USM Liver Brachytherapy Lecture

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Questions and Answers

Which of the following is NOT a step in the 3D Brachytherapy process?

  • Patient counseling (correct)
  • Contouring
  • Catheter reconstruction
  • Applicator placement

What is the primary focus of Advanced Brachytherapy in the context of Liver Brachytherapy?

  • Patient recovery
  • Applicator removal
  • 3D Brachytherapy (correct)
  • Catheter reconstruction

What is the purpose of normalization in 3D Brachytherapy?

  • To optimize applicator placement
  • To standardize treatment planning (correct)
  • To reconstruct catheters
  • To activate the brachytherapy device

What is the primary goal of optimization in 3D Brachytherapy?

<p>To maximize treatment efficacy (C)</p> Signup and view all the answers

What is the role of the Associate Professor Dr. in the context of Liver Brachytherapy?

<p>Teaching and educating students (D)</p> Signup and view all the answers

What is the purpose of refreshing Oncentra?

<p>To make new applicators available in the applicator library (D)</p> Signup and view all the answers

What is the relationship between contouring and applicator placement in 3D Brachytherapy?

<p>Contouring precedes applicator placement (C)</p> Signup and view all the answers

What is the correct way to adjust the applicator position in the Y view (Z,X)?

<p>To center of ring applicator in Y view (Z,X) (A)</p> Signup and view all the answers

What is the limitation of TPS in terms of applicator placement?

<p>TPS does not know which applicator is being used, including type, size, and coordinates (B)</p> Signup and view all the answers

What is the number of normalization points required for catheter reconstruction?

<p>Two normalization points are needed (D)</p> Signup and view all the answers

What is the purpose of the applicator library manager?

<p>To ensure the applicator is available for use in a patient (A)</p> Signup and view all the answers

What is the role of Mohd Zahri AbdulAziz in the context of the applicator placement?

<p>He is the presenter of the webinar on applicator placement (A)</p> Signup and view all the answers

What is the relationship between the applicator library manager and Oncentra?

<p>The applicator library manager is used to export applicator data to Oncentra (A)</p> Signup and view all the answers

What is the maximum distance the source can travel in the catheter for the Vienna Ring applicator?

<p>129.4 mm (B)</p> Signup and view all the answers

How many points are added for the Ring applicator during catheter reconstruction?

<p>Three points right and left, total 6 (B)</p> Signup and view all the answers

What is the limitation of CT image input in terms of applicator placement?

<p>CT image input cannot detect applicator type automatically (C)</p> Signup and view all the answers

What is the purpose of the Applicator library manager?

<p>To make new applicators available in the applicator library (B)</p> Signup and view all the answers

What is the outcome if the applicator is not available in the applicator library manager?

<p>The applicator cannot be used in the patient (C)</p> Signup and view all the answers

What is the correct way to adjust the applicator position in the X view (Y,Z)?

<p>To parallel to tandem position in X view (Y,Z) (B)</p> Signup and view all the answers

What is the purpose of adding catheters to the number of catheters used?

<p>To reconstruct every catheter slice by slice in CT images (D)</p> Signup and view all the answers

What is the primary application of image-based adaptive cervix cancer brachytherapy?

<p>Guiding radiation therapy in patients with cervical cancer (B)</p> Signup and view all the answers

What is the name of the institute associated with Mohd Zahri AbdulAziz?

<p>Advance Medical &amp; Dental Institute (C)</p> Signup and view all the answers

What is the purpose of normalization to a point?

<p>To adjust every catheter indexer length (C)</p> Signup and view all the answers

What is the purpose of manual dwell time and weight optimization in HDR brachytherapy?

<p>To control OAR doses (C)</p> Signup and view all the answers

What is the significance of automatic dose optimization in cervix cancer brachytherapy?

<p>It enables more accurate tumour targeting and reduced toxicity (C)</p> Signup and view all the answers

What is the significance of D90 in HR-CTV DVH summary?

<p>Dose received by 90% of HR-CTV (C)</p> Signup and view all the answers

What is the resource provided for further learning on applicator placement?

<p>A webinar on applicator placement (A)</p> Signup and view all the answers

What is the EQD2 for HR-CTV when prescribed 4 fractions of 7 Gy each?

