Brachytherapy最新文献

{"title":"GPP02  Presentation Time: 9:24 AM","authors":"Sandra Meyers PhD , Aranyo Mitra PhD , Lance Moore MS , Karoline Kallis PhD , Dominique Rash MD , John Einck MD , Chika Nwachukwu MD, PhD , Catheryn Yashar MD , Jyoti Mayadev MD , Diandra Ayala-Peacock MD , Onyinye Balogun MD , Junzo Chino MD , Jessika Contreras MD , Imran Zoberi MD , Kelly Kisling PhD , Jingjing Zou PhD , Nuno Vasconcelos PhD","doi":"10.1016/j.brachy.2025.06.013","DOIUrl":"10.1016/j.brachy.2025.06.013","url":null,"abstract":"<div><h3>Purpose</h3><div>We have developed a method for automated cervical brachytherapy (BT) treatment planning<sup>1</sup> based on 3D deep learning dose prediction<sup>2</sup>, which can produce auto-plans for common cervical BT applicators. The purpose of this study was to demonstrate non-inferiority in quality and clinical acceptability of auto-plans compared to manual clinical planning through blinded physician review.</div></div><div><h3>Materials and Methods</h3><div>Model data consists of 2005 BT plans from 509 cervical cancer patients (40% tandem-and-ovoid (TO), 7% TO with needles (TON), 14% tandem-and-ring (TR), 16% TR with needles (TRN), 3% tandem and cylinder (T), 17% T and needles (TN) and 2% pure interstitial (N)). Dose predictions were generated from a Cascade U-Net<sup>2</sup> trained using anatomical masks, dwell position location mask and applicator-specific 3D dose inputs (for each of T/O/R/N, computed using uniform dwell times), and converted into auto-plans using a COBYLA optimizer<sup>1</sup>. Auto-plans and treated clinical plans were imported into the treatment planning system and assigned random plan names. Plan pairs were presented to expert gynecologic BT physicians (MDs), along with EMBRACE-II dose metrics and criteria. MDs were asked to indicate preference between plans, score plans from 1-5 (where 5 is highest plan quality and 1 lowest), and determine which plan was the auto-plan. Five internal MDs from our center reviewed a sample of all implant types, and 5 external MDs from 3 other centers each reviewed 2 plan sets per implant type (Table 1). Scores were compared between MD groups and between auto and clinical plans with Wilcoxon Rank Sum and Signed Rank tests, respectively (p<0.05 significant).</div></div><div><h3>Results</h3><div>Auto-plans were deemed better or equivalent in approximately 50% of cases for both MD groups (Table 1). For TRN implants, over 60% of auto-plans were considered better or equivalent as compared to T and TN implants, which demonstrated lower auto-plan preference. Selection rates varied between MDs, often due to different loading preference and/or prioritization of tumor coverage vs. organ sparing. Auto-plans received high scores from all MDs (4 on average, indicating acceptable plans with clinically unimportant stylistic differences), and scores were similar to clinical plans scores (p=0.34). Slightly reduced auto-plan preference rates and scores (p=0.25) and clinical plan scores (p=0.01) for external MDs were attributed to stylistic planning practice differences, which were not captured in our dataset. MDs correctly identified just under 50% of auto-plans (i.e. comparable to random chance), indicating that auto-plans were generally indistinguishable from clinical plans.</div></div><div><h3>Conclusion</h3><div>Our BT AI auto-plan technology produced plans comparable in quality and indistinguishable from manual, clinical plans. The method performs especially well for hybrid implants.","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S8-S9"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MPP02  Presentation Time: 4:09 PM","authors":"Victoria Vo BA , Sasha Ebrahimi MD, PhD , Puja Venkat MD","doi":"10.1016/j.brachy.2025.06.024","DOIUrl":"10.1016/j.brachy.2025.06.024","url":null,"abstract":"<div><h3>Purpose</h3><div>Evaluating post-treatment cosmetic outcomes after interventions like skin brachytherapy requires standardized, reproducible physician grading systems. However, developing and implementing such a system can be technically challenging, especially for researchers with limited programming expertise. ChatGPT is an artificial intelligence (AI) based large language model designed to understand and generate natural, human-like language text. The platform was rapidly adopted, reaching 1 million users in 5 days, and has been increasingly used in medicine for clinical, educational, and research purposes. This study describes how AI assistance facilitated the iterative development of a Microsoft Access-based grading system, overcoming complex database, VBA scripting, and automation challenges.