title: Seed Placement in Permanent Breast Seed Implant Brachytherapy: Are Concerns Over Accuracy Valid?
abstract: To evaluate seed placement accuracy in permanent breast seed implant brachytherapy (PBSI), to identify any systematic errors and evaluate their effect on dosimetry.
  
  
  
  Treatment plans and postimplant computed tomography scans for 20 PBSI patients were spatially registered and used to evaluate differences between planned and implanted seed positions, termed seed displacements. For each patient, the mean total and directional seed displacements were determined in both standard room coordinates and in needle coordinates relative to needle insertion angle. Seeds were labeled according to their proximity to the anatomy within the breast, to evaluate the influence of anatomic regions on seed placement. Dosimetry within an evaluative target volume (seroma + 5 mm), skin, breast, and ribs was evaluated to determine the impact of seed placement on the treatment.
  
  
  
  The overall mean (±SD) difference between implanted and planned positions was 9 ± 5 mm for the aggregate seed population. No significant systematic directional displacements were observed for this whole population. However, for individual patients, systematic displacements were observed, implying that intrapatient offsets occur during the procedure. Mean displacements for seeds in the different anatomic areas were not found to be significantly different from the mean for the entire seed population. However, small directional trends were observed within the anatomy, potentially indicating some bias in the delivery. Despite observed differences between the planned and implanted seed positions, the median (range) V90 for the 20 patients was 97% (66%-100%), and acceptable dosimetry was achieved for critical structures.
  
  
  
  No significant trends or systematic errors were observed in the placement of seeds in PBSI, including seeds implanted directly into the seroma. Recorded seed displacements may be related to intrapatient setup adjustments. Despite observed seed displacements, acceptable postimplant dosimetry was achieved.
authors.affiliation: Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia, Canada; Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada. Electronic address: dmorton@bccancer.bc.ca.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morton
authors.affiliation: Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia, Canada; Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Hilts
authors.affiliation: Department of Medical Physics, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia, Canada.
authors.forename: Deidre
authors.initials: D
authors.lastname: Batchelar
authors.affiliation: Department of Radiation Oncology, BC Cancer Agency, Centre for the Southern Interior, Kelowna, British Columbia, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D058958:Organs at Risk / Q000528:radiation effects; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome