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Sethi A, Gros S, Brodin P, Ghavidel B, Chai X, Popovic M, Tomé WA, Trichter S, Yang X, Zhang H, Uhl V. Intraoperative radiation therapy with 50 kV x-rays: A multi-institutional review. J Appl Clin Med Phys 2024; 25:e14272. [PMID: 38279520 DOI: 10.1002/acm2.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/16/2023] [Accepted: 01/01/2024] [Indexed: 01/28/2024] Open
Abstract
This report covers clinical implementation of a low kV intraoperative radiation therapy (IORT) program with the INTRABEAM® System (Carl Zeiss Meditec AG, Jena, Germany). Based on collective user experience from eight institutions, we discuss best methods of INTRABEAM quality assurance (QA) tests, commissioning measurements, clinical workflow, treatment planning, and potential avenues for research. The guide provides pertinent background information and clinical justification for IORT. It describes the INTRABEAM system and commissioning measurements along with a TG100 risk management analysis to ensure safety and accuracy of the IORT program. Following safety checks, dosimetry measurements are performed for verification of field flatness and symmetry, x-ray output, and depth dose. Also discussed are dose linearity checks, beam isotropy, ion chamber measurements, calibration protocols, and in-vivo dosimetry with optically stimulated luminescence dosimeters OSLDs, and radiochromic film. Emphasis is placed on the importance of routine QA procedures (daily, monthly, and annual) performed at regular intervals for a successful IORT program. For safe and accurate dose delivery, tests of important components of IORT clinical workflow are emphasized, such as, dose prescription, pre-treatment QA, treatment setup, safety checks, radiation surveys, and independent checks of delivered dose. Challenges associated with in-vivo dose measurements are discussed, along with special treatment procedures and shielding requirements. The importance of treatment planning in IORT is reviewed with reference to a Monte Carlo-based commercial treatment planning system highlighting its main features and limitations. The report concludes with suggested topics for research including CT-based image-guided treatment planning and improved prescription dose accuracy. We hope that this multi-institutional report will serve as a guidance document on the clinical implementation and use of INTRABEAM IORT.
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Affiliation(s)
- Anil Sethi
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Sebastien Gros
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Beth Ghavidel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xuedong Chai
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
| | - Marija Popovic
- Department of Medical Physics, McGill University Health Center, Montreal, Quebec, Canada
| | - Wolfgang Axel Tomé
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Samuel Trichter
- Department of Radiation Oncology, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Valery Uhl
- Department of Radiation Oncology, Summit Medical Center, Emeryville, California, USA
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Mourtada F, Clement CH, Dauer LT, Baureus Koch C, Cosset JM, Doruff M, Damato A, Guedea F, Scalliet P, Thomadsen B, Pinillos-Ashton L, Small W. Occupational Radiological Protection in Brachytherapy. Ann ICRP 2021; 50:5-75. [PMID: 34503342 DOI: 10.1177/01466453211013514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Firas Mourtada
- Chief of Clinical Physics, ChristianaCare, Newark, Delaware.,President, American Brachytherapy Society
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Fulkerson RK, Perez‐Calatayud J, Ballester F, Buzurovic I, Kim Y, Niatsetski Y, Ouhib Z, Pai S, Rivard MJ, Rong Y, Siebert F, Thomadsen BR, Weigand F. Surface brachytherapy: Joint report of the AAPM and the GEC‐ESTRO Task Group No. 253. Med Phys 2020; 47:e951-e987. [DOI: 10.1002/mp.14436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Regina K. Fulkerson
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Jose Perez‐Calatayud
- Radiotherapy Department La Fe Hospital Valencia46026 Spain
- Radiotherapy Department Clinica Benidorm Alicante03501 Spain
| | - Facundo Ballester
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot46100 Spain
| | - Ivan Buzurovic
- Dana‐Farber/Brigham and Women’s Cancer Center Harvard Medical School Boston MA02115 USA
| | - Yongbok Kim
- Department of Radiation Oncology University of Arizona Tucson AZ85724 USA
| | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1 Veenendaal3903 DD Netherlands
| | - Zoubir Ouhib
- Radiation Oncology Department Lynn Regional Cancer CenterBoca Raton Community Hospital Boca Raton FL33486 USA
| | - Sujatha Pai
- Radion Inc. 20380 Town Center Lane, Suite 135 Cupertino CA95014 USA
| | - Mark J. Rivard
- Department of Radiation Oncology Alpert Medical School Brown University Providence RI02903 USA
| | - Yi Rong
- Department of Radiation Oncology University of California Davis Comprehensive Cancer Center Sacramento CA95817 USA
| | - Frank‐André Siebert
- UK S‐HCampus Kiel, Klinik fur Strahlentherapie (Radioonkologie) Arnold‐Heller‐Str. 3Haus 50 KielD‐24105 Germany
| | - Bruce R. Thomadsen
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Frank Weigand
- Carl Zeiss Meditec AG Rudolf‐Eber‐Straße 11 Oberkochen73447 Germany
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