</div></div><div><h3>Materials and Methods</h3><div>Our plan was to have six investigators—one attending and one resident from Dermatology, Head & Neck Surgery, and Radiation Oncology—independently evaluate the cosmetic outcomes of 125 non-melanoma skin cancer lesions using before-and-after brachytherapy treatment photos. The first initial AI consultation with ChatGPT involved choosing a database structure. Due to feasibility and patient privacy concerns, we opted for a Microsoft Access-based database hosted locally within our institution’s network. Prompted by ChatGPT, we created a photos table to store images and a grading form to store physician scores and comments. We then consulted AI to help choose a validated scale for assessing cosmetic outcomes after interventions and decided to use the Global Aesthetic Improvement Scale (GAIS: 1-very much improved, 2-much improved, 3-improved, 4-no change, 5-worse). We also incorporated our own novel Overall Cosmesis Score (OCS: 1-excellent, lesion or treatment effects not visible; 3-acceptable outcome; 5-poor, worse than before treatment), designed to give an overall gestalt of patient appearance post treatment. A six-option toggle button control (1-5 scale) was implemented using an Option Group. AI-assisted VBA scripting helped us overcome various problems, such as troubleshooting image display issues and automating structured data collection into a Microsoft excel file. GAIS-OCS relatability was assessed using linear regression, and rating differences were analyzed with Kruskal-Wallis tests. Statistical significance was set at p < 0.05, and analyses were performed in R.</div></div><div><h3>Results</h3><div>The AI-assisted development process enabled a novice researcher to successfully build a dynamic, secure, and user-friendly Access database for physician-driven grading. The 6 investigators completed their grading in 5 days, with only two requiring additional support not related to the functionality of the software itself. Iterative AI troubleshooting resolved VBA errors, ensured seamless image retrieval, optimized data security, and automated export processes, making the system efficient f","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S15-S16"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHSOP3  Presentation Time: 9:10 AM","authors":"Joel Beaudry MS, David Aramburu Nunez PhD, Tonghe Wang PhD, Marisa Kollmeier MD, Aneesh Dhar MD, Daniel Gorovets MD, Antonio L. Damato PhD","doi":"10.1016/j.brachy.2025.06.062","DOIUrl":"10.1016/j.brachy.2025.06.062","url":null,"abstract":"<div><h3>Purpose</h3><div>To quantitatively evaluate the impact of rectal spacing in high-dose-rate (HDR) prostate boost brachytherapy (15 Gy) with or without a rectal spacer placed prior to treatment delivery and identify patients who most benefit from these insertions.</div></div><div><h3>Materials and Methods</h3><div>Two patient cohorts were identified: one with hydrogel rectal spacer (n=47) and the other without rectal spacer (n=54) inserted prior to brachytherapy treatment delivery. The rectal wall-prostate distance (minimum, maximum and average across all imaging slices for each patient; mean and standard deviation across all patients are reported) and rectal wall dosimetry were compared. All implants were comparable in number of needles implanted (median 16, range 12-18) and prostate volume (mean 30.6cc, range 16.2 - 49.8cc). An in-house linear optimization algorithm was used to retrospectively replan 26 HDR brachytherapy prostate cases by systematically varying the rectal position relative to the prostate interface, with separations ranging from 1 to 15 mm. The target dose to the prostate was 15Gy, constrained with a urethral max of 18 Gy, rectum max dose of 15 Gy, and most proximal 2cc of rectum limited to 10.5 Gy. For each replanned case, dose-volume histogram (DVH) metrics were calculated and fitted with a logistic function to predict DVH outcomes as a function of rectal spacing. The distance metric was defined as the average separation along the length of the prostate-rectum midline, with both minimum and maximum distances recorded to account for potential asymmetries. Statistical significance was evaluated using a T-test (p <0.05).