Abstract
Background and purposeOn-site cone-beam computed tomography (CBCT) has gained in importance in adaptive brachytherapy during recent years. Besides treatment planning, there is increased need particularly for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide. We present the first clinical images and experiences.Materials and methodsThe novel CBCT system is constructed of a 121 cm diameter ring gantry, and features a 43.2 × 43.2 cm2 flat-panel detector, wireless remote-control via tablet-PC, and battery-powered maneuverability. Within the first months of clinical operation, we performed CBCT-based treatment QA for a total of 26 patients (8 with breast, 16 with cervix, and 2 with vaginal cancer). CBCT scans were analyzed regarding potential movements of implanted applicators in-situ during the brachytherapy course.ResultsWith the presented device, treatment QA was feasible for the majority of patients. The CBCT scans of breast patients showed sufficient contrast between implanted catheters and tissue. For gynecologic patients, a distinct visualization of applicators was achieved in general. However, reasonable differentiations of organic soft tissues were not feasible.ConclusionThe CBCT system allowed basic treatment QA measures for breast and gynecologic patients. For image-guidance during interventional brachytherapy procedures, the current image quality is not adequate. Substantial performance enhancements are required for intraoperative image-guidance.
Highlights
Computed tomography (CT) is a well-established imaging modality and integral part of the imaging workflow in several medical specialties [1–9]
A control-cone-beam computed tomography (CBCT) to planning-CT registration and reconstruction of catheter tracks was performed according to Kallis et al [25]
All patients underwent tumor resection prior to brachytherapy and had surgical clips marking the tumor bed. These were clearly identifiable on the CBCT scans (Fig. 3)
Summary
Computed tomography (CT) is a well-established imaging modality and integral part of the imaging workflow in several medical specialties [1–9]. There is increased need for improvements in treatment quality assurance (QA), both during the surgical procedure and throughout the therapy course. This is crucial for therapy success, since interfractional applicator position changes might have significant effects on the dose delivered to target volumes and organs at risk (OARs) [10–14]. There is increased need for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide. CBCT scans were analyzed regarding potential movements of implanted applicators in-situ during the brachytherapy course
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
