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</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</p> Signup and view all the answers

    What is the purpose of refreshing Oncentra?

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

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

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

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

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

    What is the purpose of normalization to a point?

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

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

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

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

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

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

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

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

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

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

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

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

    <p>All of the above</p> 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.

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