<div><h3>Purpose</h3><div>High dose rate (HDR) prostate brachytherapy (BT) procedure requires imaging to guide transperineal needle insertion, either with CT, MR, or ultrasound (US) imaging. US is occasionally favored for its streamlined workflow and when access to other imaging is limited. General anesthesia is often used throughout the procedure, thus minimizing overall planning time is crucial to mitigate potential complications and allow for better management of operating room time. In this study, we explore the accuracy and time-saving potential of AI-driven auto-reconstruction of transperineal needles in the context of US-guided prostate BT planning.</div></div><div><h3>Materials and Methods</h3><div>A total of 98 US BT cases from a single institution were used in this work. US images were acquired using a BK3000 US + E14CL4b endocavity biplane transducer and combined into 3D-US datasets using the Oncentra Prostate system from Elekta. Gray value histogram of each 3D-US image was normalized. The data was split into 3 groups: 50 for training and validation (training set), 11 to evaluate reconstruction accuracy (test set #1) and 37 to evaluate the AI tool in a clinical implementation (test set #2). A 3D-UNet machine learning network was used, using human-reconstructed needles during the BT procedure as the reference segmentation mask. Model training was performed using the PyTorch library version 2.0.1 on a NVIDIA Quadro RTX 6000 GPU using Dice loss and AdamW optimizer. A 10-fold cross-validation scheme was employed during training. Reconstruction accuracy for test set #1 was evaluated by having 4 medical physicists manually reconstructing needles on the 3D-US scan after treatments. Ground truth reference needle positions for each observer (AI included) were determined from the other 4 reconstructions using a weighted voting average inspired by the STAPLE algorithm. Reconstruction accuracy was evaluated by taking the root mean squared error from the center of each reconstructed needle to the center of the ground truth needle, on each image axial slice in which the needle was visible by both humans and AI. Interobserver variability was evaluated using one-way ANOVA and Tukey's HSD post-hoc test. The needle total reconstruction time for test set #2 was taken as the timestamp difference from scan acquisition to final modification of the plan before dose calculations. This value was compared to values of the 50 cases done before the clinical implementation of the AI-assisted tool using a two-sample z-test. For this phase, we also measured the true positive rate of needle reconstruction and the # of AI-reconstructed needles that were further adjusted by the human planner.</div></div><div><h3>Results</h3><div>A mean error of (0.47±0.31) mm was found between the AI-reconstructed and the ground truth needles in test set #1, with 95.2% of AI needle points falling below 1 mm from their human-made counterparts. One-way ANOVA showed statistical difference
{"title":"PHSOR02 Presentation Time: 9:05 AM","authors":"Mathieu Goulet PhD , Patricia Duguay-Drouin MSc , Julien Mégrourèche MSc , Nadia Octave PhD , James M. Tsui BEng, MSc, MDCM, PhD","doi":"10.1016/j.brachy.2024.08.076","DOIUrl":"10.1016/j.brachy.2024.08.076","url":null,"abstract":"<div><h3>Purpose</h3><div>High dose rate (HDR) prostate brachytherapy (BT) procedure requires imaging to guide transperineal needle insertion, either with CT, MR, or ultrasound (US) imaging. US is occasionally favored for its streamlined workflow and when access to other imaging is limited. General anesthesia is often used throughout the procedure, thus minimizing overall planning time is crucial to mitigate potential complications and allow for better management of operating room time. In this study, we explore the accuracy and time-saving potential of AI-driven auto-reconstruction of transperineal needles in the context of US-guided prostate BT planning.</div></div><div><h3>Materials and Methods</h3><div>A total of 98 US BT cases from a single institution were used in this work. US images were acquired using a BK3000 US + E14CL4b endocavity biplane transducer and combined into 3D-US datasets using the Oncentra Prostate system from Elekta. Gray value histogram of each 3D-US image was normalized. The data was split into 3 groups: 50 for training and validation (training set), 11 to evaluate reconstruction accuracy (test set #1) and 37 to evaluate the AI tool in a clinical implementation (test set #2). A 3D-UNet machine learning network was used, using human-reconstructed needles during the BT procedure as the reference segmentation mask. Model training was performed using the PyTorch library version 2.0.1 on a NVIDIA Quadro RTX 6000 GPU using Dice loss and AdamW optimizer. A 10-fold cross-validation scheme was employed during training. Reconstruction accuracy for test set #1 was evaluated by having 4 medical physicists manually reconstructing needles on the 3D-US scan after treatments. Ground truth reference needle positions for each observer (AI included) were determined from the other 4 reconstructions using a weighted voting average inspired by the STAPLE algorithm. Reconstruction accuracy was evaluated by taking the root mean squared error from the center of each reconstructed needle to the center of the ground truth needle, on each image axial slice in which the needle was visible by both humans and AI. Interobserver variability was evaluated using one-way ANOVA and Tukey's HSD post-hoc test. The needle total reconstruction time for test set #2 was taken as the timestamp difference from scan acquisition to final modification of the plan before dose calculations. This value was compared to values of the 50 cases done before the clinical implementation of the AI-assisted tool using a two-sample z-test. For this phase, we also measured the true positive rate of needle reconstruction and the # of AI-reconstructed needles that were further adjusted by the human planner.</div></div><div><h3>Results</h3><div>A mean error of (0.47±0.31) mm was found between the AI-reconstructed and the ground truth needles in test set #1, with 95.2% of AI needle points falling below 1 mm from their human-made counterparts. One-way ANOVA showed statistical difference","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S57-S58"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527290","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.058
Sai Nikitha Prattipati MScGH , Muhammad M. Qureshi MBBS, MPH , Katrin Eurich MD , Stephen Fiascone MD , Andrea Negroiu MD , Sherry X. Yan MD
Purpose
We evaluated the utilization of adjuvant external beam radiation (EBRT) and vaginal brachytherapy (VBT) and the impact on survival benefit in stage IB to IVA uterine carcinosarcoma.
Materials and Methods
Patients with FIGO stage IB to IVA uterine carcinosarcoma who underwent hysterectomy and received adjuvant chemotherapy were identified from the National Cancer Database data from 2004 to 2017. The primary outcome of interest was overall survival based on adjuvant treatment modality: chemotherapy alone versus the addition of EBRT or VBT. Median survival was estimated using the Kaplan-Meier method, and the log-rank test was used to determine statistical significance. Adjusted hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the multivariable Cox regression model. The model adjusted for following a priori selected covariates: age at diagnosis, race, year of diagnosis, insurance status, comorbidities, treatment facility type and pathologic stage.
