48 results on '"Ouhib Z"'
Search Results
2. Surface brachytherapy: Joint report of the AAPM and the GEC-ESTRO Task Group No. 253
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Fulkerson RK, Perez-Calatayud J, Ballester F, Buzurovic I, Kim Y, Niatsetski Y, Ouhib Z, Pai S, Rivard MJ, Rong Y, Siebert FA, Thomadsen BR, and Weigand F
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skin brachytherapy, surface applicator QA, surface brachytherapy - Abstract
The surface brachytherapy Task Group report number 253 discusses the common treatment modalities and applicators typically used to treat lesions on the body surface. Details of commissioning and calibration of the applicators and systems are discussed and examples are given for a risk-based analysis approach to the quality assurance measures that are necessary to consider when establishing a surface brachytherapy program.
- Published
- 2020
3. Failure mode and effects analysis of skin electronic brachytherapy using Esteya (R) unit
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Ibanez-Rosello, B, Bautista-Ballesteros, JA, Bonaque, J, Celada, F, Lliso, F, Carmona, V, Gimeno-Olmos, J, Ouhib, Z, Rosello, J, and Perez-Calatayud, J
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Esteya ,skin cancer ,electronic brachytherapy ,QA ,TG-100 ,FMEA - Abstract
Purpose: Esteya (R) (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) is an electronic brachytherapy device used for skin cancer lesion treatment. In order to establish an adequate level of quality of treatment, a risk analysis of the Esteya treatment process has been done, following the methodology proposed by the TG-100 guidelines of the American Association of Physicists in Medicine (AAPM). Material and methods: A multidisciplinary team familiar with the treatment process was formed. This team developed a process map (PM) outlining the stages, through which a patient passed when subjected to the Esteya treatment. They identified potential failure modes (FM) and each individual FM was assessed for the severity (S), frequency of occurrence (0), and lack of detection (D). A list of existing quality management tools was developed and the FMs were consensually reevaluated. Finally, the FMs were ranked according to their risk priority number (RPN) and their S. Results: 146 FMs were identified, 106 of which had RPN >= 50 and 30 had S >= 7. After introducing the quality management tools, only 21 FMs had RPN >= 50. The importance of ensuring contact between the applicator and the surface of the patient's skin was emphasized, so the setup was reviewed by a second individual before each treatment session with periodic quality control to ensure stability of the applicator pressure. Some of the essential quality management tools are already being implemented in the installation are the simple templates for reproducible positioning of skin applicators, that help marking the treatment area and positioning of X-ray tube. Conclusions: New quality management tools have been established as a result of the application of the failure modes and effects analysis (FMEA) treatment. However, periodic update of the FMEA process is necessary, since clinical experience has suggested occurring of further new possible potential failure modes.
- Published
- 2016
4. Commissioning and quality assurance procedures for the HDR Valencia skin applicators
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Granero, D, Candela-Juan, C, Ballester, F, Ouhib, Z, Vijande, J, Richart, J, and Perez-Calatayud, J
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dosimetry ,Valencia applicators ,brachytherapy ,commissioning ,Ir-192 ,QA - Abstract
The Valencia applicators (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) are cup-shaped tungsten applicators with a flattening filter used to collimate the radiation produced by a high-dose-rate (HDR) Ir-192 source, and provide a homogeneous absorbed dose at a given depth. This beam quality provides a good option for the treatment of skin lesions at shallow depth (3-4 mm). The user must perform commissioning and periodic testing of these applicators to guarantee the proper and safe delivery of the intended absorbed dose, as recommended in the standards in radiation oncology. In this study, based on AAPM and GEC-ESTRO guidelines for brachytherapy units and our experience, a set of tests for the commissioning and periodic testing of the Valencia applicators is proposed. These include general considerations, verification of the manufacturer documentation and physical integrity, evaluation of the source-to-indexer distance and reproducibility, setting the library plan in the treatment planning system, evaluation of flatness and symmetry, absolute output and percentage depth dose verification, independent calculation of the treatment time, and visual inspection of the applicator before each treatment. For each test, the proposed methodology, equipment, frequency, expected results, and tolerance levels (when applicable) are provided.
- Published
- 2016
5. Response to 'Comment on 'Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry'' [Med. Phys. 42, 4954-4964 (2015)]
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Candela-Juan C, Vijande J, Garcia-Martinez T, Niatsetski Y, Nauta G, Schuurman J, Ouhib Z, Ballester F, and Perez-Calatayud J
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Brachytherapy ,Radiometry - Published
- 2016
6. Aspects of dosimetry and clinical practice of skin brachytherapy: The American Brachytherapy Society working group report
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Ouhib, Z, Kasper, M, Caatayud, JP, Rodriguez, S, Bhatnagar, A, Pais, S, and Strasswimrner, J
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High dose rate ,Clinical target volume ,Nonmelanoma skin cancer ,Squamous cell carcinoma ,Electronic brachytherapy ,Basal cell carcinoma ,Gross target volume ,Planning target volume ,Ir-192 ,Biological equivalent dose - Abstract
PURPOSE: Nonmelanoma skin cancers (NMSCs) are the most common type of human malignancy. Although surgical techniques are the standard treatment, radiation therapy using photons, electrons, and brachytherapy (BT) (radionuclide-based and electronic) has been an important mode of treatment in specific clinical situations. The purpose of this work is to provide a clinical and dosimetric summary of the use of BT for the treatment of NMSC and to describe the different BT approaches used in treating cutaneous malignancies. METHODS AND MATERIALS: A group of experts from the fields of radiation oncology, medical physics, and dermatology, who specialize in managing cutaneous malignancies reviewed the literature and compiled their clinical experience regarding the clinical and dosimetric aspects of skin BT. RESULTS: A dosimetric and clinical review of both high dose rate (Ir-192) and electronic BT treatment including surface, interstitial, and custom mold applicators is given. Patient evaluation tools such as staging, imaging, and patient selection criteria are discussed. Guidelines for clinical and dosimetric planning, appropriate margin delineation, and applicator selection are suggested. Dose prescription and dose fractionation schedules, as well as prescription depth are discussed. Commissioning and quality assurance requirements are also outlined. CONCLUSIONS: Given the limited published data for skin BT, this article is a summary of the limited literature and best practices currently in use for the treatment of NMSC. (C) 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
- Published
- 2015
7. Commissioning and periodic tests of the Esteya (R) electronic brachytherapy system
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Candela-Juan, C, Niatsetski, Y, Ouhib, Z, Ballester, F, Vijande, J, and Perez-Calatayud, J
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Esteya ,electronic brachytherapy ,commissioning ,quality assurance - Abstract
A new electronic brachytherapy unit from Elekta, called Esteya(R), has recently been introduced to the market. As a part of the standards in radiation oncology, an acceptance testing and commissioning must be performed prior to treatment of the first patient. In addition, a quality assurance program should be implemented. A complete commissioning and periodic testing of the Esteya(R) device using the American Association of Physicists in Medicine (AAPM), Groupe Europeen de Curietherapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO) guidelines for linacs and brachytherapy units as well as our personal experience is described in this paper. In addition to the methodology, recommendations on equipment required for each test are provided, taking into consideration their availability and traceability of the detectors. Finally, tolerance levels for all the tests are provided, and a specific frequency for each test is suggested.
