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Evolution of Brachytherapy Treatment Planning to Deterministic Radiation Transport for Calculation of Cardiac Dose
Peter A. Sandwall, PhD,* Yuntao Feng, PhD,* Michael Platt, DMP,† Michael Lamba, PhD,† and Sudha Mahalingam, MD.*
*OhioHealth—Radiation Oncology, Columbus, Ohio 43214; †College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267; and ‡American Brachytherapy Society and American Society for Radiation Oncology
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 Brachy Vision (Varian Medical Systems,Inc.,PaloAlto,CA)treatmentplanningsystemandevaluatedosimetricresultsfrom 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.