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Hunt B, Cutajar D, Petasecca M, Rosenfeld A, Howie A, Bucci J, Poder J. HDR brachytherapy afterloader quality assurance optimization using monolithic silicon strip detectors. Med Phys 2024; 51:4581-4590. [PMID: 38837408 DOI: 10.1002/mp.17240] [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: 03/04/2024] [Revised: 05/22/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND There currently exists no widespread high dose-rate (HDR) brachytherapy afterloader quality assurance (QA) tool for simultaneously assessing the afterloader's positional, temporal, transit velocity and air kerma strength accuracy. PURPOSE The purpose of this study was to develop a precise and rigorous technique for performing daily QA of HDR brachytherapy afterloaders, incorporating QA of: dwell position accuracy, dwell time accuracy, transit velocity consistency and relative air kerma strength (AKS) of an Ir-192 source. METHOD A Sharp ProGuide 240 mm catheter (Elekta Brachytherapy, Veenendaal, The Netherlands) was fixed 5 mm above a 256 channel epitaxial diode array 'dose magnifying glass' (DMG256) (Centre for Medical and Radiation Physics, University of Wollongong). Three dwell positions, each of 5.0 s dwell times, were spaced 13.0 mm apart along the array with the Flexitron HDR afterloader (Elekta Brachytherapy, Veenendaal, The Netherlands). The DMG256 was connected to a data acquisition system (DAQ) and a computer via USB2.0 link for live readout and post-processing. The outputted data files were analyzed using a Python script to provide positional and temporal localization of the Ir-192 source by tracking the centroid of the detected response. Measurements were repeated on a weekly basis, for a period of 5 weeks to determine the consistency of the measured parameters over an extended period. RESULTS Using the DMG256 for relative AKS measurements resulted in measured values within 0.6%-3.0% of the expected activity over a 7-week period. The sub-millisecond temporal accuracy of the device allowed for measurements of the transit velocity with an average of (10.88 ± 1.01) cm/s for 13 mm steps. The dwell position localization for 1, 2, 3, 5, and 10 mm steps had an accuracy between 0.1 and 0.3 mm (3σ), with a fixed temporal accuracy of 10 ms. CONCLUSION The DMG256 silicon strip detector allows for clinics to perform rigorous daily QA of HDR afterloader dwell position and dwell time accuracy with greater precision than the current standard methodology using closed circuit television and a stopwatch. Additionally, DMG256 unlocks the ability to perform measurements of transit velocity/time and relative AKS, which are not possible using current standard techniques.
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Affiliation(s)
- Broady Hunt
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Dean Cutajar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Howie
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, NSW, Australia
| | - Joseph Bucci
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, NSW, Australia
| | - Joel Poder
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, NSW, Australia
- School of Physics, University of Sydney, Camperdown, NSW, Australia
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Koprivec D, Rosenfeld A, Cutajar D, Petasecca M, Howie A, Bucci J, Poder J. Feasibility of online adaptive HDR prostate brachytherapy: A novel treatment concept. Brachytherapy 2022; 21:943-955. [PMID: 36068155 DOI: 10.1016/j.brachy.2022.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/18/2022] [Accepted: 07/30/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of online adaptive transrectal ultrasound (TRUS)-based high-dose-rate prostate brachytherapy (HDRPBT) through retrospective simulation of source positioning and catheter swap errors on patient treatment plans. METHOD Source positioning errors (catheter shifts in 1 mm increments in the cranial/caudal, anterior/posterior, and medial/lateral directions up to ±6 mm) and catheter swap errors (between the most and least heavily weighted) were introduced retrospectively into DICOM treatment plans of 20 patients that previously received TRUS HDRPBT. Dose volume histogram (DVH) indices were monitored as errors were introduced sequentially into individual catheters, simulating potential errors throughout treatment. Whenever DVH indices were outside institution thresholds: prostate V100% <95%, urethra D0.1cc >118% and rectum Dmax >80%, the plan was adapted using remaining catheters (i.e., simulating previous catheters as previously delivered). The final DVH indices were recorded. RESULTS Prostate coverage (V100% >95%) could be maintained for source position errors up to 6 mm through online plan adaptation. The source position error at which the urethra D0.1cc and rectum Dmax was able to return to clinically acceptable levels using online adaptation varied between 6 mm to 1 mm, depending on the direction of the source position error and patient anatomy. After introduction of catheter swap errors to patient plans, prostate V100% was recoverable using online adaptation to near original plan characteristics. Urethra D0.1cc and rectum Dmax showed less recoverability. CONCLUSION Online adaptive HDRPBT maintains the prostate V100% to clinically acceptable values for majority of directional shifts. However, the current online adaptive method may not correct for source position errors near organs at risk.
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Affiliation(s)
- Dylan Koprivec
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Dean Cutajar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; St George Cancer Care Centre, Kogarah, NSW, Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Andrew Howie
- St George Cancer Care Centre, Kogarah, NSW, Australia
| | - Joseph Bucci
- St George Cancer Care Centre, Kogarah, NSW, Australia
| | - Joel Poder
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia; St George Cancer Care Centre, Kogarah, NSW, Australia
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Lekatou A, Peppa V, Karaiskos P, Pantelis E, Papagiannis P. On the potential of 2D ion chamber arrays for high-dose rate remote afterloading brachytherapy quality assurance. Phys Med Biol 2022; 67. [PMID: 35334474 DOI: 10.1088/1361-6560/ac612d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/25/2022] [Indexed: 01/08/2023]
Abstract
Objective. To investigate the potential of 2D ion chamber arrays to serve as a standalone tool for the verification of source strength, positioning and dwell time, within the framework of192Ir high-dose rate brachytherapy device quality assurance (QA).Approach.A commercially available ion chamber array was used. Fitting of a 2D Lorentzian peak function to experimental data from a multiple source dwell position irradiation on a frame-by-frame basis, facilitated tracking of the source center orthogonal projection on the array plane. For source air kerma strength verification, Monte Carlo simulation was employed to obtain a chamber array- and source-specific correction factor of calibration with a 6 MV photon beam. This factor converted the signal measured by each ion chamber element to air kerma in free space. A source positioning correction was also applied to lift potential geometry mismatch between experiment and Monte Carlo simulation.Main results.Spatial and temporal accuracy of source movement was verified within 0.5 mm and 0.02 s, respectively, in compliance with the test endpoints recommended by international professional societies. The source air kerma strength was verified experimentally within method uncertainties estimated as 1.44% (k = 1). The source positioning correction method employed did not introduce bias to experimental results of irradiations where source positioning was accurate. Development of a custom jig attachable to the chamber array for accurate and reproducible experimental set up would improve testing accuracy and obviate the need for source positioning correction in air kerma strength verification.Significance.Delivery of a single irradiation plan, optimized based on results of this work, to a 2D ion chamber array can be used for concurrent testing of source position, dwell time and air kerma strength, and the procedure can be expedited through automation. Chamber arrays merit further study in treatment planning QA and real time,in vivodose verification.
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Affiliation(s)
- Aristea Lekatou
- Medical Physics Laboratory, Department of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Vasiliki Peppa
- Medical Physics Laboratory, Department of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Department of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Evangelos Pantelis
- Medical Physics Laboratory, Department of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
| | - Panagiotis Papagiannis
- Medical Physics Laboratory, Department of Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece
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Fonseca GP, van Wagenberg T, Voncken R, Podesta M, van Beveren C, van Limbergen E, Lutgens L, Vanneste B, Berbee M, Reniers B, Verhaegen F. Brachytherapy treatment verification using gamma radiation from the internal treatment source combined with an imaging panel-a phantom study. Phys Med Biol 2021; 66. [PMID: 33831856 DOI: 10.1088/1361-6560/abf605] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/08/2021] [Indexed: 12/15/2022]
Abstract
Brachytherapy has an excellent clinical outcome for different treatment sites. However,in vivotreatment verification is not performed in the majority of hospitals due to the lack of proper monitoring systems. This study investigates the use of an imaging panel (IP) and the photons emitted by a high dose rate (HDR)192Ir source to track source motion and obtain some information related to the patient anatomy. The feasibility of this approach was studied by monitoring the treatment delivery to a 3D printed phantom that mimicks a prostate patient. A 3D printed phantom was designed with a template for needle insertion, a cavity ('rectum') to insert an ultrasound probe, and lateral cavities used to place tissue-equivalent materials. CT images were acquired to create HDR192Ir treatment plans with a range of dwell times, interdwell distances and needle arrangements. Treatment delivery was verified with an IP placed at several positions around the phantom using radiopaque markers on the outer surface to register acquired IP images with the planning CT. All dwell positions were identified using acquisition times ≤0.11 s (frame rates ≥ 9 fps). Interdwell distances and dwell positions (in relation to the IP) were verified with accuracy better than 0.1 cm. Radiopaque markers were visible in the acquired images and could be used for registration with CT images. Uncertainties for image registration (IP and planning CT) between 0.1 and 0.4 cm. The IP is sensitive to tissue-mimicking insert composition and showed phantom boundaries that could be used to improve treatment verification. The IP provided sufficient time and spatial resolution for real-time source tracking and allows for the registration of the planning CT and IP images. The results obtained in this study indicate that several treatment errors could be detected including swapped catheters, incorrect dwell times and dwell positions.
