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?

To maximize treatment efficacy Signup and view all the answers

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

Teaching and educating students Signup and view all the answers

What is the purpose of refreshing Oncentra?

To make new applicators available in the applicator library Signup and view all the answers

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

Contouring precedes applicator placement Signup and view all the answers

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

To center of ring applicator in Y view (Z,X) Signup and view all the answers

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

TPS does not know which applicator is being used, including type, size, and coordinates Signup and view all the answers

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

Two normalization points are needed Signup and view all the answers

What is the purpose of the applicator library manager?

To ensure the applicator is available for use in a patient Signup and view all the answers

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

He is the presenter of the webinar on applicator placement Signup and view all the answers

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

The applicator library manager is used to export applicator data to Oncentra Signup and view all the answers

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

129.4 mm Signup and view all the answers

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

Three points right and left, total 6 Signup and view all the answers

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

CT image input cannot detect applicator type automatically Signup and view all the answers

What is the purpose of the Applicator library manager?

To make new applicators available in the applicator library Signup and view all the answers

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

The applicator cannot be used in the patient Signup and view all the answers

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

To parallel to tandem position in X view (Y,Z) Signup and view all the answers

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

To reconstruct every catheter slice by slice in CT images Signup and view all the answers

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

Guiding radiation therapy in patients with cervical cancer Signup and view all the answers

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

Advance Medical & Dental Institute Signup and view all the answers

What is the purpose of normalization to a point?

To adjust every catheter indexer length Signup and view all the answers

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

To control OAR doses Signup and view all the answers

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

It enables more accurate tumour targeting and reduced toxicity Signup and view all the answers

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

Dose received by 90% of HR-CTV Signup and view all the answers

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

A webinar on applicator placement Signup and view all the answers

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

83.9 Gy Signup and view all the answers

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

75 Gy Signup and view all the answers

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

Basic Principles and Parameters for MR Imaging Signup and view all the answers

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

Establishing guidelines for cervix cancer brachytherapy Signup and view all the answers

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

To visualize tumour anatomy for treatment planning Signup and view all the answers

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

The publication is a set of guidelines developed by the Working Group Signup and view all the answers

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

Digital contouring Signup and view all the answers

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

To account for tissue inhomogeneity Signup and view all the answers

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

Dose received by 2cc of OAR volume Signup and view all the answers

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

Modify isodose slice by slice Signup and view all the answers

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

90.5 Gy Signup and view all the answers

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

All of the above Signup and view all the answers

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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Description

This quiz covers the University of Science Malaysia's (USM) experiences with liver brachytherapy, including 3D brachytherapy. It's a lecture overview of the treatment approach.