{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T19:28:59Z","timestamp":1784230139122,"version":"3.55.0"},"reference-count":38,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,26]],"date-time":"2022-11-26T00:00:00Z","timestamp":1669420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Varian research funding"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>A novel clinical workflow utilizing a direction modulated brachytherapy (DMBT) tandem applicator in combination with a patient-specific, 3D printed vaginal needle-track template for an advanced image-guided adaptive interstitial brachytherapy of the cervix. The proposed workflow has three main steps: (1) pre-treatment MRI, (2) an initial optimization of the needle positions based on the DMBT tandem positioning and patient anatomy, and a subsequent inverse optimization using the combined DMBT tandem and needles, and (3) rapid 3D printing. We retrospectively re-planned five patient cases for two scenarios; one plan with the DMBT tandem (T) and ovoids (O) with the original needle (ND) positions (DMBT + O + ND) and another with the DMBT T&amp;O and spatially reoptimized needles (OptN) positions (DMBT + O + OptN). All retrospectively reoptimized plans have been compared to the original plan (OP) as well. The accuracy of 3D printing was verified through the image registration between the planning CT and the CT of the 3D-printed template. The average difference in D2cc for the bladder, rectum, and sigmoid between the OPs and DMBT + O + OptNs were \u22128.03 \u00b1 4.04%, \u221218.67 \u00b1 5.07%, and \u221226.53 \u00b1 4.85%, respectively. In addition, these average differences between the DMBT + O + ND and DMBT + O + OptNs were \u22122.55 \u00b1 1.87%, \u221210.70 \u00b1 3.45%, and \u221222.03 \u00b1 6.01%, respectively. The benefits could be significant for the patients in terms of target coverage and normal tissue sparing and increase the optimality over free-hand needle positioning.<\/jats:p>","DOI":"10.3390\/jcm11236989","type":"journal-article","created":{"date-parts":[[2022,11,28]],"date-time":"2022-11-28T06:04:36Z","timestamp":1669615476000},"page":"6989","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Novel Workflow with a Customizable 3D Printed Vaginal Template and a Direction Modulated Brachytherapy (DMBT) Tandem Applicator for Adaptive Interstitial Brachytherapy of the Cervix"],"prefix":"10.3390","volume":"11","author":[{"given":"James J.","family":"Sohn","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitchell","family":"Polizzi","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Richeson","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Somayeh","family":"Gholami","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4094-0892","authenticated-orcid":false,"given":"Indra J.","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Y.","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA 23219, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,26]]},"reference":[{"key":"ref_1","first-page":"98","article-title":"Image-guided adaptive brachytherapy in the treatment of patients with cervix cancer","volume":"17","author":"Thomas","year":"2013","journal-title":"Cancer Radiother."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.clon.2008.04.011","article-title":"Image-guided Adaptive Brachytherapy for Cervix Carcinoma","volume":"20","author":"Fidarova","year":"2008","journal-title":"Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.radonc.2011.12.024","article-title":"Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (IV): Basic principles and parameters for MR imaging within the frame of image based adaptive cervix cancer brachytherapy","volume":"103","author":"Dimopoulos","year":"2012","journal-title":"Radiother. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/j.ijrobp.2011.04.044","article-title":"Clinical Use of the Utrecht Applicator for Combined Intracavitary\/Interstitial Brachytherapy Treatment in Locally Advanced Cervical Cancer","volume":"82","author":"Nomden","year":"2012","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1016\/j.ijrobp.2006.01.036","article-title":"The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Design, application, treatment planning, and dosimetric results","volume":"65","author":"Kirisits","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.ijrobp.2019.04.009","article-title":"Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques","volume":"105","author":"Callaghan","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.semradonc.2019.09.001","article-title":"Brachytherapy Future Directions","volume":"30","author":"Cunha","year":"2020","journal-title":"Semin. Radiat. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"11718","DOI":"10.1118\/1.4769416","article-title":"Dynamic modulated brachytherapy (DMBT) for rectal cancer","volume":"40","author":"Webster","year":"2013","journal-title":"Med. Phys."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"91704","DOI":"10.1118\/1.4816677","article-title":"HDR brachytherapy of rectal cancer using a novel grooved-shielding applicator design","volume":"40","author":"Webster","year":"2013","journal-title":"Med. Phys."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1016\/j.ijrobp.2014.02.039","article-title":"Direction-Modulated Brachytherapy for High-Dose-Rate Treatment of Cervical Cancer. I: Theoretical Design","volume":"89","author":"Han","year":"2014","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1016\/j.ijrobp.2016.06.015","article-title":"Direction modulated brachytherapy for treatment of cervical cancer. II: Comparative planning study with intracavitary and intracavitary-interstitial techniques","volume":"96","author":"Han","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.radonc.2016.07.006","article-title":"Quantitative MRI assessment of a novel direction modulated brachytherapy tandem applicator for cervical cancer at 1.5T","volume":"120","author":"Soliman","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"363","DOI":"10.5114\/jcb.2016.61817","article-title":"Metal artefacts in MRI-guided brachytherapy of cervical cancer","volume":"8","author":"Soliman","year":"2016","journal-title":"J. Contemp. Brachytherapy"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4426","DOI":"10.1002\/mp.12335","article-title":"Comparison of 192Ir, 169Yb, and 60Co high-dose rate brachytherapy sources for skin cancer treatment","volume":"44","author":"Safigholi","year":"2017","journal-title":"Med. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"6538","DOI":"10.1002\/mp.12598","article-title":"Direction modulated brachytherapy (DMBT) for treatment of cervical cancer: A planning study with 192Ir, 169Yb, and 60Co HDR sources","volume":"44","author":"Safigholi","year":"2017","journal-title":"Med. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.brachy.2017.10.006","article-title":"Quantitative CT assessment of a novel direction-modulated brachytherapy tandem applicator","volume":"17","author":"Elzibak","year":"2018","journal-title":"Brachytherapy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3524","DOI":"10.1002\/mp.13030","article-title":"Direction modulated brachytherapy (DMBT) tandem applicator for cervical cancer treatment: Choosing the optimal shielding material","volume":"45","author":"Safigholi","year":"2018","journal-title":"Med. Phys."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1030","DOI":"10.1016\/j.brachy.2018.08.001","article-title":"Modeling of the direction modulated brachytherapy tandem applicator using the Oncentra Brachy advanced collapsed cone engine","volume":"17","author":"Safigholi","year":"2018","journal-title":"Brachytherapy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.ijrobp.2019.03.026","article-title":"Dynamic Modulated Brachytherapy (DMBT) Balloon Applicator for Accelerated Partial Breast Irradiation","volume":"104","author":"Guy","year":"2019","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.radonc.2016.03.020","article-title":"Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study","volume":"120","author":"Fokdal","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_21","first-page":"48","article-title":"The EMBRACE II study: The outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies","volume":"9","author":"Tanderup","year":"2018","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Garg, A., Patil, S., Siauw, T., Cunha, J.A.M., Hsu, I.C., Abbeel, P., Pouliot, J., and Goldberg, K. (2013, January 17\u201320). An algorithm for computing customized 3D printed implants with curvature constrained channels for enhancing intracavitary brachytherapy radiation delivery. Proceedings of the 2013 IEEE International Conference on Automation Science and Engineering (CASE), Madison, WI, USA.","DOI":"10.1109\/CoASE.2013.6654002"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"6208","DOI":"10.1118\/1.4747264","article-title":"Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation","volume":"39","author":"Beaulieu","year":"2012","journal-title":"Med. Phys."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.radonc.2020.10.010","article-title":"Ureteral stenosis after 3D MRI-based brachytherapy for cervical cancer\u2014Have we identified all the risk factors?","volume":"155","author":"Ling","year":"2021","journal-title":"Radiother. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.brachy.2015.05.003","article-title":"A novel two-step optimization method for tandem and ovoid high-dose-rate brachytherapy treatment for locally advanced cervical cancer","volume":"14","author":"Sharma","year":"2015","journal-title":"Brachytherapy"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.brachy.2014.12.006","article-title":"Customized vaginal vault brachytherapy with computed tomography imaging-derived applicator prototyping","volume":"14","author":"Wiebe","year":"2015","journal-title":"Brachytherapy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.radonc.2015.12.012","article-title":"Individualised 3D printed vaginal template for MRI guided brachytherapy in locally advanced cervical cancer","volume":"118","author":"Lindegaard","year":"2016","journal-title":"Radiother. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/j.brachy.2021.03.019","article-title":"Characterization of combined intracavitary\/interstitial brachytherapy including oblique needles in locally advanced cervix cancer","volume":"20","author":"Serban","year":"2021","journal-title":"Brachytherapy"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.1002\/mp.14762","article-title":"Optimization in treatment planning of high dose-rate brachytherapy\u2014Review and analysis of mathematical models","volume":"48","author":"Larsson","year":"2021","journal-title":"Med. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.brachy.2020.02.013","article-title":"PNaV: A tool for generating a high-dose-rate brachytherapy treatment plan by navigating the Pareto surface guided by the visualization of multidimensional trade-offs","volume":"19","author":"Deufel","year":"2020","journal-title":"Brachytherapy"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.prro.2021.01.008","article-title":"Computed Tomography-Guided Optimization of Needle Insertion for Combined Intracavitary\/Interstitial Brachytherapy With Utrecht Applicator in Locally Advanced Cervical Cancer","volume":"11","author":"Tambas","year":"2021","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"6117","DOI":"10.1002\/mp.12590","article-title":"A fast inverse treatment planning strategy facilitating optimized catheter selection in image-guided high-dose-rate interstitial gynecologic brachytherapy","volume":"44","author":"Guthier","year":"2017","journal-title":"Med. Phys."},{"key":"ref_33","unstructured":"Adaptiiv (2022, May 25). Brachytherapy\u20143D Printed Applicators. Available online: https:\/\/www.adaptiiv.com\/product\/brachytherapy\/."},{"key":"ref_34","first-page":"e4913","article-title":"High Dose Rate 192-Ir-Brachytherapy for Basal Cell Carcinoma of the Skin using a 3D Printed Surface Mold","volume":"11","author":"Casey","year":"2019","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ejmp.2017.05.051","article-title":"Radiological properties of 3D printed materials in kilovoltage and megavoltage photon beams","volume":"38","author":"Dancewicz","year":"2017","journal-title":"Phys. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Kim, S.W., Shin, H.J., Kay, C.S., and Son, S.H. (2014). A customized bolus produced using a 3-dimensional printer for radiotherapy. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110746"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.ijrobp.2013.05.033","article-title":"Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States","volume":"87","author":"Han","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/IGC.0b013e31823ae3c9","article-title":"The Quality of Cervical Cancer Brachytherapy Implantation and the Impact on Local Recurrence and Disease-Free Survival in Radiation Therapy Oncology Group Prospective Trials 0116 and 0128","volume":"22","author":"Viswanathan","year":"2012","journal-title":"Int. J. Gynecol. Cancer"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6989\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:27:26Z","timestamp":1760146046000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/6989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,26]]},"references-count":38,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11236989"],"URL":"https:\/\/doi.org\/10.3390\/jcm11236989","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,26]]}}}