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- 2015
8. Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry
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Candela-Juan, C, Vijande, J, Garcia-Martinez, T, Niatsetski, Y, Nauta, G, Schuurman, J, Ouhib, Z, Ballester, F, and Perez-Calatayud, J
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dosimetry ,electronic brachytherapy ,surface applicators ,uncertainty ,x-ray beams - Abstract
Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (
- Published
- 2015
9. Non-melanoma skin cancer treated with HDR Valencia applicator: clinical outcomes
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Tormo A, Celada F, Rodriguez S, Botella R, Ballesta A, Kasper M, Ouhib Z, Santos M, and Perez-Calatayud J
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skin cancer ,Valencia applicators ,HDR ,skin brachytherapy - Abstract
Purpose: Radiotherapy (RT) has played a significant role in treating non melanoma skin cancer (NMSC). High-dose-rate brachytherapy (HDR-BT) approaches have a paramount relevance due to their adaptability, patient protection, and variable dose fractionation schedules. Several innovative applicators have been introduced to the brachytherapy community. The Valencia applicator is a new superficial device that improves the dose distribution compared with the Leipzig applicator. The purpose of this work is to assess the tumor control, cosmesis, and toxicity in patients with NMSC treated with the Valencia applicator and a new regimen of hypofractionation. Material and methods: From January 2008 to March 2010, 32 patients with 45 NMSC lesions were treated with the Valencia applicator in the Hospital La Fe. The gross tumor volume was visually assessed, but the tumor depth was evaluated using ultrasound imaging. All lesions for the selected cases were limited to 4 mm depth. The prescription dose was 42 Gy in 6 or 7 fractions (biologically effective dose [BED] approximate to 70 Gy), delivered twice a week. Results: Ninety-eight percent of the lesions were locally controlled at 47 months from treatment. Ninety-three percent of patients were out at least 36 months from treatment. The treatment was well tolerated in all cases. The highest skin toxicity was grade 1 RTOG/EORTC, having resolved with topical treatment at 4 weeks in all but one case which required 2 months. There were no grade 2 or higher late adverse events. Conclusions: In patients with superficial basal cell carcinoma lesions less than 25 mm in maximum diameter, HDRBT treatment with the Valencia applicator using a hypofractionated regimen provides excellent results, for both cosmetic and local control at a minimum of 3 years follow-up. Moreover, the shorter hypofractionated regimen facilitates compliance, which is very relevant for the elderly patients in our series. Valencia applicators offer a simple, safe, quick, and attractive nonsurgical treatment option.
- Published
- 2014
10. SU‐F‐T‐270: A Technique for Modeling a Diode Array Into the TPS for Lung SBRT Patient Specific QA
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Curley, C, primary, Ouhib, Z, additional, and Leventouri, T, additional
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- 2016
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11. WE‐H‐BRC‐01: Failure Mode and Effects Analysis of Skin Electronic Brachytherapy Using Esteya Unit
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Ibanez‐Rosello, B, primary, Bautista‐Ballesteros, J, additional, Bonaque, J, additional, Lliso, F, additional, Carmona, V, additional, Gimeno, J, additional, Ouhib, Z, additional, and Perez‐Calatayud, J, additional
- Published
- 2016
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12. SU‐E‐T‐720: Surface Electronic Brachytherapy Dosimetry: Comparison and Uncertainty Evaluation of Different Calibration Protocols and Ionization Chambers
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Candela‐Juan, C, primary, Garcia‐Martinez, T, additional, Niatsetski, Y, additional, Schuurman, J, additional, Nauta, G, additional, Vijande, J, additional, Ouhib, Z, additional, Ballester, F, additional, and Perez‐Calatayud, J, additional
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- 2015
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13. TU-D-201-03: Proposed Solutions to End-Of-Life Issue
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Ouhib, Z., primary
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- 2015
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14. MO-D-BRD-01: Clinical Implementation of An Electronic Brachytherapy Program for the Skin
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Ouhib, Z., primary
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- 2015
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15. PD-0186: Dosimetric evaluation of the electronic brachytherapy system Esteya
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Perez-Calatayud, J., primary, Candela-Juan, C., additional, Vijande, J., additional, Ouhib, Z., additional, García-Martínez, T., additional, Niatsetski, Y., additional, Nauta, G., additional, Schuurman, J., additional, and Ballester, F., additional
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- 2015
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16. HDR Valencia Applicator in Nonmelanoma Skin Cancer: Clinical Outcomes
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Rodriguez Villalba, S., primary, Tormo, A., additional, Celada, F., additional, Botella, R., additional, Ballesta, A., additional, Hernandez, M., additional, Kasper, M., additional, Ouhib, Z., additional, Santos Ortega, M., additional, and Pérez- Calatayud, J., additional
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- 2014
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17. Comment on "Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry".
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Fulkerson, Regina, Candela-Juana, C., Vijande, J., García-Martínez, T., Niatsetski, Y., Nauta, G., Schuurman, J., Ouhib, Z., Ballester, F., and Perez-Calatayud, J.
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IONIZATION chambers ,RADIOISOTOPE brachytherapy ,RADIATION dosimetry ,CALIBRATION ,MEDICAL physics - Published
- 2016
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18. SU-E-J-180: A Characterization of the LAP Aquarius Phantom for External LAP Laser Alignment and MR Geometric Distortion Verification for the use of SRS Patient Simulation
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Vergara, D, primary, Shang, C, additional, Schramm, A, additional, McPhillips, P, additional, and Ouhib, Z, additional
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- 2012
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19. PO-328 NEW DESIGN OF THE VALENCIA APPLICATORS TO REDUCE RADIATION LEAKAGE
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Granero, D., primary, Perez-Calatayud, J., additional, Ballester, F., additional, Ouhib, Z., additional, Vijande, J., additional, and Richart, J., additional
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- 2012
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20. 733 poster PRELIMINARY CLINICAL RESULTS USING VALENCIA APPLICATOR AND A NEW FRACTIONATION IN NON MELANOMA SKIN TREATMENTS
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Tormo, A., primary, Pérez-Calatayud, J., additional, Roldan, S., additional, Lliso, F., additional, Miranda, S., additional, Meseguer, V. Carmona, additional, Antonini, P., additional, Kasper, M., additional, Ouhib, Z., additional, Pujol, C., additional, and Ballesta, A., additional
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- 2011
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21. 686 poster DOSIMETRY COMPARISON BETWEEN TG-43 AND MONTE CARLO CALCULATIONS USING THE FREIBURG FLAP FOR SKIN HDR BRACHYTHERAPY
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Vijande, J., primary, Ballester, F., additional, Domingo, G., additional, Ouhib, Z., additional, Pujades, M.D.C., additional, and Pérez-Calatayud, J., additional
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- 2011
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22. TU-SAM-BRB-04: The Use of Accuboost for Breast Boost Therapy
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Ouhib, Z, primary
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- 2010
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23. SU-FF-T-357: Preliminary Results of In-Vivo Dosimetry in Prostate IMRT Patients Using DVS Implantable Dosimeters
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Ouhib, Z, primary and Williams, T, additional
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- 2007
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24. SU-F-T-270: A Technique for Modeling a Diode Array Into the TPS for Lung SBRT Patient Specific QA
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Ouhib, Z [Lynn Regional Cancer Center, Delray Beach, FL (United States)]
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- 2016
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25. AAPM task group report 288: Recommendations for guiding radiotherapy event narratives.
