Accuracy of Intracavitary Applicator Reconstruction for Cervix Cancer Brachytherapy

Abstract

The accuracy of intracavitary applicator reconstruction for cervical cancer was assessed. A homemade phantom that mimics clinical applicator placement and reference points was used. Three stainless steel (15°, 30°, and 45°) tandems, x-ray markers, and three reference points were used to compare radiography- and CT-based systems. For CT reconstructions, two Fletcher CT compatible (15° and 30°) tandems, two ovoids, and two reference points, with and without inserted x-ray markers, were used. A 2.5-mm CT slice thickness was used. To check for inter- and intra-operator variations in CT, only a 30° tandem without x-ray markers and 1.25-mm CT slice thickness were used. Applicators were reconstructed three times for each image set to verify the operator reproducibility. A 6 Gy dose was prescribed and normalized at AL-point. Source dwell times were compared to check for dose variation at A-point. Maximum standard deviations SD (σ) for radiography and CT reconstructions were 0.35 and 0.83 mm, respectively. Analysis of variance for the means of 15° and 30° tandems showed no significant difference. Levene’s test proved insignificant difference for 15° tandem (p value = 0.131), whereas it showed a significant difference for 30° tandem (p value = 0.011). This phantom study showed that the variance of dwell times between the two methods for 30° tandem was statistically significant due to increased applicator curvature. CT proves superiority to radiography. X-ray marker method was more accurate but has less image quality. Inter- and intra-oncologist variations showed good agreement.