Clinical trial · Interventional

Quality and Safety of Real-Time Brachytherapy Treatments: Clinical Implementation of a Multipoint Scintillation Detector for Treatment Monitoring

In Vivo Surveillance of Brachytherapy Using Plastic Scintillation Dosimetry: A Clinical Feasibility Study

NCT07580651CI-TRIAL-00111140(CurieInVivo)not yet recruitingN/AClinicalTrials.gov clinicaltrialsPublishedExplore in graph →

Summary

Brief summary (as posted)

This project addresses a key safety gap in High-Dose-Rate (HDR) brachytherapy, where very high, localized radiation doses mean that small geometric deviations in catheter placement or radioactive source positioning can cause clinically significant errors. Incident reports from the Radiation Oncology Incident Learning System (RO-ILS) of the American Society for Radiation Oncology (ASTRO) and guidelines from the American Association of Physicists in Medicine Task Group 59 (AAPM TG-59) identify these events-often occurring between imaging and treatment delivery-as among the most critical. Unlike external beam radiotherapy, brachytherapy lacks a prior phantom-based verification step, making in vivo dosimetry the only real-time method to confirm delivered dose and detect anomalies in dwell time or source position. International bodies such as the International Atomic Energy Agency (IAEA) recommend this approach for quality management and accident prevention. Multipoint plastic scintillation detectors (mPSD) offer water-equivalent, real-time measurements and can enable three-dimensional (3D) radioactive source tracking, but their clinical use remains limited due to integration challenges and the absence of well-defined alert thresholds. The project aims to implement a real-time in vivo monitoring solution using an mPSD at the Centre régional intégré de cancérologie (CRIC) of Lévis, Québec (QC) for HDR gynecological and prostate brachytherapy. Objectives include: (1) demonstrating clinical feasibility and integration within existing clinical workflows; (2) validating the accuracy and precision of dose, dwell-time, and source-position measurements under clinical conditions; and (3) developing practical alert thresholds to identify common deviations. The central hypothesis is that mPSD technology can provide reliable, reproducible real-time measurements without lengthening procedures or disrupting clinical workflow. The methodology relies on adapting the HYPERSCINT® platform for HDR in vivo use. A custom mPSD, consisting of several scintillators along a single optical fiber, will be insertable into a 6-French (6F) catheter. Phase 1 focuses on feasibility and integration, including HDR-specific calibration, definition of detector insertion scenarios, integration of acquisition hardware, and staff training. Phase 2 validates performance in at least 20 patients. Planned treatment parameters and time-stamped detector signals acquired at 1-10 hertz (Hz) will be used to reconstruct delivered dose, dwell times, and source-to-detector distances. Measurement accuracy and reproducibility will be quantified using mixed-effects statistical models. Phase 3 establishes preliminary alert thresholds based on deviations in dose, time, and position, along with visualization tools such as Bland-Altman plots, although these thresholds will not be applied clinically during the study. Expected outcomes include demonstrated feasibility of in vivo mPSD monitoring, quantitative performance metrics with confidence intervals, identification of influential factors and operational recommendations, preliminary alert thresholds with reporting templates, and a roadmap for sustainable deployment in Lévis and other centers. Scientific outputs will also be produced for dissemination across the Santé Québec network.

Conditions

Conditions (2)

Free-text conditions as registered, with the CancerIndex entity they were reconciled to and the match type.

Condition (as posted)	Mapped entity	Match	Confidence
Gynecologic Cancers	Malignant Female Reproductive System Neoplasm	ALIAS	0.90
Prostate Cancer	Malignant Prostate Neoplasm	CURATED_EXACT	0.92

Interventions

Interventions (1)

Intervention	Type	Mapped drug	Match
Brachytherapy treatment monitoring using a plastic scintillation detector	Device	—	UNRESOLVED

Design

Arms and outcomes

Arms (1)

type
EXPERIMENTAL
label
In-vivo dosimetry
description
Patients in this treatment arm will receive the same treatment and care as patients outside of the protocol, but will have their treatment monitored by a plastic scintillation detector placed inside or at close proximity of the tumor.
interventionNames
1. Device: Brachytherapy treatment monitoring using a plastic scintillation detector