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Thomadsen B, Kapur A, Blankenship B, Caldwell B, Claps L, Cunningham J, Elee J, Evans S, Ford E, Gilley D, Hayden S, Hintenlang K, Kapoor R, Kildea J, Kroger L, Kujundzic K, Liang Q, Mutic S, O'Donovan A, O'Hara M, Ouhib Z, Palta J, Pawlicki T, Salter W, Schmidt S, and Tripathi S
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- Humans, Risk Management, Narration, Radiotherapy
- Abstract
Incident reporting and learning systems provide an opportunity to identify systemic vulnerabilities that contribute to incidents and potentially degrade quality. The narrative of an incident is intended to provide a clear, easy to understand description of an incident. Unclear, incomplete or poorly organized narratives compromise the ability to learn from them. This report provides guidance for drafting effective narratives, with particular attention to the use of narratives in incident reporting and learning systems (IRLS). Examples are given that compare effective and less than effective narratives. This report is mostly directed to organizations that maintain IRLS, but also may be helpful for individuals who desire to write a useful narrative for entry into such a system. Recommendations include the following: (1) Systems should allow a one- or two-sentence, free-text synopsis of an incident without guessing at causes; (2) Information included should form a sequence of events with chronology; and (3) Reporting and learning systems should consider using the headings suggested to guide the reporter through the narrative: (a) incident occurrences and actions by role; (b) prior circumstances and actions; (c) method by which the incident was identified; (d) equipment related details if relevant; (e) recovery actions by role; (f) relevant time span between responses; (g) and how individuals affected during or immediately after incident. When possible and appropriate, supplementary information including relevant data elements should be included using numerical scales or drop-down choices outside of the narrative. Information that should not be included in the narrative includes: (a) patient health information (PHI); (b) conjecture or blame; (c) jargon abbreviations or details without specifying their significance; (d) causal analysis., (© 2024 American Association of Physicists in Medicine.)
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- 2024
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26. ACR-ABS-ASTRO Practice Parameter for the Performance of Low-Dose-Rate Brachytherapy.
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Woodhouse KD, Devlin PM, Kollmeier M, Lin LL, Orio P, Ouhib Z, Song D, Viswanathan AN, Watanabe Y, Yu Y, Small W Jr, and Schechter NR
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- Humans, Radiotherapy Dosage, Societies, Medical, United States, Brachytherapy, Neoplasms radiotherapy, Radiation Oncology
- Abstract
Aim/objectives/background: The American College of Radiology (ACR), the American Brachytherapy Society (ABS), and the American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for the performance of low-dose-rate (LDR) brachytherapy. LDR brachytherapy is the application of radioactive sources in or on tumors in a clinical setting with therapeutic intent. The advantages of LDR brachytherapy include improving therapeutic ratios with lower doses to nontarget organs-at-risk and higher doses to a specific target., Methods: This practice parameter was developed according to the process described under the heading. The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the Commission on Radiation Oncology, in collaboration with ABS and ASTRO., Results: This practice parameter was developed to serve as a tool in the appropriate application of this evolving technology in the care of cancer patients or other patients with conditions where radiation therapy is indicated. It addresses clinical implementation of LDR brachytherapy including personnel qualifications, quality assurance standards, indications, and suggested documentation. This includes a contemporary literature search., Conclusions: This practice parameter is a tool to guide the use of LDR brachytherapy and does not assess relative clinical indication for LDR brachytherapy when compared with other forms of brachytherapy or external beam therapy, but to focus on the best practices required to deliver LDR brachytherapy safely and effectively, when clinically indicated. Comparative costs of versus other modalities therapy may also need to be considered., Competing Interests: L.L.L. reports grants from National Cancer Institute, other from Astrazeneca, other from Pfizer, outside the submitted work. P.O. reports personal fees from Palette Life Sciences, outside the submitted work. D.S. reports grants from the National Cancer Institute, outside the submitted work. W.S. reports personal fees from Carl Zeiss Meditech, personal fees from Merck, personal fees from Varian, grants from University of Utah, other from NRG Oncology, outside the submitted work. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2022
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27. ACR-ABS-ASTRO Practice Parameter for Transperineal Permanent Brachytherapy of Prostate Cancer.
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Bittner NHJ, Cox BW, Davis B, King M, Lawton CAF, Merrick GS, Orio P, Ouhib Z, Rossi P, Showalter T, Small W Jr, and Schechter NR
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- Androgen Antagonists, Humans, Male, Patient Selection, Brachytherapy methods, Prostatic Neoplasms radiotherapy, Radiation Oncology
- Abstract
Aim/objectives/background: The American College of Radiology (ACR), American Brachytherapy Society (ABS), and American Society for Radiation Oncology (ASTRO) have jointly developed the following practice parameter for transperineal permanent brachytherapy of prostate cancer. Transperineal permanent brachytherapy of prostate cancer is the interstitial implantation of low-dose rate radioactive seeds into the prostate gland for the purpose of treating localized prostate cancer., Methods: This practice parameter was developed according to the process described under the heading The Process for Developing ACR Practice Parameters and Technical Standards on the ACR website (https://www.acr.org/Clinical-Resources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Radiation Oncology of the Commission on Radiation Oncology, in collaboration with ABS and ASTRO., Results: This practice parameter provides a framework for the appropriate use of low-dose rate brachytherapy in the treatment of prostate cancer either as monotherapy or as part of a treatment regimen combined with external-beam radiation therapy. The practice parameter defines the qualifications and responsibilities of all involved radiation oncology personnel, including the radiation oncologist, medical physicist, dosimetrist, radiation therapist, and nursing staff. Patient selection criteria and the utilization of supplemental therapies such as external-beam radiation therapy and androgen deprivation therapy are discussed. The logistics of the implant procedure, postimplant dosimetry assessment, and best practices with regard to safety and quality control are presented., Conclusions: Adherence to established standards can help to ensure that permanent prostate brachytherapy is delivered in a safe and efficacious manner., Competing Interests: P.O. reports personal fees from Palette Life Sciences, outside the submitted work; W.S. reports personal fees from Carl Zeiss Meditech, personal fees from Merck, personal fees from Varian, grants from University of Utah, other from NRG Oncology, outside the submitted work. The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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28. ACR-ABS-ACNM-ASTRO-SIR-SNMMI practice parameter for selective internal radiation therapy or radioembolization for treatment of liver malignancies.
