Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy
Aim: With the advent of computed tomography (CT)-based brachytherapy, it is possible to view the appropriate placement of the applicator within the uterine canal and detect uterine perforation. In this study, the incidence of suboptimal placement of the intracavitary applicator and the resulting dos...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Journal of Medical Physics |
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| Online Access: | http://www.jmp.org.in/article.asp?issn=0971-6203;year=2018;volume=43;issue=3;spage=168;epage=172;aulast=Rangarajan |
| _version_ | 1811294609101291520 |
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| author | Ramya Rangarajan |
| author_facet | Ramya Rangarajan |
| author_sort | Ramya Rangarajan |
| collection | DOAJ |
| description | Aim: With the advent of computed tomography (CT)-based brachytherapy, it is possible to view the appropriate placement of the applicator within the uterine canal and detect uterine perforation. In this study, the incidence of suboptimal placement of the intracavitary applicator and the resulting dosimetric impact were analyzed and compared with a similar set of ideal applicator placement. Materials and Methods: CT datasets of 282 (141 patients) high dose rate brachytherapy insertions between January and April 2016 were analyzed. The target volumes and organs at risk (OAR) were contoured as per the Groupe Européen de Curiethérapie European Society of Therapeutic Radiation Oncology guidelines. The position of the applicator in the uterine cavity was analyzed for each application. Results: The suboptimal insertion rate was 11.7%. There were 26 perforations and 7 subserosal insertions. The most common site of perforation was through the posterior wall of the uterus (42.4%). Fundus perforation and anterior wall perforation were seen in 24.2% and 12.1% of patients, respectively. The average dose to 90% of the target volume (D90 to high-risk clinical target volume) was the highest (9.15 Gy) with fundal perforation. Average dose to 2 cc (D2cc) bladder was highest for fundus perforation (7.65 Gy). The average dose received by 2 cc of rectum (D2cc) was highest (4.49 Gy) with posterior wall perforation. The average D2cc of the sigmoid was highest with anterior perforation (3.18 Gy). Conclusion: In order to achieve better local control and to decrease doses to OAR, it is important to perform a technically accurate applicator placement. A cost-effective, real-time image guidance modality like ultrasound is recommended for all insertions to ensure optimal applicator insertion. |
| first_indexed | 2024-04-13T05:19:58Z |
| format | Article |
| id | doaj.art-31633928d3af46dc9686f515676aa40d |
| institution | Directory Open Access Journal |
| issn | 0971-6203 1998-3913 |
| language | English |
| last_indexed | 2024-04-13T05:19:58Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Medical Physics |
| spelling | doaj.art-31633928d3af46dc9686f515676aa40d2022-12-22T03:00:46ZengWolters Kluwer Medknow PublicationsJournal of Medical Physics0971-62031998-39132018-01-0143316817210.4103/jmp.JMP_28_18Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapyRamya RangarajanAim: With the advent of computed tomography (CT)-based brachytherapy, it is possible to view the appropriate placement of the applicator within the uterine canal and detect uterine perforation. In this study, the incidence of suboptimal placement of the intracavitary applicator and the resulting dosimetric impact were analyzed and compared with a similar set of ideal applicator placement. Materials and Methods: CT datasets of 282 (141 patients) high dose rate brachytherapy insertions between January and April 2016 were analyzed. The target volumes and organs at risk (OAR) were contoured as per the Groupe Européen de Curiethérapie European Society of Therapeutic Radiation Oncology guidelines. The position of the applicator in the uterine cavity was analyzed for each application. Results: The suboptimal insertion rate was 11.7%. There were 26 perforations and 7 subserosal insertions. The most common site of perforation was through the posterior wall of the uterus (42.4%). Fundus perforation and anterior wall perforation were seen in 24.2% and 12.1% of patients, respectively. The average dose to 90% of the target volume (D90 to high-risk clinical target volume) was the highest (9.15 Gy) with fundal perforation. Average dose to 2 cc (D2cc) bladder was highest for fundus perforation (7.65 Gy). The average dose received by 2 cc of rectum (D2cc) was highest (4.49 Gy) with posterior wall perforation. The average D2cc of the sigmoid was highest with anterior perforation (3.18 Gy). Conclusion: In order to achieve better local control and to decrease doses to OAR, it is important to perform a technically accurate applicator placement. A cost-effective, real-time image guidance modality like ultrasound is recommended for all insertions to ensure optimal applicator insertion.http://www.jmp.org.in/article.asp?issn=0971-6203;year=2018;volume=43;issue=3;spage=168;epage=172;aulast=RangarajanComputed tomography planningintracavitary brachytherapysuboptimal applicator placement |
| spellingShingle | Ramya Rangarajan Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy Journal of Medical Physics Computed tomography planning intracavitary brachytherapy suboptimal applicator placement |
| title | Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy |
| title_full | Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy |
| title_fullStr | Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy |
| title_full_unstemmed | Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy |
| title_short | Incidence of suboptimal applicator placement and the resulting dosimetric impact in image-based intracavitary brachytherapy |
| title_sort | incidence of suboptimal applicator placement and the resulting dosimetric impact in image based intracavitary brachytherapy |
| topic | Computed tomography planning intracavitary brachytherapy suboptimal applicator placement |
| url | http://www.jmp.org.in/article.asp?issn=0971-6203;year=2018;volume=43;issue=3;spage=168;epage=172;aulast=Rangarajan |
| work_keys_str_mv | AT ramyarangarajan incidenceofsuboptimalapplicatorplacementandtheresultingdosimetricimpactinimagebasedintracavitarybrachytherapy |