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Kudla-Hooper, Michael William

University of British Columbia

Purpose: Delivering conformal treatment plans for high dose rate (HDR) gynaecological (GYN) brachytherapy (BT) using commercially available applicators can be challenging in many clinical cases. The intent of this work is to describe a treatment technology suite developed to enable treatment customization for patients with difficult-to-treat gynaecological malignancies. Methods: A workflow has been created for the creation of patient-specific cylindrical templates (PSCTs), which facilitate preplanned needle trajectories for interstitial (IS) Vaginal HDR-BT. This includes software for design automation, manufacturing processes, and sterilization. The workflow was evaluated for pre-clinical feasibility, including dosimetry, sterilization, and manufacturing quality. The Tandem and Cylinder (T&C) template has been developed for the treatment of cervical malignancies, and has a standard design which can be customized for difficult treatment cases. Both devices were evaluated in treatment cohorts, assessing preplan reproducibility, treatment dosimetry, outcomes, and practicality. A novel, easy-to-use, and fast software algorithm to generate candidate needle trajectory sets for GYN HDR-BT PSCTs is presented. Auto-planned trajectory set-based preplans were compared to original patient preplans for a retrospective patient cohort. Results: Needle trajectories can be exported directly from treatment planning software and converted into a 3D printable PSCT. PSCTs are shown to be manufactured to a clinical quality, and sterilizable. Prospective treatment plans are shown to be equivalent or improved as compared to highly specialized modern techniques. Both treatment cohorts for both PSCTs and T&C patients showed excellent treatment dosimetry, needle position reproducibility, and outcome. Auto-planner-based preplans were of high clinical quality, were equivalent in dosimetry to manually created preplans, and treatment plan libraries were able to be created very quickly. Conclusions: The technology suite developed during this research can be used to successfully preplan and deliver highly conformal treatment plans for IS GYN HDR-BT. The treatment devices are shown to be reliable and to deliver preplans accurately, and to be easy-to-use, compared to traditional treatment techniques. The autoplanning software significantly eases the pre-planning process of the PSCT, without loss of plan quality. This technology suite represents a significant step forward in the personalization of GYN HDR-BT and stands as a platform for future development.

Text

2023-08-10

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/85443

Medical Physics

University of British Columbia

UBCO

http://creativecommons.org/licenses/by-nc-nd/4.0/