March, 2019
A Message From the President
Welcome to the March 2019 edition of the American Brachytherapy Society’s  BrachyBlast  newsletter.  

The Board of Directors is working diligently to update our guidelines and consensus statements. I believe this process will help bring knowledge, and power, to practitioners and patients on the efficacy of brachytherapy for many disease sites and I am excited for the process to move forward in the next few months. D on’t forget to reach out to Dr. Da n Petereit if you have interest in participating in this process.

As you know, under the direction of President-Elect Dr. Dan Petereit, the ABS is implementing a 10-year strategy called 300 in 10 . The goal is to ensure the training of 30 competent brachytherapists per year over the next 10 years through a multi-faceted approach that includes increasing public awareness, brachytherapy mini-fellowships, updating residency training guidelines and simulator/didactic training and proctorship opportunities. Currently, the Board of Directors is moving forward to develop a budget and reach out to our industry colleagues for support of mini-fellowship opportunities. More news on this initiative in upcoming BrachyBlast editions and in the Spring BrachyNews .

Registration for the 2019 Annual Meeting at the InterContinental in Miami, Florida is open! Don’t forget to mark your calendars and register soon! F or brachytherapy practitioners, this is the conference of the year to attend - join your colleagues, along with brachytherapy pioneers from around the country and the world, as the latest patient studies, brachytherapy techniques and brachytherapy equipment are discussed. We look forward to seeing you there! In this month’s BrachyBlast Drs. Cox and Bradley will highlight what is instore for #ABSBRACHY19.

In this month’s BrachyBlast we are featuring a summary and analysis of memberships' comments about Medical Event Case 004 in the Patient Safety Corner . This will provide information on how to prevent medical errors in electronic brachytherapy and the will include tips provided by members of the organization, based on your own experiences.

As always, I encourage you to continue to advocate for all things brachytherapy. Lets all do our part to continue to innovate, educate and motivate our colleagues to offer brachytherapy as a life saving therapy

Thank you,  
Peter F. Orio III, DO, MS 
President  

Follow Us on Twitter:   
@AmericanBrachy
@peter_orio
3 Month Low Dose Rate Brachytherapy Fellowship
The ABS is implementing a 10-year strategy called 300 in 10. The goal of this initiative is to ensure the training of 30 competent brachytherapists per year over the next 10 years through a multi-faceted approach including raising public awareness, working to change ACGME brachytherapy requirements, fostering advances in simulation training, developing brachytherapy curricula for residents, and establishing centers of excellence to augment brachytherapy training – in particular, 3-month brachytherapy fellowship opportunities. The Chicago Prostate Cancer Center has been chosen by the ABS as the first site to offer the first 3-month LDR prostate brachytherapy experience as they have extensive experience. We are offering 2 residents out of training, generously co-sponsored by Theragenics Corporation , an LDR prostate 3-month fellowship starting in July of 2019. Residents will have hands on experience and will become proficient LDR brachytherapists once done.

FELLOWSHIP DETAILS
·    This fellowship is designed to instruct physicians in the evolving techniques of low dose rate prostate brachytherapy. Basic instructions will be provided for the novice who has never performed this procedure, as well as, advanced training for those who have experience. Our intention is to match, then exceed, the physician’s experience level.
 
·    Training will include interactive lectures that challenge the attendee’s current concepts regarding prostate brachytherapy. Live patient interviews and case presentations will address the spectrum of patients suitable for this procedure.   

·    Additionally, much time will be devoted to live brachytherapy demonstration utilizing a pre-planned, preloaded needle technique. Emphasis will be placed on progressive thinking and participants are encouraged to share ideas and clinical cases from their own practice. Special breakout sessions will be available for ultrasound volume studies, medical physics/dosimetry treatment planning and for patient management.

·    Finally, there will be an opportunity and expectation to participate in ongoing research projects within Prostate Cancer Foundation of Chicago’s research and education department. Opportunities include data collection, literature review, abstract and manuscript writing focusing on cure rates and quality of life outcomes.

