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Title: Retrospective review of Contura HDR breast cases to improve our standardized procedure

Abstract

To retrospectively review our first 20 Contura high dose rate breast cases to improve and refine our standardized procedure and checklists. We prepared in advance checklists for all steps, developed an in-house Excel spreadsheet for second checking the plan, and generated a procedure for efficient contouring and a set of optimization constraints to meet the dose volume histogram criteria. Templates were created in our treatment planning system for structures, isodose levels, optimization constraints, and plan report. This study reviews our first 20 high dose rate Contura breast treatment plans. We followed our standardized procedure for contouring, planning, and second checking. The established dose volume histogram criteria were successfully met for all plans. For the cases studied here, the balloon-skin and balloon-ribs distances ranged between 5 and 43 mm and 1 and 33 mm, respectively; air{sub s}eroma volume/PTV{sub E}val volume≤5.5% (allowed≤10%); asymmetry<1.2 mm (goal≤2 mm); PTV{sub E}val V90%≥97.6%; PTV{sub E}val V95%≥94.9%; skin max dose≤98%Rx; ribs max dose≤137%Rx; V150%≤29.8 cc; V200%≤7.8 cc; the total dwell time range was 225.4 to 401.9 seconds; and the second check agreement was within 3%. Based on this analysis, more appropriate ranges for the total dwell time and balloon diameter tolerance were found. Three major problems weremore » encountered: balloon migration toward the skin for small balloon-to-skin distances, lumen obstruction, and length change for the flexible balloon. Solutions were found for these issues and our standardized procedure and checklists were updated accordingly. Based on our review of these cases, the use of checklists resulted in consistent results, indicating good coverage for the target without sacrificing the critical structures. This review helped us to refine our standardized procedure and update our checklists.« less

Authors:
 [1]; ; ; ;  [1]
  1. Lahey Clinic, Radiation Oncology Department, MA (United States)
Publication Date:
OSTI Identifier:
22262804
Resource Type:
Journal Article
Journal Name:
Medical Dosimetry
Additional Journal Information:
Journal Volume: 38; Journal Issue: 2; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0958-3947
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; BALLOONS; BRACHYTHERAPY; MAMMARY GLANDS; PLANNING; RADIATION DOSE DISTRIBUTIONS; SURGERY

Citation Formats

Iftimia, Ileana, Cirino, Eileen T., Ladd, Ron, Mower, Herbert W., and McKee, Andrea B. Retrospective review of Contura HDR breast cases to improve our standardized procedure. United States: N. p., 2013. Web. doi:10.1016/J.MEDDOS.2012.10.001.
Iftimia, Ileana, Cirino, Eileen T., Ladd, Ron, Mower, Herbert W., & McKee, Andrea B. Retrospective review of Contura HDR breast cases to improve our standardized procedure. United States. https://doi.org/10.1016/J.MEDDOS.2012.10.001
Iftimia, Ileana, Cirino, Eileen T., Ladd, Ron, Mower, Herbert W., and McKee, Andrea B. 2013. "Retrospective review of Contura HDR breast cases to improve our standardized procedure". United States. https://doi.org/10.1016/J.MEDDOS.2012.10.001.
@article{osti_22262804,
title = {Retrospective review of Contura HDR breast cases to improve our standardized procedure},
author = {Iftimia, Ileana and Cirino, Eileen T. and Ladd, Ron and Mower, Herbert W. and McKee, Andrea B.},
abstractNote = {To retrospectively review our first 20 Contura high dose rate breast cases to improve and refine our standardized procedure and checklists. We prepared in advance checklists for all steps, developed an in-house Excel spreadsheet for second checking the plan, and generated a procedure for efficient contouring and a set of optimization constraints to meet the dose volume histogram criteria. Templates were created in our treatment planning system for structures, isodose levels, optimization constraints, and plan report. This study reviews our first 20 high dose rate Contura breast treatment plans. We followed our standardized procedure for contouring, planning, and second checking. The established dose volume histogram criteria were successfully met for all plans. For the cases studied here, the balloon-skin and balloon-ribs distances ranged between 5 and 43 mm and 1 and 33 mm, respectively; air{sub s}eroma volume/PTV{sub E}val volume≤5.5% (allowed≤10%); asymmetry<1.2 mm (goal≤2 mm); PTV{sub E}val V90%≥97.6%; PTV{sub E}val V95%≥94.9%; skin max dose≤98%Rx; ribs max dose≤137%Rx; V150%≤29.8 cc; V200%≤7.8 cc; the total dwell time range was 225.4 to 401.9 seconds; and the second check agreement was within 3%. Based on this analysis, more appropriate ranges for the total dwell time and balloon diameter tolerance were found. Three major problems were encountered: balloon migration toward the skin for small balloon-to-skin distances, lumen obstruction, and length change for the flexible balloon. Solutions were found for these issues and our standardized procedure and checklists were updated accordingly. Based on our review of these cases, the use of checklists resulted in consistent results, indicating good coverage for the target without sacrificing the critical structures. This review helped us to refine our standardized procedure and update our checklists.},
doi = {10.1016/J.MEDDOS.2012.10.001},
url = {https://www.osti.gov/biblio/22262804}, journal = {Medical Dosimetry},
issn = {0958-3947},
number = 2,
volume = 38,
place = {United States},
year = {Mon Jul 01 00:00:00 EDT 2013},
month = {Mon Jul 01 00:00:00 EDT 2013}
}