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Practical experience in commissioning ring applicators using ring applicator component type with bravos control

Xiuxiu He1, Michael A Trager1, Gil'ad N Cohen1

  • 1Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.

Journal of Applied Clinical Medical Physics
|May 3, 2025
PubMed
Summary
This summary is machine-generated.

A new commissioning method for the Bravos v1.2 ring applicator component type (ACT) was developed. An optimal 0.2 cm offset minimizes dosimetric discrepancies, improving accuracy over the traditional rigid ACT.

Keywords:
CommissioningGYN intracavity brachytherapyring applicator

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Brachytherapy Technology

Background:

  • Brachytherapy treatment accuracy is influenced by source positioning.
  • The Bravos v1.2 system introduced a ring applicator component type (ACT) to improve geometric accuracy.
  • Geometric and dosimetric discrepancies can arise from source positioning inaccuracies.

Purpose of the Study:

  • To commission the CT/MRI-compatible titanium ring applicator for Bravos v1.2.
  • To evaluate the performance of the new ring ACT compared to the traditional rigid ACT.
  • To investigate a novel commissioning method for accurate source positioning.

Main Methods:

  • Two commissioning methods were evaluated across three Bravos afterloaders.
  • Modified Varian commissioning involved smaller step sizes, alternating dwell times, and including odd/even positions.
  • Film analysis was performed with varying offsets (0.0-0.2 cm) on 30-, 45-, and 60-degree rings.

Main Results:

  • An optimal offset of 0.2 cm was identified, minimizing deviations between planned and delivered dwell positions for all rings and afterloaders.
  • The rigid ACT exhibited larger positional discrepancies compared to the ring ACT.
  • The optimal offset reduced dosimetric differences (<1%) for key clinical metrics (D95, D90, D2cc) and EQD2 values.

Conclusions:

  • A novel commissioning procedure effectively determines an optimal offset for accurate source positioning with the ring ACT.
  • This method significantly minimizes dosimetric discrepancies, enhancing treatment accuracy.
  • The developed procedure standardizes commissioning for Bravos afterloaders with the v1.2 control system, outperforming the rigid ACT.