Modern Tools for Modern Brachytherapy.

This review aims to showcase the brachytherapy tools and technologies that have emerged during the last 10 years. Soft-tissue contrast using magnetic resonance and ultrasound imaging has seen enormous growth in use to plan all forms of brachytherapy. The era of image-guided brachytherapy has encouraged the development of advanced applicators and given rise to the growth of individualised 3D printing to achieve reproducible and predictable implants. These advances increase the quality of implants to better direct radiation to target volumes while sparing normal tissue. Applicator reconstruction has moved beyond manual digitising, to drag and drop of three-dimensional applicator models with embedded pre-defined source pathways, ready for auto-recognition and automation. The simplified TG-43 dose calculation formalism directly linked to reference air kerma rate of high-energy sources in the medium water remains clinically robust. Model-based dose calculation algorithms accounting for tissue heterogeneity and applicator material will advance the field of brachytherapy dosimetry to become more clinically accurate. Improved dose-optimising toolkits contribute to the real-time and adaptive planning portfolio that harmonises and expedites the entire image-guided brachytherapy process. Traditional planning strategies remain relevant to validate emerging technologies and should continue to be incorporated in practice, particularly for cervical cancer. Overall, technological developments need commissioning and validation to make the best use of the advanced features by understanding their strengths and limitations. Brachytherapy has become high-tech and modern by respecting tradition and remaining accessible to all.

Comparison of four-year toxicities and local control of ultra-hypofractionated vs moderate-hypofractionated image guided prostate radiation with HDR brachytherapy boost: A phase I-II single institution trial.

Purpose/Objectives: To analyze the long term efficacy and safety of an ultra-hypofractionated (UHF) radiation therapy prostate treatment regimen with HDR brachytherapy boost (BB) and compare it to moderate-hypofractionated regimens (MHF). Materials/Methods: In this single arm, prospective monocentric study, 28 patients with intermediate risk prostate cancer were recruited in an experimental treatment arm of 25 Gy in 5 fractions plus a 15 Gy HDR BB. They were then compared to two historical control groups, treated with either 36 Gy in 12 fractions or 37.5 Gy in 15 fractions with a similar HDR BB. The control groups included 151 and 311 patients respectively. Patient outcomes were reported using the International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC-26) questionnaires at baseline and at each follow-up visit. Results: Median follow-up for the experimental arm was 48.5 months compared to 47 months and 60 months compared to the 36/12 and 37,5/15 groups respectively. The IPSS and EPIC scores did not demonstrate any significant differences in the gastrointestinal or genitourinary domains between the three groups over time. No biochemical recurrence occurred in the UHF arm as defined by the Phoenix criterion. Conclusion: The UHF treatment scheme with HDR BB seems equivalent to standard treatment arms in terms of toxicities and local control. Randomized control trials with larger cohorts are ongoing and needed to further confirm our findings.

Focal HDR brachytherapy boost to stereotactic radiotherapy (fBTsRT) for prostate cancer: a phase II randomized controlled trial.

BACKGROUND: For patients with a higher burden of localized prostate cancer, radiation dose escalation with brachytherapy boosts have improved cancer control outcomes at the cost of urinary toxicity. We hypothesize that a focal approach to brachytherapy boosts targeting only grossly visualized tumor volumes (GTV) combined with stereotactic radiotherapy will improve quality of life (QoL) outcomes without compromising cancer control. METHODS: 150 patients with intermediate or high-risk prostate cancer will be enrolled and randomized 1:1 in a cohort multiple randomized clinical trial phase 2 design. Patients are eligible if planned for standard-of-care (SOC) high dose rate (HDR) brachytherapy boost to radiotherapy (RT) with GTVs encompassing < 50% of the prostate gland. Those randomly selected will be offered the experimental treatment, consisting of focal HDR brachytherapy boost (fBT) of 13-15 Gy in 1 fraction followed by stereotactic radiotherapy (sRT) 36.25-40 Gy in 5 fractions to the prostate (+/- 25 Gy to the elective pelvis) delivered every other day. The primary endpoint is to determine if fBTsRT is superior to SOC by having fewer patients experience a minimally important decline (MID) in urinary function as measured by EPIC-26 at 1 and 2 years. Secondary endpoints include rates of toxicity measured by Common Terminology Criteria for Adverse Events (CTCAE), and failure-free survival outcomes. DISCUSSION: This study will determine whether a novel approach for the treatment of localized prostate cancer, fBTsRT, improves QoL and merits further evaluation. Trial registration This trial was prospectively registered in ClinicalTrials.gov as NCT04100174 as a companion to registry NCT03378856 on September 24, 2019.

