Learning from the past: a century of accuracy, aspirations, and aspersions in brachytherapy

Melhus, Christopher S.; Simiele, Samantha J.; Aima, Manik; Richardson, Susan

doi:10.1259/bjr.20220500

Cited by 3 publications

(2 citation statements)

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“…In the early 1900s, physicians struggled to pass radiation through healthy tissue to reach the tumor [ 25 ]. To solve this problem, the radioactive source was placed into the patient’s body.…”

Section: Endobronchial Administrationmentioning

confidence: 99%

“…In interstitial brachytherapy, the radioisotope is placed directly into the tumor, which differs from intracavity brachytherapy where it is placed into a cavity located nearby the malignancy. Depending on the duration of implantation and radiation dose, there are three different types of internal radiotherapy: low-dose rate (LDR) implants, high-dose-rate (HDR) implants and permanent implants [ 25 ]. The most used clinical radioisotopes are 125 I and 103 Pb.…”

Section: Endobronchial Administrationmentioning

confidence: 99%

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Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Claes

Wener

Neyrinck

et al. 2023

Cancers

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Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness.

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Section: Endobronchial Administrationmentioning

confidence: 99%

Section: Endobronchial Administrationmentioning

confidence: 99%

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Claes

Wener

Neyrinck

et al. 2023

Cancers

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Attention 3D U‐NET for dose distribution prediction of high‐dose‐rate brachytherapy of cervical cancer: Direction modulated brachytherapy tandem applicator

Gautam,

Osman,

Richeson

et al. 2024

Medical Physics

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BackgroundDirection Modulated Brachytherapy (DMBT) enables conformal dose distributions. However, clinicians may face challenges in creating viable treatment plans within a fast‐paced clinical setting, especially for a novel technology like DMBT, where cumulative clinical experience is limited. Deep learning‐based dose prediction methods have emerged as effective tools for enhancing efficiency.PurposeTo develop a voxel‐wise dose prediction model using an attention‐gating mechanism and a 3D UNET for cervical cancer high‐dose‐rate (HDR) brachytherapy treatment planning with DMBT six‐groove tandems with ovoids or ring applicators.MethodsA multi‐institutional cohort of 122 retrospective clinical HDR brachytherapy plans treated to a prescription dose in the range of 4.8–7.0 Gy/fraction was used. A DMBT tandem model was constructed and incorporated onto a research version of BrachyVision Treatment Planning System (BV‐TPS) as a 3D solid model applicator and retrospectively re‐planned all cases by seasoned experts. Those plans were randomly divided into 64:16:20 as training, validating, and testing cohorts, respectively. Data augmentation was applied to the training and validation sets to increase the size by a factor of 4. An attention‐gated 3D UNET architecture model was developed to predict full 3D dose distributions based on high‐risk clinical target volume (CTVHR) and organs at risk (OARs) contour information. The model was trained using the mean absolute error loss function, Adam optimization algorithm, a learning rate of 0.001, 250 epochs, and a batch size of eight. In addition, a baseline UNET model was trained similarly for comparison. The model performance was evaluated on the testing dataset by analyzing the outcomes in terms of mean dose values and derived dose‐volume‐histogram indices from 3D dose distributions and comparing the generated dose distributions against the ground‐truth dose distributions using dose statistics and clinically meaningful dosimetric indices.ResultsThe proposed attention‐gated 3D UNET model showed competitive accuracy in predicting 3D dose distributions that closely resemble the ground‐truth dose distributions. The average values of the mean absolute errors were 1.82 ± 29.09 Gy (vs. 6.41 ± 20.16 Gy for a baseline UNET) in CTVHR, 0.89 ± 1.25 Gy (vs. 0.94 ± 3.96 Gy for a baseline UNET) in the bladder, 0.33 ± 0.67 Gy (vs. 0.53 ± 1.66 Gy for a baseline UNET) in the rectum, and 0.55 ± 1.57 Gy (vs. 0.76 ± 2.89 Gy for a baseline UNET) in the sigmoid. The results showed that the mean absolute error (MAE) for the bladder, rectum, and sigmoid were 0.22 ± 1.22 Gy (3.62%) (p = 0.015), 0.21 ± 1.06 Gy (2.20%) (p = 0.172), and ‐0.03 ± 0.54 Gy (1.13%) (p = 0.774), respectively. The MAE for D90, V100%, and V150% of the CTVHR were 0.46 ± 2.44 Gy (8.14%) (p = 0.018), 0.57 ± 11.25% (5.23%) (p = 0.283), and ‐0.43 ± 19.36% (4.62%) (p = 0.190), respectively. The proposed model needs less than 5 s to predict a full 3D dose distribution of 64 × 64 × 64 voxels for any new patient plan, thus making it sufficient for near real‐time applications and aiding with decision‐making in the clinic.ConclusionsAttention gated 3D‐UNET model demonstrated a capability in predicting voxel‐wise dose prediction, in comparison to 3D UNET, for DMBT intracavitary brachytherapy planning. The proposed model could be used to obtain dose distributions for near real‐time decision‐making before DMBT planning and quality assurance. This will guide future automated planning, making the workflow more efficient and clinically viable.