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Affiliation(s)
- G P Fonseca
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - T van Wagenberg
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - R Voncken
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - M Podesta
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - C van Beveren
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - E van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - L Lutgens
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - B Vanneste
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - M Berbee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - B Reniers
- Research group NuTeC, Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - F Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Doctor Tanslaan 12, 6229 ET Maastricht, The Netherlands
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Debnath SBC, Ferre M, Tonneau D, Fauquet C, Tallet A, Goncalves A, Darreon J. High resolution small-scale inorganic scintillator detector: HDR brachytherapy application. Med Phys 2021; 48:1485-1496. [PMID: 33476399 DOI: 10.1002/mp.14727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/21/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Brachytherapy (BT) deals with high gradient internal dose irradiation made up of a complex system where the source is placed nearby the tumor to destroy cancerous cells. A primary concern of clinical safety in BT is quality assurance to ensure the best matches between the delivered and prescribed doses targeting small volume tumors and sparing surrounding healthy tissues. Hence, the purpose of this study is to evaluate the performance of a point size inorganic scintillator detector (ISD) in terms of high dose rate brachytherapy (HDR-BT) treatment. METHODS A prototype of the dose verification system has been developed based on scintillating dosimetry to measure a high dose rate while using an 192 Ir BT source. The associated dose rate is measured in photons/s employing a highly sensitive photon counter (design data: 20 photons/s). Dose measurement was performed as a function of source-to-detector distance according to TG43U1 recommendations. Overall measurements were carried out inside water phantoms keeping the ISD along the BT needle; a minimum of 0.1 cm distance was maintained between each measurement point. The planned dwell times were measured accurately from the difference of two adjacent times of transit. The ISD system performances were also evaluated in terms of dose linearity, energy dependency, scintillation stability, signal-to-noise ratio (SNR), and signal-to-background ratio (SBR). Finally, a comparison was presented between the ISD measurements and results obtained from TG43 reference dataset. RESULTS The detection efficiency of the ISD was verified by measuring the planned dwell times at different dwell positions. Measurements demonstrated that the ISD has a perfectly linear behavior with dose rate (R2 = 1) and shows high SNR (>35) and SBR (>36) values even at the lowest dose rate investigated at around 10 cm from the source. Standard deviation (1σ) remains within 0.03% of signal magnitude, and less than 0.01% STEM signal was monitored at 0.1 cm source-to-detector distance. Stability of 0.54% is achieved, and afterglow stays less than 1% of the total signal in all the irradiations. Excellent symmetrical behavior of the dose rate regarding source position was observed at different radiation planes. Finally, a comparison with TG-43 reference dataset shows that corrected measurements agreed with simulation data within 1.2% and 1.3%, and valid for the source-to-detector distance greater than 0.25 cm. CONCLUSION The proposed ISD in this study anticipated that the system could be promoted to validate with further clinical investigations. It allows an appropriate dose verification with dwell time estimation during source tracking and suitable dose measurement with a high spatial resolution both nearby (high dose gradient) and far (low dose gradient) from the source position.
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Affiliation(s)
| | | | - Didier Tonneau
- Aix Marseille Université, CNRS, CINaM UMR 7325, Marseille, 13288, France
| | - Carole Fauquet
- Aix Marseille Université, CNRS, CINaM UMR 7325, Marseille, 13288, France
| | - Agnes Tallet
- Institut Paoli-Calmettes, Marseille, 13009, France
| | - Anthony Goncalves
- Institut Paoli-Calmettes, Marseille, 13009, France.,Aix Marseille Université, CNRS UMR 7258, INSERM UMR 1068, CRCM, Marseille, 13009, France
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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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Yogo K, Noguchi Y, Okudaira K, Nozawa M, Ishiyama H, Okamoto H, Yasuda H, Oguchi H, Yamamoto S. Source position measurement by Cherenkov emission imaging from applicators for high-dose-rate brachytherapy. Med Phys 2020; 48:488-499. [PMID: 33216999 DOI: 10.1002/mp.14606] [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: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We developed a novel and simple method to measure the source positions in applicators directly for high-dose-rate (HDR) brachytherapy based on Cherenkov emission imaging, and evaluated the performance. METHODS The light emission from plastic applicators used in cervical cancer treatments, irradiated by an 192 Ir γ-ray source, was captured using a charge-coupled device camera. Moreover, we attached plastics of different shapes, including tapes, tubes, and plates to a metal applicator, to use as screens for the Cherenkov imaging. We determined the source positions and dwell intervals from the light profiles along with the applicator and compared these with preset values and dummy marker measurements. RESULTS The source positions and dwell intervals measured from the light images were comparable to the dummy marker measurements and preset values. The distance from the applicator tip to the first source positions agreed with the dummy marker measurements within 0.2 mm for the plastic tandem. The dwell intervals measured using the Cherenkov method agreed with the preset values within 0.6 mm. The distances measured with three plastic types on the metal applicator also agreed with the dummy marker measurements within 0.2 mm. The dwell intervals measured using the plastic tape agreed with the preset values within 0.7 mm. CONCLUSIONS The proposed method should be suitable for rapid and easy quality assurance (QA) investigations in HDR brachytherapy, as it enables source position using a single image. The method allows for real-time, filmless measurements of the source positions to be obtained and is useful for rapid feedback in QA procedures.
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Affiliation(s)
- Katsunori Yogo
- Graduate School of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - Yumiko Noguchi
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Kuniyasu Okudaira
- Department of Radiological Technology, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Japan
| | - Marika Nozawa
- School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hiromichi Ishiyama
- School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hiroshi Yasuda
- Department of Radiation Biophysics, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan
| | - Hiroshi Oguchi
- Graduate School of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
| | - Seiichi Yamamoto
- Graduate School of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
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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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Posar JA, Davis J, Large MJ, Basiricò L, Ciavatti A, Fraboni B, Dhez O, Wilkinson D, Sellin PJ, Griffith MJ, Lerch MLF, Rosenfeld A, Petasecca M. Characterization of an organic semiconductor diode for dosimetry in radiotherapy. Med Phys 2020; 47:3658-3668. [PMID: 32395821 DOI: 10.1002/mp.14229] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The development of novel detectors for dosimetry in advanced radiotherapy modalities requires materials that have a water equivalent response to ionizing radiation such that characterization of radiation beams can be performed without the need for complex calibration procedures and correction factors. Organic semiconductors are potentially an ideal technology in fabricating devices for dosimetry due to tissue equivalence, mechanical flexibility, and relatively cheap manufacturing cost. The response of a commercial organic photodetector (OPD), coupled to a plastic scintillator, to ionizing radiation from a linear accelerator and orthovoltage x-ray tube has been characterized to assess its potential as a dosimeter for radiotherapy. The radiation hardness of the OPD has also been investigated to demonstrate its longevity for such applications. METHODS Radiation hardness measurements were achieved by observing the response of the OPD to the visible spectrum and 70 keV x rays after pre-exposure to 40 kGy of ionizing radiation. The response of a preirradiated OPD to 6-MV photons from a linear accelerator in reference conditions was compared to a nonirradiated OPD with respect to direct and indirect (RP400 plastic scintillator) detection mechanisms. Dose rate dependence of the OPD was measured by varying the surface-to-source distance between 90 and 300 cm. Energy dependence was characterized from 29.5 to 129 keV with an x-ray tube. The percentage depth dose (PDD) curves were measured from 0.5 to 20 cm and compared to an ionization chamber. RESULTS The OPD sensitivity to visible light showed substantial degradation of the broad 450 to 600 nm peak from the donor after irradiation to 40 kGy. After irradiation, the spectral shape has a dominant absorbance peak at 370 nm, as the acceptor better withstood radiation damage. Its response to x rays stabilized to 30% after 35 kGy, with a 0.5% difference between 770 Gy increments. The OPD exhibited reproducible detection of ionizing radiation when coupled with a scintillator. Indirect detection showed a linear response from 25 to 500 cGy and constant response to dose rates from 0.31 Gy/pulse to 3.4 × 10-4 Gy/pulse. However, without the scintillator, response increased by 100% at low dose rates. Energy independence between 100 keV and 1.2 MeV advocates their use as a dosimeter without beam correction factors. A dependence on the scintillator thickness used during a comparison of the PDD to the ionizing chamber was identified. A 1-mm-thick scintillator coupled with the OPD demonstrated the best agreement of ± 3%. CONCLUSIONS The response of OPDs to ionizing radiation has been characterized, showing promising use as a dosimeter when coupled with a plastic scintillator. The mechanisms of charge transport and trapping within organic materials varies for visible and ionizing radiation, due to differing properties for direct and indirect detection mechanisms and observing a substantial decrease in sensitivity to the visible spectrum after 40 kGy. This study proved that OPDs produce a stable response to 6-MV photons, and with a deeper understanding of the charge transport mechanisms due to exposure to ionizing radiation, they are promising candidates as the first flexible, water equivalent, real-time dosimeter.
