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Rangarajan R. Vaginal Dose Reduction by Changing the Ovoid Loading Pattern in Image Guided Intracavitary Brachytherapy of Cervix. J Obstet Gynaecol India 2023; 73:179-184. [PMID: 38143988 PMCID: PMC10746660 DOI: 10.1007/s13224-023-01868-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/01/2023] [Indexed: 12/26/2023] Open
Abstract
Aim Locally advanced cervical cancer is frequently treated using a combination of external beam radiotherapy and brachytherapy. Radiotherapy often leads to vaginal morbidity, which poses a significant problem. This study aims to analyze the impact of reducing ovoid loading on dosimetry. Materials and methods We analyzed forty-five CT-based intracavitary brachytherapy plans from fifteen patients. Three plan sets were created for the 45 applications: a standard loading plan (A), a plan with reduced ovoid loading (B), and a tandem-only loading plan (C). We generated Dose-Volume Histograms and recorded dose volume parameters for the three plan sets. Results The D90 for the Clinical Target Volume (CTV) did not show significant differences among the three plan sets (p = 0.20). The average D90 values for plans A, B, and C were 8.15 Gy, 8.16 Gy, and 7.4 Gy, respectively. No statistically significant differences were observed in D2cc bladder (p = 0.09) (average values: 6.8 Gy, 6.5 Gy, and 5.9 Gy for plans A, B, and C, respectively) and D2cc sigmoid (p = 0.43) (average values: 2.8 Gy, 2.6 Gy, and 2.4 Gy, respectively) among the three plan sets. However, there was a statistically significant difference in D2cc rectum (p < 0.001) (average values: 4 Gy, 3.3 Gy, and 1.8 Gy, respectively), as well as in vaginal dose points (p < 0.001). Conclusion Reducing ovoid loading significantly decreased the doses to vaginal dose points and the rectum without compromising the dose to the Clinical Target Volume (CTV). Therefore, in carefully selected cases, the adoption of tandem-only loading or reduced ovoid loading could be considered to minimize vaginal morbidity following high dose rate intracavitary brachytherapy.
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Affiliation(s)
- Ramya Rangarajan
- Department of Radiation Oncology, Government Royapettah Hospital, 1, westcott road Royapettah, Chennai, 600014 India
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2
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Poder J, Radvan S, Howie A, Kasraei F, Parker A, Bucci J, Haworth A. Viability of focal dose escalation to prostate cancer intraprostatic lesions using HDR prostate brachytherapy. Brachytherapy 2023; 22:800-807. [PMID: 37748989 DOI: 10.1016/j.brachy.2023.09.001] [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: 05/07/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE This study aimed to determine the viability of focal dose escalation to prostate cancer intraprostatic lesions (IPLs) from multiparametric magnetic resonance (mpMRI) and prostate-specific membrane antigen positron emission tomography (PSMA-PET) images using high-dose-rate (HDR) prostate brachytherapy (pBT). METHODS AND MATERIALS Retrospective data from 20 patients treated with HDR pBT was utilized. The interobserver contouring variability of 5 observers was quantified using the dice similarity coefficient (DSC) and mean distance to agreement (MDA). Uncertainty in propagating IPL contours to trans-rectal ultrasound (TRUS) was quantified using a tissue equivalent prostate phantom. Feasibility of incorporating IPLs into HDR pBT planning was tested on retrospective patient data. RESULTS The average observer DSC was 0.65 (PSMA-PET) and 0.52 (mpMRI). The uncertainty in propagating IPL contours was 0.6 mm (PSMA-PET), and 0.4 mm (mpMRI). Uncertainties could be accounted for by expanding IPL contours by 2 mm to create IPL PTVs. The mean D98% achieved using HDR pBT was 166% and 135% for the IPL and IPL PTV contours, respectively. CONCLUSIONS Focal dose escalation to IPLs identified on either PSMA-PET or mpMRI is viable using TRUS-based HDR pBT. Utilizing HDR pBT allows dose escalation of up to 166% of the prescribed dose to the prostate.
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Affiliation(s)
- Joel Poder
- Department of Radiation Oncology, St George Hospital Cancer Care Centre, Kogarah, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; School of Physics, University of Sydney, Camperdown, NSW, Australia.