</div></div><div><h3>Results</h3><div>No statistically significant differences between the number of needles implanted and prostate volume were observed between the two cohorts. The prostate-rectum distances (mean ± st dev) were: mean = 7.8 ± 1.4 mm, min = 5.9 ± 1.5 mm, and max = 10.4 ± 2.0 mm for spacer cases, and mean = 4.0 ± 1.4 mm, min = 2.6 ± 1.3mm, and max = 6.8 ± 1.9 for non-spacer cases (all p<0.0001). Significant rectal dose differences (spacer vs non-spacer) were noted: Dmax = 10.9 ± 1.8 vs. 14.2 ± 1.6 Gy, D1cc = 8.1 ± 1.1 vs 10.3 ± 1.1 Gy, and D2cc = 7.4 ± 1.1 vs 9.2 ± 1.0 Gy (all p<0.0001). Retrospective replanning indicates that an average rectal spacing of 2.4 ± 0.3 mm is needed to achieve a prostate V100 of 98%. Rectal D2cc decreased from 9.6 Gy to 7.7 Gy with increased average rectal separation from 2.4mm to 8mm.</div></div><div><h3>Conclusions</h3><div>The use of rectal spacer resulted in a significant mean 4mm increase in rectal separation and a decrease in rectal dose. Our study suggests that patients with rectal separation < 2.4mm as measured off TRUS images are most likely to benefit from spacer insertions, to avoid unfavorable tradeoffs between coverage and sparing. For patients with a rectal spacer implanted prior to HDR prostate brachytherapy rectal dose can be significa","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S36-S37"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MSOP07  Presentation Time: 8:30 AM","authors":"Neelu Soni MS, Kim Howard MS, Julius Ojwang PhD","doi":"10.1016/j.brachy.2025.06.056","DOIUrl":"10.1016/j.brachy.2025.06.056","url":null,"abstract":"<div><h3>Purpose</h3><div>This study evaluates and compares planning approaches and treatment workflows for Accelerated Partial Breast Irradiation (APBI) using MammoSite, Contura, and Strut-Adjusted Volume Implant (SAVI) applicators at our institution. The focus is on the evolution of treatment protocols, dosimetric strategies, and quality assurance (QA) processes associated with each applicator.</div></div><div><h3>Materials and Methods</h3><div>A retrospective review of planning processes and workflows for APBI using MammoSite, Contura, and SAVI applicators was conducted. All treatments followed a standardized High Dose Rate (HDR) protocol of 340 cGy per fraction, delivered over 10 fractions across 5 days, with two treatments per day spaced 6 hours apart. MammoSite employed a single-lumen, central-channel setup with simplified planning. Key considerations included verifying distances from the balloon surface to the skin and ribs to optimize dosimetry and safety. Simulation and daily setup verification focused on balloon size and channel length confirmation. Contura treatments utilized a comprehensive physics and planning QA form to document critical parameters during CT simulation. Patient setup included an upper Vac-Lok and knee roll, with the ipsilateral arm positioned overhead for reproducibility. Daily setup verification involved short scans to confirm applicator orientation, channel lengths, and alignment markers, with diameter measurements taken in two orthogonal directions. SAVI required a more complex, resource-intensive planning process. Applicator sizes were selected based on tumor cavity dimensions in coordination with the surgical team to ensure optimal placement. Standardized planning guidelines emphasized dose conformity and organ-at-risk (OAR) sparing. A series of checklists, developed in accordance with AAPM TG-100 recommendations, were implemented across all modalities to standardize simulation protocols, radiation therapy technologist (RTT) workflows, physics reviews, and planning procedures. Daily QA included short scans and radiograph reviews conducted both in the morning and afternoon, spaced 6 hours apart, to ensure treatment accuracy and consistency.</div></div><div><h3>Results</h3><div>Findings reveal distinct differences in planning complexity and resource allocation among the applicators. Contura offered moderate flexibility in dose modulation with efficient QA protocols, while MammoSite facilitated a streamlined workflow with minimal planning complexity. SAVI required intensive planning but provided superior dose conformality and enhanced OAR sparing. The adoption of structured QA protocols and reproducible simulation setups contributed to consistent treatment outcomes across all applicators.