title: A method for verification of treatment delivery in HDR prostate brachytherapy using a flat panel detector for both imaging and source tracking.
abstract: OBJECTIVE
  Verification of high dose rate (HDR) brachytherapy treatment delivery is an important step, but is generally difficult to achieve. A technique is required to monitor the treatment as it is delivered, allowing comparison with the treatment plan and error detection. In this work, we demonstrate a method for monitoring the treatment as it is delivered and directly comparing the delivered treatment with the treatment plan in the clinical workspace. This treatment verification system is based on a flat panel detector (FPD) used for both pre-treatment imaging and source tracking.
  
  
  METHODS
  A phantom study was conducted to establish the resolution and precision of the system. A pretreatment radiograph of a phantom containing brachytherapy catheters is acquired and registration between the measurement and treatment planning system (TPS) is performed using implanted fiducial markers. The measured catheter paths immediately prior to treatment were then compared with the plan. During treatment delivery, the position of the (192)Ir source is determined at each dwell position by measuring the exit radiation with the FPD and directly compared to the planned source dwell positions.
  
  
  RESULTS
  The registration between the two corresponding sets of fiducial markers in the TPS and radiograph yielded a registration error (residual) of 1.0 mm. The measured catheter paths agreed with the planned catheter paths on average to within 0.5 mm. The source positions measured with the FPD matched the planned source positions for all dwells on average within 0.6 mm (s.d. 0.3, min. 0.1, max. 1.4 mm).
  
  
  CONCLUSIONS
  We have demonstrated a method for directly comparing the treatment plan with the delivered treatment that can be easily implemented in the clinical workspace. Pretreatment imaging was performed, enabling visualization of the implant before treatment delivery and identification of possible catheter displacement. Treatment delivery verification was performed by measuring the source position as each dwell was delivered. This approach using a FPD for imaging and source tracking provides a noninvasive method of acquiring extensive information for verification in HDR prostate brachytherapy.
authors.affiliation: Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC 3004, Australia and School of Science, RMIT University, Melbourne, VIC 3000, Australia.
authors.forename: Ryan L
authors.initials: RL
authors.lastname: Smith
authors.affiliation: School of Science, RMIT University, Melbourne, VIC 3000, Australia and Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, VIC 3002, Australia.
authors.forename: Annette
authors.initials: A
authors.lastname: Haworth
authors.affiliation: Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC 3004, Australia.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Panettieri
authors.affiliation: Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC 3004, Australia and School of Science, RMIT University, Melbourne, VIC 3000, Australia.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Millar
authors.affiliation: Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, VIC 3004, Australia and School of Science, RMIT University, Melbourne, VIC 3000, Australia.
authors.forename: Rick D
authors.initials: RD
authors.lastname: Franich
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D057785:Catheters; D004867:Equipment Design; D057918:Fiducial Markers; D006801:Humans; D007496:Iridium Radioisotopes; D008297:Male; D008953:Models, Anatomic; D019047:Phantoms, Imaging; D011467:Prostate / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D014867:Water
chemical_list: D007496:Iridium Radioisotopes; D014867:Water