On the use of polychromatic cameras for high spatial resolution spectral dose measurements.

Objective.Despite the demonstrated benefits of hyperspectral formalism for stem effect corrections in the context of fiber dose measurements, this approach has not been yet translated into volumetric measurements where cameras are typically used for their distinguishing spatial resolution. This work investigates demosaicing algorithms for polychromatic cameras based spectral imaging.Approach.The scintillation and Cherenkov signals produced in a radioluminescent phantom are imaged by a polychromatic camera and isolated using the spectral formalism. To do so, five demosaicing algorithms are investigated from calibration to measurements: a clustering method and four interpolation algorithms. The resulting accuracy of scintillation and Cherenkov images is evaluated with measurements of the differences (mean ± standard deviation) between the obtained and expected signals from profiles drawn across a scintillation spot. Signal-to-noise ratio and signal-to-background ratio are further measured and compared in the resulting scintillation images. Finally, the resulting differences on the scintillation signal from a 0.2 × 0.2 cm2region-of-interest (ROI) were reported.Main results.Clustering, OpenCV, bilinear, Malvar and Menon demosaicing algorithms respectively yielded differences of 3 ± 5%, 1 ± 3%, 1 ± 3%, 1 ± 2% and 2 ± 4% in the resulting scintillation images. For the Cherenkov images, all algorithms provided differences below 1%. All methods enabled measurements over the detectability (SBR > 2) and sensitivity (SNR > 5) thresholds with the bilinear algorithm providing the best SNR value. Clustering, OpenCV, bilinear, Malvar and Menon demosaicing algorithms respectively provided differences on the ROI analysis of 7 ± 5%, 3 ± 2%, 3 ± 2%, 4 ± 2%, 7 ± 3%.Significance.Radioluminescent signals can accurately be isolated using a single polychromatic camera. Moreover, demosaicing using a bilinear kernel provided the best results and enabled Cherenkov signal subtraction while preserving the full spatial resolution of the camera.

Deformable scintillation dosimeter I: challenges and implementation using computer vision techniques.

Plastic scintillation detectors are increasingly used to measure dose distributions in the context of radiotherapy treatments. Their water-equivalence, real-time response and high spatial resolution distinguish them from traditional detectors, especially in complex irradiation geometries. Their range of applications could be further extended by embedding scintillators in a deformable matrix mimicking anatomical changes. In this work, we characterized signal variations arising from the translation and rotation of scintillating fibers with respect to a camera. Corrections are proposed using stereo vision techniques and two sCMOS complementing a CCD camera. The study was extended to the case of a prototype real-time deformable dosimeter comprising an array of 19 scintillating fibers. The signal to angle relationship follows a gaussian distribution (FWHM = 52°) whereas the intensity variation from radial displacement follows the inverse square law. Tracking the position and angle of the fibers enabled the correction of these spatial dependencies. The detecting system provides an accuracy and precision of respectively 0.08 mm and 0.3 mm on the position detection. This resulted in an uncertainty of 2° on the angle measurement. Displacing the dosimeter by ±3 cm in depth resulted in relative intensities of 100 ± 10% (mean ± standard deviation) to the reference position. Applying corrections reduced the variations thus resulting in relative intensities of 100 ± 1%. Similarly, for lateral displacements of ±3 cm, intensities went from 98 ± 3% to 100 ± 1% after the correction. Therefore, accurate correction of the signal collected by a camera imaging the output of scintillating elements in a 3D volume is possible. This work paves the way to the development of real-time scintillator-based deformable dosimeters.

Deformable scintillation dosimeter: II. Real-time simultaneous measurements of dose and tracking of deformation vector fields.

