title: A real-time image-guided intraoperative high-dose-rate brachytherapy system.
abstract: OBJECTIVE
  To develop a real-time, image-guided intraoperative high-dose-rate brachytherapy system.
  
  
  METHODS
  The surface applicator, a catheter array on a 1-mm-thick soft and semitransparent silicone rubber sheet, was directly sutured on the surgical bed. A three-dimensional video camera was then used to instantly capture images of the catheters and the surgical surface. Tracing the catheters on the images allowed us to automatically determine the dwell source positions. Dwell times in the dwell positions were optimized to minimize the dose variation and deviation from the treatment prescription. A dose-texture plot was created to quantify the dose distribution.
  
  
  RESULTS
  Treatment planning time was reduced from hours to a few minutes. Phantom tests have shown that the new source localization is accurate with sigma<1.5 mm. All hot spots and cold spots had been eliminated after the dwell-time optimization.
  
  
  CONCLUSIONS
  This real-time, image-guided planning system can provide optimal image-guided intraoperative high-dose-rate brachytherapy with geometric and dosimetric improvements and a short planning time.
authors.affiliation: Department of Radiation Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA. lish@jhmi.edu
authors.forename: Shidong
authors.initials: S
authors.lastname: Li
authors.forename: Deborah
authors.initials: D
authors.lastname: Frassica
authors.forename: Theodore
authors.initials: T
authors.lastname: DeWeese
authors.forename: Ding-Jen
authors.initials: DJ
authors.lastname: Lee
authors.forename: Jason
authors.initials: J
authors.lastname: Geng
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
mesh_terms: D001918:Brachytherapy; D003131:Combined Modality Therapy; D003199:Computer Systems; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D009369:Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome