WP4 - TG43
Chair: Javier Viyande and José Perez-Calatayud
The TG43 data of "conventional" brachytherapy sources -mainly 137Cs and 192Ir sources- are collected by the group at the University of Valencia. New sources or new source data can be added. Data are also included on low-energy photon emitting brachytherapy sources (125I, 103Pd) that comply with the prerequisites of AAPM TG-43. If consensus datatsets could be obtained by the AAPM, these are included on the ESTRO web page. The contents are supervised by a BRAPHYQS expert team. A new entrance to the BRAPHYQS website data can be accessed. The BRAPHYQS group has written a short introductory text to the TG-43 data site with explanation on use and background information. Research data -which means: non-validated sets of TG43 data- will stay available using the 2nd website still located at the University of Valencia: http://www.uv.es/braphyqs. Transfer of the data from the http://www.uv.es/braphyqs site to this site has been done.
Some members of BRAPHYQS group are also members of the AAPM Brachytherapy Subcommittee (BTSC) and its working groups. In these positions, they represent the ESTRO community, reflected in an ESTRO’s co-sponsorship of the reports “Dosimetric prerequisites for routine clinical use of photon emitting brachytherapy sources with average energy higher than 50 keV” by Zuofeng Li et al., Med Phys. Dec 2007; 34:37-40) and “Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO” by Perez-Calatayud et al. Med. Phys. 39 (5), May 2012.
The coordination between BRAPHYQS group and the BTSC Subcommittee leads to a full consensus on the data of the LowEnergy as well High Energy Brachytherapy Dosimetry data, with an Internet presentation of such data using links from the ESTRO site to USA counterparts and vice versa.
WP14: In-vivo dosimetry, risk management and registries in brachytherapy
Chair: Jacob Johannsen
A key challenge in radiotherapy including brachytherapy is to provide a safe and preferably incidence-free treatment. This can best be achieved by monitoring of dose delivery and regular quality assurance and quality control. The aim of this working package is to ensure a high utilisation of dose delivery monitoring and reduce the risk of incidences. The primary mean to achieve the first part is through enhancing the usage of in vivo dosimetry, which is the most direct way of monitoring dose delivery. The second part will focus on central registries for incidence-based learning.
In 2020, an ESTRO task group published two “White Paper” on the current status of in vivo dosimetry and requirements needed before in vivo dosimetry can be a part of the daily clinical brachytherapy practice- both for brachytherapy and external beam radiotherapy (Olaciregui-Ruiz I et al. 2020 Aug 29;15:108-116, Fonseca GP et al. Phys Imaging Radiat Oncol. 2020 Sep 28;16:1-11).
Furthermore, a survey about patient-specific quality assurance and quality control are being prepared. The aim is to get insight into what means are currently being used to ensure a safe treatment around Europe, and to investigate if state-of-the-art method are being employed.
WP17 - Dicom standard in brachytherapy
Chair: Yury Niatsetki
The goal of the WP 17 DICOM Standard in Brachytherapy is to improve interconnectivity between different planning systems in brachytherapy, facilitating plan comparison for clinical studies:
1) Evaluation of dose distributions used for treatment
2) Exchange of treatment plans between TPS of different vendors
3) Compare 3D treatment planning dose calculations
These are not fully covered in the currently used 1st generation DICOM RT objects because the those were developed more than 20 years ago.
BRAPHYQS group is one of the stakeholders of the DICOM WG-07 Brachytherapy Subgroup, working on 2nd generation DICOM RT objects and on the IHE-RO (Integrating the Healthcare Enterprise – Radiation Oncology) Brachytherapy Workflow profile, addressing solutions for interconnectivity issues using the DICOM objects provided in its 1st generation.
WP19: Quality Control of Brachytherapy Treatment Planning Systems
Chair: Marisol De Brabandere
Currently there are no dedicated, practical reports available on commissioning and quality assurance (QA) of treatment planning systems (TPS) for brachytherapy. Most of the existing reports and handbooks on TPS commissioning are either too concise or too theoretical, or are focusing on external beam therapy only. The aim of the WP19 project is
1) to provide users with guidelines for commissioning and quality assurance (QA) of brachytherapy treatment planning systems at the time of implementation and after minor and major software upgrades/updates;
2) to provide a set of practical tools (spreadsheets, DICOM sets, checklists, …) to validate the TPS calculation accuracy and performance.
Unlike other work packages within BRAPHYQS, WP19 is an open project with support of non-BRAPHYQS members. An appeal for contributors was made in 2017, resulting in a group of brachytherapy physicists from all over Europe. Representatives from the American Association of Physicists in Medicine (AAPM) and Australasian Brachytherapy Group (ABG) are included. In spring 2018 an application for ACROP approval was submitted to ESTRO.
