S129
Brachytherapy - Physics
ESTRO 2026
of clinical procedures and the need for standardization of practices justify the implementation of recommendations that ensure the quality and reproducibility of treatments.This work aims to implement international recommendations for the clinical practice of high-dose-rate (HDR) interstitial breast brachytherapy, with the goal of harmonizing procedures and increasing the reliability of treatments. Material/Methods: The methodology was based on AAPM TG 2751, originally developed for gynecological treatments, and subsequently adapted to the technical and clinical conditions of breast brachytherapy at our institution.Validation of the proposed procedures was performed through the analysis of 20 clinical cases.The implemented methodology was structured into 10 verification steps covering the entire treatment workflow: patient data verification, clinical evaluation and treatment intent, imaging, applicator placement, target and organ delineation, treatment planning, optimization, evaluation, verification, and post-treatment analysis. Each verification step included not only dosimetric assessments but also the identification of potential error sources across the workflow. Results: The most frequently observed failure modes are summarized below: The analysis identified several areas for improvement, emphasizing the need to strengthen quality control procedures, improve team coordination, and ensure rigorous adherence to clinical protocols. Conclusion: The implementation of this verification framework enabled the identification of key critical points across all stages of HDR breast brachytherapy, providing clear guidance to prevent future failures and to ensure the safest and most efficient workflow possible. Moreover, the systematic adaptation of AAPM TG- 275 recommendations proved essential to promote continuous improvement in the quality, safety, and consistency of brachytherapy treatments, consolidating clinical practice and reinforcing the confidence of the multidisciplinary team. Keywords: Brachytherapy and Quality assurance References: 1. Eric Ford, Leigh Conroy, Lei Dong, Luis Fong de Los Santos, Anne Greener, Grace Gwe-Ya Kim, Jennifer Johnson, Perry Johnson, James G. Mechalakos, Brian
the periphery of a typical HDR prostate implant volume to evaluate system precision and accuracy. Results: Overall, the accuracy of EM-tracked needle reconstruction using a 3D-printed sleeve, compared with image-based, manual reconstruction equaled (median [interquartile range]) 0.624 [0.411, 0.902] millimeters for needle shafts and 0.581 [0.217, 0.769] millimeters for needle depths in water phantom. The sleeve mounting reproducibility was 0.088 [0.052, 0.129] millimeters and 0.10 [0.076, 0.14] degrees (pitch), 0.14 [0.13,0.16] degrees (yaw), 0.98 [0.86, 1.18] degrees (roll).A patient-specific calibration procedure was developed to mitigate the potential variability in 3D printing and sensor placement, which if uncorrected, had a measured magnitude of 0.593 [0.553, 0.719] millimeters and 2.38 [2.26, 2.57] degrees (pitch), 1.87 [1.72, 2.21] degrees (yaw), 3.06 [2.85, 3.50] degrees (roll). Conclusion: Integrating electromagnetic tracking sensors within a 3D-printed transrectal ultrasound sleeve enables sub- millimeter accuracy with high reproducibility in needle reconstruction for HDR prostate brachytherapy. The sleeve’s compatibility with commercially available ultrasound equipment and use of biocompatible materials support its potential for seamless clinical translation. Keywords: EM Tracking, Prostate, Automation References: [1] Beaulieu L, Racine E, Han DY, Vigneault E, Hsu IC, Cunha JAM. Real-time electromagnetic tracking-based treatment platform for high-dose-rate prostate brachytherapy: Clinical workflows and end-to-end validation. Brachytherapy. 2018;17(1):103-110. doi:10.1016/j.brachy.2017.04.247 Implementation of AAPM TG-275 in High-Dose-Rate Interstitial Breast Brachytherapy: A Case Study Alexandre Pereira 1,2 , Sara Pinto 1,2 , Marina Maçães 1 , Ines Lima 1 , Joana Lencart 1,2 1 Medical Physics Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal. 2 Medical Physics, Radiobiology and Radiation Protection Group, , IPO Porto Research, Center CI-IPOP, Porto Comprehensive Cancer Center (Porto.CCC) & Rise@CI- IPOP (Health Research Network), Porto, Portugal Purpose/Objective: Brachytherapy has assumed a relevant role in the conservative treatment of breast cancer, allowing the delivery of high radiation doses in a highly localized and precise manner, while minimizing exposure to surrounding healthy tissues.The increasing complexity Digital Poster 2703
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