Recommendations for intraoperative mesh brachytherapy: Report of AAPM Task Group No. 222

Mesh brachytherapy is a special type of permanent implant: it uses low-energy radioactive seeds in an absorbable mesh that sutured onto the tumor bed immediately after surgical resection. This treatment offers low additional risk to patient as implant procedure carried out part resection surgery. utilizes identification through direct visual evaluation during surgery or medical imaging following radiographic radio-opaque markers within sources located on bed. Thus, customizable for individual patients. intraoperative involving implantation and potentially real-time planning while under general anesthesia. The multidisciplinary requires complex coordination multiple specialties. preimplant dosimetry calculation can be performed days beforehand expediently operating room with use lookup tables. In this report, guidelines American Association Physicists Medicine (AAPM) are presented physics aspects brachytherapy. It describes selection sources, design preparation mesh, using Task Group (TG) 43-based table, postimplant dosimetric TG-43 formalism advanced algorithms. introduces quality metrics presents example analysis based AAPM TG-100 report. Recommendations include plan upon dose point source approximation, by either approach, preferably newer model-based algorithms (viz., TG-186 report) if available account effects material heterogeneities. To comply written directive regulations governing radionuclides, report recommends prescription implanted strength, not target-volume coverage. delivered implants vary depends factors, such postsurgery recovery distortions shape over time. For sake consistency necessary outcome analysis, prescriptions table (with intended dose, depth, area) recommended, but more techniques real situations, heterogeneities, geometric perturbations, changes orientations, encouraged evaluation. clinical workflow, logistics, precautions also presented.