Radiological Physics and Technology

Impact of the locking function of hybrid inverse planning optimization on the treatment plan quality of intracavitary/interstitial brachytherapy for locally advanced cervical cancer

To investigate the dosimetric characteristics of intracavitary/interstitial brachytherapy (IC/ISBT) plans created via the hybrid inverse planning optimization (HIPO) algorithm with the dwell time Lock function. Sixteen patients with locally advanced cervical cancer treated with high-dose-rate IC/ISBT were evaluated. Based on the clinical plan data, five plans were retrospectively created: Manchester-based HIPO for needles, HIPO for all applicators, HIPO for needles after HIPO for tandem/ovoid, HIPO for ovoid after HIPO for tandem/needle, and HIPO for ovoid/needle after HIPO for tandem. The target coverage, organs at risk (OARs) doses, therapeutic ratios, and the dwell time contributions of the needles were analyzed to evaluate the plan quality. Dice similarity coefficients (DSCs) between clinical plan and each created plan were calculated to evaluate the similarity of the shape of the dose distribution. All plans created using HIPO had a sufficient target coverage, while the OAR dose for the Manchester-based HIPO plans was considerably higher than the other plans. The plan with HIPO for all applicators and with HIPO for the ovoid applicator after HIPO for tandem/needles had comparable or superior therapeutic ratios than those of the clinical plan while the dwell time contributions of the needle were much larger. For DSCs, an intermediate to low correlation was observed between the clinical plan and all HIPO plans. The HIPO algorithm could create high-quality IC/ISBT plans, although the dosimetric consequences were affected by the locking function.

Optimizing the planning process in computed tomography-based image-guided adaptive brachytherapy for cervical cancer using a spreadsheet-based daily dose management system

This study developed a system to reduce the treatment planning time for cervical cancer brachytherapy. An in-house Excel spreadsheet was developed to streamline dosimetric evaluation by combining external beam radiotherapy and brachytherapy doses, while also displaying daily dose constraints, a novel feature of the system. This system was validated in 46 consecutive patients who underwent intracavitary and interstitial brachytherapy using several applicators and required more complex dose calculation procedures than intracavitary brachytherapy alone. The proposed system included contouring and catheter reconstruction using multiple treatment planning systems simultaneously and was integrated with Excel spreadsheets for rapid dosimetric evaluation. The median time required for treatment planning was 36 min (range: 12-72 min), which was a much shorter time than those reported previously. This optimized system demonstrated the potential to increase the efficiency of brachytherapy planning to meet prescribed dose constraints without compromising treatment quality.

Intensity-modulated brachytherapy for vaginal cancer

This study aimed to evaluate the dose modulation potential of static and dynamic steel-shielded applicators using the Geant4 Application for Emission Tomography (GATE) Monte Carlo code for the treatment of vaginal cancer. The GATE TOOLKIT (version 9.0) was used to simulate vaginal cancer intensity-modulated brachytherapy (IMBT) in a pelvic water-equivalent phantom. IMBT performance of a multichannel static and single-channel dynamic steel-shielded applicator was compared to that of a conventional multichannel Plexiglas applicator. DoseActors were defined to calculate the absorbed dose and attached to the voxelized target and organs at risk (OARs).

High-dose-rate brachytherapy using inverse planning optimization with tandem and ovoid applicators for locally advanced cervical cancer: a simulation study

The purpose of this study was to evaluate the dosimetric advantage of inverse planning optimization (IPO) in locally advanced cervical cancer using high-dose-rate (HDR) brachytherapy (BT). IPO was compared with point A plan and geometric optimization (GO). The three planning methods were evaluated using doses to the virtual organ-at-risk (OAR) and D90 (the minimum dose covering of 90% of the volume) to the virtual high-risk clinical target volume (HR-CTV) based on quantitative analysis. HR-CTV structures measuring 38.5 cm