PURPOSE: To introduce the CT based three dimensional (3D) conformal brachytherapy treatment planning for interstitial implants, to compare the conventional X-ray film based planning with the 3D planning from the point of view of reconstruction and dosimetry, to discuss the differences and highlight the advantages. MATERIAL AND METHODS: On 10 patients with breast and 5 with head and neck tumor treated with HDR interstitial implants, following the catheter implantations, CT scans were taken at 5 mm spacing. The images were loaded into the PLATO BPS v14.0 3D planning system for brachytherapy. The contours of the target volume and critical structures were outlined on each slice, the catheter describing points were identified and the anatomical structures and catheter positions were reconstructed in 3D. Having taken into account the target volume, the active lengths were determined in each catheter, and dose optimization on dose points on target was performed. RESULTS: The 3D treatment planning was applied at interstitial breast treatments and head and neck implants. We investigated the dose distribution on axial, reconstructed coronal / sagittal planes and in 3D view with respect to anatomical structures. Dose volume histograms related to the target volume and critical structures were used for quantitative assessment of the plans. We found that the conformal dose distribution might result in increase of dose inhomogeneity within the target volume. CONCLUSIONS: The three dimensional brachytherapy treatment planning can be introduced into the clinical practice under proper technical conditions. A tradeoff between conformality and dose homogeneity results in an acceptable dose plan. The dose inhomogeneity can be decreased with the use of CT scans taken before the implantation. The guidelines and quantitative parameters describing the dose distribution, which can be used for determining the optimal dose distribution in clinical point of view, are still waiting to be established.
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