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Trumpour T, du Toit C, van Gaalen A, Park CKS, Rodgers JR, Mendez LC, Surry K, Fenster A. Three-dimensional trans-rectal and trans-abdominal ultrasound image fusion for the guidance of gynecologic brachytherapy procedures: a proof of concept study. Sci Rep 2024; 14:18459. [PMID: 39117682 PMCID: PMC11310523 DOI: 10.1038/s41598-024-69211-y] [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: 01/16/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024] Open
Abstract
High dose-rate brachytherapy is a treatment technique for gynecologic cancers where intracavitary applicators are placed within the patient's pelvic cavity. To ensure accurate radiation delivery, localization of the applicator at the time of insertion is vital. This study proposes a novel method for acquiring, registering, and fusing three-dimensional (3D) trans-abdominal and 3D trans-rectal ultrasound (US) images for visualization of the pelvic anatomy and applicators during gynecologic brachytherapy. The workflow was validated using custom multi-modal pelvic phantoms and demonstrated during two patient procedures. Experiments were performed for three types of intracavitary applicators: ring-and-tandem, ring-and-tandem with interstitial needles, and tandem-and-ovoids. Fused 3D US images were registered to magnetic resonance (MR) and computed tomography (CT) images for validation. The target registration error (TRE) and fiducial localization error (FLE) were calculated to quantify the accuracy of our fusion technique. For both phantom and patient images, TRE and FLE across all modality registrations (3D US versus MR or CT) resulted in mean ± standard deviation of 4.01 ± 1.01 mm and 0.43 ± 0.24 mm, respectively. This work indicates proof of concept for conducting further clinical studies leveraging 3D US imaging as an accurate, accessible alternative to advanced modalities for localizing brachytherapy applicators.
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Affiliation(s)
- Tiana Trumpour
- Department of Medical Biophysics, Western University, London, Canada.
- Robarts Research Institute, London, Canada.
| | | | - Alissa van Gaalen
- Department of Physics and Astronomy, University of Waterloo, Waterloo, Canada
| | - Claire K S Park
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Department of Radiation Oncology, Harvard Medical School, Boston, USA
| | - Jessica R Rodgers
- Department of Physics and Astronomy, University of Manitoba, Winnipeg, Canada
| | | | - Kathleen Surry
- Department of Medical Biophysics, Western University, London, Canada
- Verspeeten Family Cancer Centre, London, Canada
- Department of Oncology, Western University, London, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Canada
- Robarts Research Institute, London, Canada
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2
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Takatsu J, Murakami N, Muramoto Y, Karino T, Oshima M, Kosugi Y, Kawamoto T, Terao Y, Shikama N. Safe dose escalation and reduction of the fraction number of uterine cervical brachytherapy using a gel spacer in the rectovaginal and vesicouterine septum: A planning study. Brachytherapy 2024; 23:115-122. [PMID: 38040605 DOI: 10.1016/j.brachy.2023.10.003] [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: 06/14/2023] [Revised: 08/22/2023] [Accepted: 10/06/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To evaluate the possibility of dose escalation and reduction of fraction number in cervical brachytherapy using a gel spacer. MATERIAL AND METHODS Twenty patients with uterine cervical cancer treated with image-guided adaptive brachytherapy (IGABT) were selected. Hyaluronic acid gel injection (HGI) was performed in the rectovaginal and vesicouterine septum for 10 patients. The other ten patients were not with HGI. Both groups were treated with IGABT involving tandem/ovoid or cylindrical applicators along with additional interstitial needles. Dose distributions approved by radiation oncologists were retrospectively analyzed, and a dose summation of 45 Gy/25 of external beam radiation therapy and IGABT was performed. Dose constraints for D2cc of bladder, rectum, and sigmoid were 80, 70, and 70 Gy, respectively. Equivalent dose in 2-Gy fractions calculations used α/β = 10 Gy for high-risk clinical target volume (CTVHR) D90 and α/β = 3 Gy for organs at risks (OARs). As a planning study, dose distribution rescaling was conducted to deliver as much dose to CTVHR D90 as possible within the dose constraint limitation for OARs when IGABT was performed for four, three, and two fractions in both groups. RESULTS The median CTVHR D90 was >80 Gy in the non-HGI group and >85 Gy in the HGI group for virtual two and three fractions. Rectum D2cc was significantly lower in the HGI group for three fractions (p < 0.01). CONCLUSIONS In the HGI group, adequate dose delivery to CTVHR could be achieved with a reduced IGABT fraction number while meeting the dose constraints of OARs.
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Affiliation(s)
- Jun Takatsu
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoya Murakami
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan.
| | - Yoichi Muramoto
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Tatsuki Karino
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuo Kosugi
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Terufumi Kawamoto
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Yasuhisa Terao
- Department of Obstetrics and Gynecology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
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3
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Lee TH, Kim KS, Kim HJ, Choi CH, Kang S, Eom KY, Wee CW, Song YS, Park NH, Kim JW, Chung HH, Kim HS, Lee M, Kang HC. Image-Guided Versus Conventional Brachytherapy for Locally Advanced Cervical Cancer: Experience of Single Institution with the Same Practitioner and Time Period. Cancer Res Treat 2023; 55:258-269. [PMID: 35952716 PMCID: PMC9873328 DOI: 10.4143/crt.2022.418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/06/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study aimed to compare treatment outcomes and toxicity profile between imaged-guided brachytherapy (IGBT) versus conventional brachytherapy (CBT) performed by the same practitioner during the same time period. MATERIALS AND METHODS Medical records of 104 eligible patients who underwent brachytherapy for locally advanced cervical cancer were retrospectively reviewed. Fifty patients (48.1%) underwent IGBT, and 54 (51.9%) patients underwent CBT. All patients underwent concurrent chemoradiation with cisplatin. High-dose-rate intracavitary brachytherapy with dose prescription of 25-30 Gy in 4-6 fractions was performed for all patients. Late lower gastrointestinal (GI) and urinary toxicities occurred more than 3 months after the end of brachytherapy were included for comparative and dosimetric analyses. RESULTS The median follow-up period was 18.33 months (range, 3.25 to 38.43 months). There were no differences in oncologic outcomes between the two groups. The IGBT group had lower rate of actuarial grade ≥ 3 toxicity than the CBT group (2-year, 4.5% vs. 25.7%; p=0.030). Cumulative equieffective D2cc of sigmoid colon was significantly correlated with grade ≥ 2 lower GI toxicity (p=0.033), while equieffective D2cc of rectum (p=0.055) and bladder (p=0.069) showed marginal significance with corresponding grade ≥ 2 toxicities in the IGBT group. Half of grade ≥ 3 lower GI toxicities impacted GI tract above the rectum. Optimal thresholds of cumulative D2cc of sigmoid colon and rectum were 69.7 Gy and 70.8 Gy, respectively, for grade ≥ 2 lower GI toxicity. CONCLUSION IGBT showed superior toxicity profile to CBT. Evaluating the dose to the GI tract above rectum by IGBT might prevent some toxicities.
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Affiliation(s)
- Tae Hoon Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
| | - Kyung Su Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea,Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea,Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
| | - Seonghee Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea,Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea,Department of Radiation Oncology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Yong Sang Song
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Noh Hyun Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Jae-Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Hyun Hoon Chung
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul,
Korea
| | - Hyun-Cheol Kang
- Department of Radiation Oncology, Seoul National University Hospital, Seoul,
Korea,Department of Radiation Oncology, Seoul National University College of Medicine, Seoul,
Korea
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4
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Murakami N, Ohno T, Toita T, Ando K, Ii N, Okamoto H, Kojima T, Tsujino K, Masui K, Yoshida K, Ikushima H. Japanese Society for Radiation Oncology Consensus Guidelines of combined intracavitary and interstitial brachytherapy for gynecological cancers. JOURNAL OF RADIATION RESEARCH 2022; 63:402-411. [PMID: 35349700 PMCID: PMC9124614 DOI: 10.1093/jrr/rrac011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/25/2022] [Indexed: 05/31/2023]
Abstract
It has been postulated that the combination of intracavitary and interstitial brachytherapy (IC/IS) is effective and safe for large and irregularly shaped uterine cervical cancer patients. However, due to its invasiveness compared to conventional intracavitary brachytherapy (ICBT), it has to be said that the implementation speed of IC/IS is slow. Until now, there have been no guidelines for required equipment, human resources, and procedural guide focusing solely on IC/IS. The purpose of this guideline is to provide radiation oncologists and medical physicists who wish to start IC/IS with practical and comprehensive guidance for a safe IC/IS introduction and to help accelerate the spread of the utilization of IC/IS nationwide. This is the English translation of the Japanese IC/IS Guidelines, and it was created in an effort to share the Japanese approach to the management of locally advanced uterine cervical cancer worldwide.
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsuya Ohno
- Corresponding author. Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan.
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Okinawa 904-2293, Japan
| | - Ken Ando
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
| | - Noriko Ii
- Department of Radiation Oncology, Ise Red Cross Hospital, Mie 516-8512, Japan
| | - Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Toru Kojima
- Department of Radiation Oncology, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Kayoko Tsujino
- Department of Radiation Oncology, Hyogo Cancer Center, Hyogo 673-8558, Japan
| | - Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University Medical Center, Osaka 573-1191, Japan
| | - Hitoshi Ikushima
- Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
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5
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Rodgers JR, Mendez LC, Hoover DA, Bax J, D'Souza D, Fenster A. Feasibility of fusing three-dimensional transabdominal and transrectal ultrasound images for comprehensive intraoperative visualization of gynecologic brachytherapy applicators. Med Phys 2021; 48:5611-5623. [PMID: 34415069 DOI: 10.1002/mp.15175] [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: 02/12/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In this study, we propose combining three-dimensional (3D) transrectal ultrasound (TRUS) and 3D transabdominal ultrasound (TAUS) images of gynecologic brachytherapy applicators to leverage the advantages of each imaging perspective, providing a broader field-of-view and allowing previously obscured features to be recovered. The aim of this study was to evaluate the feasibility of fusing these 3D ultrasound (US) perspectives based on the applicator geometry in a phantom prior to clinical implementation. METHODS In proof-of-concept experiments, 3D US images of application-specific multimodality pelvic phantoms were acquired with tandem-and-ring and tandem-and-ovoids applicators using previously validated imaging systems. Two TRUS images were acquired at different insertion depths and manually fused based on the position of the ring/ovoids to broaden the TRUS field-of-view. The phantom design allowed "abdominal thickness" to be modified to represent different body habitus and TAUS images were acquired at three thicknesses for each applicator. The merged TRUS images were then combined with TAUS images by rigidly aligning applicator components and manually refining the registration using the positions of source channels and known tandem length, as well as the ring diameter for the tandem-and-ring applicator. Combined 3D US images were manually, rigidly registered to images from a second modality (magnetic resonance (MR) imaging for the tandem-and-ring applicator and X-ray computed tomography (CT) for the tandem-and-ovoids applicator (based on applicator compatibility)) to assess alignment. Four spherical fiducials were used to calculate target registration errors (TREs), providing a metric for validating registrations, where TREs were computed using root-mean-square distances to describe the alignment of manually identified corresponding fiducials. An analysis of variance (ANOVA) was used to identify statistically significant differences (p < 0.05) between the TREs for the three abdominal thicknesses for each applicator type. As an additional indicator of geometric accuracy, the bladder was segmented in the 3D US and corresponding MR/CT images, and volumetric differences and Dice similarity coefficients (DSCs) were calculated. RESULTS For both applicator types, the combination of 3D TRUS with 3D TAUS images allowed image information obscured by the shadowing artifacts under single imaging perspectives to be recovered. For the tandem-and-ring applicator, the mean ± one standard deviation (SD) TREs from the images with increasing thicknesses were 1.37 ± 1.35 mm, 1.84 ± 1.22 mm, and 1.60 ± 1.00 mm. Similarly, for the tandem-and-ovoids applicator, the mean ± SD TREs from the images with increasing thicknesses were 1.37 ± 0.35 mm, 1.95 ± 0.90 mm, and 1.61 ± 0.76 mm. No statistically significant difference was detected in the TREs for the three thicknesses for either applicator type. The mean volume differences for the bladder segmentations were 3.14% and 2.33% and mean DSCs were 87.8% and 87.7% for the tandem-and-ring and tandem-and-ovoids applicators, respectively. CONCLUSIONS In this proof-of-concept study, we demonstrated the feasibility of fusing 3D TRUS and 3D TAUS images based on the geometry of tandem-and-ring and tandem-and-ovoids applicators. This represents a step toward an accessible and low-cost 3D imaging method for gynecologic brachytherapy, with the potential to extend this approach to other intracavitary configurations and hybrid applicators.
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Affiliation(s)
- Jessica Robin Rodgers
- School of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - Lucas C Mendez
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Douglas A Hoover
- Department of Medical Physics, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Jeffrey Bax
- Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
| | - David D'Souza
- Department of Radiation Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, The University of Western Ontario, London, Ontario, Canada.,Robarts Research Institute, The University of Western Ontario, London, Ontario, Canada
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6
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Zeng J, Liu Z, Jiang S, Pang Q, Wang P. Verification of Guiding Needle Placement by Registered Ultrasound Image During Combined Intracavitary/Interstitial Gynecologic Brachytherapy. Cancer Manag Res 2021; 13:1917-1928. [PMID: 33658854 PMCID: PMC7917343 DOI: 10.2147/cmar.s294498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Our previous research demonstrated that under ideal conditions, rigid registration between MRI images and US images had high accuracy for real-time image guidance. The work presented in this paper focused on the application of the previously established procedures to a new context, including preoperative CT images. Materials and Methods We used a template to calibrate the US probe and completed the registration between preoperative CT images and US images. Marker experiments on the accuracy of real-time needle trajectories in CT images were performed using micro electromagnetic sensors. Pelvic phantom experiments were carried out to test the registration accuracy between CT and US images, in addition to registration accuracy between US images and real-time needle trajectories (real-time space model). Results The US probe calibration error in CT images was 0.879 ± 0.149 mm. The difference of registration between US images and CT images was 0.935 ± 0.166 mm in the axial plane (n = 30) and 0.916 ± 0.143 mm in the sagittal plane (n =12). The difference of registration between US images and the needle’s real-time trajectories was 0.951 ± 0.202 mm. Conclusion Under ideal conditions, rigid registration between CT images and US images had high accuracy for real-time image guidance.
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Affiliation(s)
- Jing Zeng
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China.,Department of Gynecologic Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Affiliated Hospital of Nankai University, Tianjin, People's Republic of China
| | - Ziqi Liu
- School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, People's Republic of China
| | - Qingsong Pang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ping Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin, People's Republic of China
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7
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Morcos M, Antaki M, Viswanathan AN, Enger SA. A novel minimally invasive dynamic-shield, intensity-modulated brachytherapy system for the treatment of cervical cancer. Med Phys 2020; 48:71-79. [PMID: 32916763 DOI: 10.1002/mp.14459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/14/2020] [Accepted: 08/06/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To present a novel, MRI-compatible dynamicshield intensity modulated brachytherapy (IMBT) applicator and delivery system using 192 Ir, 75 Se, and 169 Yb radioisotopes for the treatment of locally advanced cervical cancer. Needle-free IMBT is a promising technique for improving target coverage and organs at risk (OAR) sparing. METHODS AND MATERIALS The IMBT delivery system dynamically controls the rotation of a novel tungsten shield placed inside an MRI-compatible, 6-mm wide intrauterine tandem. Using 36 cervical cancer cases, conventional intracavitary brachytherapy (IC-BT) and intracavitary/interstitial brachytherapy (IC/IS-BT) (10Ci 192 Ir) plans were compared to IMBT (10Ci 192 Ir; 11.5Ci 75 Se; 44Ci 169 Yb). All plans were generated using the Geant4-based Monte Carlo dose calculation engine, RapidBrachyMC. Treatment plans were optimized then normalized to the same high-risk clinical target volume (HR-CTV) D90 and the D2cc for bladder, rectum, and sigmoid in the research brachytherapy planning system, RapidBrachyMCTPS. Plans were renormalized until either of the three OAR reached dose limits to calculate the maximum achievable HR-CTV D90 and D98 . RESULTS Compared to IC-BT, IMBT with either of the three radionuclides significantly improves the HR-CTV D90 and D98 by up to 5.2% ± 0.3% (P < 0.001) and 6.7% ± 0.5% (P < 0.001), respectively, with the largest dosimetric enhancement when using 169 Yb followed by 75 Se and then 192 Ir. Similarly, D2cc for all OAR improved with IMBT by up to 7.7% ± 0.6% (P < 0.001). For IC/IS-BT cases, needle-free IMBT achieved clinically acceptable plans with 169 Yb-based IMBT further improving HR-CTV D98 by 1.5% ± 0.2% (P = 0.034) and decreasing sigmoid D2cc by 1.9% ± 0.4% (P = 0.048). Delivery times for IMBT are increased by a factor of 1.7, 3.3, and 2.3 for 192 Ir, 75 Se, and 169 Yb, respectively, relative to conventional 192 Ir BT. CONCLUSIONS Dynamic shield IMBT provides a promising alternative to conventional IC- and IC/IS-BT techniques with significant dosimetric enhancements and even greater improvements with intermediate energy radionuclides. The ability to deliver a highly conformal, OAR-sparing dose without IS needles provides a simplified method for improving the therapeutic ratio less invasively and in a less resource intensive manner.
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Affiliation(s)
- Marc Morcos
- Medical Physics Unit, McGill University, Montreal, QC, Canada
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Majd Antaki
- Medical Physics Unit, McGill University, Montreal, QC, Canada
| | - Akila N Viswanathan
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Shirin A Enger
- Medical Physics Unit, McGill University, Montreal, QC, Canada
- Department of Oncology, McGill University, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
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8
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Unnikrishnan S, Brenin DR, Suralik G, Showalter TN, Shami V, Libby B, Watkins WT, Showalter SL, Zhao F, Govinahallisathyanarayana S, Hossack JA. Use of an ultrasound imaging device within the applicator to evaluate placement and support treatment planning for breast brachytherapy and intraoperative radiation therapy. Brachytherapy 2020; 20:200-206. [PMID: 33041231 DOI: 10.1016/j.brachy.2020.08.004] [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: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated the use of ultrasound imaging within a brachytherapy applicator as a method for applicator positioning, evaluation, and treatment planning in a series of in vitro, cadaver, and human studies. METHODS AND MATERIALS We evaluated the performance of a prototype system comprising a small ultrasound imaging catheter inserted within the lumen of a balloon brachytherapy catheter. We tested the device in an ultrasound phantom, in human breast tissue, and in an endoscopic ultrasound catheter in cadaveric breast tissue. We evaluated the visualization of adjacent tissue to consider future development of a similar system for use in brachytherapy and intraoperative radiation therapy. RESULTS Based on the ultrasound images obtained in an ultrasound phantom, cadaveric breast, and human participants, we observed that an ultrasound imaging catheter placed within the lumen of a brachytherapy applicator can effectively image adjacent tissue, ribs, and air voids, with appropriate quality to support clinical use. We observed high correlation in clinically useful information detected on ultrasound and comparative CT, with ultrasound spatial resolution near 1 mm (spatially variant). CONCLUSIONS The findings from our pilot work suggest that real-time ultrasound imaging, operated from within the applicator, is a promising technique for image guidance and treatment planning during brachytherapy and intraoperative radiation therapy. Further expansion of this technology for clinical use will require development of a cohesive system of components to suit specific clinical applications.
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Affiliation(s)
- S Unnikrishnan
- Department of Biomedical Engineering, School of Engineering, University of Virginia, Charlottesville, VA
| | - D R Brenin
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - G Suralik
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - T N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - V Shami
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA
| | - B Libby
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - W T Watkins
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA
| | - S L Showalter
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - F Zhao
- Department of Biomedical Engineering, School of Engineering, University of Virginia, Charlottesville, VA
| | | | - J A Hossack
- Department of Biomedical Engineering, School of Engineering, University of Virginia, Charlottesville, VA.
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9
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Song J, Alyamani N, Bhattacharya G, Le T, E C, Samant R. The Impact of High-Dose-Rate Brachytherapy: Measuring Clinical Outcomes in the Primary Treatment of Cervical Cancer. Adv Radiat Oncol 2020; 5:419-425. [PMID: 32529136 PMCID: PMC7276688 DOI: 10.1016/j.adro.2020.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 02/05/2020] [Accepted: 02/08/2020] [Indexed: 12/24/2022] Open
Abstract
Purpose Radical concurrent chemoradiotherapy with combined external beam radiotherapy (EBRT) and brachytherapy is used to treat locally advanced cervical cancer. Our institution has transitioned to high-dose-rate (HDR) intracavitary brachytherapy (ICBT) from low-dose-rate (LDR) brachytherapy in 2008, and a review was conducted on the effect of this change on patient outcomes. Methods and Materials A single-arm retrospective chart review was performed on locally advanced (Fédération Internationale de Gynécologie et d’Obstétrique stage IB-IVA) patients with cervical cancer treated with combined external beam radiation therapy and HDR-ICBT with curative intent between 2008 and 2014. Clinical outcomes were evaluated, and multivariate analysis was performed to identify prognostic factors. Results Of the 76 patients selected, median age was 47.9 years and median follow-up was 5.2 years. Thirteen patients (17.1%) developed locoregional recurrence and 23 patients (30.3%) patients developed distant recurrence. Five-year progression-free survival and overall survival were 63.7% and 69.3%, respectively. A significant survival difference was found between stages (P < .001). Multivariate analysis found nodal involvement was strongly associated with poorer survival (P = .007). Conclusions Our experience with the transition to HDR-ICBT as part of concurrent chemoradiotherapy in treatment of locally advanced cervical cancer resulted in acceptable long-term outcomes and toxicity to that of LDR brachytherapy. Potential further improvement of treatment outcomes for patients may be possible with image guided brachytherapy and the addition of effective systemic therapy.
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Affiliation(s)
- Jiheon Song
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa Ontario, Canada
| | - Najlaa Alyamani
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa Ontario, Canada
| | | | - Tien Le
- Division of Gynecologic Oncology, The Ottawa Hospital, Ottawa Ontario, Canada
| | - Choan E
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa Ontario, Canada
| | - Rajiv Samant
- Division of Radiation Oncology, The Ottawa Hospital, Ottawa Ontario, Canada
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10
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Evaluation of a new bi-valve vaginal speculum applicator design for gynecologic interstitial brachytherapy. J Contemp Brachytherapy 2020; 12:27-34. [PMID: 32190067 PMCID: PMC7073339 DOI: 10.5114/jcb.2020.92406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022] Open
Abstract
Purpose We designed a bi-valve vaginal speculum high-dose-rate (HDR) interstitial gynecologic brachytherapy applicator. This allows for both a direct view of the cervix and image-guided brachytherapy applicator placement. The purpose of this study was to assess the validity of the new applicator. Material and methods The applicator was designed to have a 25-mm arc, which can be spread transversely to 35-mm wide, with 10 insertion holes; it was produced using a stereolithographic printer with biocompatible Dental SG resin. For resin radiodensity was measured in Hounsfield units (HU) using computed tomography (CT). Comparing the new applicator with a conventional intracavitary applicator, we evaluated the treated volume (including dimensions of 100% isodose volume at the central axis), V100/D90/D98 for a hypothetical cervix (a 2-cm-long and 4-cm-diameter cylinder), and dose points of organs at risk (OARs) (at 25 and 30 mm from the tandem). Based on dose-volume histogram (DVH) analysis of the cervix and dose points of OARs, the range of tolerance for the percent dose difference in the prescription dose was set at 5%. Results The mean radiodensity of the Dental SG resin, which was magnetic resonance imaging compatible, was 118 HU. Dimensions of the 100% isodose volume measured at the central axis were 4.4 × 6.6 × 7.4 cm for the new applicator and 4.3 × 6.0 × 7.7 cm for the intracavitary applicator. The 100% prescription dose volumes were 110 cc and 113 cc for the new and conventional applicator, respectively. The percent difference in the hypothetical cervix V100, D90, and D98 between the new and intracavitary applicator were within 5%. The percent differences in dose points of OARs at 25 and 30 mm between the new and conventional applicators were within 5%. Conclusions Our speculum applicator can reproduce a conventional pear-shaped dose distribution. Our current clinical practice will use this applicator, which can improve the patient’s treatment results.