Results
We identified 3038 patients diagnosed with uterine carcinosarcoma who met eligibility criteria (26% stage IB, 12% stage II, 19% stage IIIA/B, 41% stage IIIC, 3% stage IVA), of whom 1567 (51.6%) received adjuvant chemotherapy alone, 1046 (34.4%) received adjuvant EBRT with or without VBT, and 425 (14.0%) received adjuvant VBT. Patients who received radiation were younger; patients who received VBT were more likely to have earlier-stage disease, be treated at academic/research programs, and be white (all p <0.001). With a median follow-up of 39 months, median survival was 32.7, 59.8, and 127.4 months for no adjuvant radiation, EBRT, and VBT, respectively (p <0.001). The survival benefit of adjuvant radiation was maintained on multivariate analysis with HR 0.69 [0.62-0.76, p <0.001) for EBRT and HR 0.58 [0.49-0.68], p <0.001) for VBT (Table 1). The benefit of adjuvant radiation over chemotherapy alone persisted across all stages of uterine carcinosarcoma IB to IVA. Specifically, adjuvant EBRT improved survival in stage II to IVA, and adjuvant VBT improved survival in stage IB to IIIC.
Conclusions
Adjuvant radiation therapy, in addition to chemotherapy, improved overall survival in uterine carcinosarcoma. Adjuvant brachytherapy may be underutilized in this patient population.
{"title":"GSOR12 Presentation Time: 5:55 PM","authors":"Sai Nikitha Prattipati MScGH , Muhammad M. Qureshi MBBS, MPH , Katrin Eurich MD , Stephen Fiascone MD , Andrea Negroiu MD , Sherry X. Yan MD","doi":"10.1016/j.brachy.2024.08.058","DOIUrl":"10.1016/j.brachy.2024.08.058","url":null,"abstract":"<div><h3>Purpose</h3><div>We evaluated the utilization of adjuvant external beam radiation (EBRT) and vaginal brachytherapy (VBT) and the impact on survival benefit in stage IB to IVA uterine carcinosarcoma.</div></div><div><h3>Materials and Methods</h3><div>Patients with FIGO stage IB to IVA uterine carcinosarcoma who underwent hysterectomy and received adjuvant chemotherapy were identified from the National Cancer Database data from 2004 to 2017. The primary outcome of interest was overall survival based on adjuvant treatment modality: chemotherapy alone versus the addition of EBRT or VBT. Median survival was estimated using the Kaplan-Meier method, and the log-rank test was used to determine statistical significance. Adjusted hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the multivariable Cox regression model. The model adjusted for following a priori selected covariates: age at diagnosis, race, year of diagnosis, insurance status, comorbidities, treatment facility type and pathologic stage.</div></div><div><h3>Results</h3><div>We identified 3038 patients diagnosed with uterine carcinosarcoma who met eligibility criteria (26% stage IB, 12% stage II, 19% stage IIIA/B, 41% stage IIIC, 3% stage IVA), of whom 1567 (51.6%) received adjuvant chemotherapy alone, 1046 (34.4%) received adjuvant EBRT with or without VBT, and 425 (14.0%) received adjuvant VBT. Patients who received radiation were younger; patients who received VBT were more likely to have earlier-stage disease, be treated at academic/research programs, and be white (all p <0.001). With a median follow-up of 39 months, median survival was 32.7, 59.8, and 127.4 months for no adjuvant radiation, EBRT, and VBT, respectively (p <0.001). The survival benefit of adjuvant radiation was maintained on multivariate analysis with HR 0.69 [0.62-0.76, p <0.001) for EBRT and HR 0.58 [0.49-0.68], p <0.001) for VBT (Table 1). The benefit of adjuvant radiation over chemotherapy alone persisted across all stages of uterine carcinosarcoma IB to IVA. Specifically, adjuvant EBRT improved survival in stage II to IVA, and adjuvant VBT improved survival in stage IB to IIIC.</div></div><div><h3>Conclusions</h3><div>Adjuvant radiation therapy, in addition to chemotherapy, improved overall survival in uterine carcinosarcoma. Adjuvant brachytherapy may be underutilized in this patient population.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S47-S48"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527072","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}
In a radiation oncology (RO) clinic, brachytherapy (BT) is a time and resource intensive modality. Constraints to efficiency and throughput include physical resources: afterloader and vault availability, applicator inventory, and OR availability but also physician and support staff availability to maintain efficiency. Thus, several things need to be considered when scheduling cases and having a BT team with each member given their defined roles is essential. The goal of utilizing a BT procedure daily scorecard is to ensure adequate resource allocation and minimize the risk of burnout that could potentially lead to employee dissatisfaction, patient safety events, or turnover on the BT team. Utilizing a similar scorecard method will also be useful to radiation oncologists and RO clinics worldwide when starting or grow a BT program.
Methods
Each BT procedure was given a score ranging from 1 - 3 (Table 1) based on complexity. A score of 1 was allocated to procedures that were relatively less labor intensive. A score of 2 was given to procedures that required a treatment plan on the day of implant and nursing care. A score of 3 was given to procedures that required BT team members to be in the OR for pre-procedure setup and implantation or implants with longer procedural, treatment planning, and delivery times. The total BT score was limited to no more than 10 on any given day when creating a BT schedule with additional review required for schedules exceeding a score of 10 to allow for appropriate staffing. A retrospective analysis was performed analyzing the number of cases, average start/end time, the average BT score, and the average difficulty per case for 3 months pre-implementation and 3 months post-implementation.
Results
Implementing a daily BT procedural scorecard improved BT procedural efficiency without compromising procedural throughput. Despite maintaining a similar average difficulty of cases performed (1.85 vs 1.78 ±0.47), the clinic time spent in BT was reduced along with the score of the day (9.1 vs 6.87). Utilizing the scoring system may also improve BT team morale due to decreased daily case complexity, shortened hours, and through appropriate procedural staffing.
Conclusion
We show utilizing a BT scoring system can improve efficiency of BT workflow without compromising patient throughput. Strategies such as this may help BT clinics improve schedule organization, employee satisfaction, staffing models, and should be considered in all high-volume BT clinics.
{"title":"MSOR9 Presentation Time: 5:40 PM","authors":"Arjit Baghwala MS, ChengFeng Li MS, Forrest Ivey MS, Devin Olek MS, Kyle Harper MS, Ramiro Pino PhD, Andrew Farach MD","doi":"10.1016/j.brachy.2024.08.043","DOIUrl":"10.1016/j.brachy.2024.08.043","url":null,"abstract":"<div><h3>Purpose</h3><div>In a radiation oncology (RO) clinic, brachytherapy (BT) is a time and resource intensive modality. Constraints to efficiency and throughput include physical resources: afterloader and vault availability, applicator inventory, and OR availability but also physician and support staff availability to maintain efficiency. Thus, several things need to be considered when scheduling cases and having a BT team with each member given their defined roles is essential. The goal of utilizing a BT procedure daily scorecard is to ensure adequate resource allocation and minimize the risk of burnout that could potentially lead to employee dissatisfaction, patient safety events, or turnover on the BT team. Utilizing a similar scorecard method will also be useful to radiation oncologists and RO clinics worldwide when starting or grow a BT program.</div></div><div><h3>Methods</h3><div>Each BT procedure was given a score ranging from 1 - 3 (Table 1) based on complexity. A score of 1 was allocated to procedures that were relatively less labor intensive. A score of 2 was given to procedures that required a treatment plan on the day of implant and nursing care. A score of 3 was given to procedures that required BT team members to be in the OR for pre-procedure setup and implantation or implants with longer procedural, treatment planning, and delivery times. The total BT score was limited to no more than 10 on any given day when creating a BT schedule with additional review required for schedules exceeding a score of 10 to allow for appropriate staffing. A retrospective analysis was performed analyzing the number of cases, average start/end time, the average BT score, and the average difficulty per case for 3 months pre-implementation and 3 months post-implementation.</div></div><div><h3>Results</h3><div>Implementing a daily BT procedural scorecard improved BT procedural efficiency without compromising procedural throughput. Despite maintaining a similar average difficulty of cases performed (1.85 vs 1.78 ±0.47), the clinic time spent in BT was reduced along with the score of the day (9.1 vs 6.87). Utilizing the scoring system may also improve BT team morale due to decreased daily case complexity, shortened hours, and through appropriate procedural staffing.</div></div><div><h3>Conclusion</h3><div>We show utilizing a BT scoring system can improve efficiency of BT workflow without compromising patient throughput. Strategies such as this may help BT clinics improve schedule organization, employee satisfaction, staffing models, and should be considered in all high-volume BT clinics.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S39-S40"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527076","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.049
Santanu Samanta MD , Emily Baker MA , Anam Kesaria MD , Haley Kelly RN , Faraz K. Mahmoudabadi PhD , Gary Lewis MD
Purpose
Brachytherapy using HDR plays a crucial role in the treatment of gynecological cancer undergoing radiation therapy. This pilot study examines the use of Virtual Reality (VR) distraction for subjects undergoing HDR brachytherapy and its effects on their satisfaction, procedural anxiety, pain, and the need for analgesics or anxiolytics. We hypothesize that incorporating VR distraction into the brachytherapy treatment workflow will improve subjects’ satisfaction, reduce procedural anxiety and pain, and reduce the need for analgesics or anxiolytics.
Methods and Materials
From September 2022 to November 2023, 7 patients have been enrolled so far, each requiring a minimum of 4 sessions of HDR brachytherapy. Each patient underwent 2 sessions with VR and 2 sessions without. Each patient was also asked to fill out a questionnaire before and after each HDR brachytherapy session, which included pain score, and anxiety score among other details. Data including AE events were recorded post-treatment for all sessions.
Results
With an accrual goal of 20 patients, 7 women, ages 29 to 81, participated in the study. Six of the subjects were white and 1 subject was black or African American. All 7 subjects attempted to use virtual reality during brachytherapy at least once, contributing to a total of 12 sessions with virtual reality, which were compared to 13 complete sessions without virtual reality. The preliminary results show the following. Subjects reported lower average pre-procedural pain prior to VR sessions. 2. Subjects reported lower average procedural pain during VR sessions. 3. Subjects reported about the same pre-procedural anxiety with or without virtual reality 4. Subjects reported a high satisfaction score and would like to use the VR again.
Conclusions
These preliminary results suggest a potential reduction in procedural pain with the inclusion of VR sessions during HDR brachytherapy. However, there was no observed change in the need for opioid or anxiety medications among these initially enrolled patients. All subjects reported high satisfaction scores and would like to use VR again. While many subjects reported it was their first time engaging with VR, in the future, we plan to incorporate a longer demo session and modify the questionnaire to improve the subject's familiarity with the technology.
{"title":"GSOR03 Presentation Time: 5:10 PM","authors":"Santanu Samanta MD , Emily Baker MA , Anam Kesaria MD , Haley Kelly RN , Faraz K. Mahmoudabadi PhD , Gary Lewis MD","doi":"10.1016/j.brachy.2024.08.049","DOIUrl":"10.1016/j.brachy.2024.08.049","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy using HDR plays a crucial role in the treatment of gynecological cancer undergoing radiation therapy. This pilot study examines the use of Virtual Reality (VR) distraction for subjects undergoing HDR brachytherapy and its effects on their satisfaction, procedural anxiety, pain, and the need for analgesics or anxiolytics. We hypothesize that incorporating VR distraction into the brachytherapy treatment workflow will improve subjects’ satisfaction, reduce procedural anxiety and pain, and reduce the need for analgesics or anxiolytics.</div></div><div><h3>Methods and Materials</h3><div>From September 2022 to November 2023, 7 patients have been enrolled so far, each requiring a minimum of 4 sessions of HDR brachytherapy. Each patient underwent 2 sessions with VR and 2 sessions without. Each patient was also asked to fill out a questionnaire before and after each HDR brachytherapy session, which included pain score, and anxiety score among other details. Data including AE events were recorded post-treatment for all sessions.</div></div><div><h3>Results</h3><div>With an accrual goal of 20 patients, 7 women, ages 29 to 81, participated in the study. Six of the subjects were white and 1 subject was black or African American. All 7 subjects attempted to use virtual reality during brachytherapy at least once, contributing to a total of 12 sessions with virtual reality, which were compared to 13 complete sessions without virtual reality. The preliminary results show the following. Subjects reported lower average pre-procedural pain prior to VR sessions. 2. Subjects reported lower average procedural pain during VR sessions. 3. Subjects reported about the same pre-procedural anxiety with or without virtual reality 4. Subjects reported a high satisfaction score and would like to use the VR again.</div></div><div><h3>Conclusions</h3><div>These preliminary results suggest a potential reduction in procedural pain with the inclusion of VR sessions during HDR brachytherapy. However, there was no observed change in the need for opioid or anxiety medications among these initially enrolled patients. All subjects reported high satisfaction scores and would like to use VR again. While many subjects reported it was their first time engaging with VR, in the future, we plan to incorporate a longer demo session and modify the questionnaire to improve the subject's familiarity with the technology.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S43"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527133","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.095
Lucas C. Mendez MD, MSc , Matt Mulligan BSc , Douglas A. Hoover PhD , Samih Mohamed MD , Maria Thereza Starling MD , Aneesh Dhar MD , Rohann Correa MD, PhD , Vikram Velker MD , Joelle Helou MD , Glenn Bauman MD , Aaron Fenster PhD , Gary Brahm MD , David D'Souza MD , Jason Vickress PhD
<div><h3>Purpose</h3><div>Erectile disfunction (ED) is a common long-term side effect of any prostate cancer treatment. Radiation-related ED is thought to be a vascular process, related to venous occlusion caused by radiation. Low dose-rate (LDR) brachytherapy (BT) is a well-established treatment modality that has an undisputable dose conformality and a theoretical advantage in reducing dose to erectile-related structures when compared to EBRT options. Nevertheless, the role of vessel-sparing LDR-BT technique has not been previously described.</div></div><div><h3>Materials and Methods</h3><div>PRIAPUS (NCT 04718987) is a prospective, single-arm clinical trial evaluating feasibility and dosimetry associated with a novel LDR BT technique that aims to spare ED-related structures, including the prostatic neurovascular bundles (NVB) contralateral to the index lesion and the penile bulb (Figure 1). The trial planned to accrue 15 patients with intermediate-risk prostate cancer staged with MRI, with clinically significant disease (CSD) contained to one lobe of the prostate. Primary objective was for 70% of patients to achieve acceptable dose to the target structure while sufficiently sparing ED-related structures. Dosimetry was evaluated on a one-month post-implant CT-scan. In order of priority, the trial's dosimetric goals are: target D90% ≥ 140 Gy, urethra D30% < 130%, contralateral NVB median dose ≤ 50 Gy, and penile bulb D10% ≤ 50 Gy. The LDR BT workflow involved a pre-procedural prostate mpMRI for NVB definition, intra-operative use of a deformable image registration algorithm to translate NVB contours from pre-implant MRI to the live ultrasound images, and intraoperative planning using loose 125-Iodine radioactive seeds with a prescription dose of 145 Gy.</div></div><div><h3>Results</h3><div>Fifteen patients have been consented: one withdrew consent before receiving treatment, one awaits treatment, and 13 have been successfully treated with post-implant dosimetry available for analysis. In the one-month post-procedure scan, the mean target D90% was 153 Gy (SD ± 10 Gy). All patients but one had a target D90% > 140 Gy. The mean urethra D30% was 129% (SD ±10%). The mean contralateral NVB D50% was 60 Gy (SD ± 13 Gy), with 10 of 13 implants failing to meet the pre-specified goal. For comparison, the ipsilateral NVB which was not spared received a mean D50% of 131 Gy (SD ± 33 Gy). The mean penile bulb D10% was 32 Gy (SD ± 13 Gy). Only two patients had a post-implant dosimetry that met all pre-specified criteria, and so this trial's primary dosimetric endpoint will not be met after the last patient receives treatment.</div></div><div><h3>Conclusions</h3><div>The pre-specified dosimetric goals were found stringent and seldom achievable and future trials with this technique will require relaxation of the contralateral NVB constraint. While the primary dosimetric endpoint was not met, a substantial dose sparing to the contralateral NVB was achieved whi
{"title":"PPP03 Presentation Time: 10:48 AM","authors":"Lucas C. Mendez MD, MSc , Matt Mulligan BSc , Douglas A. Hoover PhD , Samih Mohamed MD , Maria Thereza Starling MD , Aneesh Dhar MD , Rohann Correa MD, PhD , Vikram Velker MD , Joelle Helou MD , Glenn Bauman MD , Aaron Fenster PhD , Gary Brahm MD , David D'Souza MD , Jason Vickress PhD","doi":"10.1016/j.brachy.2024.08.095","DOIUrl":"10.1016/j.brachy.2024.08.095","url":null,"abstract":"<div><h3>Purpose</h3><div>Erectile disfunction (ED) is a common long-term side effect of any prostate cancer treatment. Radiation-related ED is thought to be a vascular process, related to venous occlusion caused by radiation. Low dose-rate (LDR) brachytherapy (BT) is a well-established treatment modality that has an undisputable dose conformality and a theoretical advantage in reducing dose to erectile-related structures when compared to EBRT options. Nevertheless, the role of vessel-sparing LDR-BT technique has not been previously described.</div></div><div><h3>Materials and Methods</h3><div>PRIAPUS (NCT 04718987) is a prospective, single-arm clinical trial evaluating feasibility and dosimetry associated with a novel LDR BT technique that aims to spare ED-related structures, including the prostatic neurovascular bundles (NVB) contralateral to the index lesion and the penile bulb (Figure 1). The trial planned to accrue 15 patients with intermediate-risk prostate cancer staged with MRI, with clinically significant disease (CSD) contained to one lobe of the prostate. Primary objective was for 70% of patients to achieve acceptable dose to the target structure while sufficiently sparing ED-related structures. Dosimetry was evaluated on a one-month post-implant CT-scan. In order of priority, the trial's dosimetric goals are: target D90% ≥ 140 Gy, urethra D30% < 130%, contralateral NVB median dose ≤ 50 Gy, and penile bulb D10% ≤ 50 Gy. The LDR BT workflow involved a pre-procedural prostate mpMRI for NVB definition, intra-operative use of a deformable image registration algorithm to translate NVB contours from pre-implant MRI to the live ultrasound images, and intraoperative planning using loose 125-Iodine radioactive seeds with a prescription dose of 145 Gy.</div></div><div><h3>Results</h3><div>Fifteen patients have been consented: one withdrew consent before receiving treatment, one awaits treatment, and 13 have been successfully treated with post-implant dosimetry available for analysis. In the one-month post-procedure scan, the mean target D90% was 153 Gy (SD ± 10 Gy). All patients but one had a target D90% > 140 Gy. The mean urethra D30% was 129% (SD ±10%). The mean contralateral NVB D50% was 60 Gy (SD ± 13 Gy), with 10 of 13 implants failing to meet the pre-specified goal. For comparison, the ipsilateral NVB which was not spared received a mean D50% of 131 Gy (SD ± 33 Gy). The mean penile bulb D10% was 32 Gy (SD ± 13 Gy). Only two patients had a post-implant dosimetry that met all pre-specified criteria, and so this trial's primary dosimetric endpoint will not be met after the last patient receives treatment.</div></div><div><h3>Conclusions</h3><div>The pre-specified dosimetric goals were found stringent and seldom achievable and future trials with this technique will require relaxation of the contralateral NVB constraint. While the primary dosimetric endpoint was not met, a substantial dose sparing to the contralateral NVB was achieved whi","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S70"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526978","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.064
