S116
Brachytherapy - Physics
ESTRO 2026
Results:
Digital Poster Highlight 495 A novel endoscopic articulating tandem and inflatable ovoids system for precision gynecologic brachytherapy JAVAD RAHIMIAN, Ahmad Momeni Medical Physics, Voxel Rad, Ltd., Irvine, USA Purpose/Objective: Cervical and uterine cancers remain major global health burdens, with over one million new cases and over 400,000 deaths reported in 2022.1Intracavitary brachytherapy (BT) is essential for curative treatment, yet current tandem-and-ovoid applicators suffer from difficult insertion, anesthesia dependence, perforation risk, poor organ retraction, and inconsistent implant geometry. We introduce a novel steerable endoscopic multilumen tandem with inflatable ovoids, delivering real-time CMOS-guided placement, conformal organ- sparing geometry, and full MRI/CT/X-ray compatibility in a pre-sterilized, ready-to-use kit.There is a critical need for a next-generation applicator that improves precision, safety, and reproducibility while reducing procedural burden. Material/Methods: We present a novel articulating endoscopic multilumen tandem with inflatable ovoids, engineered to overcome the anatomical, procedural, and dosimetric constraints of current devices. Articulating endoscopic tandem adjusts to patient-specific anatomy, including anteverted and retroverted uteri, eliminating the need for multiple angled tandems and need for Smit-Sleeve placement. Inflatable ovoids conform atraumatically to the vaginal fornices, replacing rigid plastic ovoids that contribute to tissue trauma. Integrated retractors provide consistent bladder and rectum displacement, eliminating the variability of gauze packing. The applicator’s design enables extracorporeal pre-alignment of optimal implant geometry before final insertion, closely mirroring laparoscopic procedural logic — resulting in significantly reduced insertion times and superior reproducibility across users and settings. Results: Preliminary simulations and prototype validation confirm enhanced dosimetric conformity, increased organ-at-risk (OAR) sparing, and a marked reduction in perforation risk due to direct camera-guided placement. The system enables differential ovoid loading, supporting individualized dosimetry without requiring multiple applicator exchanges. The design is fully compatible with modern CT/MRI-guided adaptive BT workflows.Compared to currently available commercial devices, the proposed applicator offers potentially a safer, faster, and more anatomically intelligent platform, with significant advantages in patient comfort, procedural efficiency, and physician
Source trajectories were studied for 22 mm and 26 mm ovoids. Discrepancies between measured positions and manufacturer references are greater in the most proximal positions. In the most distal positions, they are always deviations below 2 mm, as shown in Table 1. Conclusion: Compared to previous studies, the proposed tools offer significant improvement in the automation of the commissioning and QC process for the Venezia applicator. A future version aims to include analysis of the component perpendicular to the plane of the ring formed by the semicircular ovoids. The developed tools facilitate the automated evaluation of source trajectories in the Venezia applicator ovoids, improving analysis accuracy and quantifying deviations of each dwell position. These tools, in addition to being simple and practical, are open source solutions. Keywords: Applicator commissioning, QA, source path References: Hansen J, Dunkerley D, Bradley K, Miller J, Huang J. Comparison of catheter reconstruction techniques for the lunar ovoid channels of the VeneziaTM applicator. J Contemp Brachytherapy 2020;12:383–92. https://doi.org/10.5114/jcb.2020.98119.Li X, Huang J, Rahimi R, Zhao H, Kunz J, Suneja G, et al. A novel approach for Venezia ovoid commissioning with a comprehensive analysis of source positions in high- dose-rate brachytherapy. Brachytherapy 2023;22:93– 100. https://doi.org/10.1016/j.brachy.2022.08.017.
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