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Hong K, Akinwande O, Bodei L, Chamarthy MR, Devlin PM, Elman S, Ganguli S, Kennedy AS, Koo SJ, Ouhib Z, Padia SA, Salem R, Selwyn RG, Yashar CM, Yoo DC, Zaki BI, Hartford AC, and Trimmer CK
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- Humans, Molecular Imaging, Yttrium Radioisotopes therapeutic use, Brachytherapy methods, Liver Neoplasms diagnostic imaging, Liver Neoplasms radiotherapy, Nuclear Medicine, Radiation Oncology
- Abstract
Purpose: The American College of Radiology (ACR), American Brachytherapy Society (ABS), American College of Nuclear Medicine (ACNM), American Society for Radiation Oncology (ASTRO), Society of Interventional Radiology (SIR), and Society of Nuclear Medicine and Molecular Imaging (SNMMI) have jointly developed a practice parameter on selective internal radiation therapy (SIRT) or radioembolization for treatment of liver malignancies. Radioembolization is the embolization of the hepatic arterial supply of hepatic primary tumors or metastases with a microsphere yttrium-90 brachytherapy device., Materials and Methods: The ACR -ABS -ACNM -ASTRO -SIR -SNMMI practice parameter for SIRT or radioembolization for treatment of liver malignancies was revised in accordance with the process described on the ACR website (https://www.acr.org/ClinicalResources/Practice-Parameters-and-Technical-Standards) by the Committee on Practice Parameters-Interventional and Cardiovascular Radiology of the ACR Commission on Interventional and Cardiovascular, Committee on Practice Parameters and Technical Standards-Nuclear Medicine and Molecular Imaging of the ACR Commission on Nuclear Medicine and Molecular Imaging and the Committee on Practice Parameters-Radiation Oncology of the ACR Commission on Radiation Oncology in collaboration with ABS, ACNM, ASTRO, SIR, and SNMMI., Results: This practice parameter is developed to serve as a tool in the appropriate application of radioembolization in the care of patients with conditions where indicated. It addresses clinical implementation of radioembolization including personnel qualifications, quality assurance standards, indications, and suggested documentation., Conclusions: This practice parameter is a tool to guide clinical use of radioembolization. It focuses on the best practices and principles to consider when using radioemboliozation effectively. The clinical benefit and medical necessity of the treatment should be tailored to each individual patient., (Copyright © 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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29. Development, implementation, and associated challenges of a new HDR brachytherapy program.
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Scanderbeg DJ, Yashar C, Ouhib Z, Jhingran A, and Einck J
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- Humans, Quality Assurance, Health Care, Radiation Oncology education, Radiotherapy Dosage, Safety Management, Brachytherapy adverse effects, Brachytherapy instrumentation, Brachytherapy methods, Brachytherapy standards, Program Development methods, Radiation Oncology organization & administration
- Abstract
Developing any new radiation oncology program requires planning and analysis of the current state of the facility and its capacity to take on another program. Staff must consider a large number of factors to establish a feasible, safe, and sustainable program. We present a simple and generic outline that lays out the process for developing and implementing a new HDR brachytherapy program in any setting, but with particular emphasis on challenges associated with starting the program in a limited resource setting. The sections include feasibility of a program, starting cases, machine and equipment selection, and quality and safety., (Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
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30. The ABS brachytherapy schools.
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Erickson B, Crook J, Vicini F, Arthur D, Ouhib Z, Thomadsen B, Bice W, Butler WM, Petereit DG, and Viswanathan AN
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- History, 20th Century, History, 21st Century, Humans, United States, Brachytherapy, Physics education, Radiation Oncology education, Schools history, Societies, Medical history
- Abstract
The American Brachytherapy Society brachytherapy schools have been pivotal in teaching and evolving the art of brachytherapy over the past decades. Founded in 1995, the schools have consistently provided content for the major disease sites including gynecologic, prostate, and breast with ocular, vascular, head and neck, pediatric, intraluminal, systemic, and intraoperative approaches more selectively addressed. In addition, Physics schools, either coupled with clinical schools or as stand-alone venues, have provided an essential educational component for practicing physicists, a pivotal part of the brachytherapy team. Celebrating 25 years in existence, this historical overview of the American Brachytherapy Society brachytherapy schools is a tribute to the many teachers who have shared their expertise, to the many students who have been enthusiastic and interactive participants, and the staff who have made it all possible, with the reward of perpetuating the important and timely art of brachytherapy., (Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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31. Safety practices and opportunities for improvement in brachytherapy: A patient safety practices survey of the American Brachytherapy Society membership.
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Sanders JC, Showalter TN, Ouhib Z, Thomadsen BR, Jacob D, Agarwal M, Cohen GN, Giles M, Palaniswammy G, Solanki AA, and Taunk NK
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- Brachytherapy adverse effects, Brachytherapy standards, Checklist, Communication, Female, Humans, Male, Organizational Culture, Patient Identification Systems statistics & numerical data, Personnel Staffing and Scheduling, Quality Improvement, Risk Management statistics & numerical data, Surveys and Questionnaires, Time Factors, Brachytherapy statistics & numerical data, Genital Neoplasms, Female radiotherapy, Patient Safety, Prostatic Neoplasms radiotherapy, Quality Assurance, Health Care statistics & numerical data, Radiation Oncology organization & administration
- Abstract
Purpose: Safe delivery of brachytherapy and establishing a safety culture are critical in high-quality brachytherapy. The American Brachytherapy Society (ABS) Quality and Safety Committee surveyed members regarding brachytherapy services offered, safety practices during treatment, quality assurance procedures, and needs to develop safety and training materials., Methods and Materials: A 22-item survey was sent to ABS membership in early 2019 to physicians, physicists, therapists, nurses, and administrators. Participation was voluntary. Responses were summarized with descriptive statistics and relative frequency distributions., Results: There were 103 unique responses. Approximately one in three was attending physicians and one in three attending physicists. Most were in practice >10 years. A total of 94% and 50% performed gynecologic and prostate brachytherapy, respectively. Ninety-one percent performed two-identification patient verification before treatment. Eighty-six percent performed a time-out. Ninety-five percent had an incident reporting or learning system, but only 71% regularly reviewed incidents. Half reviewed safety practices within the last year. Twenty percent reported they were somewhat or not satisfied with department safety culture, but 92% of respondents were interested in improving safety culture. Most reported time, communication, and staffing as barriers to improving safety. Most respondents desired safety-oriented webinars, self-assessment modules, learning modules, or checklists endorsed by the ABS to improve safety practice., Conclusions: Most but not all practices use standards and quality assurance procedures in line with society recommendations. There is a need to heighten safety culture at many departments and to shift resources (e.g., time or staffing) to improve safety practice. There is a desire for society guidance to improve brachytherapy safety practices. This is the first survey to assess safety practice patterns among a national sample of radiation oncologists with expertise in brachytherapy., (Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
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- 2020
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32. Dose-rate considerations for the INTRABEAM electronic brachytherapy system: Report from the American association of physicists in medicine task group no. 292.