Aspazia Spyrou MB Bch BAO, MSc,MRCP , Helen Minnaar M.Insta.Pa , Yu Kai Shing Mphil, BSc , Jacqueline Steinke MBchB FRCS , Alexandra Stewart DM,MRCP,FRCR,FBIR
<div><h3>Purpose</h3><div>Although rectal cancers are traditionally treated with surgical excision, more patients are opting for alternatives and choosing an organ preservation approach instead.Studies demonstrate that a radiotherapy boost improves rates of complete response with low rates of regrowth.Contact X-Ray brachytherapy (CXB) often referred to as Papillon technique, accomplishes dose escalation in the treatment of low rectal cancer.This involves inserting an X-Ray tube through the anus and placing it in contact with the tumour. The OPERA study published in 2023, showed that for tumours <3cm in size, combination treatment of external beam radiotherapy(EBRT) and CXB boost achieves a 97% success rate of organ preservation within a 3-year follow up. St Luke's oncology Center is one of the 4 centers in the UK that specialise in Papillon brachytherapy. The <u>purpose</u> of this study was to report the toxicity of CXB; both alone and in combination with external beam radiotherapy (EBRT) as documented by patients themselves as a subset of our national colorectal patient reported outcome measures (PROMs) study CITRuS (<strong>C</strong>omplex <strong>I</strong>ntervention protocol <strong>T</strong>oxicity in patients following <strong>R</strong>adiotherapy or <strong>S</strong>urgery for colorectal cancer).</div></div><div><h3>Materials and Methods</h3><div>26 patients treated with CXB alone or in combination with EBRT were identified via the CITRuS platform(506 registered, 288 consented). 22 received CXB with EBRT (combined treatment) and 4 patients CXB alone. The CXB patients received no other treatment prior to CXB. The questionnaires investigated bowel, urinary and sleep symptoms as well as weight monitoring. The data presented reflect answers to the baseline questionnaires and up to the first 8 months post completion of treatment.This study is ongoing.</div></div><div><h3>Results</h3><div>Of the 22 patients who received the combined treatment, 19 completed the baseline questionnaires, 11 completed 4-5 months, 8 completed the 7-8 months period. In this group,two patients reported mild increase in their pain by the 5th month post treatment. <u>GI</u>: Six patients reported a slight increase in mucous from baseline to 5 months whereas three patients documented increase in nocturnal bowel symptoms. Futhermore, compared to baseline, patients reported an increase in flatulence, solid and liquid stool incontinence as well as their bowel motions affecting their lifestyle, at 5 months post treatment(16%).In the Papillon alone group, pain,blood,mucous and nocturnal symptoms were significantly improved by 5 months. Flatulence seems to be more predominant in this group around the 4-5 month period post treatment. <u>GU</u>:There was a definite peak in urine frequency in the combined group. The Papillon alone group showed improvement of all urinary symptoms by 4 months. <u>Sleep</u>:Both groups demonstrated a significant impact on their sleep quality
{"title":"Saturday, July 13, 20248:00 AM - 9:00 AMMSOR01 Presentation Time: 8:00 AM","authors":"Aspazia Spyrou MB Bch BAO, MSc,MRCP , Helen Minnaar M.Insta.Pa , Yu Kai Shing Mphil, BSc , Jacqueline Steinke MBchB FRCS , Alexandra Stewart DM,MRCP,FRCR,FBIR","doi":"10.1016/j.brachy.2024.08.064","DOIUrl":"10.1016/j.brachy.2024.08.064","url":null,"abstract":"<div><h3>Purpose</h3><div>Although rectal cancers are traditionally treated with surgical excision, more patients are opting for alternatives and choosing an organ preservation approach instead.Studies demonstrate that a radiotherapy boost improves rates of complete response with low rates of regrowth.Contact X-Ray brachytherapy (CXB) often referred to as Papillon technique, accomplishes dose escalation in the treatment of low rectal cancer.This involves inserting an X-Ray tube through the anus and placing it in contact with the tumour. The OPERA study published in 2023, showed that for tumours <3cm in size, combination treatment of external beam radiotherapy(EBRT) and CXB boost achieves a 97% success rate of organ preservation within a 3-year follow up. St Luke's oncology Center is one of the 4 centers in the UK that specialise in Papillon brachytherapy. The <u>purpose</u> of this study was to report the toxicity of CXB; both alone and in combination with external beam radiotherapy (EBRT) as documented by patients themselves as a subset of our national colorectal patient reported outcome measures (PROMs) study CITRuS (<strong>C</strong>omplex <strong>I</strong>ntervention protocol <strong>T</strong>oxicity in patients following <strong>R</strong>adiotherapy or <strong>S</strong>urgery for colorectal cancer).</div></div><div><h3>Materials and Methods</h3><div>26 patients treated with CXB alone or in combination with EBRT were identified via the CITRuS platform(506 registered, 288 consented). 22 received CXB with EBRT (combined treatment) and 4 patients CXB alone. The CXB patients received no other treatment prior to CXB. The questionnaires investigated bowel, urinary and sleep symptoms as well as weight monitoring. The data presented reflect answers to the baseline questionnaires and up to the first 8 months post completion of treatment.This study is ongoing.</div></div><div><h3>Results</h3><div>Of the 22 patients who received the combined treatment, 19 completed the baseline questionnaires, 11 completed 4-5 months, 8 completed the 7-8 months period. In this group,two patients reported mild increase in their pain by the 5th month post treatment. <u>GI</u>: Six patients reported a slight increase in mucous from baseline to 5 months whereas three patients documented increase in nocturnal bowel symptoms. Futhermore, compared to baseline, patients reported an increase in flatulence, solid and liquid stool incontinence as well as their bowel motions affecting their lifestyle, at 5 months post treatment(16%).In the Papillon alone group, pain,blood,mucous and nocturnal symptoms were significantly improved by 5 months. Flatulence seems to be more predominant in this group around the 4-5 month period post treatment. <u>GU</u>:There was a definite peak in urine frequency in the combined group. The Papillon alone group showed improvement of all urinary symptoms by 4 months. <u>Sleep</u>:Both groups demonstrated a significant impact on their sleep quality","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S50-S51"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527030","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.060
Christopher Deufel Ph.D., Eric Brost Ph.D., Justine Dupere Ph.D., Ivy A. Petersen M.D., Michael G. Haddock M.D., Allison E. Garda M.D.
