An analysis of intraoperative versus post-operative dosimetry with CT, CT-MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants.
OBJECTIVE
To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants.


METHODS
Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose-volume histograms were calculated from CT, XMR and CT-MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90.


RESULTS
Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT-MR fusion assessments were: 11 Gy (-22, 45), 18 Gy (-13, 49) and 20 Gy (-17, 58) for Observer 1; and 15 Gy (-34, 63), 13 Gy (-29, 55) and 14 Gy (-27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities.


CONCLUSIONS
This is the first study to report Bland-Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume.
Acher
Peter
P
Division of Imaging Sciences, King's College London School of Medicine, London, UK. pete_acher@hotmail.com
Puttagunta
Srikanth
S
Rhode
Kawal
K
Morris
Stephen
S
Kinsella
Janette
J
Gaya
Andrew
A
Dasgupta
Prokar
P
Deehan
Charles
C
Beaney
Ronald
R
Popert
Rick
R
Keevil
Stephen
S
D001918:Brachytherapy / Q000592:standards; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D016343:Monitoring, Intraoperative; D011184:Postoperative Period; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed