TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy)

Luca Tagliaferri; Elisa Placidi; Enrico Rosa; Pierpaolo Dragonetti; Bruno Fionda; Valentina Lancellotta; Martina De Angeli; Stefania Manfrida; Filippo Leone; Alessio Giuseppe Morganti; György Kovacs; Marco De Spirito; Maria Antonietta Gambacorta; Vincenzo Valentini

doi:10.5114/jcb.2025.155095

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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5/2025
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Original paper

TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy)

Luca Tagliaferri

^{1, 2}

,

Elisa Placidi

³

,

Enrico Rosa

^{3, 4}

,

Pierpaolo Dragonetti

¹

,

Bruno Fionda

¹

,

Valentina Lancellotta

¹

,

Martina De Angeli

¹

,

Stefania Manfrida

⁵

,

Filippo Elvino Leone

²

,

Alessio Giuseppe Morganti

⁶

,

György Kovacs

⁷

,

Marco De Spirito

^{3, 8}

,

Maria Antonietta Gambacorta

^{2, 5}

,

Vincenzo Valentini

⁹

UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
UOC Fisica per le Scienze della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Department of Theoretical and Applied Sciences, eCampus University, Novedrate (CO), Italy
UOC Servizio di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Gemelli INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
Centro di Eccellenza Oncologia Radioterapica, Medica e Diagnostica per Immagini, Ospedale Isola Tiberina-Gemelli Isola, Rome, Italy

J Contemp Brachytherapy 2025; 17, 5: 333–339

DOI: https://doi.org/10.5114/jcb.2025.155095

Online publish date: 2025/10/09

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AMA

Tagliaferri L, Placidi E, Rosa E, et al. TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy). Journal of Contemporary Brachytherapy. 2025;17(5):333-339. doi:10.5114/jcb.2025.155095.

APA

Tagliaferri, L., Placidi, E., Rosa, E., Dragonetti, P., Fionda, B.,  & Lancellotta, V. et al. (2025). TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy). Journal of Contemporary Brachytherapy, 17(5), 333-339. https://doi.org/10.5114/jcb.2025.155095

Chicago

Tagliaferri, Luca, Elisa Placidi, Enrico Rosa, Pierpaolo Dragonetti, Bruno Fionda, Valentina Lancellotta,  and Martina De Angeli et al. 2025. "TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy)". Journal of Contemporary Brachytherapy 17 (5): 333-339. doi:10.5114/jcb.2025.155095.

Harvard

Tagliaferri, L., Placidi, E., Rosa, E., Dragonetti, P., Fionda, B., Lancellotta, V., De Angeli, M., Manfrida, S., Leone, F., Morganti, A., Kovacs, G., De Spirito, M., Antonietta Gambacorta, M.,  and Valentini, V. (2025). TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy). Journal of Contemporary Brachytherapy, 17(5), pp.333-339. https://doi.org/10.5114/jcb.2025.155095

MLA

Tagliaferri, Luca et al. "TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy)." Journal of Contemporary Brachytherapy, vol. 17, no. 5, 2025, pp. 333-339. doi:10.5114/jcb.2025.155095.

Vancouver

Tagliaferri L, Placidi E, Rosa E, Dragonetti P, Fionda B, Lancellotta V et al. TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy). Journal of Contemporary Brachytherapy. 2025;17(5):333-339. doi:10.5114/jcb.2025.155095.

Introduction
Interventional radiotherapy (IRT, brachytherapy) for perineal malignancies, such as anal canal cancer, is challenged by complex pelvic anatomy and procedural limitations. Therefore, TIMER® applicator was developed to address these issues, offering innovative and adaptable design, compatible with multimodal imaging (MRI, CT, PET/CT, US).

Material and methods
TIMER® applicator features MRI/CT compatibility, dual anchoring options, and optimized needle layout to improve dose distribution and anatomical conformity. A dosimetric comparison with two commercial applicators was conducted, evaluating dose non-homogeneity ratio (DNR) across varying clinical target volumes (CTVs).

Results
The TIMER® applicator demonstrated superior dose uniformity, achieving lower DNR values across most configurations and depths. It outperformed both commercially available templates, except for shallow posterior CTVs, where one applicator showed slightly better performance.

Conclusions
The TIMER® applicator enhances dose precision and adaptability in IRT for perineal cancers, outperforming commercial devices in most scenarios. Further refinements and clinical validation will establish its role in advancing IRT protocols.

keywords:

TIMER (gemelli arT Interstitial Multi-imaging pERineal applicator): Dosimetric analysis of homemade device for interventional radiotherapy (brachytherapy)

image fusion, applicator, computed tomography (CT), ultrasound, brachytherapy, template, interventional radiotherapy, magnetic resonance imaging (MRI)