<p>83.9 Gy (C)</p> Signup and view all the answers

What is the recommended dose limit for rectum in HDR brachytherapy?

<p>75 Gy (C)</p> Signup and view all the answers

What is the title of the publication referenced in the content?

<p>Basic Principles and Parameters for MR Imaging (D)</p> Signup and view all the answers

What is the primary focus of the Gynaecological (GYN) GEC-ESTRO Working Group?

<p>Establishing guidelines for cervix cancer brachytherapy (B)</p> Signup and view all the answers

What is the purpose of MR imaging in the context of cervix cancer brachytherapy?

<p>To visualize tumour anatomy for treatment planning (C)</p> Signup and view all the answers

What is the relationship between the Gynaecological (GYN) GEC-ESTRO Working Group and the publication referenced?

<p>The publication is a set of guidelines developed by the Working Group (C)</p> Signup and view all the answers

What is the recommended method for OAR contouring in HDR brachytherapy?

<p>Digital contouring (D)</p> Signup and view all the answers

What is the purpose of TG43-based calculation in HDR brachytherapy?

<p>To account for tissue inhomogeneity (B)</p> Signup and view all the answers

What is the significance of D2cc in DVH summary for OARs?

<p>Dose received by 2cc of OAR volume (C)</p> Signup and view all the answers

What is the advantage of using graphical optimization in HDR brachytherapy?

<p>Modify isodose slice by slice (A)</p> Signup and view all the answers

What is the EQD2 for bladder when prescribed 3 fractions of 7.5 Gy each?

<p>90.5 Gy (D)</p> Signup and view all the answers

What is the advantage of using MRI-based plans in brachytherapy?

<p>All of the above (D)</p> Signup and view all the answers

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Study Notes

3D Brachytherapy

  • Contouring involves manual placement or using an applicator library manager
  • Applicator placement requires physicists to ensure the position of the applicator in the Treatment Planning System (TPS) superimposes with CT images

Applicator Placement

  • TPS does not automatically detect applicator type from CT image input
  • Manual placement or applicator library manager is required
  • Physicist needs to provide information to TPS to export the applicator to Oncentra
  • The chosen applicator must be correct

Catheter Reconstruction

  • Add catheters to the number of catheters used
  • Two normalization points are needed (AL: x: -2, y: 2.4, z: 0 and AR: x: 2, y: 2.4, z: 0)
  • Reconstruct every catheter slice by slice in CT images
  • Adjust catheter indexer length to 129.4 mm (max distance source can travel in catheter)

Normalization

  • Two normalization points are needed
  • Ring applicator: add three points right and left (total 6)
  • IU tube: consider the tandem length, every 0.5 cm
  • Catheter: activate all and normalize to points

Activation

  • Activate all catheters
  • Normalize to points

Prescription

  • Depends on fractions:
    • 4 fx, 7 Gy/fx >> 83.9 Gy EQD2
    • 3 fx, 8 Gy/fx >> 80.3 Gy EQD2
  • OAR dose toxicity:
    • Rectum: 4 fx, 5 Gy/fx >> 75.2 Gy EQD2 or 3 fx, 6 Gy/fx >> 75.6 Gy EQD2
    • Sigmoid: limit not specified
    • Bladder: 4 fx, 6.3 Gy/fx > 90.1 Gy EQD2 or 3 fx, 7.5 Gy/fx > 90.5 Gy EQD2

Optimization

  • Choices of optimization:
    • Manual: choose manual dwell weights/times
    • Graphical: modify isodose slice by slice
  • Control OAR doses

Dose Volume Histogram (DVH)

  • Fx 1, Fx 2, Fx 3, EQD2, dose, and remarks
  • HR-CTV, rectum, sigmoid, and bladder doses

American Brachytherapy Society Consensus Guideline

  • For locally advanced carcinoma of the cervix, part II: HDR

GEC ESTRO - MRI-based Plan in Brachytherapy

  • Digital contouring
  • 3D planning with CT/MRI and PET/SPECT fusion
  • Fast contouring
  • Target and OAR contouring
  • DVH analysis

Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group

  • Basic principles and parameters for MR imaging within the frame of image-based adaptive cervix cancer brachytherapy

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