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Emerging Technologies
in Brachytherapy
Series in Medical Physics and Biomedical Engineering
Series Editors: John G. Webster, E. Russell Ritenour, Slavik Tabakov,
and Kwan-Hoong Ng

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Emerging Technologies in Brachytherapy

William Y. Song, Kari Tanderup, and Bradley Pieters (Eds)

Environmental Radioactivity and Emergency Preparedness

Mats Isaksson and Christopher L. Rääf

The Practice of Internal Dosimetry in Nuclear Medicine

Michael G. Stabin

Radiation Protection in Medical Imaging and Radiation Oncology

Richard J. Vetter and Magdalena S. Stoeva (Eds)

Graphics Processing Unit-Based High Performance Computing in Radiation Therapy

Xun Jia and Steve B. Jiang (Eds)

Statistical Computing in Nuclear Imaging

Arkadiusz Sitek

The Physiological Measurement Handbook

John G. Webster (Ed)

Radiosensitizers and Radiochemotherapy in the Treatment of Cancer

Shirley Lehnert

Diagnostic Endoscopy
Haishan Zeng (Ed)

Medical Equipment Management

Keith Willson, Keith Ison, and Slavik Tabakov

Targeted Muscle Reinnervation: A Neural Interface for Artificial Limbs

Todd A. Kuiken; Aimee E. Schultz Feuser; Ann K. Barlow (Eds)

Quantifying Morphology and Physiology of the Human Body Using MRI

L. Tugan Muftuler (Ed)

Monte Carlo Calculations in Nuclear Medicine, Second Edition: Applications in

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Emerging Technologies
in Brachytherapy

Edited by
William Y. Song
Sunnybrook Health Sciences Centre
University of Toronto

Kari Tanderup
Aarhus University Hospital
Aarhus University

Bradley R. Pieters
Academic Medical Center
University of Amsterdam
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2017 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-4987-3652-7 (Hardback)

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Library of Congress Cataloging-in-Publication Data

Names: Song, William Y., 1977- author. | Tanderup, Kari, author. | Pieters,
Bradley, 1965- author.
Title: Emerging technologies in brachytherapy / William Y. Song, Kari
Tanderup, and Bradley Pieters.
Other titles: Series in medical physics and biomedical engineering.
Description: Boca Raton, FL : CRC Press, Taylor & Francis Group, [2017] |
Series: Series in medical physics and biomedical engineering | Includes
bibliographical references and index.
Identifiers: LCCN 2016037962| ISBN 9781498736527 (hardback ; alk. paper) |
ISBN 1498736521 (hardback ; alk. paper) | ISBN 9781498736541 (E-book) |
ISBN 1498736548 (E-book)
Subjects: LCSH: Radioisotope brachytherapy--Technological innovations.
Classification: LCC RC271.R27 S66 2017 | DDC 615.8/424--dc23
LC record available at https://lccn.loc.gov/2016037962

Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
We dedicate this book to cancer patients worldwide.
Contents

Acknowledgments, xi
Editors, xiii
Contributors, xv
Abbreviations, xxiii

Chapter 1   ◾   Introduction 1
William Y. Song, K ari Tanderup, and Bradley R. Pieters

Section I  Physics of Brachytherapy

Chapter 2   ◾   Sources and Loading Technologies 7

Mark J. Rivard

Chapter 3   ◾   Applicators 23
Primoz Petric, Christian Kirisits, Jose Perez-Calatayud, Umesh Mahantshetty,
William Y. Song, and Bradley R. Pieters

Chapter 4   ◾   Applicator Reconstruction 39

Christoph Bert, Taran Paulsen Hellebust, and Frank-André Siebert

Chapter 5   ◾   Dose Calculation 55

Åsa Carlsson Tedgren, Xun Jia, Manuel Sanchez-Garcia, and Alexandr Malusek

Chapter 6   ◾   Dose Optimization 79

Rob van der Laarse and Peter A.N. Bosman

Chapter 7   ◾   Image Processing for Brachytherapy 99

Niclas Pettersson and Laura Cerviño

vii
viii   ◾    Contents

Chapter 8   ◾ FMEA

    for Brachytherapy 113
Susan Richardson, Daniel Scanderbeg, and Jamema Swamidas

Chapter 9   ◾ Real-Time

    In Vivo Dosimetry 131
Luc Beaulieu, Rick Franich, and Ryan L. Smith

Chapter 10   ◾   Quality Assurance Technologies 153

Antonio L. Damato, Dorin A. Todor, Laura Cervino, and Robert A. Cormack

Chapter 11   ◾   Additive Manufacturing (3D Printing) in Brachytherapy 163

Ananth R avi, Lior Dubnitzky, and Harry Easton

Chapter 12   ◾ Robotics

    in Brachytherapy 177
Tarun K. Podder and A aron Fenster

Section II  Imaging for Brachytherapy Guidance

Chapter 13   ◾   Optical Imaging and Navigation Technologies 199

Robert Weersink

Chapter 14   ◾   Ultrasound 213

Maximilian P. Schmid, Luc Beaulieu, Nicole Nesvacil, Bradley R. Pieters,
Arnoud W. Postema, Stefan G. Schalk, Frank-André Siebert, and Hessel Wijkstra

Chapter 15   ◾ X-Ray

    and Computed Tomography 233
Martin T. King and Michael J. Zelefsky

Chapter 16   ◾ Magnetic

    Resonance Imaging 243
Cynthia Ménard, Uulke A. van der Heide, Maroie Barkati, and Eirik Malinen

Chapter 17   ◾ Positron

    Emission Tomography 255
Alejandro Berlin and R achel Glicksman

Chapter 18   ◾ Imaging

    for Treatment Verification 265
Taran Paulsen Hellebust, Harald Keller, and Nicole Nesvacil

Section III  Brachytherapy Suites

Chapter 19   ◾   Medical University of Vienna, Vienna, Austria 277

Christian Kirisits, Maximilian P. Schmid, Nicole Nesvacil, and Richard Pötter

Chapter 20   ◾ University

    Medical Center Utrecht, Utrecht, the Netherlands 285
Marinus A. Moerland, Astrid A. de Leeuw, Jochem R. van der Voort van Zyp, and
Ina M. Jürgenliemk-Schulz
 Contents   ◾   ix

Chapter 21   ◾   University Hospital Erlangen, Erlangen, Germany 295

Vratislav Strnad and Michael Lotter

Chapter 22   ◾   Charles LeMoyne Hospital, Montreal, Canada 303

Marjory Jolicoeur, Talar Derashodian, Marie Lynn R acine, Georges Wakil,
Thu Van Nguyen, and Maryse Mondat

Chapter 23   ◾   Sunnybrook Health Sciences Centre, Toronto, Canada 313

Amir Owrangi, Geordi Pang, and Ananth R avi

Chapter 24   ◾   Princess Margaret Cancer Centre, Toronto, Canada 321

Marco Carlone, Teo Stanescu, Tony Tadic, Kitty Chan, Colleen Dickie,
Stephen Breen, Hamideh Alasti, K athy Han, Michael Milosevic, Cynthia Ménard,
Alexandra Rink, Anna Simeonov, and David Jaffray

Chapter 25   ◾   Tata Memorial Hospital, Mumbai, India 329

Umesh Mahantshetty, Lavanya Naidu, Sarbani (Ghosh) Laskar, Ashwini
Budrukkar, Jamema Swamidas, Siddhartha Laskar, and Shyamkishore Shrivastava

Chapter 26   ◾   Institut Joliot-Curie Cancer Center, Dakar, Senegal:

Implementing a Brachytherapy Program in a Resource
Limited Setting 337
Derek Brown, Moustafa Dieng, Macoumba Gaye, Magatte Diagne, Alana
Hudson, Adam Shulman, and John Einck

Section IV  Is Brachytherapy a Competitive Modality?

Chapter 27   ◾   EBRT or Brachytherapy? 349

K athy Han, Eve-Lyne Marchand, Jennifer Croke, and Té Vuong

Chapter 28   ◾   Particle Therapy or Brachytherapy? 361

Dietmar Georg and Richard Pötter

Chapter 29   ◾   Is Brachytherapy Cost Effective? 369

Peter Orio, Benjamin Durkee, Thomas Lanni, Yolande Lievens, and Daniel Petereit

Section V  Vision 20/20: Industry Perspective

Chapter 30   ◾   Elekta Brachytherapy 379

Mehmet Üzümcü

Chapter 31   ◾   Eckert & Ziegler BEBIG 391

Carmen Schulz, Irina Fotina, Michael Andrassy, Thomas Osche, and Sven Beerheide

INDEX, 397
Acknowledgments

T he editors of this book express their gratitude to all the contributors. The authors
have made a tremendous effort to provide us with fully up-to-date, state-of-the-art,
and emerging technologies and opinions in brachytherapy.
The editors also wish to record their gratitude and thanks for the skilful support and
encouragement of the Taylor & Francis team, in particular Francesca McGowan, Emily
Wells, and Rebecca Davies.
Finally, the editors wish to record their gratitude and thanks for the support, encour-
agement, and forbearance shown by their families and colleagues during the execution of
this work. In particular, WYS wishes to thank Hyun Hee Kim for her unending support
and love.

xi
Editors

Dr. William Y. Song, PhD, is the head of Medical Physics,

Department of Radiation Oncology, Odette Cancer Centre,
Sunnybrook Health Sciences Centre, Toronto, Canada. This is
one of the largest medical physics units in the world with 50+
staff. Along with a busy external beam radiotherapy program,
the centre sees close to 600 brachytherapy patients a year, mak-
ing it the busiest program in Canada. Since joining the centre in
2014, he has been an associate professor in the Department of
Radiation Oncology, adjunct professor in the Institute of Medical
Sciences, Institute of Biomaterials and Biomedical Engineering,
and Department of Mechanical and Industrial Engineering, at the University of Toronto.
He is also an adjunct professor in the Department of Physics, at the Ryerson University,
Toronto, Canada. He earned his PhD in 2006 at the University of Western Ontario, London,
Canada, on the topic of image-guided treatment approaches for prostate cancer. Since then,
he has pursued research in the field of image guidance systems, 4D motion management
technologies, and brachytherapy, resulting in over 50+ peer-reviewed publications and 130+
conference abstracts. Along the way, he became a fully certified medical physicist (American
Board of Radiology, 2010), directly supervised(ing) 20+ MSc and PhD graduate students,
an ad hoc reviewer for 20+ research journals, and is a member of the Editorial Board for
the Journal of Medical Physics. In brachytherapy particular, his research focus has been in
developing novel applicators and MR image processing techniques that enhances plan qual-
ity and plan quality evaluations; one in particular, in cleverly designing MR-compatible
metal alloys to create non-isotropic dose distributions that can, in combination with inverse
planning, gain exceptional dosimetric conformality for use
in image-guided adaptive brachytherapy.

Dr. Kari Tanderup, PhD, is professor at Department of

Oncology, Aarhus University Hospital in Aarhus, Denmark.
She was educated from Aarhus University with a master’s in
physics and math in 1997. In 2008 she earned her PhD with
a thesis on brachytherapy in cervical cancer. Furthermore,
since 2011, she has been appointed as visiting professor at
Medical University of Vienna.
xiii
xiv   ◾    Editors

At Aarhus University Hospital, Kari Tanderup chairs a research group working with
brachytherapy and MR image guidance. Her main research interests are MRI-guided
cervix and prostate cancer, clinical studies, and in vivo dosimetry. Within these topics
she has authored 90+ papers and has supervised 10+ PhD students. Furthermore, she was
committee member for the ICRU (The International Commission on Radiation Units &
Measurements) Report 89 on brachytherapy in cervical cancer, and she is associate senior
editor for International Journal of Radiation Oncology, Biology and Physics.
Kari Tanderup is actively contributing to committee and task group work in ESTRO
(European SocieTy for Radiotherapy and Oncology) and is course director in the ESTRO
school. She is chairing the GEC ESTRO (Group Européen de Curiethérapie-European
Society for Radiotherapy and Oncology) gyn network which represents the most active
core European academic centers within gynecological brachytherapy, and embraces mem-
bers from Central/Eastern Europe, India, Canada, and the United States. Through past and
ongoing activities this group is internationally recognized as a leading group in gynecolog-
ical image-guided brachytherapy. The group has published international guidelines, which
are now used worldwide. The GEC ESTRO gyn group has also coordinated the EMBRACE
study, which is an international multicenter study on MRI-guided brachytherapy in cervi-
cal cancer. The EMBRACE trial has recruited >1400 patients, and this material is currently
generating a wealth of clinical evidence on outcome as well as dose and effect relationships.

Dr. Bradley R. Pieters, MD, PhD, is the head of the

Brachytherapy department at the Academic Medical Center
(AMC) in Amsterdam, The Netherlands. The AMC has a
focus on brachytherapy, hyperthermia, and image-guided
radiotherapy. He was trained as radiation oncologist at the
Radboud University Hospital in Nijmegen, The Netherlands.
Because of his interest in brachytherapy he followed at the
end of the residency a brachytherapy fellowship at the Daniel
den Hoed clinic in Rotterdam and L’Institut Gustav-Roussy
in Villejuif, France. Dr. Pieters obtained his MSc in epidemi-
ology in 2006. In 2010 he earned his PhD at the University
of Amsterdam after defending his thesis “Pulsed-dose rate brachytherapy in prostate cancer.”
Dr. Pieters’ main field of interest is general brachytherapy with an emphasis on urologic
brachytherapy, gynecologic brachytherapy, and pediatric brachytherapy. His research top-
ics focus on prostate brachytherapy; development of advanced treatment planning optimi-
zation algorithms; external beam and brachytherapy dose summation in cervical cancer;
and late effects assessment in pediatric brachytherapy. In his role as leader of the brachy-
therapy research group he supervises PhD students and contributed to more than 40 peer-
reviewed papers with the majority concerning brachytherapy topics.
He is one of the coeditors of the Journal of Contemporary Brachytherapy and is a mem-
ber of the Editorial Board of Brachytherapy.
For the GEC-ESTRO he contributes as course director for the “Comprehensive and
Practical Brachytherapy” course and is member of the GEC-ESTRO Committee.
Contributors

Hamideh Alasti Alejandro Berlin

Radiation Physics Department Department of Radiation Oncology
Princess Margaret Cancer Centre Princess Margaret Cancer Centre
and University of Toronto
Department of Radiation Oncology Toronto, Canada
University of Toronto
Toronto, Canada
Christoph Bert
Department of Radiation Oncology
Michael Andrassy
Universitätsklinikum Erlangen
R&D Brachytherapy
Friedrich-Alexander Universität
Eckert & Ziegler BEBIG
Erlangen-Nürnberg
Berlin, Germany
Erlangen, Germany
Maroie Barkati
Département de Radio-oncologie Peter A.N. Bosman
Centre Hospitalier de l`Université de Centrum Wiskunde & Informatica
Montréal Life Sciences Research Group
Montréal, Canada Amsterdam, The Netherlands

Luc Beaulieu
Stephen Breen
Département de physiquede génie
Radiation Physics Department
physique et d’optique et Centre
Princess Margaret Cancer Centre
derecherche sur le cancer
and
Université Laval
Department of Radiation Oncology
and
University of Toronto
Département de radio-oncologie
Toronto, Canada
CRCHU de Québec—Université Laval
Québec, Canada
Derek Brown
Sven Beerheide Department of Radiation Medicine and
R&D Brachytherapy Applied Sciences
Eckert & Ziegler BEBIG University of California San Diego
Berlin, Germany La Jolla, California

xv
xvi   ◾    Contributors
Ashwini Budrukkar
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Marco Carlone
Radiation Physics Department
Princess Margaret Cancer Centre
and
Department of Radiation Oncology
University of Toronto
Toronto, Canada
Laura Cerviño
Department of Radiation Medicine and
Applied Sciences
University of California San Diego
La Jolla, California
Kitty Chan
Department of Radiation Oncology
Princess Margaret Cancer Centre
University of Toronto
Toronto, Canada
Robert A. Cormack
Department of Radiation Oncology
Brigham and Women’s Hospital
Harvard Medical School
Boston, Massachusetts
Jennifer Croke
Department of Radiation Oncology
Princess Margaret Cancer Centre
University of Toronto
Toronto, Canada
Antonio L. Damato
Department of Medical Physics
Memorial Sloan Kettering Cancer
Center
New York, New York
Astrid A. de Leeuw
Department of Radiation Oncology
University Medical Center Utrecht
Utrecht, The Netherlands
Talar Derashodian
Department of Radiation Oncology
Hospital Charles Lemoyne
Montreal, Canada
Magatte Diagne
Department of Radiation Oncology
Institut Joliot-Curie Cancer Center
Dakar, Senegal
Colleen Dickie
Department of Radiation Oncology
Princess Margaret Cancer Centre
University of Toronto
Toronto, Canada
Moustafa Dieng
Department of Radiation Oncology
Institut Joliot-Curie Cancer Center
Dakar, Senegal
Lior Dubnitzky
Department of Medical Physics
Sunnybrook Health Sciences Centre
Toronto, Canada
Benjamin Durkee
Department of Radiation Oncology
Swedish American Hospital
A Division of UW Health
Rockford, Illinois
Harry Easton
Department of Medical Physics
Sunnybrook Health Sciences Centre
Toronto, Canada
 Contributors   ◾   xvii

John Einck Kathy Han

Department of Radiation Medicine and Department of Radiation Oncology
Applied Sciences Princess Margaret Cancer Centre
University of California San Diego University of Toronto
La Jolla, California Toronto, Canada

Taran Paulsen Hellebust

Aaron Fenster
Department of Medical Physics
Department of Radiation Oncology
Oslo University Hospital
Case Western Reserve University
and
Cleveland, Ohio
Department of Physics
and University of Oslo
Imaging Research Laboratories Oslo, Norway
Robarts Research Institute Alana Hudson
London, Canada Department of Medical Physics
Tom Baker Cancer Center
Irina Fotina Calgary, Canada
R&D Brachytherapy
Eckert & Ziegler BEBIG David Jaffray
Berlin, Germany Radiation Physics Department
Princess Margaret Cancer Centre
Rick Franich and
Département de radio-oncologie et Department of Radiation Oncology
CRCHU de Québec University of Toronto
CHU de Québec Toronto, Canada
Québec, Canada Xun Jia
Division of Medical Physics and
Macoumba Gaye Engineering
Department of Radiation Oncology Department of Radiation Oncology
Institut Joliot-Curie Cancer Center University of Texas Southwestern
Dakar, Senegal Medical Center
Dallas, Texas
Dietmar Georg
Department of Radiation Oncology Marjory Jolicoeur
Medical University of Vienna Department of Radiation Oncology
Vienna, Austria Hospital Charles Lemoyne
Montreal, Canada
Rachel Glicksman
Department of Radiation Oncology Harald Keller
Princess Margaret Cancer Centre Radiation Physics Department
University of Toronto Princess Margaret Cancer Center
Toronto, Canada Toronto, Canada
xviii   ◾    Contributors
Martin T. King
Department of Radiation Oncology
Dana-Farber/Brigham & Women’s
Cancer Center
Harvard Medical School
Boston, Massachusetts
Christian Kirisits
Department of Radiation Oncology
Medical University of Vienna
Vienna, Austria
Thomas Lanni
Beaumont Health System
Royal Oak, Michigan
Sarbani (Ghosh) Laskar
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Siddhartha Laskar
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Yolande Lievens
Department of Radiation Oncology
Ghent University Hospital
Ghent, Belgium
Michael Lotter
Department of Radiation Oncology
University Hospital Erlangen
Erlangen, Germany
Umesh Mahantshetty
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Eirik Malinen
Department of Medical Physics
Oslo University Hospital
University of Oslo
Oslo, Norway
Alexandr Malusek
Radiation Physics
Department of Medical and Health
Sciences
Linköping University
Linköping, Sweden
Eve-Lyne Marchand
Department of Radiation Oncology
Hôpital Maisonneuve Rosemont
University of Montreal
Montreal, Canada
Cynthia Ménard
Département de Radio-oncologie
Centre Hospitalier de l`Université de
Montréal
Montréal, Canada
Michael Milosevic
Department of Radiation Oncology
Princess Margaret Cancer Centre
University of Toronto
Toronto, Canada
Marinus A. Moerland
Department of Radiation Oncology
University Medical Center Utrecht
Utrecht, The Netherlands
Maryse Mondat
Department of Radiation Oncology
Hospital Charles Lemoyne
Montreal, Canada
Lavanya Naidu
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Nicole Nesvacil
Department of Radiation Oncology
Medical University of Vienna
Vienna, Austria
 Contributors   ◾   xix

Thu Van Nguyen Daniel Petereit

Department of Radiation Oncology Department of Radiation Oncology
Hospital Charles Lemoyne Rapid City Regional Cancer Center
Montreal, Canada Rapid City, South Dakota

Peter Orio Primoz Petric

Department of Radiation Oncology
Dana-Farber/Brigham & Women’s Cancer
Center
Harvard Medical School
Boston, Massachusetts
Department of Radiation Oncology
National Center for Cancer Care and
Research
Hamad Medical Corporation
Doha, Qatar

Thomas Osche Niclas Pettersson

Product Management Brachytherapy Department of Radiation Medicine and
Eckert & Ziegler BEBIG Applied Sciences
Berlin, Germany University of California San Diego
La Jolla, California
Amir Owrangi
Department of Radiation Oncology Bradley R. Pieters
University of Toronto Department of Radiation Oncology
and Academic Medical Center
Department of Medical Physics University of Amsterdam
Sunnybrook Health Sciences Centre Amsterdam, The Netherlands
Toronto, Canada
Tarun K. Podder
Department of Radiation Oncology
Geordi Pang
Case Western Reserve University
Department of Radiation Oncology
Cleveland, Ohio
University of Toronto
and Arnoud W. Postema
Department of Medical Physics Department of Urology
Sunnybrook Health Sciences Centre Academic Medical Center
Toronto, Canada University of Amsterdam
The Netherlands
Jose Perez-Calatayud
Physics Section Richard Pötter
Department of Radiation Oncology Department of Radiation Oncology
La Fe University and Polytechnic Hospital Medical University of Vienna
Valencia, Spain Vienna, Austria
and
Marie Lynn Racine
Department of Radiotherapy Department of Radiation Oncology
Clínica Benidorm Hospital Charles Lemoyne
Benidorm, Spain Montreal, Canada
xx   ◾    Contributors
Ananth Ravi
Department of Radiation Oncology
University of Toronto
and
Department of Medical Physics
Sunnybrook Health Sciences Centre
Toronto, Canada
Susan Richardson
Department of Radiation Oncology
Swedish Cancer Institute
Seattle, Washington
Alexandra Rink
Radiation Physics Department
Princess Margaret Cancer Centre
and
Department of Radiation Oncology
University of Toronto
Toronto, Canada
Mark J. Rivard
Department of Radiation Oncology
Tufts University School of Medicine
Boston, Massachusetts
Manuel Sanchez-Garcia
Department of Nuclear Medicine
Beaujon Hospital
Assistance Publique-Hôpitaux de Paris
Clichy, France
Daniel Scanderbeg
Department of Radiation Medicine and
Applied Sciences
University of California San Diego
La Jolla, California
Stefan G. Schalk
Department of Electrical and Biomedical
Engineering
Eindhoven University of Technology
Eindhoven, The Netherlands
Maximilian P. Schmid
Department of Radiation Oncology
Medical University of Vienna
Vienna, Austria
Carmen Schulz
Product Management Brachytherapy
Eckert & Ziegler BEBIG
Berlin, Germany
Ina M. Jürgenliemk-Schulz
Department of Radiation Oncology
University Medical Center Utrecht
Utrecht, The Netherlands
Shyamkishore Shrivastava
Department of Radiation Oncology
Tata Memorial Hospital
Mumbai, India
Adam Shulman
Department of Radiation Oncology
Hamad Medical Corporation
Doha, Qatar
Frank-André Siebert
Department of Medical Physics
Clinic of Radiotherapy
Universitätsklinikum
Schleswig-Holstein
Kiel, Germany
Anna Simeonov
Radiation Physics Department
Princess Margaret Cancer Centre
and
Department of Radiation Oncology
University of Toronto
Toronto, Canada

Ryan L. Smith
Department of Radiation Oncology
The Alfred Hospital
and
School of Science
RMIT University
Melbourne, Australia
William Y. Song
Department of Radiation Oncology
Sunnybrook Health Sciences Centre
University of Toronto
Toronto, Ontario, Canada
Teo Stanescu
Radiation Physics Department
Princess Margaret Cancer Centre
and
Department of Radiation Oncology
University of Toronto
Toronto, Canada
Vratislav Strnad
Department of Radiation Oncology
University Hospital Erlangen
Erlangen, Germany
Jamema Swamidas
Department of Medical Physics
Tata Memorial Hospital
Mumbai, India
Tony Tadic
Department of Radiation Oncology
University of Toronto
and
Radiation Physics Department
Princess Margaret Cancer Centre
Toronto, Canada
Contributors   ◾   xxi
Kari Tanderup
Department of Oncology
Aarhus University Hospital/Aarhus
University
Aarhus, Denmark
Åsa Carlsson Tedgren
Department of Medical and Health
Sciences
Linköping University
Linköping, Sweden
and
Department of Medical Physics
Section for Radiotherapy Physics and
Engineering
The Karolinska University Hospital
Stockholm, Sweden
Dorin A. Todor
Department of Radiation Oncology
Virginia Commonwealth University
Richmond, Virginia
Mehmet Üzümcü
Elekta Brachytherapy Solutions
Veenendaal, The Netherlands
Uulke A. van der Heide
Department of Radiation Oncology
The Netherlands Cancer Institute
Amsterdam, The Netherlands
Rob van der Laarse
Department of Radiation Oncology
Academic Medical Center
University of Amsterdam
Amsterdam, The Netherlands
Jochem R. van der Voort van Zyp
Department of Radiation Oncology
University Medical Center Utrecht
Utrecht, The Netherlands
xxii   ◾    Contributors
Té Vuong
Department of Radiation Oncology
Jewish General Hospital
McGill University
Montreal, Canada
Georges Wakil
Department of Radiation Oncology
Hospital Charles Lemoyne
Montreal, Canada
Robert Weersink
Radiation Physics Department
Princess Margaret Cancer Centre
Department of Radiation Oncology
University of Toronto
and
Techna Institute
University Health Network
Toronto, Canada
Hessel Wijkstra
Department of Electrical and Biomedical
Engineering
Eindhoven University of Technology
Eindhoven, The Netherlands
and
Department of Urology
Academic Medical Center
University of Amsterdam
The Netherlands
Michael J. Zelefsky
Department of Radiation Oncology
Memorial Sloan Kettering Cancer
Center
New York, New York
Abbreviations

AAPM American Association of Physicists in Medicine

ABS American Brachytherapy Society
ACA Affordable Healthcare Act
ACE Advanced Collapsed cone Engine
ACR American College of Radiology
ADC apparent diffusion coefficient
AESOP Automated Endoscopic System for Optimal Positioning
AGOI Association of Gynecologic Oncologists of India
ALA 5-aminolevulinic acid
ALARA As low as reasonably achievable
AM additive manufacturing
AMIGO advances multimodality image guided operating suite
AMPI Association of Medical Physicists of India
AP anterior-posterior
APBI accelerated partial breast irradiation
AROI Association of Radiation Oncologists of India
ASTRO American Society for Radiation Oncology
AUA American Urological Association
BEEUD biologically effective equivalent uniform dose
BED biological equivalent dose
BRIT Board of Radiation and Isotope Technology
CAD computer-aided design
CBCT cone beam CT
CC collapsed cone
CEUS contrast-enhanced ultrasound
CI confidence interval
CN conformation number
CNS central nervous system
COIN conformity index
co-RASOR center-out RAdial Sampling with Off-resonance Reconstruction
CPE charged particle equilibrium
CPT current procedural terminology
CPU central processing unit

xxiii
xxiv   ◾    Abbreviations

CSTAR Canadian Surgical Technologies & Advanced Robotics

CT computed tomography
CTV clinical target volume
CTVHR high-risk CTV
CUDI contrast ultrasound dispersion imaging
DA direct addition
DCE dynamic contrast enhanced
DECT dual energy computed tomography
DFS disease-free survival
DIR deformable image registration
DMBT direction (dynamic) modulated brachytherapy
DOF degree of freedom
DSC dice similarity coefficient
DVF deformation vector field
DVH dose volume histogram
DWI diffusion weighted imaging
EBRT external beam radiotherapy
eBT electronic brachytherapy
EES extravascular-extracellular space
EGO enhanced geometric optimization
EGSnrc National Research Council’s (NRC) electron gamma shower software
EM electromagnetic
EMT electromagnetic tracking
EPID electronic portal imaging device
EQD2 equivalent dose in 2 Gy per fraction
ESTRO European Society for Radiotherapy and Oncology
EUD equivalent uniform dose
FAA Federal Aeronautics Administration
FAD flavin adenine dinucleotide
FIGO International Federation of Gynecology and Obstetrics
FITC fluorescein isothiocyanate
FLS fluorescence-guided surgery
FMEA failure modes and effects analysis
FSE fast-spin-echo
GBBS grid-based Boltzman solver
GEC-ESTRO Group Européen de Curiethérapie – European Society for Radiotherapy
and Oncology
gEUD generalized equivalent uniform dose
GO geometric optimization
GPS global positioning system
GPU graphics processing unit
GrO graphical optimization
GTV gross tumor volume
 Abbreviations   ◾   xxv

GYN gynecology
HCC hepatocellular carcinoma
HDR high-dose rate
HDREBT high-dose rate endorectal brachytherapy
HIPO hybrid inverse planning optimization
HR hazard ratio
H&N head and neck
IAEA International Atomic Energy Agency
IBS Indian Brachytherapy Society
IC intracavitary
IC/IS intracavitary/Interstitial
ICER Institute for Clinical and Economic Review
ICG Indocyanine green
ICRP International Commission on Radiological Protection
ICRU International Commission on Radiation Units & Measurements
IGABT image-guided adaptive brachytherapy
IGBT image-guided brachytherapy
IGRT image-guided radiotherapy
IIP interactive inverse planning
IL intraprostatic lesions
IMOO interactive multiobjective optimization
IMPT intensity modulated proton therapy
IMRT intensity modulated radiotherapy
IORT intraoperative radiotherapy
IPIP inverse planning by integer program
IPSA inverse planning by simulated annealing
IRB Institutional Review Board
IS interstitial
IVD in vivo dosimetry
keV kilo electron volt
LAC linear attenuation coefficient
LDR low-dose rate
LDV linear dose-volume
LET linear energy transfer
MBDCA model based dose calculation algorithms
MBIR model-based image reconstruction
MC Monte Carlo
MCNP Monte Carlo N-Particle code
MD medical doctor
MDR medium-dose rate
MEMs microelectromechanical systems
MeV mega electron volt
MIRA minimally invasive robot assistant
xxvi   ◾    Abbreviations

MIRALVA Mallinckrodt Institute of Radiology Afterloading Vaginal Applicator

MIRD medical internal radiation dose
mpMRI multiparametric MRI
mpUS multiparametric ultrasound
MRC Medical Research Council
MR magnetic resonance
MRI magnetic resonance imaging
MRS magnetic resonance spectroscopy
MTV metabolically active tumor volume
MUPIT Martinez Universal Perineal Interstitial Template
MUV Medical University of Vienna
NADH nicotinamide adenine dinucleotide
NASA National Aeronautics and Space Administration
NCDB National Cancer Data Base
NDR natural dose ratio
NDVH natural dose volume histogram
NEMA National Electrical Manufacturers Association
NMSC non-melanoma skin cancer
NPD natural prescription dose
NRC Nuclear Regulatory Commission
NSC Nuclear Safety and Control
NT normal tissue
NTCP normal tissue complication probability
OAR organ at risk
OCC Odette Cancer Centre
OCT optical coherence tomography
OIS oncology information system
OR operating room
OSLD optically stimulated luminescence dosimetry
PAI pubic arch interference
PD proton-density
PDR pulsed-dose rate
PEEK polyether ether ketone
PEG polyethylene-glycol
PET positron emission tomography
PET/CT positron emission tomography/computed tomography
PPL peripheral pulmonary lesions
PODP polynomial optimization on dose points
PR prostatectomy
PSD plastic scintillator detectors
PSA prostate-specific antigen
PSMA prostate-specific membrane antigen
PTV planning target volume
 Abbreviations   ◾   xxvii

QI quality index
RF radio frequency
RL radioluminescence
ROI region of interest
RP radical prostatectomy
RPN risk priority number
RSBT rotating shield brachytherapy
RT radiation therapist
RTT radiotherapy technologists
QA quality assurance
QC quality control
SAE Society for Automotive Engineers
SAUR safety, accuracy, user-friendliness, and reliability
SBRT stereotactic body radiotherapy
SDD source-to-dosimeter distance
SEER surveillance, epidemiology, and end results
SFE scanning fiber endoscopy
SIRT selective internal radiotherapy
SNR signal-to-noise ratio
SPECT single-photon emission computed tomography
SPECT/CT single-photon emission computed tomography/computed tomography
STL standard tessellation language
SUVmax maximum standardized uptake value
SWE shear wave elastography
TAUS transabdominal ultrasound
TCP tumor control probability
TE echo time
TICs time–intensity curves
TG task group
TLD thermoluminescent dosimeter
TMH Tata Memorial Hospital
TPS treatment planning system
TRAK total reference air kerma
TRUS transrectal ultrasound
TSE turbo spin echo
UCA ultrasound contrast agents
UCSD University of California San Diego
UI Uniformity index
UICC Union for International Cancer Control
UMCU University Medical Center Utrecht
US ultrasound
USP United States Pharmacopeia
UTE ultrashort echo time
xxviii   ◾    Abbreviations

UV ultraviolet
UWO University of Western Ontario
VA vibro-acoustography
VP virtual patient
WHO World Health Organization
WLE white light endoscopy
2D 2-dimensional
2DUS 2D ultrasound
3D 3-dimensional
3DUS 3D ultrasound
[18F]FAZA [18F] Fluoroazomycin-arabinoside
[18F]FDG [18F] Fluorodeoxyglucose
[18F]FMISO [18F] Fluoromisonidazole
[18F]DCFPyL [ 18F] Fluoro-pyridine-3-carbonyl)-amino]-pentyl)-ureido)-pentanedioic acid
Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Dixie: A monthly
magazine, Vol. I, No. 2, February 1899
 This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this ebook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

Title: Dixie: A monthly magazine, Vol. I, No. 2, February 1899

Author: Various

Release date: August 30, 2023 [eBook #71526]

Language: English

Original publication: Baltimore: The Dixie Publishing Co, 1899

Credits: hekula03 and the Online Distributed Proofreading Team

at https://www.pgdp.net (This book was produced from
images made available by the HathiTrust Digital
Library.)

*** START OF THE PROJECT GUTENBERG EBOOK DIXIE: A

MONTHLY MAGAZINE, VOL. I, NO. 2, FEBRUARY 1899 ***
FEBRUARY 1899 10 CENTS

DIXIE. A MONTHLY MAGAZINE.

THE DIXIE BALTIMORE PUBLISHING CO.

Vol. I No. 2.
 Terms: $1.00 a Year in Advance. 10 Cents a Number.

DIXIE
A MONTHLY MAGAZINE. FEBRUARY, 1899.

Henry Clayton Hopkins, Editor, 326 St. Paul St., Baltimore.

G. Alden Peirson, }
Clinton Peters, } Art Editors.
Chas. J. Pike, }
George B. Wade, Business Manager.

CONTENTS.
I. Frontispiece, Drawn by Lucius Hitchcock.
Illustration for “How Randall Got Into The Salon”.

II. If Like a Rose (Poem)—Edward A. U. Valentine 3

III. Anna Evauovna—Margaret Sutton Briscoe 4
Full Page Picture by Katharine Gassaway.

IV. Death and Love (Poem)—William Theodore Peters 17

Illustration by Clarence Herbert Rowe.

V. Channoah—Edward Lucas White 18

Head and Tail-Piece by G. A. Peirson.

VI. Here and There in Maryland—Edward G. McDowell 33

(Eight Illustrations.)
VII. How Randall Got Into The Salon—Clinton Peters 49
Illustrated by Frontispiece.

VIII. A Valentine (Poem)—Maurice Weyland 56

IX. Elena’s Daughters—D. Ramon Ortega y Frias 57
(To be Continued.)
Head-Piece by Chas. J. Pike.

X. Quatrain (Poem)—H. C. H. 78
XI. Extracts from the Log of the Rita 79
Illustrated by Numerous Sketches.

XII. The Four Fears of Our General (The Second Fear)—

Adele Bacon, 95
Full Page Picture by Clinton Peters.

XIII. The Happiness of Being Nearsighted—Walter Edgar

M’Cann, 113
XIV. “An Eighteenth Century Beauty” 117
Reproduction of the Miniature by Hugh Nicholson.

XV. Comment, 119

XVI. Books and Authors—Edward A. U. Valentine 125

Copyright, 1899, by Dixie Publishing Company.

 Drawn by Lucius Hitchcock.

“He slowly pushed the massive door ajar, and the next instant
perceived he was standing in the actual, awful presence of the
famous master”—(See page 49)
 DIXIE.

Vol. I. February, 1899. No. 2.

 IF LIKE A ROSE.
If life were like a rose designed,
That proves its purpose to be fair
And with the grace its bud divined
Distils June’s sweetness on the air;
Then would the stubborn sheaths that hold
The flower of the heart’s ideal
Beneath the stress of time unfold
And what we dream become the real—
If life had but the rose’s art
And beauty burgeoned from the heart!

Then like the rose that o’er the grass

Spills leaf by leaf its lovely freight
And tho’ its purple fortunes pass
Is calm in an accomplished fate,
Might we with less reluctant will
Yield up the harvest of our hours,
Seeing the inner grace fulfil
Its promise in old age’s powers—
If life had but the rose’s art
And beauty burgeoned from the heart!

—Edward A. Uffington Valentine.

 ANNA EVAUOVNA
A STUDY OF RUSSIAN LIFE
By Margaret Sutton Briscoe
And M.A.R.

They stood in the village street talking together, two little Russian
peasant girls, dressed in rough carpet skirts, thick leather boots, with
hair plaited in two long plaits and heads covered with bright kerchiefs
as became unmarried girls.
Grusha was larger and taller than Masha, and her coloring
stronger, in fact, she was stronger in all respects, and good-
naturedly conscious of her superiority. She stood looking down on
Masha with a mischievous smile on her red lips and in her black
eyes.
“Is it that you mean to marry Ivan when he comes from the war,
Grusha?” Masha was asking.
Grusha laughed.
 “Perhaps,” she replied lightly.
“Then you are a bad girl, Grusha. Why do you keep Alioscha
dancing after you?”
Grusha laughed again.
“What if he likes it? Alioscha would be more unhappy if I did not let
him do his dancing. And besides, I like him.”
“Do you mean to marry him then, Grusha?”
“Perhaps.”
Grusha caught Masha’s hand as she turned from her with a
gesture of anger.
“Come back, Masha, listen to me. Ask Anna Evauovna what I
mean to do. She knows all things, the old witch!”
Masha crossed herself, glancing over her shoulder.
“And she will know you have said that,” she answered.
Grusha’s face wore a reflected uneasiness for a moment.
“Bah!” she replied, shaking herself. “What harm can she do me!”
Masha nodded her head gravely.
“That was what Marusa said, and how did the Njania punish her?
Has she a child to call hers? And look at poor Julina. She defied the
Njania also, and has had children showered on her faster than she
can breathe. Her isba is like a beehive. Anna Evauovna can give you
a draught that will cure any sickness if she will, and oh! what
fortunes she can tell, Grusha! And what do we here in the village that
she does not know of at once?”
“Who teaches her and who tells her? Answer me that, Masha. Oh,
you may well cross yourself! Ask her if you want to know anything
and if you are not afraid of her teacher. Have done then. What are
you after?”
While the girls talked, two of the young men of the village had
crept behind Grusha unseen. Each held one of her plaits in his hand
as a rein, and they began shouting as to a restive horse, when she
struggled to escape. Grusha’s heavy plaits were favorite playthings,
never safe from attack; for she was a belle in the village. In the
confusion of the romp, Masha turned away and walked off.
“I will go to Anna Evauovna,” she said to herself.
It is easy to state the positions of Grusha and Masha. They were
only two little Russian peasant girls, who worked in the garden of the
Prince in Summer, and about his great house in winter.
But for Anna Evauovna, the Prince himself could hardly have
defined her position. She had been Njania (nurse) to his children,
and was now housekeeper. Anna Evauovna was the only peasant on
the estate who wore a cap, who spoke a pure Russian, and wore
dresses and shoes. She was older by years than her actual days
numbered, capable, resolute, silent and invaluable to her employers.
The peasants spoke to her with deference, calling her Anna
Evauovna. Behind her back they called her the old witch, and the
Princess had been appealed to for protection from her more than
once.
Anna Evauovna was in the housekeeping room assorting the
house linen from the wash, when Masha came to her and humbly
proffered her request to know the future.
The old woman looked up at the girl keenly.
“He who wants to know too much grows old too soon, Masha,” she
said.
“Tell me only a little then, Anna Evauovna, but tell me that.”
“Have it your own way then, Masha. Open the drawer of the table
and look in the left hand corner, and you will find a pack of cards
under a wooden box that has a strange smell about it. Bring them to
me, but no, I forgot—the box has something lying open in it which
you might touch and find harmful.”
As Anna Evauovna opened the drawer herself, Masha made the
sign of the cross furtively.
The old woman turning sharply, caught the gesture, and the girl’s
head drooped in confusion.
 Anna Evauovna’s eyes twinkled. She shuffled the cards and
began to deal them out on the table, glancing now and then at
Masha, who sat opposite, the light of the lamp falling on her round
good-natured face, fair hair, and solemn blue eyes.
“Ah! there you are,” said Anna Evauovna, as the queen of hearts
fell. “And there is a dark man near you—the king of clubs. Now mark,
you are nearer to him in thought than he to you. Ah! ah! ah! I thought
so. Here she comes, there lies the cause. The queen of clubs, a dark
woman, lies between you and him. She separates you.”
Masha bent forward breathless.
“And will she succeed, Njania?”
“We shall see. Who comes here? The king of diamonds—and near
the queen of clubs. Here is one who is away, very far away, but
coming nearer. He is thinking of the queen of clubs. ‘Is she waiting
for me, is she waiting for me,’ he is thinking. Look for yourself,
Masha. The queen of spades, emblem of all that is bad, lies across
him, and thus it is easy to see that he is worrying about the dark
woman, your rival. Once more I will lay the cards. Now see; the king
of diamonds is thinking of a journey and of home. The dark woman is
restless, she thinks of the king of diamonds, and then of the king of
clubs. But how is this? The king of diamonds is close to your dark
rival, and the nine and ten of diamonds on either side. A marriage!”
Masha clasped her hands.
“And does that leave the king of clubs to me, Anna Evauovna?”
Anna Evauovna swept the cards into a heap.
“God knows,” she answered. “Would you seek to know as much
as He, Masha?”
“May the saints forbid!”
Anna Evauovna returned to her interrupted occupation, and
Masha still sat gazing at her, awestruck.
“Njania,” she said timidly, “is it right that a girl should keep a man
dangling after her, as a lash to a whip, if she means nothing by it?”
 “You mean Grusha and Alioscha,” said Anna Evauovna shortly. “Is
it not her own affair?”
Masha blushed and hung her head.
“It was Grusha I thought of,” she stammered. “You know the very
hairs on our heads, Anna Evauovna.”
The Njania nodded, not ill pleased.
“I know what I know. Grusha thinks Ivan will marry her when he
comes back from the war.”
“Then why does she keep Alioscha waiting and sticking to her like
a wet leaf?” cried Masha passionately. “It is wicked, Njania, if she
loves Ivan.”
“Who said she loved Ivan!” answered Anna Evauovna drily. “Do all
girls love some one?”
“Did not you say that she loved him?” stammered Masha.
“I did not, my child. Njania is not to be fooled by a Grusha. Ah, but
she is a girl of wits, is Grusha, and so smooth to see. In still waters,
devils thrive, remember that, Masha.”
Masha’s lip quivered.
“But if she does not love Ivan, Njania, she may marry Alioscha.”
“Perhaps, who knows! It takes a wise man to tell the future, and a
wiser yet to tell a girl’s mind.”
“And she will surely marry Alioscha if Ivan has forgotten her by the
time he comes back,” added Masha more piteously.
Anna Evauovna laughed a dry chuckle and rubbed her hand on
the girl’s head.
“Your wits sharpen, little Masha. You may grow as wise as Grusha
some day.”
“Ivan does not write to her—I know that.”
“Now, now, as for writing, Masha, could Grusha read if he did?
Ivan may have been fool enough to remember her but even a
peasant does not like his love letters read from the house-tops.”
“But Grusha could take his letters to the doctor or the deacon.
They would read them to her alone.”
“Would they? A man is a man, doctor or deacon. He may keep
another man’s secret, but a woman’s—no. Come, child, Grusha will
marry whom God wills, and meantime, let her have rope. All is for
the best. Did Grusha know Ivan faithful to her, she would not have
this curiosity which makes her wish to wait and see how he will act
when he finds her waiting. Meantime, Alioscha is the best singer and
dancer in the village. And what could the village have to talk of but
for her behavior? For your part, eat, drink, sleep on the top of the
stove at night, and work by day. Let each hold up his share of the
burden, and all will go well.”
Masha listened, sighed, and assented.
The next day, as Anna Evauovna was walking in the field near the
village street, she heard sounds of music, the clapping of hands and
beating of feet in measured time, and loud shouts. She might have
walked to the isba whence the sounds came, and inquired the
cause, but that was not Anna Evauovna’s way. She slipped behind a
hedge, and walking along in its shadow, reached the spot where the
merry-making was taking place.
 MASHA CLASPED HER HANDS

“AND DOES THAT LEAVE THE KING OF CLUBS TO ME?”

Drawn by Katharine Gassaway.

 On a bit of ground in front of three of the principal isbas, the
peasants were assembled. A wooden bench had been brought out,
and a plain deal table, beneath which could be seen a wooden pail
of vodka (brandy). On the table stood a steaming samovar, a white
stone teapot, some huge pieces of rye bread, thick tumblers for tea,
and a paper bag of lump sugar. Spoons were not needed, as the
sugar was held in the fingers and nibbled between the sips of hot tea
served in the glasses.
Ivan had returned, and this was his welcome.
The samovar had been borrowed for the great occasion; for not
every peasant can afford that luxury, and Ivan’s parents were not
rich.
There were three musicians present, one playing on a concertina,
one on a trumpet-like instrument, which gave out bag-pipe sounds,
and the other on a melon-shaped guitar, strung with a few strings, on
which he twanged merrily.
The peasants kept time with feet and voice in barbaric medley.
Ivan, the hero of the day, sat at the centre of the table in an
unsoldierly, weary attitude, unkempt and unwashed. He had been
tramping for days. The trousers of his weather-stained uniform were
tucked in his travel-worn boots, and he wore a summer cap on his
dark hair.
He was replying at his leisure to the numberless questions asked
as his fagged brain comprehended them, but when the table was
cleared, and the musician with the concertina leaped upon it, his
loose linen trousers tucked in his boots, his kaftan into his belt, his
hoarse voice cheering the company to the dance, Ivan sprang to his
feet, and seizing Grusha as his partner, danced more furiously than
any.
Anna Evauovna, peering through the leaves, could see it all.
Alioscha, as eager in his welcome to the wanderer as Grusha
herself, was now dancing merrily also, and Masha was his happy
partner. Her kerchief had fallen back, leaving her good-natured,
round face unframed, and exposing the line of white forehead which
had been protected from the sun. She was a pretty picture.
The dance grew wilder, the voices louder, the stamping and
clapping more vehement. The musician on the table shouted more
lustily as he danced himself, now on one foot, now on the other, all
over the table-top.
Anna Evauovna looked at Grusha’s excited face flushed with her
exertion, and then at her rival suitors, both of the same height, both
well built, and both with the same heavy square face and mass of
thick hair. That Ivan was fair, and Alioscha dark, seemed the only
difference.
The old woman turned away with a wicked chuckle.
“There is not a pin to choose between them,” she said to herself,
“Grusha must draw lots.”
When, a little later, Masha came into the housekeeper’s room,
breathless and over-running with her news, Anna Evauovna could be
told nothing. She knew when Ivan had arrived, from where, by what
roads, and, in fact, everything. The only thing she did not know, or as
Masha believed, would not tell, was how Grusha would choose.
On her way home, Masha came across Grusha sweeping the
leaves from a path in the garden. She was alone, and Masha could
not help questioning her.
“Grusha, Ivan has come back, what are you going to do now?”
Grusha leaned on her broom and looked at Masha’s earnest face.
She laughed aloud, but good-naturedly still.
“I am going to sweep this path when you stand off it,” she said,
and Masha could get no further satisfaction.
But the next day, Anna Evauovna was able, or willing, to relieve
Masha’s anxiety.
“She takes Ivan, and they are to be married in a week. Both get
what they want and have waited long for. Now we shall see what we
shall see,” said Anna Evauovna grimly.