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Developments in Brachytherapy

B Cai1*, X Jia2*, Z Grelewicz3*, I Veltchev4*, M Studenski5*, (1) Washington University School of Medicine, St. Louis, MO, (2) The University of Texas Southwestern Medical Ctr, Dallas, TX, (3) Rush University Medical Center, Chicago, IL, (4) Fox Chase Cancer Center, Philadelphia, PA, (5) University Miami, Miami, FL


(Sunday, 3/31/2019) 8:00 AM - 10:00 AM

Room: Osceola Ballroom C

Brachytherapy has played an important role in cancer treatment for over 100 years. It is facing some great development opportunity as well as challenges associated with it. Our session aims to prepare the audience for the new stage of the brachytherapy by providing them tools to streamline the clinical processes as well as the knowledge of starting an IORT program using the newest developed unidirectional brachytherapy sources.

Automation in radiation therapy helps to avoid human error and to streamline the processes in patient care. This is especially critical in high dose rate (HDR) brachytherapy that requires quick turnaround and high precision. However, automation in brachytherapy is not as widely applied as in external beam radiation therapy (EBRT). Our speakers in the first half of the session will introduce their clinical use of the automatic systems in HDR brachytherapy cases, including image processing, automatic segmentation, treatment planning, optimization, and quality assurance.

Intraoperative radiation therapy (IORT) is another growing field with various systems and sources dedicated to providing radiation dose directly to the surgical margin. Implantable low dose rate (LDR) radiation sources embedded in a bioabsorbable substrate sutured directly to the surgical margin provide conformal radiation coverage directly to surgical margins suspicious for microscopic disease (i.e. positive surgical margin). IORT with LDR brachytherapy is especially beneficial to centers that do not have established IORT program. Directional brachytherapy has been demonstrated to be especially beneficial to locally recurrent patients that have already received EBRT. The second half of the session will explain how to initiate an IORT program with directional brachytherapy, perform treatment planning for directional brachytherapy, and control of IORT patient workflow. Initiating an IORT program requires training, meeting required regulatory and professional standards, preparing for receiving new sources, and commissioning of treatment planning system. Treatment planning for directional brachytherapy sources can be accomplished with commercially available 3D treatment planning software. There are some special considerations for directional sources to be adequately planned that will be reviewed. Control of IORT patient workflow can be cumbersome depending on the location of operating rooms relative to radiation oncology. Advice for working with surgeons to plan patients and order sources will be discussed. This session will discuss each step of implementing and maintaining a new IORT directional brachytherapy program.

Learning Objectives:
1. To learn the available applications of automation in clinical HDR brachytherapy.
2. To acknowledge the capability of automation in HDR brachytherapy.
3. To be able to implement these methods in clinics.
4. Introduce the participants to the required steps for clinical implementation of an IORT LDR Brachytherapy program.
5. The participants should receive adequate knowledge to be able to configure, commission and use existing Treatment Planning Systems for Directional Brachytherapy dose calculations.
6. Understand the radiation safety considerations and the optimal patient workflow.


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