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Grigo J, Karius A, Hanspach J, Mücke L, Laun FB, Huang Y, Strnad V, Fietkau R, Bert C, Putz F. Toward a deep learning-based magnetic resonance imaging only workflow for postimplant dosimetry in I-125 seed brachytherapy for prostate cancer. Brachytherapy 2024; 23:96-105. [PMID: 38008648 DOI: 10.1016/j.brachy.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND AND PURPOSE The current standard imaging-technique for creating postplans in seed prostate brachytherapy is computed tomography (CT), that is associated with additional radiation exposure and poor soft tissue contrast. To establish a magnetic resonance imaging (MRI) only workflow combining improved tissue contrast and high seed detectability, a deep learning-approach for automatic seed segmentation on MRI-scans was developed. MATERIAL AND METHODS Patients treated with I-125 seed brachytherapy received a postplan-CT and a 1.5 T MRI-scan on nominal day 30 after implantation. For MRI-based seed visualization, DIXON-sequences were acquired and deep learning-based quantitative susceptibility maps (QSM) were generated from 3D-gradient-echo-sequences from 20 patients. Seed segmentations created on CT served as ground truth. For automatic seed segmentation on MRI, a 3D nnU-net model was trained using QSM and DIXON, both solely and combined. RESULTS Of the implanted seeds 94.8 ± 2.4% were detected with deep learning automatic segmentation entrained on both QSM and DIXON data. Models trained on the individual sequence data-sets performed worse with detection rates of 87.5 ± 2.6% or 88.6 ± 7.5% for QSM and DIXON respectively. The seed centers identified on CT versus QSM and DIXON were on average 1.8 ± 1.3 mm apart. Postimplant dosimetry for evaluation of positioning inaccuracies revealed only small variations of up to 0.4 ± 4.26 Gy in D90 (dose 90% of the prostate receives) between the standard CT-approach and our MRI-only workflow. CONCLUSION The proposed deep learning-based MRI-only workflow provided a promisingly accurate and robust seed localization and thus has the potential to compete with current state-of-the-art CT-based postimplant dosimetry in the future.
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Affiliation(s)
- Johanna Grigo
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Andre Karius
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lion Mücke
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Yixing Huang
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Helou J, Charas T. Acute and late side-effects after low dose-rate brachytherapy for prostate cancer; incidence, management and technical considerations. Brachytherapy 2021; 20:956-965. [PMID: 33972182 DOI: 10.1016/j.brachy.2021.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/16/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To review common reported side effects and complications after primary LDR-BT (monotherapy) and discuss some of the technical aspects that could impact the treatment outcomes. METHODS AND MATERIALS A literature search was undertaken using medical subject headings (MeSH) complemented by the authors' personal and institutional expertise. RESULTS The reported incidence of acute and late grade 2 or above urinary, bowel and sexual side effects is very variable across the literature. The learning curve and the implant quality have a clear impact on the toxicity outcomes. Being aware of some of the technical challenges encountered during the procedure and ways to mitigate them could decrease the incidence of side effects. Careful planning of seed placement and seed deposition allow sparing of the organs at risk and a lower incidence of urinary and gastro-intestinal toxicity. CONCLUSIONS Low dose-rate brachytherapy remains a standard monotherapy treatment in the setting of favorable-risk prostate cancer. High disease control and low long-term toxicities are achievable in expert hands with a good technique.
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Affiliation(s)
- Joelle Helou
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
| | - Tomer Charas
- Radiotherapy Unit, Oncology Division, Rambam Health Care Campus, Haifa, Israel
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Tisseverasinghe S, Marbán M, Crook J, Petrik D, Araujo C. Comparison between postoperative TRUS-CT fusion with MRI-CT fusion for postimplant quality assurance in prostate LDR permanent seed brachytherapy. Brachytherapy 2021; 20:849-856. [PMID: 33867295 DOI: 10.1016/j.brachy.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/22/2021] [Accepted: 03/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE/OBJECTIVE Permanent seed Low-Dose-Rate brachytherapy is planned and delivered using transrectal ultrasound (TRUS). Post-implant evaluation for quality assurance is usually performed using Computed Tomography (CT). Registration of the CT images with MRI reduces subjectivity in contouring by improving prostate edge detection. We hypothesized that a set of TRUS images post procedure may provide the same benefit. MATERIAL/METHODS Consecutive patients undergoing Low-Dose-Rate prostate brachytherapy were recruited. TRUS images were recorded under anesthesia at completion of their implant. In addition, all patients underwent standard post-implant quality assurance including prostate CT and MRI at day 30. These were co-registered, contoured and seeds were identified. Three independent observers contoured and registered the post implant TRUS images to the Day 30 CT using seed matching. Prostate volumes and dosimetric parameters were compared through Intraclass Correlation Coefficient (ICC) to evaluate the concordance between MRI and ultrasound (US). RESULTS 26 patients were recruited from 10/17 to 01/18. Mean prostate volume was 34.5 (SD 10.8) cm3 at baseline on planning TRUS images, 37.4 (SD 11.3) cm3 on Day 0 post implant TRUS and 36.7 (SD 11.7) cm3 on Day 30 MRI. D90 was 112.6% (SD 9.3) on CT-MRI and 112.9% (SD 11.1) on CT-US. V100 was 94.6% (SD 3.8) for CT-MRI, 95.1% (SD 4.3) for CT-US. Student t-tests were used to compare groups. No significant differences were noted. CONCLUSION Post implant TRUS may be useful for quality assurance for post-implant dosimetry particularly if access to an MRI is limited.
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Affiliation(s)
- Steven Tisseverasinghe
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Marina Marbán
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Juanita Crook
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada.
| | - David Petrik
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
| | - Cynthia Araujo
- British Columbia Cancer Center for the Southern Interior, Dept of Radiation Oncology. Dept of Radiation Physics, British Columbia, Canada
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Comparison of post-implant dosimetrics between intraoperatively built custom-linked seeds and loose seeds by sector analysis at 24 hours and 1 month for localized prostate cancer. J Contemp Brachytherapy 2020; 12:317-326. [PMID: 33293970 PMCID: PMC7690227 DOI: 10.5114/jcb.2020.98110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/11/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To compare post-implant dosimetrics between intraoperatively built custom-linked (IBCL) seeds and loose seeds (LS) at 24 hours and 1 month by sector analysis, and to evaluate the effect of IBCL seeds with regard to change in dosimetric parameters, in patients with prostate cancer treated with brachytherapy. Material and methods Consecutive patients treated for localized prostate cancer who received definitive brachytherapy between March 2013 and October 2017 were retrospectively analyzed. Prostate V100 (PV100), prostate D90 (PD90), prostate V150 (PV150), urethral D30 (UD30), urethral V150 (UV150), and rectal V100 (RV100) were assessed. Results Thirty-two patients were treated with LS and 32 patients were treated with IBCL seeds. The median follow-up time was 49.9 months in the LS group and 27.1 months in the IBCL group. PV150, UV150, and UD30 at 24 hours and UD30 at 1 month showed significant difference (F-test), and standard deviation (SD) tended to be lower in the IBCL group. Analysis of change in the variables revealed significance for ΔPV100 and ΔPD90 (F-test, p = 0.014 and < 0.001, respectively), and ΔPV150 and ΔUD30 showed marginal significance (p = 0.084 and 0.097, respectively). PV150, UV150, and UD30 at 24 hours and 1 month were significantly lower in the IBCL group, and there was no significant difference in PV100, PD90, and RV100 compared with the LS group (t-test). The homogeneity index (HI) was significantly higher in the IBCL group (p < 0.001). Conclusions In this retrospective single institutional study, there was a decrease in the SD of the dosimetric parameters in the IBCL group, and it was statistically significant in change in the variables between 24 hours and 1 month (F-test). The use of IBCL seeds significantly decreased PV150, UV150, and UD30, and significantly improved HI, without lowering PD90 or PD100.
