Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-10T15:52:18.319Z Has data issue: false hasContentIssue false
  • English
  • Français

The implementation of a PDR 3D-guided gynaecological brachytherapy service in a UK centre

Published online by Cambridge University Press:  19 August 2013

D. Wood ,
L. Lane ,
W. Gillespie ,
S. Baker  and
C. Rowbottom
D. Wood*
Affiliation:
CMPE, The Christie NHS Foundation Trust, Manchester, UK
L. Lane
Affiliation:
CMPE, The Christie NHS Foundation Trust, Manchester, UK
W. Gillespie
Affiliation:
CMPE, The Christie NHS Foundation Trust, Manchester, UK
S. Baker
Affiliation:
CMPE, The Christie NHS Foundation Trust, Manchester, UK
C. Rowbottom
Affiliation:
CMPE, The Christie NHS Foundation Trust, Manchester, UK
*
Correspondence to: David Wood, CMPE, The Christie NHS Foundation Trust, Radiotherapy Theatre, Wilmslow Road, Manchester M20 4BX, UK. Tel: +441614463983. Fax: +441614463520. E-mail: David.wood@christie.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Due to the discontinuation of the widely used low-dose rate (LDR) Caesium afterloader units, many centres in the past 10 years have moved from LDR Selectron treatments to Iridium 192 afterloaders. While the majority of UK centres have opted for high-dose rate (HDR) units, the Christie have invested in two pulsed dose rate (PDR) afterloaders alongside a move to full 3D-planned gynaecological brachytherapy.

Purpose

To share the experience and learning curve involved in the implementation of a 3D-guided PDR brachytherapy service.

Methods

The specific logistical and practical challenges of implementing a PDR service are discussed alongside the more general challenges of implementing 3D-guided magnetic resonance (MR) based brachytherapy. A multidisciplinary approach was undertaken to streamline the patient pathway and give all disciplines a forum to discuss service improvements and resolve problems.

Conclusions

The lessons learned throughout this experience can inform the decisions of departments that may wish to implement a PDR service or indeed a 3D image-guided HDR brachytherapy service in the future. The focus on the utilisation of lean principles to the patient pathway, improved multidisciplinary working and enhancing service efficiency is of interest to all centres.

Keywords

BrachytherapycervixGEC-ESTROgynaeIGBTimage guidedMRIPDRreconstruction
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 3 , September 2014 , pp. 322 - 331
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Nucletron Customer Information Bulletin CIB-ARD 190.233-01A: Availability of sources and service discontinuation announcement. Scope: Selectron-LDR/MDR. Veenendaal, The Netherlands.Google Scholar
2.The Royal College of Radiologists. Implementing Image-Guided Brachytherapy for Cervix Cancer in the UK. London: The Royal College of Radiologists, 2009. ISBN 978-1-905034-36-9.Google Scholar
3.Davidson, S E, Hendry, J H, West, C M. Point: why choose pulsed dose-rate brachytherapy for treating gynaecologic cancers? Brachytherapy 2009; 8 (3): 269–272.Google Scholar
4.Baker, S, Pooler, A, Hendry, J, Davidson, S. The implementation of the Gynaecological Groupe Europeen de Curietherapiee European Society for Therapeutic Radiology and Oncology Radiobiology Considerations in the conversion of low dose rate to pulsed dose rate treatment schedules for gynaecological brachytherapy. Clin Oncol 2013; 25: 265–271.Google Scholar
5.Tan, L. Implementation of image-guided brachytherapy for cervix cancer in the UK: progress update. Clin Oncol 2011; 23: 681–684.Google Scholar
6.Jones, D. Lean thinking in the NHS Lean enterprise academy, Lean Healthcare network. http://leanuk.org/downloads/health/lean_thinking_for_the_nhs.pdf. Accessed on 29th April 2013.Google Scholar
7.Department of Health. The NHS cancer plan: a plan for investment, a plan for reform; Department of Health; Crown Copyright. London, 2000.Google Scholar
8.Fleissig, A, Jenkins, V, Catt, S, Fallowfield, L. Multidisciplinary teams in cancer care: are they effective in the UK? Lancet Oncol 2006; 7 (11): 935–943.CrossRefGoogle ScholarPubMed
9.Underwood, T, Dale, R, Bidmead, A, Nalder, C. Pulsed brachytherapy: a modelled consideration of repair parameter uncertainties and their influence on treatment duration extension and daytime-only ‘‘block schemes’’. Br J Radiol 2011; 84: 449–456.CrossRefGoogle ScholarPubMed
10.Krempien, R C, Daeuber, S, Hensley, F W, Wannenmacher, M, Harms, W. Image fusion of CT and MRI data enables improved target volume definition in 3D-brachytherapy treatment planning. Brachytherapy 2003; 2 (3): 164–171.Google Scholar
11.Hellebust, T P, Kirisits, C, Berger, Det al. Recommendations from Gynaecological (GYN) GEC-ESTRO working group: considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy. Radiother Oncol 2010; 96: 153–160.CrossRefGoogle Scholar
12.Dimopoulos, J, Petrow, P, Tanderup, Ket al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother Oncol 2012; 103: 113–122.CrossRefGoogle Scholar
13.Tanderup, K, Paulsen, T, Lang, Set al. Consequences of random and systematic reconstruction uncertainties in 3D image based brachytherapy in cervical cancer. Radiother Oncol 2008; 89: 156–163.CrossRefGoogle ScholarPubMed
14.Haie-Meder, C, Potter, R, Limber, Eet al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group* (I): concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV. Radiother Oncol 2005; 74: 235–245.CrossRefGoogle Scholar
15.Potter, R, Haie-Meder, C, Van Limbergen, Eet al. Recommendations from gynaecological (GYN) GEC ESTRO working group (II): concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology. Radiother Oncol 2006; 78 (1): 67–77.Google Scholar
16.Tanderup, K, Hudej, R, Lowe, Get al. EMBRACE Study Protocol. https://www.embracestudy.dk/UserUpload/PublicDocuments/Applicator%20reconstruction%20catalogue.PDF. Accessed 4th March 2013.Google Scholar
17.Haack, S, Kynde, S, Lindegaard, J, Gelineck, J, Tanderup, K. Applicator reconstruction in MRI 3D image-based dose planning of brachytherapy for cervical cancer. Radiother Oncol 2009; 91: 187–193.Google Scholar
18.Pötter, R, Georg, P, Dimopoulos, J Cet al. Clinical outcome of protocol based image (MRI) guided adaptive brachytherapy combined with 3D conformal radiotherapy with or without chemotherapy in patients with locally advanced cervical cancer. Radiother Oncol 2011; 100 (1): 116–123.Google Scholar
19.Donaldson, S R. Towards Safer Radiotherapy. London: British Institute of Radiology, Institute of Physics and Engineering in Medicine, National Patient Safety Agency, Society and College of Radiographers, The Royal College of Radiologists, 2007.Google Scholar