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Time-resolved clinical dose volume metrics, calculations and predictions based on source tracking measurements and uncertainties to aid treatment verification and error detection for HDR brachytherapy—a proof-of-principle study

van Wagenberg,

Voncken,

van Beveren

et al. 2024

Phys. Med. Biol.

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Objective. High-dose-rate (HDR) brachytherapy lacks routinely available treatment verification methods. Real-time tracking of the radiation source during HDR brachytherapy can enhance treatment verification capabilities. Recent developments in source tracking allow for measurement of dwell times and source positions with high accuracy. However, more clinically relevant information, such as dose discrepancies, is still needed. To address this, a real-time dose calculation implementation was developed to provide more relevant information from source tracking data. A proof-of-principle of the developed tool was shown using source tracking data obtained from a 3D-printed anthropomorphic phantom. Approach. Software was developed to calculate dose-volume-histograms (DVH) and clinical dose metrics from experimental HDR prostate treatment source tracking data, measured in a realistic pelvic phantom. Uncertainty estimation was performed using repeat measurements to assess the inherent dose measuring uncertainty of the in vivo dosimetry (IVD) system. Using a novel approach, the measurement uncertainty can be incorporated in the dose calculation, and used for evaluation of cumulative dose and clinical dose-volume metrics after every dwell position, enabling real-time treatment verification. Main results. The dose calculated from source tracking measurements aligned with the generated uncertainty bands, validating the approach. Simulated shifts of 3 mm in 5/17 needles in a single plan caused DVH deviations beyond the uncertainty bands, indicating errors occurred during treatment. Clinical dose-volume metrics could be monitored in a time-resolved approach, enabling early detection of treatment plan deviations and prediction of their impact on the final dose that will be delivered in real-time. Significance. Integrating dose calculation with source tracking enhances the clinical relevance of IVD methods. Phantom measurements show that the developed tool aids in tracking treatment progress, detecting errors in real-time and post-treatment evaluation. In addition, it could be used to define patient-specific action limits and error thresholds, while taking the uncertainty of the measurement system into consideration.

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Learning from the past: a century of accuracy, aspirations, and aspersions in brachytherapy

Cited by 3 publications

References 71 publications

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Innovative Invasive Loco-Regional Techniques for the Treatment of Lung Cancer

Attention 3D U‐NET for dose distribution prediction of high‐dose‐rate brachytherapy of cervical cancer: Direction modulated brachytherapy tandem applicator

Time-resolved clinical dose volume metrics, calculations and predictions based on source tracking measurements and uncertainties to aid treatment verification and error detection for HDR brachytherapy—a proof-of-principle study

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