S51
Brachytherapy - Gynaecology
ESTRO 2026
Conclusion: Intraoperative mobile CBCT is a feasible and effective adjunct to ultrasound-guided cervical cancer brachytherapy. It enhances needle placement accuracy, improves dosimetric outcomes, and provides a practical solution for overcoming ultrasound limitations, with potential to improve clinical treatment results and reduce toxicity. Keywords: intraoperative imaging, adaptive brachytherapy Digital Poster Highlight 1006 Baseline timing of the MRI-guided HDR brachytherapy workflow in primary cervical cancer: a Dutch national benchmark L.A.L. Verhagen 1 , L.A. Velema 1 , L.R.M. Dickhoff 2 , D.L.J. Barten 2 , K.M. van Vliet - van den Ende 3 , J.L.G. Steenhuijsen 4 , C.G. Verhoef 5 , E.E. Schaake 6 , J.C. Beukema 7 , H. Westerveld 8 , T. Alderliesten 1 , E.M. Kerkhof 1 1 Department of Radiation Oncology, Leiden University Medical Center, Leiden, Netherlands. 2 Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, Netherlands. 3 Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands. 4 Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands. 5 Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, Netherlands. 6 Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, Netherlands. 7 Department of Radiation Oncology, University Medical Center Groningen, Groningen, Netherlands. 8 Department of Radiotherapy, University Medical Center Rotterdam, Erasmus MC Cancer Institute, Rotterdam, Netherlands Purpose/Objective: MRI-guided HDR brachytherapy for cervical cancer is a labor intensive procedure involving applicator placement, imaging, segmentation, reconstruction, and treatment planning by a multidisciplinary team. This study provides the first national benchmark of workflow timing across Dutch centers. The goal is to quantify the total lead time and identify the most time- consuming tasks, thereby informing the future integration of (semi-)automated approaches into clinical practice. Material/Methods: In June 2025, all nine Dutch cervical brachytherapy centers were invited to perform baseline timings for ≥ 1 intra-uterine application in 3-5 patients with primary cervical cancer. Using a standardized template, ten workflow steps were timed, including operating room, patient recovery, MRI acquisition,
segmentation of OARs/targets, reconstruction of applicator/needles, treatment planning, and physics check(s). The duration of these steps and the total lead time from start of the operating room to the first irradiation were calculated. Results: Eight centers performed baseline timings for 63 applications in 37 patients. Figure 1 shows the duration per workflow step. The most time-consuming steps were patient recovery, segmentation, and treatment planning, with a duration of 56, 55, and 42 minutes on average. The total duration (mean±SD) of all steps was 231±50 minutes if segmentation and reconstruction were performed in parallel. The total lead time (mean±SD) was 313±71 minutes and included additional waiting time for patient transport, MRI access, and RT staff availability. Table 1 shows workflow information relevant for timing and the total lead time per center. Center 1 and 3 needed an efficient workflow as they treated most patients with two fractions a day six hours apart. Patients from center 2, 5, and 7 had a relatively long waiting time, but stayed overnight with applicator in situ, thereby making the total lead time probably less of a concern. Center 4 and 8 started segmentation twice as fast, as patient recovery occurred during the segmentation step as the MRI scanner is located in or next to the operating room. Patients from center 4 and 6 were treated with one fraction per application, which means that the total lead time determined the moment that patients were discharged from the hospital.
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