title: Establishing high-quality prostate brachytherapy using a phantom simulator training program.
abstract: OBJECTIVE
  To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education.
  
  
  METHODS
  Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ((125)I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis.
  
  
  RESULTS
  Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process.
  
  
  CONCLUSIONS
  Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Thaker
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Rajat J
authors.initials: RJ
authors.lastname: Kudchadker
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: David A
authors.initials: DA
authors.lastname: Swanson
authors.affiliation: Department of Radiation Oncology, Banner Health, Loveland/Greeley, Colorado.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Albert
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Pugh
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Boehling
authors.affiliation: Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Teresa L
authors.initials: TL
authors.lastname: Bruno
authors.affiliation: Department of Radiation Oncology, Bon Secours Health System, Norfolk, Virginia.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Prestidge
authors.affiliation: Department of Radiation Oncology, Cancer Center for the Southern Interior, Kelowna, British Columbia, Canada.
authors.forename: Juanita M
authors.initials: JM
authors.lastname: Crook
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York.
authors.forename: Brett W
authors.initials: BW
authors.lastname: Cox
authors.affiliation: Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York.
authors.forename: Louis
authors.initials: L
authors.lastname: Potters
authors.affiliation: Chicago Prostate Center, Westmont, Illinois.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Center, Vancouver, British Columbia, Canada.
authors.forename: Mira
authors.initials: M
authors.lastname: Keyes
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: sjfrank@mdanderson.org.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Frank
mesh_terms: D001918:Brachytherapy / Q000379:methods / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D059032:Learning Curve; D008297:Male; D019047:Phantoms, Imaging / Q000592:standards*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D018787:Radiation Oncology / Q000193:education*; D018084:Ultrasonography, Interventional
chemical_list: D007457:Iodine Radioisotopes