title: Stranded seed displacement, migration, and loss after permanent prostate brachytherapy as estimated by Day 0 fluoroscopy and 4-month postimplant pelvic x-ray.
abstract: The aim of the study was to determine the incidence of local displacement, distant seed migration to the chest, and seed loss after permanent prostate brachytherapy (PPB) with stranded seeds (SSs) using sequential two-dimensional fluoroscopic pelvic and chest x-rays.
  
  
  
  Between October 2010 and April 2014, a total of 137 patients underwent PPB and 4-month followup pelvic and chest x-ray imaging. All patients had exclusively SSs placed and an immediate postimplant fluoroscopic image of the seed cluster. Followup x-ray images were evaluated for the number, location, and displacement of seeds in comparison to Day 0 fluoroscopic images. Significant seed displacement was defined as seed displacement >1 cm from the seed cluster. Followup chest x-rays were evaluated for seed migration to the chest.
  
  
  
  Seed migration to the chest occurred in 3 of the 137 patients (2%). Seed loss occurred in 38 of the 137 patients (28%), with median loss of one seed (range, 1-16), and total seeds loss of 104 of 10,088 (1.0%) implanted. Local seed displacement was seen in 12 of the 137 patients (8.8%), and total seeds displaced were 0.15% (15/10,088).
  
  
  
  SS placement in PPB is associated with low rates of substantial seed loss, local displacement, or migration to the chest. Comparing immediate postimplant fluoroscopic images to followup plain x-ray images is a straightforward method to supplement quality assurance in PPB and was found to be useful in identifying cases where seed loss was potentially of clinical significance.
authors.affiliation: Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: B J
authors.initials: BJ
authors.lastname: Birckhead
authors.affiliation: Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: C C
authors.initials: CC
authors.lastname: Fossum
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: C L
authors.initials: CL
authors.lastname: Deufel
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: K M
authors.initials: KM
authors.lastname: Furutani
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: K W
authors.initials: KW
authors.lastname: Merrell
authors.affiliation: Department of Radiology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: B A
authors.initials: BA
authors.lastname: Schueler
authors.affiliation: Department of Urology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: L A
authors.initials: LA
authors.lastname: Mynderse
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
authors.forename: R
authors.initials: R
authors.lastname: Choo
authors.affiliation: Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN. Electronic address: davis.brian@mayo.edu.
authors.forename: B J
authors.initials: BJ
authors.lastname: Davis
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D010388:Pelvis / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D019736:Prostheses and Implants / Q000009:adverse effects; D013909:Thorax / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D007457:Iodine Radioisotopes
keywords: Brachytherapy; Prostate; Radiotherapy; Seed migration; X-ray