<div><h3>Purpose</h3><div>To design, construct, and evaluate a system for assisted placement of brachytherapy applicators using electromagnetic tracking (EMT) technology that has been registered to CT or MRI images. The system provides real-time localization of needles during the insertion process, a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts. Such a system might be used to reduce brachytherapy procedure times, improve correspondence between intended and actual needle positions, or decrease the trainee learning curve. The system is notable for the following features: 1) Real-time visual and quantitative feedback of needle placement with respect to the underlying anatomy, as visualized by MRI or CT image, without continuous or repeated imaging 2) Pre-planning capability with a graphical overlay of target needle trajectories 3) Reference tracking to account for electromagnetic field generator or target anatomy shifts 4) DICOM-coordinate digital reconstruction of applicator locations for treatment planning and/or pre-treatment quality assurance 5) Compatibility with standard brachytherapy workflows including fixed table CT and MRI systems, procedures within or outside of a brachy suite, and insertion of needles in dorsal lithotomy position 6) Consists of commercially available EMT technology components</div></div><div><h3>Methods</h3><div>The system was constructed using an Aurora (Northern Digital Instruments, Waterloo, ON) planar 20 × 20 cm<sup>2</sup> field generator (EFG), System Control Unit, Sensor Interface Unit, and 6DOF and 5DOF Flextube sensor tools. The graphical user interface was written as a Matlab application with native functions and toolboxes. EMT-to-DICOM registration was based upon intracavitary applicators (e.g., tandem and ovoids), placed prior to imaging and digitized automatically using thresholding methods. The EFG was positioned above the pelvis (Figure 1A), EMT sensors were translated through the tandem and ovoid channels, and the EMT system was registered to the DICOM image set using an iterative closest-point algorithm. Next, a 5DOF EMT sensor was loaded into the distal inner lumen of a brachytherapy needle for placement. The system display provides axial, coronal, sagittal, and 3D-volumetric CT/MRI views. Proof-of concept and system accuracy were evaluated in phantom and human cadaver by comparing EM-tracked needle positions with ground-truth, post-implant CTs.</div></div><div><h3>Results</h3><div>Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles in a realistic clinical environment and on a brachy suite CT table. Figure 1B provides an example of how a pre-planned needle location (blue) can be visualized alongside real-time needle placement (red) to provide feedback to the user. The left-hand panel in Figure 1B shows an initial attempt where a
{"title":"PL02 Presentation Time: 1:45 PM","authors":"Christopher Deufel Ph.D., Eric Brost Ph.D., Justine Dupere Ph.D., Ivy A. Petersen M.D., Michael G. Haddock M.D., Allison E. Garda M.D.","doi":"10.1016/j.brachy.2024.08.060","DOIUrl":"10.1016/j.brachy.2024.08.060","url":null,"abstract":"<div><h3>Purpose</h3><div>To design, construct, and evaluate a system for assisted placement of brachytherapy applicators using electromagnetic tracking (EMT) technology that has been registered to CT or MRI images. The system provides real-time localization of needles during the insertion process, a three-dimensional display of planned needle sites, visibility of the anatomy and needle position during placement, and reference tracking to account for generator or target anatomy shifts. Such a system might be used to reduce brachytherapy procedure times, improve correspondence between intended and actual needle positions, or decrease the trainee learning curve. The system is notable for the following features: 1) Real-time visual and quantitative feedback of needle placement with respect to the underlying anatomy, as visualized by MRI or CT image, without continuous or repeated imaging 2) Pre-planning capability with a graphical overlay of target needle trajectories 3) Reference tracking to account for electromagnetic field generator or target anatomy shifts 4) DICOM-coordinate digital reconstruction of applicator locations for treatment planning and/or pre-treatment quality assurance 5) Compatibility with standard brachytherapy workflows including fixed table CT and MRI systems, procedures within or outside of a brachy suite, and insertion of needles in dorsal lithotomy position 6) Consists of commercially available EMT technology components</div></div><div><h3>Methods</h3><div>The system was constructed using an Aurora (Northern Digital Instruments, Waterloo, ON) planar 20 × 20 cm<sup>2</sup> field generator (EFG), System Control Unit, Sensor Interface Unit, and 6DOF and 5DOF Flextube sensor tools. The graphical user interface was written as a Matlab application with native functions and toolboxes. EMT-to-DICOM registration was based upon intracavitary applicators (e.g., tandem and ovoids), placed prior to imaging and digitized automatically using thresholding methods. The EFG was positioned above the pelvis (Figure 1A), EMT sensors were translated through the tandem and ovoid channels, and the EMT system was registered to the DICOM image set using an iterative closest-point algorithm. Next, a 5DOF EMT sensor was loaded into the distal inner lumen of a brachytherapy needle for placement. The system display provides axial, coronal, sagittal, and 3D-volumetric CT/MRI views. Proof-of concept and system accuracy were evaluated in phantom and human cadaver by comparing EM-tracked needle positions with ground-truth, post-implant CTs.</div></div><div><h3>Results</h3><div>Proof of concept was demonstrated for EMT-assisted placement of brachytherapy needles in a realistic clinical environment and on a brachy suite CT table. Figure 1B provides an example of how a pre-planned needle location (blue) can be visualized alongside real-time needle placement (red) to provide feedback to the user. The left-hand panel in Figure 1B shows an initial attempt where a ","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S48-S49"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527074","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.037
Zepaer Abudureheman MBBA , Tao Zhu MBBA , Dengyao Liu M.D., Ph.D.
Purpose
The study aimed to evaluate the combined efficacy of systemic therapy and iodine-125 seed implantation as a local treatment in patients with oligometastatic non-small cell lung cancer (NSCLC), defined by ≤3 metastatic organs and ≤5 metastatic lesions, and to identify factors that influence patient outcomes.
Materials and Methods
A retrospective review was conducted of 40 patients with oligometastatic NSCLC treated from January 2018 to June 2023 at our institution. Patients were divided into Group A (n=20), receiving both systemic therapy and iodine-125 seed implantation, and Group B (n=20), treated with systemic therapy alone. The primary outcome was progression-free survival (PFS), with overall survival (OS) serving as a secondary outcome. Survival analysis for PFS and OS was performed using Kaplan-Meier curves, with the Log-rank test for intergroup comparisons, and Cox regression analysis was used for univariate and multivariate analyses.
Results
The median PFS for Group A was 14.9 months (95% CI: 12.8-17.0), which was significantly longer than the 6.9 months (95% CI: 4.7-9.1) for Group B (HR=6.50, 95% CI: 4.60-9.20). The median OS was 28.7 months (95% CI: 19.5-37.9) for Group A, surpassing the 17.0 months (95% CI: 13.5-20.5) for Group B (HR=1.60, 95% CI: 1.05-2.40). Multivariate analysis highlighted intracranial metastasis as a significant risk factor for PFS. Influential factors for OS included oligometastatic status, the presence of brain metastases, histologic subtype, the use of immune checkpoint inhibitors (ICIs), driver mutations, anti-angiogenic treatments, and the implementation of iodine-125 seed implantation for local therapy.
Conclusion
In patients with oligometastatic NSCLC and stable primary lesions, the integration of systemic therapy with iodine-125 seed implantation markedly improves PFS and OS compared to systemic therapy alone. This underscores the value of iodine-125 seed implantation in the comprehensive treatment strategy, highlighting its significant role in enhancing patient survival outcomes.