| | - Samantha Radvan
- School of Physics, University of Sydney, Camperdown, NSW, Australia
| | - Andrew Howie
- Department of Radiation Oncology, St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Farshad Kasraei
- Department of Radiation Oncology, St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Annaleise Parker
- Department of Radiation Oncology, St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Joseph Bucci
- Department of Radiation Oncology, St George Hospital Cancer Care Centre, Kogarah, NSW, Australia
| | - Annette Haworth
- School of Physics, University of Sydney, Camperdown, NSW, Australia
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3
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Sung S, Lee M, Choi HJ, Park H, Cheon BW, Min CH, Yeom YS, Kim H, You SH, Choi HJ. Feasibility of internal-source tracking with C-arm CT/SPECT imaging with limited-angle projection data for online in vivo dose verification in brachytherapy: A Monte Carlo simulation study. Brachytherapy 2023; 22:673-685. [PMID: 37301703 DOI: 10.1016/j.brachy.2023.05.003] [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: 10/01/2022] [Revised: 03/13/2023] [Accepted: 05/07/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE The current protocol for use of the image-guided adaptive brachytherapy (IGABT) procedure entails transport of a patient between the treatment room and the 3-D tomographic imaging room after implantation of the applicators in the body, which movement can cause position displacement of the applicator. Moreover, it is not possible to track 3-D radioactive source movement inside the body, even though there can be significant inter- and intra-fractional patient-setup changes. In this paper, therefore, we propose an online single-photon emission computed tomography (SPECT) imaging technique with a combined C-arm fluoroscopy X-ray system and attachable parallel-hole collimator for internal radioactive source tracking of every source position in the applicator. METHODS AND MATERIALS In the present study, using Geant4 Monte Carlo (MC) simulation, the feasibility of high-energy gamma detection with a flat-panel detector for X-ray imaging was assessed. Further, a parallel-hole collimator geometry was designed based on an evaluation of projection image quality for a 192Ir point source, and 3-D limited-angle SPECT-image-based source-tracking performances were evaluated for various source intensities and positions. RESULTS The detector module attached to the collimator could discriminate the 192Ir point source with about 3.4% detection efficiency when including the total counts in the entire deposited energy region. As the result of collimator optimization, hole size, thickness, and length were determined to be 0.5, 0.2, and 45 mm, respectively. Accordingly, the source intensities and positions also were successfully tracked with the 3-D SPECT imaging system when the C-arm was rotated within 110° in 2 seconds. CONCLUSIONS We expect that this system can be effectively implemented for online IGABT and in vivo patient dose verification.
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Affiliation(s)
- Saerom Sung
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Minjae Lee
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Hyung-Joo Choi
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Hyojun Park
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Bo-Wi Cheon
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Chul Hee Min
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Yeon Soo Yeom
- Department of Radiation Convergence Engineering, Yonsei University, Wonju-si, Gangwon-do, Republic of Korea
| | - Hyemi Kim
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea
| | - Sei Hwan You
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea
| | - Hyun Joon Choi
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju-si, Gangwon-do, Republic of Korea.
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4
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Patterson E, Stokes P, Cutajar D, Rosenfeld A, Baines J, Metcalfe P, Powers M. High-resolution entry and exit surface dosimetry in a 1.5 T MR-linac. Phys Eng Sci Med 2023; 46:787-800. [PMID: 36988905 DOI: 10.1007/s13246-023-01251-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Abstract
The magnetic field of a transverse MR-linac alters electron trajectories as the photon beam transits through materials, causing lower doses at flat entry surfaces and increased doses at flat beam-exiting surfaces. This study investigated the response of a MOSFET detector, known as the MOSkin™, for high-resolution surface and near-surface percentage depth dose measurements on an Elekta Unity. Simulations with Geant4 and the Monaco treatment planning system (TPS), and EBT-3 film measurements, were also performed for comparison. Measured MOSkin™ entry surface doses, relative to Dmax, were (9.9 ± 0.2)%, (10.1 ± 0.3)%, (11.3 ± 0.6)%, (12.9 ± 1.0)%, and (13.4 ± 1.0)% for 1 × 1 cm2, 3 × 3 cm2, 5 × 5 cm2, 10 × 10 cm2, and 22 × 22 cm2 fields, respectively. For the investigated fields, the maximum percent differences of Geant4, TPS, and film doses extrapolated and interpolated to a depth suitable for skin dose assessment at the beam entry, relative to MOSkin™ measurements at an equivalent depth were 1.0%, 2.8%, and 14.3%, respectively, and at a WED of 199.67 mm at the beam exit, 3.2%, 3.7% and 5.7%, respectively. The largest measured increase in exit dose, due to the electron return effect, was 15.4% for the 10 × 10 cm2 field size using the MOSkin™ and 17.9% for the 22 × 22 cm2 field size, using Geant4 calculations. The results presented in the study validate the suitability of the MOSkin™ detector for transverse MR-linac surface dosimetry.