Anatomical motion and deformation pose challenges to the understanding of the delivered dose distribution during radiotherapy treatments. Hence, deformable image registration (DIR) algorithms are increasingly used to map contours and dose distributions from one image set to another. However, the lack of validation tools slows their clinical adoption, despite their commercial availability. This work presents a novel water-equivalent deformable dosimeter that simultaneously measures the dose distribution and tracks deformation vector fields (DVF). The dosimeter in made of an array of 19 scintillating fiber detectors embedded in a cylindrical elastomer matrix. It is imaged by two pairs of stereoscopic cameras tracking the position and angulation of the scintillators, while measuring the dose. The resulting system provides a precision of 0.3 mm on DVF measurements. The dosimeter was irradiated with 5 × 3, 4 × 3 and 3 × 3 cm26 MV photon beams in both fixed and deformed conditions. The measured DVF was compared to the one computed with a DIR algorithm (Plastimatch). The deviations between the computed and measured DVFs was below 1.5 mm. As for dose measurements, the dosimeter acquired the dose distribution in fixed and deformed conditions within 1% of the treatment planning system calculation and complementary dose validation using the Hyperscint dosimetry system. Using the demonstrated qualities of scintillating detectors, we developed a real-time, water-equivalent deformable dosimeter. Given it's sensor tracking position precision and dose measurements accuracy, the developed detector is a promising tools for the validation of DIR algorithms as well as dose distribution measurements under fixed and deformed conditions.

Reduction of bacterial biofilm formation using marine natural antimicrobial peptides.

There is an important need for the development of new "environmentally-friendly" antifouling molecules to replace toxic chemicals actually used to fight against marine biofouling. Marine biomass is a promising source of non-toxic antifouling products such as natural antimicrobial peptides produced by marine organisms. The aim of this study was to demonstrate the efficiency of antimicrobial peptides extracted from snow crab (SCAMPs) to reduce the formation of marine biofilms on immerged mild steel surfaces. Five antimicrobial peptides were found in the snow crab hydrolysate fraction used in this study. SCAMPs were demonstrated to interact with natural organic matter (NOM) during the formation of the conditioning film and to limit the marine biofilm development in terms of viability and bacterial structure. Natural SCAMPs could be considered as a potential alternative and non-toxic product to reduce biofouling, and as a consequence microbial induced corrosion on immerged surfaces.

An automated system for performing continuous viscosity versus temperature measurements of fluids using an Ostwald viscometer.

An automated system was developed to measure the viscosity of fluids as a function of temperature using image analysis tracking software. An Ostwald viscometer was placed in a three-wall dewar in which ethylene glycol was circulated using a thermal bath. The system collected continuous measurements during both heating and cooling cycles exhibiting no hysteresis. The use of video tracking analysis software greatly reduced the measurement errors associated with measuring the time required for the meniscus to pass through the markings on the viscometer. The stability of the system was assessed by performing 38 consecutive measurements of water at 42.50 ± 0.05 °C giving an average flow time of 87.7 ± 0.3 s. A device was also implemented to repeatedly deliver a constant volume of liquid of 11.00 ± 0.03 ml leading to an average error in the viscosity of 0.04%. As an application, the system was used to measure the viscosity of two Li-ion battery electrolyte solvents from approximately 10 to 40 °C with results showing excellent agreement with viscosity values calculated using Gering's Advanced Electrolyte Model (AEM).

Real-time electromagnetic seed drop detection for permanent implants brachytherapy: Technology overview and performance assessment.