Five main subtopics have been defined for this report: (a) geometry and imaging, (b) source specification, (c) dose calculation accuracy and representation, (d) (library) applicator specification and (e) output/data transfer and reporting. For each topic a coordinator and several contributors were assigned. The guidelines will handle both HDR/PDR/LDR and seed implant brachytherapy. It will focus on TG43-based algorithms only; for advanced MC-based dose calculation algorithms the report will refer to existing AAPM reports on this topic. As of summer 2022, the draft manuscript is almost complete.
The use of an accurate treatment planning system (TPS) for dose calculation of brachytherapy treatment plans is essential for precise, safe and efficacious brachytherapy treatment. Several TPS functionalities need to be verified before clinical implementation (commissioning), such as image geometry, source and applicator specification and dose calculation accuracy. The GEC-ESTRO BRAPHYQS Working Group 19 (WP19) has defined recommendations to validate a TG-43 based treatment planning system:
De Brabandere M, Beaulieu L, Dejean C, Dempsey C, Lee C, Mason J, Rivard M. J., Perez-Calatayud J, Smith R, Steenhuijsen J, Walter R, Workman G, Zuchora A, Siebert F-A 2025 GEC-ESTRO guidelines for commissioning and quality assurance of TG-43 based brachytherapy treatment planning systems, Radiother Oncol 210 111008
WP21 Calibration in high-energy photon brachytherapy
Chair: Javier Vijande Asenjo
The WP21 group aim is to present guidance for brachytherapy (BT) high energy (HE) source calibrations, including practical aspects and issues not specifically accounted for in the former current and well-accepted societal recommendations. This European guideline report has impact to all European sites offering HDR/PDR BT to ensure a high quality in HE source calibration. This presented recommendations report complements for HE the recently published ACROP BRAPHYQS WP18 report dedicated to low energy (seeds) (Radiother Oncol 2019). With both reports, the medical physicist has available a set of clear societal recommendations to consistently address the aspects of BT source calibration.
In particular, the rationale and charges of WP21 is to guide users of HE HDR-PDR BT sources (Ir-192 and Co-60) on:
- Calibration of HE sources and the instruments and to keep these efficiently operative (including an updated list of available calibration laboratories in Europe). Comparison of users RAKR measurements with manufacturer’s calibration and required procedures when potential discrepancies exceed an action limit.
- In addition, WP-21 evidenced that there is an ambiguous responsibility definition of source leakage verification, being also the aim of this report to help with this issue.
These recommendations will reflect the guidance to the ESTRO BT users and describe the procedures in a clinic or hospital to ensure the correct calibration of HE HDR (and PDR) sources.
WP22 Ru-106 eye plaque brachytherapy
Chair: Åsa Carlsson Tedgren
Co-chair: Lotte Fog
The WP-22 is a collaboration between Braphyqs and the GEC ESTRO Head Neck, Skin and Eye Working Group including also an extended network of international participants. It started by conducting two surveys on physics and clinical practice. The physicist survey has been published while the physician part is a work in progress. A continuation of the WP-22 is likely.
De Brabandere M, Placidi E, Siebert F-A, Carlsson Tedgren Å, Slocker Escarpa A, Tagliaferri L, Andrássy M, Schultz C, Fog L S 2024 GEC-ESTRO survey of 106Ru eye applicator practice for ocular melanoma - Physicist survey, Radiother Oncol 193 110114
WP23: The Medical Device Regulation
Chair: Jacob Johannsen
The EU regulation 2017/745 (Medical Device Regulation, MDR) has now succeeded the directive 93/42ECC (MDD). The implication of the MDR and the impact on the current brachytherapy procedure is still not clear, and it has led to uncertainty within the committee regarding, e.g. how to adhere to this. For instance, what is allowed in terms of in-house usage, sharing with clinics in the same country or even worldwide. What is considered a medical device in the MDR etc. It is also not clear how this will impact the availability and maintenance of the many different afterloaders and applicators. The aim of this work package is to provide guidelines for clinics on how to adhere to the MDR e.g. when using in-house developed equipment, and to give an overview of how the MDR will impact brachytherapy.
Two sessions on the MDR are organised for the GEC-ESTRO workshop 2023. The two sessions addresses the challenge from the users side and the vendors side respectively.
WP 24 - Dose accumulation for external beam radiotherapy and brachytherapy
Chairs: Laura van Heerden and Taran Hellebust
The goal of this working group is to review the current status on performing dose accumulation for external beam radiotherapy (EBRT) and multiple brachytherapy (BT) fractions. For some treatment sites, it remains unclear whether total dose evaluation for combined EBRT and BT is necessary, and which methods should be used. This uncertainty hinders broader adoption in clinical practice.
To address this, we identify key tools and functionalities essential for accurate dose accumulation. These will be outlined in a consensus paper currently in preparation. By defining these requirements, we aim to guide software vendors in developing solutions that support the planning, evaluation, and delivery of accumulated doses for both BT and EBRT.