title: Intraoperative factors associated with stranded source placement accuracy in low-dose-rate prostate brachytherapy.
abstract: The quality of a low-dose rate prostate brachytherapy implant depends on the accurate placement of sources in their planned locations. This study investigates intraoperative factors that potentially contribute to stranded source placement inaccuracy in prostate brachytherapy.
  
  
  
  Intraoperative video images of the brachytherapist's hand motions and needle insertions during the implant procedure were acquired for analysis. Using video analysis software, maximum and average needle insertion velocities were determined. The number of needle insertion attempts and the use of the brachytherapist's other hand to manipulate the needle direction were also recorded. Sources misplacements were analyzed using an ultrasound-based method described elsewhere.
  
  
  
  Fifteen patients agreed to undergo this study; 1619125I seeds were inserted using 357 needles; 1197 seeds were confidently identified using ultrasound images and included in the analysis. The mean overall misplacement was 0.49 cm (0-2 cm, 95% CI = 0.47-0.51); 614 seeds were delivered with a single pass and 583 seeds with >1 passes (range 2-6). The mean maximum needle velocity was 12.34 cm s-1(range 4-28 cm s-1) and mean average velocity was 4.76 cm s-1(range 0.4-17.4 cm s-1); 747 seeds were delivered with manipulation of the needle. The generalized linear model test was used to analyze factors contributing to seed misplacement, and it was found that a maximum speed <12 cm s-1was associated with a decrease in seed misplacement by 0.049 cm vs. a maximum speed >12 cm s-1, p = 0.0121). Other evaluated factors were found to have no statistically significant correlation with seed misplacement: average speed (p = 0.4947), manual manipulation of needle (p = 0.9264), and number of needle passes (p = 0.8907).
  
  
  
  This study identified that needles inserted with lower maximum velocity were associated with less seed misplacement. Manual manipulation of the needle, number of passes, and average speed did not show statistically significant correlation with seed misplacement.
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: M F
authors.initials: MF
authors.lastname: Jamaluddin
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Electrical and Computer Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada.
authors.forename: M P
authors.initials: MP
authors.lastname: Waine
authors.affiliation: Department of Electrical and Computer Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Tavakoli
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Amanie
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: A D
authors.initials: AD
authors.lastname: Murtha
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Yee
authors.affiliation: Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada. Electronic address: nawaid.usmani@albertahealthservices.ca.
authors.forename: N
authors.initials: N
authors.lastname: Usmani
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods* / Q000592:standards*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009339:Needles; D011471:Prostatic Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D019736:Prostheses and Implants; D011879:Radiotherapy Dosage; D014463:Ultrasonography; D014741:Video Recording
chemical_list: D007457:Iodine Radioisotopes; C000614960:Iodine-125
keywords: Brachytherapy; Intraoperative factors; Low dose rate; Misplacement; Prostate; Transrectal ultrasound