Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator

Elzibak, Alyaa H.; Kager, P.M.; Soliman, A; Paudel, Moti; Safigholi, Habib; Han, Dan; Karotki, Aliaksandr; Ravi, Ananth; Song, William Y.

doi:10.1016/j.brachy.2017.10.006

Cited by 16 publications

(16 citation statements)

References 45 publications

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“…Furthermore, OAR sparing with DMBT&R further improved when 169 Yb was used instead of the conventional 192 Ir source, particularly for bulkier CTV HR (>30 cm 3 ). Important advantages of the current DMBT design are/include the minimal artifacts under MR imaging and the compatibility with CT when metal artifact reduction algorithms are applied. This suggests that DMBT is an excellent candidate for applications in IGABT.…”

Section: Introductionmentioning

confidence: 99%

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

et al. 2018

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Section: Introductionmentioning

confidence: 99%

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

et al. 2018

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“…Two studies for conceptual IMBT were reported with no specific applicator design. 81,82 Twenty-five studies were on clinically implemented IMBT techniques, 6,7,23,26,35,36,38-43,47-49,53,56,58,63,83-88 13 included a prototype of the applicator, 3,4,18,19,27,28,[31][32][33][34]66,73,78 and most of the other studies using simulated IMBT plans on real patients' simulation scans or dosimetric evaluations.…”

Section: Literature Searchmentioning

confidence: 99%

“…Grooved-shielding HDR applicators (Figs. 1K, L, and M), also known as direction-modulated brachytherapy (DirMBT) applicators, for rectal cancer, 25 breast cancer, 21 and cervical cancer, [27][28][29][30][31][32][33] have been introduced relatively recently, with the advance of dose optimization and heterogeneity-corrected dose-calculation technique. In this technique, a central tandem or cylinder with a high atomic number (Z) has "grooves" symmetrically placed around the periphery, into which sources can be translated.…”

Section: Static-shielded Applicatorsmentioning

confidence: 99%

“…"Static" IMBT approaches include those in which the shield does not move relative to the source or surrounding tissues during BT delivery, such as shielded applicators (eg, shielded cylinders, [3][4][5][6][7][8][9][10][11] shielded tandem and ovoids, [12][13][14][15][16][17][18][19][20] Strut-Adjusted Volume Implants [SAVI], 21 intracavitary mold applicators [ICMA], [22][23][24][25][26] direction-modulated brachytherapy [DirMBT], 21,25,[27][28][29][30][31][32][33][34] and cup or D-shaped applicators [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]…”

Section: Introductionmentioning

confidence: 99%

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Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

Callaghan

Adams

Flynn

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To systematically review scientific literature on the use of intensity-modulated brachytherapy (IMBT), including static and dynamic shielding approaches, to enhance therapeutic ratio. Studies were evaluated for technique, disease site, dosimetry, applicators, dosimetric calculations, and planning algorithms. Comparisons with standard-of-care brachytherapy techniques, alternative IMBT methods, or both were performed for dose-to-target volumes, organs at risk (OARs), and treatment planning or delivery times. Methods and Materials: Inclusion criteria were any peer-reviewed journal articles on IMBT published from January 1, 1980, to January 1, 2019, on PubMed, Google Scholar, Cochrane Library, and EBSCO databases. Two independent investigators reviewed each article for inclusion and exclusion criteria and scope. Data collected on each study included technique, source or shield material, disease site, n of study (n Z number of simulated plans/treated patients), doseto-target/OARs, and planning or delivery times. This review adhered to the Preferred Reporting Items for Systemic reviews and Meta Analyses (PRISMA). Results: Database queries yielded 1734 results, which were reduced to 436 after exclusion criteria and 78 peer-reviewed journal articles after evaluation of scope. Studies per disease site were 31 for cervical; 16 for rectal; 10 for oculocutaneous; 7 for breast; 6 for prostate; and 8 for other, multiple, or no specific disease site. Eighteen studies demonstrated a significant decrease in dose to OARs (5.1%-68.2%), 11 improved treatment planning or delivery times (7.6%-99.7%), and 6 increased target coverage (18.6%-71.6%) relative to standard-of-care or alternative IMBT technique. IMBT consistently decreased dose to OAR compared with the standard of care at the cost of increased planning or delivery times. Innovations in dose calculation or planning algorithms and applicators were capable of ameliorating prolonged treatment intervals.

