In this work, the dose rate distribution of a new high dose rate source (Flexisource used in the afterloading Flexitron system, Isodose Control, Veenendaal, The Netherlands) is studied by means of Monte Carlo techniques using the GEANT4 code. The dosimetric parameters of the Task Group No. 43 Report (TG43) formalism and two‐dimensional rectangular look‐up tables have been obtained.
S1253ESTRO 37(GI) and genitourinary (GU) toxicity were analyzed by univariate analysis. ResultsNeither acute nor late grade 2 to 3 GI toxicities developed.Acute grade 2 GU toxicity occurred in 11.4% (grade 3 in 0.0%).Any predictors of acute grade 2 GU toxicity weren't founded.Late grade 2 to 3 GU toxicity occurred in 23.8% (grade 3 in 2.9%).Grade 2 urethral obstruction, urinary tract pain, urinary urgency, urinary frequency, hematuria, and grade 3 urethral obstruction were observed in 9, 2, 7, 7, 4, and 3 patients, respectively.Any predictors of late grade 2 to 3 GU toxicity weren't also founded. ConclusionThere was no statistically-significant correlation between the incidence of Grade 2 to 3 GI and GU toxicity and the clinical and dosimetric factors after HDR brachytherapy as monotherapy in localized prostate cancer.
In low energy brachytherapy, the presence of tissue heterogeneities contributes significantly to the discrepancies observed between treatment plan and delivered dose.In this work, we present a simplified analytical dose calculation algorithm for heterogeneous tissue.We compare it with Monte Carlo computations and assess its suitability for integration in clinical treatment planning systems.The algorithm, named as RayStretch, is based on the classic equivalent path length method and TG-43 reference data.Analytical and Monte Carlo dose calculations using Penelope2008 are compared for a benchmark case: a prostate patient with calcifications.The results show a remarkable agreement between simulation and algorithm, the latter having in addition a high calculation speed.The proposed analytical model is compatible with clinical real-time treatment planning systems based on TG-43 consensus datasets for improving dose calculation and treatment quality in heterogeneous tissue.Moreover, the algorithm is applicable for any type of heterogeneities.
The common use of nomograms in Low Dose Rate (LDR) permanent prostate brachytherapy (BT) allows to estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for each clinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adapted to High Dose Rate (HDR). This work sets nomograms for LDR and HDR prostate-BT implants, which are applied to three different institutions that use different implant techniques.Patients treated throughout 2010 till April 2011 were considered for this study. This example was chosen to be the representative of the latest implant techniques and to ensure consistency in the planning. A sufficient number of cases for both BT modalities, prescription dose and different work methodology (depending on the institution) were taken into account. The specific nomograms were built using the correlation between the prostate volume and some characteristic parameters of each BT modality, such as the source Air Kerma Strength, number of implanted seeds in LDR or total radiation time in HDR.For each institution and BT modality, nomograms normalized to the prescribed dose were obtained and fitted to a linear function. The parameters of the adjustment show a good agreement between data and the fitting. It should be noted that for each institution these linear function parameters are different, indicating that each centre should construct its own nomograms.Nomograms for LDR and HDR prostate brachytherapy are simple quality assurance tools, specific for each institution. Nevertheless, their use should be complementary to the necessary independent verification.
espanolEste trabajo recoge el informe del Grupo de Braquiterapia de la Sociedad Espanola de Fisica Medica dedicado a la planificacion en Braquiterapia (BT) ginecologica de cervix basada exclusivamente en Resonancia Magnetica (RM). Esta modalidad de BT ha experimentado un importante desarrollo en los ultimos anos, con la aparicion de aplicadores especiales con componente intersticial, que permiten una notable mejora en la conformacion, una vez definidos los volumenes en RM T2W. Este informe tiene como objetivo el conjugar aspectos practicos y ser resumen de la literatura y de las recomendaciones de sociedades cientificas, para armonizar y servir de base a los miembros de la SEFM en los inicios de la implementacion de esta tecnica. En este trabajo se describen los aplicadores disponibles, centrandonos fundamentalmente en los de componente intersticial. Tras el analisis de las condiciones de uso de la RM y el resumen de recomendaciones de sociedades cientificas y organismos, de acuerdo con la experiencia de los miembros del grupo de trabajo, se van a describir-discutir-proponer procedimientos de planificacion que van desde la reconstruccion hasta la optimizacion, la prescripcion y la elaboracion del informe. En este trabajo, tambien se incluye el uso de ultrasonidos por su gran potencial de futuro, finalizando con la descripcion de los aspectos especificos del Estado de Referencia Inicial (ERI) y analisis de incertidumbres en esta modalidad de planificacion de cervix con RM T2W. English3D image guided brachytherapy, based exclusively on MR has been introduced into clinical practice for the treatment of patients undergoing gynecological brachytherapy for cervical cancer. Recently, this brachytherapy modality shows a significant progress since the appearance of new type of applicators incorporating interstitial components with the aim of better coverage of volumes outlined on MR images. This report gathers the work of the Brachytherapy Group of the Spanish Society of Medical Physics (SEFM), dedicated to gynecological brachytherapy of cervical cancer based exclusively on MR. The goal of this report is to combine practical aspects, summary of literature and recommendations of scientific societies in order to ease other members of the SEFM with the implementation of this technique. This report summarizes many aspects involved in the whole process of the MR brachytherapy. Firstly, a description of the commercially available applicators is done, focusing on those having interstitial component. Secondly, some considerations about the use of MR imaging are described. A summary of recommendations published by relevant organisations or societies are also detailed in the document. Finally, and based on the experience of the members of this task group, many considerations and proposals are discussed about different aspects involved in the planning process, reconstruction alternatives, optimization methods, prescription and reporting. The use of ultrasonography is also included in this report due to its good prospects and increasing role in these procedures. The report ends with a description of specific aspects about commissioning and considerations about uncertainty analysis in this MR image based modality of brachytherapy of cervical cancer.