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Title: SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy

Abstract

Purpose: Bile duct cancer affects 2–3 thousand people annually in the United States. Radiation therapy has been shown to double median survival, with combined external beam and intraluminal high dose-rate (HDR) brachytherapy being most effective. Endoscopic retrograde cholangiopancreatography (ERCP) biliary HDR, a less-invasive alternative to trans-hepatic brachytherapy, is delivered through a catheter that travels a tortuous path from nose to bile duct, requiring wire drive force and dexterity beyond typical afterloader performance specifications. Thus, specific afterloader quality assurance(QA) is recommended for this procedure. Our aim was to create a device and process for Varisource afterloader clearance QA with objectives that it be quantitative and can monitor afterloader performance over time, compare performance between two distinct afterloaders and potentially Result in a predictive nomogram for patient-specific clearance. Methods: Based on retrospective reconstruction of 20 ERCP patient anatomies, we designed a phantom to test afterloader ability to drive the source wire along an intended treatment path. The ability of the afterloader to fully extend the intended treatment path is a function of number and diameters of turns. We have determined experimentally that relative position of the turns does not impact performance. Results: Both patient and QA paths involve three common turns/loops: amore » large turn representing the stomach(10.8cm±2.0cm), an elliptical loop representing the duodenum(7.3cm±1.5cmx4.8cm±0.7cm), and a final turn at the end of the bile duct that may be tight for some patient-specific anatomies and absent in others(3.7cm±0.7cm, where present). Our phantom design uses anatomical average turn diameters for the stomach and duodenum then terminates in a turn of quantitatively selectable diameter. The smallest final turn diameter that an afterloader can pass is recorded as the QA parameter. Conclusion: With this device and QA process, we have the ability to quantitatively evaluate and track our afterloader performance for a technically challenging ERCP brachytherapy procedure.« less

Authors:
;  [1]
  1. Mayo Clinic, Rochester, MN (United States)
Publication Date:
OSTI Identifier:
22548300
Resource Type:
Journal Article
Journal Name:
Medical Physics
Additional Journal Information:
Journal Volume: 42; Journal Issue: 6; Other Information: (c) 2015 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0094-2405
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; ANATOMY; BILIARY TRACT; BRACHYTHERAPY; CLEARANCE; DOSE RATES; LIVER; NEOPLASMS; NOMOGRAMS; PARTICLE TRACKS; PATIENTS; PERFORMANCE; PHANTOMS; SMALL INTESTINE; STOMACH

Citation Formats

Mullins, JP, and Deufel, CL. SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy. United States: N. p., 2015. Web. doi:10.1118/1.4924604.
Mullins, JP, & Deufel, CL. SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy. United States. https://doi.org/10.1118/1.4924604
Mullins, JP, and Deufel, CL. 2015. "SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy". United States. https://doi.org/10.1118/1.4924604.
@article{osti_22548300,
title = {SU-E-T-242: Design of a Novel Afterloader Clearance QA Device for Biliary HDR Therapy},
author = {Mullins, JP and Deufel, CL},
abstractNote = {Purpose: Bile duct cancer affects 2–3 thousand people annually in the United States. Radiation therapy has been shown to double median survival, with combined external beam and intraluminal high dose-rate (HDR) brachytherapy being most effective. Endoscopic retrograde cholangiopancreatography (ERCP) biliary HDR, a less-invasive alternative to trans-hepatic brachytherapy, is delivered through a catheter that travels a tortuous path from nose to bile duct, requiring wire drive force and dexterity beyond typical afterloader performance specifications. Thus, specific afterloader quality assurance(QA) is recommended for this procedure. Our aim was to create a device and process for Varisource afterloader clearance QA with objectives that it be quantitative and can monitor afterloader performance over time, compare performance between two distinct afterloaders and potentially Result in a predictive nomogram for patient-specific clearance. Methods: Based on retrospective reconstruction of 20 ERCP patient anatomies, we designed a phantom to test afterloader ability to drive the source wire along an intended treatment path. The ability of the afterloader to fully extend the intended treatment path is a function of number and diameters of turns. We have determined experimentally that relative position of the turns does not impact performance. Results: Both patient and QA paths involve three common turns/loops: a large turn representing the stomach(10.8cm±2.0cm), an elliptical loop representing the duodenum(7.3cm±1.5cmx4.8cm±0.7cm), and a final turn at the end of the bile duct that may be tight for some patient-specific anatomies and absent in others(3.7cm±0.7cm, where present). Our phantom design uses anatomical average turn diameters for the stomach and duodenum then terminates in a turn of quantitatively selectable diameter. The smallest final turn diameter that an afterloader can pass is recorded as the QA parameter. Conclusion: With this device and QA process, we have the ability to quantitatively evaluate and track our afterloader performance for a technically challenging ERCP brachytherapy procedure.},
doi = {10.1118/1.4924604},
url = {https://www.osti.gov/biblio/22548300}, journal = {Medical Physics},
issn = {0094-2405},
number = 6,
volume = 42,
place = {United States},
year = {Mon Jun 15 00:00:00 EDT 2015},
month = {Mon Jun 15 00:00:00 EDT 2015}
}