Mission
Members
Projects
Intensity Modulated Brachytherapy
Alana Thibodeau-Antonacci, Ph.D. Student, Jake Reid, M.Sc. Student, Maude Robitaille, M.Sc. Student, & Bjorn Moren, Postdoctoral Fellow
The critical limitation with brachytherapy is the rotationally symmetric dose distribution provided by brachytherapy sources, delivering high dose to the tumor but often with poor tumor conformity due to the non-symmetrical shape of the tumors resulting in dose spillage to surrounding healthy tissues.
For example, large and irregular gynecological tumors, which extend into the parametrial and/or paravaginal tissues cannot be treated with curative intend by using intracavitary brachytherapy implants alone without overdosing nearby healthy organs causing side effects but must be supplemented with invasive interstitial high dose rate brachytherapy to enable conformal dose delivery to the tumor while reducing dose to healthy tissues. However, despite the excellent clinical results, this treatment is not available to all patients due to its invasive nature, lack of resources and trained radiation oncologists. For prostate cancer, disease-free survival is higher in patients treated with high dose rate brachytherapy combined with external beam radiotherapy compared to those treated with external beam radiotherapy alone.
Our group is developing the next generation of high dose rate brachytherapy technology, including prototype delivery systems for intensity modulated brachytherapy treatment of prostate, cervix, vaginal and rectal cancers. These systems will enable anisotropic intensity modulation of brachytherapy dose distributions by incorporating rotating metallic shields inside brachytherapy catheters and applicators.
Designed and delivered with accurate anatomic reference, the developed systems will tailor treatments to each individual patient by treating all parts of the tumor without needlessly irradiating large regions of normal tissues surrounding the tumor. Intensity modulated brachytherapy will increase the probability of response and cure while avoiding toxicity, which will increase the quality of life of patients suffering from cancer.
Monte Carlo-based Dosimetry
Jonathan Kalinowski, M.Sc. Student
Monte Carlo method is gold standard in simulation of radiation interaction with matter and is widely used in medical imaging and radiation physics. It plays a key role in medical physics research and development of novel technology for imaging and therapy equipment. Our group develops Monte Carlo based radiation dose calculation engines and treatment planning systems for use in conventional and intensity modulated brachytherapy, as well external beam radiotherapy.
For brachytherapy applications we have developed a Monte Carlo based radiation transport package called RapidBrachyMC, coupled to dose optimization algorithms, contouring tools and a comprehensive analysis package. This toolkit is standalone and enables planning of an optimal and accurate radiation dose to the tumour while sparing healthy tissues. The complete treatment planning system is called RapidBrachyMCTPS. It can be used to validate dose distributions from clinical treatment planning systems or commercial model-based dose calculation algorithms and is also well suited to develop and validate novel combinations of radiation sources and applicators, especially those shielded with high-Z materials.
Characterizing the Axxent® electronic brachytherapy source x-ray spectrum and its dosimetry
Azin Esmaelbeigi, Ph.D. Student
In addition to sealed photon emitting radionuclides, electronic x-ray systems can also be used to deliver high dose rate brachytherapy. At the Jewish General Hospital, we use the Axxent® electronic brachytherapy system (Xoft Inc., Fremont, California) to treat rectal cancer. This system uses a miniature electronic x-ray source (50 kVp) contained within a flexible probe to generate low energy x-rays. Azin is characterizing the Axxent® electronic brachytherapy source x-ray spectrum and its dosimetry through x-ray spectrometery, Monte Carlo simulations as well as measurements with ion chambers, scintillator based detectors and radiochromic films.
Development of a Fast and Accurate Dosimetry Toolkit for Radioembolization with Yttrium-90
Diane Alvarez, Ph.D. Student & Peter Kim, M.Sc.
The standard dosimetry for radionuclide-based cancer treatments is built on the simplistic medical internal radiation dose (MIRD) formalism that assumes a uniform radionuclide and absorbed dose distribution in the tumor. A more accurate dosimetry method that considers a heterogeneous radionuclide uptake and hence a heterogeneous dose distribution in the tumor is required. Ideally, attenuation of the radiation by heterogeneities in the patient tissues should also be taken into account. The purpose of this project is to develop and validate an image-based dosimetry software with a Monte Carlo dose calculation engine that will enable accurate and personalized dosimetry. The software considers heterogeneous radionuclide uptake and attenuation of the radiation by heterogeneities in the patient tissues.
Although the software toolkit may be applicable to many radionuclide treatments, this project focuses on a treatment called radioembolization, which uses Yttirum-90 filled resin or glass microspheres. Injected through a micro-catheter, microspheres are selectively deposited and permanently lodged within the hepatic arteries to preferentially irradiate hepatic tumors. With this software, we aim to establish a standard methodology that provides accurate dosimetry.
Treatment Plan Optimization in High Dose Rate Brachytherapy
Hossein Jafarzadeh, M.Sc. Student
Catheter Position Optimization in High Dose Rate Brachytherapy
In interstitial high dose rate brachytherapy, a highly radioactive source, usually 192Ir, is temporarily placed inside or in proximity of the tumor via thin hollow implanted catheters which are connected a machine called an afterloader. The afterloader contains a single radioactive source at the end of a wire. The source is pushed into each of the catheters, one by one under computer control and guided to the tumor site. The computer controls where along the catheter the source should pause to deliver its radiation (dwell positions) and how long it dwells at each position (dwell time). After the desired dose is delivered, the source is pulled back to the afterloader and the catheters are removed. Since the dwell times are optimized, the position of catheters has a major impact on the treatment plan quality. Efforts in optimizing the catheter positions have not been explored as extensively as the other aspects of the treatment planning workflow. This gap in knowledge motivates us to further explore this problem.
Penalty Weight Optimization in High Dose Rate Brachytherapy
Treatment plan optimization problem in high dose rate brachytherapy is formulated as a constrained optimization problem. First the dose constraints and penalty weights are determined by the clinicians, then the optimization problem is solved by linear programing. The dose constraints are usually fixed for each patient depending on the treated tumor site and the treatment planning guidelines followed. However, the clinicians select different penalty weights, leading to different optimization problems and finally adopt the one that results in the most desirable dose distribution. To remove the clinicians, influence on plan quality, reinforcement learning is explored.
Development of a Software Package for Monte Carlo-based Intravascular Brachytherapy Dosimetry
Maryam Rahbaran, M.Sc. Student
Intravascular brachytherapy is a means of treating restenosis after an angioplasty and stent insertion. Angioplasty and stent insertion can provoke an inflammatory response in the treated vessel which causes the rapid proliferation of neotintimal (scar) tissue. By eliminating neointimal tissue, intravascular brachytherapy allows treated vessels to maintain a healthy diameter. In recent years intravascular brachytherapy has seen reduced use, in favour of drug eluting stents. However, a demand for intravascular brachytherapy continues to exist in patients for whom drug eluting stents have been unsuccessful.
Beta sources are typically used in intravascular brachytherapy to reduce the need for radiation shielding in catheterization labs and to reduce the dose delivered to healthy tissues of the patient. Beta sources have high dose gradients that are affected by the presence of heterogeneities. Arterial plaques, stents, and guidewires have been shown to reduce the dose delivered to target volume from beta sources in intravascular brachytherapy. Our work allows for an understanding of the dosimetric shortcomings of commercially available intravascular brachytherapy delivery systems.
Publications
2022
Kalinowski, Jonathan
McGill Faculty of Medicine and Health Sciences Internal Studentship award
2022.
@award{nokey,
title = {McGill Faculty of Medicine and Health Sciences Internal Studentship},
author = {Jonathan Kalinowski},
url = {https://www.mcgill.ca/medhealthsci-gradstudies/funding-opportunities/graduate-students/internal-studentships},
year = {2022},
date = {2022-08-15},
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abstract = {Internal Studentships are open to highly qualified Faculty of Medicine graduate students who are registered full-time in a research training program (Thesis) leading to an M.Sc or PhD degree.
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Rahbaran, Maryam
Graduate Excellence Award award
2022.
@award{nokey,
title = {Graduate Excellence Award },
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Jafarzadeh, Hossein
Biological & Biomedical Engineering PhD Recruitment Award award
2022.
@award{nokey,
title = {Biological & Biomedical Engineering PhD Recruitment Award },
author = {Hossein Jafarzadeh },
url = {https://www.mcgill.ca/bbme/programs/funding#BME-Recruitment-Award},
year = {2022},
date = {2022-05-10},
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Enger, Shirin A.; Famulari, Gabriel
Delivery system for intensity modulated high dose rate brachytherapy with intermediate energy brachytherapy isotopes Patent
2022, (US Patent 11,324,966).
@patent{enger2022delivery,
title = {Delivery system for intensity modulated high dose rate brachytherapy with intermediate energy brachytherapy isotopes},
author = {Shirin A. Enger and Gabriel Famulari},
year = {2022},
date = {2022-05-01},
urldate = {2022-05-01},
publisher = {Google Patents},
note = {US Patent 11,324,966},
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pubstate = {published},
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Rahbaran, Maryam; Kalinowski, Jonathan; Tsui, James Man Git; DeCunha, Joseph; Enger, Shirin A.
Monte-Carlo Based Simulations of the Uncertainties in Clinical Water-Based Intravascular Brachytherapy Dosimetry Presentation
11.04.2022.
@misc{nokey,
title = {Monte-Carlo Based Simulations of the Uncertainties in Clinical Water-Based Intravascular Brachytherapy Dosimetry},
author = {Maryam Rahbaran and Jonathan Kalinowski and James Man Git Tsui and Joseph DeCunha and Shirin A. Enger},
year = {2022},
date = {2022-04-11},
urldate = {2022-04-11},
journal = {MCMA},
abstract = {"Introduction
Coronary artery disease (CAD) is the most common form of cardiovascular disease and is caused by excess plaque along the arterial wall, blocking blood flow to the heart (stenosis). Percutaneous transluminal coronary angioplasty widens a narrowed artery, leaving behind metal stents (1). However, in-stent restenosis (ISR) may occur due to damage to the arterial wall tissue, triggering neointimal hyperplasia which produces fibrotic and calcified plaques, narrowing the artery again. Drug-eluting stents (DES) slowly release medication to inhibit neointimal hyperplasia to prevent ISR but they fail in 3% to 20% of cases (2). Intravascular brachytherapy (IVBT), which uses b-emitting radionuclides to prevent ISR, is used in these failed cases. However, current dosimetry for IVBT is water based and does not consider attenuation of the radiation by heterogeneities such as the IVBT device guidewire, non-uniform distribution of calcified plaques, and stent material, or the angular dependence of dose distribution (3, 4, 5). The aim of this study was to investigate the uncertainties in clinical water based IVBT dosimetry, considering the effect of heterogeneities on dose distribution.
Materials & Methods
An inhouse Monte-Carlo based dosimetry package for IVBT applications based on Geant4 10.04 (patch 2) was developed. Patient’s artery was modelled as a 32 mm long, 8.4 mm diameter cylinder comprised of three layers: tunica media, represented with muscle, tunica intima, represented with fibrotic plaque, and tunica adventitia, represented with collagen. These layers had mass densities 1.06 g/cm3, 1.22 g/cm3 and 1.07 g/cm3 respectively. The innermost layer consisted of calcified plaque of density 1.45 g/cm3 with varying thicknesses between 0.9 and 1.9 mm with an eccentric shape and a rough surface. The stents had similar composition to Boston Scientific Synergy stents and were modelled to not overlap. The Novoste Beta-Cath 3.5F IVBT device model was used, which has a 90Sr90Y source. The geometry is shown in Figure 1a. A cylindrical scoring geometry was implemented. Two set of simulations were performed. In the first simulation called water phantom, the entire system consisted of water with unit density, and dose to water was calculated similar to the clinical water based dosimetry. In the second simulation called the artery model proper material and mass densities were assigned to each component. To ensure uncertainties below 0.8% within a 1 mm radial distance to the source and 2% within 4.2 mm from the source, 100 million decay events were simulated. The Penelope physics list was used to simulate the electromagnetic interactions between particles. Average, minimum, and maximum dose was calculated at 2.0 mm from the source center and directly and 1 mm behind the outermost stents and guidewire. Absorbed dose was normalized to 23 Gy at 2.0 mm from the source center.
Results
International Conference on Monte Carlo Techniques for Medical Applications, 2022
Compared to the water phantom (Figure 1b), average dose in the artery model (Figure 1c) was attenuated by 50.9% at 2 mm from the source centre and directly behind the guidewire and outermost stent by 66.2%, and by 69.5% 1 mm behind this region. There was significant variation in dose around the source due to the guidewire attenuating dose the most, and heterogeneous distribution of calcification.
Discussion & Conclusions
Dosimetry for IVBT based on dose rate in water is not accurate. Heterogeneities need to be considered to deliver adequate dose to the lesion area. Stent material, heterogenous distribution of calcification and the off cantered placement of the guidewire affects the uniformity of dose distribution around the source. Patients may benefit from personalized treatment planning taking dose-attenuating by different tissue/material heterogeneities into account.
References
[1] Virani, Salim, S., et al. ""Heart Disease and Stroke Statistics—2020 Update"". Circulation, vol. 141, no. 9, March 03, 2020, pp. e336. doi: 10.1161/CIR.0000000000000757.
[2] Lee M, Banka G. In-stent restenosis. Interv Cardiol Clin 2016;5: 211e220.
[3] Chiu-Tsao ST, Schaart DR, Soares CG, et al. Dose calculation formalisms and consensus dosimetry parameters for intravascular brachytherapy dosimetry: Recommendations of the AAPM Therapy Physics Committee Task Group No. 149. Med Phys 2007;34: 4126e4157.
[4] Rivard MJ, Coursey BM, DeWerd LA, et al. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations. Med Phys 2004;31:633e674.
[5] Nath R, Amols H, Coffey C, et al. Intravascular brachytherapy physics: Report of the AAPM Radiation Therapy Committee Task group No. 60. Med Phys 1999;26:119e152.’
[6] Agostinelli S, Allison J, Amako K, et al. Geant4da simulation toolkit. Nucl Instrum Methods Phys Res 2003;506:230e303."},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Coronary artery disease (CAD) is the most common form of cardiovascular disease and is caused by excess plaque along the arterial wall, blocking blood flow to the heart (stenosis). Percutaneous transluminal coronary angioplasty widens a narrowed artery, leaving behind metal stents (1). However, in-stent restenosis (ISR) may occur due to damage to the arterial wall tissue, triggering neointimal hyperplasia which produces fibrotic and calcified plaques, narrowing the artery again. Drug-eluting stents (DES) slowly release medication to inhibit neointimal hyperplasia to prevent ISR but they fail in 3% to 20% of cases (2). Intravascular brachytherapy (IVBT), which uses b-emitting radionuclides to prevent ISR, is used in these failed cases. However, current dosimetry for IVBT is water based and does not consider attenuation of the radiation by heterogeneities such as the IVBT device guidewire, non-uniform distribution of calcified plaques, and stent material, or the angular dependence of dose distribution (3, 4, 5). The aim of this study was to investigate the uncertainties in clinical water based IVBT dosimetry, considering the effect of heterogeneities on dose distribution.
Materials & Methods
An inhouse Monte-Carlo based dosimetry package for IVBT applications based on Geant4 10.04 (patch 2) was developed. Patient’s artery was modelled as a 32 mm long, 8.4 mm diameter cylinder comprised of three layers: tunica media, represented with muscle, tunica intima, represented with fibrotic plaque, and tunica adventitia, represented with collagen. These layers had mass densities 1.06 g/cm3, 1.22 g/cm3 and 1.07 g/cm3 respectively. The innermost layer consisted of calcified plaque of density 1.45 g/cm3 with varying thicknesses between 0.9 and 1.9 mm with an eccentric shape and a rough surface. The stents had similar composition to Boston Scientific Synergy stents and were modelled to not overlap. The Novoste Beta-Cath 3.5F IVBT device model was used, which has a 90Sr90Y source. The geometry is shown in Figure 1a. A cylindrical scoring geometry was implemented. Two set of simulations were performed. In the first simulation called water phantom, the entire system consisted of water with unit density, and dose to water was calculated similar to the clinical water based dosimetry. In the second simulation called the artery model proper material and mass densities were assigned to each component. To ensure uncertainties below 0.8% within a 1 mm radial distance to the source and 2% within 4.2 mm from the source, 100 million decay events were simulated. The Penelope physics list was used to simulate the electromagnetic interactions between particles. Average, minimum, and maximum dose was calculated at 2.0 mm from the source center and directly and 1 mm behind the outermost stents and guidewire. Absorbed dose was normalized to 23 Gy at 2.0 mm from the source center.
Results
International Conference on Monte Carlo Techniques for Medical Applications, 2022
Compared to the water phantom (Figure 1b), average dose in the artery model (Figure 1c) was attenuated by 50.9% at 2 mm from the source centre and directly behind the guidewire and outermost stent by 66.2%, and by 69.5% 1 mm behind this region. There was significant variation in dose around the source due to the guidewire attenuating dose the most, and heterogeneous distribution of calcification.
Discussion & Conclusions
Dosimetry for IVBT based on dose rate in water is not accurate. Heterogeneities need to be considered to deliver adequate dose to the lesion area. Stent material, heterogenous distribution of calcification and the off cantered placement of the guidewire affects the uniformity of dose distribution around the source. Patients may benefit from personalized treatment planning taking dose-attenuating by different tissue/material heterogeneities into account.
References
[1] Virani, Salim, S., et al. ""Heart Disease and Stroke Statistics—2020 Update"". Circulation, vol. 141, no. 9, March 03, 2020, pp. e336. doi: 10.1161/CIR.0000000000000757.
[2] Lee M, Banka G. In-stent restenosis. Interv Cardiol Clin 2016;5: 211e220.
[3] Chiu-Tsao ST, Schaart DR, Soares CG, et al. Dose calculation formalisms and consensus dosimetry parameters for intravascular brachytherapy dosimetry: Recommendations of the AAPM Therapy Physics Committee Task Group No. 149. Med Phys 2007;34: 4126e4157.
[4] Rivard MJ, Coursey BM, DeWerd LA, et al. Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations. Med Phys 2004;31:633e674.
[5] Nath R, Amols H, Coffey C, et al. Intravascular brachytherapy physics: Report of the AAPM Radiation Therapy Committee Task group No. 60. Med Phys 1999;26:119e152.’
[6] Agostinelli S, Allison J, Amako K, et al. Geant4da simulation toolkit. Nucl Instrum Methods Phys Res 2003;506:230e303."
Jafarzadeh, Hossein; Mao, Ximeng; Enger, Shirin A.
Bayesian Optimization in Treatment Planning of High Dose Rate Brachytherapy Inproceedings
In: MEDICAL PHYSICS, pp. E200–E200, WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA 2022.
@inproceedings{jafarzadeh2022bayesian,
title = {Bayesian Optimization in Treatment Planning of High Dose Rate Brachytherapy},
author = { Hossein Jafarzadeh and Ximeng Mao and Shirin A. Enger},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
booktitle = {MEDICAL PHYSICS},
volume = {49},
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Thibodeau-Antonacci, Alana; Enger, Shirin A.; Bekerat, Hamed; Vuong, Te
Gafchromic film and scintillator detector measurements in phantom with a novel intensity-modulated brachytherapy endorectal shield Inproceedings
In: MEDICAL PHYSICS, pp. 5688–5689, WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA 2022.
@inproceedings{thibodeau2022gafchromic,
title = {Gafchromic film and scintillator detector measurements in phantom with a novel intensity-modulated brachytherapy endorectal shield},
author = {Alana Thibodeau-Antonacci and Shirin A. Enger and Hamed Bekerat and Te Vuong},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
booktitle = {MEDICAL PHYSICS},
volume = {49},
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Berumen-Murillo, Francisco; Enger, Shirin A.; Beaulieu, Luc
Sub-Second D (M, M) Calculation for LDR Prostate Brachytherapy Using Deep Learning Methods Inproceedings
In: MEDICAL PHYSICS, pp. E163–E163, WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA 2022.
@inproceedings{berumen2022sub,
title = {Sub-Second D (M, M) Calculation for LDR Prostate Brachytherapy Using Deep Learning Methods},
author = {Francisco Berumen-Murillo and Shirin A. Enger and Luc Beaulieu},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
booktitle = {MEDICAL PHYSICS},
volume = {49},
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Thibodeau-Antonacci, Alana; Vuong, Te; Liontis, B; Rayes, F; Pande, S; Enger, Shirin A.
Development of a Novel MRI-Compatible Applicator for Intensity Modulated Rectal Brachytherapy Inproceedings
In: MEDICAL PHYSICS, pp. E240–E240, WILEY 111 RIVER ST, HOBOKEN 07030-5774, NJ USA 2022.
@inproceedings{thibodeau2022development,
title = {Development of a Novel MRI-Compatible Applicator for Intensity Modulated Rectal Brachytherapy},
author = {Alana Thibodeau-Antonacci and Te Vuong and B Liontis and F Rayes and S Pande and Shirin A. Enger},
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Weishaupt, Luca L.; Vuong, Te; Thibodeau-Antonacci, Alana; Garant, A; Singh, K; Miller, C; Martin, A; Schmitt-Ulms, F; Enger, Shirin A.
