PURPOSE: Permanent breast seed implant (PBSI) using 103Pd is emerging as an effective adjuvant radiation technique for early-stage breast cancer. However, clinical dose evaluations follow the water-based TG-43 approach with its considerable approximations. Towards clinical adoption of advanced TG-186 model-based dose evaluations, this study presents a comprehensive investigation for PBSI considering both target and normal tissue doses. METHODS: Dose calculations are performed with the free open-source Monte Carlo (MC) code, egs_brachy, using 2 types of virtual patient models: TG43sim (simulated TG-43 conditions: all water with no interseed attenuation) and MCref (heterogeneous tissue modelling from patient CT, interseed attenuation, seeds at implant angle) for 35 patients. Sensitivity of dose metrics to seed orientation and the threshold for glandular/adipose tissue segmentation are assessed. RESULTS: In the target volume, D90 is 14.1% lower with MCref than with TG43sim, on average. Conversely, normal tissue doses are generally higher with MCref than with TG43sim, e.g., by 22% for skin D1cm2, 82% for ribs Dmax, and 71% for heart D1cm3. Discrepancies between MCref and TG43sim doses vary over the patient cohort, as well as with the tissue and metric considered. Doses are sensitive to the glandular/adipose tissue segmentation threshold with differences of a few percent in target D90. Skin doses are sensitive to seed orientation. CONCLUSIONS: TG-43 dose evaluations generally underestimate doses to critical normal organs/tissues while overestimating target doses. There is considerable variation in MCref and TG43sim on a patient-by-patient basis, suggesting that clinical adoption of patient-specific MC dose calculations is motivated. The MCref framework presented herein provides a consistent modelling approach for clinical implementation of advanced TG-186 dose calculations.
Purpose: Many planning methods for high dose rate (HDR) brachytherapy treatment planning require an iterative approach. A set of computational parameters are hypothesized that will give a dose plan that meets dosimetric criteria. A dose plan is computed using these parameters, and if any dosimetric criteria are not met, the process is iterated until a suitable dose plan is found. In this way, the dose distribution is controlled by abstract parameters. The purpose of this study is to improve HDR brachytherapy planning by developing a new approach that directly optimizes the dose distribution ba…
The $^{192}$Ir sources are widely used for high dose rate (HDR) brachytherapy treatments. The aim of this study is to simulate $^{192}$Ir MicroSelectron v2 HDR brachytherapy source and calculate the air kerma strength, dose rate constant, radial dose function and anisotropy function established in the updated AAPM Task Group 43 protocol. The EGSnrc Monte Carlo (MC) code package is used to calculate these dosimetric parameters, including dose contribution from secondary electron source and also contribution of bremsstrahlung photons to air kerma strength. The Air kerma strength, dose rate const…
Purpose: To determine whether alternative HDR prostate brachytherapy catheter patterns can result in improved dose distributions while providing better access and reducing trauma. Methods: Prostate HDR brachytherapy uses a grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. On CT data from ten previously-treated patients new catheters were digitized following three catheter patterns: coni…
Purpose: Automatic planning for focal low-dose-rate prostate brachytherapy (LDR-PB) boost. Methods: A simulated annealing approach was utilized for creating automatic focal LDR-PB boost plans using both geometric (i.e. adherence of isodose contours to structure contours) and dosimetric constraints. In 46 patients, four unilateral focal lesion scenarios were considered as the boost region, in the anterior/posterior and superior/inferior quadrants. Plans consisted of seeds with two air kerma strengths (0.740U and 0.351 or 0.354U) to achieve required dose coverage on these smaller focal targets. …
Purpose: To present the performance of a multi-point plastic scintillation detector (mPSD) as a tool in vivo dosimetry in brachytherapy. Methods: A previously optimized three-point sensor system was used for in vivo HDR brachytherapy measurements (using the scintillators BCF-60, BCF-12, and BCF-10). The light detection system of the mPSD consisted of compactly assembled photomultiplier tubes (PMTs) and dichroic mirrors and filters to achieve a highly sensitive scintillation light collection. The PMT signals were recorded using a NI-DAQ board at a rate of 100 kHz. Dose measurements covering a r…