PURPOSE: To describe the principles and report on the performance of a novel real-time electromagnetic (EM) seed drop detection technology for permanent implants brachytherapy procedures. METHODS: A novel EM hollow needle prototype was recently developed by Philips. It possesses standard 3D tracking capability as well as a seed drop detection mechanism, both performed from a single custom built EM sensor. The detection mechanism is based on the magnetic permeability changes in the sensor as the seeds pass through. Drop position estimates are generated by the tracking information at the dropping instants. Three validation experiments were carried out in this study. First, the robustness of the detection mechanism was tested in free air with four different seed types. Detection waveforms were measured and commented. The accuracy of the seed drop position estimates was then evaluated using both 2D and 3D experiments. The procedures consisted of dropping seeds in phantoms, recording the drop position estimates, and finally registering the resulting spatial distributions on reference ones obtained by accurate modalities. Seeds were dropped on a specially designed plastic support adapted to brachytherapy template dimensions for 2D experiments, and true seed positions (reference distribution) were obtained by optical detection. In 3D experiments, seeds were dropped in edible gelatin and reference distributions were obtained by localizing the implants from CT scans of the phantoms. RESULTS: All four seed types were correctly detected by the needle prototype. In total, 250 seeds were dropped on the plastic support, and 96 were dropped in gelatin phantoms. The detection rate was 100% in both cases. The minimum, maximum, and average drop position errors were, respectively, 0.1(+1.6/ - 0.1), 2.9(+1.4/ - 1.5), and 0.9(+1.4/ - 0.7) mm for 2D, and 0.1(+1.0/ - 0.1), 2.1(+1.1/ - 0.8), and 0.6(+1.2/ - 0.5) mm for 3D experiments. CONCLUSIONS: The hollow needle prototype combines both EM tracking and automatic seed drop detection in a compact and convenient form. The EM detection mechanism is robust, and the seed drop position estimates appear sufficiently accurate for potential integration of the technology to current brachytherapy treatment planning systems. In that context, it would serve as a valuable tool for rapid dosimetry validation in real-time treatment delivery.

Repetitive peripheral magnetic stimulation to reduce pain or improve sensorimotor impairments: A literature review on parameters of application and afferents recruitment.

INTRODUCTION: Repetitive peripheral magnetic stimulation (rPMS over spinal root, nerve or muscle belly) is a promising technology in physiopathology research. As compared to electrical stimulation, rPMS is deemed to activate deep conductive structures and produce strong muscle contractions and massive proprioceptive afferents with minimal cutaneous recruitment. RPMS may thus act differently on neural plasticity involved in pain reduction and motor recovery in musculoskeletal or neurological conditions. However, literature is very scant and still controversial concerning afferents recruited by rPMS, thus no consensus is reached yet for its clinical use. STUDY AIM: This review dealt with stimulation parameters reported in any scientific research that applied rPMS as an intervention to improve somatosensory or motor disorders with a view of proposing recommendations for future applications. Also, controversy on afferents recruitment was discussed. RESULTS: The literature search resulted in 24 studies. Literature is scant on the topic but our review presents the rationale and the experimental data that may underlie the selection of parameters in future studies using rPMS as an intervention. Although controversy remains, the review presents that the specific recruitment of sensory afferents by magnetic stimulation may offer advantages and disadvantages depending on the pathology. CONCLUSIONS: The review proposed recommendations to improve rPMS application in clinical research. However, the development of guidelines still requires methodological and clinical studies enrolling larger samples and with randomized sham-controlled designs.

Development of virtual patient models for permanent implant brachytherapy Monte Carlo dose calculations: interdependence of CT image artifact mitigation and tissue assignment.

This work investigates and compares CT image metallic artifact reduction (MAR) methods and tissue assignment schemes (TAS) for the development of virtual patient models for permanent implant brachytherapy Monte Carlo (MC) dose calculations. Four MAR techniques are investigated to mitigate seed artifacts from post-implant CT images of a homogeneous phantom and eight prostate patients: a raw sinogram approach using the original CT scanner data and three methods (simple threshold replacement (STR), 3D median filter, and virtual sinogram) requiring only the reconstructed CT image. Virtual patient models are developed using six TAS ranging from the AAPM-ESTRO-ABG TG-186 basic approach of assigning uniform density tissues (resulting in a model not dependent on MAR) to more complex models assigning prostate, calcification, and mixtures of prostate and calcification using CT-derived densities. The EGSnrc user-code BrachyDose is employed to calculate dose distributions. All four MAR methods eliminate bright seed spot artifacts, and the image-based methods provide comparable mitigation of artifacts compared with the raw sinogram approach. However, each MAR technique has limitations: STR is unable to mitigate low CT number artifacts, the median filter blurs the image which challenges the preservation of tissue heterogeneities, and both sinogram approaches introduce new streaks. Large local dose differences are generally due to differences in voxel tissue-type rather than mass density. The largest differences in target dose metrics (D90, V100, V150), over 50% lower compared to the other models, are when uncorrected CT images are used with TAS that consider calcifications. Metrics found using models which include calcifications are generally a few percent lower than prostate-only models. Generally, metrics from any MAR method and any TAS which considers calcifications agree within 6%. Overall, the studied MAR methods and TAS show promise for further retrospective MC dose calculation studies for various permanent implant brachytherapy treatments.

