5 cm laterally at the level of point A. In two initial applications 55 and 54 cc of high-risk clinical target volumes (HRCTV) were treated, and 90% of the HRCTV was covered by 96% and 97% of prescribed doses, respectively. Additionally, the needles guided by the template helped in sculpting the dose from bladder and rectum. Conclusions We have developed an easy to use IC + IS type of template/applicator, which was successfully implemented in our clinical practice. Copyright © 2020 Termedia.Purpose The purpose of this study was to evaluate the dosimetric differences between two different applicators and rectal-retraction methods used in image-guided brachytherapy (IGBT) for locally advanced cervical cancer (LACC). Material and methods Ten patients with LACC treated with definitive chemoradiotherapy and inverse optimization-based IGBT were included in this study. In each patient, at least one fraction of IGBT was performed using tandem-ovoids (TO) with vaginal gauze packing (VGP) or tandem-ring (TR) with rectal-retractor (RR). High-risk clinical target volume (CTVHR) and intermediate-risk CTV (CTVIR) were defined as CTVs, and bladder, rectum, sigmoid, small bowel, urethra, and vaginal mucosa were defined as organs at risk (OARs). All patients received 50.4 Gy external beam radiotherapy (EBRT) in 28 fractions. After EBRT, 28 Gy high-dose-rate (HDR) IGBT in 4 fractions was delivered to central disease. A plan comparison was performed using dose-volume histogram (DVH) and treatment planning parameters for CTVs and OARs. Results There were no significant differences in D90 values of CTVHR. In terms of rectum dose, TR with RR was found to be significantly better than TO with VGP (p less then 0.0001 for D2cm3 and p less then 0.013 for V5Gy). Although, there were no statistically significant differences in D2cm3 value of bladder, sigmoid, small bowel, upper vaginal mucosa, and urethra, mean value of D2cm3 for all defined OARs were found lower in TR than in TO. Bladder V7Gy, upper vaginal mucosa V7Gy, middle and lower vaginal mucosa D2cm3 values were all found to be significantly lower for TR than for TO (p less then 0.035). CTVHR and CTVIR volumes contoured in TR were approximately 11% and 9% smaller than TO, respectively. Conclusions The results showed that there were no statistically differences in D90 value of CTVHR and CTVIR. Rilematovir nmr However, all DVH parameters for OARs in TR with RR were found to be better than in TO with VGP. Copyright © 2020 Termedia.Purpose We designed a bi-valve vaginal speculum high-dose-rate (HDR) interstitial gynecologic brachytherapy applicator. This allows for both a direct view of the cervix and image-guided brachytherapy applicator placement. The purpose of this study was to assess the validity of the new applicator. Material and methods The applicator was designed to have a 25-mm arc, which can be spread transversely to 35-mm wide, with 10 insertion holes; it was produced using a stereolithographic printer with biocompatible Dental SG resin. For resin radiodensity was measured in Hounsfield units (HU) using computed tomography (CT). Comparing the new applicator with a conventional intracavitary applicator, we evaluated the treated volume (including dimensions of 100% isodose volume at the central axis), V100/D90/D98 for a hypothetical cervix (a 2-cm-long and 4-cm-diameter cylinder), and dose points of organs at risk (OARs) (at 25 and 30 mm from the tandem). Based on dose-volume histogram (DVH) analysis of the cervix and dose points of OARs, the range of tolerance for the percent dose difference in the prescription dose was set at 5%. Results The mean radiodensity of the Dental SG resin, which was magnetic resonance imaging compatible, was 118 HU. Dimensions of the 100% isodose volume measured at the central axis were 4.4 × 6.6 × 7.4 cm for the new applicator and 4.3 × 6.0 × 7.7 cm for the intracavitary applicator. The 100% prescription dose volumes were 110 cc and 113 cc for the new and conventional applicator, respectively. The percent difference in the hypothetical cervix V100, D90, and D98 between the new and intracavitary applicator were within 5%. The percent differences in dose points of OARs at 25 and 30 mm between the new and conventional applicators were within 5%. Conclusions Our speculum applicator can reproduce a conventional pear-shaped dose distribution. Our current clinical practice will use this applicator, which can improve the patient’s treatment results. Copyright © 2020 Termedia.Purpose To design a novel high-dose-rate intracavitary applicator which may lead to enhanced dose modulation in the brachytherapy of gynecological cancers. Material and methods A novel brachytherapy applicator, auxiliary equipment and quality control phantom were modeled in SketchUp Pro 2017 modeling software and printed out from a MakerBot Replicator Z18 three-dimensional printer. As a printing material polylactic acid (PLA) filament was used and compensator materials including aluminum, stainless-steel and Cerrobend alloy were selected according to their radiation attenuation properties. To evaluate the feasibility of the novel applicator, two sets of measurements were performed in a Varian GammaMed iX Plus high-dose rate iridium-192 (192Ir) brachytherapy unit and all of the treatment plans were calculated in Varian BrachyVision treatment planning system v.8.9 with TG43-based formalism. In the first step, catheter and source-dwell positioning accuracy, reproducibility of catheter and source positions, lineace to agreement and 3% dose difference of local dose. Conclusions The novel brachytherapy applicator met the necessary requirements in quality control tests. Copyright © 2020 Termedia.Purpose Magnetic resonance imaging (MRI)-guided adaptive brachytherapy is the standard of care for cervical cancer. Hybrid intracavitary/interstitial applicators for bulky tumor (high-risk clinical target volume [HR-CTV] > 30 cc) dose escalation is recommended in the EMBRACE II trial. The value of hybrid applicators for smaller HR-CTV ( less then 30 cc) in organ at risk (OAR) sparing is less certain. Material and methods Twenty-seven patients with FIGO stage I-IVA cervical cancer treated with definitive chemoradiation and MRI-based brachytherapy using conventional tandem and ring (TR) applicators were re-planned using virtual needles. They were then summed with the external beam dose to evaluate target coverage and OAR dose using EQD2 summation. Target and OAR dose with/without hybrid applicator use were compared. Results Eighty-one percent had HR-CTV volumes less then 30 cc, for which, hybrid TR applicators had significantly lower mean D2cc to all OARs without differences in target coverage. For HR-CTV less then 30 cc, the bladder and rectal OAR goals per EMBRACE II were exceeded in significantly fewer patients with the hybrid TR applicators.