Development, implementation, and associated challenges of a new HDR brachytherapy program.

Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting.

Surface brachytherapy: Joint report of the AAPM and the GEC-ESTRO Task Group No. 253.

The surface brachytherapy Task Group report number 253 discusses the common treatment modalities and applicators typically used to treat lesions on the body surface. Details of commissioning and calibration of the applicators and systems are discussed and examples are given for a risk-based analysis approach to the quality assurance measures that are necessary to consider when establishing a surface brachytherapy program.

Dose-rate considerations for the INTRABEAM electronic brachytherapy system: Report from the American association of physicists in medicine task group no. 292.

The purpose of this report is to provide detailed guidance on the dosimetry of the INTRABEAM® (Carl Zeiss Medical AG, Jena, Germany) electronic brachytherapy (eBT) system as it stands at the present time. This report has been developed by the members of American Association of Physicists in Medicine (AAPM) Task Group 292 and endorsed by the AAPM. Members of AAPM Task Group 292 on Electronic-Brachytherapy Dosimetry have reviewed pertinent publications and user manuals regarding the INTRABEAM system dosimetry and manufacturer-supplied dose calculation protocols.

Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.

Purpose: The purpose of this study was to provide guidance on quality management for electronic brachytherapy.

Materials And Methods: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation.

American College of Radiology-American Brachytherapy Society practice parameter for electronically generated low-energy radiation sources.

Background: This collaborative practice parameter technical standard has been created between the American College of Radiology and American Brachytherapy Society to guide the usage of electronically generated low energy radiation sources (ELSs). It refers to the use of electronic X-ray sources with peak voltages up to 120 kVp to deliver therapeutic radiation therapy.

Main Findings: The parameter provides a guideline for utilizing ELS, including patient selection and consent, treatment planning, and delivery processes.

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) 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.

Guidelines by the AAPM and GEC-ESTRO on the use of innovative brachytherapy devices and applications: Report of Task Group 167.

Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used in the evaluation of innovative devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining the equivalence of the innovative treatment modality to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of innovative radiotherapy devices or applications is a critical part in which physicists should be actively involved.

Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry.

Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry.

Non-melanoma skin cancer treated with HDR Valencia applicator: clinical outcomes.

Purpose: Radiotherapy (RT) has played a significant role in treating non melanoma skin cancer (NMSC). High-dose-rate brachytherapy (HDR-BT) approaches have a paramount relevance due to their adaptability, patient protection, and variable dose fractionation schedules. Several innovative applicators have been introduced to the brachytherapy community.

SU-E-J-180: A Characterization of the LAP Aquarius Phantom for External LAP Laser Alignment and MR Geometric Distortion Verification for the use of SRS Patient Simulation.

Purpose: To explore additional application of the new Aquarius external laser alignment verification Phantom by LAP (Aq-LAP Phantom) examining geometric accuracy of magnetic resonance images (MRI) commonly used for planning intracranial stereotactic radiation surgery (ICSRS) cases.

Methods: Newly designed external patient alignment lasers were first aligned by the Aq-LAP Phantom at a Siemens Magneton Vario 3T MR unit. The scans were then performed with the T1 Axial 3D MPRAGE protocols with 0.

A geologic survey of the medicare RBRVS system.

The Resource Based Relative Value System (RBRVS) was established over fifteen years ago in an attempt to bring order to the Medicare reimbursement system. The RBRVS relies on a complicated formula to determine how much each procedure is worth. This article uses an unusual approach to describe the components of the RBRVS equation, how those relative values are developed and managed, and how they relate to each other, even though each one is calculated differently.

Adjuvant systemic therapy for breast cancer. Issues for primary care physicians.

Chemotherapy, hormone therapy, or both are used for adjuvant management in patients with breast cancer. Early systemic therapy can delay and possibly prevent the progression of micrometastatic disease. Positive axillary nodes constitute the major risk factor for later systemic disease, and most oncologists believe that all women with positive nodes should have adjuvant therapy.

Local and regional therapy for primary breast tumors. Answers to major questions.

Because all primary care physicians see patients with breast cancer, it is imperative that they maintain an up-to-date working knowledge of its diagnosis and treatment. The diagnosis of breast cancer requires awareness and diligence on the part of both physician and patient, and surgical consultation is most appropriate before any invasive diagnostic procedures are done. The ultimate treatment plan evolves from consideration of tumor- and patient-related factors.