Brain control of volitional ankle tasks in people with chronic stroke and in healthy individuals.

This study explored the relationships between motor cortical control of ankle dorsiflexors and clinical impairments of volitional ankle dorsiflexion in people with chronic stroke. Eighteen persons with stroke and 14 controls were evaluated. Clinical tools were used to assess ankle dorsiflexion amplitude and isometric strength. Transcranial magnetic stimulation (TMS) of the primary motor cortex (M1) tested the functional integrity of cortical circuits controlling the tibialis anterior (TA). All clinical scores and most TMS outcomes were impaired in people with chronic stroke. The lower clinical scores were related to the reduction of the strength of corticospinal projections onto spinal motoneurons. Concurrent TMS and clinical testing in chronic stroke provided original data demonstrating relationships between the integrity of cortical and corticospinal components of TA motor control and volitional ankle tasks. Our study proposes that volitional ankle mobilization in chronic stroke may be explained by the residual abnormal M1 circuits which may be responsive for rehabilitation intervention. This should be confirmed in longitudinal studies with larger samples to determine whether TMS outcomes associated with lower limb muscles are predictive of clinical changes or vice versa.

Effects of repetitive peripheral magnetic stimulation on normal or impaired motor control. A review.

INTRODUCTION: Repetitive magnetic stimulation at the periphery (rPMS), i.e. over spinal roots, nerves or muscles, represents a new painless and noninvasive approach that can contribute to motor recovery. This method is based on the assumption that, under rPMS, neural networks involved in motor control would be regulated by the large recruitment of proprioceptive afferents, with little activation of cutaneous receptors. STUDY AIM: This literature review dealing with rPMS after-effects on motor control aimed at better understanding the outcome measures and further discussing some possible involved mechanisms. RESULTS: Our literature search resulted in 13 studies that used different types of outcomes (neurophysiological, biomechanical, clinical) to test the influence of rPMS over spinal roots or muscles in healthy individuals and in persons with stroke or spinal disorders. Dynamic changes were reported post-rPMS, such as spasticity reduction and improvements of movement dynamics. Studies also brought about some interesting insights on the cortical plasticity associated with rPMS effects, such as the activation of fronto-parietal loops that may explain the post-rPMS improvement of motor planning. CONCLUSIONS: Due to the heterogeneous and scant literature on the topic, no conclusion can be drawn to date. However, the results encourage the concurrent testing of clinical, neurophysiological and biomechanical outcomes to investigate more precisely the relevance of rPMS in neurological rehabilitation.

ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.

Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms. The scientific community has expressed the need for an accurate dosimetry platform in brachytherapy. The purpose of this paper is to present ALGEBRA, a Monte Carlo platform for dosimetry in brachytherapy which is sufficiently fast and accurate for clinical and research purposes. ALGEBRA is based on the GEANT4 Monte Carlo code and is capable of handling the DICOM RT standard to recreate a virtual model of the treated site. Here, the performance of ALGEBRA is presented for the special case of LDR brachytherapy in permanent prostate and breast seed implants. However, the algorithm is also capable of handling other treatments such as HDR brachytherapy.

Sci-Thur PM: YIS - 10: A new optically encoded single-fiber plastic scintillation detector for multi-point radiation dosimetry.

