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HDR brachytherapy of rectal cancer using a novel grooved-shielding applicator design. 2013

Matthew J Webster, and Slobodan Devic, and Te Vuong, and Dae Yup Han, and Dan Scanderbeg, and Dongju Choi, and Bongyong Song, and William Y Song
Center for Advanced Radiotherapy Technologies and Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California 92093, USA.

OBJECTIVE The aim of this work was to design a novel high-dose rate (HDR) ((192)Ir) brachytherapy applicator for treatment of rectal carcinomas that uses tungsten shielding for possibly improved dosimetric results over commercial brachytherapy applicator(s). METHODS A set of 15 single-depth applicators and one dual-depth applicator were designed and simulated using Monte Carlo (MCNPX). All applicators simulated were high-density tungsten alloy cylinders, 16-mm in diameter, and 60-mm long, with longitudinal grooves within which an (192)Ir source can be placed. The single-depth designs varied regarding the number and depth of these grooves, ranging from 8 to 16 and 1-mm to 3-mm, respectively. The dual-depth design had ten channels, each of which had two depths at which the source could be placed. Optimized treatment plans were generated for each design on data from 13 treated patients (36 fractions) with asymmetrical clinical target volumes (CTVs). All results were compared against the clinically treated plans which used intracavitary mold applicator (ICMA), as well as a recently designed, highly automated, and collimated intensity modulation device named dynamic modulated brachytherapy (DMBT) device. RESULTS All applicator designs outperformed the ICMA in every calculated dosimetric criteria, except the total dwell times (∼30% increase). There were clear, but relative, tradeoffs regarding both the number of channels and the depth of each channel. Overall, the 12-channel, 1-mm depth, and 14-channel 2-mm depth designs had the best results of the simpler designs, sparing the healthy rectal tissues the most while achieving comparable CTV coverage with the dose heterogeneity index and lateral spill doses improving by over 10% and the contralateral healthy rectum dose dropping over 30% compared to ICMA. The ten-channel dual-depth design outperformed each single-depth design, yielding the best coverage and sparing. CONCLUSIONS New grooved tungsten HDR-brachytherapy devices have been designed and simulated. The results of this work attest to the capability of these new, highly anisotropic, intelligently shielded applicators to limit dose to healthy tissues while maintaining a conformal prescription dose to the CTV.

UI MeSH Term Description Entries
D007496 Iridium Radioisotopes Unstable isotopes of iridium that decay or disintegrate emitting radiation. Ir atoms with atomic weights 182-190, 192, and 194-198 are radioactive iridium isotopes. Radioisotopes, Iridium
D009010 Monte Carlo Method In statistics, a technique for numerically approximating the solution of a mathematical problem by studying the distribution of some random variable, often generated by a computer. The name alludes to the randomness characteristic of the games of chance played at the gambling casinos in Monte Carlo. (From Random House Unabridged Dictionary, 2d ed, 1993) Method, Monte Carlo
D011829 Radiation Dosage The amount of radiation energy that is deposited in a unit mass of material, such as tissues of plants or animal. In RADIOTHERAPY, radiation dosage is expressed in gray units (Gy). In RADIOLOGIC HEALTH, the dosage is expressed by the product of absorbed dose (Gy) and quality factor (a function of linear energy transfer), and is called radiation dose equivalent in sievert units (Sv). Sievert Units,Dosage, Radiation,Gray Units,Gy Radiation,Sv Radiation Dose Equivalent,Dosages, Radiation,Radiation Dosages,Units, Gray,Units, Sievert
D011835 Radiation Protection Methods and practices adopted to protect against RADIATION. Protection, Radiation
D011874 Radiometry The measurement of radiation by photography, as in x-ray film and film badge, by Geiger-Mueller tube, and by SCINTILLATION COUNTING. Geiger-Mueller Counters,Nuclear Track Detection,Radiation Dosimetry,Dosimetry, Radiation,Geiger Counter,Geiger-Mueller Counter Tube,Geiger-Mueller Probe,Geiger-Mueller Tube,Radiation Counter,Counter Tube, Geiger-Mueller,Counter Tubes, Geiger-Mueller,Counter, Geiger,Counter, Radiation,Counters, Geiger,Counters, Geiger-Mueller,Counters, Radiation,Detection, Nuclear Track,Dosimetries, Radiation,Geiger Counters,Geiger Mueller Counter Tube,Geiger Mueller Counters,Geiger Mueller Probe,Geiger Mueller Tube,Geiger-Mueller Counter Tubes,Geiger-Mueller Probes,Geiger-Mueller Tubes,Probe, Geiger-Mueller,Probes, Geiger-Mueller,Radiation Counters,Radiation Dosimetries,Tube, Geiger-Mueller,Tube, Geiger-Mueller Counter,Tubes, Geiger-Mueller,Tubes, Geiger-Mueller Counter
D011879 Radiotherapy Dosage The total amount of radiation absorbed by tissues as a result of radiotherapy. Dosage, Radiotherapy,Dosages, Radiotherapy,Radiotherapy Dosages
D011880 Radiotherapy Planning, Computer-Assisted Computer-assisted mathematical calculations of beam angles, intensities of radiation, and duration of irradiation in radiotherapy. Computer-Assisted Radiotherapy Planning,Dosimetry Calculations, Computer-Assisted,Planning, Computer-Assisted Radiotherapy,Calculation, Computer-Assisted Dosimetry,Calculations, Computer-Assisted Dosimetry,Computer Assisted Radiotherapy Planning,Computer-Assisted Dosimetry Calculation,Computer-Assisted Dosimetry Calculations,Dosimetry Calculation, Computer-Assisted,Dosimetry Calculations, Computer Assisted,Planning, Computer Assisted Radiotherapy,Radiotherapy Planning, Computer Assisted
D012004 Rectal Neoplasms Tumors or cancer of the RECTUM. Cancer of Rectum,Rectal Cancer,Rectal Tumors,Cancer of the Rectum,Neoplasms, Rectal,Rectum Cancer,Rectum Neoplasms,Cancer, Rectal,Cancer, Rectum,Neoplasm, Rectal,Neoplasm, Rectum,Rectal Cancers,Rectal Neoplasm,Rectal Tumor,Rectum Cancers,Rectum Neoplasm,Tumor, Rectal
D001918 Brachytherapy A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. Curietherapy,Implant Radiotherapy,Plaque Therapy, Radioisotope,Radioisotope Brachytherapy,Radiotherapy, Interstitial,Radiotherapy, Intracavity,Radiotherapy, Surface,Brachytherapy, Radioisotope,Interstitial Radiotherapy,Intracavity Radiotherapy,Radioisotope Plaque Therapy,Radiotherapy, Implant,Surface Radiotherapy,Therapy, Radioisotope Plaque
D004867 Equipment Design Methods and patterns of fabricating machines and related hardware. Design, Equipment,Device Design,Medical Device Design,Design, Medical Device,Designs, Medical Device,Device Design, Medical,Device Designs, Medical,Medical Device Designs,Design, Device,Designs, Device,Designs, Equipment,Device Designs,Equipment Designs

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