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Brachytherapy. 2017 Mar-Apr;16(2):421-432. doi: 10.1016/j.brachy.2016.11.011. Epub 2016 Dec 28.
2
High- and low-dose-rate intraoperative radiotherapy for thoracic malignancies resected with close or positive margins.高剂量率和低剂量率术中放疗用于切缘接近或阳性的胸部恶性肿瘤切除术。
Brachytherapy. 2016 Mar-Apr;15(2):208-15. doi: 10.1016/j.brachy.2015.11.007. Epub 2016 Jan 26.
3
Air-kerma strength determination of a new directional (103)Pd source.新型定向（103）钯源的空气比释动能强度测定
Med Phys. 2015 Dec;42(12):7144-52. doi: 10.1118/1.4935409.
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Ann Surg Oncol. 2015 Jul;22(7):2168-78. doi: 10.1245/s10434-014-4271-8. Epub 2015 Jan 29.
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Local recurrence outcomes using the ³²P intraoperative brachytherapy plaque in the management of malignant lesions of the spine involving the dura.使用³²P术中近距离放射治疗板治疗累及硬脑膜的脊柱恶性病变的局部复发结果。
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术中植入定向钯源网（CivaSheet）：剂量测定验证、临床调试、剂量规范及初步经验。

Intraoperative implantation of a mesh of directional palladium sources (CivaSheet): Dosimetry verification, clinical commissioning, dose specification, and preliminary experience.

作者信息

Cohen Gil'ad N, Episcopia Karen, Lim Seng-Boh, LoSasso Thomas J, Rivard Mark J, Taggar Amandeep S, Taunk Neil K, Wu Abraham J, Damato Antonio L

机构信息

Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.

Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA.

出版信息

Brachytherapy. 2017 Nov-Dec;16(6):1257-1264. doi: 10.1016/j.brachy.2017.07.010. Epub 2017 Aug 18.

DOI:10.1016/j.brachy.2017.07.010
PMID:28827006
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5744045/
Abstract

PURPOSE

To present the clinical commissioning of a novel Pd directional brachytherapy device (CivaSheet) for intraoperative radiation therapy.

METHODS AND MATERIALS

Clinical commissioning for the CivaSheet consisted of establishing: (1) source strength calibration capabilities, (2) experimental verification of TG-43 dosimetry parameters, (3) treatment planning system validation, and (4) departmental practice for dose specification and source ordering. Experimental verification was performed in water with radiochromic film calibrated with a 37 kVp X-ray beam. Percentage difference ([measurements - calculation]/calculation) and distance to agreement (difference between film-to-source distance and distance that minimized the percentage difference) were calculated. Nomogram values (in U/100 Gy) for all configurations (up to 20 × 20 sources) were calculated for source ordering. Clinical commissioning was used on patients enrolled in an ongoing Institutional Review Board-approved protocol.

RESULTS

A source calibration procedure was established, and the treatment planning system was commissioned within standard clinical uncertainties. Percentage dose differences (distances to agreement) between measured and calculated doses were 8.6% (-0.12 mm), 0.6% (-0.01 mm), -6.4% (0.22 mm), and -10.0% (0.44 mm) at depths of 2.3, 5.1, 8.0, and 11.1 mm, respectively. All differences were within the experimental uncertainties. Nomogram values depended on sheet size and spatial extent. A value of 2.4U/100 Gy per CivaDot was found to satisfy most cases, ranging from 2.3 to 3.3U/100 Gy. Nomogram results depended on elongation of the treatment area with a higher variation observed for smaller treatment areas. Postimplantation dose evaluation was feasible.

CONCLUSIONS

Commissioning and clinical deployment of CivaSheet was feasible using BrachyVision for postoperative dose evaluation. Experimental verification confirmed that the available TG-43 dosimetry parameters are accurate for clinical use.

摘要

目的

介绍一种用于术中放射治疗的新型钯定向近距离放射治疗装置（CivaSheet）的临床调试。

方法和材料

CivaSheet的临床调试包括建立：（1）源强度校准能力，（2）TG-43剂量学参数的实验验证，（3）治疗计划系统验证，以及（4）剂量规范和源订购的部门实践。实验验证在水中进行，使用经37 kVp X射线束校准的放射变色胶片。计算百分比差异（[测量值 - 计算值]/计算值）和一致性距离（胶片到源的距离与使百分比差异最小化的距离之间的差异）。计算所有配置（最多20×20个源）的诺模图值（以U/100 Gy为单位）用于源订购。临床调试应用于正在进行的机构审查委员会批准方案中的患者。

结果

建立了源校准程序，治疗计划系统在标准临床不确定性范围内完成调试。在2.3、5.1、8.0和11.1 mm深度处，测量剂量与计算剂量之间的百分比剂量差异（一致性距离）分别为8.6%（-0.12 mm）、0.6%（-0.01 mm）、-6.4%（0.22 mm）和-10.0%（0.44 mm）。所有差异均在实验不确定性范围内。诺模图值取决于片材尺寸和空间范围。发现每个CivaDot的值为2.4U/100 Gy可满足大多数情况，范围为2.3至3.3U/100 Gy。诺模图结果取决于治疗区域的伸长，较小治疗区域观察到的变化更大。植入后剂量评估是可行的。

结论

使用BrachyVision对CivaSheet进行调试和临床部署以进行术后剂量评估是可行的。实验验证证实，可用的TG-43剂量学参数在临床使用中是准确的。