AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy


"In the last decade, there have been signifiant developments into integration of   robots and automation tools with brachytherapy delivery systems. These systems aim to   improve the current paradigm by executing higher precision and accuracy in seed   placement, improving calculation of optimal seed locations, minimizing surgical   trauma, and reducing radiation exposure to medical staff Most of the applications of   this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where   interstitial brachytherapy is appropriate. In consideration of the rapid developments   in this area, the American Association of Physicists in Medicine (AAPM) commissioned   Task Group 192 to review the state-of-the-art in the fild of robotic interstitial   brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-  European Society for Radiotherapy & Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality   assurance procedures for the safe and consistent use of these systems are also   provided. Manual seed placement techniques with a rigid template have an estimated in   vivo accuracy of 3–6 mm. In addition to the placement accuracy, factors such as tissue   deformation, needle deviation, and edema may result in a delivered dose distribution   that diffrs from the preimplant or intraoperative plan. However, real-time needle   tracking and seed identifiation for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems   should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy   systems and propagation of uncertainties. During clinical commissioning, tests should   be conducted to ensure that this level of accuracy is achieved. These tests should   mimic the real operating procedure as closely as possible. Additional recommendations   on robotic brachytherapy systems include display of the operational state; capability   of manual override; documented policies for independent check and data verifiation;   intuitive interface displaying the implantation plan and visualization of needle   positions and seed locations relative to the target anatomy; needle insertion in a   sequential order; robot–clinician and robot–patient interactions robustness,   reliability, and safety while delivering the correct dose at the correct site for the   correct patient; avoidance of excessive force on radioactive sources; delivery   confimation of the required number or position of seeds; incorporation of a collision   avoidance system; system cleaning, decontamination, and sterilization procedures.   These recommendations are applicable to end users and manufacturers of robotic   brachytherapy systems."  


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