Brain brachytherapy treatment planning and delivery: A competency-based framework for contemporary multidisciplinary practice.

Brain brachytherapy remains a specialized but important component of modern neuro-oncologic care. Following the introduction of contemporary cesium-131 (Cs-131)-based platforms, intracranial brachytherapy has seen renewed growth and increasing adoption for recurrent and newly diagnosed brain metastases, recurrent glioblastoma, recurrent meningioma, and selected other intracranial tumors in which immediate focal irradiation may be advantageous. This article outlines core competencies for brain brachytherapy planning and delivery, with emphasis on contemporary multidisciplinary practice. It is intended for clinicians, medical physicists, trainees, neurosurgeons, radiation oncologists, and teams involved in developing or implementing intracranial brachytherapy programs. Key domains include patient and platform selection, imaging and target delineation, treatment planning, prescription strategy, operative workflow, radiation safety, quality assurance, and postimplant verification. Brain brachytherapy is best understood as a multidisciplinary procedural competency rather than a narrow planning exercise. Because prescription approaches, dosimetric reporting, dose constraints, and outcome-linked planning thresholds remain incompletely standardized, a competency-based framework may support training, communication across specialties, and safe program expansion.