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Koprivec D, Belanger C, Beaulieu L, Chatigny PY, Rosenfeld A, Cutajar D, Petasecca M, Howie A, Bucci J, Poder J. Development of patient and catheter specific error thresholds for high dose rate prostate brachytherapy. Med Phys 2024; 51:2144-2154. [PMID: 38308854 DOI: 10.1002/mp.16971] [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: 05/16/2023] [Revised: 12/21/2023] [Accepted: 01/14/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND In-vivo source tracking has been an active topic of research in the field of high-dose rate brachytherapy in recent years to verify accuracy in treatment delivery. Although detection systems for source tracking are being developed, the allowable threshold of treatment error is still unknown and is likely patient-specific due to anatomy and planning variation. PURPOSE The purpose of this study was to determine patient and catheter-specific shift error thresholds for in-vivo source tracking during high-dose-rate prostate brachytherapy (HDRPBT). METHODS A module was developed in the previously described graphical processor unit multi-criteria optimization (gMCO) algorithm. The module generates systematic catheter shift errors retrospectively into HDRPBT treatment plans, performed on 50 patients. The catheter shift model iterates through the number of catheters shifted in the plan (from 1 to all catheters), the direction of shift (superior, inferior, medial, lateral, cranial, and caudal), and the magnitude of catheter shift (1-6 mm). For each combination of these parameters, 200 error plans were generated, randomly selecting the catheters in the plan to shift. After shifts were applied, dose volume histogram (DVH) parameters were re-calculated. Catheter shift thresholds were then derived based on plans where DVH parameters were clinically unacceptable (prostate V100 < 95%, urethra D0.1cc > 118%, and rectum Dmax > 80%). Catheter thresholds were also Pearson correlated to catheter robustness values. RESULTS Patient-specific thresholds varied between 1 to 6 mm for all organs, in all shift directions. Overall, patient-specific thresholds typically decrease with an increasing number of catheters shifted. Anterior and inferior directions were less sensitive than other directions. Pearson's correlation test showed a strong correlation between catheter robustness and catheter thresholds for the rectum and urethra, with correlation values of -0.81 and -0.74, respectively (p < 0.01), but no correlation was found for the prostate. CONCLUSIONS It was possible to determine thresholds for each patient, with thresholds showing dependence on shift direction, and number of catheters shifted. Not every catheter combination is explorable, however, this study shows the feasibility to determine patient-specific thresholds for clinical application. The correlation of patient-specific thresholds with the equivalent robustness value indicated the need for robustness consideration during plan optimization and treatment planning.
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Affiliation(s)
- Dylan Koprivec
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Cedric Belanger
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Luc Beaulieu
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Philippe Y Chatigny
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Canada
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Canada
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Dean Cutajar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Andrew Howie
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Joseph Bucci
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Joel Poder
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- St George Cancer Care Centre, Kogarah, New South Wales, Australia
- School of Physics, University of Sydney, Camperdown, New South Wales, Australia
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van Wagenberg T, Fonseca GP, Voncken R, van Beveren C, van Limbergen E, Lutgens L, Vanneste BGL, Berbee M, Reniers B, Verhaegen F. Treatment verification in high dose rate brachytherapy using a realistic 3D printed head phantom and an imaging panel. Brachytherapy 2023; 22:269-278. [PMID: 36631373 DOI: 10.1016/j.brachy.2022.11.012] [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: 06/15/2022] [Revised: 10/24/2022] [Accepted: 11/26/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Even though High Dose Rate (HDR) brachytherapy has good treatment outcomes in different treatment sites, treatment verification is far from widely implemented because of a lack of easily available solutions. Previously it has been shown that an imaging panel (IP) near the patient can be used to determine treatment parameters such as the dwell time and source positions in a single material pelvic phantom. In this study we will use a heterogeneous head phantom to test this IP approach, and simulate common treatment errors to assess the sensitivity and specificity of the error-detecting capabilities of the IP. METHODS AND MATERIALS A heterogeneous head-phantom consisting of soft tissue and bone equivalent materials was 3D-printed to simulate a base of tongue treatment. An High Dose Rate treatment plan with 3 different catheters was used to simulate a treatment delivery, using dwell times ranging from 0.3 s to 4 s and inter-dwell distances of 2 mm. The IP was used to measure dwell times, positions and detect simulated errors. Measured dwell times and positions were used to calculate the delivered dose. RESULTS Dwell times could be determined within 0.1 s. Source positions were measured with submillimeter accuracy in the plane of the IP, and average distance accuracy of 1.7 mm in three dimensions. All simulated treatment errors (catheter swap, catheter shift, afterloader errors) were detected. Dose calculations show slightly different distributions with the measured dwell positions and dwell times (gamma pass rate for 1 mm/1% of 96.5%). CONCLUSIONS Using an IP, it was possible to verify the treatment in a realistic heterogeneous phantom and detect certain treatment errors.
