Variations of intracavitary applicator geometry during multiple HDR brachytherapy insertions in carcinoma cervix and its influence on reporting as per ICRU report 38

Datta, Niloy Ranjan; Kumar, Shaleen; Das, K.J. Maria; Pandey, Chandra Kant; Halder, Shikha; Ayyagari, S.

doi:10.1016/s0167-8140(01)00352-8

Cited by 53 publications

(38 citation statements)

References 11 publications

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“…Interand intrafraction deformations of prostate, bladder and rectum have been studied, [42][43][44][45][46] and the dosimetric impact owing to more general anatomical variations has been evaluated in a multicentre comparison of cervix BT. 41 Organ-applicator movements occurring between patient imaging and treatment delivery stages have been identified as a major source of uncertainty 33,[47][48][49][50][51][52][53] and their impact further analysed. [54][55][56][57] In cervical cancer BT, inter-and intrafraction uncertainties owing to organ movements and deformations account for 20-25% of the D 2cm3 parameter (minimum dose to the most irradiated 2 cm 3 ) per fraction and is the most essential component in the uncertainty budget for OARs.…”

Section: Treatment Errors In Btmentioning

confidence: 99%

In vivodosimetry: trends and prospects for brachytherapy

Kertzscher¹,

Rosenfeld²,

Beddar³

et al. 2014

BJR

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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.

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Section: Treatment Errors In Btmentioning

confidence: 99%

In vivodosimetry: trends and prospects for brachytherapy

Kertzscher¹,

Rosenfeld²,

Beddar³

et al. 2014

BJR

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“…However, depending on the institutional protocols HDR ICBT requires multiple applications. This could lead to a variation in the applicator geometry and its spatial position in relation to the pelvic organs, pelvic bony anatomy and the organs at risk [13][14][15][16][17] . These have been reported in terms of changes in the uterine axis, uterine length, slippage of tandem, colpostat separation and vaginal packing, resulting in fluctuations in spatial location of the applicator in craniocaudal axis, lateral and antero-posterior rotation as well as variation in coronal, transverse and saggital planes ( Figure 1) [18] .…”

Section: Dose Prescriptions In Hdr Era Using Point a And Icru Report 38mentioning

confidence: 99%

“…The variation in the applicator position in successive brachytherapy sessions, results in varying location of point A, as it is primarily defined in relation to the applicator itself [14,19,20] . Multiple HDR applications, thus result in different set of point As for both right and left sides, each set corresponding to each application.…”

Section: Dose Prescriptions In Hdr Era Using Point a And Icru Report 38mentioning

confidence: 99%

“…All these could result in variation in the doses to various ICRU Report 38 reporting parameters-OARs, ICRU volumes, total reference air kerma in the same patient during the course of multiple HDR ICBT [14,18,19] . Continuing to report dose to point A or ICRU Report 38 parameters, is therefore fraught with uncertainty.…”

Section: Dose Prescriptions In Hdr Era Using Point a And Icru Report 38mentioning

confidence: 99%

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Brachytherapy in cancer cervix: Time to move ahead from point A?

Srivastava¹

2014

WJCO

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Brachytherapy forms an integral part of the radiation therapy in cancer cervix. The dose prescription for intracavitary brachytherapy (ICBT) in cancer cervix is based on Tod and Meredith's point A and has been in practice since 1938. This was proposed at a time when accessibility to imaging technology and dose computation facilities was limited. The concept has been in practice worldwide for more than half a century and has been the fulcrum of all ICBT treatments, strategies and outcome measures. The method is simple and can be adapted by all centres practicing ICBT in cancer cervix. However, with the widespread availability of imaging techniques, clinical use of different dose-rates, availability of a host of applicators fabricated with image compatible materials, radiobiological implications of dose equivalence and its impact on tumour and organs at risk; more and more weight is being laid down on individualised image based brachytherapy. Thus, computed tomography, magnetic-resonance imaging and even positron emission computerized tomography along with brachytherapy treatment planning system are being increasingly adopted with promising outcomes. The present article reviews the evolution of dose prescription concepts in ICBT in cancer cervix and brings forward the need for image based brachytherapy to evaluate clinical outcomes. As is evident, a gradual transition from "point" based brachytherapy to "profile" based image guided brachytherapy is gaining widespread acceptance for dose prescription, reporting and outcome evaluation in the clinical practice of ICBT in cancer cervix.

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“…Second, geometry of the applicators changes as a consequence of the differences in vaginal packing and anatomical position of the patient. [9][10][11][12][13][14][15] As a result every parameter that influences the treatment should be thoroughly studied.…”

Section: Introductionmentioning

confidence: 99%