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Affiliation(s)
- Jessie A Posar
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Jeremy Davis
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Matthew J Large
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Laura Basiricò
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, Bologna, 40127, Italy
| | - Andrea Ciavatti
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, Bologna, 40127, Italy
| | - Beatrice Fraboni
- Department of Physics and Astronomy, University of Bologna, Viale Berti Pichat 6/2, Bologna, 40127, Italy
| | - Olivier Dhez
- ISORG, 60 Rue des berges, Parc Polyetc, Immeuble Tramontane, Grenoble, 38000, France
| | - Dean Wilkinson
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia.,Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, NSW, 2500, Australia
| | - Paul J Sellin
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Matthew J Griffith
- Priority Research Centre for Organic Electronics, University of Newcastle, Callaghan, NSW, 2308, Australia.,School of Aeronautical, Mechanical and Mechatronic Engineering, University of Sydney, Camperdown, NSW, 2050, Australia
| | - Michael L F Lerch
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Marco Petasecca
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, 2522, Australia
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Yogo K, Matsushita A, Tatsuno Y, Shimo T, Hirota S, Nozawa M, Ozawa S, Ishiyama H, Yasuda H, Nagata Y, Hayakawa K. Imaging Cherenkov emission for quality assurance of high-dose-rate brachytherapy. Sci Rep 2020; 10:3572. [PMID: 32108157 PMCID: PMC7046619 DOI: 10.1038/s41598-020-60519-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 02/12/2020] [Indexed: 11/26/2022] Open
Abstract
With advances in high-dose-rate (HDR) brachytherapy, the importance of quality assurance (QA) is increasing to ensure safe delivery of the treatment by measuring dose distribution and positioning the source with much closer intervals for highly active sources. However, conventional QA is time-consuming, involving the use of several different measurement tools. Here, we developed simple QA method for HDR brachytherapy based on the imaging of Cherenkov emission and evaluated its performance. Light emission from pure water irradiated by an 192Ir γ-ray source was captured using a charge-coupled device camera. Monte Carlo calculations showed that the observed light was primarily Cherenkov emissions produced by Compton-scattered electrons from the γ-rays. The uncorrected Cherenkov light distribution, which was 5% on average except near the source (within 7 mm from the centre), agreed with the dose distribution calculated using the treatment planning system. The accuracy was attributed to isotropic radiation and short-range Compton electrons. The source positional interval, as measured from the light images, was comparable to the expected intervals, yielding spatial resolution similar to that permitted by conventional film measurements. The method should be highly suitable for quick and easy QA investigations of HDR brachytherapy as it allows simultaneous measurements of dose distribution, source strength, and source position using a single image.
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Affiliation(s)
- Katsunori Yogo
- Graduate School of Medicine, Nagoya University, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
- Graduate School of Medical Science, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan.
