Analysis of applicator displacement in accelerated partial breast irradiation using a strut-based design brachytherapy applicator

PURPOSE: This study aimed to identify factors associated with strut-adjusted volume implant (SAVI) displacement in accelerated partial breast irradiation (APBI) using a SAVI device.METHODS AND MATERIALS: We retrospectively analyzed computed tomography scans taken at the time of treatment planning and immediately before treatment in 61 patients (median age; 55 years, range; 40-85) treated with SAVI and determined the amount of SAVI displacement that occurred between the time from planning to the treatment. The displacement was calculated for the CT axis and SAVI axis, which is related to the SAVI structure. To investigate the cause of the displacement, multivariate analysis was performed on the calculated standard deviation and the insertion angle of SAVI with respect to the sternum in each cross-section, breast density, amount of air around the SAVI, and SAVI length inside the patient to obtain the /3 coefficient ( p-value).RESULTS: On the CT coordinate system, positive correlations were observed between the SAVI insertion angle and air volume in the lateral ( /3 coefficient:0.255-0.483) and rotational directions ( /3 coefficient:0.341). On the SAVI coordinate system, positive correlations were observed between the SAVI insertion angle and air volume in all lateral ( /3 coefficient:0.270-0.354) and rotational directions ( /3 coefficient:0.294). A negative correlation was observed between the SAVI length inside the patient and the rotational direction ( /3 coefficient: -0.262).CONCLUSION: SAVI insertion angle, the amount of the air outside SAVI and SAVI insertion length are factors which affect the displacement of the applicator. From the results, the applicator displacement and rotation must be < 3 mm and 10 o in order to meet all the dose criteria. Thus, we should be aware of these factors during insertion of the device to avoid the problem in treatment delivery for the APBI. (c) 2023 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.