PO-1325 Automated rectal tumor segmentation with inter-observer variability-based uncertainty estimates Journal Article
In: Radiotherapy and Oncology, vol. 170, pp. S1120–S1121, 2022.
@article{weishaupt2022po,
title = {PO-1325 Automated rectal tumor segmentation with inter-observer variability-based uncertainty estimates},
author = {Luca L. Weishaupt and Te Vuong and Alana Thibodeau-Antonacci and A Garant and K Singh and C Miller and A Martin and F Schmitt-Ulms and Shirin A. Enger},
year = {2022},
date = {2022-01-01},
urldate = {2022-01-01},
journal = {Radiotherapy and Oncology},
volume = {170},
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Weishaupt, Luca L; Vuong, Te; Thibodeau-Antonacci, Alana; Garant, A; Singh, KS; Miller, C; Martin, A; Enger, Shirin A.
A121 QUANTIFYING INTER-OBSERVER VARIABILITY IN THE SEGMENTATION OF RECTAL TUMORS IN ENDOSCOPY IMAGES AND ITS EFFECTS ON DEEP LEARNING Journal Article
In: Journal of the Canadian Association of Gastroenterology, vol. 5, no. Supplement_1, pp. 140–142, 2022.
@article{weishaupt2022a121,
title = {A121 QUANTIFYING INTER-OBSERVER VARIABILITY IN THE SEGMENTATION OF RECTAL TUMORS IN ENDOSCOPY IMAGES AND ITS EFFECTS ON DEEP LEARNING},
author = {Luca L Weishaupt and Te Vuong and Alana Thibodeau-Antonacci and A Garant and KS Singh and C Miller and A Martin and Shirin A. Enger},
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2021
Thibodeau-Antonacci, Alana
Canada Graduate Scholarship – Doctoral Program award
2021.
@award{Thibodeau-Antonacci2021d,
title = {Canada Graduate Scholarship – Doctoral Program},
author = {Alana Thibodeau-Antonacci},
url = {https://www.nserc-crsng.gc.ca/students-etudiants/pg-cs/cgsd-bescd_eng.asp},
year = {2021},
date = {2021-09-01},
organization = {NSERC},
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Esmaelbeigi, Azin
Biological & Biomedical Engineering PhD Recruitment Award award
2021.
@award{nokey,
title = {Biological & Biomedical Engineering PhD Recruitment Award },
author = {Azin Esmaelbeigi},
url = {https://www.mcgill.ca/bbme/programs/funding#BME-Recruitment-Award},
year = {2021},
date = {2021-09-01},
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Kalinowski, Jonathan
Merit-based recruitment award for first year MSc students. award
2021.
@award{nokey,
title = {Merit-based recruitment award for first year MSc students.},
author = {Jonathan Kalinowski},
year = {2021},
date = {2021-09-01},
urldate = {2021-09-01},
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Weishaupt, Luca L.; Thibodeau-Antonacci, Alana; Garant, Aurelie; Singh, Kelita; Miller, Corey; Vuong, Té; Enger, Shirin A.
Deep learning based tumor segmentation of endoscopy images for rectal cancer patients Presentation
ESTRO Annual meeting, 27.08.2021.
@misc{Weishaupt2021b,
title = {Deep learning based tumor segmentation of endoscopy images for rectal cancer patients},
author = {Luca L. Weishaupt and Alana Thibodeau-Antonacci and Aurelie Garant and Kelita Singh and Corey Miller and Té Vuong and Shirin A. Enger},
url = {https://www.estro.org/Congresses/ESTRO-2021/610/posterdiscussion34-deep-learningforauto-contouring/3710/deeplearning-basedtumorsegmentationofendoscopyimag},
year = {2021},
date = {2021-08-27},
urldate = {2021-08-27},
abstract = {Purpose or Objective
The objective of this study was to develop an automated rectal tumor segmentation algorithm from endoscopy images. The algorithm will be used in a future multimodal treatment outcome prediction model. Currently, treatment outcome prediction models rely on manual segmentations of regions of interest, which are prone to inter-observer variability. To quantify this human error and demonstrate the feasibility of automated endoscopy image segmentation, we compare three deep learning architectures.
Material and Methods
A gastrointestinal physician (G1) segmented 550 endoscopy images of rectal tumors into tumor and non-tumor regions. To quantify the inter-observer variability, a second gastrointestinal physician (G2) contoured 319 of the images independently.
The 550 images and annotations from G1 were divided into 408 training, 82 validation, and 60 testing sets. Three deep learning architectures were trained; a fully convolutional neural network (FCN32), a U-Net, and a SegNet. These architectures have been used for robust medical image segmentation in previous studies.
All models were trained on a CPU supercomputing cluster. Data augmentation in the form of random image transformations, including scaling, rotation, shearing, Gaussian blurring, and noise addition, was used to improve the models' robustness.
The neural networks' output went through a final layer of noise removal and hole filling before evaluation. Finally, the segmentations from G2 and the neural networks' predictions were compared against the ground truth labels from G1.
Results
The FCN32, U-Net, and SegNet had average segmentation times of 0.77, 0.48, and 0.43 seconds per image, respectively. The average segmentation time per image for G1 and G2 were 10 and 8 seconds, respectively.
All the ground truth labels contained tumors, but G2 and the deep learning models did not always find tumors in the images. The scores are based on the agreement of tumor contours with G1’s ground truth and were thus only computed for images in which tumor was found. The automated segmentation algorithms consistently achieved equal or better scores than G2's manual segmentations. G2's low F1/DICE and precision scores indicate poor agreement between the manual contours.
Conclusion
There is a need for robust and accurate segmentation algorithms for rectal tumor segmentation since manual segmentation of these tumors is susceptible to significant inter-observer variability. The deep learning-based segmentation algorithms proposed in this study are more efficient and achieved a higher agreement with our manual ground truth segmentations than a second expert annotator. Future studies will investigate how to train deep learning models on multiple ground truth annotations to prevent learning observer biases.},
howpublished = {ESTRO Annual meeting},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
The objective of this study was to develop an automated rectal tumor segmentation algorithm from endoscopy images. The algorithm will be used in a future multimodal treatment outcome prediction model. Currently, treatment outcome prediction models rely on manual segmentations of regions of interest, which are prone to inter-observer variability. To quantify this human error and demonstrate the feasibility of automated endoscopy image segmentation, we compare three deep learning architectures.
Material and Methods
A gastrointestinal physician (G1) segmented 550 endoscopy images of rectal tumors into tumor and non-tumor regions. To quantify the inter-observer variability, a second gastrointestinal physician (G2) contoured 319 of the images independently.
The 550 images and annotations from G1 were divided into 408 training, 82 validation, and 60 testing sets. Three deep learning architectures were trained; a fully convolutional neural network (FCN32), a U-Net, and a SegNet. These architectures have been used for robust medical image segmentation in previous studies.
All models were trained on a CPU supercomputing cluster. Data augmentation in the form of random image transformations, including scaling, rotation, shearing, Gaussian blurring, and noise addition, was used to improve the models' robustness.
The neural networks' output went through a final layer of noise removal and hole filling before evaluation. Finally, the segmentations from G2 and the neural networks' predictions were compared against the ground truth labels from G1.
Results
The FCN32, U-Net, and SegNet had average segmentation times of 0.77, 0.48, and 0.43 seconds per image, respectively. The average segmentation time per image for G1 and G2 were 10 and 8 seconds, respectively.
All the ground truth labels contained tumors, but G2 and the deep learning models did not always find tumors in the images. The scores are based on the agreement of tumor contours with G1’s ground truth and were thus only computed for images in which tumor was found. The automated segmentation algorithms consistently achieved equal or better scores than G2's manual segmentations. G2's low F1/DICE and precision scores indicate poor agreement between the manual contours.
Conclusion
There is a need for robust and accurate segmentation algorithms for rectal tumor segmentation since manual segmentation of these tumors is susceptible to significant inter-observer variability. The deep learning-based segmentation algorithms proposed in this study are more efficient and achieved a higher agreement with our manual ground truth segmentations than a second expert annotator. Future studies will investigate how to train deep learning models on multiple ground truth annotations to prevent learning observer biases.
Lecavalier-Barsoum, Magali; Khosrow-Khavar, Farzin; Asiev, Krum; Popovic, Marija; Vuong, Te; Enger, Shirin A.
Utilization of brachytherapy in Quebec, Canada Journal Article
In: Brachytherapy, pp. S1538–4721(21)00452–9, 2021, ISSN: 1873-1449.
@article{lecavalier-barsoum_utilization_2021,
title = {Utilization of brachytherapy in Quebec, Canada},
author = {Magali Lecavalier-Barsoum and Farzin Khosrow-Khavar and Krum Asiev and Marija Popovic and Te Vuong and Shirin A. Enger},
doi = {10.1016/j.brachy.2021.07.002},
issn = {1873-1449},
year = {2021},
date = {2021-08-01},
journal = {Brachytherapy},
pages = {S1538--4721(21)00452--9},
abstract = {BACKGROUND AND PURPOSE: Despite the excellent clinical outcomes from brachytherapy treatments compared with other modalities and the low associated costs, there have been reports of a decline in utilization of brachytherapy. The aim of this study was to investigate in detail the trend in utilization of brachytherapy in the province of Québec, Canada, from 2011 to 2019.
MATERIALS AND METHODS: All radiotherapy clinics in the province of Quebec, and among these the clinics that provide brachytherapy treatments, were identified. This observational retrospective cohort study involved analysis of data compiled by the Ministère de la Santé et des Services Sociaux du Québec for the period of 2011 to end of 2019 on all brachytherapy procedures performed in the province of Quebec. Time series graphs were used to describe the number of high dose rate (HDR) and low dose rate (LDR) brachytherapy treatments during the studied time period. Statistical analysis was conducted using R statistical software.
RESULTS: Between 2011 and 2019, 12 hospitals in the province of Québec provided radiotherapy treatments, and all of them offered brachytherapy services. The median annual number of brachytherapy sessions was 4413 (range 3930-4829). HDR brachytherapy represented over 90% of all brachytherapy treatments throughout the study period. Significant changes over time were observed in the number of treatments: at least 5% change was seen only for the two most common subtypes of brachytherapy, HDR interstitial and HDR intracavitary, with an increase of 9.6% and a decrease of 9.2%, respectively. The use of other subtypes of brachytherapy (HDR-plesiotherapy, LDR-interstitial, LDR-intracavitary, LDR-eye plaque) was stable between 2011 and 2019, with ≤ 2.5% variation.