PURPOSE: To develop a new multi-point plastic scintillation detector (mPSD) that allows for simultaneous dose measurements at multiple points and uses a single optical guide. MATERIALS AND METHODS: Two different prototypes were built. A two-point mPSD was built and light discrimination was based on the use of multiple color filters at the outputs of a network of optical fiber splitters. Light intensity was measured by an EMCCD camera. For the three-point mPSD, the light discrimination setup was replaced by a low-noise spectrometer. Depth-dose and profiles measurements were obtained on a 6 MV photon beam with the mPSDs inside a water phantom. An ion chamber was also used for comparison purpose. Finally, the three-point mPSD was tested under an Ir-192 high-dose-rate (HDR) brachytherapy dose delivery and compared to the treatment planning system. RESULTS: A good agreement was found between the measured and expected dose for both mPSDs. The average relative differences to the ion chamber measurement for the two-point mPSD were of (2.4 ± 1.6)% and (1.3 ± 0.8)%. For the three-point mPSD, these differences were of (2.3±1.1)%, (1.6±0.4)% and (0.32±0.19)%. The latter mPSD was shown very versatile, being able to measure dose from HDR brachytherapy with an average accuracy of (2.3±1.0)% per catheter. CONCLUSIONS: The practical feasibility of mPSDs using a single optical guide has been demonstrated under irradiation from a 6 MV photon beam and an Ir-192 HDR brachytherapy source. Their application for pre-treatment quality assurance and in vivo dosimetry will be various.

Sci-Thur PM: YIS - 05: Tomographic dosimetry using scintillating fibers and its application to 2D and 3D dosimetry.

PURPOSE: To present the proof of concept and the experimental validation of tomographic dosimetry (tomodosimetry), where a tomographic acquisition of the incident deposited dose is performed using long scintillating fibers. METHOD: 2D tomodosimetry: 50 long scintillating fibers were aligned on a 20cm diameter disk inside a 30cm diameter masonite phantom. 3D tomodosimetry: 128 long scintillating fibers of various orientation were simulated on the surface of two cylindrical regions of radius 7.5 and 3.75cm inside a 20cm diameter, 20cm long cylindrical phantom. In both case, the dose projections were acquire each 5 degrees over a 180 degrees (2D) or 360 degrees (3D) rotation of the device, and the dose in each scintillating fiber plane was reconstructed using a total variation minimization reconstruction iterative algorithm at a resolution of 1×1mm2 . The 3D dose was obtained by interpolating between in each cylindrical plane in the 3D prototype. RESULTS: 3%/3mm gamma tests conducted in the isocentre plane for both configurations achieved a success rate of more than 99% of the dose pixels in the region over 50% of the maximum dose. Absolute dose differences in the high dose low gradient region of each scintillating fiber plane were on average below 1% for the 2D configuration and below 1.3% for the 3D configuration. CONCLUSIONS: This work illustrates the potential and capacity of scintillating fiber based 2D and 3D tomodosimeters. The presented methodology allows for millimeter resolution dosimetry in a whole 2D plane or 3D volumes in real-time using only a limited number of detectors.

Sci-Sat AM: Brachy - 07: Plastic scintillation detector validation for kV dosimetry.

PURPOSE: To characterize the plastic scintillation detectors (PSDs) response in the diagnostic energy range. A fast and adaptable method for real-time dosimetry in superficial x-ray therapy and interventional radiology is proposed. METHOD: A PSD (1 mm diameter and 10 mm long) is coupled to a 5 m long optical fiber. Scintillation photons are guided to a polychromatic photodiode which provides an electrical current proportional to the input light signal. If the incident energy spectrum is known, the dose measured in the PSD's polystyrene sensitive volume can be converted to score dose in any other media such as air, water or soft tissues using the large cavity theory (LCT). A software simulating x-ray tube spectra and filtration has been benchmarked and is used for analysis. The method is confirmed by Monte Carlo simulations. RESULTS: PSDs cannot be assumed energy independent with low-energy photons as a factor 2 has been observed in the energy response between 80 kVp and 150 kVp. When the dose is converted to the desired medium, the PSD's energy dependence is compensated and a 2.1% standard deviation was observed upon the studied energy ranges, which is inside the measurement and calculation uncertainties. Percent depth dose (PDD) measurements are in good agreement with Monte Carlo simulations and results can be improved if the proposed method is applied to compensate beam hardening. CONCLUSION: PSDs present great potential for real-time dose measurements with radiologic photon energy.

Sci-Sat AM: Brachy - 10: Adaptation of the CVT algorithm for catheter optimization in high dose rate brachytherapy.