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11
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Shoemaker T, Vuong T, Glickman H, Kaifi S, Famulari G, Enger SA. Dosimetric Considerations for Ytterbium-169, Selenium-75, and Iridium-192 Radioisotopes in High-Dose-Rate Endorectal Brachytherapy. Int J Radiat Oncol Biol Phys 2019; 105:875-883. [DOI: 10.1016/j.ijrobp.2019.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/09/2019] [Accepted: 07/10/2019] [Indexed: 02/02/2023]
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12
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Rodgers JR, Bax J, Surry K, Velker V, Leung E, D'Souza D, Fenster A. Intraoperative 360-deg three-dimensional transvaginal ultrasound during needle insertions for high-dose-rate transperineal interstitial gynecologic brachytherapy of vaginal tumors. J Med Imaging (Bellingham) 2019; 6:025001. [PMID: 30989088 DOI: 10.1117/1.jmi.6.2.025001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
Brachytherapy, a type of radiotherapy, may be used to place radioactive sources into or in close proximity to tumors, providing a method for conformally escalating dose in the tumor and the local area surrounding the malignancy. High-dose-rate interstitial brachytherapy of vaginal tumors requires precise placement of multiple needles through holes in a plastic perineal template to deliver treatment while optimizing dose and avoiding overexposure of nearby organs at risk (OARs). Despite the importance of needle placement, image guidance for adaptive, intraoperative needle visualization, allowing misdirected needles to be identified and corrected during insertion, is not standard practice. We have developed a 360-deg three-dimensional (3-D) transvaginal ultrasound (TVUS) system using a conventional probe with a template-compatible custom sonolucent vaginal cylinder and propose its use for intraoperative needle guidance during interstitial gynecologic brachytherapy. We describe the 3-D TVUS mechanism and geometric validation, present mock phantom procedure results, and report on needle localization accuracy in patients. For the six patients imaged, landmark anatomical features and all needles were clearly visible. The implementation of 360-deg 3-D TVUS through a sonolucent vaginal cylinder provides a technique for visualizing needles and OARs intraoperatively during interstitial gynecologic brachytherapy, enabling implants to be assessed and providing the potential for image guidance.
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Affiliation(s)
- Jessica Robin Rodgers
- University of Western Ontario, School of Biomedical Engineering, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
| | - Jeffrey Bax
- University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
| | - Kathleen Surry
- London Health Sciences Centre, Department of Medical Physics, London Regional Cancer Program, London, Ontario, Canada
| | - Vikram Velker
- London Health Sciences Centre, Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Eric Leung
- Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - David D'Souza
- London Health Sciences Centre, Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Aaron Fenster
- University of Western Ontario, School of Biomedical Engineering, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
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13
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Zolciak-Siwinska A, Kowalczyk A, Sikorska K, Bijok M, Michalski W, Gruszczynska E. Comparison of computed tomography with magnetic resonance imaging for imaging-based clinical target volume contours in cervical cancer brachytherapy. Brachytherapy 2019; 17:667-672. [PMID: 29764769 DOI: 10.1016/j.brachy.2018.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/04/2018] [Accepted: 04/04/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To compare CT- and MRI-based brachytherapy (BT) target volumes for patients with advanced cervical cancer so as to identify those who benefit most from MRI-based planning. We also studied how the natural mobility of the organ at risks (OARs) affects the given doses. METHODS AND MATERIALS Subjects were 60 patients with International Federation of Gynecology and Obstetrics (FIGO) Stage IB-IVA cervical cancer. The CT high-risk clinical target volume (HR-CTV) was first delineated, then the MRI HR-CTV, with volume discrepancies calculated by subtraction. The DICE coefficient (DC) of similarity was calculated from a superimposition of the volumes. Maximum doses delivered to D2cc of OARs in CT and MRI plans were compared; the effect of time on the natural mobility was analyzed. RESULTS The mean HR-CTVs and the maximum doses given to OARs in CT- and MRI-based planes were similar. Multivariate analysis showed that deep infiltration affecting the uterine corpus and bowel loops adjacent to the cervix were the factors significantly impacting on the volume discrepancy between CT and MRI HR-CTV (p = 0.001, p = 0.045) and on the DC (p = 0.005, p = 0.028). Univariate analysis demonstrated that the FIGO stage had a significant impact on DC (p = 0.022). Patients with bowel loops adjacent to the cervix had lower body mass indices (p = 0.003). The median difference between the doses given in CT- and MRI-based plans, caused by mobility, were 0.5 Gy, 0.3 Gy, and 0.45 Gy per fraction for the rectum, bladder and sigmoid, respectively. No correlation of observed uncertainties and time between image acquisitions was detected. CONCLUSIONS CT- or MRI-based scans at BT are adequate for OAR dose-volume histograms analysis. Cervical cancer patients with deep infiltration affecting the uterine corpus, a low body mass index with bowel loops adjacent to the cervix and an FIGO Stage III-IVA benefit most from MRI-based planning of BT.