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Affiliation(s)
- Teun van Wagenberg
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Gabriel Paiva Fonseca
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Robert Voncken
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Celine van Beveren
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evert van Limbergen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ludy Lutgens
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ben G L Vanneste
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Human Structure and Repair; Department of Radiation Oncology, Ghent University Hospital, Gent, Belgium
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Brigitte Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.
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Wilby S, Palmer A, Polak W, Bucchi A. A review of brachytherapy physical phantoms developed over the last 20 years: clinical purpose and future requirements. J Contemp Brachytherapy 2021; 13:101-115. [PMID: 34025743 PMCID: PMC8117707 DOI: 10.5114/jcb.2021.103593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/13/2020] [Indexed: 12/04/2022] Open
Abstract
Within the brachytherapy community, many phantoms are constructed in-house, and less commercial development is observed as compared to the field of external beam. Computational or virtual phantom design has seen considerable growth; however, physical phantoms are beneficial for brachytherapy, in which quality is dependent on physical processes, such as accuracy of source placement. Focusing on the design of physical phantoms, this review paper presents a summary of brachytherapy specific phantoms in published journal articles over the last twenty years (January 1, 2000 - December 31, 2019). The papers were analyzed and tabulated by their primary clinical purpose, which was deduced from their associated publications. A substantial body of work has been published on phantom designs from the brachytherapy community, but a standardized method of reporting technical aspects of the phantoms is lacking. In-house phantom development demonstrates an increasing interest in magnetic resonance (MR) tissue mimicking materials, which is not yet reflected in commercial phantoms available for brachytherapy. The evaluation of phantom design provides insight into the way, in which brachytherapy practice has changed over time, and demonstrates the customised and broad nature of treatments offered.
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Affiliation(s)
- Sarah Wilby
- Department of Radiotherapy Physics, Clinical Hematology, and Oncology Centre, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, United Kingdom
- Department of Mechanical Engineering, Faculty of Technology University of Portsmouth, Portsmouth, United Kingdom
| | - Antony Palmer
- Department of Radiotherapy Physics, Clinical Hematology, and Oncology Centre, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, United Kingdom
- Department of Mechanical Engineering, Faculty of Technology University of Portsmouth, Portsmouth, United Kingdom
| | - Wojciech Polak
- Department of Radiotherapy Physics, Clinical Hematology, and Oncology Centre, Portsmouth Hospitals NHS Trust, Cosham, Portsmouth, United Kingdom
- Department of Mechanical Engineering, Faculty of Technology University of Portsmouth, Portsmouth, United Kingdom
| | - Andrea Bucchi
- Department of Mechanical Engineering, Faculty of Technology University of Portsmouth, Portsmouth, United Kingdom
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Guthier CV, Devlin PM, Harris TC, O'Farrell DA, Cormack RA, Buzurovic I. Development and clinical implementation of semi-automated treatment planning including 3D printable applicator holders in complex skin brachytherapy. Med Phys 2020; 47:869-879. [PMID: 31855280 DOI: 10.1002/mp.13975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE High-dose-rate brachytherapy (HDR-BT) is a treatment option for malignant skin diseases compared to external beam radiation therapy, HDR-BT provides improved target coverage, better organ sparing, and has comparable treatment times. This is especially true for large clinical targets with complex topologies. To standardize and improve the quality and efficacy of the treatments, a novel streamlined treatment approach in complex skin HDR-BT was developed and implemented. This approach consists of auto generated treatment plans and a 3D printable applicator holder (3D-AH). MATERIALS AND METHODS The in-house developed planning system automatically segments computed tomography simulation images (a), optimizes a treatment plan (b), and generates a model of the 3D-AH (c). The 3D-AH is used as an immobilization device for the flexible Freiburg flap applicator used to deliver treatment. The developed, automated planning is compared against the standard clinical plan generation process for a flat 10 × 10 cm2 field, curved fields with radii of 4, 6, and 8 cm, and a representative clinical case. The quality of the 3D print is verified via an additional CT of the flap applicator latched into the holder, followed by an automated rigid registration with the original planning CT. Finally, the methodology is implemented and tested clinically under an IRB approval. RESULTS All automatically generated plans were reviewed and accepted for clinical use. For the clinical workflow, the coverage achieved at a prescription depth for the flat 4, 6, and 8 cm applicator was (100.0 ± 4.9)%, (100.0 ± 4.9)%, (96.0 ± 0.3)%, and (98.4 ± 0.3)%, respectively. For auto planning, the coverage was (99.9 ± 0.3)%, (100.0 ± 0.2)%, (100.0 ± 0.3)%, and (100.1 ± 0.2)%. For the clinical test case, the D90 for the clinical workflow and auto planning was found to be 93.5% and 100.29% of the prescribed dose, respectively. Processing of the patient's CT to generate trajectories and positions as well as the 3D model of the applicator took <5 min. CONCLUSION This workflow automates time intensive catheter digitizing and treatment planning. Compared to printing full applicators, the use of 3D-AH reduces the complexity of the 3D prints, the amount of the material to be used, the time of 3D printing, and amount of quality assurance required. The proposed methodology improves the overall treatment plan quality in complex HDR-BT and impact patient treatment outcomes potentially.
