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Brachytherapy Applicator Commissioning and Clinical Implementation Using TG100 Safety Strategies

J Faught

J Faught*, L Schubert , Univ. of Colorado Denver, Aurora, CO


PO-BPC-Exhibit Hall-22 (Saturday, March 18, 2017)  Room: Exhibit Hall

Purpose: Guidance for comprehensive commissioning and clinical implementation of brachytherapy applicators is lacking. The goal of this work is to use safety strategies recommended by AAPM TG-100 to comprehensively commission new HDR brachytherapy applicators.

Methods: A procedure for brachytherapy applicator commissioning was formulated based on risk mitigation strategies. Potential failure modes of HDR treatment when using the new applicators were identified from prospective assessment and retrospective incident learning. Commissioning tests and widespread training efforts were performed to address the identified failure modes.

Results: Failure modes associated with using a new HDR segmented cylinder applicator set included erroneous assembly of the applicator, incorrect treatment length during planning or delivery, and incorrect identification of the most distal source position during planning. Characterization of the applicators using physical measurements and imaging verified functionality of clamping nuts, treatment lengths, and distal source position. A new treatment length, which significantly differed from the older applicator model, was discovered. Failure modes when assembling the cylinder were identified and emphasized during training. Detailed procedure guides were generated, including planning guides, cylinder assembly and verification guides, and pre-treatment safety checklists. Training was completed for each group involved in the HDR treatment process in our clinic including radiation oncologists, physicists, dosimetrists, and nurses.

Conclusion: The introduction of new brachytherapy applicators presents an array of potential clinical failures. TG-100 recommended risk analysis strategies were used to commission and clinically implement new HDR brachytherapy applicator set, resulting in robust testing, procedures, and training.

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