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Nosrati R, Wronski M, Tseng CL, Chung H, Pejović-Milić A, Morton G, Stanisz GJ. Postimplant Dosimetry of Permanent Prostate Brachytherapy: Comparison of MRI-Only and CT-MRI Fusion-Based Workflows. Int J Radiat Oncol Biol Phys 2020; 106:206-215. [DOI: 10.1016/j.ijrobp.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 11/24/2022]
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Watanabe K, Katayama N, Katsui K, Matsushita T, Takamoto A, Ihara H, Nasu Y, Takemoto M, Kuroda M, Kanazawa S. Interobserver variability of 3.0-tesla and 1.5-tesla magnetic resonance imaging/computed tomography fusion image-based post-implant dosimetry of prostate brachytherapy. JOURNAL OF RADIATION RESEARCH 2019; 60:483-489. [PMID: 31083713 PMCID: PMC6640899 DOI: 10.1093/jrr/rrz012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/14/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to compare the interobserver variabilities in magnetic resonance imaging (MRI)/computed tomography (CT) fusion image-based post-implant dosimetry of permanent prostate brachytherapy (PPB) between 1.5-T and 3.0-T MRI. The study included 60 patients. Of these patients, 30 underwent 1.5-T MRI and CT 30 days after seed implantation (1.5-T group), and 30 underwent 3.0-T MRI and CT 30 days after seed implantation (3.0-T group). All patients received PPB alone. Two radiation oncologists performed MRI/CT fusion image-based post-implant dosimetry, and the interobserver variabilities of dose-volume histogram (DVH) parameters [dose (Gy) received by 90% of the prostate volume (prostate D90)], percentage of the prostate volume receiving at least the full prescribed dose (prostate V100), percentage of the prostate volume receiving at least 150% of the prescribed dose (prostate V150), dose (Gy) received by 5% of the urethral volume (urethral D5) and the urethral volume receiving at least 150% of the prescribed dose (urethral V150)] were retrospectively estimated using the paired Student's t test and Pearson's correlation coefficient. The Pearson's correlation coefficients of all DVH parameters were higher in the 3.0-T group than in the 1.5-T group (1.5-T vs 3.0-T: prostate D90, 0.65 vs 0.93; prostate V100, 0.62 vs 0.82; prostate V150, 0.97 vs 0.98; urethral D5, 0.92 vs 0.93; and urethral V150, 0.88 vs 0.93). In the paired Student's t test, no significant differences were observed in any of the DVH parameters between the two radiation oncologists in the 3.0-T group (0.068 ≤ P ≤ 0.842); however, significant differences were observed in prostate D90 (P = 0.004), prostate V100 (P = 0.011) and prostate V150 (P = 0.002) between the oncologists in the 1.5-T group. The interobserver variability of DVH parameters in the MRI/CT fusion image-based post-implant dosimetry analysis of brachytherapy was lower with 3.0-T MRI than with 1.5-T MRI.
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Affiliation(s)
- Kenta Watanabe
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Norihisa Katayama
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Kuniaki Katsui
- Department of Proton Beam Therapy, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Toshi Matsushita
- Department of Radiology Medical Support Division Okayama University Hospital, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Atsushi Takamoto
- Department of Urology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Hiroki Ihara
- Department of Proton Beam Therapy, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Mitsuhiro Takemoto
- Department of Radiation Oncology, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, Japan
| | - Masahiro Kuroda
- Radiological Technology, Okayama University Graduate School of Health Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Medical School, 2-5-1 Shikata-cho, Kitaku, Okayama, Japan
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Hrinivich WT, Park S, Le Y, Song DY, Lee J. Deformable registration of x ray and MRI for postimplant dosimetry in low dose rate prostate brachytherapy. Med Phys 2019; 46:3961-3973. [PMID: 31215042 DOI: 10.1002/mp.13667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/06/2019] [Accepted: 06/05/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Dosimetric assessment following permanent prostate brachytherapy (PPB) commonly involves seed localization using CT and prostate delineation using coregistered MRI. However, pelvic CT leads to additional imaging dose and requires significant resources to acquire and process both CT and MRI. In this study, we propose an automatic postimplant dosimetry approach that retains MRI for soft-tissue contouring, but eliminates the need for CT and reduces imaging dose while overcoming the inconsistent appearance of seeds on MRI with three projection x rays acquired using a mobile C-arm. METHODS Implanted seeds are reconstructed using x rays by solving a combinatorial optimization problem and deformably registered to MRI. Candidate seeds are located in MR images using local hypointensity identification. X ray-based seeds are registered to these candidate seeds in three steps: (a) rigid registration using a stochastic evolutionary optimizer, (b) affine registration using an iterative closest point optimizer, and (c) deformable registration using a local feature point search and nonrigid coherent point drift. The algorithm was evaluated using 20 PPB patients with x rays acquired immediately postimplant and T2-weighted MR images acquired the next day at 1.5 T with mean 0.8 × 0.8 × 3.0 mm 3 voxel dimensions. Target registration error (TRE) was computed based on the distance from algorithm results to manually identified seed locations using coregistered CT acquired the same day as the MRI. Dosimetric accuracy was determined by comparing prostate D90 determined using the algorithm and the ground truth CT-based seed locations. RESULTS The mean ± standard deviation TREs across 20 patients including 1774 seeds were 2.23 ± 0.52 mm (rigid), 1.99 ± 0.49 mm (rigid + affine), and 1.76 ± 0.43 mm (rigid + affine + deformable). The corresponding mean ± standard deviation D90 errors were 5.8 ± 4.8%, 3.4 ± 3.4%, and 2.3 ± 1.9%, respectively. The mean computation time of the registration algorithm was 6.1 s. CONCLUSION The registration algorithm accuracy and computation time are sufficient for clinical PPB postimplant dosimetry.
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Affiliation(s)
- William T Hrinivich
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Seyoun Park
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Yi Le
- Department of Radiation Oncology, Indiana University, Indianapolis, IN, 46202, USA
| | - Daniel Y Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Junghoon Lee
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, 21287, USA
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Nosrati R, Soliman A, Safigholi H, Hashemi M, Wronski M, Morton G, Pejović-Milić A, Stanisz G, Song WY. MRI-based automated detection of implanted low dose rate (LDR) brachytherapy seeds using quantitative susceptibility mapping (QSM) and unsupervised machine learning (ML). Radiother Oncol 2018; 129:540-547. [DOI: 10.1016/j.radonc.2018.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 12/19/2022]
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Tanaka O, Komeda H, Hirose S, Taniguchi T, Ono K, Matsuo M. Visibility of an iron-containing fiducial marker in magnetic resonance imaging for high-precision external beam prostate radiotherapy. Asia Pac J Clin Oncol 2017; 14:e405-e411. [DOI: 10.1111/ajco.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/30/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Hisao Komeda
- Department of Urology; Gifu Municipal Hospital; Gifu City Gifu Japan
| | - Shigeki Hirose
- Division of Radiation Service; Gifu Municipal Hospital; Gifu City Gifu Japan
| | - Takuya Taniguchi
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Kousei Ono
- Department of Radiation Oncology; Murakami Memorial Hospital; 3-23 Hashimoto-cho Gifu City Gifu Japan
| | - Masayuki Matsuo
- Department of Radiology; Gifu University School of Medicine; Gifu City Gifu Japan
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Tanaka O, Komeda H, Tamaki M, Seike K, Fujimoto S, Yama E, Hirose S, Matsuo M. Comparison of MRI visualization between linearly placed iron-containing and non-iron-containing fiducial markers for prostate radiotherapy. Br J Radiol 2017; 91:20170612. [PMID: 29120662 DOI: 10.1259/bjr.20170612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Visualizing the gold marker (GM) in CT and MRI is critical, especially for registration in high-precision radiotherapy. GM sizes vary. Large markers are easily visualized in MRI. Small GMs show fewer artefacts in CT but are harder to detect in MRI because the signal is influenced by metal in MRI. Therefore, we compared MRI visualization between linearly placed new iron-containing marker and non-iron containing marker. METHODS 27 patients underwent CT/MRI fusion-based intensity-modulated radiotherapy. The gold markers were placed by urologists. An iron-containing Gold Anchor™ (GA) marker (diameter, 0.28 mm; length, 10 mm) was placed by using a 22 G needle on one side of the prostate linearly. A non-iron-containing VISICOIL™ (VIS) marker (diameter, 0.35 mm; length, 10 mm) was placed by using a 19 G needle on the opposite side linearly. T2* weighted MRI was mostly performed. Two Radiation Oncologists and one Radiation Technologist evaluated and assigned visual quality scores (GA shape, CT artefacts, MRI signal voids). RESULTS The mean visualization scores of artefacts were similar between GA and VIS in planning CT. GM visualization in MRI of the prostate was better for GA than for VIS. The visibility of the linear shape of the GA was 3.4-4.1 points when the VIS was 5 points (1 is worst and 5 is best). CONCLUSION Visualization quality was similar between GA (iron-containing marker) and VIS (non-iron-containing marker) in planning CT, but was better for GA than for VIS in MRI. To achieve high-precision radiotherapy, an iron-containing gold marker was useful for CT and MRI registration. Advances in knowledge: An iron-containing fiducial marker was useful for CT and MRI registration, especially in high-precision radiotherapy, such as stereotactic body radiotherapy and intensity-modulated radiotherapy.