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Affiliation(s)
- Christian V Guthier
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Phillip M Devlin
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Thomas C Harris
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Desmond A O'Farrell
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Robert A Cormack
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Ivan Buzurovic
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
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Poder J, Cutajar D, Guatelli S, Petasecca M, Howie A, Bucci J, Carrara M, Rosenfeld A. A Monte Carlo study on the feasibility of real-time in vivo source tracking during ultrasound based HDR prostate brachytherapy treatments. Phys Med 2019; 59:30-36. [DOI: 10.1016/j.ejmp.2019.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022] Open
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Romanyukha A, Carrara M, Mazzeo D, Tenconi C, Al-Salmani T, Poder J, Cutajar D, Fuduli I, Petasecca M, Bucci J, Cerrotta A, Pappalardi B, Piccolo F, Pignoli E, Rosenfeld A. An innovative gynecological HDR brachytherapy applicator system for treatment delivery and real-time verification. Phys Med 2019; 59:151-157. [DOI: 10.1016/j.ejmp.2019.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022] Open
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Miyahara Y, Hara Y, Nakashima H, Nishimura T, Itakura K, Inomata T, Kitagaki H. Performance evaluation of a direct-conversion flat-panel detector system in imaging and quality assurance for a high-dose-rate 192Ir source. Phys Med Biol 2018; 63:055017. [PMID: 29424364 DOI: 10.1088/1361-6560/aaae18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In high-dose-rate (HDR) brachytherapy, a direct-conversion flat-panel detector (d-FPD) clearly depicts a 192Ir source without image halation, even under the emission of high-energy gamma rays. However, it was unknown why iridium is visible when using a d-FPD. The purpose of this study was to clarify the reasons for visibility of the source core based on physical imaging characteristics, including the modulation transfer functions (MTF), noise power spectral (NPS), contrast transfer functions, and linearity of d-FPD to high-energy gamma rays. The acquired data included: x-rays, [X]; gamma rays, [γ]; dual rays (X + γ), [D], and subtracted data for depicting the source ([D] - [γ]). In the quality assurance (QA) test for the positional accuracy of a source core, the coordinates of each dwelling point were compared between the planned and actual source core positions using a CT/MR-compatible ovoid applicator and a Fletcher-Williamson applicator. The profile curves of [X] and ([D] - [γ]) matched well on MTF and NPS. The contrast resolutions of [D] and [X] were equivalent. A strongly positive linear correlation was found between the output data of [γ] and source strength (r 2 > 0.99). With regard to the accuracy of the source core position, the largest coordinate difference (3D distance) was noted at the maximum curvature of the CT/MR-compatible ovoid and Fletcher-Williamson applicators, showing 1.74 ± 0.02 mm and 1.01 ± 0.01 mm, respectively. A d-FPD system provides high-quality images of a source, even when high-energy gamma rays are emitted to the detector, and positional accuracy tests with clinical applicators are useful in identifying source positions (source movements) within the applicator for QA.
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Affiliation(s)
- Yoshinori Miyahara
- Department of Radiology, Shimane University Hospital, 89-1 Enya, Izumo, Shimane, Japan
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Smith RL, Hanlon M, Panettieri V, Millar JL, Matheson B, Haworth A, Franich RD. An integrated system for clinical treatment verification of HDR prostate brachytherapy combining source tracking with pretreatment imaging. Brachytherapy 2018; 17:111-121. [DOI: 10.1016/j.brachy.2017.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/29/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
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In vivo dose verification method in catheter based high dose rate brachytherapy. Phys Med 2017; 44:1-10. [DOI: 10.1016/j.ejmp.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 11/03/2017] [Accepted: 11/04/2017] [Indexed: 11/19/2022] Open
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