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Affiliation(s)
- E Patterson
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - P Stokes
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
| | - D Cutajar
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - A Rosenfeld
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - J Baines
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
- College of Science and Engineering, James Cook University, Townsville, QLD, Australia
| | - P Metcalfe
- Centre of Medical and Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Illawarra Health Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - M Powers
- Townsville Cancer Centre, Townsville Hospital and Health Service, Townsville, QLD, Australia
- College of Science and Engineering, James Cook University, Townsville, QLD, Australia
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5
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Strigari L, Marconi R, Solfaroli-Camillocci E. Evolution of Portable Sensors for In-Vivo Dose and Time-Activity Curve Monitoring as Tools for Personalized Dosimetry in Molecular Radiotherapy. SENSORS (BASEL, SWITZERLAND) 2023; 23:2599. [PMID: 36904802 PMCID: PMC10007630 DOI: 10.3390/s23052599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
Treatment personalization in Molecular Radiotherapy (MRT) relies on pre- and post-treatment SPECT/ PET-based images and measurements to obtain a patient-specific absorbed dose-rate distribution map and its evolution over time. Unfortunately, the number of time points that are available per patient to investigate individual pharmacokinetics is often reduced by limited patient compliance or SPECT or PET/CT scanner availability for dosimetry in busy departments. The adoption of portable sensors for in-vivo dose monitoring during the entire treatment could improve the assessment of individual biokinetics in MRT and, thus, the treatment personalization. The evolution of portable devices, non-SPECT/PET-based options, already used for monitoring radionuclide activity transit and accumulation during therapy with radionuclides (i.e., MRT or brachytherapy), is presented to identify valuable ones, which combined with conventional nuclear medicine imaging systems could be effective in MRT. External probes, integration dosimeters and active detecting systems were included in the study. The devices and their technology, the range of applications, the features and limitations are discussed. Our overview of the available technologies encourages research and development of portable devices and dedicated algorithms for MRT patient-specific biokinetics study. This would represent a crucial advancement towards personalized treatment in MRT.
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Affiliation(s)
- Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Giuseppe Massarenti 9, 40138 Bologna, Italy
| | - Raffaella Marconi
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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6
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Houlihan OA, Workman G, Hounsell AR, Prise KM, Jain S. In vivo dosimetry in pelvic brachytherapy. Br J Radiol 2022; 95:20220046. [PMID: 35635803 PMCID: PMC10996950 DOI: 10.1259/bjr.20220046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This paper describes the potential role for in vivo dosimetry in the reduction of uncertainties in pelvic brachytherapy, the pertinent factors for consideration in clinical practice, and the future potential for in vivo dosimetry in the personalisation of brachytherapy.
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Affiliation(s)
- Orla Anne Houlihan
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Geraldine Workman
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Alan R Hounsell
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Suneil Jain
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
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7
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Towards real time in-vivo rectal dosimetry during trans-rectal ultrasound based high dose rate prostate brachytherapy using MOSkin dosimeters. Radiother Oncol 2020; 151:273-279. [DOI: 10.1016/j.radonc.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/28/2023]
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8
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Fonseca GP, Johansen JG, Smith RL, Beaulieu L, Beddar S, Kertzscher G, Verhaegen F, Tanderup K. In vivo dosimetry in brachytherapy: Requirements and future directions for research, development, and clinical practice. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2020; 16:1-11. [PMID: 33458336 PMCID: PMC7807583 DOI: 10.1016/j.phro.2020.09.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
Brachytherapy can deliver high doses to the target while sparing healthy tissues due to its steep dose gradient leading to excellent clinical outcome. Treatment accuracy depends on several manual steps making brachytherapy susceptible to operational mistakes. Currently, treatment delivery verification is not routinely available and has led, in some cases, to systematic errors going unnoticed for years. The brachytherapy community promoted developments in in vivo dosimetry (IVD) through research groups and small companies. Although very few of the systems have been used clinically, it was demonstrated that the likelihood of detecting deviations from the treatment plan increases significantly with time-resolved methods. Time–resolved methods could interrupt a treatment avoiding gross errors which is not possible with time-integrated dosimetry. In addition, lower experimental uncertainties can be achieved by using source-tracking instead of direct dose measurements. However, the detector position in relation to the patient anatomy remains a main source of uncertainty. The next steps towards clinical implementation will require clinical trials and systematic reporting of errors and near-misses. It is of utmost importance for each IVD system that its sensitivity to different types of errors is well understood, so that end-users can select the most suitable method for their needs. This report aims to formulate requirements for the stakeholders (clinics, vendors, and researchers) to facilitate increased clinical use of IVD in brachytherapy. The report focuses on high dose-rate IVD in brachytherapy providing an overview and outlining the need for further development and research.
