Verification of Guiding Needle Placement by Registered Ultrasound Image During Combined Intracavitary/Interstitial Gynecologic Brachytherapy

Needle-tissue interaction model based needle path planning method

BACKGROUND AND OBJECTIVE

In needle insertion procedure, needle deflection and target movement will affect targeting accuracy. Existing planning algorithms rely on predetermined interaction force and parameters, which increase the targeting error for the patient-specific difference. In this paper, we proposed a needle-tissue interaction model based needle path planning method with patient-specific parameter identification algorithm, which is able to use iteration learning control and interaction model predicted information to improve targeting accuracy with the consideration of patient-specific differences.

METHODS

A 3D needle-tissue interaction deformation model has been constructed using local constraint method. The model, termed as the full computation model, predicts the needle-tissue interaction force using a Kriging-based model as well as the target movement and needle deflection simultaneously only requiring patient specific parameters. Needle paths without incorporating deformation, which is called static path, are generated by rapidly-exploring random trees algorithm first. Then, the needle-tissue interaction deformation model can calculate force and deformation of the static path and iterative learning control can correct the targeting error of moved target. In addition, the intraoperative parameter identification algorithm is proposed to identify patient-specific parameter. Simulations are carried out to verify the full computation model and needle path planning. A testbed is constructed and experiments are designed to validate the proposed method using phantom with common lesion-size obstacle markers and target markers. The deformation of tissue and needle are captured through charge coupled device camera.

RESULTS

Simulation results indicated the full computation model can simulate the needle-tissue interaction process and the proposed method can achieve needle path planning incorporating tissue deformation. Experiment results indicated the tissue deformation and needle deflection agree between model prediction and experiments. The proposed path planning method can reduce targeting error from maximum of 3.89 mm without incorporating deformation to less than 1 mm in 4 phantom experiments.

CONCLUSIONS

The full computation model based needle path planning is verified to be effective by experiments. The planning accuracy is improved based on the deformation predicted by full computation model and the desired accuracy is achieved.

High-Dose-Rate Three-Dimensional Image-Guided Adaptive Brachytherapy (3D IGABT) for Locally Advanced Cervical Cancer (LACC): A Narrative Review on Imaging Modality and Clinical Evidence

Background: Brachytherapy (BT) is a critical component of radiotherapy for locally advanced cervical cancer (LACC), and it has rapidly developed in recent decades. Since the advent of three-dimensional image-guided adaptive brachytherapy (3D-IGABT), magnetic resonance imaging (MRI) has emerged as the primary modality for image guidance. Meanwhile, other imaging modalities, such as computed tomography, 18F-fluorodeoxyglucose positron emission tomography, ultrasound, and their combinations have also been widely studied. Materials and methods: We reviewed studies on different imaging modalities utilized for target delineation and planning. Emerging techniques in IGABT like real-time image guidance and 3D printing were also included. We summarized research on their feasibility and concentrated on their clinical outcomes. Results: MRI-guided BT was the gold standard, and CT-guided BT was the most widely applied. Other modalities have shown feasibility and promising efficacy in dosimetry studies and preliminary outcomes. The longer-term clinical outcomes associated with these approaches require further elucidation. Conclusions: As 3D-IGABT was validated by promising clinical outcomes, the future of BT for LACC is expected to progress toward the refinement of more effective image-guided procedures. Moreover, achieving operational consensus and driving technological advancements to mitigate the inherent limitations associated with different imaging modes remain essential.

Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer

BACKGROUND

Three-dimensional (3D) imaging has an important role in brachytherapy and the treatment of cervical cancer. The main imaging methods used in the cervical cancer brachytherapy include magnetic resonance imaging (MRI), computer tomography (CT), ultrasound (US), and positron emission tomography (PET). However, single-imaging methods have certain limitations compared to multi-imaging. The application of multi-imaging can make up for the shortcomings and provide a more suitable imaging selection for brachytherapy.

PURPOSE

This review details the situation and scope of existing multi-imaging combination methods in cervical cancer brachytherapy and provides a reference for medical institutions.

MATERIALS AND METHODS

Searched the literature related to application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer in PubMed/Medline and Web of Science electronic databases. Summarized the existing combined imaging methods and the application of each method in cervical cancer brachytherapy.

CONCLUSION

The current imaging combination methods mainly include MRI/CT, US/CT, MRI/US, and MRI/PET. The combination of two imaging tools can be used for applicator implantation guidance, applicator reconstruction, target and organs at risk (OAR) contouring, dose optimization, prognosis evaluation, etc., which provides a more suitable imaging choice for brachytherapy.