title: Real-Time Verification of a High-Dose-Rate Iridium 192 Source Position Using a Modified C-Arm Fluoroscope.
abstract: High-dose-rate (HDR) brachytherapy misdeliveries can occur at any institution, and they can cause disastrous results. Even a patient's death has been reported. Misdeliveries could be avoided with real-time verification methods. In 1996, we developed a modified C-arm fluoroscopic verification of an HDR Iridium 192 source position prevent these misdeliveries. This method provided excellent image quality sufficient to detect errors, and it has been in clinical use at our institutions for 20 years. The purpose of the current study is to introduce the mechanisms and validity of our straightforward C-arm fluoroscopic verification method.
  
  
  
  Conventional X-ray fluoroscopic images are degraded by spurious signals and quantum noise from Iridium 192 photons, which make source verification impractical. To improve image quality, we quadrupled the C-arm fluoroscopic X-ray dose per pulse. The pulse rate was reduced by a factor of 4 to keep the average exposure compliant with Japanese medical regulations. The images were then displayed with quarter-frame rates.
  
  
  
  Sufficient quality was obtained to enable observation of the source position relative to both the applicators and the anatomy. With this method, 2 errors were detected among 2031 treatment sessions for 370 patients within a 6-year period.
  
  
  
  With the use of a modified C-arm fluoroscopic verification method, treatment errors that were otherwise overlooked were detected in real time. This method should be given consideration for widespread use.
authors.affiliation: Department of Radiation Oncology, Nippon Medical School Tamanagayama Hospital, Tama, Japan. Electronic address: nose-takayuki@nms.ac.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nose
authors.affiliation: Department of Radiation Oncology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Chatani
authors.affiliation: Department of Radiology, Kaizuka City Hospital, Kaizuka, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Otani
authors.affiliation: Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Teruki
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Department of Radiology, Nippon Medical School Hospital, Tokyo, Japan.
authors.forename: Shinichirou
authors.initials: S
authors.lastname: Kumita
mesh_terms: D003199:Computer Systems; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005471:Fluoroscopy / Q000295:instrumentation*; D006801:Humans; D007495:Iridium / Q000032:analysis*; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011829:Radiation Dosage; D011868:Radioisotopes / Q000032:analysis; D011874:Radiometry / Q000295:instrumentation*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D011868:Radioisotopes; D007495:Iridium