@Article{Rockey2013,
journal="Journal of Contemporary Brachytherapy",
issn="1689-832X",
volume="5",
number="1",
year="2013",
title="Original paperThe dosimetric impact of vaginal balloon-packing on intracavitary high-dose-rate brachytherapy for gynecological cancer",
abstract=" Purpose : We perform a clinical retrospective study to determine whether a vaginal balloon-packing system provides a dosimetric reduction to organs at risk (OARs)  versus  traditional gauze packing for gynecological high-dose-rate brachytherapy (HDR-BT). We also test various balloon filling materials for optimizing imaging quality.    Material and methods:  Filling materials for balloon-packing were evaluated based on imaging quality with X-ray, computerized tomography, and magnetic resonance imaging modalities. We then retrospectively reviewed 45 HDR-BT plans of 18 patients performed with gauze packing and 39 plans of 16 patients performed with balloon-packing. Twelve patients received both gauze and balloon-packing. HDR-BT was delivered with an iridium-192 afterloader and a Fletcher-Suit-Declos-style T\&O applicator. At each fraction, 3D imaging was obtained. The D2 cc  values of OARs were calculated, as well as ICRU-defined point doses.    Results: I n the 84 HDR fractions reviewed, vaginal balloon-packing provides statistically equivalent doses to rectum, bladder, and sigmoid compared to gauze packing. On average balloon-packing produced average reductions of 3.3% and 6.9% in the rectal and sigmoid D2 cc  doses and an increase of 3.2% to the bladder D2 cc  dose (normalized to prescription dose), although none of these values were statistically significant for the twelve patients who received both gauze and balloon-packing (32 and 40 total fractions, respectively).    Conclusions : In the 84 HDR fractions analyzed, vaginal balloon-packing is as effective as gauze packing for dose sparing to the rectum, bladder, and sigmoid. A 1 : 1 solution of saline and contrast for filling material enables easy contouring for image-guided HDR with minimal artefacts.",
author="Rockey, William M.
and Bhatia, Sudershan K.
and Jacobson, Geraldine M.
and Kim, Yusung",
pages="17--22",
doi="10.5114/jcb.2013.34449",
url="http://dx.doi.org/10.5114/jcb.2013.34449"
}