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To use quantities measurable during in vivo dosimetry to build unique channel identifiers, that enable detection of brachytherapy errors. Treatment plan of 360 patients with prostate cancer who underwent high-dose-rate brachytherapy (range, 16–25 catheters; mean, 17) were used. A single point virtual dosimeter was placed at multiple positions within the treatment geometry, and the source-dosimeter distance and dwell time were determined for each dwell position in each catheter. These values were compared across all catheters, dwell position by dwell position, simulating a treatment delivery. A catheter was considered uniquely identified if, for a given dwell position, no other catheters had the same measured values. The minimum number of dwell positions needed to identify a specific catheter and the optimal dosimeter location uniquely were determined. The radial (r) and vertical (z) dimensions of the source-dosimeter distance were also examined for their utility in discriminating catheters. Using a virtual dosimeter with no uncertainties, all catheters were identified in 359 of the 360 cases with 9 dwell position measurements. When only the dwell time were measured, all catheters were uniquely identified after 1 dwell position. With a 2-mm spatial accuracy (r,z), all catheters were identified in 94% of the plans. Simultaneous measurement of source-dosimeter distance and dwell time ensured full catheter identification in all plans ranging from 2 to 6 dwell positions. The number of dwell positions needed to uniquely identify all catheters was lower when the distance from the implant center was higher. The most efficient fingerprinting approach involved combining source-dosimeter distance (i.e., source tracking) and dwell time. The further the dosimeter is placed from the center of the implant the better it can uniquely identify catheters. [ABSTRACT FROM AUTHOR]

Background: Electromagnetic tracking (EMT) has been researched for brachytherapy applications, showing a great potential for automating implant reconstruction, and overcoming image‐based limitations such as contrast and spatial resolution. One of the challenges of this technology is that it does not intrinsically share the same reference frame as the patient's medical imaging. Purpose: To present a novel phantom that can be used for a comprehensive quality assurance (QA) program of brachytherapy EMT systems and use this phantom to validate a novel applicator‐based registration method of EMT and image reference frames for gynecological (GYN) interstitial brachytherapy. Materials and Methods: Eleven 6F‐catheters (20 cm long), one 6F round tip catheter (29.4 cm long) and a tandem and ring gynecological applicator (Elekta, CT/MR 60°, 40 mm long tandem, 30 mm diameter ring) were placed in a rigid custom‐made phantom (Elekta Brachytherapy, Veenendaal, The Netherlands) to reconstruct their geometry using a five‐degree of freedom EMT sensor attached to an afterloader's check cable. All EMT reconstructions were done in three different environments: disturbance free (no metal nearby), computed tomography (CT)‐on‐rails brachytherapy suite and magnetic resonance imaging (MRI) brachytherapy suite. Implants were placed parallel to a magnetic field generatorand were reconstructed using two different acquisition methods: step‐and‐record and continuous motion. In all cases, the acquisition is performed at a rate of approximately 40 Hz. A CT scan of the phantom inside a water cube was obtained. In the treatment planning system (TPS), all catheters in the CT images were manually reconstructed and the applicator reconstruction was achieved by manually placing its solid 3D model, found in the applicator library of the TPS. The Iterative Closest Point and the Coherent Point Drift algorithms were used, initialized with four known points, to register both EMT and CT scan reference frames using corresponding points from the EMT and CT based reconstructions of the phantom, following three approaches: one gynecological applicator, four interstitial catheters inside four calibration plates having an S‐shaped path, and four 5 mm diameter ceramic marbles found in each of the four calibration plates. Once registered, the registration error (perpendicular distance) was computed. Results: The absolute median deviation from the expected value for EMT measurements in the disturbance free environment, CT‐on‐rails brachytherapy suite, and MRI‐brachytherapy suite are 0.41, 0.23, and 0.31 mm, respectively, while for the CT scan it is 0.18 mm. These values significantly lie below the sensor's expected accuracy of 0.70 mm (p < 0.001), suggesting that the environment did not have a significant impact on the measurements, given that care is taken in the immediate surroundings. In all three environments, the two acquisitions and three registration approaches have mean and median registration errors that lie at or below 1 mm, which is lower than the clinical acceptable threshold of 2 mm. Conclusions: The novel phantom allowed to successfully evaluate the accuracy of EMT‐based reconstructions of catheters and a GYN tandem and ring applicator in different clinical environments. A registration method based only on the applicator geometry, reconstructed withan EMT sensor and the TPS solid applicator library, was validated and shows clinically acceptable accuracy, comparable to CT‐based reconstruction but within a few minutes. Since the applicator is also visible in MRI, this method could potentially be used in clinics in an EMT‐MR interstitial GYN brachytherapy workflow. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of an electromagnetic (EM)‐tracked scintillation dosimeter in detecting source positional errors of IVD in HDR brachytherapy treatment. Materials and Methods: Two different scintillator dosimeter prototypes were coupled to 5 degrees‐of‐freedom (DOF) EM sensors read by an Aurora V3 system. The scintillators used were a 0.3 × 0.4 × 0.4 mm3 ZnSe:O and a BCF‐60 plastic scintillator of 0.5 mm diameter and 2.0 mm in length (Saint‐Gobain Crystals). The sensors were placed at the dosimeter's tip at 20.0 mm from the scintillator. The EM sampling rate was 40/s while the scintillator signal was sampled at 100 000/s using two photomultiplier tubes from Hamamatsu (series H10722) connected to a data acquisition board. A high‐pass filter and a low‐pass filter were used to separate the light signal into two different channels. All measurements were performed with an afterloader unit (Flexitron‐Elekta AB, Sweden) in full‐scattered (TG43) conditions. EM tracking was further used to provide distance/angle‐dependent energy correction for the ZnSe:O inorganic scintillator. For the error detection part, lateral shifts of 0.5 to 3 mm were induced by moving the source away from its planned position. Indexer length (longitudinal) errors between 0.5 to 10 mm were also introduced. The measured dose rate difference was converted to a shift distance, with and without using the positional information from the EM sensor. Results: The inorganic scintillator had both a signal‐to‐noise‐ratio (SNR) and signal‐to‐background‐ratio (SBR) close to 70 times higher than those of the plastic scintillator. The mean absolute difference from the dose measurement to the dose calculated with TG‐43U1 was 1.5% ±0.7%. The mean absolute error for BCF‐60 detector was 1.7% ±1.2%$\pm 1.2\%$ when compared to TG‐43 calculations formalism. With the inorganic scintillator and EM tracking, a maximum area under the curve (AUC) gain of 24.0% was obtained for a 0.5‐mm lateral shift when using the EMT data with the ZnSe:O. Lower AUC gains were obtained for a 3‐mm lateral shifts with both scintillators. For the plastic scintillator, the highest gain from using EM tracking information occurred for a 0.5‐mm lateral shift at 20 mm from the source. The maximal gain (17.4%) for longitudinal errors was found at the smallest shifts (0.5 mm). Conclusions: This work demonstrates that integrating EM tracking to in vivo scintillation dosimeters enables the detection of smaller shifts, by decreasing the dosimeter positioning uncertainty. It also serves to perform position‐dependent energy correction for the inorganic scintillator,providing better SNR and SBR, allowing detection of errors at greater distances from the source. [ABSTRACT FROM AUTHOR]