| | - Akihiro Matsushita
- Graduate School of Medical Science, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Yuya Tatsuno
- Graduate School of Medical Science, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Takahiro Shimo
- Department of Radiology, Tokyo Nishi Tokushukai Hospital, 3-1-1 Matsubara-cho, Akishima, Tokyo, 196-0003, Japan
| | - Seiko Hirota
- Department of Radiation Biophysics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan
| | - Marika Nozawa
- School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Shuichi Ozawa
- Hiroshima High Precision Radiotherapy Cancer Center, 3-2-2 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiromichi Ishiyama
- Graduate School of Medical Science, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
- School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hiroshi Yasuda
- Department of Radiation Biophysics, Research Institute for Radiation Biology and Medicine, Hiroshima University, Kasumi 1-2-3, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yasushi Nagata
- Hiroshima High Precision Radiotherapy Cancer Center, 3-2-2 Futabanosato, Higashi-ku, Hiroshima, 732-0057, Japan
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazushige Hayakawa
- Graduate School of Medical Science, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
- School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0373, Japan
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Johansen J, Kertzscher G, Jørgensen E, Rylander S, Bentzen L, Hokland S, Søndergaard C, With A, Buus S, Tanderup K. Dwell time verification in brachytherapy based on time resolved in vivo dosimetry. Phys Med 2019; 60:156-161. [DOI: 10.1016/j.ejmp.2019.03.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/22/2019] [Accepted: 03/29/2019] [Indexed: 10/27/2022] Open
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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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Krause F, Risske F, Bohn S, Delaperriere M, Dunst J, Siebert FA. End-to-end test for computed tomography-based high-dose-rate brachytherapy. J Contemp Brachytherapy 2018; 10:551-558. [PMID: 30662478 PMCID: PMC6335556 DOI: 10.5114/jcb.2018.81026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE One of the important developments in brachytherapy in recent years has been the clinical implementation of complex modern technical procedures. Today, 3D-imaging has become the standard procedure and it is used for contouring and precise position determination and reconstruction of used brachytherapy applicators. Treatment planning is performed on the basis of these imaging methods, followed by data transfer to the afterloading device. Therefore, checking the entire treatment chain is of high importance. In this work, we describe an end-to-end test for computed tomography (CT)-based brachytherapy with an high-dose-rate (HDR) afterloading device, which fulfills the recommendation of the German radiation-protection-commission. MATERIAL AND METHODS The treatment chain consists of a SOMATOM S64 CT scanner (Siemens Medical), the treatment planning system (TPS) BrachyVision v.13.7 (VMS), which utilizes the calculation formalism TG-43 and the Acuros algorithm v. 1.5.0 (VMS) as well as GammaMedplus HDR afterloader (VMS) using an Ir-192 source. Measurement setups for common brachytherapy applicators are defined in a water phantom, and the required PMMA applicator holders are developed. These setups are scanned with the CT and the data is imported into the TPS. Computed TPS reference dose values for significant points located on the side of the applicator are compared with dose measurements performed with a PinPoint 3D chamber 31016 (PTW Freiburg). RESULTS The deviations for the end-to-end test between computed and measured values are shown to be ≤ 5%, when using an implant needle or vaginal cylinder. Furthermore, it can be demonstrated that the test procedure provides reproducible results, while repositioning the applicators without carrying out a new CT-scan. CONCLUSIONS The end-to-end test presented allows a practice-oriented realization for checking the whole treatment chain for HDR afterloading technique and CT-imaging. The presented phantom seems feasible for performing periodic system checks as well as to verify newly introduced brachytherapy techniques with sufficient accuracy.
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Affiliation(s)
- Fabian Krause
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Franziska Risske
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Susann Bohn
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Marc Delaperriere
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Frank-André Siebert
- Clinic of Radiotherapy, University Hospital Schleswig-Holstein, Kiel, Germany
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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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15
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Poder J, Cutajar D, Guatelli S, Petasecca M, Howie A, Bucci J, Rosenfeld A. HDR brachytherapy in vivo source position verification using a 2D diode array: A Monte Carlo study. J Appl Clin Med Phys 2018; 19:163-172. [PMID: 29855128 PMCID: PMC6036394 DOI: 10.1002/acm2.12360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/21/2018] [Accepted: 04/18/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aims to assess the accuracy of source position verification during high-dose rate (HDR) prostate brachytherapy using a novel, in-house developed two-dimensional (2D) diode array (the Magic Plate), embedded exactly below the patient within a carbon fiber couch. The effect of tissue inhomogeneities on source localization accuracy is examined. METHOD Monte Carlo (MC) simulations of 12 source positions from a HDR prostate brachytherapy treatment were performed using the Geant4 toolkit. An Ir-192 Flexisource (Isodose Control, Veenendaal, the Netherlands) was simulated inside a voxelized patient geometry, and the dose deposited in each detector of the Magic Plate evaluated. The dose deposited in each detector was then used to localize the source position using a proprietary reconstruction algorithm. RESULTS The accuracy of source position verification using the Magic Plate embedded in the patient couch was found to be affected by the tissue inhomogeneities within the patient, with an average difference of 2.1 ± 0.8 mm (k = 1) between the Magic Plate predicted and known source positions. Recalculation of the simulations with all voxels assigned a density of water improved this verification accuracy to within 1 mm. CONCLUSION Source position verification using the Magic Plate during a HDR prostate brachytherapy treatment was examined using MC simulations. In a homogenous geometry (water), the Magic Plate was able to localize the source to within 1 mm, however, the verification accuracy was negatively affected by inhomogeneities; this can be corrected for by using density information obtained from CT, making the proposed tool attractive for use as a real-time in vivo quality assurance (QA) device in HDR brachytherapy for prostate cancer.