Purpose: To present an efficient NEEdle Position Optimization (NEEPO) algorithm for prostate rotating shield brachytherapy (RSBT). With RSBT, the increased flexibility beyond conventional high-dose-rate brachytherapy (HDR-BT) due to the partially shielded radiation source has been shown by Adams et al. in 2020 to enable improved urethra sparing (23.1%), enhanced dose escalation (29.9%), or both, with 20 needles without NEEPO-optimized positions. Within this regime of improved dosimetry, we propose in this work that the benefits of RSBT can be maintained while also reducing the number of needle…
In this study, recommendations of the AAPM TG- 43 (U1) report have been followed to characterize the new 192Ir pulse dose rate source, provided by the Applied Radiation Research School, Nuclear Science and Technology Research Institute in Iran. Dose rate constant, radial dose function, geometry factors, and anisotropy function were calculated according to the relevant American Association of Physicists in Medicine AAPM and TG43 (U1) reports. In this study, 192Ir source was characterized using Monte Carlo simulation in water phantom, and in addition, experimental measurements were carried out u…
Monte Carlo calculations using the codes PENELOPE and GEANT4 have been performed to characterize the dosimetric properties of monoenergetic photon point sources in water. The dose rate in water has been calculated for energies of interest in brachytherapy, ranging between 10 keV and 2 MeV. A comparison of the results obtained using the two codes with the available data calculated with other Monte Carlo codes is carried out. A chi2-like statistical test is proposed for these comparisons. PENELOPE and GEANT4 show a reasonable agreement for all energies analyzed and distances to the source larger…
Dosimetric equivalence of deep learning prostate contours after LDR brachytherapy: pre-declared margins, patient-level acceptance thresholds and the incremental predictive value of DVH indices
Université Laval（拉瓦尔大学）；Radiation Oncology Service, Department of Specialized Medicine, Centre Intégré de Cancérologie (CIC), Hôpital de l’Enfant-Jésus, Centre Hospitalier Universitaire (CHU) de Québec-Université Laval（魁北克大学附属医院（CHU）儿童耶稣医院综合癌症中心专科医学部放射肿瘤服务）；Service of Radio-oncology, CHU de Québec-Université Laval（魁北克大学附属医院放疗服务）；Oncology division, Research Center of the CHU de Québec-Université Laval（魁北克大学附属医院研究中心肿瘤科）；Université Laval, Faculté de médecine（拉瓦尔大学医学院）
Multi-needle Localization for Pelvic Seed Implant Brachytherapy based on Tip-handle Detection and Matching
Image Processing Center, Beihang University（北航图像处理中心）；Department of Radiation Oncology, Peking University Third Hospital（北京大学第三医院放疗科）；Department of Radiation Oncology, Duke University Medical Center（达勒姆大学医学中心放疗科）
Purpose: This study aims to optimize and characterize the response of a mPSD for in vivo dosimetry in HDR brachytherapy. Methods: An exhaustive analysis was carried out in order to obtain an optimized mPSD design that maximize the scintillation light collection produced by the interaction of ionizing photons. Several mPSD prototypes were built and tested in order to determine the appropriate order of scintillators relative to the photodetector, as well as their length as a function of the scintillation light emitted. Scintillators BCF-60, BCF-12 and BCF-10 constituted the mPSD sensitive volume…
Monte Carlo calculations using the codes PENELOPE and GEANT4 have been performed to characterize the dosimetric parameters of the new 20 mm long catheter based $^{32}$P beta source manufactured by Guidant Corporation. The dose distribution along the transverse axis and the two dimensional dose rate table have been calculated. Also, the dose rate at the reference point, the radial dose function and the anisotropy function were evaluated according to the adapted TG-60 formalism for cylindrical sources. PENELOPE and GEANT4 codes were first verified against previous results corresponding to the ol…
Most commercially available treatment planning systems for brachytherapy operate based on physical dose and do not incorporate fractionation or tissue-specific response. The purpose of this study is to investigate the potential for hypofractionation in HDR brachytherapy, thereby reducing the number of implants required. A new treatment planning algorithm was built in order to optimize based on tissue and fractionation specific parameters. Different fractionation schemes were considered for 6 patients, and plans were created using the new algorithm. A baseline fractionation scheme consisting of…