{"title":"MSOR3 Presentation Time: 5:10 PM","authors":"Zepaer Abudureheman MBBA , Tao Zhu MBBA , Dengyao Liu M.D., Ph.D.","doi":"10.1016/j.brachy.2024.08.037","DOIUrl":"10.1016/j.brachy.2024.08.037","url":null,"abstract":"<div><h3>Purpose</h3><div>The study aimed to evaluate the combined efficacy of systemic therapy and iodine-125 seed implantation as a local treatment in patients with oligometastatic non-small cell lung cancer (NSCLC), defined by ≤3 metastatic organs and ≤5 metastatic lesions, and to identify factors that influence patient outcomes.</div></div><div><h3>Materials and Methods</h3><div>A retrospective review was conducted of 40 patients with oligometastatic NSCLC treated from January 2018 to June 2023 at our institution. Patients were divided into Group A (n=20), receiving both systemic therapy and iodine-125 seed implantation, and Group B (n=20), treated with systemic therapy alone. The primary outcome was progression-free survival (PFS), with overall survival (OS) serving as a secondary outcome. Survival analysis for PFS and OS was performed using Kaplan-Meier curves, with the Log-rank test for intergroup comparisons, and Cox regression analysis was used for univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>The median PFS for Group A was 14.9 months (95% CI: 12.8-17.0), which was significantly longer than the 6.9 months (95% CI: 4.7-9.1) for Group B (HR=6.50, 95% CI: 4.60-9.20). The median OS was 28.7 months (95% CI: 19.5-37.9) for Group A, surpassing the 17.0 months (95% CI: 13.5-20.5) for Group B (HR=1.60, 95% CI: 1.05-2.40). Multivariate analysis highlighted intracranial metastasis as a significant risk factor for PFS. Influential factors for OS included oligometastatic status, the presence of brain metastases, histologic subtype, the use of immune checkpoint inhibitors (ICIs), driver mutations, anti-angiogenic treatments, and the implementation of iodine-125 seed implantation for local therapy.</div></div><div><h3>Conclusion</h3><div>In patients with oligometastatic NSCLC and stable primary lesions, the integration of systemic therapy with iodine-125 seed implantation markedly improves PFS and OS compared to systemic therapy alone. This underscores the value of iodine-125 seed implantation in the comprehensive treatment strategy, highlighting its significant role in enhancing patient survival outcomes.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S36-S37"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526608","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.005
Umhes Mahantshetty MD , Lavanya Gurram MD , Raviteja Miriyala MD , KK. Sreelakshmi DRP , Ajeet Gandhi MD , Abhishek Basu MD , Harjot Kaur Bajwa MD , Bhavana Rai MD , V Srinivasan MD , Manoj Gupta MD , Rajesh Vashishta MD , Primoz Petric MD , Kari Tanderup PhD , Christian Kirisits Ph.D , Richard Potter MD
Purpose
Six teaching courses with focus on 3D IGABT for cervical cancer were conducted in India between 2017 & 2023, as collaborative effort of AROI and ESTRO. The purpose is to report impact of teaching courses, as observed from pre-course surveys and a recent master survey of all course participants.
Material and Methods
Pre-course surveys were conducted before each of the six courses, where in information related to pre-course BT practice of each participating team (physician and physicist) was collected. Recently, a detailed online master survey was conducted to understand impact of courses on BT approach and practice.
Results
A total of 456 participants (344 physicians and 112 physicists) who were responsible for treating cervical cancer patients attended the courses. As per pre-course surveys, BT planning was frequently done using X rays, CT and MRI by 25%, 75% and 10% of participants respectively. Hybrid IC+IS and 3D dose prescription (to high-risk CTV) were commonly used by 31% and 35% participants. Among 456 participants, 104 teams (one team per institute was allowed to respond) from 104 centres responded (83 physicians and 21 physicists). Of these, 101 (97.1%) continued to practice cervical cancer brachytherapy at the time of the survey. Percentage-wise implementation/utilisation of various critical processes/resources in cervical cancer brachytherapy workflow at the time of master survey are presented in Figure 1 (upper panel).Teaching course empowered participants in implementing/ improvising critical processes, like examination under anaesthesia (14%), clinical drawings (55%), ultrasound guidance (23%), IC+IS (32%), target volume delineation (46%) & volume-based prescription (39%); however, these processes could be sustained in 8%, 32%, 17%, 25%, 41% and 33% centres, respectively,. (FIgure1 lower panel). Frequent reasons cited for inability to implement and sustain these critical processes include heavy patient load, lack of availability of infrastructure (dedicated ultrasonography, compatible applicators, access to MRI etc), suboptimal human resources (Anesthesiologists, Radiologists, Radiation Oncologists) etc.Among the participants, 94% and 87% felt that their knowledge and practice of BT improved substantially after the course, respectively. About 94% of the participants expressed interest in collaborative prospective research related to IGABT for cervical cancer.
Conclusion
Survey results suggest that the teaching courses substantially improved clinical workflow, use of ultrasonography for guidance, utilisation of pre-BT MR/MR/CT-TRUS based BT, advanced BT applications (IC + IS), target volume delineation and volumetric dose prescription. Majority of centres appear to be interested in exploring prospective research related to IGABT.
{"title":"GPP03 Presentation Time: 9:18 AM","authors":"Umhes Mahantshetty MD , Lavanya Gurram MD , Raviteja Miriyala MD , KK. Sreelakshmi DRP , Ajeet Gandhi MD , Abhishek Basu MD , Harjot Kaur Bajwa MD , Bhavana Rai MD , V Srinivasan MD , Manoj Gupta MD , Rajesh Vashishta MD , Primoz Petric MD , Kari Tanderup PhD , Christian Kirisits Ph.D , Richard Potter MD","doi":"10.1016/j.brachy.2024.08.005","DOIUrl":"10.1016/j.brachy.2024.08.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Six teaching courses with focus on 3D IGABT for cervical cancer were conducted in India between 2017 & 2023, as collaborative effort of AROI and ESTRO. The purpose is to report impact of teaching courses, as observed from pre-course surveys and a recent master survey of all course participants.</div></div><div><h3>Material and Methods</h3><div>Pre-course surveys were conducted before each of the six courses, where in information related to pre-course BT practice of each participating team (physician and physicist) was collected. Recently, a detailed online master survey was conducted to understand impact of courses on BT approach and practice.</div></div><div><h3>Results</h3><div>A total of 456 participants (344 physicians and 112 physicists) who were responsible for treating cervical cancer patients attended the courses. As per pre-course surveys, BT planning was frequently done using X rays, CT and MRI by 25%, 75% and 10% of participants respectively. Hybrid IC+IS and 3D dose prescription (to high-risk CTV) were commonly used by 31% and 35% participants. Among 456 participants, 104 teams (one team per institute was allowed to respond) from 104 centres responded (83 physicians and 21 physicists). Of these, 101 (97.1%) continued to practice cervical cancer brachytherapy at the time of the survey. Percentage-wise implementation/utilisation of various critical processes/resources in cervical cancer brachytherapy workflow at the time of master survey are presented in <strong>Figure 1</strong> (upper panel).Teaching course empowered participants in implementing/ improvising critical processes, like examination under anaesthesia (14%), clinical drawings (55%), ultrasound guidance (23%), IC+IS (32%), target volume delineation (46%) & volume-based prescription (39%); however, these processes could be sustained in 8%, 32%, 17%, 25%, 41% and 33% centres, respectively,. (FIgure1 lower panel). Frequent reasons cited for inability to implement and sustain these critical processes include heavy patient load, lack of availability of infrastructure (dedicated ultrasonography, compatible applicators, access to MRI etc), suboptimal human resources (Anesthesiologists, Radiologists, Radiation Oncologists) etc.Among the participants, 94% and 87% felt that their knowledge and practice of BT improved substantially after the course, respectively. About 94% of the participants expressed interest in collaborative prospective research related to IGABT for cervical cancer.