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Affiliation(s)
- Gabriel P Fonseca
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands
| | - Jacob G Johansen
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Ryan L Smith
- Alfred Health Radiation Oncology, Alfred Health, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Luc Beaulieu
- Department of Physics, Engineering Physics & Optics and Cancer Research Center, Université Laval, Quebec City, QC, Canada.,Department of Radiation Oncology, Research Center of CHU de Québec, Université Laval, Quebec City, QC, Canada
| | - Sam Beddar
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1420, Houston, TX 77030, United States
| | - Gustavo Kertzscher
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
| | - Frank Verhaegen
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, Doctor Tanslaan 12, 6229 ET Maastricht, the Netherlands
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus, Denmark
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Rosenfeld AB, Biasi G, Petasecca M, Lerch MLF, Villani G, Feygelman V. Semiconductor dosimetry in modern external-beam radiation therapy. Phys Med Biol 2020; 65:16TR01. [PMID: 32604077 DOI: 10.1088/1361-6560/aba163] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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10
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Error detection thresholds for routine real time in vivo dosimetry in HDR prostate brachytherapy. Radiother Oncol 2020; 149:38-43. [DOI: 10.1016/j.radonc.2020.04.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 01/11/2023]
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11
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Ruiz-Arrebola S, Fabregat-Borrás R, Rodríguez E, Fernández-Montes M, Pérez-Macho M, Ferri M, García A, Cardenal J, Pacheco MT, Anchuelo J, Tornero-López AM, Prada PJ, Guirado D. Characterization of microMOSFET detectors for in vivo dosimetry in high-dose-rate brachytherapy with 192 Ir. Med Phys 2020; 47:2242-2253. [PMID: 32031263 DOI: 10.1002/mp.14080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE The objective of this study was to characterize the Best Medical Canada microMOSFET detectors for their application in in vivo dosimetry for high-dose-rate brachytherapy (HDRBT) with 192 Ir. We also developed a mathematical model to correct dependencies under the measurement conditions of these detectors. METHODS We analyzed the linearity, reproducibility, and interdetector variability and studied the microMOSFET response dependence on temperature, source-detector distance, and angular orientation of the receptor with respect to the source. The correction model was applied to 19 measurements corresponding to five simulated treatments in a custom phantom specifically designed for this purpose. RESULTS The detectors (high bias applied in all measurements) showed excellent linearity up to 160 Gy. The response dependence on source-detector distance varied by (8.65 ± 0.06)% (k = 1) for distances between 1 and 7 cm, and the variation with temperature was (2.24 ± 0.05)% (k = 1) between 294 and 310 K. The response difference due to angular dependence can reach (10.3 ± 1.3)% (k = 1). For the set of measurements analyzed, regarding angular dependences, the mean difference between administered and measured doses was -4.17% (standard deviation of 3.4%); after application of the proposed correction model, the mean difference was -0.1% (standard deviation of 2.2%). For the treatments analyzed, the average difference between calculations and measures was 4.7% when only the calibration coefficient was used, but it is reduced to 0.9% when the correction model is applied. CONCLUSION Important response dependencies of microMOSFET detectors used for in vivo dosimetry in HDRBT treatments, especially the angular dependence, can be adequately characterized by a correction model that increases the accuracy of this system in clinical applications.
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Affiliation(s)
- Samuel Ruiz-Arrebola
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Rosa Fabregat-Borrás
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Eduardo Rodríguez
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Manuel Fernández-Montes
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Mercedes Pérez-Macho
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - María Ferri
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Ana García
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Juan Cardenal
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - María T Pacheco
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Javier Anchuelo
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Ana M Tornero-López
- Servicio de Radiofísica y Protección Radiológica, Hospital Universitario Dr. Negrín, Gran Canaria, Spain
| | - Pedro J Prada
- Marqués de Valdecilla University Hospital, Department of Radiation Oncology and Radiophysics, Santander, Spain
| | - Damián Guirado
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Hospital Clínico Universitario San Cecilio, Unidad de Radiofísica, Granada, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
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12
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Jamalludin Z, Jong W, Malik R, Rosenfeld A, Ung N. Evaluation of rectal dose discrepancies between planned and in vivo dosimetry using MOSkin detector and PTW 9112 semiconductor probe during 60Co HDR CT-based intracavitary cervix brachytherapy. Phys Med 2020; 69:52-60. [DOI: 10.1016/j.ejmp.2019.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022] Open
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13
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Jamalludin Z, Jong WL, Ho GF, Rosenfeld AB, Ung NM. In vivo dosimetry using MOSkin detector during Cobalt-60 high-dose-rate (HDR) brachytherapy of skin cancer. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:1099-1107. [PMID: 31650362 DOI: 10.1007/s13246-019-00809-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
The MOSkin, a metal-oxide semiconductor field-effect transistor based detector, is suitable for evaluating skin dose due to its water equivalent depth (WED) of 0.07 mm. This study evaluates doses received by target area and unavoidable normal skin during a the case of skin brachytherapy. The MOSkin was evaluated for its feasibility as detector of choice for in vivo dosimetry during skin brachytherapy. A high-dose rate Cobalt-60 brachytherapy source was administered to the tumour located at the medial aspect of the right arm, complicated with huge lymphedema thus limiting the arm motion. The source was positioned in the middle of patients' right arm with supine, hands down position. A 5 mm lead and 5 mm bolus were sandwiched between the medial aspect of the arm and lateral chest to reduce skin dose to the chest. Two calibrated MOSkin detectors were placed on the target and normal skin area for five treatment sessions for in vivo dose monitoring. The mean dose to the target area ranged between 19.9 and 21.1 Gy and was higher in comparison with the calculated dose due to contribution of backscattered dose from lead. The mean measured dose at normal skin chest area was 1.6 Gy (1.3-1.9 Gy), less than 2 Gy per fraction. Total dose in EQD2 received by chest skin was much lower than the recommended skin tolerance. The MOSkin detector presents a reliable real-time dose measurement. This study has confirmed the applicability of the MOSkin detector in monitoring skin dose during brachytherapy treatment due to its small sensitive volume and WED 0.07 mm.
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Affiliation(s)
- Z Jamalludin
- Medical Physics Unit, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - W L Jong
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - G F Ho
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - A B Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - N M Ung
- Department of Clinical Oncology, University of Malaya Medical Centre, 59100, Kuala Lumpur, Malaysia.
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
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14
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Tariq M, Gomez C, Riegel AC. Dosimetric impact of placement errors in optically stimulated luminescent in vivo dosimetry in radiotherapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 11:63-68. [PMID: 33458280 PMCID: PMC7807655 DOI: 10.1016/j.phro.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/02/2022]
Abstract
Introduction Studies have suggested that optically stimulated luminescent dosimeters (OSLDs) can be used for in vivo dosimetry of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Clinical uncertainties such as placement error have not been thoroughly investigated. The purpose of this work was to measure OSLD placement error in a clinical sample and analyze its dosimetric impact. Methods and materials The analysis consisted of three parts: first, quantification of placement error in a clinical sample of 128 patients yielding 293 cone-beam CT (CBCT) with visible OSLDs registered to the treatment plan; Second, correlation of placement error and clinical OSLD measurements; third, simulation of dosimeter placement in the treatment plan and correlation of recalculated dose with placement error. Results In the first analysis, average placement error was 9.7 ± 9.5 mm. In the second analysis, placement error and measured-to-planned dose agreement yielded no correlation (R2 = 0.02) for a subsample of 77 CBCTs of 55 head-and-neck patients. Average placement error was 7.0 ± 6.0 mm. Several factors, including image-guided shifts, introduced uncharacterized uncertainty to the measured-to-planned dose agreement. The third analysis isolated placement error from these other effects. Average dosimetric error was -2.4 ± 19.3%. Simulated dosimetric impact was weakly correlated with placement error (R2 = 0.39). Removing outliers reduced the average dosimetric error to -2.1 ± 10.9%, marginally improving the correlation (R2 = 0.44). Conclusion Placement error can substantially impact measured-to-planned dose agreement of OSLDs in high gradient regions, demonstrating the criticality of accurate dosimeter placement for IMRT and VMAT treatments.
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Affiliation(s)
- Mahin Tariq
- St. Peter's Health Partners, Albany, NY 12208, United States.,Hofstra University, Hempstead, NY 11549, United States.,Northwell Health, New Hyde Park, NY 11402, United States
| | - Cindy Gomez
- Hofstra University, Hempstead, NY 11549, United States
| | - Adam C Riegel
- Hofstra University, Hempstead, NY 11549, United States.,Northwell Health, New Hyde Park, NY 11402, United States.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States
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15
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Poder J, Carrara M, Howie A, Cutajar D, Bucci J, Rosenfeld A. Derivation of in vivo source tracking error thresholds for TRUS-based HDR prostate brachytherapy through simulation of source positioning errors. Brachytherapy 2019; 18:711-719. [DOI: 10.1016/j.brachy.2019.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/23/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
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16
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Dynamic Modulated Brachytherapy (DMBT) Balloon Applicator for Accelerated Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2019; 104:953-961. [PMID: 30910767 DOI: 10.1016/j.ijrobp.2019.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/07/2019] [Accepted: 03/17/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To propose a novel high-dose-rate brachytherapy applicator for balloon-based dynamic modulated brachytherapy (DMBT) for accelerated partial breast irradiation (APBI) and to demonstrate its dosimetric advantage compared to the widely used Contura applicator. METHODS AND MATERIALS The DMBT balloon device consists of a fixed central channel enabling real-time, in vivo dosimetry and an outer motion-dynamic, adjustable-radius channel capable of moving to any angular position within the balloon. This design allows placement of dwell positions anywhere within the balloon volume, guaranteeing optimal placement and generation of the applicator and treatment plan, respectively. Thirteen clinical treatment plans for patients with early-stage breast cancer receiving APBI after lumpectomy using Contura were retrospectively obtained under institutional review board approval. New treatment plans were created by replacing the Contura with the DMBT device. DMBT plans were limited to 4 angular positions and an outer channel radius of 1.5 cm. The new plans were optimized to limit dose to ribs and skin while maintaining target coverage similar to that of the clinical plan. RESULTS Similar target coverage was obtained for the DMBT plans compared with clinical Contura plans. Across all patients the mean (standard deviation) reductions in D0.1 cc to the ribs and skin were 6.70% (6.28%) and 5.13% (6.54%), respectively. A threshold separation distance between the balloon surface and the organ at risk (OAR), below which dosimetric changes of greater than 5% were obtained, was observed to be 12 mm for ribs and skin. When both OARs were far from the balloon, DMBT plans were of similar quality to Contura plans, as expected. CONCLUSIONS This study demonstrates the superior ability of the APBI DMBT applicator to spare OARs while achieving target coverage comparable to current treatment plans, especially when in close proximity. The DMBT balloon may enable new modes of dynamic high-dose-rate treatment delivery and allow for ultrahypofractionated dose regimens to be safely used.
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17
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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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18
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Jamalludin Z, Jong WL, Abdul Malik R, Rosenfeld A, Ung NM. Characterization of MOSkin detector for in vivo dose verification during Cobalt-60 high dose-rate intracavitary brachytherapy. Phys Med 2019; 58:1-7. [PMID: 30824140 DOI: 10.1016/j.ejmp.2019.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022] Open
Abstract
In vivo dosimetry in high dose-rate (HDR) intracavitary brachytherapy (ICBT) is important for assessing the true dose received by surrounding organs at risk during treatment. It also serves as part of the treatment delivery quality assurance and verification program with the use of a suitable dosimeter. Such a dosimeter should be characterized under brachytherapy conditions before clinical application to ensure the accuracy of in vivo measurement. In this study, a MOSFET-based detector, MOSkin, was calibrated and characterized under HDR Cobalt-60 (Co-60) brachytherapy source. MOSkin possessed the major advantages of having small physical and dosimetric sizes of 4.8 × 10-6 mm3 with the ability to provide real-time measurements. Using solid water and polymethyl methacrylate (PMMA) phantom, the detectors' reproducibility, linearity, angular and distance dependency was tested for its suitability as an in vivo detector. Correction factors to account for differences in depth measurements were determined. The MOSkin detector showed a reliable response when tested under Co-60 brachytherapy range of doses with an excellent linearity of R2 = 0.9997 and acceptable reproducibility. A phantom verification study was also conducted to verify the differences between MOSkin responses and treatment planning (TPS) calculated doses. By taking into account several correction factors, deviations ranging between 0.01 and 0.4 Gy were found between MOSkin measured and TPS doses at measurement distance of 20-55 mm. The use of MOSkin as the dosimeter of choice for in vivo dosimetry under Co-60 brachytherapy condition is feasible.
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Affiliation(s)
- Zulaikha Jamalludin
- Department of Clinical Oncology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia; Medical Physics Unit, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Wei Loong Jong
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Rozita Abdul Malik
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
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19
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Pittet P, Jalade P, Gindraux L, Guiral P, Wang R, Galvan JM, Lu GN. DoRGaN: Development of Quality Assurance and Quality Control Systems for High Dose Rate Brachytherapy Based on GaN Dosimetry Probes. Ing Rech Biomed 2018. [DOI: 10.1016/j.irbm.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Grisotto S, Cerrotta A, Pappalardi B, Carrara M, Messina A, Tenconi C, Valdagni R, Fallai C. Pre-implant magnetic resonance and transrectal ultrasound imaging in high-dose-rate prostate brachytherapy: comparison of prostate volumes, craniocaudal extents, and contours. J Contemp Brachytherapy 2018; 10:285-290. [PMID: 30237811 PMCID: PMC6142648 DOI: 10.5114/jcb.2018.77947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/17/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the prostate contours drawn by two radiation oncologists and one radiologist on magnetic resonance (MR) and transrectal ultrasound (TRUS) images. TRUS intra- and inter-fraction variability as well as TRUS vs. MR inter-modality and inter-operator variability were studied. MATERIAL AND METHODS Thirty patients affected by localized prostate cancer and treated with interstitial high-dose-rate (HDR) prostate brachytherapy at the National Cancer Institute in Milan were included in this study. Twenty-five patients received an exclusive two-fraction (14 Gy/fraction) treatment, while the other 5 received a single 14 Gy fraction as a boost after external beam radiotherapy. The prostate was contoured on TRUS images acquired before (virtual US) and after (real US) needle implant by two radiation oncologists, whereas on MR prostate was independently contoured by the same radiation oncologists (MR1, MR2) and by a dedicated radiologist (MR3). Absolute differences of prostate volumes (│ΔV│) and craniocaudal extents (│Δdz│) were evaluated. The Dice's coefficient (DC) was calculated to quantify spatial overlap between MR contours. RESULTS Significant difference was found between Vvirtual and Vlive (p < 0.001) for the first treatment fractions and between VMR1 and VMR2 (p = 0.043). Significant difference between cranio-caudal extents was found between dzvirtual and dzlive (p < 0.033) for the first treatment fractions, between dzvirtual of the first treatment fractions and dzMR1 (p < 0.001) and between dzMR1 and dzMR3 (p < 0.01). Oedema might be responsible for some of the changes in US volumes. Average DC values resulting from the comparison MR1 vs. MR2, MR1 vs. MR3 and MR2 vs. MR3 were 0.95 ± 0.04 (range, 0.82-0.99), 0.87 ± 0.04 (range, 0.73-0.91) and 0.87 ± 0.04 (range, 0.72-0.91), respectively. CONCLUSIONS Our results demonstrate the importance of a multiprofessional approach to TRUS-guided HDR prostate brachytherapy. Specific training in MR and US prostate imaging is recommended for centers that are unfamiliar with HDR prostate brachytherapy.
