The American Brachytherapy Society

For this week’s discussion post I chose to discuss the American Brachytherapy
Society (ABS) dose calculation system. This system uses a series of points for
calculations and dose tracking much like other systems, and has its own advantages
and disadvantages. The dose prescription point is referred to as point A and its
location is dependent upon the type of applicator used. For example, when a
tandem and ovoid applicator is used point A is found by drawing a line through the
center of each ovoid, finding the center of where this point intersects on the tandem,
extending 2cm along the tandem, and from that location extend 2cm on either side.1
This location can be visualized in Figure 1.

Figure 1. Location of point A for a tandem and ovoid applicator.1

Figure 2 shows the location of point A when a tandem and ring applicator is used.
This point is located by connecting a line through the center of the lateral most
dwell positions on the ring and finding where the tandem intersects this line. From
that location move superiorly to the most superior portion of the ring cap and then
extend 2 cm further along the tandem. After extending 2 cm, point A can be found
by extending 2 cm lateral on either side.

Figure 2. Location of point A for a tandem and ring applicator.1

Finally, if a tandem and cylinder applicator is used, point A can be found by
extending 2cm from the tip of the cylinder that marks the os and then extending 2
cm on either side.

Figure 3. Location of point A for a tandem and cylinder applicator.1

Dose to bladder and rectal points are also considered in the ABS consensus
guidelines. These points are taken from ICRU 38, which describes how to define
both of these points. To find the bladder point, a catheter is used to fill a balloon
which rests against the neck of the patient’s bladder. A lateral film is taken and a
line is drawn through the center of the balloon in the AP/PA orientation. In this
plane, the point is on the line at the mid-posterior surface of the balloon and on an
AP film, it is defined at the center of the balloon.1
The rectal point for a tandem and ovoid implant is also found by taking a lateral and
anterior film. On a lateral film the rectal point is found by drawing a line along the
lower end of the source and extending the line 5mm posterior to the vaginal wall.
For an anterior film, the rectal point is at the lower end of the source, which is
approximately at the level of the ovoids.1
The ABS recommends a cumulative delivered dose of 80-90 Gy be delivered for
definitive treatment of locally advanced cervical cancer.2 When measuring dose to
the organs at risk, 2cc limits are used. For the rectum, the dose should be kept to
70-75Gy and for the bladder a maximum of 90Gy should be observed.
There are advantages and disadvantages to using brachytherapy. For example, with
the ABS calculation system, the dose to the points that are used are dependent on
proper placement of the applicator. If the applicator is not placed or secured
properly, this could result in incorrect dose delivery and treatment errors. An
advantage of using the ABS system is that a sidewall dose is used rather than a point
B, which is used in the Manchester system.3 In the Manchester system, point B
represents the location of the obturator nodes; however, CT-based studies have
found that this is rarely the case.3

1. Lenards N, Berner P, Schmidt K. Intracavitary Brachytherapy Dose

Specifications. [Soft Chalk]. La Crosse, WI: UW-L Medical Dosimetry Program;
2018.
2. Viswanathan AN, Thomadsen B. American brachytherapy society consensus
guidelines for locally advanced carcinoma of the cervix. part 1: general
 priniciples. Brachytherapy. 2012;11:33-46.
http://dx.doi.org/10.1016/j.brachy.2011.07.003
3. Khan FM. Treatment Planning in Radiation Oncology. 3rd ed. Philadelphia, PA:
Lippincott Williams & Wilkins; 2011.