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Affiliation(s)
- Osamu Tanaka
- 1 Department of Radiation Oncology, Murakami Memorial Hospital , Murakami Memorial Hospital , Gifu city, Gifu , Japan
| | - Hisao Komeda
- 2 Department of Urology, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Masayoshi Tamaki
- 2 Department of Urology, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Kensaku Seike
- 2 Department of Urology, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Shota Fujimoto
- 2 Department of Urology, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Eiichi Yama
- 3 Division of Radiation Service, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Shigeki Hirose
- 3 Division of Radiation Service, Gifu Municipal Hospital , Gifu Municipal Hospital , Gifu city , Japan
| | - Masayuki Matsuo
- 4 Department of Radiology, Gifu University School of Medicine , Gifu University School of Medicine , Gifu City , Japan
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Tanaka O, Komeda H, Hattori M, Hirose S, Yama E, Matsuo M. Comparison of MRI sequences in ideal fiducial maker-based radiotherapy for prostate cancer. Rep Pract Oncol Radiother 2017; 22:502-506. [PMID: 29123458 DOI: 10.1016/j.rpor.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/11/2017] [Accepted: 10/07/2017] [Indexed: 12/31/2022] Open
Abstract
Aim Prostate contouring using CT alone is difficult. To overcome the uncertainty, CT/MRI registration using a fiducial marker is generally performed. However, visualization of the marker itself can be difficult with MRI. This study aimed to determine the optimal MRI pulse sequence for defining the marker as well as the prostate outline among five sequences. Materials and methods A total of 21 consecutive patients with prostate cancer were enrolled. Two gold fiducial markers were placed before CT/MRI examination. We used the following five sequences: T1-weighted spin-echo (T1WI; TR/TE, 400-650/8 ms); T2-weighted fast spin-echo (T2WI; 4000/80); T2*-2D-weighted gradient echo (T2*2D; 700/18); T2*-3D-weighted gradient echo (T2*3D; TR/TE1/deltaTE, 37/14/7.3); and contrast-enhanced T1-weighted spin-echo (CE-T1WI; 400-650/8). Qualitative image analysis of the sequences was performed by three observers. These observers subjectively scored all images on a scale of 1-3 (1 = unclear, 2 = moderate, 3 = well visualized). A higher score indicated better visualization. Results T2WI was significantly superior to the other sequences in terms of prostate definition. T2*2D and T2*3D were strongly superior to the other sequences and were significantly superior in terms of fiducial marker definition. Conclusions T2*2D and T2*3D are superior to the other sequences for prostate contouring and marker identification. Therefore, we recommend initial T2*3D and T2*2D examinations.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, Japan
| | - Hisao Komeda
- Department of Urology, Gifu Municipal Hospital, Japan
| | | | - Shigeki Hirose
- Department of Radiation Oncology, Gifu Municipal Hospital, Japan
| | - Eiichi Yama
- Department of Radiation Oncology, Gifu Municipal Hospital, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, Japan
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Evaluation of intraoperative magnetic resonance imaging/ultrasound fusion optimization for low-dose-rate prostate brachytherapy. J Contemp Brachytherapy 2017; 9:309-315. [PMID: 28951749 PMCID: PMC5611458 DOI: 10.5114/jcb.2017.69412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022] Open
Abstract
Purpose Intraoperative planning with transrectal ultrasound (US) is used for accurate seed placement and optimal dosimetry in prostate brachytherapy. However, prostate magnetic resonance imaging (MRI) has shown superiority in delineation of prostate anatomy. Accordingly, MRI/US fusion may be useful for accurate intraoperative planning. We analyzed planning with MRI/US fusion to compare differences in dosimetry and volume to that derived from the postoperative computed tomography (CT). Material and methods Twenty patients underwent preoperative prostate MRI, which was fused intraoperatively with US during prostate brachytherapy. Intraoperative 125I or 103Pd seed placement was modified by the use of MRI fusion when indicated. Following implantation, dose comparisons were made between data derived from MRI/US and that from post-operative CT scans. Plan parameters analyzed included the D90 (dose to 90% of the prostate), rectal D30, V30 (volume of the rectum receiving 30 percent of dose), and prostate V100. Results The median number of seeds implanted per patient was seventy-six. The MRI measured prostate volume, which was on average 4.47 cc larger than the CT measured prostate volume. In 9 patients, the apex of the prostate was better identified under MRI with the fusion protocol, and an average of 4 fewer seeds were required to be placed in the apex/urinary sphincter region. Both MRI and US individually showed a reduced intraoperative prostate D90 in comparison to the postoperative CT, with a larger mean difference for MRI in comparison with US (9.71 vs. 4.31 Gy, p = 0.007). This was also true for the prostate V100 (5.18 vs. 2.73 cc, p = 0.009). Post-operative CT underestimated rectal D30 and V30 in comparison to both MRI and US with MRI showing a larger mean difference than US for D30 (40.64 vs. 35.92 Gy, p = 0.04) and V30 (50.20 vs. 44.38 cc, p = 0.009). Conclusions The MRI/US fusion demonstrated greater prostate volume compared to standard CT/US based planning likely due to the better resolution of the prostate apex. Furthermore, rectal dose was underestimated with CT vs. MRI based planning. Additional study is required to assess long-term clinical implications of disease control and effects on long-term toxicity, especially as related to the rectum and urinary sphincter. MRI/US intraoperative fusion may improve prostate dosimetry while sparing the rectum and urethra, potentially impacting disease control and late toxicity.
