Medical Physics Contribution:| Volume 43, ISSUE 2, P150-158, June 2018

Evolution of brachytherapy treatment planning to deterministic radiation transport for calculation of cardiac dose


      Brachytherapy was among the first methods of radiotherapy and has steadily continued to evolve. Here we present a brief review of the progression of dose calculation methods in brachytherapy to the current state-of-the art computerized methods for heterogeneity correction. We further review the origin and development of the BrachyVision (Varian Medical Systems, Inc., Palo Alto, CA) treatment planning system and evaluate dosimetric results from 12 patients implanted with the strut-assisted volumetric implant (SAVI) applicator (Cianna Medical, Aliso Viejo, CA) for accelerated partial breast irradiation (APBI). Dosimetric results from plans calculated using homogenous and heterogeneous algorithms have been compared to investigate the impact of heterogeneity corrections. Our study showed large percent difference between mean cardiac doses 11.8 ± 6.2% (p = 0.0007) calculated with and without heterogeneity corrections. Our findings are consistent with those of others, indicating an overestimation of the distal dose to organs-at-risk by traditional methods, especially at interfaces between air and tissue.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Medical Dosimetry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mould R.F.
        A Century of X-Rays and Radioactivity in Medicine: With Emphasis on Photographic Records of the Early Years.
        CRC Press, Boca Raton, FL1993
        • Hilaris B.S.
        Brachytherapy, Conquering Cancer, The First 100 Years.
        Best Cure Foundation, Brachytherapy Research & Educational Foundation, Springfield, VA2014
        • Williamson J.F.
        Semi-empirical dose-calculation models in brachytherapy.
        in: Brachytherapy Physics. 2nd ed. American Association of Physicists in Medicine Medical Monograph 31, Madison, WI2004
        • Aronowitz J.N.
        • Rivard M.J.
        The evolution of computerized treatment planning for brachytherapy: American contributions.
        J. Contemp. Brachytherapy. 2014; 6: 185-190
        • Nath R.
        • Anderson L.L.
        • Luxton G.
        • et al.
        Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group No. 43.
        Med. Phys. 1995; 22: 209-234
        • Venselaar J.
        • Baltas D.
        • Meigooni A.
        • et al.
        Comprehensive brachytherapy: Physical and clinical aspects, imaging.
        in: Hendee W.R. Medical Diagnosis and Therapy. CRC/Taylor & Francis Group, Boca Raton, FL2013
        • Rivard M.J.
        • Coursey B.M.
        • DeWerd L.A.
        • et al.
        Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations.
        Med. Phys. 2004; 31: 633-674
        • Rivard M.J.
        • Butler W.M.
        • DeWerd L.A.
        • et al.
        Supplement to the 2004 update of the AAPM Task Group No. 43 Report.
        Med. Phys. 2007; 34: 2187-2205
        • Rivard M.J.
        • Butler W.M.
        • DeWerd L.A.
        • et al.
        Supplement 2 for the 2004 update of the AAPM Task Group No. 43 Report: Joint recommendations by the AAPM and GEC-ESTRO.
        Med. Phys. 2017;
        • Rivard M.J.
        • Venselaar J.L.
        • Beaulieu L.
        The evolution of brachytherapy treatment planning.
        Med. Phys. 2009; 36: 2136-2153
        • McDermott P.N.
        Tutorials in Radiotherapy Physics: Advanced Topics with Problems and Solutions.
        CRC Press, 2016
        • Scanderbeg D.J.
        • Yashar C.
        • Rice R.
        • et al.
        Clinical implementation of a new HDR brachytherapy device for partial breast irradiation.
        Radiother. Oncol. 2009; 90: 36-42
        • Yashar C.M.
        • Scanderbeg D.
        • Kuske R.
        • et al.
        Initial clinical experience with the Strut-Adjusted Volume Implant (SAVI) breast brachytherapy device for accelerated partial-breast irradiation (APBI): first 100 patients with more than 1 year of follow-up.
        Int. J. Radiat. Oncol. Biol. Phys. 2011; 80: 765-770
        • Gurdalli S.
        • Kuske R.R.
        • Quiet C.A.
        • et al.
        Dosimetric performance of strut-adjusted volume implant: a new single-entry multicatheter breast brachytherapy applicator.
        Brachytherapy. 2011; 10: 128-135
        • Fisher B.
        • Daugherty L.
        • Shaikh T.
        • et al.
        Tumor bed-to-skin distance using accelerated partial-breast irradiation with the strut-adjusted volume implant device.
        Brachytherapy. 2012; 11: 387-391
      1. NSABP. B-39, RTOG 0413: A randomized phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I, or II breast cancer.
        Clin. Adv. Hematol. Oncol. 2006; 4: 719-721
        • Darby S.C.
        • McGale P.
        • Taylor C.W.
        • et al.
        Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: Prospective cohort study of about 300 000 women in US SEER cancer registries.
