contributed to effective tumour eradication while preserving organ function. Patient is due for first follow up imaging at three months post completion of treatment.</div></div><div><h3>Conclusions</h3><div>This case underscores the critical role of brachytherapy, particularly in the era of advanced 3D imaging, in the management of locally advanced tongue cancer. Modern imaging techniques enhance the accuracy and safety of brachytherapy, making it a viable alternative to surgery in select patients who prioritize organ preservation. The decline in brachytherapy utilization over the years calls for renewed clinical interest and training to re-establish its role in contemporary oncologic practice. For stage IVA tongue cancer, interstitial brachytherapy, when combined with EBRT, can offer excellent oncologic outcomes while maintaining quality of life. Further clinical trials and research are needed to further identify technological and training gaps in providing optimal tumour control in oral ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S31"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889052","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.2025.06.054
Andreas A. Tjavaras BS , Gurpreet Heir HS , Henry Santorsola HS , Richard F. Cohen MD , Evangelia Katsoulakis MD , Stella Lymberis MD
<div><h3>Purpose</h3><div>Since OpenAI’s release of a Large Language Model (LLM) chatbot in 2022, there has been increasing public usage for clinical information gathering. However, little research examines ChatGPT in the field of brachytherapy. The present study evaluated the accuracy of ChatGPT-4o responses to frequently asked questions pertaining to prostate (PrCa) and cervical (CrCa) cancer prevention, diagnosis, treatment, survivorship, and role of brachytherapy as a treatment modality.</div></div><div><h3>Materials and Methods</h3><div>We created a questionnaire by adapting questions related to PrCa and CrCa cancer from the cancer.net FAQ, and clinical practice. Questions were edited to increase clarity and entered into ChatGPT-4o utilizing zero-shot prompting. Questions were asked without any instruction, or examples, allowing for a natural, conversational exchange approximating the interaction between a patient and their physician. Each question was posed in a new chat to avoid reliance on and confusion from prior questions and answers. ChatGPT’s answers were compiled and sent to two physicians for review. Physicians scored the responses according to a 4-point Likert scale: 1) correct and comprehensive, 2) correct but not comprehensive, 3) some correct, some incorrect; 4) completely incorrect. Physicians were asked to leave comments explaining their score, highlight text that was incorrect and highlight text that was ambiguous, and required further explanation. When physicians' scores did not agree, a 3rd physician was brought in to reach a consensus. A t-test was done to compare correctness between answers on prostate cancer and cervical cancer.</div></div><div><h3>Results</h3><div>73 questions related to CrCa (34) and PrCa (39) cancer were inputted into ChatGPT-4o (see Table). CrCa answers were less likely to be correct compared with PrCa answers, 18% vs 49% overall (p-value = 0.0024). For PrCa, we found incorrect recommendations regarding active surveillance, androgen deprivation and brachytherapy. For example, ChatGPT stated that “hormonal therapy alone may be combined with other treatments to reduce the need for higher radiation therapy”. In answers related to PrCa brachytherapy considerable inaccuracies were noted: 1) ChatGPT mainly referenced LDR and ignored HDR brachytherapy as a treatment modality, 2) Side effects after brachytherapy were described as self-limited, and 3) LDR was described as less precise compared with HDR. For CrCa, we found incorrect information regarding screening, imaging, and treatment. ChatGPT was inaccurate when describing radiation and brachytherapy for CrCa: 1) When asked how are organs protected during radiation therapy? ChatGPT answered that “bladder and rectal shields are used to shield these organs during external radiation”, 2) When asked what is the most effective treatment for cervical cancer? ChatGPT answered that radiation therapy was “often used for locally advanced cervical cancer”, “often was
{"title":"MSOP05 Presentation Time: 8:20 AM","authors":"Andreas A. Tjavaras BS , Gurpreet Heir HS , Henry Santorsola HS , Richard F. Cohen MD , Evangelia Katsoulakis MD , Stella Lymberis MD","doi":"10.1016/j.brachy.2025.06.054","DOIUrl":"10.1016/j.brachy.2025.06.054","url":null,"abstract":"<div><h3>Purpose</h3><div>Since OpenAI’s release of a Large Language Model (LLM) chatbot in 2022, there has been increasing public usage for clinical information gathering. However, little research examines ChatGPT in the field of brachytherapy. The present study evaluated the accuracy of ChatGPT-4o responses to frequently asked questions pertaining to prostate (PrCa) and cervical (CrCa) cancer prevention, diagnosis, treatment, survivorship, and role of brachytherapy as a treatment modality.</div></div><div><h3>Materials and Methods</h3><div>We created a questionnaire by adapting questions related to PrCa and CrCa cancer from the cancer.net FAQ, and clinical practice. Questions were edited to increase clarity and entered into ChatGPT-4o utilizing zero-shot prompting. Questions were asked without any instruction, or examples, allowing for a natural, conversational exchange approximating the interaction between a patient and their physician. Each question was posed in a new chat to avoid reliance on and confusion from prior questions and answers. ChatGPT’s answers were compiled and sent to two physicians for review. Physicians scored the responses according to a 4-point Likert scale: 1) correct and comprehensive, 2) correct but not comprehensive, 3) some correct, some incorrect; 4) completely incorrect. Physicians were asked to leave comments explaining their score, highlight text that was incorrect and highlight text that was ambiguous, and required further explanation. When physicians' scores did not agree, a 3rd physician was brought in to reach a consensus. A t-test was done to compare correctness between answers on prostate cancer and cervical cancer.</div></div><div><h3>Results</h3><div>73 questions related to CrCa (34) and PrCa (39) cancer were inputted into ChatGPT-4o (see Table). CrCa answers were less likely to be correct compared with PrCa answers, 18% vs 49% overall (p-value = 0.0024). For PrCa, we found incorrect recommendations regarding active surveillance, androgen deprivation and brachytherapy. For example, ChatGPT stated that “hormonal therapy alone may be combined with other treatments to reduce the need for higher radiation therapy”. In answers related to PrCa brachytherapy considerable inaccuracies were noted: 1) ChatGPT mainly referenced LDR and ignored HDR brachytherapy as a treatment modality, 2) Side effects after brachytherapy were described as self-limited, and 3) LDR was described as less precise compared with HDR. For CrCa, we found incorrect information regarding screening, imaging, and treatment. ChatGPT was inaccurate when describing radiation and brachytherapy for CrCa: 1) When asked how are organs protected during radiation therapy? ChatGPT answered that “bladder and rectal shields are used to shield these organs during external radiation”, 2) When asked what is the most effective treatment for cervical cancer? ChatGPT answered that radiation therapy was “often used for locally advanced cervical cancer”, “often was","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S32"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889054","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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