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Tanaka O, Komeda H, Tamaki M, Seike K, Fujimoto S, Yama E, Hirose S, Matsuo M. Efficacy of butylscopolamine in obtaining clear MR image for intensity-modulated radiotherapy for prostate cancer. Tech Innov Patient Support Radiat Oncol 2017; 3-4:19-22. [PMID: 32095562 PMCID: PMC7033771 DOI: 10.1016/j.tipsro.2017.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 10/27/2022] Open
Abstract
Purpose The use of butylscopolamine in magnetic resonance imaging (MRI) of the prostate is controversial in the context of diagnostic imaging where local invasion and the presence of metastases are evaluated. However, in radiation oncology, MRI is performed as part of the simulation process, and the objectives differ to the diagnostic setting. MRI is primarily used for accurate target delineation; hence, the use of an agent to reduce intestinal peristalsis and increase image quality may be beneficial. The impact of butylscopolamine on MRI for radiation oncology purposes has not previously been described. The aim of this study was to evaluate the efficacy of butylscopolamine in MRI acquired for radiation oncology simulation of the prostate. Methods and materials In total, 67 patients were enrolled in this study. Thirty-five patients received intramuscular injection of butylscopolamine (group A) and 32 patients did not (group B). Visualization of the prostate outline and detection of fiducial gold markers (GMs) in the prostate were evaluated on MRI. Two blinded radiation oncologists (ROs) and one radiation technologist (RT) scored the image quality of the detection of prostate outline and recognition of GMs in the prostate on a scale of 1-5 (1 = poor; 5 = excellent), and the results were evaluated using Mann-Whitney U test and p < 0.05 was considered as statistically significant. Results On MRI, group A was statistically superior to group B in terms of fiducial marker detection by two ROs (p < 0.01). However, there was no significant difference in RT scoring. Furthermore, on MRI, group A was statistically superior to group B in terms of the detection of the prostate outline by an RT. Conclusions Butylscopolamine is effective with respect to detection of the prostate outline and GM recognition (without endorectal coil). The addition of butylscopolamine is simple and cost efficient. We recommend the use of butylscopolamine routinely to obtain good MR images, particularly in the detection of GMs.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Hisao Komeda
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Masayoshi Tamaki
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Kensaku Seike
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Shota Fujimoto
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiichi Yama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Shigeki Hirose
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Masayuki Matsuo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido Gifu City, Gifu 501-1193, Japan
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14
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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15
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Tanaka O, Nishigaki Y, Hayashi H, Iida T, Yokoyama T, Takenaka E, Yama E, Tomita E. The advantage of iron-containing fiducial markers placed with a thin needle for radiotherapy of liver cancer in terms of visualization on MRI: an initial experience of Gold Anchor. Radiol Case Rep 2017; 12:416-421. [PMID: 28491201 PMCID: PMC5417757 DOI: 10.1016/j.radcr.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/05/2017] [Accepted: 03/06/2017] [Indexed: 12/27/2022] Open
Abstract
Radiotherapy for liver malignancy is increasing due to advances in radiotherapy technique. Visualization of the tumor as well as fiducial markers is essential. To see if improved visibility exists on computed tomography (CT) and magnetic resonance imaging (MRI), we evaluated an iron-containing fiducial marker. A patient with hepatocellular carcinoma and a patient with cholangiocarcinoma were enrolled. Pain caused by placement of marker and the best MRI sequence for visualization of both the fiducial marker as well as the liver tumor on MRI was evaluated. CT was obtained in 2.5-mm thickness, and MRIs were obtained in eight sequences (ie, T2-weighted image). 22G preloaded needles were used for marker placement in both patients; this caused little pain during placement under local anesthesia with xylocaine. No complication occurred in either patient. Both markers and tumors were well visualized by the same MRI sequence. The iron-containing fiducial marker is safe and useful for detecting fiducial markers in the liver and for registration using CT and MRI.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Yoichi Nishigaki
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
| | - Hideki Hayashi
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
| | - Takayoshi Iida
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Takamasa Yokoyama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiji Takenaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiichi Yama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City, Gifu 500-8513, Japan
| | - Eiichi Tomita
- Department of Hepatology, Gifu Municipal Hospital, Gifu City, Gifu, Japan
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16
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Martin GV, Pugh TJ, Mahmood U, Kudchadker RJ, Wang J, Bruno TL, Bathala T, Blanchard P, Frank SJ. Permanent prostate brachytherapy postimplant magnetic resonance imaging dosimetry using positive contrast magnetic resonance imaging markers. Brachytherapy 2017; 16:761-769. [PMID: 28501429 DOI: 10.1016/j.brachy.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Permanent prostate brachytherapy dosimetry using computed tomography-magnetic resonance imaging (CT-MRI) fusion combines the anatomic detail of MRI with seed localization on CT but requires multimodality imaging acquisition and fusion. The purpose of this study was to compare the utility of MRI only postimplant dosimetry to standard CT-MRI fusion-based dosimetry. METHODS AND MATERIALS Twenty-three patients undergoing permanent prostate brachytherapy with use of positive contrast MRI markers were included in this study. Dose calculation to the whole prostate, apex, mid-gland, and base was performed via standard CT-MRI fusion and MRI only dosimetry with prostate delineated on the same T2 MRI sequence. The 3-dimensional (3D) distances between seed positions of these two methods were also evaluated. Wilcoxon-matched-pair signed-rank test compared the D90 and V100 of the prostate and its sectors between methods. RESULTS The day 0 D90 and V100 for the prostate were 98% versus 94% and 88% versus 86% for CT-MRI fusion and MRI only dosimetry. There were no differences in the D90 or V100 of the whole prostate, mid-gland, or base between dosimetric methods (p > 0.19), but prostate apex D90 was high by 13% with MRI dosimetry (p = 0.034). The average distance between seeds on CT-MRI fusion and MRI alone was 5.5 mm. After additional automated rigid registration of 3D seed positions, the average distance between seeds was 0.3 mm, and the previously observed differences in apex dose between methods was eliminated (p > 0.11). CONCLUSIONS Permanent prostate brachytherapy dosimetry based only on MRI using positive contrast MRI markers is feasible, accurate, and reduces the uncertainties arising from CT-MRI fusion abating the need for postimplant multimodality imaging.
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Affiliation(s)
- Geoffrey V Martin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas J Pugh
- Department of Radiation Oncology, University of Colorado, Aurora, CO
| | - Usama Mahmood
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rajat J Kudchadker
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Teresa L Bruno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Tharakeswara Bathala
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Pierre Blanchard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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17
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Clinical use of magnetic resonance imaging across the prostate brachytherapy workflow. Brachytherapy 2017; 16:734-742. [PMID: 28153700 DOI: 10.1016/j.brachy.2016.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022]
Abstract
MRI produces better soft tissue contrast than does ultrasonography or computed tomography for visualizing male pelvic anatomy and prostate cancer. Better visualization of the tumor and organs at risk could allow better conformation of the dose to the target volumes while at the same time minimizing the dose to critical structures and the associated toxicity. Although the use of MRI for prostate brachytherapy would theoretically result in an improved therapeutic ratio, its implementation been slow, mostly because of technical challenges. In this review, we describe the potential role of MRI at different steps in the treatment workflow for prostate brachytherapy: for patient selection, treatment planning, in the operating room, or for postimplant assessment. We further present the current clinical experience with MRI-guided prostate brachytherapy, both for permanent seed implantation and high-dose-rate brachytherapy.
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18
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Tanaka O, Iida T, Komeda H, Tamaki M, Seike K, Kato D, Yokoyama T, Hirose S, Kawaguchi D. Initial experience of using an iron-containing fiducial marker for radiotherapy of prostate cancer: Advantages in the visualization of markers in Computed Tomography and Magnetic Resonance Imaging. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2016. [DOI: 10.1515/pjmpe-2016-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Visualization of markers is critical for imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). However, the size of the marker varies according to the imaging technique. While a large-sized marker is more useful for visualization in MRI, it results in artifacts on CT and causes substantial pain on administration. In contrast, a small-sized marker reduces the artifacts on CT but hampers MRI detection. Herein, we report a new ironcontaining marker and compare its utility with that of non-iron-containing markers. Five patients underwent CT/MRI fusion-based intensity-modulated radiotherapy, and the markers were placed by urologists. A Gold Anchor™ (GA; diameter, 0.28 mm; length, 10 mm) was placed using a 22G needle on the right side of the prostate. A VISICOIL™ (VIS; diameter, 0.35 mm; length, 10 mm) was placed using a 19G needle on the left side. MRI was performed using T2*-weighted imaging. Three observers evaluated and scored the visual qualities of the acquired images. The mean score of visualization was almost identical between the GA and VIS in radiography and cone-beam CT (Novalis Tx). The artifacts in planning CT were slightly larger using the GA than using the VIS. The visualization of the marker on MRI using the GA was superior to that using the VIS. In conclusion, the visualization quality of radiography, conebeam CT, and planning CT was roughly equal between the GA and VIS. However, the GA was more strongly visualized than was the VIS on MRI due to iron containing.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Takayoshi Iida
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Hisao Komeda
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Masayoshi Tamaki
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Kensaku Seike
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Daiki Kato
- Department of Urology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Takamasa Yokoyama
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Shigeki Hirose
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
| | - Daisuke Kawaguchi
- Department of Radiation Oncology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu City Gifu, 500-8513, Japan
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19
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Fiducial marker for prostate radiotherapy: comparison of 0.35- and 0.5-mm-diameter computed tomography and magnetic resonance images. Radiol Med 2016; 122:204-207. [DOI: 10.1007/s11547-016-0715-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/27/2016] [Indexed: 12/31/2022]
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20
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Jason Stafford R, Brezovich IA. Image-guided prostate brachytherapy should be MRI-based. Med Phys 2016; 43:6213. [PMID: 27908186 DOI: 10.1118/1.4965810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- R Jason Stafford
- Imaging Physics, UT MD Anderson Cancer Center, Houston, Texas 77030-4009 (Tel: 713-563-5082; E-mail: )
| | - Ivan A Brezovich
- Hazelrig-Salter Radiation Oncology Center, University of Alabama, Birmingham, Alabama 35249-6832 (Tel: 205-934-1758; E-mail: )
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21
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Katayama N, Takemoto M, Takamoto A, Ihara H, Katsui K, Ebara S, Nasu Y, Kanazawa S. Comparison of implant quality between intraoperatively built custom-linked seeds and loose seeds in permanent prostate brachytherapy using sector analysis. JOURNAL OF RADIATION RESEARCH 2016; 57:393-399. [PMID: 26976125 PMCID: PMC4973643 DOI: 10.1093/jrr/rrw018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/08/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
We compared the implant quality of intraoperatively built custom-linked (IBCL) seeds with loose seeds in permanent prostate brachytherapy. Between June 2012 and January 2015, 64 consecutive prostate cancer patients underwent brachytherapy with IBCL seeds (n = 32) or loose seeds (n = 32). All the patients were treated with 144 Gy of brachytherapy alone. Brachytherapy was performed using a dynamic dose calculation technique. Computed tomography/magnetic resonance imaging fusion-based dosimetry was performed 1 month after brachytherapy. Post-implant dose-volume histogram (DVH) parameters, prostate sector dosimetry, operation time, seed migration, and toxicities were compared between the IBCL seed group and the loose seed group. A sector analysis tool was used to divide the prostate into six sectors (anterior and posterior sectors at the base, mid-gland, and apex). V100 (95.3% vs 89.7%; P = 0.014) and D90 (169.7 Gy vs 152.6 Gy; P = 0.013) in the anterior base sector were significantly higher in the IBCL seed group than in the loose seed group. The seed migration rate was significantly lower in the IBCL seed group than in the loose seed group (6% vs 66%; P < 0.001). Operation time per seed was significantly longer in the IBCL seed group than in the loose seed group (1.31 min vs 1.13 min; P = 0.003). Other post-implant DVH parameters and toxicities did not differ significantly between the two groups. Our study showed more dose coverage post-operatively in the anterior base prostate sector and less seed migration in IBCL seed implantation compared with loose seed implantation.