INTRODUCTION: In interstitial high dose rate (HDR) brachytherapy, the number and positions of the catheter are usually fixed by the use of a template, without considering tumor size and shape. In this work, we present a simple and fast method to optimize both the number and position of catheters, using a modified version of the Centroidal Voronoi Tessellations (CVT) algorithm. METHODS: 8 prostate HDR clinical cases were chosen randomly to test our method. The treatment plan was obtained from a research version of IPSA. Clinically relevant dosimetric parameters were computed to evaluate our method and help optimizing the CVT algorithm parameters. Plans were generated with a specified number of catheters ranging from 9 to 18 and compared to the clinical cases with 17 catheters. RESULTS: The computation time to optimize the positions of a specific number of catheters was 1.5 s. The prostate V100 was better than the clinical case up to 12 catheters. Plans with 9 or less catheters would not be clinically acceptable in terms of prostate V100 and D90. High conformity is achieved whether the number of catheters used. The V75 of the bladder seems slightly higher, but not significant clinically. All other dosimetric indices are as good as the clinical plan. CONCLUSION: We have devised a simple, fast and efficient method to optimize the number and position of catheters in HDR brachytherapy. Ultimately, this catheter optimization algorithm could be coupled with a 3D ultrasound system to allow real-time guidance and planning for any interstitial brachytherapy sites.

SU-E-T-265: Reducing Pacemaker Doses with a Lead Sheet: A Multi-Detector Study.

PURPOSE: Evaluate the usability of lead shielding to reduce the dose to pacemakers. The efficiency and risk of this type of skin block will be presented. METHODS: A solid water phantom was used and all measurements were made at a depth of 0.5 cm for 6 MV and 23 MV photon beams. Measurements were performed with a parallel plate ion chamber and with a plastic scintillation detector (PSD) prototype. Measurements were made for fields of 10, 20 and 30 cm square. For every field, measurements were made in increment of 5 cm from the center of the field to the edge of the 60 cm long phantom for anterior and posterior beams. All measures have been made with and without a 1.6 mm of lead shielding wrapped in a thermoplastic. RESULTS: For all measurements, both detectors agree to 0.6%, well within the uncertainties of the detectors. With antero-posterior fields, the benefit of shielding is more important at 23MV (reduction of dose by65%) compared to 6MV (reduction of dose by 46%) when the shielding is out of the field. For distances larger than 35 cm, no benefits are measured. In the case were the lead is completely inside the fields, the dose is increased by the presence of shielding. The same observation is made for postero-anterior fields. For shielding out of field, the dose is slightly increased. CONCLUSIONS: The used of lead shielding with antero-posterior field is advised and provided an easy way to decrease dose to pacemaker. For a postero-anterior field, it is preferable to avoid shielding, but it could be used if it stays outside fields in the case of a multiple beams treatment. PSD has been shown to be an excellent candidate for in vivo monitoring dose to pacemakers and also site like foetus.

WE-G-BRB-06: Real-Time Radiation Field Tracking Using Long Scintillating Fibers.

PURPOSE: To ensure the quality assurance of small field, dynamic radiotherapy, we present and validate a radiation tracking system based on long scintillating fibers that allows for the real-time measurement of the position and energetic fluence of a small incident radiation field. METHOD: We aligned 60 parallel scintillating fibers on a thin grooved acrylic slab with a 100-cm source-to-fibers distance. Both ends of each scintillating fiber were coupled to clear optical fibers to enable light collection by a single CCD camera using an f/0.95, 50 mm focal length lens. Using a small, static photon radiation field of 2×2 cm2 of a Varian Clinac iX, we changed the interaction position on the prototype using the linac treatment couch. The interaction position parallel and perpendicular to the scintillating fiber array were deduced using the optical attenuation of the scintillating fibers. The energetic fluence of the incident field was calculated from the fibers light fluxes, corrected for the position dependent optical attenuation and scintillation efficiency. RESULTS: Considering a treatment couch positioning error of ±0.5 mm, the system was able to measure the field position with a mean error of 0.1 mm perpendicular and 0.8 mm parallel to the scintillating fiber array. The maximum error measured using this setup was of 0.13 mm perpendicular and 3.2 mm parallel to the scintillating fiber array. The energetic fluence was determined with a mean error of 0.5% and a maximum error of 2.2%. CONCLUSIONS: This work demonstrates the capacity of a long scintillating fibers array to detect in real-time both the position and the energetic fluence of an incident small radiation field. Such methodology would allow for the real-time tracking of small field in both photon and particle radiation therapy.