1.
Pre-Treatment Planning
1.1 Patient Evaluation and Imaging
1. Review the patient’s clinical history, pathology reports,
and treatment goals.
2. Coordinate with the radiation oncologist to determine
the appropriate imaging modality (e.g., CT, MRI,
ultrasound).
3. Ensure that imaging protocols are optimized for
brachytherapy planning (e.g., slice thickness, contrast
use).
4. Verify that all imaging data is transferred to the
treatment planning system (TPS).
1.2 Treatment Planning System Setup
1. Import imaging data into the TPS.
2. Define the target volume (GTV, CTV, PTV) and organs
at risk (OARs) based on imaging.
3. Select the appropriate brachytherapy technique (e.g.,
HDR, LDR, interstitial, intracavitary).
4. Choose the correct source model and verify its
calibration date.
5. Set up dose constraints according to institutional
protocols or international guidelines (e.g., AAPM,
ESTRO).
1.3 Source Calibration and Verification
1. Verify the source strength (activity) using a well
chamber or other appropriate dosimetry equipment.
2. Cross-check the source activity with the manufacturer’s
certificate.
3. Document the source calibration results and ensure
they are within acceptable tolerances.
4. Perform periodic quality assurance (QA) checks on the
afterloader or source delivery system.
2. Treatment Delivery
2.1 Applicator Placement
1. Collaborate with the radiation oncologist and/or
surgeon during applicator placement.
2. Confirm that the applicator is positioned accurately
using imaging (e.g., fluoroscopy, CT, or ultrasound).
3. Document the applicator type, size, and position
relative to the target volume.
2.2 Image-Guided Planning
1. Acquire post-implant imaging (CT, MRI, or X-ray) to
verify applicator placement.
2. Reconstruct the applicator geometry in the TPS.
3. Adjust the source dwell positions and times to optimize
dose distribution.
4. Perform dose-volume histogram (DVH) analysis to
ensure target coverage and OAR sparing.
2.3 Dose Calculation and Optimization
1. Use the TPS to calculate the dose distribution based on
the source dwell positions and times.
2. Optimize the plan to meet the prescribed dose to the
target while minimizing dose to OARs.
3. Review the plan with the radiation oncologist to ensure
it meets clinical objectives.
4. Document all planning parameters, including source
dwell times, positions, and total dose.
2.4 Treatment Delivery Verification
1. Perform an independent verification of the treatment
plan using secondary dose calculation software or
manual calculations.
2. Verify the source dwell positions and times against the
treatment plan.
3. Conduct a final check of the afterloader or source
delivery system before treatment initiation.
4. Monitor the treatment delivery in real-time using
imaging or other verification tools (e.g., in vivo
dosimetry).
3. Post-Treatment Procedures
3.1 Post-Treatment Imaging and Dosimetry
1. Acquire post-treatment imaging (if applicable) to verify
source placement and dose delivery.
2. Perform post-implant dosimetry (e.g., for permanent
seed implants) to assess the actual dose distribution.
3. Compare the planned dose distribution with the
delivered dose and document any discrepancies.
4. Quality Assurance (QA) and Safety
•Objective: Ensure the accuracy and reliability of
brachytherapy equipment.
1. Perform daily, monthly, and annual QA checks on the
afterloader, imaging systems, and TPS.
2. Verify the mechanical integrity of applicators and
source delivery systems.
3. Conduct periodic end-to-end testing to simulate the
entire brachytherapy process.
4.2 Radiation Safety
1. Follow institutional radiation safety protocols, including
time, distance, and shielding principles.
2. Monitor radiation levels in the treatment room using
area monitors.
3. Ensure proper storage and handling of radioactive
sources.
4. Document all radiation safety incidents and report
them to the appropriate regulatory bodies.
5. Carry out annual emergency drill.
5. Documentation and Reporting
5.1 Record Keeping
1. Document all aspects of the treatment planning,
delivery, and post-treatment evaluation.
2. Store imaging data, treatment plans, and dose
distributions in a treatment planning system
3. Retain records for the required regulatory period (e.g.,
10 years or more, depending on local regulations).
5.2 Reporting
Prepare a summary report of the treatment plan,
including dose distributions, DVHs, and any deviations
from the plan.
