title: Intraoperative ultrasound-fluoroscopy fusion can enhance prostate brachytherapy quality.
abstract: OBJECTIVE
  To evaluate a transrectal ultrasound (TRUS)-fluoroscopy fusion-based intraoperative dosimetry system.
  
  
  METHODS
  Twenty-five patients were treated for prostate cancer with Pd-103 implantation. After the execution of the treatment plan, two sets of TRUS images were collected using the longitudinal and axial transducers of a biplanar probe. Then, three fluoroscopic images were acquired at 0, -15 and +15 degrees . The three-dimensional locations of all implanted seeds were reconstructed from fluoroscopic images. A subset of the implanted seeds was manually identified in TRUS images and used as fiducial markers to perform TRUS-fluoroscopy fusion. To improve the implant quality, additional seeds were placed if adverse isodose patterns were identified during visual inspection. If additional seeds were placed, intraoperative dosimetry was repeated. Day 0 computed tomography-based dosimetry was compared with final intraoperative dosimetry to validate dosimetry achieved in the implant suite.
  
  
  RESULTS
  An average of additional 4.0 seeds was implanted in 16 patients after initial intraoperative dose evaluation. Based on TRUS-fluoroscopy fusion-based dosimetry, the V100 improved from 86% to 93% (p = 0.005), whereas D90 increased from 94% to 109% (p = 0.011) with the guided additional seed implantation. No statistical difference was observed in V200 and V300 values. V100 and D90 values were 95 +/- 4% and 120 +/- 24%, respectively, based on the final intraoperative dosimetry evaluation, compared with 95 +/- 4% and 122 +/- 24%, respectively, based on Day 0 computed tomography-based dosimetry.
  
  
  CONCLUSIONS
  Implantation of extra seeds based on TRUS-fluoroscopy fusion-based intraoperative dosimetry can improve the final V100 and D90 values with minimal increase in V200 and V300 values.
authors: Department of Radiation Oncology, University of Washington, Seattle, WA, USA.
authors: Peter F
authors: PF
authors: Orio
authors: Ismail B
authors: IB
authors: Tutar
authors: Sreeram
authors: S
authors: Narayanan
authors: Sandra
authors: S
authors: Arthurs
authors: Paul S
authors: PS
authors: Cho
authors: Yongmin
authors: Y
authors: Kim
authors: Gregory
authors: G
authors: Merrick
authors: Kent E
authors: KE
authors: Wallner
mesh_terms: D000465:Algorithms; D001918:Brachytherapy / Q000295:instrumentation / Q000592:standards*; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D010165:Palladium / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D011868:Radioisotopes / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D014463:Ultrasonography / Q000379:methods
chemical_list: D011868:Radioisotopes; D010165:Palladium