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Transition from 2D brachytherapy to 3D HDR brachytherapy


Access to volumetric imaging in the form of CT, MR and ultrasound has allowed the possibility of the transition away from 2D brachytherapy based on planar imaging and point dose prescription and dose reporting, as has commonly been used for the treatment of gynaecologic cancers with brachytherapy. Instead brachytherapy treatment planning can be achieved with volumetric images, contouring of the target and organs at risk and possibly the use of an inverse planning algorithm to find the optimum treatment plan. The transition allows a more individualised approach to treatment planning with the likelihood of reduced treatment toxicity and better treatment outcomes.

Important Principles

The first step in transitioning to new radiotherapy techniques is to consider the resource implications. New equipment, new procedures, additional staff and training of staff will be required. Equipment needed includes volumetric imaging devices, brachytherapy applicators, a 3D treatment planning system, a HDR afterloader, networking between the treatment planning system and the afterloader unit as well as dosimetry, safety  and QC equipment.  A thorough commissioning process is required including in this case a staged transition from 2D treatment planning and point dose prescribing and reporting to 3D treatment planning and volume dose reporting. Ongoing quality assurance of equipment and processes is recommended as well as regular independent audits of the service.

Introduction to References

The IAEA Human Health Reports No. 12 provides comprehensive guidance on the transition to 3D HDR brachytherapy. Advice on establishing a brachytherapy service can be found in IAEA publication 1296, while an example of the design of a brachytherapy suite is provided in IAEA Human Health Reports No. 10. The questionnaire from Human Health Reports  No. 12 (available on this page on the upper right side) can assist departments in determining their readiness for 3D HDR brachytherapy or can be used as a quality audit tool.