Impact of robust optimization on patient specific error thresholds for high dose rate prostate brachytherapy source tracking.

Purpose: The purpose of this study was to compare the effect of catheter shift errors and determine patient specific error thresholds (PSETs) for different high dose rate prostate brachytherapy (HDRPBT) plans generated by different forms of inverse optimization.

Methods: Three plans were generated for 50 HDRPBT patients and PSETs were determined for each of the 3 plans. Plan 1 was the original Oncentra Prostate (v4.

Automatic plan selection using deep network-A prostate study.

Background: Recently, high-dose-rate (HDR) brachytherapy treatment plans generation was improved with the development of multicriteria optimization (MCO) algorithms that can generate thousands of pareto optimal plans within seconds. This brings a shift, from the objective of generating an acceptable plan to choosing the best plans out of thousands.

Purpose: In order to choose the best plans, new criteria beyond usual dosimetrics volumes histogram (DVH) metrics are introduced and a deep learning (DL) framework is added as an automatic plan selection algorithm.

Proof-of-concept of real-time electromagnetic guidance for gynecologic interstitial catheters in high dose rate brachytherapy.

Background And Purpose: The addition of interstitial needles to intracavitary gynecologic (GYN) high dose rate (HDR) brachytherapy has been shown to improve target coverage and organs-at-risk (OAR) sparing. However, no commercial solution allows real-time guidance of interstitial catheter placement. This phantom study aimed to evaluate the feasibility of an electromagnetic (EM) tracking system guidance workflow for GYN HDR brachytherapy treatment in a magnetic resonance imaging (MRI) and real-time transrectal ultrasound (TRUS) fusion scenario.

Haralick texture feature analysis for Monte Carlo dose distributions of permanent implant prostate brachytherapy.

Purpose: Demonstrate quantitative characterization of 3D patient-specific absorbed dose distributions using Haralick texture analysis, and interpret measures in terms of underlying physics and radiation dosimetry.

Methods: Retrospective analysis is performed for 137 patients who underwent permanent implant prostate brachytherapy using two simulation conditions: "TG186" (realistic tissues including 0-3.8% intraprostatic calcifications; interseed attenuation) and "TG43" (water-model; no interseed attenuation).

Aleatoric and epistemic uncertainty extraction of patient-specific deep learning-based dose predictions in LDR prostate brachytherapy.

In brachytherapy, deep learning (DL) algorithms have shown the capability of predicting 3D dose volumes. The reliability and accuracy of such methodologies remain under scrutiny for prospective clinical applications. This study aims to establish fast DL-based predictive dose algorithms for low-dose rate (LDR) prostate brachytherapy and to evaluate their uncertainty and stability.

A comprehensive quality assurance protocol for electromagnetic tracking in brachytherapy.

Background: Electromagnetic tracking (EMT) systems have proven to be a valuable source of information regarding the location and geometry of applicators in patients undergoing brachytherapy (BT). As an important element of an enhanced and individualized pre-treatment verification, EMT can play a pivotal role in detecting treatment errors and uncertainties to increase patient safety.

Purpose: The purpose of this study is two-fold: to design, develop and test a dedicated measurement protocol for the use of EMT-enabled afterloaders in BT and to collect and compare the data acquired from three different radiation oncology centers in different clinical environments.

Development of patient and catheter specific error thresholds for high dose rate prostate brachytherapy.

Background: In-vivo source tracking has been an active topic of research in the field of high-dose rate brachytherapy in recent years to verify accuracy in treatment delivery. Although detection systems for source tracking are being developed, the allowable threshold of treatment error is still unknown and is likely patient-specific due to anatomy and planning variation.

Purpose: The purpose of this study was to determine patient and catheter-specific shift error thresholds for in-vivo source tracking during high-dose-rate prostate brachytherapy (HDRPBT).

Multi-point calorimeter using distributed fiber Bragg gratings for small field dosimetry in radiotherapy.

Background: The interest of using fiber Bragg gratings (FBGs) dosimeters in radiotherapy (RT) lies in their (i) microliter detection volume, (ii) customizable spatial resolution, (iii) multi-point dose measurement, (iv) real-time data acquisition and (v) insensitivity to Cherenkov light. These characteristics could prove very useful for characterizing dose distributions of small and nonstandard fields with high spatial resolution.

Purpose: We developed a multi-point FBGs dosimeter customized for small field RT dosimetry with a spatial resolution of 1 mm.