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“…Despite the dosimetric advantages of IC/IS over IC, IC/IS is more challenging, 7 invasive, 8,9 and time‐consuming 3 to deliver than IC. Multiple intracavitary HDR‐BT approaches using partial source shielding within the tandem applicator have been proposed to reduce or eliminate the need for interstitial HDR‐BT in cervical cancer patients, including rotating shield brachytherapy (RSBT) 10–14 and direction‐modulated brachytherapy (DMBT) 15–21 . Rotating shield brachytherapy relies on rotational movement of high‐density shields to modulate dose rate and direct radiation away from organs‐at‐risk (OARs) and into the HR‐CTV, which can increase dose delivered to the HR‐CTV without violating OAR dose constraints.…”

Section: Introductionmentioning

confidence: 99%

Needle‐free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the ¹⁶⁹Yb Isotope

et al. 2020

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Purpose: To assess the capability of an intracavitary 169 Yb-based helical multishield rotating shield brachytherapy (RSBT) delivery system to treat cervical cancer. The proposed RSBT delivery system contains a pair of 1.25 mm thick platinum partial shields with 45°and 180°emission angles, which travel in a helical pattern within the applicator. Methods: A helically threaded tandem applicator with a 45°tandem curvature containing a helically threaded catheter was designed. A 0.6 mm diameter 169 Yb source with a length of 10.5 mm was simulated. A 37-patient treatment planning study, based on Monte Carlo dose calculations using MCNP5, was conducted with high-risk clinical target volumes (HR-CTVs) of 41.2-192.8 cm 3 (average AE standard deviation of 79.9 AE 35.8 cm 3 ). All patients were assumed to receive 25 fractions of 1.8 Gy of external beam radiation therapy (EBRT) before receiving 5 fractions of high-dose-rate brachytherapy (HDR-BT). For each patient, 192 Ir-based intracavitary (IC) HDR- BT, 192 Ir-based intracavitary/interstitial (IC/IS) HDR-BT using a hybrid applicator with eight IS needles, and 169 Yb-based RSBT plans were generated. Results: For the IC, IC/IS, and RSBT treatment plans, 38%, 84%, and 86% of the plans, respectively, met the planning goal of an HR-CTV D 90 (minimum dose to hottest 90%) of 85 Gy EQD2 (a/ b = 10 Gy). Median (25th percentile, 75th percentile) treatment times for IC, IC/IS, and RSBT were 11.71 (6.62, 15.40) min, 68.00 (45.02, 80.02) min, and 25.30 (13.87, 35.39) min, respectively. 192 Ir activities ranging from 159.1-370 GBq (4.3-10 Ci) and 169 Yb activities ranging from 429.2-999 GBq (11.6-27 Ci) were used, which correspond to the same clinical ranges of dose rates at 1 cm off-source-axis in water. Extra needle insertion and planning time beyond that needed for intracavitary-only approaches was accounted for in the IC/IS treatment time calculations. Conclusion: 169 Yb-based RSBT for cervical cancer met the HR-CTV D 90 goal of 85 Gy in a greater percentage of the patients considered than IC/IS (86% vs 84%, respectively) and can reduce overall treatment time relative to IC/IS. 169 Yb-based RSBT could be used to replace IC/IS in instances where IC/IS treatment is not available, especially in instances when HR-CTV volumes are ≥30 cm 3 .

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Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator

Cited by 16 publications

References 45 publications

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

Needle‐free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the ¹⁶⁹Yb Isotope

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Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator

Cited by 16 publications

References 45 publications

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material

Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

Needle‐free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the 169Yb Isotope

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Needle‐free cervical cancer treatment using helical multishield intracavitary rotating shield brachytherapy with the ¹⁶⁹Yb Isotope