- Author
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Culberson WS, Davis SD, Gwe-Ya Kim G, Lowenstein JR, Ouhib Z, Popovic M, Waldron TJ, Safigholi H, Simiele SJ, and Rivard MJ
- Subjects
- Calibration, Electronics, Germany, Radiometry, Radiotherapy Dosage, United States, Brachytherapy
- Abstract
The purpose of this report is to provide detailed guidance on the dosimetry of the INTRABEAM® (Carl Zeiss Medical AG, Jena, Germany) electronic brachytherapy (eBT) system as it stands at the present time. This report has been developed by the members of American Association of Physicists in Medicine (AAPM) Task Group 292 and endorsed by the AAPM. Members of AAPM Task Group 292 on Electronic-Brachytherapy Dosimetry have reviewed pertinent publications and user manuals regarding the INTRABEAM system dosimetry and manufacturer-supplied dose calculation protocols. Formal written correspondence with Zeiss has also provided further clarification. Dose-rate calculations for the INTRABEAM system are highly dependent on choice of dosimetry protocol. Even with careful protocol selection, large uncertainties remain due to the incomplete characterization of the ionization chambers used for verification with respect to their energy dependence as well as manufacturing variations. There are two distinct sets of dose-rate data provided by Zeiss for the INTRABEAM system. One dataset (Calibration V4.0) is representative of the physical dose surrounding the source and the other dataset (TARGIT) has been adjusted to be consistent with a clinical trial named TARGIT (TARGeted Intraoperative RadioTherapy). The adjusted TARGIT doses are quite dissimilar to the physical doses, with differences ranging from 14% to 30% at the surface of a spherical applicator, depending on its diameter, and up to a factor of two at closer distances with the smaller needle applicators. In addition, ion chamber selection and associated manufacturing tolerances contribute to significant additional uncertainties. With these substantial differences in dose rates and their associated uncertainties, it is important for users to be aware of how each value is calculated and whether it is appropriate to be used for the intended treatment. If users intend to deliver doses that are the same as they were in 1998 at the onset of the TARGIT trial, then the TARGIT dose-rate tables should be used. The Calibration V4.0 dose rates may be more appropriate to use for applications other than TARGIT trial treatments, since they more closely represent the physical doses being delivered. Users should also be aware of the substantial uncertainties associated with the provided dose rates, which are due to beam hardening, chamber geometry, and selection of the point-of-measurement for a given ionization chamber. This report serves to describe the details and implications of the manufacturer-recommended dosimetry formalism for users of the INTRABEAM system., (© 2020 American Association of Physicists in Medicine.)
- Published
- 2020
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33. The American Brachytherapy society consensus statement for skin brachytherapy.
- Author
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Shah C, Ouhib Z, Kamrava M, Koyfman SA, Campbell SR, Bhatnagar A, Canavan J, Husain Z, Barker CA, Cohen GN, Strasswimmer J, and Joshi N
- Subjects
- Brachytherapy methods, Consensus, Dose Fractionation, Radiation, Humans, Patient Selection, Radioisotopes therapeutic use, United States, Brachytherapy standards, Carcinoma, Basal Cell radiotherapy, Carcinoma, Squamous Cell radiotherapy, Skin Neoplasms radiotherapy
- Abstract
Purpose: Keratinocyte carcinoma (KC, previously nonmelanoma skin cancer) represents the most common cancer worldwide. While surgical treatment is commonly utilized, various radiation therapy techniques are available including external beam and brachytherapy. As such, the American Brachytherapy Society has created an updated consensus statement regarding the use of brachytherapy in the treatment of KCs., Methods: Physicians and physicists with expertise in skin cancer and brachytherapy created a consensus statement for appropriate patient selection, data, dosimetry, and utilization of skin brachytherapy and techniques based on a literature search and clinical experience., Results: Guidelines for patient selection, evaluation, and dose/fractionation schedules to optimize outcomes for patients with KC undergoing brachytherapy are presented. Studies of electronic brachytherapy are emerging, although limited long-term data or comparative data are available. Radionuclide-based brachytherapy represents an appropriate option for patients with small KCs with multiple techniques available., Conclusions: Skin brachytherapy represents a standard of care option for appropriately selected patients with KC. Radionuclide-based brachytherapy represents a well-established technique; however, the current recommendation is that electronic brachytherapy be used for KC on prospective clinical trial or registry because of a paucity of mature data., (Copyright © 2020 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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34. Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182.
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Thomadsen BR, Biggs PJ, Cardarelli GA, Chu JCH, Cormack RA, Feng W, Heaton HT 2nd, Hiatt JR, Law JN, Limmer JP, Ouhib Z, Pai S, Pillai S, Ringor MR, Rivard MJ, Waldron TJ, Caldwell BS, Holt RW, Pike TL, Safigholi H, Stacey C, and Weigand F
- Subjects
- Quality Control, Risk Assessment, Workflow, Brachytherapy instrumentation, Electrical Equipment and Supplies, Research Report, Societies, Medical
- Abstract
Purpose: The purpose of this study was to provide guidance on quality management for electronic brachytherapy., Materials and Methods: The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation. To demonstrate the methodology to extend an existing risk analysis for a different application, the task group modified the analysis for the case of post-hysterectomy, vaginal cuff irradiation for one of the devices., Results: The analysis illustrated how the TG-100 methodology can lead to interventions to reduce risks and improve quality for each unit and procedure addressed., Conclusion: This report provides a model to guide facilities establishing a quality management program for electronic brachytherapy., (© 2019 American Association of Physicists in Medicine.)
- Published
- 2020
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- View/download PDF
35. American College of Radiology-American Brachytherapy Society practice parameter for electronically generated low-energy radiation sources.
- Author
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Devlin PM, Gaspar LE, Buzurovic I, Demanes DJ, Kasper ME, Nag S, Ouhib Z, Petit JH, Rosenthal SA, Small W Jr, Wallner PE, and Hartford AC
- Subjects
- Brachytherapy instrumentation, Brachytherapy methods, Brachytherapy standards, Breast Neoplasms radiotherapy, Female, Humans, Medical Oncology education, Neoplasms radiotherapy, Patient Safety, Patient Selection, Radiotherapy methods, Radiotherapy Planning, Computer-Assisted methods, Radiotherapy Planning, Computer-Assisted standards, Skin Neoplasms radiotherapy, Societies, Medical, United States, Radiotherapy instrumentation, Radiotherapy standards
- Abstract
Background: This collaborative practice parameter technical standard has been created between the American College of Radiology and American Brachytherapy Society to guide the usage of electronically generated low energy radiation sources (ELSs). It refers to the use of electronic X-ray sources with peak voltages up to 120 kVp to deliver therapeutic radiation therapy., Main Findings: The parameter provides a guideline for utilizing ELS, including patient selection and consent, treatment planning, and delivery processes. The parameter reviews the published clinical data with regard to ELS results in skin, breast, and other cancers., Conclusions: This technical standard recommends appropriate qualifications of the involved personnel. The parameter reviews the technical issues relating to equipment specifications as well as patient and personnel safety. Regarding suggestions for educational programs with regard to this parameter,it is suggested that the training level for clinicians be equivalent to that for other radiation therapies. It also suggests that ELS must be done using the same standards of quality and safety as those in place for other forms of radiation therapy., (Copyright © 2017 American Brachytherapy Society and American College of Radiology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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36. In the era of IGRT and small- and focal-field external beam radiotherapy, brachytherapy is a dying modality.