        Lancet Oncol. 2005; 6: 557-565
        • Taylor C.W.
        • Nisbet A.
        • McGale P.
        • et al.
        Cardiac exposures in breast cancer radiotherapy: 1950s–1990s.
        Int. J. Radiat. Oncol. Biol. Phys. 2007; 69: 1484-1495
        • Shah C.
        • Badiyan S.
        • Berry S.
        • et al.
        Cardiac dose sparing and avoidance techniques in breast cancer radiotherapy.
        Radiother. Oncol. 2014; 112: 9-16
        • Varian Medical Systems
        BrachyVision version 13.7: Installation product acceptance.
        Var. Med. Syst. 2016; (IPA-BV-137-B)
        • Beaulieu L.
        • Carlsson Tedgren Å.
        • Carrier J.F.
        • et al.
        Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation.
        Med. Phys. 2012; 39: 6208-6236
        • Kubo H.D.
        • Glasgow G.P.
        • Pethel T.D.
        • et al.
        High dose-rate brachytherapy treatment delivery: Report of the AAPM Radiation Therapy Committee Task Group No. 59.
        Med. Phys. 1998; 25: 375-403
        • Feng M.
        • Moran J.M.
        • Koelling T.
        • et al.
        Development and validation of a heart atlas to study cardiac exposure to radiation following treatment for breast cancer.
        Int. J. Radiat. Oncol. Biol. Phys. 2011; 79: 10-18
        • Varian Medical Systems
        BrachyVision algorithms reference guide.
        Var. Med. Syst. 2017; (P1020725-001-A)
        • Worsnop R.
        Personal communication.
        (January 27-28)2018
        • Wald M.L.
        2 Radiation overdoses prompt federal inquiry.
        (New York Times [New York City, NY] December, 17)1992
        • Prionas S.
        Personal communication.
        (January 24)2018
        • Varian Medical Systems
        BrachyVision instructions for use.
        Var. Med. Syst. 2017; (P1020506-002-B)
        • Varian Medical Systems
        BrachyVision reference guide.
        Var. Med. Syst. 2017; (P1020507-002-B)
        • Rutter C.E.
        • Chagpar A.B.
        • Evans S.B.
        Breast cancer laterality does not influence survival in a large modern cohort: Implications for radiation-related cardiac mortality.
        Int. J. Radiat. Oncol. Biol. Phys. 2014; 90: 329-334
        • Weed D.W.
        • Edmundson G.K.
        • Vicini F.A.
        • et al.
        Accelerated partial breast irradiation: A dosimetric comparison of three different techniques.
        Brachytherapy. 2005; 4: 121-129
        • Patel R.R.
        • Becker S.J.
        • Das R.K.
        • et al.
        A dosimetric comparison of accelerated partial breast irradiation techniques: Multicatheter interstitial brachytherapy, three-dimensional conformal radiotherapy, and supine versus prone helical tomotherapy.
        Int. J. Radiat. Oncol. Biol. Phys. 2007; 68: 935-942
        • Khan A.J.
        • Goyal S.
        • Vicini F.A.
        Cardiac avoidance in breast radiotherapy: Many choices for a worthwhile objective.
        Front. Oncol. 2014; 4: 269
        • Sardaro A.
        • Petruzzelli M.F.
        • D'Errico M.P.
        • et al.
        Radiation-induced cardiac damage in early left breast cancer patients: Risk factors, biological mechanisms, radiobiology, and dosimetric constraints.
        Radiother. Oncol. 2012; 103: 133-142
        • Zagar T.M.
        • Marks L.B.
        Breast cancer radiotherapy and coronary artery stenosis: Location, location, location.
        • Sinacki M.
        • Serkies K.
        • Dziadziuszko R.
        • et al.
        Radiation dose to the left anterior descending coronary artery during interstitial pulsed-dose-rate brachytherapy used as a boost in breast cancer patients undergoing organ-sparing treatment.
        J. Contemp. Brachytherapy. 2017; 9: 7
        • Sinnatamby M.
        • Nagarajan V.
        • Reddy K.S.
        • et al.
        Dosimetric comparison of Acuros™ BV with AAPM TG43 dose calculation formalism in breast interstitial high-dose-rate brachytherapy with the use of metal catheters.
        J. Contemp. Brachytherapy. 2015; 7: 273
        • Chen K.L.
        • Pino R.
        • Bloch C.
        • et al.
        Dosimetric comparison of TG-43 formalism with Brachyvision Acuros and Monte Carlo method for partial breast irradiation with MammoSite device.
        Brachytherapy. 2013; 12: S60-S61
        • Richardson S.
        • Chen K.L.
        • Pino R.
        • et al.
        Dosimetric comparison of TG-43 formalism with brachyvision Acuros and Monte Carlo method for patients treated with the SAVI partial breast applicator.
        Brachytherapy. 2013; 12: S22-S23