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Affiliation(s)
- Agnieszka Zolciak-Siwinska
- Department of Brachytherapy, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
| | - Adam Kowalczyk
- Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Katarzyna Sikorska
- Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Michal Bijok
- Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Wojciech Michalski
- Department of Clinical Trials and Biostatistics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Ewelina Gruszczynska
- Department of Medical Physics, The Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
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14
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Effects of vaginal cylinder position on dose distribution in patients with endometrial carcinoma in treatment of vaginal cuff brachytherapy. J Contemp Brachytherapy 2017; 9:230-235. [PMID: 28725246 PMCID: PMC5509981 DOI: 10.5114/jcb.2017.68171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 05/10/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To investigate the impact of different cylinder positions on dosimetry of critical structures in patients with endometrial carcinoma undergoing three-dimensional image-based vaginal cuff brachytherapy (VCB). MATERIAL AND METHODS We delivered VCB at a dose of 4 Gy to a depth of 5 mm in the vaginal cuff of 15 patients using three different cylinder positions (neutral [N], parallel [P], and angled [A]) according to the longitudinal axis of the patient. We analyzed the dose-volume distribution and volumetric variability of the rectum and bladder. We converted the total doses to equivalent doses in 2 Gy (EQD2) using a linear-quadratic model (a/b = 3 Gy). RESULTS The mean rectum volume for the N, P, and A positions was 68.2 ± 22.7 cc, 79.3 ± 33.7 cc, and 74.2 ± 29.6 cc, respectively. The mean rectum volume for the P position was significantly larger than that for the N position (p = 0.03). Relative to the N position, the A position resulted in a lower total EQD2 in the highest irradiated 2 cc (D2cc; p = 0.001), 1 cc (D1cc; p = 0.004), and 0.1 cc (D0.1cc; p = 0.047) of the rectum. Similarly, the P position resulted in a lower EQD2 in the D2cc (p = 0.018) and D1cc (p = 0.024) of the rectum relative to the N position. In the bladder, the P position resulted in a higher EQD2 in the D2cc relative to the N position (p = 0.02). There was no dosimetric difference between the P and A positions in either the rectum or the bladder. CONCLUSIONS Vaginal cuff brachytherapy in the P and A positions is significantly superior to that in the N position in terms of rectum dosimetry. The bladder dose in the N position is considerably lower than that in the other positions.
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15
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The use of trans-applicator intracavitary ultrasonography in brachytherapy for cervical cancer: phantom study of a novel approach to 3D image-guided brachytherapy. J Contemp Brachytherapy 2017; 9:151-157. [PMID: 28533804 PMCID: PMC5437077 DOI: 10.5114/jcb.2017.66588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/20/2017] [Indexed: 12/04/2022] Open
Abstract
Purpose To assess the feasibility of applying trans-applicator intracavitary ultrasonography to image-guided brachytherapy for cervical cancer. Material and methods For this experiment, a phantom was created and included a polyethylene tube, intended to simulate a tandem applicator, which was inserted into chicken meat and embedded in agar, along with magnetic resonance imaging (MRI)-compatible ovoid applicators. Three-dimensional images of the phantom were obtained using computed tomography (CT), MRI (T2-weighted), and intracavitary ultrasonography sectional images acquired at 1 mm slice intervals. Intracavitary ultrasonography images were acquired from within the simulated tandem applicator using a radial transducer. Magnetic resonance imaging and intracavitary ultrasonography images were manually registered onto CT images. The chicken meat was contoured as the target volume independently on the CT, MRI, and intracavitary ultrasonography images, and the Dice similarity coefficient was used to compare the target volumes. The dose distributions of a sample brachytherapy plan were also evaluated. Results Computed tomography, MRI, and intracavitary ultrasonography all visualized the three-dimensional phantom volumes. Intracavitary ultrasonography images depicted the meat with high echoic signals and a border clearly distinguishable from the surrounding agar. The Dice similarity coefficient values for the target volumes on CT vs. MRI, CT vs. intracavitary ultrasonography, and MRI vs. intracavitary ultrasonography were 0.966, 0.965, and 0.971, respectively, indicating similar contouring with the three modalities. Among the modalities, the differences in D50, D90, D98, and D100 values were 1.8%, 2.9%, 3.7%, and 2.9%, respectively. Conclusions Three-dimensional reconstructed trans-applicator intracavitary ultrasonographic images clearly depicted meat tissue within the phantom, and could thus be used for brachytherapy planning. This study proves the concept of trans-applicator intracavitary ultrasonography for intracavitary brachytherapy. Further research such as development of intracavitary ultrasonography system, 3D reconstruction method, ultrasonography-compatible applicators, and ultrasonography-based target concept is warranted to assess the potential clinical application.