This study aims to introduce IViST (In Vivo Source Tracking), a novel multi-sensors dosimetry platform for real-time treatment monitoring in HDR brachytherapy. IViST is a platform that comprises 3 parts: 1) an optimized and characterized multi-point plastic scintillator dosimeter (3 points mPSD; using BCF-60, BCF-12, and BCF-10 scintillators), 2) a compact assembly of photomultiplier tubes (PMTs) coupled to dichroic mirrors and filters for high-sensitivity scintillation light collection, and 3) a Python-based graphical user interface used for system management and signal processing. IViST can …
Multi-Catheter Digitization in Brachytherapy via Few-Shot Synthetic-to-Real Learning and Structure-Aware Tracking
Image Processing Center, Beihang University（北京航空航天大学图像处理中心）；State Key Laboratory of High-Efficiency Reusable Aerospace Transportation Technology（高能效可重复使用航天运输技术国家重点实验室）；Department of Radiation Oncology, Peking University Third Hospital（北京大学第三医院放射肿瘤科）；Department of Radiation Oncology, Duke University Medical Center（杜克大学医学中心放射肿瘤科）
The effects of gold nanoparticles in 125I brachytherapy dose enhancement on choroidal Melanoma are examined using the Monte Carlo simulation technique. Usually, Monte Carlo ophthalmic brachytherapy dosimetry is performed in a water phantom. However, here, the compositions of human eye have been considered instead of water. Both human eye and water phantoms have been simulated with MCNP5 code. These simulations were performed for a fully-loaded 16 mm COMS eye plaque containing 13 125I seeds. The dose delivered to the tumor and healthy tissues have been calculated in both phantoms, with and with…
Post-implant dosimetry (PID) is an essential step of prostate brachytherapy that utilizes CT to image the prostate and allow the location and dose distribution of the radioactive seeds to be directly related to the actual prostate. However, it it a very challenging task to identify these seeds in CT images due to the severe metal artifacts and high-overlapped appearance when multiple seeds clustered together. In this paper, we propose an automatic and efficient algorithm based on 3D deep fully convolutional network for identifying implanted seeds in CT images. Our method models the seed locali…
Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this issue. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that result from catheter reconstruction errors and source positioning inaccu…
University of British Columbia（不列颠哥伦比亚大学）；BC Cancer - Vancouver Centre（不列颠哥伦比亚癌症中心温哥华中心）
Treatment planning in low-dose-rate prostate brachytherapy (LDR-PB) aims to produce arrangement of implantable radioactive seeds that deliver a minimum prescribed dose to the prostate whilst minimizing toxicity to healthy tissues. There can be multiple seed arrangements that satisfy this dosimetric criterion, not all deemed 'acceptable' for implant from a physician's perspective. This leads to plans that are subjective to the physician's/centre's preference, planning style, and expertise. We propose a method that aims to reduce this variability by training a model to learn from a large pool of…
In this contribution, an image-guided therapy system supporting gynecologic radiation therapy is introduced. The overall workflow of the presented system starts with the arrival of the patient and ends with follow-up examinations by imaging and a superimposed visualization of the modeled device from a PACS system. Thereby, the system covers all treatments stages (pre-, intra- and postoperative) and has been designed and constructed by a computer scientist with feedback from an interdisciplinary team of physicians and engineers. This integrated medical system enables dispatch of diagnostic imag…
Automatic Treatment Planning using Reinforcement Learning for High-dose-rate Prostate Brachytherapy
Department of Medical Physics, Memorial Sloan Kettering Cancer Center（医学物理系，纪念斯隆-凯特琳癌症中心）；Department of Radiation Oncology and Winship Cancer Institute, Emory University（放射肿瘤学系和Winship癌症研究所，埃默里大学）；Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine（Wallace H. Coulter生物医学工程系，佐治亚理工学院和埃默里大学医学院）；Department of Biomedical Informatics, Emory University（生物医学信息学系，埃默里大学）
Grenoble University Hospital（格勒诺布尔大学医院）；TIMC-GMCAO Lab (CNRS UMR 5525)（TIMC-GMCAO实验室（CNRS UMR 5525））
Purpose: We report what is to our knowledge the initial experience with a new 3-dimensional ultrasound robotic system for prostate brachytherapy assistance, focal therapy and prostate biopsies. Its ability to track prostate motion intraoperatively allows it to manage motions and guide needles to predefined targets. Materials and Methods: A robotic system was created for transrectal ultrasound guided needle implantation combined with intraoperative prostate tracking. Experiments were done on 90 targets embedded in a total of 9 mobile, deformable, synthetic prostate phantoms. Experiments involve…