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Affiliation(s)
- Norihisa Katayama
- Department of Radiology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | | | - Atsushi Takamoto
- Department of Urology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Hiroki Ihara
- Department of Radiology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Kuniaki Katsui
- Department of Radiology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Shin Ebara
- Department of Urology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Okayama 700-8558, Japan
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22
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Zaorsky NG, Horwitz EM. Brachytherapy for Prostate Cancer: An Overview. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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23
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24
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Tanaka O, Komeda H, Iida T, Tamaki M, Seike K, Kato D, Yokoyama T, Hirose S, Kawaguchi D, Yama E. RETRACTED: <i>Usefulness of Iron-Containing Fiducial Marker for Prostate Radiotherapy</i>. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ijmpcero.2016.54033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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25
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Assessment of the feasibility of using transrectal ultrasound for postimplant dosimetry in low-dose-rate prostate brachytherapy. Med Dosim 2016; 41:290-295. [DOI: 10.1016/j.meddos.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 05/26/2016] [Accepted: 07/05/2016] [Indexed: 11/19/2022]
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26
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Effect of a urinary catheter on seed position and rectal and bladder doses in CT-based post-implant dosimetry for prostate cancer brachytherapy. J Contemp Brachytherapy 2015. [PMID: 26207109 PMCID: PMC4499521 DOI: 10.5114/jcb.2015.52624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To assess the variability in rectal and bladder dosimetric parameters determined according to post-implant computed tomography (CT) images in patients with or without a urethral catheter. MATERIAL AND METHODS Patients with prostate cancer who were scheduled to undergo CT after brachytherapy between October 2012 and January 2014 were included. We obtained CT series with and without a urinary catheter in each patient. We compared the rectal and bladder doses in 18 patients on each CT series. RESULTS The shifts in the seed positions between with and without a catheter in place were 1.3 ± 0.3 mm (mean ± standard deviation). The radiation doses to the rectum, as determined on the CT series, with a urethral catheter were higher than those on CT without a catheter (p < 0.001). Radiation doses to the bladder with a catheter were significantly lower than those without a catheter (p = 0.027). CONCLUSIONS Post-implant dosimetry (PID) with no catheter showed significantly lower rectal doses and higher bladder doses than those of PID with a catheter. We recommend the PID procedure for CT images in patients without a catheter. Use of CT with a catheter is limited to identifying urethral position.
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27
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A new two-step accurate CT-MRI fusion technique for post-implant prostate cancer. J Contemp Brachytherapy 2015; 7:117-21. [PMID: 26034491 PMCID: PMC4444459 DOI: 10.5114/jcb.2015.51290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 01/18/2015] [Accepted: 02/24/2015] [Indexed: 01/14/2023] Open
Abstract
Purpose To develop an accurate method of fusing computed tomography (CT) with magnetic resonance imaging (MRI) for post-implant dosimetry after prostate seed implant brachytherapy. Material and methods Prostate cancer patients were scheduled to undergo CT and MRI after brachytherapy. We obtained the three MRI sequences on fat-suppressed T1-weighted imaging (FST1-WI), T2-weighted imaging (T2-WI), and T2*-weighted imaging (T2*-WI) in each patient. We compared the lengths and widths of 450 seed source images in the 10 study patients on CT, FST1-WI, T2-WI, and T2*-WI. After CT-MRI fusion using source positions by the least-squares method, we decided the center of each seed source and measured the distance of these centers between CT and MRI to estimate the fusion accuracy. Results The measured length and width of the seeds were 6.1 ± 0.5 mm (mean ± standard deviation) and 3.2 ± 0.2 mm on CT, 5.9 ± 0.4 mm, and 2.4 ± 0.2 mm on FST1-WI, 5.5 ± 0.5 mm and 1.8 ± 0.2 mm on T2-WI, and 7.8 ± 1.0 mm and 4.1 ± 0.7 mm on T2*-WI, respectively. The measured source location shifts on CT/FST1-WI and CT/T2-WI after image fusion in the 10 study patients were 0.9 ± 0.4 mm and 1.4 ± 0.2 mm, respectively. The shift on CT/FST1-WI was less than on CT/T2-WI (p = 0.005). Conclusions For post-implant dosimetry after prostate seed implant brachytherapy, more accurate fusion of CT and T2-WI is achieved if CT and FST1-WI are fused first using the least-squares method and the center position of each source, followed by fusion of the FST1-WI and T2-WI images. This method is more accurate than direct image fusion.
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Improved dosimetry in prostate brachytherapy using high resolution contrast enhanced magnetic resonance imaging: a feasibility study. J Contemp Brachytherapy 2015; 6:337-43. [PMID: 25834576 PMCID: PMC4300354 DOI: 10.5114/jcb.2014.46555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/04/2014] [Accepted: 09/14/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess detailed dosimetry data for prostate and clinical relevant intra- and peri-prostatic structures including neurovascular bundles (NVB), urethra, and penile bulb (PB) from postbrachytherapy computed tomography (CT) versus high resolution contrast enhanced magnetic resonance imaging (HR-CEMRI). Material and methods Eleven postbrachytherapy prostate cancer patients underwent HR-CEMRI and CT imaging. Computed tomography and HR-CEMRI images were randomized and 2 independent expert readers created contours of prostate, intra- and peri-prostatic structures on each CT and HR-CEMRI scan for all 11 patients. Dosimetry data including V100, D90, and D100 was calculated from these contours. Results Mean V100 values from CT and HR-CEMRI contours were as follows: prostate (98.5% and 96.2%, p = 0.003), urethra (81.0% and 88.7%, p = 0.027), anterior rectal wall (ARW) (8.9% and 2.8%, p < 0.001), left NVB (77.9% and 51.5%, p = 0.002), right NVB (69.2% and 43.1%, p = 0.001), and PB (0.09% and 11.4%, p = 0.005). Mean D90 (Gy) derived from CT and HR-CEMRI contours were: prostate (167.6 and 150.3, p = 0.012), urethra (81.6 and 109.4, p = 0.041), ARW (2.5 and 0.11, p = 0.003), left NVB (98.2 and 58.6, p = 0.001), right NVB (87.5 and 55.5, p = 0.001), and PB (11.2 and 12.4, p = 0.554). Conclusions Findings of this study suggest that HR-CEMRI facilitates accurate and meaningful dosimetric assessment of prostate and clinically relevant structures, which is not possible with CT. Significant differences were seen between CT and HR-CEMRI, with volume overestimation of CT derived contours compared to HR-CEMRI.
