A Message From the President
Prostate BT featured in Nature, 300 in 10, and UA Flight 3767

One of our ABS goals is to increase public awareness on the value of BT. Dr. Peter Orio did a phenomenal job during his presidency with multiple press releases, including the “Know Your Options” campaign featuring actor Rob Lowe who narrated the segment. Much to our surprise and delight, the journal, Nature , had a phenomenal review on the role of prostate brachytherapy in the management of prostate cancer including efficacy and the cost effectiveness compared to other treatment modalities, and the ongoing “crisis” of decreased BT utilization ( Prostate Cancer: A Declining Art ). The author, Michael Eisenstein, was very thorough in that he even mentioned the ABS 300 in 10 campaign. ABS will be pushing this out on social media and we are asking all of you to repost on Facebook and/or retweet on Twitter. We need to increase the public demand for competent brachytherapists as this will fuel 300 in 10. We need a brachytherapy resurgence – similar to what the Seattle Prostate Institute successfully accomplished in the 1990s.

Great news for the membership: we were asked by the Radiation Oncology Institute to submit a full grant proposal for our project - Increasing Access to Quality Brachytherapy For Cervical Cancer . Funding of this grant will accelerate the overall process including reaching out to our industry partners and potentially, foundations, to fund our parallel project of increasing access to quality brachytherapy for prostate cancer. The 300 in 10 program was discussed at length during our annual BOD retreat in Phoenix, including a new our new mentorship program that we will launch in 2020 - more details will be forthcoming.

We all have our “travel woes” and mine returning home on UA Flight 3767 from the Phoenix BOD meeting on December 8 th will go down in “my history” for a number of reasons. The day started out reasonably well with an on-time flight from Phoenix to Denver. The flight from Denver to Rapid City was delayed due to mechanical issues. Fortunately, the flight finally left 4 hours later. As I was relieved to see the lights of my hometown with 10 minutes from landing, our flight was suddenly diverted to Scottsbluff, Nebraska, (halfway between Denver and Rapid City) due to a storm. The passengers on our flight were quite interesting in that half were from a college women's basketball team. The flight attendant was very attentive and friendly by offering free drinks, food, and a pleasant disposition. We sat on the tarmac for one hour as United Airlines decided our fate.  We were then given the option of getting off the plane and stretching our legs in this small airport with vending machines only for food. Three of us decided to order pizzas for the entire plane as the basketball team and others were obviously hungry. The decision was then made to return to Denver. Since several of us had busy work schedules the following day, including myself with a full clinic schedule and procedures, 15 of us rented 3 vehicles and drove 5 hours in a blizzard back to Rapid City. The experience was surreal in that I was with 5 others who I had never met until this flight. We finally made it back at 12:30 AM and was in clinic by 7:45 AM. What struck me during this journey was the patience, kindness, and calmness exhibited by everyone, especially the flight attendant, and those I traveled with on the 5-hour blizzard drive. Like our patients, colleagues, friends and family, everyone has a story. As I drove to work Monday morning somewhat exhausted, I felt a sense of peace realizing that a small “Christmas Miracle” had just occurred a few hours ago: we all arrived safely, everything had worked out and I had the pleasure of meeting five incredibly interesting people who are making their own contributions to society. 

The last year has been most rewarding as your ABS president. I am grateful to all of you for your dedication and time in continuing the mission of ABS, and by doing everything possible to keep brachytherapy a viable treatment option for our patients - as highlighted by the recent article in Nature .

So, in the spirit of this season, Merry Christmas, Happy Hanukkah, Happy Eid, Happy Davali, and Happy Holidays!

Cheers!

Daniel G. Petereit, MD, FASTRO
President  

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@AmericanBrachy
Announcing Brachytherapy “Perspectives” – A Collaboration between the Journal Brachytherapy and the
ABS Newsletter/Brachyblast
Scott Glaser, MD
The guiding mission of Brachyblast and the ABS newsletter has been to curate and distribute timely perspectives in brachytherapy. This has included focused topic based reviews, opinion pieces, summaries of emerging data, and challenging/interesting cases. Hopefully these pieces have been of interest to the ABS membership and the greater brachytherapy community.  A great deal of time and effort goes into developing this content and I would like to thank and acknowledge all the previous authors who have contributed to this cause. While the majority of high impact medical journals have a section devoted to pieces akin to the content we have attempted to solicit for Brachyblast/ABS newsletter, historically the official journal of ABS, Brachytherapy, has not.

With the support of leadership from ABS and the journal Brachytherapy , I am pleased to announce a new collaboration between Brachytherapy and the ABS brachyblast/newsletter to co-publish “Perspectives in Brachytherapy”. The publication of these sorts of pieces in the journal will ensure that the work put in by authors is more enduring, referenceable, and credible in terms of academic output.  Simultaneously, the inclusion of these pieces in the brachyblast/newsletter will ensure rapid distribution to a broad readership. Hopefully this will translate into an elevated exposure and excitement for brachytherapy related topics.

