title: Parallelized patient-specific quality assurance for high-dose-rate image-guided brachytherapy in an integrated computed tomography-on-rails brachytherapy suite.
abstract: OBJECTIVE
  To describe a parallelized patient-specific quality assurance (QA) program designed to ensure safety and quality in image-guided high-dose-rate brachytherapy in an integrated computed tomography (CT)-on-rails brachytherapy suite.
  
  
  METHODS
  A patient-specific QA program has been modified for the image-guided brachytherapy (IGBT) program in an integrated CT-on-rails brachytherapy suite. In the modification of the QA procedures of Task Group-59, the additional patient-specific QA procedures are included to improve rapid IGBT workflow with applicator placement, imaging, planning, treatment, and applicator removal taking place in one room.
  
  
  RESULTS
  The IGBT workflow is partitioned into two groups of tasks that can be performed in parallel by two or more staff members. One of the unique components of our implemented workflow is that groups work together to perform QA steps in parallel and in series during treatment planning and contouring. Coordinating efforts in this systematic way enable rapid and safe brachytherapy treatment while incorporating 3-dimensional anatomic variations between treatment days.
  
  
  CONCLUSIONS
  Implementation of these patient-specific QA procedures in an integrated CT-on-rails brachytherapy suite ensures confidence that a rapid workflow IGBT program can be implemented without sacrificing patient safety or quality and deliver highly-conformal dose to target volumes. These patient-specific QA components may be adapted to other IGBT environments that seek to provide rapid workflow while ensuring quality.
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Taeho
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Timothy N
authors.initials: TN
authors.lastname: Showalter
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA.
authors.forename: W Tyler
authors.initials: WT
authors.lastname: Watkins
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Trifiletti
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, Charlottesville, VA. Electronic address: BL8B@virginia.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Libby
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D014057:Tomography, X-Ray Computed; D057188:Workflow
keywords: HDR image-guided brachytherapy; Patient-specific QA; Rapid workflow