SCHEDULE
·    Approximately 7:00 am – 3:00 pm each day.
·    Monday: Consultations, Follow-ups, Volume studies, Research, Physics
·    Tuesday: Implants, Consultations, Volume studies, follow-ups, physics
·    Wednesday: Implants, Consultations, follow-ups, physics
·    Thursday: Implants, Consultations, follow-ups, research
·    Friday: Implants, Consultations, follow-ups, physics

LEARNING OBJECTIVES
·    Identify clinical appropriateness (low, intermediate, high risk patients)
·    Identify and utilize the latest techniques
·    Realize the roles of each team member in the treatment process
·    Detail the risk and management of post implant complications
·    Explain the concept and importance of radiation safety
·    Participants will have the research opportunities

COMPENSATION
·    3-month fellowship compensation: $18,000.00

Questions or concerns about fellowship details can be directed to:

Executive Director
American Brachytherapy Society

Your application should include the following: 
·    Curriculum Vitae
·    Supporting letter from your department chair or program director
·    Personal statement describing your brachytherapy experience and future goals, including if you plan on implementing a prostate LDR program
·    Preference will be given to applicants who plan on starting a prostate brachytherapy practice as this is the primary goal of the 300 in 10 strategy.
·    ABS Member

What is Happening at #ABSBRACHY19
On behalf of the American Brachytherapy Society, we warmly invite you to attend the 2019 Annual Meeting! This year’s meeting will be held in Miami from June 13-15 at the chic InterContinental Miami. The theme of the meeting is “Knowledge is Power: Generating Awareness for Patients and Practitioners”, which emphasizes the essential role of brachytherapy in modern oncology practice. We have an exciting meeting lined up with a sterling roster of nationally and internationally known experts. Each of the sessions will highlight new developments in brachytherapy as they relate to modern practice.  

The prostate sessions will focus on advances in diagnostics and patient selection, with presentations from multidisciplinary speakers on genomic classifiers, targeted biopsies, and molecular imaging, as well as dedicated sessions for both for focal and salvage therapies. The gynecology sessions will focus on the issues that are redefining modern practice, including hybrid applicators, contemporary controversies in uterine cancer treatment, and a session about custom implants and challenging case presentations with experts sharing the latest technical tips and techniques. Physics sessions include a review of modern radiobiological principles and their application to clinical practice, a critical analysis of modern brachytherapy technologies and optimization strategies, and a special “How We Do It” session with experts sharing insights on transition to ultrasound based planning for prostate HDR brachytherapy, optimizing MRI workflow in clinical practice, and software for the automation of treatment planning and plan checking.  A novel session has been added to reexamine the optimal use of anesthesia and pain management in modern brachytherapy practice. Other exciting breakouts will focus on how to build and refresh a brachytherapy practice, a roundtable entrepreneurial discussion about how to transition a novel technological idea into a finalized industry product, and updates on target dose and organ at risk constraints for all major brachytherapy treatment sites. The social media session includes some of the most well-known digital names in radiation oncology and will certainly add value to any academic or clinical practice. Socioeconomic sessions include national thought leaders from ABS and ASTRO sharing the future of the socioeconomic landscape which will define your practice – big changes are coming and you need to be ready! Finally, sessions featuring presentations from experts in brachytherapy nursing/advanced practitioners have been added. We have tailored all sessions in response to membership feedback and believe you will find them invaluable.

Additionally, the practical sessions have been completely revamped, expanded and updated based on YOUR feedback, with renewed emphasis on hands-on sessions, phantom work and practical clinical flow in addition to the traditional training in contouring critical for brachytherapy treatment planning. These sessions will emphasize the practical delivery of brachytherapy from both the clinician’s and physicist’s standpoint. The gynecology sessions will include new opportunities for phantom work using the latest advanced and hybrid applicators, with stations for anatomic mannequin models for practical demonstrations and attendee training. The prostate sessions will include an emphasis on intraoperative workflow including the similarities and differences between LDR and HDR. The skin workshop will continue to amaze with stations on treatment planning for HDR brachytherapy, applicators for electronic brachytherapy and custom mold making, 3D printing and the use of ultrasound. 

Finally, new opportunities for socializing with your peers and breakfast symposia have been added to enhance your conference experience.

We look forward to seeing you all in sunny Miami!

