Abstract
Misplacement of dwell positions is a potential source of misadministration in high dose rate (HDR) brachytherapy. In this work, we present a dwell position verification method using fluoroscopic images. A mobile C‐arm fluoroscopic machine is used to take a snapshot of the treatment machine's check cable as it reaches the most distal dwell position. This fluoroscopic image is displayed side‐by‐side with a treatment planning image on a dual monitor relay station at the HDR treatment console. Any discrepancy between the check cable's position on the verification image and the intended dwell position on the planning image can be identified, immediately, thus avoiding the possibility of treating the wrong target volume.PACS numbers: 87.53.Jw, 87.53.Xd, 87.59.Ci
Highlights
In high dose rate (HDR) brachytherapy, the treatment dose to a target site is delivered by leaving a high activity 192Ir source at each dwell position for a specific amount of dwell time
The dwell positions and dwell times are determined during the treatment planning process, and they are programmed into the HDR treatment machine
Sheikh-Bagheri and Munro[2] evaluated the possibility of monitoring the high activity 192Ir source using x ray fluoroscopic images. They suggested that use of a large air gap between the patient and the x ray image intensifier, a well designed antiscatter grid to suppress the spurious signals generated by the 192Ir γ rays, and a high current x ray fluoroscopy technique can make the real time monitoring of source position feasible
Summary
In high dose rate (HDR) brachytherapy, the treatment dose to a target site is delivered by leaving a high activity 192Ir source at each dwell position for a specific amount of dwell time. Human and computer errors during the treatment planning and treatment preparation process can, potentially, place the dwell positions in the wrong location, resulting in treating the wrong target volume. Such incidents are rare, but they do occur, as evidenced by the US Nuclear Regulatory Commission (USNRC)’s event notification reports (see, for example, the USNRC website at http://www.nrc.gov - searching for “HDR” in the “Event and Status Reports” collection gives the event reports) and other reports in the literature.(1) It is, desirable to have an independent method available that allows for the verification of dwell positions before treatment delivery. Images produced with these methods were either of poor quality(2) or contained no patient anatomic information.(3)
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