Establishing a fingerprinting method for fast catheter identification in HDR brachytherapy in vivo dosimetry.

Purpose: To use quantities measurable during in vivo dosimetry to build unique channel identifiers, that enable detection of brachytherapy errors.

Materials And Methods: Treatment plan of 360 patients with prostate cancer who underwent high-dose-rate brachytherapy (range, 16-25 catheters; mean, 17) were used. A single point virtual dosimeter was placed at multiple positions within the treatment geometry, and the source-dosimeter distance and dwell time were determined for each dwell position in each catheter.

Accuracy of an electromagnetic tracking enabled afterloader based on the automated registration with CT phantom images.

Background: Electromagnetic tracking (EMT) has been researched for brachytherapy applications, showing a great potential for automating implant reconstruction, and overcoming image-based limitations such as contrast and spatial resolution. One of the challenges of this technology is that it does not intrinsically share the same reference frame as the patient's medical imaging.

Purpose: To present a novel phantom that can be used for a comprehensive quality assurance (QA) program of brachytherapy EMT systems and use this phantom to validate a novel applicator-based registration method of EMT and image reference frames for gynecological (GYN) interstitial brachytherapy.

Simultaneous catheter and multicriteria optimization for HDR cervical cancer brachytherapy with a complex intracavity/interstitial applicator.

Background: Complex intracavity and interstitial (IC/IS) applicators, such as the Venezia applicator, can improve the HR-CTV coverage while adequately protecting organs at risk in the treatment of cervical cancer with high-dose-rate (HDR) brachytherapy. Although the Venezia applicator offers more choice for catheter selection, commercially available catheter and dose optimization algorithms are still missing for complex applicators. Moreover, studies on catheter and dose optimization for IC/IS implants in the treatment of cervical cancer are still limited.

A Monte Carlo dose recalculation pipeline for durable datasets: an I-125 LDR prostate brachytherapy use case.

Monte Carlo (MC) dose datasets are valuable for large-scale dosimetric studies. This work aims to build and validate a DICOM-compliant automated MC dose recalculation pipeline with an application to the production of I-125 low dose-rate prostate brachytherapy MC datasets. Built as a self-contained application, the recalculation pipeline ingested clinical DICOM-RT studies, reproduced the treatment into the Monte Carlo simulation, and outputted a traceable and durable dose distribution in the DICOM dose format.

US-guided EM tracked system for HDR brachytherapy: A first in-men randomized study for whole prostate treatment.

Purpose: An electromagnetic tracking device (EMT) has been integrated in an HDR 3D ultrasound guidance system for prostate HDR. The aim of this study was to compare the efficiency of HDR workflows with and without EM tracking.

Methods And Materials: A total of 58 patients with a 15 Gy HDR prostate boost were randomized in two arms and two operation room (OR) procedures using: (1) the EMT investigational device, and (2) the Oncentra prostate system (OCP).

A scintillation dosimeter with real-time positional tracking information for in vivo dosimetry error detection in HDR brachytherapy.

Purpose: To evaluate the performance of an electromagnetic (EM)-tracked scintillation dosimeter in detecting source positional errors of IVD in HDR brachytherapy treatment.

Materials And Methods: Two different scintillator dosimeter prototypes were coupled to 5 degrees-of-freedom (DOF) EM sensors read by an Aurora V3 system. The scintillators used were a 0.

Generation and comparison of 3D dosimetric reference datasets for COMS eye plaque brachytherapy using model-based dose calculations.

Purpose: A joint Working Group of the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy and Oncology (ESTRO), and the Australasian Brachytherapy Group (ABG) was created to aid in the transition from the AAPM TG-43 dose calculation formalism, the current standard, to model-based dose calculations. This work establishes the first test cases for low-energy photon-emitting brachytherapy using model-based dose calculation algorithms (MBDCAs).

Acquisition And Validation Methods: Five test cases are developed: (1) a single model 6711 I brachytherapy seed in water, 13 seeds (2) individually and (3) in combination in water, (4) the full Collaborative Ocular Melanoma Study (COMS) 16 mm eye plaque in water, and (5) the full plaque in a realistic eye phantom.

Tumor Shape-Specific Brachytherapy Implants by 3D-Printing, Precision Radioactivity Painting, and Biomedical Imaging.

In brachytherapy (BT), or internal radiation therapy, cancer is treated by radioactive implants. For instance, episcleral plaques (EPs) for the treatment of uveal melanoma, are designed according to generic population approximations. However, more personalized implants can enhance treatment precision through better adjustment of dose profiles to the contours of cancerous tissues.

