title: Safety aspects of pulsed dose rate brachytherapy: analysis of errors in 1,300 treatment sessions.
abstract: OBJECTIVE
  To determine the safety of pulsed-dose-rate (PDR) brachytherapy by analyzing errors and technical failures during treatment.
  
  
  METHODS
  More than 1,300 patients underwent treatment with PDR brachytherapy, using five PDR remote afterloaders. Most patients were treated with consecutive pulse schemes, also outside regular office hours. Tumors were located in the breast, esophagus, prostate, bladder, gynecology, anus/rectum, orbit, head/neck, with a miscellaneous group of small numbers, such as the lip, nose, and bile duct. Errors and technical failures were analyzed for 1,300 treatment sessions, for which nearly 20,000 pulses were delivered. For each tumor localization, the number and type of occurring errors were determined, as were which localizations were more error prone than others.
  
  
  RESULTS
  By routinely using the built-in dummy check source, only 0.2% of all pulses showed an error during the phase of the pulse when the active source was outside the afterloader. Localizations treated using flexible catheters had greater error frequencies than those treated with straight needles or rigid applicators. Disturbed pulse frequencies were in the range of 0.6% for the anus/rectum on a classic version 1 afterloader to 14.9% for orbital tumors using a version 2 afterloader. Exceeding the planned overall treatment time by >10% was observed in only 1% of all treatments. Patients received their dose as originally planned in 98% of all treatments.
  
  
  CONCLUSIONS
  According to the experience in our institute with 1,300 PDR treatments, we found that PDR is a safe brachytherapy treatment modality, both during and outside of office hours.
authors.affiliation: Department of Radiation Oncology, Academic Medical Center, University Hospital, Amsterdam, The Netherlands. c.koedooder@amc.uva.nl
authors.forename: Kees
authors.initials: K
authors.lastname: Koedooder
authors.forename: Niek
authors.initials: N
authors.lastname: van Wieringen
authors.forename: Hans N B
authors.initials: HN
authors.lastname: van der Grient
authors.forename: Yvonne R J
authors.initials: YR
authors.lastname: van Herten
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Pieters
authors.forename: Leo E C M
authors.initials: LE
authors.lastname: Blank
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D019583:Dose Fractionation, Radiation; D019544:Equipment Failure Analysis / Q000379:methods; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000532:radiotherapy*; D011214:Practice, Psychological