BP02 演讲时间：下午 4:09

IF 1.7 4区医学 Q4 ONCOLOGY

Brachytherapy Pub Date : 2024-10-25 DOI:10.1016/j.brachy.2024.08.026

Birte Christina Sauer (M. Sc.), Rainer Fietkau (Prof. Dr. Med.), Vratislav Strnad (Dr. med.), Christoph Bert (Prof. Dr.), Christopher Dürrbeck Dr.

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引用次数: 0

摘要

目的乳腺间质近距离放射治疗是一种成熟的治疗方法，临床效果非常好。然而，根据一些安全报告[1-4]，它很容易出现人为故障，这表明及时发现和预防治疗错误是明智之举。可以使用电磁追踪技术（EMT）实施广泛的患者特定质量保证程序，该技术已显示出其潜力，可对植入的导管或针头进行独立于视线且无剂量的追踪。所有患者均在 2016 年 10 月至 2023 年 11 月期间接受治疗，并参与了我们的 EMT 研究。通过 EMT，在每次治疗分段后和规划 CT 后对植入物的几何形状进行了评估。结果关于规划错误，我们没有发现任何（部分）交换，但发现了一个重建方向的反转（尖端端交换）。在治疗前，我们检测到 35% 的测量导管移位超过 0.8 毫米，其中 50% 为 2 毫米，15% 为 5 毫米，2% 为 10 毫米。记录到的最大偏移量为 21.9 毫米，中位偏移量为 3.0 毫米。输送错误还包括三次经目测验证的相邻导管调换。值得注意的是，启用 EMT 的后装载器不携带主动源，因此必须手动重新连接输送管。这意味着检测到的调换可能并不代表临床状态，但它们提供了临床实践中发生调换概率的估计值。它强调了在乳腺间质近距离治疗中针对患者进行质量保证和治疗验证的必要性，以防止潜在的错误，尤其是在分次方案越来越短的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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BP02 Presentation Time: 4:09 PM

Purpose

Interstitial brachytherapy of the breast is a well-established treatment option with very good clinical results. However, it is prone to human failures according to several safety reports [1-4], indicating that a timely detection and prevention of treatment errors is advised. An extensive patient specific quality assurance procedure could be implemented using electromagnetic tracking (EMT), which has shown its potential by enabling a line-of-sight independent and dose free tracing of implanted catheters or needles.

Materials and Methods

We retrospectively analyzed and categorized potential treatment errors in a cohort of 72 patients comprising more than 580 fractions and more than 8000 catheters. All patients were treated between October 2016 and November 2023 and participated in our EMT study. The implant geometry was assessed after each treatment fraction and after the planning CT by means of EMT. The detection and classification of errors is based on deviations between expected and measured catheter positions.

Results

Concerning planning errors, we did not find any (partial) swaps, but detected one inversion of the reconstruction direction (tip-end-swap). Before treatment delivery, we detected shifts larger than 0.8 mm in 35 % of all measured catheters, out of which 50 % were > 2 mm, 15 % were > 5 mm and 2 % were > 10 mm. The highest recorded shift reached 21.9 mm, the median magnitude was 3.0 mm. Delivery errors also included three swaps of neighboring catheters that were visually verified. It should be noted that the EMT enabled afterloader does not carry an active source, therefore, the transfer tubes had to be manually reconnected. This means that the detected swaps may not represent the clinical state, however, they provide an estimate for the probability of swaps to occur in clinical practice.

Conclusions

This study presents a first of its kind systematic treatment error analysis. It emphasizes the necessity for a patient specific quality assurance and treatment verification in interstitial breast brachytherapy to prevent potential errors, especially in view of ever shorter fractionation schemes.

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来源期刊

Brachytherapy 医学-核医学

CiteScore

3.40

自引率

21.10%

发文量

119

审稿时长

9.1 weeks

期刊介绍： Brachytherapy is an international and multidisciplinary journal that publishes original peer-reviewed articles and selected reviews on the techniques and clinical applications of interstitial and intracavitary radiation in the management of cancers. Laboratory and experimental research relevant to clinical practice is also included. Related disciplines include medical physics, medical oncology, and radiation oncology and radiology. Brachytherapy publishes technical advances, original articles, reviews, and point/counterpoint on controversial issues. Original articles that address any aspect of brachytherapy are invited. Letters to the Editor-in-Chief are encouraged.