CONCLUSION: This study demonstrates an overall steady use of brachytherapy between 2011 and 2019 in Quebec. Brachytherapy offers numerous advantages for the treatment of diverse cancer sites. Although more sophisticated external beam radiotherapy treatments have emerged in the last decades, the precision and cost-effectiveness of brachytherapy remain unbeaten. To ensure the continued use and availability of brachytherapy, governments must put in place policies and regulations to that effect. Training and exposure of future health care professionals to brachytherapy within Quebec and Canada is essential to provide all patients the same access to this life saving modality.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
MATERIALS AND METHODS: All radiotherapy clinics in the province of Quebec, and among these the clinics that provide brachytherapy treatments, were identified. This observational retrospective cohort study involved analysis of data compiled by the Ministère de la Santé et des Services Sociaux du Québec for the period of 2011 to end of 2019 on all brachytherapy procedures performed in the province of Quebec. Time series graphs were used to describe the number of high dose rate (HDR) and low dose rate (LDR) brachytherapy treatments during the studied time period. Statistical analysis was conducted using R statistical software.
RESULTS: Between 2011 and 2019, 12 hospitals in the province of Québec provided radiotherapy treatments, and all of them offered brachytherapy services. The median annual number of brachytherapy sessions was 4413 (range 3930-4829). HDR brachytherapy represented over 90% of all brachytherapy treatments throughout the study period. Significant changes over time were observed in the number of treatments: at least 5% change was seen only for the two most common subtypes of brachytherapy, HDR interstitial and HDR intracavitary, with an increase of 9.6% and a decrease of 9.2%, respectively. The use of other subtypes of brachytherapy (HDR-plesiotherapy, LDR-interstitial, LDR-intracavitary, LDR-eye plaque) was stable between 2011 and 2019, with ≤ 2.5% variation.
CONCLUSION: This study demonstrates an overall steady use of brachytherapy between 2011 and 2019 in Quebec. Brachytherapy offers numerous advantages for the treatment of diverse cancer sites. Although more sophisticated external beam radiotherapy treatments have emerged in the last decades, the precision and cost-effectiveness of brachytherapy remain unbeaten. To ensure the continued use and availability of brachytherapy, governments must put in place policies and regulations to that effect. Training and exposure of future health care professionals to brachytherapy within Quebec and Canada is essential to provide all patients the same access to this life saving modality.
Thibodeau-Antonacci, Alana; Jafarzadeh, Hossein; Carroll, Liam; Weishaupt, Luca L.
Mitacs Globalink Research Award award
2021.
@award{Thibodeau-Antonacci2021c,
title = {Mitacs Globalink Research Award},
author = {Alana Thibodeau-Antonacci and Hossein Jafarzadeh and Liam Carroll and Luca L. Weishaupt},
url = {https://www.mitacs.ca/en/programs/globalink/globalink-research-award},
year = {2021},
date = {2021-07-01},
urldate = {2021-07-01},
organization = {MITACS},
abstract = {The Mitacs Globalink Research Award (GRA) supports research collaborations between Canada and select partner organizations and eligible countries and regions. It was awarded to Alana Thibodeau-Antonacci, Hossein Jafarzadeh, Liam Carroll and Luca L. Weishaupt.
Under the joint supervision of a home and host professor, successful senior undergraduate students, graduate students, as well as postdoctoral fellows will receive a $6,000 research award to conduct a 12- to 24-week research project in the other country. Awards are offered in partnership with Mitacs’s Canadian academic partners (and, in some cases, with Mitacs’s international partners) and are subject to available funding. },
howpublished = {Mitacs},
keywords = {},
pubstate = {published},
tppubtype = {award}
}
Under the joint supervision of a home and host professor, successful senior undergraduate students, graduate students, as well as postdoctoral fellows will receive a $6,000 research award to conduct a 12- to 24-week research project in the other country. Awards are offered in partnership with Mitacs’s Canadian academic partners (and, in some cases, with Mitacs’s international partners) and are subject to available funding.
Weishaupt, Luca L.; Thibodeau-Antonacci, Alana; Garant, Aurelie; Singh, Kelita; Miller, Corey; Vuong, Té; Enger, Shirin A.
Inter-Observer Variability and Deep Learning in Rectal Tumor Segmentation from Endoscopy Images Presentation
The COMP Annual Scientific Meeting 2021, 22.06.2021.
@misc{Weishaupt2021c,
title = {Inter-Observer Variability and Deep Learning in Rectal Tumor Segmentation from Endoscopy Images},
author = {Luca L. Weishaupt and Alana Thibodeau-Antonacci and Aurelie Garant and Kelita Singh and Corey Miller and Té Vuong and Shirin A. Enger},
year = {2021},
date = {2021-06-22},
urldate = {2021-06-22},
abstract = {Purpose
To develop an automated rectal tumor segmentation algorithm from endoscopy images.
Material/Methods
A gastrointestinal physician (G1) segmented 2005 endoscopy images into tumor and non-tumor
regions. To quantify the inter-observer variability, a second gastrointestinal physician (G2)
contoured the images independently.
Three deep-learning architectures used for robust medical image segmentation in previous
studies were trained: a fully convolutional neural network (FCN32), a U-Net, and a SegNet.
Since the majority of the images did not contain tumors, two methods were compared for
training. Models were trained using only tumor images (M1) and all images (M2). G1’s images
and annotations were divided into 408 training, 82 validation, and 60 testing sets for M1, 1181
training, 372 validation, and 452 testing sets for M2.
Finally, segmentations from G2 and neural networks' predictions were compared against ground
truth labels from G1, and F1 scores were computed for images where both physicians found
tumors.
Results
The deep-learning segmentation took less than 1 second, while manual segmentation took
approximately 10 seconds per image.
The M1’s models consistently achieved equal or better scores (SegNet F1:0.80±0.08) than G2's
manual segmentations (F1:0.68±0.25). G2's low F1/DICE and precision scores indicate poor
agreement between the manual contours. Models from M2 achieved lower scores than G2 and
M1’s models since they demonstrated a strong bias towards predicting no tumor for all images.
Conclusion
Future studies will investigate training on an equal number of images with/without tumor, using
ground truth contours from multiple experts simultaneously.},
howpublished = {The COMP Annual Scientific Meeting 2021},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
To develop an automated rectal tumor segmentation algorithm from endoscopy images.
Material/Methods
A gastrointestinal physician (G1) segmented 2005 endoscopy images into tumor and non-tumor
regions. To quantify the inter-observer variability, a second gastrointestinal physician (G2)
contoured the images independently.
Three deep-learning architectures used for robust medical image segmentation in previous
studies were trained: a fully convolutional neural network (FCN32), a U-Net, and a SegNet.
Since the majority of the images did not contain tumors, two methods were compared for
training. Models were trained using only tumor images (M1) and all images (M2). G1’s images
and annotations were divided into 408 training, 82 validation, and 60 testing sets for M1, 1181
training, 372 validation, and 452 testing sets for M2.
Finally, segmentations from G2 and neural networks' predictions were compared against ground
truth labels from G1, and F1 scores were computed for images where both physicians found
tumors.
Results
The deep-learning segmentation took less than 1 second, while manual segmentation took
approximately 10 seconds per image.
The M1’s models consistently achieved equal or better scores (SegNet F1:0.80±0.08) than G2's
manual segmentations (F1:0.68±0.25). G2's low F1/DICE and precision scores indicate poor
agreement between the manual contours. Models from M2 achieved lower scores than G2 and
M1’s models since they demonstrated a strong bias towards predicting no tumor for all images.
Conclusion
Future studies will investigate training on an equal number of images with/without tumor, using
ground truth contours from multiple experts simultaneously.
Morcos, Marc; Antaki, Majd; Thibodeau-Antonacci, Alana; Kalinowski, Jonathan; Glickman, Harry; Enger, Shirin A.
RapidBrachyMCTPS: An open-source dose calculation and optimization tool for brachytherapy research Presentation
COMP, 01.06.2021.
@misc{Morcos2021c,
title = {RapidBrachyMCTPS: An open-source dose calculation and optimization tool for brachytherapy research},
author = {Marc Morcos and Majd Antaki and Alana Thibodeau-Antonacci and Jonathan Kalinowski and Harry Glickman and Shirin A. Enger},
year = {2021},
date = {2021-06-01},
howpublished = {COMP},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Thibodeau-Antonacci, Alana; Vuong, Té; Bekerat, Hamed; Liang, Liheng; Enger, Shirin A.
2021.
@award{Thibodeau-Antonacci2021b,
title = {Development of a Dynamic Shielding Intensity-Modulated Brachytherapy Applicator for the Treatment of Rectal Cancer},
author = {Alana Thibodeau-Antonacci and Té Vuong and Hamed Bekerat and Liheng Liang and Shirin A. Enger},
url = {https://curietherapi.es/},
year = {2021},
date = {2021-05-23},
urldate = {2021-05-23},
organization = {Curietherapies},
abstract = {Oral presentation given online at the annual congress of Curietherapies https://curietherapi.es/},
howpublished = {Annual Congress of Curietherapies},
keywords = {},
pubstate = {published},
tppubtype = {award}
}
Morcos, Marc; Viswanathan, Akila N.; Enger, Shirin A.
In: Medical Physics, vol. 48, no. 5, pp. 2604–2613, 2021, ISSN: 2473-4209.
@article{morcos_impact_2021,
title = {On the impact of absorbed dose specification, tissue heterogeneities, and applicator heterogeneities on Monte Carlo-based dosimetry of Ir-192, Se-75, and Yb-169 in conventional and intensity-modulated brachytherapy for the treatment of cervical cancer},
author = {Marc Morcos and Akila N. Viswanathan and Shirin A. Enger},
doi = {10.1002/mp.14802},
issn = {2473-4209},
year = {2021},
date = {2021-05-01},
journal = {Medical Physics},
volume = {48},
number = {5},
pages = {2604--2613},
abstract = {PURPOSE: The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192 Ir-, 75 Se-, and 169 Yb-based MRI-guided conventional and intensity-modulated brachytherapy. METHODS AND MATERIALS: Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192 Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w ); (b) Dw,w taking the applicator material into consideration (Dw,wApp ); (c) dose to water in medium (Dw,m ); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom) ) or voxel-by-voxel (Dm,m ).
RESULTS: Ignoring the plastic Venezia applicator (Dw,wApp ) overestimates Dm,m by up to 1% (average) with high energy source (192 Ir and 75 Se) and up to 2% with 169 Yb. Scoring dose to water (Dw,wApp or Dw,m ) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom ) for 169 Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered.