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Trifiletti DM, Grover S, Libby B, Showalter TN. Trends in cervical cancer brachytherapy volume suggest case volume is not the primary driver of poor compliance rates with brachytherapy delivery for locally advanced cervical cancer. Brachytherapy 2017; 16:547-551. [DOI: 10.1016/j.brachy.2017.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/27/2017] [Accepted: 02/21/2017] [Indexed: 01/29/2023]
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17
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Shaw W, Rae WI, Alber ML. Image-guided adaptive brachytherapy dose escalation for cervix cancer via fractionation compensation. Brachytherapy 2017; 16:534-546. [DOI: 10.1016/j.brachy.2017.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 12/19/2016] [Accepted: 01/05/2017] [Indexed: 11/16/2022]
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Rodgers JR, Surry K, Leung E, D'Souza D, Fenster A. Toward a 3D transrectal ultrasound system for verification of needle placement during high-dose-rate interstitial gynecologic brachytherapy. Med Phys 2017; 44:1899-1911. [PMID: 28295403 DOI: 10.1002/mp.12221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/13/2017] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Treatment for gynecologic cancers, such as cervical, recurrent endometrial, and vaginal malignancies, commonly includes external-beam radiation and brachytherapy. In high-dose-rate (HDR) interstitial gynecologic brachytherapy, radiation treatment is delivered via hollow needles that are typically inserted through a template on the perineum with a cylinder placed in the vagina for stability. Despite the need for precise needle placement to minimize complications and provide optimal treatment, there is no standard intra-operative image-guidance for this procedure. While some image-guidance techniques have been proposed, including magnetic resonance (MR) imaging, X-ray computed tomography (CT), and two-dimensional (2D) transrectal ultrasound (TRUS), these techniques have not been widely adopted. In order to provide intra-operative needle visualization and localization during interstitial brachytherapy, we have developed a three-dimensional (3D) TRUS system. This study describes the 3D TRUS system and reports on the system validation and results from a proof-of-concept patient study. METHODS To obtain a 3D TRUS image, the system rotates a conventional 2D endocavity transducer through 170 degrees in 12 s, reconstructing the 2D frames into a 3D image in real-time. The geometry of the reconstruction was validated using two geometric phantoms to ensure the accuracy of the linear measurements in each of the image coordinate directions and the volumetric accuracy of the system. An agar phantom including vaginal and rectal canals, as well as a model uterus and tumor, was designed and used to test the visualization and localization of the interstitial needles under idealized conditions by comparing the needles' positions between the 3D TRUS scan and a registered MR image. Five patients undergoing HDR interstitial gynecologic brachytherapy were imaged using the 3D TRUS system following the insertion of all needles. This image was manually, rigidly registered to the clinical postinsertion CT scan based on the vaginal cylinder of the needle template. The positions of the tips and the trajectory of the needle paths were compared between the modalities. RESULTS The observed geometric errors of the system were ≤ 0.3 mm in each of the three coordinate planes of the 3D US image and the mean measured volumetric error was 0.10 cm3 . In the phantom study, the mean needle tip difference was 1.54 ± 0.71 mm and the mean trajectory difference was 0.94 ± 0.89 degrees (n = 14). In the in vivo study, a total of 73 needles were placed, of which 88% of needles were visible and 79% of tips were identifiable in the 3D TRUS images. Six of the nine needles that were not visible were due to shadowing artifacts created by the presence of the vaginal cylinder of the needle template. The mean distance between corresponding needle tips in the two modalities was 3.82 ± 1.86 mm and the mean trajectory difference was 3.04 ± 1.63 degrees for the five patients. CONCLUSIONS In this proof-of-concept study, the 3D TRUS system allowed for localization of needles not obscured by shadowing artifacts, providing a method for visualizing needles intra-operatively during HDR interstitial brachytherapy of gynecologic cancers and providing the potential for 3D image-guidance.
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Affiliation(s)
- Jessica Robin Rodgers
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, ON, N6A 3K7, Canada.,Robarts Research Institute, The University of Western Ontario, London, ON, N6A 5B7, Canada
| | - Kathleen Surry
- Department of Medical Physics, London Regional Cancer Program, London, ON, N6A 5W9, Canada
| | - Eric Leung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
| | - David D'Souza
- Department of Radiation Oncology, London Regional Cancer Program, London, ON, N6A 5W9, Canada
| | - Aaron Fenster
- Biomedical Engineering Graduate Program, The University of Western Ontario, London, ON, N6A 3K7, Canada.,Robarts Research Institute, The University of Western Ontario, London, ON, N6A 5B7, Canada
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Zolciak-Siwinska A, Gruszczynska E, Bijok M, Jonska-Gmyrek J, Dabkowski M, Staniaszek J, Michalski W, Kowalczyk A, Milanowska K. Computed Tomography–Planned High-Dose-Rate Brachytherapy for Treating Uterine Cervical Cancer. Int J Radiat Oncol Biol Phys 2016; 96:87-92. [DOI: 10.1016/j.ijrobp.2016.04.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 04/01/2016] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
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20
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Trifiletti DM, Showalter TN. Image-guided brachytherapy in cervical cancer: past, present and future. Future Oncol 2015; 11:2629-2632. [DOI: 10.2217/fon.15.196] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daniel M Trifiletti
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia School of Medicine, 1240 Lee Street, Box 800383, Charlottesville, VA 22908, USA
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