294 - AAPM GEC-ESTRO Task Group 342: An Update on Image-Guided Robotic Brachytherapy

T. K. Podder¹, I. Buzurovic², J. A. M. Cunha³, C. Langmack⁴, R. Merzouki⁵, M. Moreland⁶, M. J. Rivard⁷, A. Schlaefer⁸, D. Song⁹, B. J. Traughber Jr¹⁰, K. Yan¹¹, and Y. Yu¹²; ¹SUNY Upstate Medical University, Syracuse, NY, ²Brigham and Women’s Hospital and Dana-Farber Cancer Institute, Boston, MA, ³University of California at San Francisco, San Francisco, CA, ⁴University Hospitals Seidman Cancer Center, Cleveland, OH, ⁵University of Lille, Villeneuve dAscq, France, ⁶University Medical Center Utrecht, Utrecht, Netherlands, ⁷Brown University, Providence, RI, ⁸Institute of Medical Technology and Intelligent Systems, Hamburg, Germany, ⁹Johns Hopkins University School of Medicine, Baltimore, MD, ¹⁰Mayo Clinic, Rochester, MN, ¹¹Florida Cancer Specialists at Tampa Cancer Center, Tampa, FL, ¹²Thomas Jefferson University, Philadelphia, PA

Purpose/Objective(s): Since the publication of TG-192 report in 2014, improvements in robotic brachytherapy technology have been realized and many new robotic systems were developed. Some of these devices are also being used clinically. In response to these progresses, the AAPM Brachytherapy Subcommittee and GEC-ESTRO BRAPHYQS Subcommittee assembled a joint task group (TG-342)to update TG-192 report and provide comprehensive guidelines for implementation of robotic devices in clinic. Materials/

Methods: TG-342 report includes robotic systems developed in the past 10 years (after publication of TG-192). A 12-member international committee of TG-342 has gathered information and prepared a report. There is minimal overlap with TG-192 as far the robotic systems are concerned. However, there are some overlaps in methodology of clinical applications and recommendations.
Results: Most of the new systems differ from each other with respect to available features, functionalities, and levels of automation. They are either US guided or CT guided, only 3 systems are MRI guided. About 50% of the systems are needle guides with manual needle insertion, rest of the systems accommodate autonomous needle insertion. Reported accuracy of needle or catheter placement ranges from 0.9 to 2.9 mm. Several new robotic systems have successfully been translated to clinic and the reported clinical outcomes are encouraging. In TG-342, a total of nineteen new robotic systems are described and their specifications, status, and applications are illustrated. Unlike the robotics systems in TG-192 focused on prostate seed implantation (PSI), the new robotic systems in TG-342 are developed to perform HDR brachytherapy as well as seed implantation to lung, liver, breast, and other anatomical sites in addition to PSI. Many of these systems are designed for hybrid applications, i.e., extending the application to biopsy, RFA, and IORT, beyond LDR and HDR brachy. In addition, the recommendation section has been expanded.
Conclusion: International initiatives to develop brachytherapy robots have been realized; a vast majority of the new 19 systems are reported from Asia (8) and Europe (8). Some of these robotic systems have been used clinically. Increased involvement of industry as well as industry:university collaboration are remarkable. Currently available brachytherapy robotic systems greatly vary in design, characteristics, features, and imaging modalities. Therefore, the TG-342 report provides general, rather than very strict recommendations and encourages all researchers to develop and document their own calibration procedures specific for their robotic system. An increasing number of robotic systems transitioning into clinical practice is anticipated. Table 1

Brachytherapy Robotics Systems
	Location	Party Involved
TG-192 (till 2013)	Asia (0), Europe (3) N. America (10)	Univ/Lab (12), Industry (1), Univ:Industry (0)
TG342 (2013-2023)	Asia (8), Europe (8) N. America (3)	Univ/Lab (10), Industry (6), Univ:Industry (3)