- Author
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Ishmael Parsai E, Ouhib Z, and Orton CG
- Subjects
- Brachytherapy adverse effects, Brachytherapy instrumentation, Brachytherapy methods, Humans, Neoplasms radiotherapy, Brachytherapy trends
- Published
- 2017
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- View/download PDF
37. Failure mode and effects analysis of skin electronic brachytherapy using Esteya ® unit.
- Author
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Ibanez-Rosello B, Bautista-Ballesteros JA, Bonaque J, Celada F, Lliso F, Carmona V, Gimeno-Olmos J, Ouhib Z, Rosello J, and Perez-Calatayud J
- Abstract
Purpose: Esteya
® (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) is an electronic brachytherapy device used for skin cancer lesion treatment. In order to establish an adequate level of quality of treatment, a risk analysis of the Esteya treatment process has been done, following the methodology proposed by the TG-100 guidelines of the American Association of Physicists in Medicine (AAPM)., Material and Methods: A multidisciplinary team familiar with the treatment process was formed. This team developed a process map (PM) outlining the stages, through which a patient passed when subjected to the Esteya treatment. They identified potential failure modes (FM) and each individual FM was assessed for the severity (S), frequency of occurrence (O), and lack of detection (D). A list of existing quality management tools was developed and the FMs were consensually reevaluated. Finally, the FMs were ranked according to their risk priority number (RPN) and their S., Results: 146 FMs were identified, 106 of which had RPN ≥ 50 and 30 had S ≥ 7. After introducing the quality management tools, only 21 FMs had RPN ≥ 50. The importance of ensuring contact between the applicator and the surface of the patient's skin was emphasized, so the setup was reviewed by a second individual before each treatment session with periodic quality control to ensure stability of the applicator pressure. Some of the essential quality management tools are already being implemented in the installation are the simple templates for reproducible positioning of skin applicators, that help marking the treatment area and positioning of X-ray tube., Conclusions: New quality management tools have been established as a result of the application of the failure modes and effects analysis (FMEA) treatment. However, periodic update of the FMEA process is necessary, since clinical experience has suggested occurring of further new possible potential failure modes.- Published
- 2016
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38. Commissioning and quality assurance procedures for the HDR Valencia skin applicators.
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Granero D, Candela-Juan C, Ballester F, Ouhib Z, Vijande J, Richart J, and Perez-Calatayud J
- Abstract
The Valencia applicators (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) are cup-shaped tungsten applicators with a flattening filter used to collimate the radiation produced by a high-dose-rate (HDR)
192 Ir source, and provide a homogeneous absorbed dose at a given depth. This beam quality provides a good option for the treatment of skin lesions at shallow depth (3-4 mm). The user must perform commissioning and periodic testing of these applicators to guarantee the proper and safe delivery of the intended absorbed dose, as recommended in the standards in radiation oncology. In this study, based on AAPM and GEC-ESTRO guidelines for brachytherapy units and our experience, a set of tests for the commissioning and periodic testing of the Valencia applicators is proposed. These include general considerations, verification of the manufacturer documentation and physical integrity, evaluation of the source-to-indexer distance and reproducibility, setting the library plan in the treatment planning system, evaluation of flatness and symmetry, absolute output and percentage depth dose verification, independent calculation of the treatment time, and visual inspection of the applicator before each treatment. For each test, the proposed methodology, equipment, frequency, expected results, and tolerance levels (when applicable) are provided.- Published
- 2016
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39. Guidelines by the AAPM and GEC-ESTRO on the use of innovative brachytherapy devices and applications: Report of Task Group 167.
- Author
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Nath R, Rivard MJ, DeWerd LA, Dezarn WA, Thompson Heaton H 2nd, Ibbott GS, Meigooni AS, Ouhib Z, Rusch TW, Siebert FA, and Venselaar JLM
- Abstract
Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used in the evaluation of innovative devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining the equivalence of the innovative treatment modality to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of innovative radiotherapy devices or applications is a critical part in which physicists should be actively involved. The physicist's role, along with physician colleagues, in this process is highlighted for innovative brachytherapy devices and applications and includes evaluation of (1) dosimetric considerations for clinical implementation (including calibrations, dose calculations, and radiobiological aspects) to comply with existing societal dosimetric prerequisites for sources in routine clinical use, (2) risks and benefits from a regulatory and safety perspective, and (3) resource assessment and preparedness. Further, it is suggested that any developed calibration methods be traceable to a primary standards dosimetry laboratory (PSDL) such as the National Institute of Standards and Technology in the U.S. or to other PSDLs located elsewhere such as in Europe. Clinical users should follow standards as approved by their country's regulatory agencies that approved such a brachytherapy device. Integration of this system into the medical source calibration infrastructure of secondary standard dosimetry laboratories such as the Accredited Dosimetry Calibration Laboratories in the U.S. is encouraged before a source is introduced into widespread routine clinical use. The American Association of Physicists in Medicine and the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) have developed guidelines for the safe and consistent application of brachytherapy using innovative devices and applications. The current report covers regulatory approvals, calibration, dose calculations, radiobiological issues, and overall safety concerns that should be addressed during the commissioning stage preceding clinical use. These guidelines are based on review of requirements of the U.S. Nuclear Regulatory Commission, U.S. Department of Transportation, International Electrotechnical Commission Medical Electrical Equipment Standard 60601, U.S. Food and Drug Administration, European Commission for CE Marking (Conformité Européenne), and institutional review boards and radiation safety committees.
- Published
- 2016
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40. Aspects of dosimetry and clinical practice of skin brachytherapy: The American Brachytherapy Society working group report.
- Author
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Ouhib Z, Kasper M, Perez Calatayud J, Rodriguez S, Bhatnagar A, Pai S, and Strasswimmer J
- Subjects
- Brachytherapy instrumentation, Carcinoma, Basal Cell pathology, Carcinoma, Squamous Cell pathology, Dose Fractionation, Radiation, Humans, Patient Selection, Practice Guidelines as Topic, Quality Assurance, Health Care, Skin Neoplasms pathology, United States, Brachytherapy methods, Carcinoma, Basal Cell radiotherapy, Carcinoma, Squamous Cell radiotherapy, Skin Neoplasms radiotherapy, Societies, Medical
- Abstract
Purpose: Nonmelanoma skin cancers (NMSCs) are the most common type of human malignancy. Although surgical techniques are the standard treatment, radiation therapy using photons, electrons, and brachytherapy (BT) (radionuclide-based and electronic) has been an important mode of treatment in specific clinical situations. The purpose of this work is to provide a clinical and dosimetric summary of the use of BT for the treatment of NMSC and to describe the different BT approaches used in treating cutaneous malignancies., Methods and Materials: A group of experts from the fields of radiation oncology, medical physics, and dermatology, who specialize in managing cutaneous malignancies reviewed the literature and compiled their clinical experience regarding the clinical and dosimetric aspects of skin BT., Results: A dosimetric and clinical review of both high dose rate ((192)Ir) and electronic BT treatment including surface, interstitial, and custom mold applicators is given. Patient evaluation tools such as staging, imaging, and patient selection criteria are discussed. Guidelines for clinical and dosimetric planning, appropriate margin delineation, and applicator selection are suggested. Dose prescription and dose fractionation schedules, as well as prescription depth are discussed. Commissioning and quality assurance requirements are also outlined., Conclusions: Given the limited published data for skin BT, this article is a summary of the limited literature and best practices currently in use for the treatment of NMSC., (Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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41. AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams.