</div></div><div><h3>Conclusion</h3><div>Survey results suggest that the teaching courses substantially improved clinical workflow, use of ultrasonography for guidance, utilisation of pre-BT MR/MR/CT-TRUS based BT, advanced BT applications (IC + IS), target volume delineation and volumetric dose prescription. Majority of centres appear to be interested in exploring prospective research related to IGABT.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Page S17"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526613","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 : 2024-10-25DOI: 10.1016/j.brachy.2024.08.018
Elena Dizendorf MD, PhD , Alina Sturdza MD
<div><h3>Purpose</h3><div>Education in brachytherapy (BT) is multidisciplinary and has multiple facets; industry plays here also a pivotal role. As image-guided brachytherapy (IGBT) experiences a rapid growth, companies are increasingly receiving requests from customers seeking education and practical skill training. Traditional product training for BT equipment is insufficient in addressing the educational requirements for IGBT. The objective of this study was to analyze the live clinical workshops (WS) conducted by the BrachyAcademy (BA) with the aim of enhancing the adoption of IGBT among radiation therapy professionals. Additionally, the study sought to evaluate the influence of BA WS on the clinical practice of the participants.</div></div><div><h3>Materials and Methods</h3><div>The BA WS is designed for a limited group, typically a maximum of 10-20 participants. The workshop program, spanning 2 or 3 days, usually includes live observation of BT cases in the operating theater, hands-on training covering applicator/needles/catheters insertion, contouring, and treatment planning (TP), as well as lectures and discussions. The WS faculty comprises Radiation Oncologists (RO) and Medical Physicists (MP) from the hosting hospital, along with invited clinical experts. We gathered and examined data of the live clinical BA WS in hospitals globally from 2008 to 2023. In March 2020, BA initiated a survey to gather feedback from participants of the previous live WS. The survey sought insights into the workshop impact on their clinical practice.</div></div><div><h3>Results</h3><div>The inaugural BA WS, titled “IGBT for gynecology using the combined intracavitary/interstitial technique”, took place in July 2008 in collaboration with a reputable institution. Subsequently, a total of 28 gynecological workshops have been organized in the same place. These WS attracted 435 participants from 47 countries, including 243 RO, 179 MP, and 13 Radiation Therapy Technologists (RTT), who provided highly positive evaluations. Between 2008 and 2023, BrachyAcademy organized a total of 117 live clinical workshops (including the gynae workshops mentioned above), as illustrated in Figure 1, showcasing the distribution of WS based on BT indication and location. The reduced number of WS in 2020-2021 was a consequence of the COVID-19 pandemic. Over the 15-year period, the total number of WS by BT indication was as follows: gynecological - 53, prostate - 28, breast - 13, skin - 13, general BT for residents - 4, bladder - 3, rectal - 2, head and neck - 1. Geographically, the WS were distributed as follows: Europe - 68, North America - 30, Asia - 17, Africa - 1, Australia - 1. Based on 933 available evaluation forms filled by EG WS participants, 59% attendees rated their achievement of learning objectives as “very good,” while 39% rated it as “good”, and 2% as “neutral". The overall workshop satisfaction score was 9 out of 10. In 2020, we received feedback on the survey from 64 pa
{"title":"MPP04 Presentation Time: 4:27 PM","authors":"Elena Dizendorf MD, PhD , Alina Sturdza MD","doi":"10.1016/j.brachy.2024.08.018","DOIUrl":"10.1016/j.brachy.2024.08.018","url":null,"abstract":"<div><h3>Purpose</h3><div>Education in brachytherapy (BT) is multidisciplinary and has multiple facets; industry plays here also a pivotal role. As image-guided brachytherapy (IGBT) experiences a rapid growth, companies are increasingly receiving requests from customers seeking education and practical skill training. Traditional product training for BT equipment is insufficient in addressing the educational requirements for IGBT. The objective of this study was to analyze the live clinical workshops (WS) conducted by the BrachyAcademy (BA) with the aim of enhancing the adoption of IGBT among radiation therapy professionals. Additionally, the study sought to evaluate the influence of BA WS on the clinical practice of the participants.</div></div><div><h3>Materials and Methods</h3><div>The BA WS is designed for a limited group, typically a maximum of 10-20 participants. The workshop program, spanning 2 or 3 days, usually includes live observation of BT cases in the operating theater, hands-on training covering applicator/needles/catheters insertion, contouring, and treatment planning (TP), as well as lectures and discussions. The WS faculty comprises Radiation Oncologists (RO) and Medical Physicists (MP) from the hosting hospital, along with invited clinical experts. We gathered and examined data of the live clinical BA WS in hospitals globally from 2008 to 2023. In March 2020, BA initiated a survey to gather feedback from participants of the previous live WS. The survey sought insights into the workshop impact on their clinical practice.</div></div><div><h3>Results</h3><div>The inaugural BA WS, titled “IGBT for gynecology using the combined intracavitary/interstitial technique”, took place in July 2008 in collaboration with a reputable institution. Subsequently, a total of 28 gynecological workshops have been organized in the same place. These WS attracted 435 participants from 47 countries, including 243 RO, 179 MP, and 13 Radiation Therapy Technologists (RTT), who provided highly positive evaluations. Between 2008 and 2023, BrachyAcademy organized a total of 117 live clinical workshops (including the gynae workshops mentioned above), as illustrated in Figure 1, showcasing the distribution of WS based on BT indication and location. The reduced number of WS in 2020-2021 was a consequence of the COVID-19 pandemic. Over the 15-year period, the total number of WS by BT indication was as follows: gynecological - 53, prostate - 28, breast - 13, skin - 13, general BT for residents - 4, bladder - 3, rectal - 2, head and neck - 1. Geographically, the WS were distributed as follows: Europe - 68, North America - 30, Asia - 17, Africa - 1, Australia - 1. Based on 933 available evaluation forms filled by EG WS participants, 59% attendees rated their achievement of learning objectives as “very good,” while 39% rated it as “good”, and 2% as “neutral\". The overall workshop satisfaction score was 9 out of 10. In 2020, we received feedback on the survey from 64 pa","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"23 6","pages":"Pages S25-S26"},"PeriodicalIF":1.7,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142526618","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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