Multidisciplinary Consensus and Evaluation of Gynecological High-Dose-Rate (HDR) Brachytherapy

Abstract

To improve the consistency and quality of gynecological HDR brachytherapy through multidisciplinary evaluation of implants and treatment plans.A quality assurance (QA) task force initiated in 2020 consisting of radiation oncologists, physicists, and radiation therapists reviewed applicator implant and treatment plan quality convened monthly for 48 gynecology patients undergoing high-dose-rate (HDR) brachytherapy. Each implant was scored based on the location and symmetry of applicators (tandem and ovoids/ring), interstitial needle location (if applicable), and packing quality as previously described (PMID: 22193645, 29705049). Treatment plans were evaluated based on contouring quality and dosimetry (target dose and OAR doses). Each quality measure was scored from 0 (inadequate) to 1 (excellent) to and a mean score for implant and treatment plan was calculated for each patient. The assigned scores represent a consensus among task force members who provided feedback according to their areas of expertise. Individual measures, implant types and mean scores were analyzed at the mid-year-mark.QA evaluation proved more beneficial for implant placement compared to treatment planning. Mean implant scores increased by 15% with significant improvements in needle positions (P = 0.02) and nonsignificant increases in packing scores (P = 0.09). In contrast, mean treatment plan scores remained unchanged throughout the year (P = 0.56). No differences were noted in the scores assigned for dosimetry, contouring, OAR doses or target doses after the mid-year mark.The QA initiative enabled the interprofessional team to share knowledge and resources to facilitate immediate mid-course changes in implant and planning strategy. The feedback generated encouraged members to alter practices and expand their understanding of treatment goals and limitations. Specific criteria for the scoring of individual quality measures should be developed to improve objectivity. The utility of HDR QA should be correlated with tumor control, recurrence, and OAR toxicity to bolster patient safety and treatment outcomes. QA sessions require quantifiable measures such as team member satisfaction and ongoing assessment due to the multidisciplinary nature of the process.C.Y. Mollings Puentes: Independent Contractor; UWorld. T. Banks: Develop/vet educational website content; AAPM.B.A. Hrycushko: None. X. Jia: None. C.R. Nwachukwu: Scientific Advisory board; Boston Scientific. K.V. Albuquerque: Research Grant; Astra Zeneca. Honoraria; ACR, ARRT. Travel Expenses; ACR, ARRT, ASCO.