Incidence of Suboptimal Applicator Placement and the Resulting Dosimetric Impact in Image-Based Intracavitary Brachytherapy

Content Provider	Semantic Scholar
Author	Rangarajan, Ramya R.
Copyright Year	2018
Abstract	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.
Starting Page	168
Ending Page	172
Page Count	5
File Format	PDF HTM / HTML
PubMed reference number	30305774v1
Alternate Webpage(s)	https://doi.org/10.4103/jmp.JMP_28_18
DOI	10.4103/jmp.jmp_28_18
Journal	Journal of medical physics
Volume Number	43
Language	English
Access Restriction	Open
Subject Keyword	Bladder Tissue Brachytherapy Clinical Target Volume Clinical act of insertion Clomiphene Dental caries Insertion Mutation Intracavity Radiotherapy Medical Device Material Perforation Organ Organs at Risk Patients Rectum Sigmoid colon Therapeutic radiology procedure Urinary Bladder Uterine Perforation Uterus X-Ray Computed Tomography
Content Type	Text
Resource Type	Article