AAPM WGDCAB Report 372: A joint AAPM, ESTRO, ABG, and ABS report on commissioning of model-based dose calculation algorithms in brachytherapy.

The introduction of model-based dose calculation algorithms (MBDCAs) in brachytherapy provides an opportunity for a more accurate dose calculation and opens the possibility for novel, innovative treatment modalities. The joint AAPM, ESTRO, and ABG Task Group 186 (TG-186) report provided guidance to early adopters. However, the commissioning aspect of these algorithms was described only in general terms with no quantitative goals.

Fastcalculation in LDR brachytherapy using deep learning methods.

The Monte Carlo (MC) method provides a complete solution to the tissue heterogeneity effects in low-energy low-dose rate (LDR) brachytherapy. However, long computation times limit the clinical implementation of MC-based treatment planning solutions. This work aims to apply deep learning (DL) methods, specifically a model trained with MC simulations, to predict accurate dose to medium in medium () distributions in LDR prostate brachytherapy.

Validation of the TOPAS Monte Carlo toolkit for LDR brachytherapy simulations.

Purpose: This work has the purpose of validating the Monte Carlo toolkit TOol for PArticle Simulation (TOPAS) for low-dose-rate (LDR) brachytherapy uses.

Methods And Materials: Simulations of 12 LDR sources and 2 COMS eye plaques (10 mm and 20 mm in diameter) and comparisons with published reference data from the Carleton Laboratory for Radiotherapy Physics (CLRP), the TG-43 consensus data and the TG-129 consensus data were performed. Sources from the IROC Houston Source Registry were modeled.

Brachytherapy evolution as seen today.

While brachytherapy is the oldest form of radiation therapy, it is also a very exciting field from both physics and clinical perspectives. From the physics standpoint, brachytherapy dosimetry is largely being governed by the inverse-square law, leading to an unparalleled dose deposition kernel (dose emitted by a seed or single dwell position), even compared to proton or heavy-ion beamlets. There is slightly more dose beyond the central deposition point, but comparatively very little prior to it, that is, little or no entrance dose! It is easy to sum multiple dwell positions that cover a tumor, and the intensity can be modulated quite effectively using dwell times.

Real-Time Temperature Correction of Medical Range Fiber Bragg Gratings Dosimeters.

The interest in fiber Bragg gratings dosimeters for radiotherapy dosimetry lies in their (i) submillimeter size, (ii) multi-points dose measurements, and (iii) customizable spatial resolution. However, since the radiation measurement relies on the thermal expansion of the surrounding polymer coating, such sensors are strongly temperature dependent, which needs to be accounted for; otherwise, the errors on measurements can be higher than the measurements themselves. In this paper, we test and compare four techniques for temperature compensation: two types of dual grating techniques using different coatings, a pre-irradiation and post-irradiation temperature drift technique, which is used for calorimetry, and finally, we developed a real-time interpolated temperature gradient for the multi-points dosimetry technique.

Hybrid Cerenkov-scintillation detector validation using Monte Carlo simulations.

This study aimed at investigating through Monte Carlo simulations the limitations of a novel hybrid Cerenkov-scintillation detector and the associated method for irradiation angle measurements.Using Monte Carlo simulations, previous experimental irradiations of the hybrid detector with a linear accelerator were replicated to evaluate its general performances and limitations. Cerenkov angular calibration curves and irradiation angle measurements were then compared.

Benchmark of the PenRed Monte Carlo framework for HDR brachytherapy.

Purpose: The purpose of this study is to validate the PenRed Monte Carlo framework for clinical applications in brachytherapy. PenRed is a C++ version of Penelope Monte Carlo code with additional tallies and utilities.

Methods And Materials: Six benchmarking scenarios are explored to validate the use of PenRed and its improved bachytherapy-oriented capabilities for HDR brachytherapy.

Commissioning of GPU-based multi-criteria optimizer combined with plan navigation tools for high-dose-rate brachytherapy.

Purpose: Recently, our GPU-based multi-criteria optimization (gMCO) algorithm has been integrated in a graphical user interface (gMCO-GUI) that allows real-time plan navigation through a gMCO-generated set of Pareto-optimal plans for high-dose-rate (HDR) brachytherapy. This work reports on the commissioning of the gMCO algorithm into clinical workflow.

Material And Methods: Our MCO workflow was validated against Oncentra Prostate v.