</div></div><div><h3>Conclusions</h3><div>This single-institution study highlights the evolution of APBI planning approaches using MammoSite, Contura, and SAVI applicators. The findings underscore the importance of tailored planni","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S33"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHSOP9  Presentation Time: 9:40 AM","authors":"Javad Rahimian Ph.D.","doi":"10.1016/j.brachy.2025.06.068","DOIUrl":"10.1016/j.brachy.2025.06.068","url":null,"abstract":"<div><h3>Purpose</h3><div>Cervical and uterine cancers remain a significant global health concern, with over one million new cases and nearly 440,000 deaths reported in 2020. Treatment options including surgery, chemotherapy, external beam radiation, and brachytherapy, are complex. Intracavitary brachytherapy using tandem and ovoids, received by nearly a quarter of patients, is challenging due to lengthy procedure times, patient discomfort, and lengthy sedation and anesthesia requirements. Suboptimal device geometry and improper vaginal packing further compromise survival. Additionally, risks such as uterine perforation and inadequate bladder and rectum retraction highlight an urgent need for improved brachytherapy applicators. This study aims to address these limitations.</div></div><div><h3>Materials and Methods</h3><div>We developed an articulating endoscopic multilumen tandem with inflatable ovoids for cervical and uterine cancer treatment. The device adapts to patient anatomy, enables differential ovoids’ radiation loading, eliminating the need for multiple angled tandems. By incorporating image guidance, it mitigates potential uterine injuries from uterine manipulation, particularly in retroverted uteri, enhancing safety and dosimetry precision.</div></div><div><h3>Results</h3><div>The novel brachytherapy (BT) applicator significantly advances current designs. Key features include: Pre-sterilized, ready-to-use configuration. CMOS camera visualization for precise tandem placement, eliminating uterine perforation risk.Inflatable ovoids conforming to patient anatomy, reducing trauma due to solid plastic ovoids and optimizing radiation dosing.Optional balloon retractors to protect the bladder and rectum, replacing inconsistent gauze packing.Compatibility with MRI, CT, and X-ray imaging.Reduced implantation time with optimal implant geometry performed largely outside the patient similar to a laparoscopic procedure.Articulating tandem allowing conformal dosimetry with the articulating tandem’s conforming to the angle of the uteri rather than the other way around in both anteverted and retroverted uteri.Adjustable geometry to optimize tumor targeting and spare critical organs, akin to laparoscopic precision. These innovations simplify implantation, enhance dosimetry, and improve patient comfort and outcomes.</div></div><div><h3>Conclusions</h3><div>Preliminary simulations and prototype testing confirm the novel applicator's practicality, reproducibility, and MR, CT, X-ray imaging compatibility. With superior dosimetry and reduced procedural complexity, the device is poised to surpass current commercial options, benefiting both clinicians and patients. Further validation through phantom and clinical studies is warranted.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S40-S41"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary vaginal cancer treated with high-dose rate brachytherapy and intraprocedural magnetic resonance imaging","authors":"Ulysses G. Gardner,&nbsp;Keara English,&nbsp;Michael Roumeliotis,&nbsp;Serena Mao,&nbsp;Todd McNutt,&nbsp;Mohammad Rezaee,&nbsp;Junghoon Lee,&nbsp;Akila N. Viswanathan","doi":"10.1016/j.brachy.2025.03.001","DOIUrl":"10.1016/j.brachy.2025.03.001","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To report outcomes among primary vaginal cancer patients treated definitively with either external beam radiation therapy plus high-dose rate (HDR) brachytherapy (EBRT-BT) or BT (BT) alone with placement of interstitial catheters under magnetic resonance imaging (MRI) guidance.</div></div><div><h3>METHODS</h3><div>Retrospective review of 41 patients treated for primary vaginal cancer from 2016 to 2022. Kaplan-Meier (KM) estimates were generated for disease-free survival (DFS), local control (LC), and overall survival (OS).