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Affiliation(s)
- Simone Grisotto
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Annamaria Cerrotta
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Brigida Pappalardi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Mauro Carrara
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Antonella Messina
- Diagnostic Imaging Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Chiara Tenconi
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Riccardo Valdagni
- Radiotherapy 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Prostate Program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Department of Medicine and Surgery, Universita’ degli Studi, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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21
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Jong W, Ung N, Tiong A, Rosenfeld A, Wong J. Characterisation of a MOSFET-based detector for dose measurement under megavoltage electron beam radiotherapy. Radiat Phys Chem Oxf Engl 1993 2018. [DOI: 10.1016/j.radphyschem.2017.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Pejović MM, Pejović SM. VDMOSFET as a prospective dosimeter for radiotherapy. Appl Radiat Isot 2018; 132:1-5. [DOI: 10.1016/j.apradiso.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 11/30/2022]
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23
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Johansen JG, Rylander S, Buus S, Bentzen L, Hokland SB, Søndergaard CS, With AKM, Kertzscher G, Tanderup K. Time-resolved in vivo dosimetry for source tracking in brachytherapy. Brachytherapy 2018; 17:122-132. [DOI: 10.1016/j.brachy.2017.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/25/2022]
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24
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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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25
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Romanyukha AA, Carrara M, Tenconi C, Mazzeo D, Rossi G, Borroni M, Pignoli E, Cerrotta A, Cutajar D, Petasecca M, Lerch M, Bucci J, Rosenfeld AB. Applications of MOSkin dosimeters for quality assurance in gynecological HDR brachytherapy: An in-phantom feasibility study. RADIAT MEAS 2017. [DOI: 10.1016/j.radmeas.2016.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Carrara M, Tenconi C, Mazzeo D, Romanyukha A, Borroni M, Pignoli E, Cutajar D, Petasecca M, Lerch M, Bucci J, Gambarini G, Cerrotta A, Fallai C, Rosenfeld A. Study of the correlation between rectal wall in vivo dosimetry performed with MOSkins and implant modification during TRUS-guided HDR prostate brachytherapy. RADIAT MEAS 2017. [DOI: 10.1016/j.radmeas.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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27
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Semiconductor real-time quality assurance dosimetry in brachytherapy. Brachytherapy 2017; 17:133-145. [PMID: 28964727 DOI: 10.1016/j.brachy.2017.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
With the increase in complexity of brachytherapy treatments, there has been a demand for the development of sophisticated devices for delivery verification. The Centre for Medical Radiation Physics (CMRP), University of Wollongong, has demonstrated the applicability of semiconductor devices to provide cost-effective real-time quality assurance for a wide range of brachytherapy treatment modalities. Semiconductor devices have shown great promise to the future of pretreatment and in vivo quality assurance in a wide range of brachytherapy treatments, from high-dose-rate (HDR) prostate procedures to eye plaque treatments. The aim of this article is to give an insight into several semiconductor-based dosimetry instruments developed by the CMRP. Applications of these instruments are provided for breast and rectal wall in vivo dosimetry in HDR brachytherapy, urethral in vivo dosimetry in prostate low-dose-rate (LDR) brachytherapy, quality assurance of HDR brachytherapy afterloaders, HDR pretreatment plan verification, and real-time verification of LDR and HDR source dwell positions.
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28
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Carrara M, Romanyukha A, Tenconi C, Mazzeo D, Cerrotta A, Borroni M, Cutajar D, Petasecca M, Lerch M, Bucci J, Richetti A, Presilla S, Fallai C, Gambarini G, Pignoli E, Rosenfeld A. Clinical application of MOSkin dosimeters to rectal wall in vivo dosimetry in gynecological HDR brachytherapy. Phys Med 2017; 41:5-12. [DOI: 10.1016/j.ejmp.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/27/2017] [Accepted: 05/01/2017] [Indexed: 10/19/2022] Open
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29
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Smith RL, Haworth A, Panettieri V, Millar JL, Franich RD. 3D catheter reconstruction in HDR prostate brachytherapy for pre-treatment verification using a flat panel detector. Phys Med 2017. [PMID: 28625472 DOI: 10.1016/j.ejmp.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE High dose rate prostate brachytherapy is a widely-practiced treatment, delivering large conformal doses in relatively few treatment fractions. Inter- and intra-fraction catheter displacements have been reported. Unrecognized displacement can have a significant impact on dosimetry. Knowledge of the implant geometry at the time of treatment is important for ensuring safe and effective treatment. In this work we demonstrate a method to reconstruct the catheter positions pre-treatment, using a 'shift' imaging technique, and perform registration with the treatment plan for verification relative to the prostate. METHODS Two oblique 'shift' images were acquired of a phantom containing brachytherapy catheters, representing the patient immediately pre-treatment. Using a back projection approach, the catheter paths were reconstructed in 3D and registered with the planned catheter paths. The robustness of the reconstruction and registration process was investigated as a function of phantom rotation. Catheter displacement detection was performed and compared to known applied displacements. RESULTS Reconstruction of the implant geometry in 3D immediately prior to treatment was achieved. A mean reconstruction uncertainty of 0.8mm was determined for all catheters with a mean registration uncertainty of 0.5mm. A catheter displacement detection threshold of 2.2mm was demonstrated. Catheter displacements were all detected to within 0.5mm of the applied displacements. CONCLUSION This technique is robust and sensitive to assess catheter displacements throughout the implant volume. This approach provides a method to detect, in 3D, changes in catheter positions relative to the prostate. The method has sufficient sensitivity to enable clinically significant decisions immediately prior to treatment delivery.