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Affiliation(s)
- Joel Poder
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
- St George Hospital Cancer Care CentreKogarahNSWAustralia
| | - Dean Cutajar
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
- St George Hospital Cancer Care CentreKogarahNSWAustralia
| | - Susanna Guatelli
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
| | - Marco Petasecca
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
| | - Andrew Howie
- St George Hospital Cancer Care CentreKogarahNSWAustralia
| | - Joseph Bucci
- St George Hospital Cancer Care CentreKogarahNSWAustralia
| | - Anatoly Rosenfeld
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
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Verification of high-dose-rate brachytherapy treatment planning dose distribution using liquid-filled ionization chamber array. J Contemp Brachytherapy 2018; 10:142-154. [PMID: 29789763 PMCID: PMC5961529 DOI: 10.5114/jcb.2018.75599] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/23/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aims to investigate the dosimetric performance of a liquid-filled ionization chamber array in high-dose-rate (HDR) brachytherapy dosimetry. A comparative study was carried out with air-filled ionization chamber array and EBT3 Gafchromic films to demonstrate its suitability in brachytherapy. Material and methods The PTW OCTAVIUS detector 1000 SRS (IA 2.5-5 mm) is a liquid-filled ionization chamber array of area 11 x 11 cm2 and chamber spacing of 2.5-5 mm, whereas the PTW OCTAVIUS detector 729 (IA 10 mm) is an air vented ionization chamber array of area 27 x 27 cm2 and chamber spacing of 10 mm. EBT3 films were exposed to doses up to a maximum of 6 Gy and evaluated using multi-channel analysis. The detectors were evaluated using test plans to mimic a HDR intracavitary gynecological treatment. The plan was calculated and delivered with the applicator plane placed 20 mm from the detector plane. The acquired measurements were compared to the treatment plan. In addition to point dose measurement, profile/isodose, gamma analysis, and uncertainty analysis were performed. Detector sensitivity was evaluated by introducing simulated errors to the test plans. Results The mean point dose differences between measured and calculated plans were 0.2% ± 1.6%, 1.8% ± 1.0%, and 1.5% ± 0.81% for film, IA 10 mm, and IA 2.5-5 mm, respectively. The average percentage of passed gamma (global/local) values using 3%/3 mm criteria was above 99.8% for all three detectors on the original plan. For IA 2.5-5 mm, local gamma criteria of 2%/1 mm with a passing rate of at least 95% was found to be sensitive when simulated positional errors of 1 mm was introduced. Conclusion The dosimetric properties of IA 2.5-5 mm showed the applicability of liquid-filled ionization chamber array as a potential QA device for HDR brachytherapy treatment planning systems.
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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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Guiral P, Ribouton J, Jalade P, Wang R, Galvan JM, Lu GN, Pittet P, Rivoire A, Gindraux L. Design and testing of a phantom and instrumented gynecological applicator based on GaN dosimeter for use in high dose rate brachytherapy quality assurance. Med Phys 2016; 43:5240. [DOI: 10.1118/1.4961393] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Smith RL, Haworth A, Panettieri V, Millar JL, Franich RD. A method for verification of treatment delivery in HDR prostate brachytherapy using a flat panel detector for both imaging and source tracking. Med Phys 2016; 43:2435. [DOI: 10.1118/1.4946820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Brachytherapy: a dying art or missed opportunity? AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:5-9. [DOI: 10.1007/s13246-016-0430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Safavi-Naeini M, Han Z, Alnaghy S, Cutajar D, Petasecca M, Lerch MLF, Franklin DR, Bucci J, Carrara M, Zaider M, Rosenfeld AB. BrachyView, a novel in-body imaging system for HDR prostate brachytherapy: Experimental evaluation. Med Phys 2015; 42:7098-107. [DOI: 10.1118/1.4935866] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Espinoza A, Petasecca M, Fuduli I, Howie A, Bucci J, Corde S, Jackson M, Lerch MLF, Rosenfelda AB. The evaluation of a 2D diode array in “magic phantom” for use in high dose rate brachytherapy pretreatment quality assurance. Med Phys 2015; 42:663-673. [PMID: 25771556 DOI: 10.1118/1.4905233] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 12/09/2014] [Accepted: 12/16/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High dose rate (HDR) brachytherapy is a treatment method that is used increasingly worldwide. The development of a sound quality assurance program for the verification of treatment deliveries can be challenging due to the high source activity utilized and the need for precise measurements of dwell positions and times. This paper