# A potential usefulness of ultra-high-resolution computed tomography in quality assurance of remote after-loading system for cervical cancer

## TL;DR

Ultra-high-resolution CT can detect hidden cracks in brachytherapy applicators, improving safety in cervical cancer treatment.

## Contribution

Demonstrates the potential of ultra-high-resolution CT for detecting applicator damage not visible with standard imaging.

## Key findings

- A linear crack in a sterilized applicator was detected only by ultra-high-resolution CT.
- Standard treatment-planning CT failed to identify the crack due to lower resolution.
- No cracks were found in eight other undamaged applicators using ultra-high-resolution CT.

## Abstract

Intracavitary brachytherapy with a remote after-loading system (RALS) is performed as a part of radical radiation therapy in cervical cancer. The radiation source is delivered directly through an applicator placed inside the uterus or vagina. Thorough quality control is important to prevent accidents that can lead to serious irradiation error, and an applicator check is one such quality control measure. We experienced a clinical situation in which a small volume of water was observed in the lumen of a post-sterilized applicator on treatment-planning CT. Although the submersion test was negative and no air bubbles emerged from the applicator, ultra-high-resolution computed tomography (U-HRCT) showed a linear crack reaching the inside of the applicator. This abnormality was not identified on treatment-planning CT, which has lower spatial resolution than U-HRCT. In addition, no linear cracks were seen on U-HRCT images of eight other applicators considered to be free from damage. U-HRCT may have superior potential to detect applicator damage and could be useful for quality assurance of the RALS procedure.