</div></div><div><h3>RESULTS</h3><div>Median follow-up was 28 months (range 2–82 months). A total of 36 patients had EBRT-BT, 5 had BT alone. Forty patients had template interstitial and 1 had a multichannel cylinder. Among patients who received EBRT-BT, median total D90 EQD2 was 68.3 Gray (Gy) (range 56.6–91.5 Gy)<strong>;</strong> BT only, median 40.3 Gy (range 38.1–86.3 Gy). No patient experienced local only failure. Relapse occurred in 12 patients treated with EBRT-BT versus 1 with BT alone group. For the EBRT-BT cohort versus BT only cohort, 2-year OS was 81% versus 60%, DFS 61% versus 40%, and LC was 94% versus 80%, respectively. For the entire cohort, 2-year OS was 67%, and median OS was 5 years. The 2-year DFS was 57% and 2-year LC was 93%. The most common any grade acute treatment-related toxicity were grade 1 vaginal pain and stenosis. Grade 3 acute and late toxicities were minimal.</div></div><div><h3>CONCLUSIONS</h3><div>MRI-guided HDR BT for primary vaginal cancer yields high rates of local control with limited toxicities. Lower rates of distant control indicate the need for newer options such as immunotherapy or other systemic agents.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 486-494"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PPP06  Presentation Time: 4:45 PM","authors":"Ghada Aldosary PhD,&nbsp;AB Mohamed Yoosuf MSc,&nbsp;Hanoof Alkhurayji MSc,&nbsp;Ghazi Almutairi MSc,&nbsp;Abdulrahman Alhadab MD,&nbsp;Mamdouh Alqathami PhD","doi":"10.1016/j.brachy.2025.06.035","DOIUrl":"10.1016/j.brachy.2025.06.035","url":null,"abstract":"<div><h3>Purpose</h3><div>Brachytherapy plays an important role in cancer treatment. Recent initiatives, such as the American Brachytherapy Society’s 300 in 10 Initiative, aim to promote brachytherapy utilization and technical proficiency through focused training. While technical skills are critical, successful brachytherapy implementation requires logistical and safety considerations as well. For example, although brachytherapy emergencies are rare, risk-mitigation and training are necessary to ensure its safe adoption. The purpose of this work is to share experience gained from preparing a multidisciplinary team to manage a brachytherapy stuck source emergency at a large, busy national referral centre.</div></div><div><h3>Materials and Methods</h3><div>High dose rate brachytherapy stuck source training for cervical treatment was conducted using a hybrid training module. To accommodate busy schedules and facilitate engagement, training was divided into two parts: 1) virtual self-paced study material including overview of the response plan and a follow up 5-question online quiz, and 2) an in-person simulated stuck source emergency drill where the response plan was carried out and the theoretical exposure times were recorded for the first responder (physicist) and the second responder (radiation oncologist). Part 1 included general technical and safety information about the brachytherapy unit and suite safety aspects and outlined the roles of each individual/ profession in an emergency. Part 2 was held 5 times in a span of 1 month and consisted of a drill allowing multiple opportunities for role playing in each session.</div></div><div><h3>Results</h3><div>22 radiotherapy team members were trained: 5 radiation oncologists, 4 medical physicists, 7 radiation therapists and 6 nurses. 73% did not have prior brachytherapy experience. The average score in the online quiz was 4.7± 0.45 out of 5. The concept least understood was that a stuck source can occur regardless of the presence of a patient. The team preferred a small group setting for drills (3-4 people). After multiple practice drills, the simulated total exposure time for the first responder was reduced from 14 min to 3 min, translating to an estimated total effective dose decrease from 5 mSv to 0.5 mSv and 4 mSv to 0.1 mSv for the physicist and radiation oncologist, respectively. Upon concluding training, all team members expressed that they found the training helpful and agreed that they felt confident in managing a brachytherapy stuck source emergency.</div></div><div><h3>Conclusion</h3><div>A hybrid, HDR brachytherapy stuck source emergency training module was implemented and successfully carried out for a large, multi-disciplinary team. Allowing self-paced learning for theory and small groups for the drill promoted more confidence and engagement among the team. The module is undergoing development to translate to other HDR brachytherapy treatment sites/ techniques (e.g., interstitial brachy","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S22"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MSOP04  Presentation Time: 8:15 AM","authors":"Ulysses Grant Gardner MD, MBA ,&nbsp;Panos Papanikolaou MD ,&nbsp;Ardian Latifi MD ,&nbsp;Daniel Song MD ,&nbsp;Lonny Yarmus DO ,&nbsp;Michael Roumeliotis PhD","doi":"10.1016/j.brachy.2025.06.053","DOIUrl":"10.1016/j.brachy.2025.06.053","url":null,"abstract":"<div><h3>Purpose</h3><div>Stereotactic ablative radiotherapy (SABR) is the standard non-surgical treatment for early-stage non-small cell lung cancer (NSCLC), but unintentional irradiation of healthy lung tissue remains a concern. High-dose rate (HDR) bronchoscopic brachytherapy (BT) is a novel approach that may enhance dose conformity while reducing radiation exposure to adjacent normal tissues. To date, a comparative dosimetric analysis between HDR BT and modern SABR in lung cancer has not been performed. We hypothesize that HDR BT will demonstrate superior dose conformity, thereby reducing collateral radiation exposure compared to SABR.</div></div><div><h3>Materials &amp; Methods</h3><div>In this study, patients who underwent robotic bronchoscopy between November 2020 and April 2022 at our institution under an IRB-approved protocol were considered. Patients were included if they had biopsy-confirmed stage IA NSCLC and were treated with SABR. Approved SABR plans were extracted from the electronic medical record, and corresponding single-channel HDR BT plans were simulated using identical prescription doses and fractionation schedules. Dose conformity index (CI) was calculated as the ratio of the prescription dose volume to the target volume and compared between both modalities using paired Student’s t-tests (α &lt; 0.05 for statistical significance).</div></div><div><h3>Results</h3><div>Of 182 screened patients, 12 met inclusion criteria after exclusions for advanced disease, non-confirmed histology, or SABR not performed. Of those patients, 8 were excluded for lack of using active breathing control (ABC) to minimize target motion. The mean ± standard deviation (SD) tumor size was 1.4 ± 0.3 cm. SABR plans delivered 50 Gy in 4-5 fractions. Dosimetric analysis revealed that HDR BT achieved higher V95% (volume of target receiving at least 95% of prescription dose), suggesting improved dose coverage within the tumor, while also demonstrating a lower V25 % conformity index, indicating reduced irradiation of surrounding tissues (Table 1).</div></div><div><h3>Conclusions</h3><div>This is the first dosimetric comparison of HDR BT and SABR for stage IA NSCLC. Our findings suggest that HDR BT offers improved dose conformity and potential for improved dose coverage within the target while minimizing low-dose exposure to adjacent lung tissue, which may reduce radiation-related toxicity. Prospective studies are warranted to further assess the clinical feasibility and therapeutic benefits of HDR BT in early-stage NSCLC.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages S31-S32"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The NorCal brachytherapy waste audit: A simple, validated, toolkit for clinician led waste reduction","authors":"Claire C. Baniel ,&nbsp;Katie E. Lichter ,&nbsp;Melissa A. Frick ,&nbsp;Jaclyn Wu ,&nbsp;Eniola Oladipo ,&nbsp;Yufan Fred Wu ,&nbsp;Aneesh SwamyS ,&nbsp;I-Chow Hsu ,&nbsp;Nicolas Prionas ,&nbsp;Erik S Blomain ,&nbsp;Elizabeth A. Kidd ,&nbsp;Mark K Buyyounouski ,&nbsp;Glenn Rosenbluth ,&nbsp;Osama Mohamad ,&nbsp;Hilary P. Bagshaw","doi":"10.1016/j.brachy.2025.01.002","DOIUrl":"10.1016/j.brachy.2025.01.002","url":null,"abstract":"<div><h3>PURPOSE</h3><div>The healthcare system is resource intensive, and many opportunities exist to reduce medical waste. Brachytherapists performing inherently resource intensive procedures are well poised to initiate the transition to sustainable, climate-smart care. The authors developed a quality improvement-based (QI) NorCal Brachytherapy Waste Audit Toolkit to guide medical waste reduction in brachytherapy procedures and provide climate health education.</div></div><div><h3>METHODS AND MATERIALS</h3><div>The NorCal Brachytherapy Waste Audit Toolkit was validated through brachytherapy waste audits conducted at 2 neighboring hospitals between 2021 and 2023. Waste was categorized into biohazardous waste, nonbiohazardous waste, and anesthesia waste and was weighed and cataloged after each procedure using a standard template by auditors not involved in the brachytherapy case. Findings were analyzed for key drivers of waste production and high impact interventions were selected.