CONCLUSIONS: The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192 Ir and 75 Se, but do for 169 Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RESULTS: Ignoring the plastic Venezia applicator (Dw,wApp ) overestimates Dm,m by up to 1% (average) with high energy source (192 Ir and 75 Se) and up to 2% with 169 Yb. Scoring dose to water (Dw,wApp or Dw,m ) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom ) for 169 Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered.
CONCLUSIONS: The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192 Ir and 75 Se, but do for 169 Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.
Thibodeau-Antonacci, Alana; Vuong, Té; Bekerat, Hamed; Childress, Lilian; Enger, Shirin A.
OC-0112 development of a dynamic-shielding intensity modulated endorectal brachytherapy applicator Presentation
Radiotherapy and Oncology, 01.05.2021, ISBN: 0167-8140, 1879-0887.
@misc{Thibodeau-Antonacci2021,
title = {OC-0112 development of a dynamic-shielding intensity modulated endorectal brachytherapy applicator},
author = {Alana Thibodeau-Antonacci and Té Vuong and Hamed Bekerat and Lilian Childress and Shirin A. Enger},
url = {https://www.thegreenjournal.com/article/S0167-8140(21)06316-7/fulltext},
doi = {10.1016/S0167-8140(21)06316-7},
isbn = {0167-8140, 1879-0887},
year = {2021},
date = {2021-05-01},
abstract = {www.thegreenjournal.com},
howpublished = {Radiotherapy and Oncology},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Morcos, Marc; Enger, Shirin A.
A novel minimally invasive IMBT delivery system for cervical cancer Presentation
JGH-Lady Davis Institute, 01.02.2021.
@misc{Morcos2021b,
title = {A novel minimally invasive IMBT delivery system for cervical cancer},
author = {Marc Morcos and Shirin A. Enger},
year = {2021},
date = {2021-02-01},
howpublished = {JGH-Lady Davis Institute},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Morcos, Marc; Antaki, Majd; Viswanathan, Akila N.; Enger, Shirin A.
A novel minimally invasive dynamic-shield, intensity-modulated brachytherapy system for the treatment of cervical cancer Journal Article
In: Medical Physics, vol. 48, no. 1, pp. 71–79, 2021, ISSN: 2473-4209.
@article{morcos_novel_2021,
title = {A novel minimally invasive dynamic-shield, intensity-modulated brachytherapy system for the treatment of cervical cancer},
author = {Marc Morcos and Majd Antaki and Akila N. Viswanathan and Shirin A. Enger},
doi = {10.1002/mp.14459},
issn = {2473-4209},
year = {2021},
date = {2021-01-01},
journal = {Medical Physics},
volume = {48},
number = {1},
pages = {71--79},
abstract = {PURPOSE: To present a novel, MRI-compatible dynamicshield intensity modulated brachytherapy (IMBT) applicator and delivery system using 192 Ir, 75 Se, and 169 Yb radioisotopes for the treatment of locally advanced cervical cancer. Needle-free IMBT is a promising technique for improving target coverage and organs at risk (OAR) sparing.
METHODS AND MATERIALS: The IMBT delivery system dynamically controls the rotation of a novel tungsten shield placed inside an MRI-compatible, 6-mm wide intrauterine tandem. Using 36 cervical cancer cases, conventional intracavitary brachytherapy (IC-BT) and intracavitary/interstitial brachytherapy (IC/IS-BT) (10Ci 192 Ir) plans were compared to IMBT (10Ci 192 Ir; 11.5Ci 75 Se; 44Ci 169 Yb). All plans were generated using the Geant4-based Monte Carlo dose calculation engine, RapidBrachyMC. Treatment plans were optimized then normalized to the same high-risk clinical target volume (HR-CTV) D90 and the D2cc for bladder, rectum, and sigmoid in the research brachytherapy planning system, RapidBrachyMCTPS. Plans were renormalized until either of the three OAR reached dose limits to calculate the maximum achievable HR-CTV D90 and D98 . RESULTS: Compared to IC-BT, IMBT with either of the three radionuclides significantly improves the HR-CTV D90 and D98 by up to 5.2% ± 0.3% (P textless 0.001) and 6.7% ± 0.5% (P textless 0.001), respectively, with the largest dosimetric enhancement when using 169 Yb followed by 75 Se and then 192 Ir. Similarly, D2cc for all OAR improved with IMBT by up to 7.7% ± 0.6% (P textless 0.001). For IC/IS-BT cases, needle-free IMBT achieved clinically acceptable plans with 169 Yb-based IMBT further improving HR-CTV D98 by 1.5% ± 0.2% (P = 0.034) and decreasing sigmoid D2cc by 1.9% ± 0.4% (P = 0.048). Delivery times for IMBT are increased by a factor of 1.7, 3.3, and 2.3 for 192 Ir, 75 Se, and 169 Yb, respectively, relative to conventional 192 Ir BT.
CONCLUSIONS: Dynamic shield IMBT provides a promising alternative to conventional IC- and IC/IS-BT techniques with significant dosimetric enhancements and even greater improvements with intermediate energy radionuclides. The ability to deliver a highly conformal, OAR-sparing dose without IS needles provides a simplified method for improving the therapeutic ratio less invasively and in a less resource intensive manner.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS AND MATERIALS: The IMBT delivery system dynamically controls the rotation of a novel tungsten shield placed inside an MRI-compatible, 6-mm wide intrauterine tandem. Using 36 cervical cancer cases, conventional intracavitary brachytherapy (IC-BT) and intracavitary/interstitial brachytherapy (IC/IS-BT) (10Ci 192 Ir) plans were compared to IMBT (10Ci 192 Ir; 11.5Ci 75 Se; 44Ci 169 Yb). All plans were generated using the Geant4-based Monte Carlo dose calculation engine, RapidBrachyMC. Treatment plans were optimized then normalized to the same high-risk clinical target volume (HR-CTV) D90 and the D2cc for bladder, rectum, and sigmoid in the research brachytherapy planning system, RapidBrachyMCTPS. Plans were renormalized until either of the three OAR reached dose limits to calculate the maximum achievable HR-CTV D90 and D98 . RESULTS: Compared to IC-BT, IMBT with either of the three radionuclides significantly improves the HR-CTV D90 and D98 by up to 5.2% ± 0.3% (P textless 0.001) and 6.7% ± 0.5% (P textless 0.001), respectively, with the largest dosimetric enhancement when using 169 Yb followed by 75 Se and then 192 Ir. Similarly, D2cc for all OAR improved with IMBT by up to 7.7% ± 0.6% (P textless 0.001). For IC/IS-BT cases, needle-free IMBT achieved clinically acceptable plans with 169 Yb-based IMBT further improving HR-CTV D98 by 1.5% ± 0.2% (P = 0.034) and decreasing sigmoid D2cc by 1.9% ± 0.4% (P = 0.048). Delivery times for IMBT are increased by a factor of 1.7, 3.3, and 2.3 for 192 Ir, 75 Se, and 169 Yb, respectively, relative to conventional 192 Ir BT.
CONCLUSIONS: Dynamic shield IMBT provides a promising alternative to conventional IC- and IC/IS-BT techniques with significant dosimetric enhancements and even greater improvements with intermediate energy radionuclides. The ability to deliver a highly conformal, OAR-sparing dose without IS needles provides a simplified method for improving the therapeutic ratio less invasively and in a less resource intensive manner.
Morcos, Marc; Viswanathan, Akila N.; Enger, Shirin A.
In: Medical Physics, vol. 48, no. 5, pp. 2604–2613, 2021, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14802).
@article{morcos_impact_2021b,
title = {On the impact of absorbed dose specification, tissue heterogeneities, and applicator heterogeneities on Monte Carlo-based dosimetry of Ir-192, Se-75, and Yb-169 in conventional and intensity-modulated brachytherapy for the treatment of cervical cancer},
author = {Marc Morcos and Akila N. Viswanathan and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.14802},
doi = {10.1002/mp.14802},
issn = {2473-4209},
year = {2021},
date = {2021-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {48},
number = {5},
pages = {2604--2613},
abstract = {Purpose The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192Ir-, 75Se-, and 169Yb-based MRI-guided conventional and intensity-modulated brachytherapy. Methods and Materials Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w); (b) Dw,w taking the applicator material into consideration (Dw,wApp); (c) dose to water in medium (Dw,m); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom)) or voxel-by-voxel (Dm,m). Results Ignoring the plastic Venezia applicator (Dw,wApp) overestimates Dm,m by up to 1% (average) with high energy source (192Ir and 75Se) and up to 2% with 169Yb. Scoring dose to water (Dw,wApp or Dw,m) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom) for 169Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered. Conclusions The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192Ir and 75Se, but do for 169Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14802},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Morcos, Marc; Antaki, Majd; Viswanathan, Akila N.; Enger, Shirin A.
ESTRO Newsletter, 2021.
@misc{nokey,
title = {A novel, minimally invasive, dynamic‐shield, intensity‐modulated brachytherapy system for the treatment of cervical cancer. Editors’ pick.},
author = {Marc Morcos and Majd Antaki and Akila N. Viswanathan and Shirin A. Enger},
url = {https://www.estro.org/About/Newsroom/Newsletter/Brachytheraphy/A-novel,-minimally-invasive,-dynamic%E2%80%90shield,-inten },
year = {2021},
date = {2021-01-01},
howpublished = {ESTRO Newsletter},
keywords = {},
pubstate = {published},
tppubtype = {misc}
}
Morcos, Marc; Enger, Shirin A.
MR-guided intensity modulated brachytherapy for gynecologic cancers Presentation
McGill FMT, 01.01.2021.
@misc{Morcos2021,
title = {MR-guided intensity modulated brachytherapy for gynecologic cancers},
author = {Marc Morcos and Shirin A. Enger},
year = {2021},
date = {2021-01-01},
howpublished = {McGill FMT},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
2020
Famulari, Gabriel; Enger, Shirin A.
La curiethérapie avec modulation d’intensité par blindage dynamique pour le cancer de la prostate Presentation
Association Québécoise des Physiciens Médicaux Cliniques (AQPMC) Annual Meeting in QC, 02.11.2020.
@misc{Famulari2020b,
title = {La curiethérapie avec modulation d’intensité par blindage dynamique pour le cancer de la prostate},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2020},
date = {2020-11-02},
howpublished = {Association Québécoise des Physiciens Médicaux Cliniques (AQPMC) Annual Meeting in QC},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Turgeon, Vincent; Morcos, Marc; Antaki, Majd; Enger, Shirin A.
Impact of choices in dosimetric calculation method for high dose rate brachytherapy of breast cancer Presentation
Radiotherapy and Oncology, 01.11.2020, ISSN: 0167-8140, 1879-0887.
