This review aims to showcase the brachytherapy tools and technologies that have emerged
during the last 10 years. Soft-tissue contrast using magnetic resonance and ultrasound
imaging has seen enormous growth in use to plan all forms of brachytherapy. The era
of image-guided brachytherapy has encouraged the development of advanced applicators
and given rise to the growth of individualised 3D printing to achieve reproducible
and predictable implants. These advances increase the quality of implants to better
direct radiation to target volumes while sparing normal tissue. Applicator reconstruction
has moved beyond manual digitising, to drag and drop of three-dimensional applicator
models with embedded pre-defined source pathways, ready for auto-recognition and automation.
The simplified TG-43 dose calculation formalism directly linked to reference air kerma
rate of high-energy sources in the medium water remains clinically robust. Model-based
dose calculation algorithms accounting for tissue heterogeneity and applicator material
will advance the field of brachytherapy dosimetry to become more clinically accurate.
Improved dose-optimising toolkits contribute to the real-time and adaptive planning
portfolio that harmonises and expedites the entire image-guided brachytherapy process.
Traditional planning strategies remain relevant to validate emerging technologies
and should continue to be incorporated in practice, particularly for cervical cancer.
Overall, technological developments need commissioning and validation to make the
best use of the advanced features by understanding their strengths and limitations.
Brachytherapy has become high-tech and modern by respecting tradition and remaining
accessible to all.