- Author
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Smilowitz JB, Das IJ, Feygelman V, Fraass BA, Kry SF, Marshall IR, Mihailidis DN, Ouhib Z, Ritter T, Snyder MG, and Fairobent L
- Subjects
- Humans, Male, Practice Guidelines as Topic, Radiotherapy Dosage, United States, Electrons, Health Physics standards, Photons, Prostatic Neoplasms radiotherapy, Quality Assurance, Health Care standards, Radiation Oncology standards, Radiotherapy Planning, Computer-Assisted standards
- Abstract
The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:• Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.• Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.
- Published
- 2015
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42. Comparison and uncertainty evaluation of different calibration protocols and ionization chambers for low-energy surface brachytherapy dosimetry.
- Author
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Candela-Juan C, Vijande J, García-Martínez T, Niatsetski Y, Nauta G, Schuurman J, Ouhib Z, Ballester F, and Perez-Calatayud J
- Subjects
- Calibration, Phantoms, Imaging, Photons, Uncertainty, Water, X-Rays, Brachytherapy instrumentation, Brachytherapy methods, Radiometry instrumentation, Radiometry methods
- Abstract
Purpose: A surface electronic brachytherapy (EBT) device is in fact an x-ray source collimated with specific applicators. Low-energy (<100 kVp) x-ray beam dosimetry faces several challenges that need to be addressed. A number of calibration protocols have been published for x-ray beam dosimetry. The media in which measurements are performed are the fundamental difference between them. The aim of this study was to evaluate the surface dose rate of a low-energy x-ray source with small field applicators using different calibration standards and different small-volume ionization chambers, comparing the values and uncertainties of each methodology., Methods: The surface dose rate of the EBT unit Esteya (Elekta Brachytherapy, The Netherlands), a 69.5 kVp x-ray source with applicators of 10, 15, 20, 25, and 30 mm diameter, was evaluated using the AAPM TG-61 (based on air kerma) and International Atomic Energy Agency (IAEA) TRS-398 (based on absorbed dose to water) dosimetry protocols for low-energy photon beams. A plane parallel T34013 ionization chamber (PTW Freiburg, Germany) calibrated in terms of both absorbed dose to water and air kerma was used to compare the two dosimetry protocols. Another PTW chamber of the same model was used to evaluate the reproducibility between these chambers. Measurements were also performed with two different Exradin A20 (Standard Imaging, Inc., Middleton, WI) chambers calibrated in terms of air kerma., Results: Differences between surface dose rates measured in air and in water using the T34013 chamber range from 1.6% to 3.3%. No field size dependence has been observed. Differences are below 3.7% when measurements with the A20 and the T34013 chambers calibrated in air are compared. Estimated uncertainty (with coverage factor k = 1) for the T34013 chamber calibrated in water is 2.2%-2.4%, whereas it increases to 2.5% and 2.7% for the A20 and T34013 chambers calibrated in air, respectively. The output factors, measured with the PTW chambers, differ by less than 1.1% for any applicator size when compared to the output factors that were measured with the A20 chamber., Conclusions: Measurements using both dosimetric protocols are consistent, once the overall uncertainties are considered. There is also consistency between measurements performed with both chambers calibrated in air. Both the T34013 and A20 chambers have negligible stem effect. Any x-ray surface brachytherapy system, including Esteya, can be characterized using either one of these calibration protocols and ionization chambers. Having less correction factors, lower uncertainty, and based on measurements, performed in closer to clinical conditions, the TRS-398 protocol seems to be the preferred option.
- Published
- 2015
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43. Commissioning and periodic tests of the Esteya(®) electronic brachytherapy system.
- Author
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Candela-Juan C, Niatsetski Y, Ouhib Z, Ballester F, Vijande J, and Perez-Calatayud J
- Abstract
A new electronic brachytherapy unit from Elekta, called Esteya(®), has recently been introduced to the market. As a part of the standards in radiation oncology, an acceptance testing and commissioning must be performed prior to treatment of the first patient. In addition, a quality assurance program should be implemented. A complete commissioning and periodic testing of the Esteya(®) device using the American Association of Physicists in Medicine (AAPM), Groupe Européen de Curiethérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO) guidelines for linacs and brachytherapy units as well as our personal experience is described in this paper. In addition to the methodology, recommendations on equipment required for each test are provided, taking into consideration their availability and traceability of the detectors. Finally, tolerance levels for all the tests are provided, and a specific frequency for each test is suggested.
- Published
- 2015
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44. Complete response of endemic Kaposi sarcoma lesions with high-dose-rate brachytherapy: treatment method, results, and toxicity using skin surface applicators.
- Author
-
Kasper ME, Richter S, Warren N, Benda R, Shang C, and Ouhib Z
- Subjects
- Aged, Aged, 80 and over, Biopsy, Dose-Response Relationship, Radiation, Female, Follow-Up Studies, Humans, Male, Neoplasm Recurrence, Local radiotherapy, Radiotherapy, High-Energy, Retrospective Studies, Skin pathology, Brachytherapy methods, Sarcoma, Kaposi radiotherapy, Skin radiation effects, Skin Neoplasms radiotherapy
- Abstract
Purpose: To analyze the clinical outcome of Kaposi sarcoma skin lesions treated with high-dose-rate (HDR) brachytherapy in patients with a minimum of 2 years of followup., Methods and Materials: Between February 2006 and July 2008, all patients with Kaposi sarcoma who received (192)Ir HDR brachytherapy using a skin surface applicator were evaluated for clinical response. Responses to treatment and toxicity were scored using standard criteria., Results: Sixteen cases were collected. Treatment was delivered in four to six fractions, over a period of approximately 12 days. The specified dose ranged from 24 to 35Gy. Median followup the lesion was 41.4 months. No lesion was greater than 2cm. All patients had a complete response to treatment, with no evidence of local recurrence or tumor progression. Thirteen lesions developed Grade 1 and two lesions had Grade 2 acute skin reactions. One patient developed late skin changes with telangiectasias and hypopigmentation., Conclusions: HDR brachytherapy treatment seems to be an effective noninvasive option for patients with small cutaneous Kaposi sarcoma lesions, delivering excellent cosmesis and local control in our small series. Fewer fractions over a shorter period used in our group offer patients more convenience compared with other common regimens. Although HDR is being used more frequently for many surface applications, additional clinical studies with larger numbers of patients and longer followup are needed to confirm the general impression that it is an excellent option for many patients., (Copyright © 2013 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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45. Dosimetry comparison between TG-43 and Monte Carlo calculations using the Freiburg flap for skin high-dose-rate brachytherapy.
- Author
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Vijande J, Ballester F, Ouhib Z, Granero D, Pujades-Claumarchirant MC, and Perez-Calatayud J
- Subjects
- Equipment Design, Equipment Failure Analysis, Humans, Monte Carlo Method, Radiotherapy Dosage, Reproducibility of Results, Sensitivity and Specificity, Brachytherapy instrumentation, Radiotherapy Planning, Computer-Assisted methods, Skin radiation effects, Skin Neoplasms radiotherapy, Software
- Abstract
Purpose: The purpose of this work was to evaluate whether the delivered dose to the skin surface and at the prescription depth when using a Freiburg flap applicator is in agreement with the one predicted by the treatment planning system (TPS) using the TG-43 dose-calculation formalism., Methods and Materials: Monte Carlo (MC) simulations and radiochromic film measurements have been performed to obtain dose distributions with the source located at the center of one of the spheres and between two spheres. Primary and scatter dose contributions were evaluated to understand the role played by the scatter component. A standard treatment plan was generated using MC- and TG-43-based TPS applying the superposition principle., Results: The MC model has been validated by performing additional simulations in the same conditions but transforming air and Freiburg flap materials into water to match TG-43 parameters. Both dose distributions differ less than 1%. Scatter defect compared with TG-43 data is up to 15% when the source is located at the center of the sphere and up to 25% when the source is between two spheres. Maximum deviations between TPS- and MC-based distributions are of 5%., Conclusions: The deviations in the TG-43-based dose distributions for a standard treatment plan with respect to the MC dose distribution calculated taking into account the composition and shape of the applicator and the surrounding air are lower than 5%. Therefore, this study supports the validity of the TPS used in clinical practice., (Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
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46. Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: report of the AAPM and ESTRO.