@misc{Turgeon2020,
title = {Impact of choices in dosimetric calculation method for high dose rate brachytherapy of breast cancer},
author = {Vincent Turgeon and Marc Morcos and Majd Antaki and Shirin A. Enger},
url = {https://www.thegreenjournal.com/article/S0167-8140(21)01974-5/fulltext},
doi = {10.1016/S0167-8140(21)01974-5},
issn = {0167-8140, 1879-0887},
year = {2020},
date = {2020-11-01},
abstract = {www.thegreenjournal.com},
howpublished = {Radiotherapy and Oncology},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Rosales, Haydee M. Linares; Dupere, Justine; Medich, David C.; Beaulieu, Luc; Enger, Shirin A.
In: Medical Physics, vol. 47, no. 9, pp. 4563–4573, 2020, ISSN: 2473-4209.
@article{famulari_monte_2020,
title = {Monte Carlo dosimetric characterization of a new high dose rate 169 Yb brachytherapy source and independent verification using a multipoint plastic scintillator detector},
author = {Gabriel Famulari and Haydee M. Linares Rosales and Justine Dupere and David C. Medich and Luc Beaulieu and Shirin A. Enger},
doi = {10.1002/mp.14336},
issn = {2473-4209},
year = {2020},
date = {2020-09-01},
journal = {Medical Physics},
volume = {47},
number = {9},
pages = {4563--4573},
abstract = {PURPOSE: A prototype 169 Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded 169 Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD).
METHODS: The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( 0 ∘ , 9 0 ∘ , 18 0 ∘ , and 27 0 ∘ ).
RESULTS: The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5-10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6-6.2%) for BCF-10, 1.7% (0.9-2.9%) for BCF-12, and 2.2% (0.3-4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC.
CONCLUSIONS: The dose distribution for the bare/shielded 169 Yb source was independently verified using mPSD with good agreement in regions close to the source. The 169 Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS: The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( 0 ∘ , 9 0 ∘ , 18 0 ∘ , and 27 0 ∘ ).
RESULTS: The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5-10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6-6.2%) for BCF-10, 1.7% (0.9-2.9%) for BCF-12, and 2.2% (0.3-4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC.
CONCLUSIONS: The dose distribution for the bare/shielded 169 Yb source was independently verified using mPSD with good agreement in regions close to the source. The 169 Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.
Famulari, Gabriel; Enger, Shirin A.
AIM-Brachy: a novel intensity modulated brachytherapy (IMBT) delivery system for prostate cancer. Winner of the 2019 Jean Pouliot Prize for best paper published in 2019 awarded by Association Québécoise des Physicien(ne) Médicaux Cliniques. award
2020.
@award{Famulari2020,
title = {AIM-Brachy: a novel intensity modulated brachytherapy (IMBT) delivery system for prostate cancer. Winner of the 2019 Jean Pouliot Prize for best paper published in 2019 awarded by Association Québécoise des Physicien(ne) Médicaux Cliniques.},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2020},
date = {2020-07-01},
urldate = {2020-07-01},
organization = {Association Québécoise des Physicien(ne) Médicaux Cliniques},
howpublished = {Med. Phys., 47(3):859-868 (2020)},
keywords = {},
pubstate = {published},
tppubtype = {award}
}
Famulari, Gabriel; Enger, Shirin A.
Monte Carlo dosimetry of a custom-made 169Yb source for intensity modulated brachytherapy Presentation
MCMA, 20.06.2020.
@misc{Famulari2020c,
title = {Monte Carlo dosimetry of a custom-made 169Yb source for intensity modulated brachytherapy},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2020},
date = {2020-06-20},
howpublished = {MCMA},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Morcos, Marc; Enger, Shirin A.
Monte Carlo Dosimetry Study of Novel Rotating MRI-Compatible Shielded Tandems for Intensity Modulated Cervix Brachytherapy Presentation
MCMA, 20.06.2020.
@misc{Morcos2020,
title = {Monte Carlo Dosimetry Study of Novel Rotating MRI-Compatible Shielded Tandems for Intensity Modulated Cervix Brachytherapy},
author = {Marc Morcos and Shirin A. Enger},
year = {2020},
date = {2020-06-20},
howpublished = {MCMA},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Alfieri, Joanne; Duclos, Marie; Vuong, Té; Enger, Shirin A.
Can intermediate-energy sources lead to elevated bone doses for prostate and head & neck high-dose-rate brachytherapy? Journal Article
In: Brachytherapy, vol. 19, no. 2, pp. 255–263, 2020, ISSN: 1873-1449.
@article{famulari_can_2020,
title = {Can intermediate-energy sources lead to elevated bone doses for prostate and head & neck high-dose-rate brachytherapy?},
author = {Gabriel Famulari and Joanne Alfieri and Marie Duclos and Té Vuong and Shirin A. Enger},
doi = {10.1016/j.brachy.2019.12.004},
issn = {1873-1449},
year = {2020},
date = {2020-04-01},
journal = {Brachytherapy},
volume = {19},
number = {2},
pages = {255--263},
abstract = {PURPOSE: Several radionuclides with high (60Co, 75Se) and intermediate (169Yb, 153Gd) energies have been investigated as alternatives to 192Ir for high-dose-rate brachytherapy. The purpose of this study was to evaluate the impact of tissue heterogeneities for these five high- to intermediate-energy sources in prostate and head & neck brachytherapy. METHODS AND MATERIALS: Treatment plans were generated for a cohort of prostate (n = 10) and oral tongue (n = 10) patients. Dose calculations were performed using RapidBrachyMCTPS, an in-house Geant4-based Monte Carlo treatment planning system. Treatment plans were simulated using 60Co, 192Ir, 75Se, 169Yb, and 153Gd as the active core of the microSelectron v2 source. Two dose calculation scenarios were presented: (1) dose to water in water (Dw,w), and (2) dose to medium in medium (Dm,m).
RESULTS: Dw,w overestimates planning target volume coverage compared with Dm,m, regardless of photon energy. The average planning target volume D90 reduction was ∼1% for high-energy sources, whereas larger differences were observed for intermediate-energy sources (1%-2% for prostate and 4%-7% for oral tongue). Dose differences were not clinically relevant (textless5%) for soft tissues in general. Going from Dw,w to Dm,m, bone doses were increased two- to three-fold for 169Yb and four- to five-fold for 153Gd, whereas the ratio was close to ∼1 for high-energy sources.
CONCLUSIONS: Dw,w underestimates the dose to bones and, to a lesser extent, overestimates the dose to soft tissues for radionuclides with average energies lower than 192Ir. Further studies regarding bone toxicities are needed before intermediate-energy sources can be adopted in cases where bones are in close vicinity to the tumor.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
RESULTS: Dw,w overestimates planning target volume coverage compared with Dm,m, regardless of photon energy. The average planning target volume D90 reduction was ∼1% for high-energy sources, whereas larger differences were observed for intermediate-energy sources (1%-2% for prostate and 4%-7% for oral tongue). Dose differences were not clinically relevant (textless5%) for soft tissues in general. Going from Dw,w to Dm,m, bone doses were increased two- to three-fold for 169Yb and four- to five-fold for 153Gd, whereas the ratio was close to ∼1 for high-energy sources.
CONCLUSIONS: Dw,w underestimates the dose to bones and, to a lesser extent, overestimates the dose to soft tissues for radionuclides with average energies lower than 192Ir. Further studies regarding bone toxicities are needed before intermediate-energy sources can be adopted in cases where bones are in close vicinity to the tumor.
Famulari, Gabriel; Duclos, Marie; Enger, Shirin A.
A novel 169 Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer Journal Article
In: Medical Physics, vol. 47, no. 3, pp. 859–868, 2020, ISSN: 2473-4209.
@article{famulari_novel_2020,
title = {A novel 169 Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer},
author = {Gabriel Famulari and Marie Duclos and Shirin A. Enger},
doi = {10.1002/mp.13959},
issn = {2473-4209},
year = {2020},
date = {2020-03-01},
journal = {Medical Physics},
volume = {47},
number = {3},
pages = {859--868},
abstract = {PURPOSE: Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer.
METHODS: The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169 Yb source. Conventional HDR BT (10 Ci 192 Ir) and IMBT (18 Ci 169 Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors ( ± 1 mm, ± 2 mm, and ± 3 mm) and rotational errors ( ± 5 ∘ , ± 10 ∘ , and ± 15 ∘ ) on clinically relevant parameters (PTV D90 and urethra D10 ).
RESULTS: The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% ± 4.7%, without change to other plan quality indices (PTV V100 , V150, V200 , bladder V75 , rectum V75 , HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors ( ± 1 mm, ± 5 ∘ ), the overall tolerance was textless2%.
CONCLUSIONS: The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS: The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169 Yb source. Conventional HDR BT (10 Ci 192 Ir) and IMBT (18 Ci 169 Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors ( ± 1 mm, ± 2 mm, and ± 3 mm) and rotational errors ( ± 5 ∘ , ± 10 ∘ , and ± 15 ∘ ) on clinically relevant parameters (PTV D90 and urethra D10 ).
RESULTS: The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% ± 4.7%, without change to other plan quality indices (PTV V100 , V150, V200 , bladder V75 , rectum V75 , HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors ( ± 1 mm, ± 5 ∘ ), the overall tolerance was textless2%.
CONCLUSIONS: The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.
Morcos, Marc; Enger, Shirin A.
Monte Carlo dosimetry study of novel rotating MRI-compatible shielded tandems for intensity modulated cervix brachytherapy Journal Article
In: Physica medica: PM: an international journal devoted to the applications of physics to medicine and biology: official journal of the Italian Association of Biomedical Physics (AIFB), vol. 71, pp. 178–184, 2020, ISSN: 1724-191X.
@article{morcos_monte_2020,
title = {Monte Carlo dosimetry study of novel rotating MRI-compatible shielded tandems for intensity modulated cervix brachytherapy},
author = {Marc Morcos and Shirin A. Enger},
doi = {10.1016/j.ejmp.2020.02.014},
issn = {1724-191X},
year = {2020},
date = {2020-03-01},
journal = {Physica medica: PM: an international journal devoted to the applications of physics to medicine and biology: official journal of the Italian Association of Biomedical Physics (AIFB)},
volume = {71},
pages = {178--184},
abstract = {PURPOSE: Intensity modulated brachytherapy (IMBT) with rotating metal shields enables dose modulation that can better conform to the tumor while reducing OAR doses. In this work, we investigate novel rotating shields, compatible with MRI-compatible tandems used for cervix brachytherapy. Three unique shields were evaluated using the traditional 192Ir source. Additionally, 75Se and 169Yb isotopes were investigated as alternative sources.