To ensure quality, and in keeping with the journal’s standards, pieces will undergo peer-review prior to publication. Submissions will be expected to have a more formal tone/style than that of some historical brachyblast pieces. Invited content will be sought on a wide variety of brachytherapy topics from a diverse pool of authors. If you have any questions, or have a concept you would like to discuss for development/inclusion, please do not hesitate to reach out to me at [email protected] .

Guidelines for prospective pieces will be available shortly at the journals website. However, as a rough outline the following types of submission will be sought:

  Invited Topic Based Review - Invited contributions from experts in the field reviewing a topic of interest. The intent is for the topic to be focused rather than broad and may describe new developments or be an analysis of the available evidence related to the topic.
o    Required Elements:
o    Title page
o    Manuscript ≤ 2000 words, tables and figures ≤ 3
o    References ≤ 30
o    Figure captions if figures are present
o    Uniform disclosure forms (1 for each author)
 
Editorials - Commentary, analysis, or opinion pieces related to timely issues involving brachytherapy. This may include summarizations of recently presented/published data with analysis as to the impact of such data
  • Required Elements:
  • Title page
  • Manuscript ≤ 1500 words, tables and figures ≤ 2
  • References ≤ 20
  • Figure captions if figures are present
  • Uniform disclosure forms (1 for each author)

Brief Opinions – Opinion on scientific, educational, or policy issues
  • Required Elements:
  • Title page
  • Manuscript ≤ 500 words, tables and figures ≤ 1
  • References ≤ 10
  • Figure captions if figures are present
  • Uniform disclosure forms (1 for each author)

Challenging Cases with Expert Opinion - Short pieces describing a clinical problem, ideally with an accompanying figure, and asking 1-4 questions to a set of invited experts. Maximum 4 authors. Accepted cases may be edited prior to publication to clarify the subject matter or to highlight aspects of interest

  • Required Elements for Challenging Cases:
  • Title page
  • Manuscript ≤ 400 words, tables and figures ≤ 2
  • References ≤ 10
  • Figure captions if figures are present
  • Uniform disclosure forms (1 for each author)

  • Required Elements for Expert Opinions (Invited)
  • Title page
  • Manuscript ≤ 250 words, tables and figures ≤ 1
  • References ≤ 10
  • Figure captions if figures are present
  • Uniform disclosure forms (1 for each author)
Chairman's Corner
Peter F. Orio, III, DO, MS
Welcome to the Chairman’s Corner of the American Brachytherapy Society’s BrachyBlast .

At the beginning of December, the Annual Board Meeting and Strategic Planning Summit took place in Phoenix, Arizona. This is always a great opportunity for the society’s leadership team to gather together and plan next steps for the organization in the year to come. This year’s meeting was filled with discussions regarding the 300 in 10 initiative, planning for the 2020 World Congress of Brachytherapy and continuing to work on planning programs for direct patient and practitioner education on the efficacy of brachytherapy.
 
I am looking forward to all that we will accomplish together in 2020 and beyond. If you would like to kick off 2020 by getting more involved in the society and all that we plan to accomplish, please reach out to Executive Director Melissa Pomerene .
 
As we approach the end of a very successful 2019 for the ABS, we again wish you a very Happy New Year filled with bountiful brachytherapy!

Thank you,  
Peter F. Orio III, DO, MS 
Chairman of the Board
 
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ABS Medical Event Project
Case 0007 Responses and Feedback from Brachyblast Readers
Panagiota Galanakou¹, Sarah Wisnoskie¹, Zoubir Ouhib MS FACR FABS FAAPM
¹Florida Atlantic University

