title: Bypassing the learning curve in permanent seed implants using state-of-the-art technology.
abstract: OBJECTIVE
  The aim of this study was to demonstrate, based on clinical postplan dose distributions, that technology can be used efficiently to eliminate the learning curve associated with permanent seed implant planning and delivery.
  
  
  METHODS
  Dose distributions evaluated 30 days after the implant of the initial 22 consecutive patients treated with permanent seed implants at two institutions were studied. Institution 1 (I1) consisted of a new team, whereas institution 2 (I2) had performed more than 740 preplanned implantations over a 9-year period before the study. Both teams had adopted similar integrated systems based on three-dimensional (3D) transrectal ultrasonography, intraoperative dosimetry, and an automated seed delivery and needle retraction system (FIRST, Nucletron). Procedure time and dose volume histogram parameters such as D90, V100, V150, V200, and others were collected in the operating room and at 30 days postplan.
  
  
  RESULTS
  The average target coverage from the intraoperative plan (V100) was 99.4% for I1 and 99.9% for I2. D90, V150, and V200 were 191.4 Gy (196.3 Gy), 75.3% (73.0%), and 37.5% (34.1%) for I1 (I2) respectively. None of these parameters shows a significant difference between institutions. The postplan D90 was 151.2 Gy for I1 and 167.3 Gy for I2, well above the 140 Gy from the Stock et al. analysis, taking into account differences at planning, results in a p value of 0.0676. The procedure time required on average 174.4 min for I1 and 89 min for I2. The time was found to decrease with the increasing number of patients.
  
  
  CONCLUSIONS
  State-of-the-art technology enables a new brachytherapy team to obtain excellent postplan dose distributions, similar to those achieved by an experienced team with proven long-term clinical results. The cost for bypassing the usual dosimetry learning curve is time, with increasing team experience resulting in shorter treatment times.
authors.affiliation: Département de Radio-oncologie, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Québec, PQ, Canada. beaulieu@phy.ulaval.ca
authors.forename: Luc
authors.initials: L
authors.lastname: Beaulieu
authors.forename: Dee-Ann Radford
authors.initials: DA
authors.lastname: Evans
authors.forename: Sylviane
authors.initials: S
authors.lastname: Aubin
authors.forename: Steven
authors.initials: S
authors.lastname: Angyalfi
authors.forename: Siraj
authors.initials: S
authors.lastname: Husain
authors.forename: Ian
authors.initials: I
authors.lastname: Kay
authors.forename: André-Guy
authors.initials: AG
authors.lastname: Martin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Varfalvy
authors.forename: Eric
authors.initials: E
authors.lastname: Vigneault
authors.forename: Peter
authors.initials: P
authors.lastname: Dunscombe
mesh_terms: D001918:Brachytherapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D002983:Clinical Competence; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D011214:Practice, Psychological; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D013679:Technology, Radiologic / Q000592:standards*; D013997:Time Factors; D014463:Ultrasonography