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Tao R, Tavakoli M, Sloboda R, Usmani N. A comparison of US- versus MR-based 3-D Prostate Shapes Using Radial Basis Function Interpolation and Statistical Shape Models. IEEE J Biomed Health Inform 2014; 19:623-34. [PMID: 24860042 DOI: 10.1109/jbhi.2014.2324975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper presents a comparison of three-dimensional (3-D) segmentations of the prostate, based on two-dimensional (2-D) manually segmented contours, obtained using ultrasound (US) and magnetic resonance (MR) imaging data collected from 40 patients diagnosed with localized prostate cancer and scheduled to receive brachytherapy treatment. The approach we propose here for 3-D prostate segmentation first uses radial basis function interpolation to construct a 3-D point distribution model for each prostate. Next, a modified principal axis transformation is utilized for rigid registration of the US and MR images of the same prostate in preparation for the following shape comparison. Then, statistical shape models are used to capture the segmented 3-D prostate geometries for the subsequent cross-modality comparison. Our study includes not only cross-modality geometric comparisons in terms of prostate volumes and dimensions, but also an investigation of interchangeability of the two imaging modalities in terms of automatic contour segmentation at the pre-implant planning stage of prostate brachytherapy treatment. By developing a new scheme to compare the two imaging modalities in terms of the segmented 3-D shapes, we have taken a first step necessary for building coupled US-MR segmentation strategies for prostate brachytherapy pre-implant planning, which at present is predominantly informed by US images only.
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Brown AP, Pugh TJ, Swanson DA, Kudchadker RJ, Bruno TL, Christensen EN, van Vulpen M, Frank SJ. Improving prostate brachytherapy quality assurance with MRI-CT fusion-based sector analysis in a phase II prospective trial of men with intermediate-risk prostate cancer. Brachytherapy 2013; 12:401-7. [PMID: 23380383 DOI: 10.1016/j.brachy.2012.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/21/2012] [Accepted: 10/01/2012] [Indexed: 02/03/2023]
Abstract
PURPOSE We combined sector analysis with MRI-CT fusion to comprehensively assess postimplant dosimetry after prostate brachytherapy. METHODS AND MATERIALS Subjects were 50 men with intermediate-risk prostate cancer treated with (125)I brachytherapy in a prospective phase II clinical trial. On Day 30 after the implantation, dosimetry was evaluated in the prostate base, midgland, and apex regions on fused MRI-CT scans and CT scans. Volumes of each sector receiving 100% of the prescribed dose (V100) and doses to 90% of each sector (D90) were also calculated on the ultrasonogram used for treatment planning and compared with values derived from CT and fused MRI-CT scans. RESULTS Fused MRI-CT scans revealed lower-than-expected doses for the whole prostate (V100=91.3%, D90=152.9Gy) compared with CT scans (98.5% and 183.6Gy, p<0.0001) and lower doses to the prostate base (V100=79%, D90=130Gy) vs. CT (96% and 170Gy, p<0.0001). However, lower doses to the prostate base did not adversely affect biochemical outcomes in men with biopsy-proven disease at the base. At a median followup time of 42 months, the mean prostate-specific antigen level for all patients was 0.3ng/mL, and no patient had experienced biochemical or clinical progression or recurrence. CONCLUSIONS MRI-CT fusion-based sector analysis was feasible and revealed significantly lower doses to the prostate base than doses estimated from CT alone, although this did not affect biochemical outcomes. MRI-CT fusion-based sector analysis may be useful for developing MRI-based dosimetric markers to predict disease outcomes and treatment-related morbidity.
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Affiliation(s)
- Aaron P Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Marcu LG, Gowda R. Comparison of 3 different postimplant dosimetry methods following permanent 125I prostate seed brachytherapy. Med Dosim 2013; 38:309-14. [DOI: 10.1016/j.meddos.2013.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/19/2012] [Accepted: 02/21/2013] [Indexed: 11/29/2022]
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De Brabandere M, Al-Qaisieh B, De Wever L, Haustermans K, Kirisits C, Moerland MA, Oyen R, Rijnders A, Van den Heuvel F, Siebert FA. CT- and MRI-based seed localization in postimplant evaluation after prostate brachytherapy. Brachytherapy 2013; 12:580-8. [PMID: 23876358 DOI: 10.1016/j.brachy.2013.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 02/12/2013] [Accepted: 06/07/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the uncertainties in CT- and MRI-based seed reconstruction in postimplant evaluation after prostate seed brachytherapy in terms of interobserver variability and quantify the impact of seed detection variability on a selection of dosimetric parameters for three postplan techniques: (1) CT, (2) MRI-T1 weighted fused with MRI-T2 weighted, and (3) CT fused with MRI-T2 weighted. METHODS AND MATERIALS Seven physicists reconstructed the seed positions on postimplant CT and MRI-T1 images of three patients. For each patient and imaging modality, the interobserver variability was calculated with respect to a reference seed set. The effect of this variability on dosimetry was calculated for CT and CT + MRI-T2 (CT-based seed reconstruction), as well as for MRI-T1 + MRI-T2 (MRI-T1-based seed reconstruction), using fixed CT and MRI-T2 prostate contours. RESULTS Averaged over three patients, the interobserver variability in CT-based seed reconstruction was 1.1 mm (1 SDref, i.e., standard deviation with respect to the reference value). The D90 (dose delivered to 90% of the target) variability was 1.5% and 1.3% (1 SDref) for CT and CT + MRI-T2, respectively. The mean interobserver variability in MRI-based seed reconstruction was 3.0 mm (1 SDref), and the impact of this variability on D90 was 6.6% for MRI-T1 + MRI-T2. CONCLUSIONS Seed reconstruction on MRI-T1-weighted images was less accurate than on CT. This difference in uncertainties should be weighted against uncertainties due to contouring and image fusion when comparing the overall reliability of postplan techniques.
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Affiliation(s)
- Marisol De Brabandere
- Department of Radiation Oncology, University Hospital Gasthuisberg, Leuven, Belgium.
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Defining a magnetic resonance scan sequence for permanent seed prostate brachytherapy postimplant assessment. Brachytherapy 2013; 12:25-9. [DOI: 10.1016/j.brachy.2012.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 03/06/2012] [Accepted: 03/13/2012] [Indexed: 11/21/2022]
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Bowes D, Crook JM, Araujo C, Batchelar D. Ultrasound–CT fusion compared with MR–CT fusion for postimplant dosimetry in permanent prostate brachytherapy. Brachytherapy 2013; 12:38-43. [DOI: 10.1016/j.brachy.2012.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 03/19/2012] [Accepted: 03/30/2012] [Indexed: 11/30/2022]
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Ohashi T, Momma T, Yamashita S, Nagatsuma K, Kanai K, Kitagawa K, Takahashi S, Hanada T, Yorozu A, Shigematsu N. Impact of MRI-based postimplant dosimetric assessment in prostate brachytherapy using contrast-enhanced T1-weighted images. Brachytherapy 2012; 11:468-75. [DOI: 10.1016/j.brachy.2011.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/19/2011] [Accepted: 12/27/2011] [Indexed: 11/28/2022]
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Comparison of CT and MR–CT Fusion for Prostate Post-Implant Dosimetry. Int J Radiat Oncol Biol Phys 2012; 82:1912-7. [DOI: 10.1016/j.ijrobp.2011.01.064] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Revised: 01/19/2011] [Accepted: 01/27/2011] [Indexed: 11/20/2022]
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Chng N, Spadinger I, Rasoda R, Morris WJ, Salcudean S. Prostate brachytherapy postimplant dosimetry: Seed orientation and the impact of dosimetric anisotropy in stranded implants. Med Phys 2012; 39:721-31. [DOI: 10.1118/1.3671921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Davis BJ, Horwitz EM, Lee WR, Crook JM, Stock RG, Merrick GS, Butler WM, Grimm PD, Stone NN, Potters L, Zietman AL, Zelefsky MJ. American Brachytherapy Society consensus guidelines for transrectal ultrasound-guided permanent prostate brachytherapy. Brachytherapy 2012; 11:6-19. [PMID: 22265434 DOI: 10.1016/j.brachy.2011.07.005] [Citation(s) in RCA: 326] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 07/23/2011] [Accepted: 07/26/2011] [Indexed: 10/14/2022]
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Liu D, Usmani N, Ghosh S, Kamal W, Pedersen J, Pervez N, Yee D, Danielson B, Murtha A, Amanie J, Sloboda RS. Comparison of prostate volume, shape, and contouring variability determined from preimplant magnetic resonance and transrectal ultrasound images. Brachytherapy 2011; 11:284-91. [PMID: 22197014 DOI: 10.1016/j.brachy.2011.11.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/08/2011] [Accepted: 11/10/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare preimplant prostate contours and contouring variability between magnetic resonance (MR) and transrectal ultrasound images. METHODS AND MATERIALS Twenty-three patients were imaged using ultrasound (US) and MR before permanent brachytherapy treatment. Images were anonymized, randomized, and duplicated, and the prostate was independently delineated by five radiation oncologists. Contours were compared in terms of volume, dimensions, posterior rectal indentation, and observer variability. The Jaccard index quantified spatial overlap between contours from duplicated images. RESULTS The mean US/MR volume ratio was 0.99±0.08 (p=0.5). The width, height, and length ratios for the prostate were 0.98±0.06 (p=0.09), 0.99±0.08 (p=0.4), and 1.05±0.14 (p=0.1). Rectal indentation was larger on US by 0.18mL (p=0.01) and correlated with prostate volume (p<0.01). MR and US interobserver variability in volume were similar at 3.5±1.7 and 3.3±1.9mL (p=0.6). Intraobserver variability was smaller on US at 1.4±1.1mL compared with MR at 2.4±2.2mL (p=0.01). Local intraobserver variability was lower on US at the midgland slice (p<0.01) but lower on MR at the base (p<0.01) and apex (p<0.01) slices. CONCLUSIONS US is comparable to MR for preimplant prostate delineation, with no significant difference in volume and dimensions. Rectal indentation because of the transrectal ultrasound probe was measurable, although the effects were small. Intraobserver variability was lower on US for the prostate volume but was lower on MR locally at the base and apex. However, the difference was not observed for the interobserver variability, which was similar between MR and US.
