Time-resolved QA and brachytherapy applicator commissioning: Towards the clinical implementation

PURPOSE: Brachytherapy has a busy workflow relying on manual steps to ensure accurate delivery of the treatment. Systematic treatment errors have been reported due to faulty equipment, inadequate quality assurance (QA) and applicator commissioning methods. This study describes the use of a novel method, the Iridium Imaging System for QA (IrIS - QA), to automate and improve the applicator commissioning for HDR 192 Ir brachytherapy. METHODS AND MATERIALS: A 3D printed holder attached to an Imaging Panel (IP) has been developed to: (1) acquire a high-definition projection of the applicator using the gamma rays of the 192 Ir source for imaging; (2) Track the source within the applicator verifying in a time-resolved manner the dwell positions and dwell times with a high resolution. Results obtained for two applicator models are described in this manuscript. RESULTS: IrIS-QA is capable of measuring the dwell times with an accuracy better than 0.1 s and interdwell distances with submillimetre precision. The applicators tested in the study showed good agreement between planned and delivered dwell times and positions, with mean and maximum dwell position deviations below 0.5 mm and 1.3 mm, respectively. Dwell time measurements showed agreement superior to 0.05 s except for the first dwell position for which up to 0.15 s differences were observed. CONCLUSIONS: IrIS-QA is a compact system that includes many features necessary to improve the accuracy and efficiency of applicator commissioning and daily QA. No commercial system exists with similar capabilities. IrIS-QA is intended to replace current clinical procedures using film dosimetry. (c) 2021 Published by Elsevier Inc. on behalf of American Brachytherapy Society.