METHODS: Three different IMBT shields were modeled and simulated in RapidBrachyMCTPS. Each tungsten shield was designed to fit inside a 6 mm-wide MRI-compatible tandem. The active core of the source was replaced with 192Ir, 75Se and 169Yb. Transmission factors (TFs) were calculated and defined as the dose ratio at 1 cm on opposite sides of the shielded tandem on the transverse plane. Polar and azimuthal anisotropy plots were extracted from simulations. Dose homogeneities V200%V100% were calculated for all radionuclide-shield combinations.
RESULTS: TFs are favorable for IMBT and ranged between 12.9% and 32.2% for 192Ir, 4.0%-16.1% for 75Se and 1.2-6.4% for 169Yb for all shield designs. Average beam-widths in the polar and azimuthal directions were reduced to the range of 42°-112° and 27°-107°, respectively, for all shield-radionuclide combinations. Dose homogeneities for all the radionuclide-shield combinations were within 12% of the non-IMBT tandem.
CONCLUSIONS: This study has quantitatively assessed the influence of various rotating cervical cancer-specific IMBT tandem shields on dosimetry. The dynamic single-channel shields and narrow beam-widths in the polar and azimuthal direction give rise to highly anisotropic distributions. Intermediate-to-high energy radionuclides, 75Se and 169Yb substantially improve the modulation capacity of IMBT and pave the way for treating large and complex cervical cancer without interstitial needle implantation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS: Three different IMBT shields were modeled and simulated in RapidBrachyMCTPS. Each tungsten shield was designed to fit inside a 6 mm-wide MRI-compatible tandem. The active core of the source was replaced with 192Ir, 75Se and 169Yb. Transmission factors (TFs) were calculated and defined as the dose ratio at 1 cm on opposite sides of the shielded tandem on the transverse plane. Polar and azimuthal anisotropy plots were extracted from simulations. Dose homogeneities V200%V100% were calculated for all radionuclide-shield combinations.
RESULTS: TFs are favorable for IMBT and ranged between 12.9% and 32.2% for 192Ir, 4.0%-16.1% for 75Se and 1.2-6.4% for 169Yb for all shield designs. Average beam-widths in the polar and azimuthal directions were reduced to the range of 42°-112° and 27°-107°, respectively, for all shield-radionuclide combinations. Dose homogeneities for all the radionuclide-shield combinations were within 12% of the non-IMBT tandem.
CONCLUSIONS: This study has quantitatively assessed the influence of various rotating cervical cancer-specific IMBT tandem shields on dosimetry. The dynamic single-channel shields and narrow beam-widths in the polar and azimuthal direction give rise to highly anisotropic distributions. Intermediate-to-high energy radionuclides, 75Se and 169Yb substantially improve the modulation capacity of IMBT and pave the way for treating large and complex cervical cancer without interstitial needle implantation.
Famulari, Gabriel; Alfieri, Joanne; Duclos, Marie; Vuong, Té; Enger, Shirin A.
Can intermediate-energy sources lead to elevated bone doses for prostate and head & neck high-dose-rate brachytherapy? Journal Article
In: Brachytherapy, vol. 19, no. 2, pp. 255–263, 2020, ISSN: 1538-4721.
@article{famulari_can_2020b,
title = {Can intermediate-energy sources lead to elevated bone doses for prostate and head & neck high-dose-rate brachytherapy?},
author = {Gabriel Famulari and Joanne Alfieri and Marie Duclos and Té Vuong and Shirin A. Enger},
url = {https://www.sciencedirect.com/science/article/pii/S1538472119306531},
doi = {10.1016/j.brachy.2019.12.004},
issn = {1538-4721},
year = {2020},
date = {2020-03-01},
urldate = {2021-09-08},
journal = {Brachytherapy},
volume = {19},
number = {2},
pages = {255--263},
abstract = {Purpose
Several radionuclides with high (60Co, 75Se) and intermediate (169Yb, 153Gd) energies have been investigated as alternatives to 192Ir for high-dose-rate brachytherapy. The purpose of this study was to evaluate the impact of tissue heterogeneities for these five high- to intermediate-energy sources in prostate and head & neck brachytherapy.
Methods and Materials Treatment plans were generated for a cohort of prostate (n = 10) and oral tongue (n = 10) patients. Dose calculations were performed using RapidBrachyMCTPS, an in-house Geant4-based Monte Carlo treatment planning system. Treatment plans were simulated using 60Co, 192Ir, 75Se, 169Yb, and 153Gd as the active core of the microSelectron v2 source. Two dose calculation scenarios were presented: (1) dose to water in water (Dw,w), and (2) dose to medium in medium (Dm,m).
Results
Dw,w overestimates planning target volume coverage compared with Dm,m, regardless of photon energy. The average planning target volume D90 reduction was ∼1% for high-energy sources, whereas larger differences were observed for intermediate-energy sources (1%–2% for prostate and 4%–7% for oral tongue). Dose differences were not clinically relevant (textless5%) for soft tissues in general. Going from Dw,w to Dm,m, bone doses were increased two- to three-fold for 169Yb and four- to five-fold for 153Gd, whereas the ratio was close to ∼1 for high-energy sources.
Conclusions
Dw,w underestimates the dose to bones and, to a lesser extent, overestimates the dose to soft tissues for radionuclides with average energies lower than 192Ir. Further studies regarding bone toxicities are needed before intermediate-energy sources can be adopted in cases where bones are in close vicinity to the tumor.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Several radionuclides with high (60Co, 75Se) and intermediate (169Yb, 153Gd) energies have been investigated as alternatives to 192Ir for high-dose-rate brachytherapy. The purpose of this study was to evaluate the impact of tissue heterogeneities for these five high- to intermediate-energy sources in prostate and head & neck brachytherapy.
Methods and Materials Treatment plans were generated for a cohort of prostate (n = 10) and oral tongue (n = 10) patients. Dose calculations were performed using RapidBrachyMCTPS, an in-house Geant4-based Monte Carlo treatment planning system. Treatment plans were simulated using 60Co, 192Ir, 75Se, 169Yb, and 153Gd as the active core of the microSelectron v2 source. Two dose calculation scenarios were presented: (1) dose to water in water (Dw,w), and (2) dose to medium in medium (Dm,m).
Results
Dw,w overestimates planning target volume coverage compared with Dm,m, regardless of photon energy. The average planning target volume D90 reduction was ∼1% for high-energy sources, whereas larger differences were observed for intermediate-energy sources (1%–2% for prostate and 4%–7% for oral tongue). Dose differences were not clinically relevant (textless5%) for soft tissues in general. Going from Dw,w to Dm,m, bone doses were increased two- to three-fold for 169Yb and four- to five-fold for 153Gd, whereas the ratio was close to ∼1 for high-energy sources.
Conclusions
Dw,w underestimates the dose to bones and, to a lesser extent, overestimates the dose to soft tissues for radionuclides with average energies lower than 192Ir. Further studies regarding bone toxicities are needed before intermediate-energy sources can be adopted in cases where bones are in close vicinity to the tumor.
Famulari, Gabriel; Rosales, Haydee M. Linares; Dupere, Justine; Medich, David C.; Beaulieu, Luc; Enger, Shirin A.
In: Medical Physics, vol. 47, no. 9, pp. 4563–4573, 2020, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14336).
@article{famulari_monte_2020b,
title = {Monte Carlo dosimetric characterization of a new high dose rate Yb brachytherapy source and independent verification using a multipoint plastic scintillator detector},
author = {Gabriel Famulari and Haydee M. Linares Rosales and Justine Dupere and David C. Medich and Luc Beaulieu and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.14336},
doi = {10.1002/mp.14336},
issn = {2473-4209},
year = {2020},
date = {2020-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {47},
number = {9},
pages = {4563--4573},
abstract = {Purpose A prototype Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD). Methods The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( , 9 , 18 , and 27 ). Results The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5–10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6–6.2%) for BCF-10, 1.7% (0.9–2.9%) for BCF-12, and 2.2% (0.3–4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC. Conclusions The dose distribution for the bare/shielded Yb source was independently verified using mPSD with good agreement in regions close to the source. The Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14336},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Famulari, Gabriel; Duclos, Marie; Enger, Shirin A.
A novel 169Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer Journal Article
In: Medical Physics, vol. 47, no. 3, pp. 859–868, 2020, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.13959).
@article{famulari_novel_2020b,
title = {A novel 169Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer},
author = {Gabriel Famulari and Marie Duclos and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.13959},
doi = {10.1002/mp.13959},
issn = {2473-4209},
year = {2020},
date = {2020-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {47},
number = {3},
pages = {859--868},
abstract = {Purpose Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer. Methods The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169Yb source. Conventional HDR BT (10 Ci 192Ir) and IMBT (18 Ci 169Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors (1 mm, 2 mm, and 3 mm) and rotational errors (5, 10 and 15) on clinically relevant parameters (PTV D90 and urethra D10). Results The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% 4.7%, without change to other plan quality indices (PTV V100, V150, V200, bladder V75, rectum V75, HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors (1 mm, 5), the overall tolerance was textless2%. Conclusions The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.13959},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2019
Shoemaker, Tristan; Vuong, Té; Glickman, Harry; Kaifi, Samar; Famulari, Gabriel; Enger, Shirin A.
Dosimetric Considerations for Ytterbium-169, Selenium-75, and Iridium-192 Radioisotopes in High-Dose-Rate Endorectal Brachytherapy Journal Article
In: International Journal of Radiation Oncology, Biology, Physics, vol. 105, no. 4, pp. 875–883, 2019, ISSN: 1879-355X.
@article{shoemaker_dosimetric_2019,
title = {Dosimetric Considerations for Ytterbium-169, Selenium-75, and Iridium-192 Radioisotopes in High-Dose-Rate Endorectal Brachytherapy},
author = {Tristan Shoemaker and Té Vuong and Harry Glickman and Samar Kaifi and Gabriel Famulari and Shirin A. Enger},
doi = {10.1016/j.ijrobp.2019.07.003},
issn = {1879-355X},
year = {2019},
date = {2019-11-01},
journal = {International Journal of Radiation Oncology, Biology, Physics},
volume = {105},
number = {4},
pages = {875--883},
abstract = {PURPOSE: To investigate differences between prescribed and postimplant calculated dose in 192Ir high-dose-rate endorectal brachytherapy (HDR-EBT) by evaluating dose to clinical target volume (CTV) and organs at risk (OARs) calculated with a Monte Carlo-based dose calculation software, RapidBrachyMC. In addition, dose coverage, conformity, and homogeneity were compared among the radionuclides 192Ir, 75Se, and 169Yb for use in HDR-EBT.