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Affiliation(s)
- Ryan L Smith
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia; School of Science, RMIT University, Melbourne 3000, VIC, Australia.
| | - Annette Haworth
- School of Science, RMIT University, Melbourne 3000, VIC, Australia; School of Physics, University of Sydney, Camperdown 2006, NSW, Australia
| | - Vanessa Panettieri
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia; School of Science, RMIT University, Melbourne 3000, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Rick D Franich
- School of Science, RMIT University, Melbourne 3000, VIC, Australia
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30
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Legge K, Greer PB, O'Connor DJ, Wilton L, Richardson M, Hunter P, Wilfert A, Martin J, Rosenfeld A, Cutajar D. Real-time in vivo rectal wall dosimetry using MOSkin detectors during linac based stereotactic radiotherapy with rectal displacement. Radiat Oncol 2017; 12:41. [PMID: 28241841 PMCID: PMC5327549 DOI: 10.1186/s13014-017-0781-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MOSFET dosimetry is a method that has been used to measure in-vivo doses during brachytherapy treatments and during linac based radiotherapy treatment. Rectal displacement devices (RDDs) allow for safe dose escalation for prostate cancer treatment. This study used dual MOSkin detectors to assess real-time in vivo rectal wall dose in patients with an RDD in place during a high dose prostate stereotactic body radiation therapy (SBRT) boost trial. METHODS The PROMETHEUS study commenced in 2014 and provides a prostate SBRT boost dose with a RDD in place. Twelve patients received two boost fractions of 9.5-10 Gy each delivered to the prostate with a dual arc volumetric modulated arc therapy (VMAT) technique. Two MOSkins in a face-to-face arrangement (dual MOSkin) were used to decrease angular dependence. A dual MOSkin was attached to the anterior surface of the Rectafix and read out at 1 Hz during each treatment. The planned dose at each measurement point was exported from the planning system and compared with the measured dose. The root mean square error normalised to the total planned dose was calculated for each measurement point and treatment arc for the entire course of treatment. RESULTS The average difference between the measured and planned doses over the whole course of treatment for all arcs measured was 9.7% with a standard deviation of 3.6%. The cumulative MOSkin reading was lower than the total planned dose for 64% of the arcs measured. The average difference between the final measured and final planned doses for all arcs measured was 3.4% of the final planned dose, with a standard deviation of 10.3%. CONCLUSIONS MOSkin detectors were an effective tool for measuring dose delivered to the anterior rectal wall in real time during prostate SBRT boost treatments for the purpose of both ensuring the rectal doses remain within acceptable limits during the treatment and for the verification of final rectal doses.
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Affiliation(s)
- Kimberley Legge
- University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.
| | - Peter B Greer
- University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.,Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | - Daryl J O'Connor
- University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Lee Wilton
- Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | - Matthew Richardson
- Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | - Perry Hunter
- Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | - Alex Wilfert
- Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | - Jarad Martin
- Calvary Mater Newcastle, Cnr Edith and Platt Streets, Waratah, 2298, NSW, Australia
| | | | - Dean Cutajar
- University of Wollongong, Wollongong, 2522, NSW, Australia
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31
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Tanderup K, Lindegaard JC, Kirisits C, Haie-Meder C, Kirchheiner K, de Leeuw A, Jürgenliemk-Schulz I, Van Limbergen E, Pötter R. Image Guided Adaptive Brachytherapy in cervix cancer: A new paradigm changing clinical practice and outcome. Radiother Oncol 2016; 120:365-369. [PMID: 27555228 DOI: 10.1016/j.radonc.2016.08.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Kari Tanderup
- Aarhus University Hospital, Department of Oncology, Denmark
| | | | - Christian Kirisits
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Christine Haie-Meder
- Gustave Roussy Cancer Campus Grand Paris, Department of Radiation Oncology, Villejuif, France
| | - Kathrin Kirchheiner
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria
| | - Astrid de Leeuw
- University Medical Center Utrecht, Department of Radiotherapy, The Netherlands
| | | | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Richard Pötter
- Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Austria.
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