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Abstract
Introduction Optimally placing interstitial needles for interstitial only gynecologic brachytherapy requires time and expertise. Individualized vaginal templates to guide needles to dosimetrically beneficial positions could simplify interstitial procedures, decrease procedure time, improve needle distribution and optimize dosimetry.
Methods We developed a novel approach using 3D printed Vaginal Individualized Applicator (VIA) templates that contain internal channels that guide interstitial needles from the vaginal introitus to the desired locations within the tumor. A series of 9 patients underwent 2 interstitial procedures each separated by approximately 1 week with the first procedure involving standard freehand/template-based interstitial and the second procedure utilizing a customized VIA. All patients underwent a pre-brachytherapy MRI, and both CT and MRI were performed following interstitial placement.
Results We have created and used clinically 3D printed VIA templates for interstitial gynecologic brachytherapy. In clinical use the novel VIA had an average procedure time of 44.8 minutes, approximately 43% shorter than the average of 79.1 minutes for the standard interstitial cases. The average CTV volume was 32.1 cc for the initial standard approach and 26.9 cc for VIA. The traditional and VIA cases averaged similar number of needles (14, 3) and maintained similar excellent dosimetry with an average CTV V100% of 94.4%, 94.5%, respectively.
Conclusion/Implications Our team developed a novel 3D printed VIA template that significantly facilitates gynecologic interstitial brachytherapy by simplifying the placement of needles and significantly decreasing procedure time while maintaining excellent dosimetry.
