The unique resource constraints, urgency, and virulence of the coronavirus disease 2019 pandemic has sparked immense innovation in the development of barrier devices to protect healthcare providers from infectious airborne particles generated by patients during airway management interventions. Of the existing devices, all have shortcomings which render them ineffective and impractical in out-of-hospital environments. Therefore, we propose a new design for such a device, along with a pragmatic evaluation of its efficacy. Must-have criteria for the device included: reduction of aerosol transmission by at least 90% as measured by pragmatic testing; construction from readily available, inexpensive materials; easy to clean; and compatibility with common EMS stretchers. The Patient Particle Containment Chamber (PPCC) consists of a standard shower liner draped over a modified octagonal PVC pipe frame and secured with binder clips. 3D printed sleeve portals were used to secure plastic sleeves to the shower liner wall. A weighted tube sealed the exterior base of the chamber with the contours of the patient’s body and stretcher. Upon testing, the PPCC contained 99% of spray-paint particles sprayed over a 90s period. Overall, the PPCC provides a compact, affordable option that can be used in both the in-hospital and out-of-hospital environments.
PurposeHigh dose rate (HDR) brachytherapy rapidly delivers dose to targets with steep dose gradients. This treatment method must adhere to prescribed treatment plans with high spatiotemporal accuracy and precision, as failure to do so may degrade clinical outcomes. One approach to achieving this goal is to develop imaging techniques to track HDR sources in vivo in reference to surrounding anatomy. This work investigates the feasibility of using an isocentric C‐arm x‐ray imager and tomosynthesis methods to track Ir‐192 HDR brachytherapy sources in vivo over time (4D).MethodsA tomosynthesis imaging workflow was proposed and its achievable source detectability, localization accuracy, and spatiotemporal resolution were investigated in silico. An anthropomorphic female XCAT phantom was modified to include a vaginal cylinder applicator and Ir‐192 HDR source (0.5 × 0.5 × 5.0 mm3), and the workflow was carried out using the MC‐GPU Monte Carlo image simulation platform. Source detectability was characterized using the reconstructed source signal‐difference‐to‐noise‐ratio (SDNR), localization accuracy by the absolute 3D error in its measured centroid location, and spatiotemporal resolution by the full‐width‐at‐half‐maximum (FWHM) of line profiles through the source in each spatial dimension considering a maximum C‐arm angular velocity of 30° per second. The dependence of these parameters on acquisition angular range (θtot = 0°–90°), number of views, angular increment between views (Δθ = 0°–15°), and volumetric constraints imposed in reconstruction was evaluated. Organ voxel doses were tallied to derive the workflow's attributable effective dose.ResultsThe HDR source was readily detected and its centroid was accurately localized with the proposed workflow and method (SDNR: 10–40, 3D error: 0–0.144 mm). Tradeoffs were demonstrated for various combinations of image acquisition parameters; namely, increasing the tomosynthesis acquisition angular range improved resolution in the depth‐encoded direction, for example from 2.5 mm to 1.2 mm between θtot = 30o and θtot = 90o, at the cost of increasing acquisition time from 1 to 3 s. The best‐performing acquisition parameters (θtot = 90o, Δθ = 1°) yielded no centroid localization error, and achieved submillimeter source resolution (0.57 × 1.21 × 5.04 mm3 apparent source dimensions, FWHM). The total effective dose for the workflow was 263 µSv for its required pre‐treatment imaging component and 7.59 µSv per mid‐treatment acquisition thereafter, which is comparable to common diagnostic radiology exams.ConclusionsA system and method for tracking HDR brachytherapy sources in vivo using C‐arm tomosynthesis was proposed and its performance investigated in silico. Tradeoffs in source conspicuity, localization accuracy, spatiotemporal resolution, and dose were determined. The results suggest this approach is feasible for localizing an Ir‐192 HDR source in vivo with submillimeter spatial resolution, 1–3 second temporal resolution and minimal additional dose burden.
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