In vivo dosimetry in pelvic brachytherapy

Brachytherapy is an effective treatment in the curative management of prostate and gynaecological cancers. With advances in technology, brachytherapy has increased in complexity in recent years. Human error, equipment malfunction, patient organ motion and radioactive source displacement can result in substantial deviation of delivered dose from planned dose. To limit adverse clinical outcomes, adequate steps to improve the robustness of pathway processes, ensure the implementation of appropriate treatment margins and confirm the delivered dose must be considered. In vivo dosimetry is one such method of dose validation which, if implemented appropriately within clinical practice, is an attractive technique for reducing dosimetric uncertainties and identifying potential errors. This review aims to describe the dosimetric uncertainties and potential errors associated with brachytherapy, the potential for in vivo dosimetry in adaptive brachytherapy as a key method of dose validation, and the clinical considerations and future directions of in vivo dosimetry.

Advances in knowledge
This paper describes the potential role for in vivo dosimetry in the reduction of uncertainties in pelvic brachytherapy, the pertinent factors for consideration in clinical practice, and the future potential for in vivo dosimetry in the personalisation of brachytherapy.