describes the application of a novel phantom, based on a 2D 11 × 11 diode array detection system, named “magic phantom” (MPh), to accurately measure plan dwell positions and times, compare them directly to the treatment plan, determine errors in treatment delivery, and calculate absorbed dose. METHODS The magic phantom system was CT scanned and a 20 catheter plan was generated to simulate a nonspecific treatment scenario. This plan was delivered to the MPh and, using a custom developed software suite, the dwell positions and times were measured and compared to the plan. The original plan was also modified, with changes not disclosed to the primary authors, and measured again using the device and software to determine the modifications. A new metric, the “position–time gamma index,” was developed to quantify the quality of a treatment delivery when compared to the treatment plan. The MPh was evaluated to determine the minimum measurable dwell time and step size. The incorporation of the TG-43U1 formalism directly into the software allows for dose calculations to be made based on the measured plan. The estimated dose distributions calculated by the software were compared to the treatment plan and to calibrated EBT3 film, using the 2D gamma analysis method. RESULTS For the original plan, the magic phantom system was capable of measuring all dwell points and dwell times and the majority were found to be within 0.93 mm and 0.25 s, respectively, from the plan. By measuring the altered plan and comparing it to the unmodified treatment plan, the use of the position–time gamma index showed that all modifications made could be readily detected. The MPh was able to measure dwell times down to 0.067 ± 0.001 s and planned dwell positions separated by 1 mm. The dose calculation carried out by the MPh software was found to be in agreement with values calculated by the treatment planning system within 0.75%. Using the 2D gamma index, the dose map of the MPh plane and measured EBT3 were found to have a pass rate of over 95% when compared to the original plan. CONCLUSIONS The application of this magic phantom quality assurance system to HDR brachytherapy has demonstrated promising ability to perform the verification of treatment plans, based upon the measured dwell positions and times. The introduction of the quantitative position–time gamma index allows for direct comparison of measured parameters against the plan and could be used prior to patient treatment to ensure accurate delivery.
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Espinoza A, Petasecca M, Cutajar D, Fuduli I, Howie A, Bucci J, Corde S, Jackson M, Zaider M, Lerch MLF, Rosenfeld AB. Pretreatment verification of high dose rate brachytherapy plans using the ‘magic phantom’ system. Biomed Phys Eng Express 2015. [DOI: 10.1088/2057-1976/1/2/025201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Dosimetry systems based on Gallium Nitride probe for radiotherapy, brachytherapy and interventional radiology. Ing Rech Biomed 2015. [DOI: 10.1016/j.irbm.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kertzscher G, Rosenfeld A, Beddar S, Tanderup K, Cygler JE. In vivo dosimetry: trends and prospects for brachytherapy. Br J Radiol 2014; 87:20140206. [PMID: 25007037 DOI: 10.1259/bjr.20140206] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The error types during brachytherapy (BT) treatments and their occurrence rates are not well known. The limited knowledge is partly attributed to the lack of independent verification systems of the treatment progression in the clinical workflow routine. Within the field of in vivo dosimetry (IVD), it is established that real-time IVD can provide efficient error detection and treatment verification. However, it is also recognized that widespread implementations are hampered by the lack of available high-accuracy IVD systems that are straightforward for the clinical staff to use. This article highlights the capabilities of the state-of-the-art IVD technology in the context of error detection and quality assurance (QA) and discusses related prospects of the latest developments within the field. The article emphasizes the main challenges responsible for the limited practice of IVD and provides descriptions on how they can be overcome. Finally, the article suggests a framework for collaborations between BT clinics that implemented IVD on a routine basis and postulates that such collaborations could improve BT QA measures and the knowledge about BT error types and their occurrence rates.
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Affiliation(s)
- G Kertzscher
- 1 Centre for Nuclear Technologies, Technical University of Denmark, Roskilde, Denmark
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Kertzscher G, Andersen CE, Tanderup K. Adaptive error detection for HDR/PDR brachytherapy: Guidance for decision making during real-time in vivo
point dosimetry. Med Phys 2014; 41:052102. [DOI: 10.1118/1.4870438] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|