title: Independent brachytherapy plan verification software: improving efficacy and efficiency.
abstract: OBJECTIVE
  To compare the pre-treatment brachytherapy plan verification by a physicist assisted by custom plan verification software (SAV) with those performed manually (MV).
  
  
  METHODS
  All HDR brachytherapy plans used for treatment in 2013, verified using either SAV or MV, were retrospectively reviewed. Error rate (number of errors/number of plans) was measured and verification time calculated. All HDR brachytherapy safety events recorded between 2010 and 2013 were identified. The rate of patient-related safety events (number of events/number of fractions treated) and the impact of SAV on the underlying errors were assessed.
  
  
  RESULTS
  Three/106 errors (2.8%) were found in the SAV group and 24/273 (8.8%) in the MV group (p=0.046). The mean ±1 standard deviation plan verification time was 8.4±4.0min for SAV and 11.6±5.3 for MV (p=0.006). Seven safety events out of 4729 fractions delivered (0.15%) were identified. Four events (57%) were associated with plan verification and could have been detected by SAV.
  
  
  CONCLUSIONS
  We found a safety event rate in HDR brachytherapy of 0.15%. SAV significantly reduced the number of undetected errors in HDR treatment plans compared to MV, and reduced the time required for plan verification.
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: adamato@lroc.harvard.edu.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Damato
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Mandar S
authors.initials: MS
authors.lastname: Bhagwat
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Ivan
authors.initials: I
authors.lastname: Buzurovic
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Friesen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Jorgen L
authors.initials: JL
authors.lastname: Hansen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Molodowitch
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Desmond A
authors.initials: DA
authors.lastname: O'Farrell
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Williams
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Killoran
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cormack
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012986:Software Validation; D016896:Treatment Outcome
keywords: Brachytherapy; Errors; Plan verification