Primary outcomes (1)

measure
Proportion of brachytherapy treatments with successful scintillation detector-based measurement
timeFrame
From the patient anesthesia at the beginning of the brachytherapy procedure to the end of brachytherapy radiation delivery on the same day.
description
Feasibility will be assessed by determining whether a scintillation detector successfully acquires a measurement during brachytherapy treatment. Radiation emitted from the brachytherapy source induces optical scintillation in the detector. The emitted light is transmitted via optical fiber and collected by a spectrometer located outside the treatment room. A successful measurement is defined as the acquisition of scintillation data that can be analyzed to infer clinically relevant parameters, including either the radiation dose rate as a function of time and/or the radioactive source position during treatment delivery. The outcome will be reported as the number and proportion of treatments with successful measurements.

Eligibility

Eligibility (as posted)

Sex: All
Minimum age: 18 Years

Show eligibility criteria text

Inclusion Criteria:

* Patients receiving prostate brachytherapy treatment, or female user receiving gynecological brachytherapy treatment for cervical cancer.

Exclusion Criteria:

* Patients with a Clostridium difficile infection or any other high-risk positive infection.

References

Publications (9)

BACKGROUNDFonseca GP, Johansen JG, Smith RL, Beaulieu L, Beddar S, Kertzscher G, Verhaegen F, Tanderup K. In vivo dosimetry in brachytherapy: Requirements and future directions for research, development, and clinical practice. Phys Imaging Radiat Oncol. 2020 Sep 28;16:1-11. doi: 10.1016/j.phro.2020.09.002. eCollection 2020 Oct. PMID 33458336
BACKGROUNDLinares Rosales HM, Duguay-Drouin P, Archambault L, Beddar S, Beaulieu L. Optimization of a multipoint plastic scintillator dosimeter for high dose rate brachytherapy. Med Phys. 2019 May;46(5):2412-2421. doi: 10.1002/mp.13498. Epub 2019 Apr 2. PMID 30891803
BACKGROUNDLinares Rosales HM, Johansen JG, Kertzscher G, Tanderup K, Beaulieu L, Beddar S. 3D source tracking and error detection in HDR using two independent scintillator dosimetry systems. Med Phys. 2021 May;48(5):2095-2107. doi: 10.1002/mp.14607. Epub 2021 Mar 28. PMID 33222208
BACKGROUNDTherriault-Proulx F, Beddar S, Beaulieu L. On the use of a single-fiber multipoint plastic scintillation detector for 192Ir high-dose-rate brachytherapy. Med Phys. 2013 Jun;40(6):062101. doi: 10.1118/1.4803510. PMID 23718599
BACKGROUNDKubo HD, Glasgow GP, Pethel TD, Thomadsen BR, Williamson JF. High dose-rate brachytherapy treatment delivery: report of the AAPM Radiation Therapy Committee Task Group No. 59. Med Phys. 1998 Apr;25(4):375-403. doi: 10.1118/1.598232. PMID 9571605
BACKGROUNDHoopes DJ, Dicker AP, Eads NL, Ezzell GA, Fraass BA, Kwiatkowski TM, Lash K, Patton GA, Piotrowski T, Tomlinson C, Ford EC. RO-ILS: Radiation Oncology Incident Learning System: A report from the first year of experience. Pract Radiat Oncol. 2015 Sep-Oct;5(5):312-318. doi: 10.1016/j.prro.2015.06.009. Epub 2015 Jun 25. PMID 26362705
BACKGROUNDTherriault-Proulx F, Archambault L, Beaulieu L, Beddar S. Development of a novel multi-point plastic scintillation detector with a single optical transmission line for radiation dose measurement. Phys Med Biol. 2012 Nov 7;57(21):7147-59. doi: 10.1088/0031-9155/57/21/7147. Epub 2012 Oct 12.