Mass-manufacturable scintillation-based optical fiber dosimeters for brachytherapy.

Scintillation-based fiber dosimeters are a powerful tool for minimally invasive localized real-time monitoring of the dose rate during Low Dose Rate (LDR) and High Dose Rate (HDR) brachytherapy (BT). This paper presents the design, fabrication, and characterization of such dosimeters, consisting of scintillating sensor tips attached to polymer optical fiber (POF). The sensor tips consist of inorganic scintillators, i.e. Gd2O2S:Tb for LDR-BT, and Y2O3:Eu+4YVO4:Eu for HDR-BT, dispersed in a polymer host. The shape and size of the tips are optimized using non-sequential ray tracing simulations towards maximizing the collection and coupling of the scintillation signal into the POF. They are then manufactured by means of a custom moulding process implemented on a commercial hot embossing machine, paving the way towards series production. Dosimetry experiments in water phantoms show that both the HDR-BT and LDR-BT sensors feature good consistency in the magnitude of the average photon count rate and that the photon count rate signal is not significantly affected by variations in sensor tip composition and geometry. Whilst individual calibration remains necessary, the proposed dosimeters show great potential for in-vivo dosimetry for brachytherapy.

In vivo dosimetry in pelvic brachytherapy.

ADVANCES IN KNOWLEDGE: This paper describes the potential role for in vivo dosimetry in the reduction of uncertainties in pelvic brachytherapy, the pertinent factors for consideration in clinical practice, and the future potential for in vivo dosimetry in the personalisation of brachytherapy.

UK & Ireland Prostate Brachytherapy Practice Survey 2014-2016.

PURPOSE: To document the current prostate brachytherapy practice across the UK and Ireland and compare with previously published audit results. MATERIAL AND METHODS: Participants from 25 centers attending the annual UK & Ireland Prostate Brachytherapy Conference were invited to complete an online survey. Sixty-three questions assessed the center's experience and staffing, clinician's experience, clinical selection criteria and scheduling, number of cases per modality in the preceding three years, low-dose-rate (LDR) pre- and post-implant technique and high-dose-rate (HDR) implant technique. Responses were collated, and descriptive statistical analysis performed. RESULTS: Eighteen (72%) centers responded with 17 performing LDR only, 1 performing HDR only, and 6 performing both LDR and HDR. Seventy-one percent of centers have > 10 years of LDR brachytherapy experience, whereas 71% centers that perform HDR brachytherapy have > 5 years of experience. Thirteen centers have 2 or more clinicians performing brachytherapy with 61% of lead consultants performing > 25 cases (LDR + HDR) in 2016. The number of implants (range), that includes LDR and HDR, performed by individual practitioners in 2016 was > 50 by 21%, 25-50 by 38%, and < 25 by 41%. Eight centers reported a decline in LDR monotherapy case numbers in 2016. Number of center's performing HDR brachytherapy increased in last five years. Relative uniformity in patient selection is noted, and LDR pre- and post-implant dosimetry adheres to published quality guidelines, with an average post-implant D90 of > 145 Gy in 69% of centers in 2014 and 2015 compared to 63% in 2016. The median CT/US volume ratios were > 0.9 ≤ 1.0 (n = 4), > 1.0 ≤ 1.1 (n = 7), and > 1.1 (n = 2). CONCLUSION: There is considerable prostate brachytherapy experience in the UK and Ireland. An apparent fall in LDR case numbers is noted. Maintenance of case numbers and ongoing compliance with published quality guidelines is important to sustain high quality outcomes.

Verification of high-dose-rate brachytherapy treatment planning dose distribution using liquid-filled ionization chamber array.

PURPOSE: This study aims to investigate the dosimetric performance of a liquid-filled ionization chamber array in high-dose-rate (HDR) brachytherapy dosimetry. A comparative study was carried out with air-filled ionization chamber array and EBT3 Gafchromic films to demonstrate its suitability in brachytherapy. MATERIAL AND METHODS: The PTW OCTAVIUS detector 1000 SRS (IA 2.5-5 mm) is a liquid-filled ionization chamber array of area 11 x 11 cm2 and chamber spacing of 2.5-5 mm, whereas the PTW OCTAVIUS detector 729 (IA 10 mm) is an air vented ionization chamber array of area 27 x 27 cm2 and chamber spacing of 10 mm. EBT3 films were exposed to doses up to a maximum of 6 Gy and evaluated using multi-channel analysis. The detectors were evaluated using test plans to mimic a HDR intracavitary gynecological treatment. The plan was calculated and delivered with the applicator plane placed 20 mm from the detector plane. The acquired measurements were compared to the treatment plan. In addition to point dose measurement, profile/isodose, gamma analysis, and uncertainty analysis were performed. Detector sensitivity was evaluated by introducing simulated errors to the test plans. RESULTS: The mean point dose differences between measured and calculated plans were 0.2% ± 1.6%, 1.8% ± 1.0%, and 1.5% ± 0.81% for film, IA 10 mm, and IA 2.5-5 mm, respectively. The average percentage of passed gamma (global/local) values using 3%/3 mm criteria was above 99.8% for all three detectors on the original plan. For IA 2.5-5 mm, local gamma criteria of 2%/1 mm with a passing rate of at least 95% was found to be sensitive when simulated positional errors of 1 mm was introduced. CONCLUSION: The dosimetric properties of IA 2.5-5 mm showed the applicability of liquid-filled ionization chamber array as a potential QA device for HDR brachytherapy treatment planning systems.

Sector analysis provides additional spatial information on the permanent prostate brachytherapy learning curve.

PURPOSE: To evaluate the permanent prostate brachytherapy (PPB) learning curve using postimplant multisector dosimetric analysis and to assess the correlation between sector -specific dosimetry and patient-reported outcome measures (PROMs). METHODS AND METHODS: First 200 patients treated with (125)I PPB monotherapy (145 Gy) at a single institution were assessed. Postimplant dosimetry (PID) using CT was evaluated for whole prostate (global) and 12 sectors, assessing minimum dose to 90% of prostate (D90) and dose to 0.1 cm(3) of rectum (D0.1cc). Global and sector PID results were evaluated to investigate changes in D90 with case number. Urinary and bowel PROMs were assessed using the International Prostate Symptom Score and the Expanded Prostate Cancer Index Composite questionnaire. The correlation between global and individual sector PID and urinary/bowel PROMs was also evaluated. RESULTS: Linear regression confirmed a significant improvement in global D90 with case number (r(2) = 0.20; p = 0.001) at a rate of 0.11 Gy/case. Postimplant D90 of base sectors increased at a rate of 0.11-0.15 Gy/case (p = 0.0001) and matched global improvement. The regression lines of midgland and apex sectors were significantly different from global D90 (p = 0.01). Posterior midgland sectors showed a significant reduction in D90 with case number at a rate of 0.13-0.19 Gy/case (p = 0.01). Dose to posterior midgland sectors correlated with rectal D0.1cc dose but not bowel PROMs. Dose to posterior midgland sectors correlated with urinary International Prostate Symptom Score change, which was not apparent when global D90 alone was considered. CONCLUSIONS: Sector analysis provided increased spatial information regarding the PPB learning curve. Furthermore, sector analysis correlated with urinary PROMs and rectal dose.

Sector analysis of 125I permanent prostate brachytherapy provides a rapid and effective method of evaluating and comparing pre- and post-implant dosimetry.

PURPOSE: To evaluate a sector analysis program in the assessment and comparison of pre- and post-implant dosimetric parameters during the development of an (125)I permanent prostate brachytherapy service. METHODS AND MATERIALS: A total of 50 consecutive men being treated with permanent prostate brachytherapy had dose-volume analysis in 12 sectors of their pre-implant ultrasound (USpre) and post-implant CT (CTpost) studies. Individual sectors were created by dividing prostate into three equal lengths, namely base, midgland, and apex. Each of these volumes was then divided into four axial sectors. Dosimetric parameters were compared in adjoining sectors within each study and between studies. RESULTS: There were statistically significant differences between individual sectors on USpre and CTpost volumes with CTpost higher than USpre (p=0.001). Statistically significant differences were found in corresponding sectors on USpre and CTpost for all dosimetric parameters. The dosimetric parameters were significantly lower on CTpost in the anterior base and midgland (p=0.001) and significantly higher at the posterior apex and midgland (p=0.05). Dose homogeneity was demonstrated in adjoining sectors in all USpre and most adjoining sectors on CTpost. CONCLUSIONS: Sector analysis allows rapid assessment of USpre and CTpost dosimetry. It offers a scientific method of identifying areas of increased and reduced dosing on CTpost when compared with USpre, providing a learning tool to refine dosimetric analysis and highlight sectors where implant quality could be improved.