METHODS AND MATERIALS: Postimplant dosimetry was evaluated using 23 computed tomography (CT) images from patients treated with HDR-EBT using the 192Ir microSelectron v2 (Elekta AB, Stockholm, Sweden) source and the Intracavitary Mold Applicator Set (Elekta AB, Stockholm, Sweden), which is a flexible applicator capable of fitting a tungsten rod for OAR shielding. Four tissue segmentation schemes were evaluated: (1) TG-43 formalism, (2) materials and nominal densities assigned to contours of foreign objects, (3) materials and nominal densities assigned to contoured organs in addition to foreign objects, and (4) materials specified as in (3) but with voxel mass densities derived from CT Hounsfield units. Clinical plans optimized for 192Ir were used, with the results for 75Se and 169Yb normalized to the D90 of the 192Ir clinical plan. RESULTS: In comparison to segmentation scheme 4, TG-43-based dosimetry overestimates CTV D90 by 6% (P = .00003), rectum D50 by 24% (P = .00003), and pelvic bone D50 by 5% (P = .00003) for 192Ir. For 169Yb, CTV D90 is overestimated by 17% (P = .00003) and rectum D50 by 39% (P = .00003), and pelvic bone D50 is significantly underestimated by 27% (P = .007). Postimplant dosimetry calculations also showed that a 169Yb source would give 20% (P = .00003) lower rectum V60 and 17% (P = .00008) lower rectum D50.
CONCLUSIONS: Ignoring high-Z materials in dose calculation contributes to inaccuracies that may lead to suboptimal dose optimization and disagreement between prescribed and calculated dose. This is especially important for low-energy radionuclides. Our results also show that with future magnetic resonance imaging-based treatment planning, loss of CT density data will only affect calculated dose in nonbone OARs by 2% or less and bone OARs by 13% or less across all sources if material composition and nominal mass densities are correctly assigned.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
METHODS AND MATERIALS: Postimplant dosimetry was evaluated using 23 computed tomography (CT) images from patients treated with HDR-EBT using the 192Ir microSelectron v2 (Elekta AB, Stockholm, Sweden) source and the Intracavitary Mold Applicator Set (Elekta AB, Stockholm, Sweden), which is a flexible applicator capable of fitting a tungsten rod for OAR shielding. Four tissue segmentation schemes were evaluated: (1) TG-43 formalism, (2) materials and nominal densities assigned to contours of foreign objects, (3) materials and nominal densities assigned to contoured organs in addition to foreign objects, and (4) materials specified as in (3) but with voxel mass densities derived from CT Hounsfield units. Clinical plans optimized for 192Ir were used, with the results for 75Se and 169Yb normalized to the D90 of the 192Ir clinical plan. RESULTS: In comparison to segmentation scheme 4, TG-43-based dosimetry overestimates CTV D90 by 6% (P = .00003), rectum D50 by 24% (P = .00003), and pelvic bone D50 by 5% (P = .00003) for 192Ir. For 169Yb, CTV D90 is overestimated by 17% (P = .00003) and rectum D50 by 39% (P = .00003), and pelvic bone D50 is significantly underestimated by 27% (P = .007). Postimplant dosimetry calculations also showed that a 169Yb source would give 20% (P = .00003) lower rectum V60 and 17% (P = .00008) lower rectum D50.
CONCLUSIONS: Ignoring high-Z materials in dose calculation contributes to inaccuracies that may lead to suboptimal dose optimization and disagreement between prescribed and calculated dose. This is especially important for low-energy radionuclides. Our results also show that with future magnetic resonance imaging-based treatment planning, loss of CT density data will only affect calculated dose in nonbone OARs by 2% or less and bone OARs by 13% or less across all sources if material composition and nominal mass densities are correctly assigned.
Famulari, Gabriel; Enger, Shirin A.
Evaluation of the intershield attenuation effect for a new intensity modulated brachytherapy system for prostate cancer Presentation
American Association of Physicists in Medicine (AAPM) 61st Annual Meeting, 18.07.2019.
@misc{Famulari2019c,
title = { Evaluation of the intershield attenuation effect for a new intensity modulated brachytherapy system for prostate cancer},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2019},
date = {2019-07-18},
howpublished = {American Association of Physicists in Medicine (AAPM) 61st Annual Meeting},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Enger, Shirin A.
Dosimetric characterization of a new 169Yb source for high dose rate brachytherapy Presentation
American Brachytherapy Society (ABS) Annual Meeting, 08.06.2019.
@misc{Famulari2019d,
title = {Dosimetric characterization of a new 169Yb source for high dose rate brachytherapy},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2019},
date = {2019-06-08},
howpublished = {American Brachytherapy Society (ABS) Annual Meeting},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Morcos, Marc; Enger, Shirin A.
MR-Compatible Intensity Modulated Brachytherapy Applicator for Cervical Cancer Presentation
American Brachytherapy Society (ABS) Annual Meeting, 08.06.2019.
@misc{Morcos2019,
title = {MR-Compatible Intensity Modulated Brachytherapy Applicator for Cervical Cancer},
author = {Marc Morcos and Shirin A. Enger},
year = {2019},
date = {2019-06-08},
howpublished = {American Brachytherapy Society (ABS) Annual Meeting},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Enger, Shirin A.
Urethra sparing with intensity modulated brachytherapy for prostate cancer Presentation
Curietherapies, 17.05.2019.
@misc{Famulari2019e,
title = {Urethra sparing with intensity modulated brachytherapy for prostate cancer},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2019},
date = {2019-05-17},
howpublished = {Curietherapies},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Morcos, Marc; Enger, Shirin A.
MR-Compatible Intensity Modulated Brachytherapy for the Treatment of Locally Advanced Cervical Cancer Presentation
Curietherapies, 17.05.2019.
@misc{Morcos2019b,
title = {MR-Compatible Intensity Modulated Brachytherapy for the Treatment of Locally Advanced Cervical Cancer},
author = {Marc Morcos and Shirin A. Enger},
year = {2019},
date = {2019-05-17},
howpublished = {Curietherapies},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Enger, Shirin A.
Intensity modulated brachytherapy for prostate cancer: plan quality, robustness and delivery time Presentation
Radiotherapy and Oncology, 01.04.2019, ISSN: 0167-8140, 1879-0887.
@misc{Famulari2019f,
title = {Intensity modulated brachytherapy for prostate cancer: plan quality, robustness and delivery time},
author = {Gabriel Famulari and Shirin A. Enger},
url = {https://www.thegreenjournal.com/article/S0167-8140(19)30817-5/fulltext},
doi = {10.1016/S0167-8140(19)30817-5},
issn = {0167-8140, 1879-0887},
year = {2019},
date = {2019-04-01},
abstract = {www.thegreenjournal.com},
howpublished = {Radiotherapy and Oncology},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
Famulari, Gabriel; Enger, Shirin A.
Young Investigator Competition Award - Urethra-Sparing with Intensity Modulated Brachytherapy for Prostate Cancer award
2019.
@award{Famulari2019,
title = {Young Investigator Competition Award - Urethra-Sparing with Intensity Modulated Brachytherapy for Prostate Cancer},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2019},
date = {2019-01-01},
urldate = {2019-01-01},
howpublished = {Curietherapies 2019},
keywords = {},
pubstate = {published},
tppubtype = {award}
}
Famulari, Gabriel; Pater, Piotr; Enger, Shirin A.
Microdosimetry calculations for monoenergetic electrons using Geant4-DNA combined with a weighted track sampling algorithm Presentation
Physica Medica, 01.01.2019.
@misc{Famulari2019b,
title = {Microdosimetry calculations for monoenergetic electrons using Geant4-DNA combined with a weighted track sampling algorithm},
author = {Gabriel Famulari and Piotr Pater and Shirin A. Enger},
year = {2019},
date = {2019-01-01},
howpublished = {Physica Medica},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}
2018
Famulari, Gabriel; Renaud, Marc-André; Poole, Christopher M.; Evans, Michael D. C.; Seuntjens, Jan; Enger, Shirin A.
RapidBrachyMCTPS: a Monte Carlo-based treatment planning system for brachytherapy applications Journal Article
In: Physics in Medicine and Biology, vol. 63, no. 17, pp. 175007, 2018, ISSN: 1361-6560.
@article{famulari_rapidbrachymctps_2018,
title = {RapidBrachyMCTPS: a Monte Carlo-based treatment planning system for brachytherapy applications},
author = {Gabriel Famulari and Marc-André Renaud and Christopher M. Poole and Michael D. C. Evans and Jan Seuntjens and Shirin A. Enger},
doi = {10.1088/1361-6560/aad97a},
issn = {1361-6560},
year = {2018},
date = {2018-08-01},
journal = {Physics in Medicine and Biology},
volume = {63},
number = {17},
pages = {175007},
abstract = {Despite being considered the gold standard for brachytherapy dosimetry, Monte Carlo (MC) has yet to be implemented into a software for brachytherapy treatment planning. The purpose of this work is to present RapidBrachyMCTPS, a novel treatment planning system (TPS) for brachytherapy applications equipped with a graphical user interface (GUI), optimization tools and a Geant4-based MC dose calculation engine, RapidBrachyMC. Brachytherapy sources and applicators were implemented in RapidBrachyMC and made available to the user via a source and applicator library in the GUI. To benchmark RapidBrachyMC, TG-43 parameters were calculated for the microSelectron v2 (192Ir) and SelectSeed (125I) source models and were compared against previously validated MC brachytherapy codes. The performance of RapidBrachyMC was evaluated for a prostate high dose rate case. To assess the accuracy of RapidBrachyMC in a heterogeneous setup, dose distributions with a cylindrical shielded/unshielded applicator were validated against film measurements in a Solid WaterTM phantom. TG-43 parameters calculated using RapidBrachyMC generally agreed within 1%-2% of the results obtained in previously published work. For the prostate case, clinical dosimetric indices showed general agreement with Oncentra TPS within 1%. Simulation times were on the order of minutes on a single core to achieve uncertainties below 2% in voxels within the prostate. The calculation time was decreased further using the multithreading features of Geant4. In the comparison between MC-calculated and film-measured dose distributions, at least 95% of points passed the 3%/3 mm gamma index criteria in all but one case. RapidBrachyMCTPS can be used as a post-implant dosimetry toolkit, as well as for MC-based brachytherapy treatment planning. This software is especially well suited for the development of new source and applicator models.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Famulari, Gabriel; Enger, Shirin A.
AIMBrachy, A Novel Radiation Delivery System Presentation
The Cancer Research Program Research day at RI-MUHC, 22.05.2018.
@misc{Famulari2018d,
title = {AIMBrachy, A Novel Radiation Delivery System},
author = {Gabriel Famulari and Shirin A. Enger},
year = {2018},
date = {2018-05-22},
howpublished = {The Cancer Research Program Research day at RI-MUHC},
keywords = {},
pubstate = {published},
tppubtype = {presentation}
}