Respectfully,
Brett Cox, MD 2019 Scientific Program Chair
Kristin Bradley, MD 2019 Scientific Program Vice Chair
Patient Safety Corner
ABS Medical Event Case 004
Sarah Price & Panagiota Galanakou
Graduate Students, Florida Atlantic University
Zoubir Ouhib, MS
Boca Raton Community Hospital
As promised in case 0004 posted on the Brachyblast on January 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 0004 is related to a patient who received electronic brachytherapy treatment with the Xoft Axxent system. The patient received weekly dose about 145% of the prescribed weekly dose due to dose error during the second day of the treatment. This case implied that incorrect placement of the treatment catheter in the well chamber was the main cause of the incident.
Immediate (Short -Term) Preventive Actions
When calibration of the source is performed prior to treatment, the medical physicist should ensure that it is done as per manufacturer recommendation. At the time of source commissioning/initial calibration, the marker line printed on the treatment catheter must correctly line-up with the top of the well chamber and the distal tip of the catheter must be in contact with the bottom of the well chamber. See Figure 1 and 2.

A simple check, using a ruler (See arrow in Figure 2), can be performed to confirm that the marker line (grey or black) has not shifted away (Not expected to) from the distal tip of the catheter as this could lead to a lower reading during the calibration.

Have a time out to compare the treatment time to the previous fraction or to the manufacturer's Air Kerma Rate (AKR) value in µGy/min. A deviation above facility and manufacturer defined % indicates a need to investigate before delivering the treatment.

Track the AKR with a spreadsheet, or QA program over time, and have it flag the outlier measurement. Alternatively, have a sticker on the device at the time of source commissioning with AKR +/- 5%. If the AKR is outside this value, contact the physicist immediately
Long Term Actions
Vendor could include in their software a warning message or lock out of the system if the source strength measurement differs from a defined %, as an additional safety measure.

The manufacturer could key the catheters (sources) such that they can only be inserted into the well chamber one way, and with increased repeatability.
We would like to thank Daniel Scanderbeg PhD, DABR, Stephen Klash MS, DABR, Wesley
S Culberson PhD, DABR, Sujatha Pai MS, DABMP, and Linda Kelley (Xoft) for their valuable feedback.

We encourage our readers to continue to submit their feedback, and comments to PreventMedEvent@gmail.com 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 0005!
For more information, please email bradleyl@theragenics.com
International Committee
The  National and International Observerships  Task Group of the ABS International Committee is conducting a brief survey of institutions performing brachytherapy treatments. We seek your participation on behalf of your center.
 
The objective of this survey is to develop a current list of institutions who might be able to host local, national and or international visitors to observe brachytherapy programs. The overall goal of this survey is to help advance brachytherapy as an essential treatment modality through provider education and outreach.
 
Complet ing the survey will take less than five minutes. We appreciate your time.
 
Sincerely,
 
Beth A. Erickson, MD, FACR
Pranshu Mohindra, MD, MBBS
Mac M. Longo, MD
Umesh M. Mahantshetty, DMRT, MD
Junzo P. Chino, MD
Zoubir Ouhib, MS, DABR
On behalf of ABS International Committee

Did You Renew Your 2019 Membership?
If you have not renewed your ABS membership, it expired on December 31, 2018 and your membership benefits end on March 3 1. We are at watershed moment and we must all come together to continue to advocate for brachytherapy. The ABS is committed to promoting the highest possible standard for the practice of brachytherapy. We are committed to education, innovation, ensuring access, developing future leaders, and promoting brachytherapy to ensure the best outcomes for our patients. The strength of the association relies on individual members like you, who are committed to making an impact in the field of brachytherapy
 
The online renewal process is fast and easy. Click here to log into your members only portal on ABS’s new website. While you are there, be sure to review and update your member profile.
 
To pay by check, please request an invoice for your dues before mailing your payment.

Questions? Melinda Long
2018-2019 ABS Board of Directors

Peter F. Orio, III, DO, MS , President
Daniel G. Petereit, MD, President Elect
Firas Mourtada, PhD, Vice President
Ann Klopp, MD, PhD, Treasurer
Zoubir Ouhib, MS, Secretary
Catheryn Yashar, MD, Chairwoman of the Board
Steven J. Frank, MD, Past Chairman of the Board

Directors-at-Large
  
Sushil Beriwal, MD
Christopher L. Deufel, PhD
Peter J. Rossi, MD
Timothy Showalter, MD

Meetings and Workshops of Interest