- Author
-
Perez-Calatayud J, Ballester F, Das RK, Dewerd LA, Ibbott GS, Meigooni AS, Ouhib Z, Rivard MJ, Sloboda RS, and Williamson JF
- Subjects
- Anisotropy, Humans, Monte Carlo Method, Phantoms, Imaging, Radioisotopes therapeutic use, Radiometry, Radiotherapy Dosage, Brachytherapy methods, Photons therapeutic use, Radiation Dosage, Research Report, Societies, Medical
- Abstract
Purpose: Recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO) on dose calculations for high-energy (average energy higher than 50 keV) photon-emitting brachytherapy sources are presented, including the physical characteristics of specific (192)Ir, (137)Cs, and (60)Co source models., Methods: This report has been prepared by the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group. This report includes considerations in the application of the TG-43U1 formalism to high-energy photon-emitting sources with particular attention to phantom size effects, interpolation accuracy dependence on dose calculation grid size, and dosimetry parameter dependence on source active length., Results: Consensus datasets for commercially available high-energy photon sources are provided, along with recommended methods for evaluating these datasets. Recommendations on dosimetry characterization methods, mainly using experimental procedures and Monte Carlo, are established and discussed. Also included are methodological recommendations on detector choice, detector energy response characterization and phantom materials, and measurement specification methodology. Uncertainty analyses are discussed and recommendations for high-energy sources without consensus datasets are given., Conclusions: Recommended consensus datasets for high-energy sources have been derived for sources that were commercially available as of January 2010. Data are presented according to the AAPM TG-43U1 formalism, with modified interpolation and extrapolation techniques of the AAPM TG-43U1S1 report for the 2D anisotropy function and radial dose function.
- Published
- 2012
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47. Accurate verification of balloon rotation correction for the Contura multilumen device for accelerated partial breast irradiation.
- Author
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Ouhib Z, Benda R, Kasper M, Vargas C, Kyriacou A, and Lyden M
- Subjects
- Breast Neoplasms diagnostic imaging, Breast Neoplasms surgery, Female, Fiducial Markers, Follow-Up Studies, Humans, Mastectomy, Segmental, Radiotherapy Dosage, Reproducibility of Results, Tomography, X-Ray Computed methods, Brachytherapy instrumentation, Breast Neoplasms radiotherapy, Catheters
- Abstract
Purpose: To validate a method of accurately confirming the orientation of the Contura multilumen balloon catheter before each fraction and to determine if any residual device rotation remains after adjustment., Methods and Materials: Sixteen patients underwent CT scans before each treatment with accelerated partial breast irradiation. Before acquisition of CT scans for planning, each patient had a skin mark drawn to align with Lumen #1 (the Contura [SenoRx, Inc., Irvine, CA] has a black line on the shaft of the applicator to identify this lumen). In addition, a CT spot marker was used as a fixed reference point on the patient's skin. CT markers (used for lumen identification and reconstruction) were also used as additional reference points for distance measurements. The distances measured from the CT spot marker to the three reproducible points on the CT markers were used for balloon rotation verification. These measurements were performed for each daily fraction on reproducible CT axial views., Results: Three hundred eighteen measurements were obtained. Median residual rotation for all cases was 0.2mm (standard deviation=0.797). Later fractions and skin spacing changes over time were associated with slightly greater residual rotation (Fraction #1 vs. Fraction #10, 0.1 vs. 0.3mm, p=0.05; and skin spacing change ≤2 vs. >2mm, 0.2 vs. 0.5mm, p=0.0019, respectively)., Conclusions: These results confirm external alignment of a skin mark with Lumen #1 (on the Contura catheter) is an accurate and reliable method to align the balloon before treatment and that no significant internal device rotation (0.2mm) is likely to occur., (Copyright © 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
- View/download PDF
48. Off-label use of medical products in radiation therapy: summary of the report of AAPM Task Group No. 121.
- Author
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Thomadsen BR, Heaton HT 2nd, Jani SK, Masten JP, Napolitano ME, Ouhib Z, Reft CS, Rivard MJ, Robin TT, Subramanian M, and Suleiman OH
- Subjects
- Brachytherapy instrumentation, Humans, Liability, Legal, Microspheres, Neoplasms therapy, Off-Label Use statistics & numerical data, Reimbursement Mechanisms legislation & jurisprudence, United States, Advisory Committees, Equipment and Supplies, Off-Label Use legislation & jurisprudence, Radiotherapy instrumentation, Societies, Scientific, United States Food and Drug Administration legislation & jurisprudence
- Abstract
Medical products (devices, drugs, or biologics) contain information in their labeling regarding the manner in which the manufacturer has determined that the products can be used in a safe and effective manner. The Food and Drug Administration (FDA) approves medical products for use for these specific indications which are part of the medical product's labeling. When medical products are used in a manner not specified in the labeling, it is commonly referred to as off-label use. The practice of medicine allows for this off-label use to treat individual patients, but the ethical and legal implications for such unapproved use can be confusing. Although the responsibility and, ultimately, the liability for off-label use often rests with the prescribing physician, medical physicists and others are also responsible for the safe and proper use of the medical products. When these products are used for purposes other than which they were approved, it is important for medical physicists to understand their responsibilities. In the United States, medical products can only be marketed if officially cleared, approved, or licensed by the FDA; they can be used if they are not subject to or specifically exempt from FDA regulations, or if they are being used in research with the appropriate regulatory safeguards. Medical devices are either cleared or approved by FDA's Center for Devices and Radiological Health. Drugs are approved by FDA's Center for Drug Evaluation and Research, and biological products such as vaccines or blood are licensed under a biologics license agreement by FDA's Center for Biologics Evaluation and Research. For the purpose of this report, the process by which the FDA eventually clears, approves, or licenses such products for marketing in the United States will be referred to as approval. This report summarizes the various ways medical products, primarily medical devices, can legally be brought to market in the United States, and includes a discussion of the approval process, along with manufacturers' responsibilities, labeling, marketing and promotion, and off-label use. This is an educational and descriptive report and does not contain prescriptive recommendations. This report addresses the role of the medical physicist in clinical situations involving off-label use. Case studies in radiation therapy are presented. Any mention of commercial products is for identification only; it does not imply recommendations or endorsements of any of the authors or the AAPM. The full report, containing extensive background on off-label use with several appendices, is available on the AAPM website (http://www.aapm.org/pubs/reports/).
- Published
- 2010
- Full Text
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