The use of isodose curves on radiographs and on CT scans in interstitial brachytherapy

In brachytherapy an accurate dose distribution is usually not definable, and therefore not required. If flexible catheters are implanted, such as in head and neck cancer, resulting isodose curves only rarely fit exactly to radiographic films, and the target volume is not easily reconstructed. Usually no clear relationship exists between the three-dimensional (3D) dose distribution and target volume on the one hand and the two-dimensional (2D) radiographic films on the other. Dose distributions on radiographs are not sufficient to define the target absorbed dose and doses that critical areas will receive. A 3D imaging system, like computed tomographic (CT) scans, is needed in order to visualize underdosage inside the target volume and non-tolerable hot spots outside the tumour. Large-scale and expensive techniques exist to tackle these problems. Our inexpensive and verifiable approach to solve these problems combines localization radiographs with CT scans. Whereas tumour and critical areas are displayed on CT scans, flexible catheters loaded with dummy sources are best seen on radiographic films. With the help of a self-developed computer program, dose distributions are superimposed on CT scans. Doses to the target and critical organs are easily read and verified by external and internal detectors.