In vivodosimetry: trends and prospects for brachytherapy

Abstract

The error types during brachytherapy (BT) treatments and their occurrence rates are not well known. The limited knowledge is partly attributed to the lack of independent verification systems of the treatment progression in the clinical workflow routine. Within the field of in vivo dosimetry (IVD), it is established that real-time IVD can provide efficient error detection and treatment verification. However, it is also recognized that widespread implementations are hampered by the lack of available high-accuracy IVD systems that are straightforward for the clinical staff to use. This article highlights the capabilities of the state-of-the-art IVD technology in the context of error detection and quality assurance (QA) and discusses related prospects of the latest developments within the field. The article emphasizes the main challenges responsible for the limited practice of IVD and provides descriptions on how they can be overcome. Finally, the article suggests a framework for collaborations between BT clinics that implemented IVD on a routine basis and postulates that such collaborations could improve BT QA measures and the knowledge about BT error types and their occurrence rates.

Inorganic scintillation detectors based on Eu-activated phosphors for192Ir brachytherapy

“…Scintillation detectors have shown a strong potential to provide real-time treatment verification during BT (Tanderup et al 2013, Kertzscher et al 2014). For example, detectors based on the blue-emitting Al 2 O 3 :C crystal (Andersen et al 2011, Kertzscher et al 2011a, Beierholm et al 2008) exhibit the high signal intensities that are required for monitoring the absorbed dose rate with small statistical uncertainties over the wide dynamic range that is common with BT sources (Tanderup et al 2013, Kertzscher et al 2011b).…”

Ruby-based inorganic scintillation detectors for192Ir brachytherapy

“…Inorganic scintillation detectors (ISDs) have demonstrated promise for use in in vivo dosimetry and radiotherapy quality assurance routines (Tanderup et al 2013, Mijnheer et al 2013, O’Keeffe et al 2015, Kertzscher et al 2014b). Both ISDs and plastic scintillation detectors (PSDs) (Beddar et al 1992c, 1992b) possess several characteristics that make them suitable for in vivo brachytherapy (BT) dosimetry (Tanderup et al 2013).…”

“…This could be accomplished with a narrow band-pass filter to monitor the wavelength region near the emission peak of the ruby signal. Such a simple design could facilitate the development of dosimetry systems that employ the standard one-channel electrometers that are already available in the vast majority of radiotherapy clinics and could encourage the dissemination of in vivo dosimetry technology to more clinics (Tanderup et al 2013, Kertzscher et al 2014b). Furthermore, sufficiently large light outputs also eliminate the need for high-sensitivity photodetectors, making such dosimetry systems more affordable.…”

Real-time in vivo dosimetry in high dose rate prostate brachytherapy

“…It is therefore important to have confidence in the dose that is being delivered and there is increasing interest in performing in-vivo dosimetry (IVD) [3,4]. UK guidelines recommend that IVD is performed for most radiotherapy patients at the beginning of their treatment [5].…”