title: On-line implant reconstruction in HDR brachytherapy.
abstract: OBJECTIVE
  To evaluate the accuracy of on-line planning in an Integrated Brachytherapy Unit (IBU) using dedicated image distortion correction algorithms, correcting the geometric distortion and magnetic distortion separately, and to determine the effect of the reconstruction accuracy on clinical treatment plans in terms of deviations in treatment time and dose.
  
  
  METHODS
  The reconstruction accuracy has been measured using 20 markers, positioned at well known locations in a QA phantom. Treatment plans of two phantoms representing clinical implant geometries, have been compared with reference plans to determine the effect of the reconstruction accuracy on the treatment plan. Before clinical introduction, treatment plans of three representative patients, based on on-line reconstruction, have been compared with reference plans.
  
  
  RESULTS
  The average reconstruction error for 10 in. images reduces from -0.6 mm (range -2.6 to +1.0 mm) to -0.2 mm (range -1.2 to +0.6 mm) after image distortion correction and for 15 in. images from 0.8 mm (range -0.5 to +3.0 mm) to 0.0 mm (range -0.8 to +0.8 mm). The error in case of eccentric positioning of the phantom, i.e. 0.8 mm (range -1.0 to +3.3 mm), reduces to 0.1 mm (range -0.5 to +0.9 mm). Correction of the image distortions reduces the deviation in the calculated treatment time of maximally 2.7% to less than 0.8% in case of eccentrically positioned clinical phantoms. The deviation in the treatment time or reference dose in the plans based on on-line reconstruction with image distortion correction of the three patient examples is smaller than 0.3%.
  
  
  CONCLUSIONS
  Accurate on-line implant reconstruction using the IBU localiser and dedicated correction algorithms separating the geometric distortion and the magnetic distortion is possible. The results fulfill the minimum requirements as imposed by the Netherlands Commission on Radiation Dosimetry (NCS) without limitations regarding the usable range of the field of view of the image intensifier. However, the C-arm angle is limited to those angles for which magnetic distortion corrections have been obtained.
authors.affiliation: Department of Radiation Oncology, Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands. i.kolkman-deurloo@erasmusmc.nl
authors.forename: Inger-Karine K
authors.initials: IK
authors.lastname: Kolkman-Deurloo
authors.forename: Wilhelmus J M
authors.initials: WJ
authors.lastname: de Kruijf
authors.forename: Peter C
authors.initials: PC
authors.lastname: Levendag
mesh_terms: D000465:Algorithms; D001918:Brachytherapy; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation / Q000592:standards*; D009369:Neoplasms / Q000532:radiotherapy*; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D012680:Sensitivity and Specificity