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Affiliation(s)
- Derek Liu
- Division of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada.
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Katayama N, Takemoto M, Yoshio K, Katsui K, Uesugi T, Nasu Y, Matsushita T, Kaji M, Kumon H, Kanazawa S. T2*-weighted image/T2-weighted image fusion in postimplant dosimetry of prostate brachytherapy. JOURNAL OF RADIATION RESEARCH 2011; 52:680-684. [PMID: 21857148 DOI: 10.1269/jrr.11011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Computed tomography (CT)/magnetic resonance imaging (MRI) fusion is considered to be the best method for postimplant dosimetry of permanent prostate brachytherapy; however, it is inconvenient and costly. In T2*-weighted image (T2*-WI), seeds can be easily detected without the use of an intravenous contrast material. We present a novel method for postimplant dosimetry using T2*-WI/T2-weighted image (T2-WI) fusion. We compared the outcomes of T2*-WI/T2-WI fusion-based and CT/T2-WI fusion-based postimplant dosimetry. Between April 2008 and July 2009, 50 consecutive prostate cancer patients underwent brachytherapy. All the patients were treated with 144 Gy of brachytherapy alone. Dose-volume histogram (DVH) parameters (prostate D90, prostate V100, prostate V150, urethral D10, and rectal D2cc) were prospectively compared between T2*-WI/T2-WI fusion-based and CT/T2-WI fusion-based dosimetry. All the DVH parameters estimated by T2*-WI/T2-WI fusion-based dosimetry strongly correlated to those estimated by CT/T2-WI fusion-based dosimetry (0.77 ≤ R ≤ 0.91). No significant difference was observed in these parameters between the two methods, except for prostate V150 (p = 0.04). These results show that T2*-WI/T2-WI fusion-based dosimetry is comparable or superior to MRI-based dosimetry as previously reported, because no intravenous contrast material is required. For some patients, rather large differences were observed in the value between the 2 methods. We thought these large differences were a result of seed miscounts in T2*-WI and shifts in fusion. Improving the image quality of T2*-WI and the image acquisition speed of T2*-WI and T2-WI may decrease seed miscounts and fusion shifts. Therefore, in the future, T2*-WI/T2-WI fusion may be more useful for postimplant dosimetry of prostate brachytherapy.
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Affiliation(s)
- Norihisa Katayama
- Department of Radiology, Japanese Red Cross Society Himeji Hospital, Japan.
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Polo A. Image fusion techniques in permanent seed implantation. J Contemp Brachytherapy 2010; 2:98-106. [PMID: 27853470 PMCID: PMC5104828 DOI: 10.5114/jcb.2010.16920] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 09/17/2010] [Indexed: 11/22/2022] Open
Abstract
Over the last twenty years major software and hardware developments in brachytherapy treatment planning, intraoperative navigation and dose delivery have been made. Image-guided brachytherapy has emerged as the ultimate conformal radiation therapy, allowing precise dose deposition on small volumes under direct image visualization. In this process imaging plays a central role and novel imaging techniques are being developed (PET, MRI-MRS and power Doppler US imaging are among them), creating a new paradigm (dose-guided brachytherapy), where imaging is used to map the exact coordinates of the tumour cells, and to guide applicator insertion to the correct position. Each of these modalities has limitations providing all of the physical and geometric information required for the brachytherapy workflow. Therefore, image fusion can be used as a solution in order to take full advantage of the information from each modality in treatment planning, intraoperative navigation, dose delivery, verification and follow-up of interstitial irradiation. Image fusion, understood as the visualization of any morphological volume (i.e. US, CT, MRI) together with an additional second morphological volume (i.e. CT, MRI) or functional dataset (functional MRI, SPECT, PET), is a well known method for treatment planning, verification and follow-up of interstitial irradiation. The term image fusion is used when multiple patient image datasets are registered and overlaid or merged to provide additional information. Fused images may be created from multiple images from the same imaging modality taken at different moments (multi-temporal approach), or by combining information from multiple modalities. Quality means that the fused images should provide additional information to the brachytherapy process (diagnosis and staging, treatment planning, intraoperative imaging, treatment delivery and follow-up) that cannot be obtained in other ways. In this review I will focus on the role of image fusion for permanent seed implantation.
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Affiliation(s)
- Alfredo Polo
- Brachytherapy and Intraoperative Radiotherapy Unit, Radiation Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain
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An analysis of intraoperative versus post-operative dosimetry with CT, CT–MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants. Radiother Oncol 2010; 96:166-71. [PMID: 20615565 DOI: 10.1016/j.radonc.2010.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Revised: 05/17/2010] [Accepted: 06/07/2010] [Indexed: 11/23/2022]
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Usmani N, Sloboda R, Kamal W, Ghosh S, Pervez N, Pedersen J, Yee D, Danielson B, Murtha A, Amanie J, Monajemi T. Can images obtained with high field strength magnetic resonance imaging reduce contouring variability of the prostate? Int J Radiat Oncol Biol Phys 2010; 80:728-34. [PMID: 20630667 DOI: 10.1016/j.ijrobp.2010.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE The objective of this study is to determine whether there is less contouring variability of the prostate using higher-strength magnetic resonance images (MRI) compared with standard MRI and computed tomography (CT). METHODS AND MATERIALS Forty patients treated with prostate brachytherapy were accrued to a prospective study that included the acquisition of 1.5-T MR and CT images at specified time points. A subset of 10 patients had additional 3.0-T MR images acquired at the same time as their 1.5-T MR scans. Images from each of these patients were contoured by 5 radiation oncologists, with a random subset of patients repeated to quantify intraobserver contouring variability. To minimize bias in contouring the prostate, the image sets were placed in folders in a random order with all identifiers removed from the images. RESULTS Although there was less interobserver contouring variability in the overall prostate volumes in 1.5-T MRI compared with 3.0-T MRI (p < 0.01), there was no significant differences in contouring variability in the different regions of the prostate between 1.5-T MRI and 3.0-T MRI. MRI demonstrated significantly less interobserver contouring variability in both 1.5-T and 3.0-T compared with CT in overall prostate volumes (p < 0.01, p = 0.01), with the greatest benefits being appreciated in the base of the prostate. Overall, there was less intraobserver contouring variability than interobserver contouring variability for all of the measurements analyzed. CONCLUSIONS Use of 3.0-T MRI does not demonstrate a significant improvement in contouring variability compared with 1.5-T MRI, although both magnetic strengths demonstrated less contouring variability compared with CT.
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Affiliation(s)
- Nawaid Usmani
- Department of Radiation Oncology, Cross Cancer Institute, Edmonton, AB, Canada.