As promised in case 0007 posted on the Brachyblast on October 2019, we are eager to present the feedback (immediate and long-term actions) that we have collected from several colleagues (medical physicists and radiation oncologists). As a reminder to readers, case 0007 is related to dose misadministration involving two patients that were treated with I-125 temporary brachytherapy eye-plaque implants. The two patients received higher dose than the planned dose. The error was made in converting the Air-Kerma strength of the I-125 sources to millicuries. The licensee’s treatment planning system is in Air-Kerma units, whereas the vendor requires the order to be placed in millicuries.
Immediate (Short-Term) Preventive Actions 
Provide a calculator in the form of a locked Excel spreadsheet to physics staff to use when ordering seeds.
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Complete a physics plan check and review all critical parameters before ordering seeds, which includes checking ordered seed strength.
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Source strength between generated treatment plan and seeds ordered should be verified before placement of the seed order. A discrepancy between the plan and the order can ideally be detected before the order goes out. This check should be done by a second physics staff not involved in planning and completion of the order form.
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Seed confirmation from the vendor should be checked against plan to ensure correct transcription of information by the vendor.
In-house calibration of the seeds: All assays should be done in Air-Kerma strength and validated against plan (not just vendor certificate).
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As with EBRT, secondary check of all parameters that are entered manually should be the norm in brachytherapy planning. This would even include secondary check of the TG43 when they are entered or validated in the TPS.
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Submit to the manufacturer, together with the order, a printout of the TPS showing clearly the number of sources and the Air-Kerma strength used in the plan. That way, a second set of eyes can look at what the TPS really used vs the order.
Long Term Actions
It would be helpful to eliminate the use of mCi but that seems a lost battle (At least for now). That will require cooperation between manufacturers, regulators, and users.
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Readers' Comments
"In our practice, we require that vendors process all orders in U rather than mCi. It is our condition for doing business – and they comply by generating alternative order forms that comply with AAPM recommendations."
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"I have been trying to completely eliminate the use of mCi at my own institutions for years now, but mCi does not want to die".
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“It is unfortunate that after years if not decades of AAPM/ABS efforts, manufacturers are still asking for mCi instead of U".
___________________________________________________________________________________
"This is the type of event that has been warned against many times, and yet they keep recurring".
___________________________________________________________________________________
"Thank you for putting this event up for discussion: as the community does less and less Brachytherapy implants in general, and LDR implants specifically, staff expertise diminishes as well, and the likelihood of these occurring is likely to increase".
___________________________________________________________________________________
"Was there a 2nd check being done on the plan before placing the order? Was the dosimetrist placing the order trained for the work she/he was doing in brachytherapy? If a dosimetrist was doing this kind of work infrequently, maybe the physicist should have provided a printout with conversion from mCi to U. Were there other elements of the plans being reviewed? Prescription point, plaque size, etc.? It appears that this group could use additional training to avoid these types of errors".
We would like to thank Gil'ad N. Cohen MS, Thomas Niedermayr PhD, Luc Beaulieu PhD and Dorin Todor PhD for their valuable feedback and comments!

We encourage our readers to continue to submit their feedback, and comments to [email protected] as there may have been preventive and corrective actions we did not identify. Be sure to check out next month’s BrachyBlast where we will present case 0008!
Don't Let Hindsight be 2020
Join us in February for #BrachySummit2020
Join us in Big Sky, MT, February 14 - 16 as we come together for BrachySummit 2020. Our Scientific Chair, Dr. Kristin Bradley and Scientific Co-Chairs, Drs. Peter Rossi & Mitchell Kamrava have organized an outstanding meeting with superb speakers. Maintaining a vibrant brachytherapy practice and helping teams to start and/or re-invigorate their brachytherapy practice are key meeting objectives.

Highlights include:
·    A prostate “journal club” session on practice-changing clinical trial publications that will identify and discuss the important trial in GU cancers that have come out in the last year. In addition, this session will review upcoming GU studies in development.
·    A debate between Dr. Brian Davis and Dr. Mitchell Kamrava on whether LDR or HDR brachytherapy is better for prostate cancer.
·    A gynecologic session focusing on how to minimize and manage brachytherapy complications with a discussion of the current data and dose recommendations for image-guided cervical brachytherapy.

For brachytherapy practitioners, this is the conference to attend. Register today and join experts from around the country to review the latest medical evidence, emerging techniques, and future directions of brachytherapy.
Hotel Deadline - January 13, 2020
Looking for the 2020 Class of ABS Fellows
Spread the word: American Brachytherapy is looking for their 2020 Class of ABS Fellows. Join an elite group of physicians and medical physicists known for their far-reaching contributions to brachytherapy!

Click here for more information
COMMITTEE CORNER
Want to get more involved with the ABS? Here's your chance! Our goal to reshape the vision and future of the ABS to best serve the industry continues to guide how we approach every aspect of the organization. We've revamped our volunteer opportunities to better meet your needs. If you're interested in being part of one our committees, please feel free to fill out an interest form and return to Melissa Pomerene .
 
We look forward to working with you!
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For more information, please email [email protected]
2019-2020 ABS Board of Directors

Daniel G. Petereit, MD , President
Firas Mourtada, PhD, President Elect
Ann Klopp, MD, PhD, Vice President
Brett W. Cox, MD, Treasurer
Christopher L. Deufel, Secretary
Peter F. Orio, III, DO, MS , Chairman of the Board
Catheryn Yashar, MD, Past Chairwoman of the Board

Directors-at-Large
  
Sushil Beriwal, MD
Kristin Bradley, MD
Peter J. Rossi, MD
Timothy Showalter, MD

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Brachytherapy Fellowship Programs
The Department of Radiation Oncology at The Ohio State University – Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Institute (OSUCCC-James) has experienced unprecedented growth over the last several years. Due to this continued growth we are recruiting for a brachytherapy fellowship position. The fellow will focus primarily on GU and GYN brachytherapy but will have the opportunity to learn other forms of brachytherapy as well. The James Cancer Hospital and Solove Research Institute is a transformational facility that integrates scientific research, education and innovative patient care. https://cancer.osu.edu/about
 
Candidates for the position should have completed an accredited residency and be Board Certified or eligible for certification by the American Board of Radiology.
 
All inquiries should be directed to:
Brachytherapy Fellowship Coordinator
Meetings and Workshops of Interest