Exclusive MRI-based tandem and colpostats reconstruction in gynaecological brachytherapy treatment planning

Purpose: According to the GYN GEC-ESTRO Recommendations, MRI is needed with the modality of T2 weighted. CT-MR compatible tandem Plus colpostats (T/C) (Nucletron) is widely used in cervical brachytherapy. The major challenge of MRI is the lack of dummy catheters. Therefore, an additional imaging modality is usually required. One disadvantage of sliced-based reconstruction is that resolution in longitudinal directions can be affected by the slice thickness. The aim of this study is to present a modified T/C applicator in which the catheter visibility is significantly improved. Methods and materials: A modification to the existing T/C applicator has been made available, increasing the cathete…

A program for the independent verification of brachytherapy planning system calculations

Purpose: In this work a spreadsheet based program is presented that to a large extent independently verifies the calculations of individual plans of brachytherapy treatment planning systems for low dose rate, high dose rate and pulsed dose rate techniques.Material and methods: The verification program has been developed based on workbooks/spreadsheets. The treatment planning system output text files are automatically loaded into the new program, allowing the use of the source coordinates, the desired calculation point coordinates, and the dwell times of a patient plan. The source strength and the reference dates are entered by the user and then dose points calculations are independently per…

Novel simple templates for reproducible positioning of skin applicators in brachytherapy.

Purpose : Esteya and Valencia surface applicators are designed to treat skin tumors using brachytherapy. In clinical practice, in order to avoid errors that may affect the treatment outcome, there are two issues that need to be carefully addressed. First, the selected applicator for the treatment should provide adequate margin for the target, and second, the applicator has to be precisely positioned before each treatment fraction. In this work, we describe the development and use of a new acrylic templates named Template La Fe-ITIC. They have been designed specifically to help the clinical user in the selection of the correct applicator, and to assist the medical staff in reproducing the po…

The necessity of systematic verification of applicator position in brachytherapy treatment of the vaginal cuff

Urethral Dose Limit in Boost Permanent Prostate 125I Seed Implants Based on Biologically Effective Dose Values

Dose Escalation in Permanent Brachytherapy for Prostate Cancer: Preliminary Results

MRI based treatment planning in gynaecological brachytherapy

Interobserver study of countouringbased on ultrasound image in real-time interactive prostate brachytherapy

The use of nomograms in LDR-HDR prostate brachytherapy

Purpose: The common use of nomograms in Low Dose Rate (LDR) permanent prostate brachytherapy (BT) allows to estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for each clinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adapt ed to High Dose Rate (HDR). This work sets nomograms for LDR and HDR prostate-BT implants, which are applied to three different institutions that use different implant techniques. Material and methods: Patients treated throughout 2010 till April 2011 were considered for this study. This exam ple was chosen to be the representative of the latest implant tech…

SU-FF-T-62: Dosimetric Evaluation of An Internal Shielding Used with a HDR Skin Applicator

Purpose: The Valencia HDR skin applicators are accessories of the microSelectron HDR afterloading system (Nucletron) cup shaped to limit the dose to the irradiation area. Applicators sizes are: diameter 2 and 3 cm. The typical prescription depth is 3 mm. This work aims to evaluate the backscatter and electron contamination of an internal shielding used to reduce the dose to the ocular globe when the lesion is located at the eyelid. Monte Carlo(MC) and experimental methods have been used. Method and Materials: The geometry has been: the Valencia applicator (2 cm diameter) on the surface of a solid polystyrene slab phantom; inside, a 2 mm lead slab located at 3 mm depth. MC simulation charact…

A practical MRI-based reconstruction method for a new endocavitary and interstitial gynaecological template

Purpose: There are perineal templates for interstitial implants such as MUPIT and Syed applicators. Their limitations are the intracavitary component deficit and the necessity to use computed tomography (CT) for treatment planning since both applicators are non-magnetic resonance imaging (MRI) compatibles. To overcome these problems, a new template named Template Benidorm (TB) has been recently developed. Titanium needles are usually reconstructed based on their own artifacts, mainly in T1-weighted sequence, using the void on the tip as the needle tip position. Nevertheless, patient tissues surrounding the needles present heterogeneities that complicate the accurate identification of these …

QA of dynamic MLC based on EPID portal dosimetry.

Abstract Purpose Dynamic delivery of intensity modulated beams (dIMRT) requires not only accurate verification of leaf positioning but also a control on the speed of motion. The latter is a parameter that has a major impact on the dose delivered to the patient. Time consumed in quality assurance (QA) procedures is an issue of relevance in any radiotherapy department. Electronic portal imaging dosimetry (EPID) can be very efficient for routine tests. The purpose of this work is to investigate the ability of our EPID for detecting small errors in leaf positioning, and to present our daily QA procedures for dIMRT based on EPID. Methods and materials A Varian 2100 CD Clinac equipped with an 80 …

PO-1047: Late G3 toxicity in prostate cancer patients treated with escalated dose (ED) technique: technical dependence

SU-GG-T-227: Dynamic IMRT Split Beam Technique Verification Using EPID Based Dosimetry

Purpose: On dynamic IMRT plans with Millenium 80 (Varian) fields wider of 15 cm must be splitted. Since the EPIDdosimetry software does not allow to sum splitted subfluences in the same dosimetric portal image they have to be measured separately and compared independently with the subfluences previously calculated by the TPS Eclipse. The purpose of our work is the development of a tool to: 1) analyze the correct match between the two abutted ports for splitted fields. 2) study the effect of gravity and analyze repercussions of possible misalignments and 3) illustrate that the gamma evaluation should be made with the global summed fluence per field instead of with the individual subfluences.…

Commissioning and quality assurance procedures for the HDR Valencia skin applicators

The Valencia applicators (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) are cup-shaped tungsten applicators with a flattening filter used to collimate the radiation produced by a high-dose-rate (HDR) 192 Ir source, and provide a homogeneous absorbed dose at a given depth. This beam quality provides a good option for the treatment of skin lesions at shallow depth (3-4 mm). The user must perform commissioning and periodic testing of these applicators to guarantee the proper and safe delivery of the intended absorbed dose, as recommended in the standards in radiation oncology. In this study, based on AAPM and GEC-ESTRO guidelines for brachytherapy units and our experience, a set …