title: Optimization of MammoSite therapy.
abstract: OBJECTIVE
  Radiation source anisotropy causes about 10% of a spherically shaped planning target volume surrounding a MammoSite balloon to receive less than the prescribed dose. The principal dose-limiting factor for MammoSite therapy is the dose to the overlying skin. Additional limiting factors potentially include the dose to portions of the heart and lung. The goal of optimization is to deliver the prescribed dose to as much of the planning target volume as possible while avoiding toxicity to adjacent organs.
  
  
  METHODS
  An experimental CT-based high-dose-rate brachytherapy treatment planning system was used to investigate optimization strategies for MammoSite treatment. This system implements a linear optimization of high-dose-rate dwell times on the basis of constraints assigned to points of interest and a set of potential dwell positions.
  
  
  RESULTS
  The cylindrical symmetry of the MammoSite catheter limits the optimization process to creating spherical, ellipsoidal, or egg-shaped isodose distributions whose major axis is oriented along the catheter axis. If the dose to a limiting structure, such as skin, is not an issue, the use of multiple dwell positions can compensate for source anisotropy and create a more spherical isodose surface enclosing the planning target volume compared with a single dwell position. When skin becomes a dose-limiting factor, the catheter axis orientation, source anisotropy, dwell position, and dwell weighting can be exploited to limit the skin dose while simultaneously preserving the prescribed dose to as much of the target volume as possible.
  
  
  CONCLUSIONS
  Optimization of MammoSite therapy using multiple dwell positions within the balloon is both possible and practical.
authors.affiliation: Department of Radiation Oncology, University of Southern California Norris Cancer Hospital, Los Angeles, CA 90033, USA. astrahan@hsc.usc.edu
authors.forename: Melvin A
authors.initials: MA
authors.lastname: Astrahan
authors.forename: Gabor
authors.initials: G
authors.lastname: Jozsef
authors.forename: Oscar E
authors.initials: OE
authors.lastname: Streeter
mesh_terms: D016880:Anisotropy; D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted