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Session: Safety and Quality Improvements in Brachytherapy [Return to Session]

Safety and Quality Improvements in Brachytherapy

Z Shen1*, J Zhou2*, M Rivard3*, (1) University of Southern California, Arcadia, CA, (2) University of Maryland Shore Medical Center at Easton, Easton, MD, (3) Rhode Island Hospital/Brown University, Providence, RI


TH-F-202-0 (Thursday, 7/14/2022) 2:00 PM - 3:00 PM [Eastern Time (GMT-4)]

Room 202


CT/MRI/PET Image-guided brachytherapy, electronic brachytherapy, fractional planning brachytherapy and intra-operative brachytherapy have gradually become the standard of care for many treatment sites, which demand a higher efficiency even if the number of treatments remains the same. Plan and treat in same day or even on-spot in OR leading to time sensitive brachytherapy process. The increasing demand for higher efficiency and improved safety of the brachytherapy process without a significant increase in manpower poses serious challenges to medical physicists. To guide the process change to balance the competing needs for efficiency and safety. practical clinical examples on HDR failures and solutions will be reviewed.

Intracavitary and Interstitial brachytherapy (IBT) is often utilized to treat women with gynecological cancers. A modern trend in IBT is the utilization of magnetic resonance imaging (MRI) or computed tomography (CT) if MRI is not accessible, with a high dose rate (HDR) afterloader for conformal 3D image‐based treatments. The challenging part of this procedure is to properly complete many sequenced and co‐related physics preparations During this session. we will discuss the importance of quality control checklists for HDR brachytherapy procedures at various stages (imaging, planning, treatment, and post treatment chart review).

After pre-treatment imaging done on the Truebeam, there are many steps have to be completed before the brachytherapy treatment starts, such as managing externally cached plan, generating the pre-treatment summary, preparing the initial chart check, and checking documents with physician. This sequential procedure is not only time-consuming for the patient under treatment, but also has inconsistent duration of brachytherapy procedures which affects the whole external beam treatment schedule. In order to overcome the above challenges, a parallel processing procedure of non-Aria database based brachytherapy treatment and Aria database based pre-treatment imaging is developed. The quantitative comparison of duration of brachytherapy procedures using t-test shows that our proposed procedure can be more efficient compared with the sequential processing procedure. This procedure not only saves time for the patient under treatment, but also helps keep a consistent external beam treatment schedule.

Learning objectives:
1. Understand the scope and challenges of managing current brachytherapy therapy process.
2. Exposed to the automatic tools for HDR treatment planning.
3. Learn the quality control tools and their implementation in the brachytherapy workflow.
4. Review recommendations for HDR checklists
5. Learn importance of developing an HDR‐IBT program over time and progressively validate the checklists through clinical experience.
6. Learn the workflow guideline for implementing and performing the HDR IBT procedure.



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