</div></div><div><h3>RESULTS</h3><div>Postaudit results demonstrate biohazardous waste reduction of greater than 50%, elimination of over 90% improper biohazardous waste sorting, cost savings ($4.22/kg) and a reduction in landfill waste by over 20%. The Toolkit was made public online and over 18 months, was accessed by 34 distinct individuals from 21 healthcare organizations across 7 countries and led to waste reduction projects in multiple specialties including radiation oncology, emergency medicine, and pediatrics.</div></div><div><h3>CONCLUSION</h3><div>A QI-based NorCal Brachytherapy Waste Audit Toolkit may help radiation oncologists and healthcare teams beyond radiation oncology reduce waste and contribute toward environmentally sustainable healthcare.</div></div>","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Pages 622-630"},"PeriodicalIF":1.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GSOR07  Presentation Time: 12:00 PM","authors":"Agnes Ewongwo MD, MPH ,&nbsp;Rajabu Kiaratu MD ,&nbsp;Joseph Blickenstaff III PhD ,&nbsp;Chika Nwachukwu MD, PhD","doi":"10.1016/j.brachy.2025.06.088","DOIUrl":"10.1016/j.brachy.2025.06.088","url":null,"abstract":"<div><h3>Purpose</h3><div>Cervical cancer remains a leading cause of cancer-related mortality in Low- and Middle-Income Countries (LMICs), with Tanzania bearing a substantial burden. High-dose rate (HDR) brachytherapy is a critical component of definitive cervical cancer treatment; however, its implementation is hindered by infrastructure limitations, equipment costs, and workforce shortages. This study describes the development and optimization of a 3D-HDR brachytherapy program at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, highlighting successes, challenges, and strategies for sustainability.</div></div><div><h3>Materials and Methods</h3><div>A collaborative initiative between ORCI, Stanford University, and the University of Texas Southwestern (UTSW) was established to transition from 2D to 3D image-guided brachytherapy (IGBT). A needs-based assessment identified gaps in training, treatment planning, and workflow efficiency. The implementation strategy included remote didactic sessions, physics-led remote QA trainings, on-site hands-on training, and infrastructure support for 3D brachytherapy planning using computed tomography (CT)-based imaging. An on-site quality assurance review was performed for the HDR treatment delivery systems, inventory of applicators, and treatment planning system (TPS). Resources were then developed to improve both workflow and plan quality evaluation. Dosimetric comparisons between 2D and 3D treatment plans were performed as part of an ongoing prospective study to assess improvements in target coverage and organ-at-risk (OAR) sparing.</div></div><div><h3>Results</h3><div>Over a two-year period, the integration of CT-based brachytherapy planning at ORCI led to measurable improvements in treatment accuracy and quality. Dosimetric analyses demonstrated enhanced high-risk clinical target volume (HR-CTV) coverage while achieving OAR dose constraints. Training initiatives successfully improved local staff proficiency in 3D contouring, dose optimization, applicator maintenance, plan evaluation, and cumulative dose monitoring. Key challenges included the lack of MRI access for advanced planning, high patient volumes exceeding treatment capacity, limited infrastructure to facilitate more robust treatment planning, and the need for continued education to ensure long-term sustainability. Despite these barriers, the program has significantly expanded access to 3D-HDR brachytherapy in Tanzania, serving as a scalable model for other LMICs.</div></div><div><h3>Conclusions</h3><div>The implementation of 3D-HDR brachytherapy at ORCI represents a critical advancement in cervical cancer care in Tanzania. Through strategic partnerships, hands-on training, and workflow optimization, significant improvements in treatment delivery and patient outcomes were achieved. However, ongoing efforts are required to address workforce shortages, equipment maintenance, and integration of MRI-based planning. Expanding such initiative","PeriodicalId":55334,"journal":{"name":"Brachytherapy","volume":"24 4","pages":"Page S53"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144889070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}