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Acher P, Rhode K, Morris S, Gaya A, Miquel M, Popert R, Tham I, Nichol J, McLeish K, Deehan C, Dasgupta P, Beaney R, Keevil SF. Comparison of Combined X-Ray Radiography and Magnetic Resonance (XMR) Imaging–Versus Computed Tomography–Based Dosimetry for the Evaluation of Permanent Prostate Brachytherapy Implants. Int J Radiat Oncol Biol Phys 2008; 71:1518-25. [PMID: 18513881 DOI: 10.1016/j.ijrobp.2008.03.065] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Revised: 01/26/2008] [Accepted: 03/18/2008] [Indexed: 10/22/2022]
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Bloch BN, Kaplan ID, Lenkinski RE, Rofsky NM. In Reply to Drs. Beaulieu and Verhagen. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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MRI-based preplanning in low-dose-rate prostate brachytherapy. Radiother Oncol 2008; 88:115-20. [DOI: 10.1016/j.radonc.2007.09.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/30/2007] [Accepted: 09/20/2007] [Indexed: 11/24/2022]
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Tanaka O, Hayashi S, Matsuo M, Nakano M, Uno H, Ohtakara K, Miyoshi T, Deguchi T, Hoshi H. Effect of Edema on Postimplant Dosimetry in Prostate Brachytherapy Using CT/MRI Fusion. Int J Radiat Oncol Biol Phys 2007; 69:614-8. [PMID: 17869675 DOI: 10.1016/j.ijrobp.2007.05.082] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 04/27/2007] [Accepted: 05/29/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the time course of prostatic edema and the effect on the dose-volume histograms of the prostate for patients treated with brachytherapy. METHODS AND MATERIALS A total of 74 patients with prostate cancer were enrolled in this prospective study. A transrectal ultrasound-based preplan was performed 4 weeks before implantation and computed tomography/magnetic resonance imaging fusion-based postimplant dosimetry was performed on the day after implantation (Day 1) and 30 days after implantation (Day 30). The prostate volume, prostate volume covered by 100% of the prescription dose (V100), and dose covering 90% of the prostate (D90) were evaluated with prostatic edema over time. RESULTS Prostatic edema was greatest on Day 1, with the mean prostate volume 36% greater than the preplan transrectal ultrasound-based volume; it thereafter decreased over time. It was 9% greater than preplan volume on Day 30. The V(100) increased 5.7% from Day 1 to Day 30, and the D90 increased 13.1% from Day 1 to Day 30. The edema ratio (postplan/preplan) on Day 1 of low-quality implants with a V(100) of <80% was significantly greater than that of intermediate- to high-quality implants (>80% V100; p = 0.0272). The lower V100 on Day 1 showed a greater increase from Day 1 to Day 30. A V100 on Day 1 of >92% is unlikely to increase >0% during the interval studied. CONCLUSION Low-quality implants on Day 1 were highly associated with edema; however, such a low-quality implant on Day 1, with significant edema, tended to improve by Day 30. If a high-quality implant (V100 >92%) can be obtained on Day 1, a re-examination is no longer necessary.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiology, Gifu University School of Medicine, Gifu, Japan.
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Tanaka O, Hayashi S, Matsuo M, Nakano M, Kubota Y, Maeda S, Ohtakara K, Deguchi T, Hoshi H. Comparison of urethral diameters for calculating the urethral dose after permanent prostate brachytherapy. ACTA ACUST UNITED AC 2007; 25:329-34. [PMID: 17705002 DOI: 10.1007/s11604-007-0146-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 03/22/2007] [Indexed: 11/24/2022]
Abstract
PURPOSE No studies have yet evaluated the effects of a dosimetric analysis for different urethral volumes. We therefore evaluated the effects of a dosimetric analysis to determine the different urethral volumes. METHODS This study was based on computed tomography/magnetic resonance imaging (CT/MRI) combined findings in 30 patients who had undergone prostate brachytherapy. Postimplant CT/MRI scans were performed 30 days after the implant. The urethra was contoured based on its diameter (8, 6, 4, 2, and 0 mm). The total urethral volume-in cubic centimeters [UrV150/200(cc)] and percent (UrV150%/200%), of the urethra receiving 150% or 200% of the prescribed dose-and the doses (UrD90/30/5) in Grays to 90%, 30%, and 5% of the urethral volume were measured based on the urethral diameters. RESULTS The UrV150(cc) and UrD30 were statistically different between the of 8-, 6-, 4-, 2-, and 0-mm diameters, whereas the UrD5 was statistically different only between the 8-, 6-, and 4-mm diameters. Especially for UrD5, there was an approximately 40-Gy difference between the mean values for the 8- and 0-mm diameters. CONCLUSION We recommend that the urethra should be contoured as a 4- to 6-mm diameter circle or one side of a triangle of 5-7 mm. By standardizing the urethral diameter, the urethral dose will be less affected by the total urethral volume.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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Tanaka O, Hayashi S, Kanematsu M, Matsuo M, Nakano M, Maeda S, Deguchi T, Hoshi H. CT-based postimplant dosimetry of prostate brachytherapy: comparison of 1-mm and 5-mm section CT. RADIATION MEDICINE 2007; 25:22-6. [PMID: 17225049 DOI: 10.1007/s11604-006-0096-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2006] [Accepted: 09/27/2006] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to compare the outcomes between 1-mm and 5-mm section computed tomography (CT)-based postimplant dosimetry. MATERIALS AND METHODS A series of 21 consecutive patients underwent permanent prostate brachytherapy. The postimplant prostate volume was calculated using 1-mm and 5-mm section CT. One radiation oncologist contoured the prostate on CT images to obtain the reconstructed prostate volume (pVol), prostate V(100) (percent of the prostate volume receiving at least the full prescribed dose), and prostate D(90) (mean dose delivered to 90% of the prostate gland). The same radiation oncologist performed the contouring three times to evaluate intraobserver variation and subjectively scored the quality of the CT images. RESULTS The mean +/-1 SD postimplant pVol was 20.17 +/- 6.66 cc by 1-mm section CT and 22.24 +/- 8.48 cc by 5-mm section CT; the difference in the mean values was 2.06 cc (P < 0.01). The mean postimplant prostate V(100) was 80.44% +/- 7.06% by 1-mm section CT and 77.33% +/- 10.22% by 5-mm section CT. The mean postimplant prostate D(90) was 83.28% +/- 10.81% by 1-mm section CT and 78.60% +/- 15.75% by 5-mm section CT. In the evaluation of image quality, 5-mm section CT was assigned significantly higher scores than 1-mm section CT. In regard to intraobserver variation, 5-mm section CT revealed less intraobserver variation than 1-mm section CT. CONCLUSION Our current results suggested that the outcomes of postimplant dosimetry using 1-mm section CT did not improved the results over those obtained using 5-mm section CT in terms of the quality of the CT image or reproducibility.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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Tanaka O, Hayashi S, Sakurai K, Matsuo M, Nakano M, Maeda S, Hoshi H, Deguchi T. Importance of the CT/MRI fusion method as a learning tool for CT-based postimplant dosimetry in prostate brachytherapy. Radiother Oncol 2006; 81:303-8. [PMID: 17125859 DOI: 10.1016/j.radonc.2006.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 09/22/2006] [Accepted: 10/04/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To compare the CT-based and CT/MRI fusion-based postimplant dosimetry after permanent prostate brachytherapy and to evaluate the improvement in CT-based dosimetry by physicians with or without experience in using the CT/MRI fusion method. PATIENTS AND METHODS Thirty-eight consecutive patients agreed to participate in a prospective study. The prostate contours from CT/MRI fusion are the gold standard for determining the prostate volume and dose volume histogram (DVH). CT-based postimplant dosimetries were performed by two physicians. Observer 1 was a radiologist who had never used CT/MRI fusion method for postimplant dosimetric analysis. Observer 2 was a radiation oncologist experienced in postimplant analysis using the CT/MRI fusion method. The prostate dosimetry was evaluated by prostate D90 and V100. RESULTS No significant difference was observed in the mean prostate volumes between the two observers and the CT/MRI fusion data. However, the correlation coefficient value for observer 2 (R(2)=0.932) was greater than that for observer 1 (R(2)=0.793). The D90 and V100 values as evaluated by the two observers were significantly underestimated in comparison to those evaluated using the CT/MRI fusion methods. The DVH related parameters were underestimated more frequently by observer 1 than by observer 2: (prostate D90: 99.56% for observer 1, 102.97% for observer 2, 109.37% for CT/MRI fusion. Prostate V100: 88.12% for observer 1, 90.14% for observer 2, 91.91% for CT/MRI fusion). CONCLUSIONS The difference in the mean value in D90 and V100 by observer 1 was significantly greater than that for observer 2. These findings suggest that the CT/MRI fusion method provides accurate feedback which thereby improves CT-based postimplant dosimetry for prostate brachytherapy.
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Affiliation(s)
- Osamu Tanaka
- Department of Radiology, Gifu University School of Medicine, Gifu City, Japan.
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