Comparison of prostate verification with implanted gold markers in tissue surrounding the prostate and pelvic bony anatomy for external beam radiation therapy following low-dose-rate brachytherapy: a prospective clinical trial

We aimed to investigate whether gold marker implantation in the tissue surrounding the prostate could accurately monitor setup errors during external beam radiation therapy (EBRT) following low-dose-rate (LDR) brachytherapy. Thirty-eight patients had confirmed intermediate- or high-risk prostate cancer and received EBRT following LDR brachytherapy. In >175 computed tomography imaging sessions, the average values of the weekly setup error during EBRT to the prostate centroid at the time of gold marker matching in the surrounding tissue of the prostate and pelvic bone matching were measured and then compared using the Wilcoxon signed-rank test. Gold marker matching in the surrounding tissue of the prostate estimated setup errors better than those estimated by bone matching (3D displacement = 2.7 ± 2.0 vs 3.8 ± 2.6 mm, P < 0.01). Overall, the standard deviation of systematic (Σ) and random (σ) setup error was lower with gold marker matching than with bone matching (3D displacement = 1.8 and 1.1 mm vs 2.1 and 1.6 mm, respectively). With gold marker matching, the setup error of the position of the prostate centroid was smaller, and the optimal setup margin was lower than that with bone matching (2Σ + 0.7σ and 2.5Σ + 0.7σ of 3D displacement = 4.3 and 5.2 mm vs 5.3 and 6.4 mm, respectively). This high-precision radiotherapy approach placing gold markers in the surrounding tissue of the prostate can allow more accurate setup during EBRT following LDR brachytherapy.

Review of ultrasound image guidance in external beam radiotherapy: I. Treatment planning and inter-fraction motion management

In modern radiotherapy, verification of the treatment to ensure the target receives the prescribed dose and normal tissues are optimally spared has become essential. Several forms of image guidance are available for this purpose. The most commonly used forms of image guidance are based on kilovolt or megavolt x-ray imaging. Image guidance can also be performed with non-harmful ultrasound (US) waves. This increasingly used technique has the potential to offer both anatomical and functional information.This review presents an overview of the historical and current use of two-dimensional and three-dimensional US imaging for treatment verification in radiotherapy. The US technology and the implementation in the radiotherapy workflow are described. The use of US guidance in the treatment planning process is discussed. The role of US technology in inter-fraction motion monitoring and management is explained, and clinical studies of applications in areas such as the pelvis, abdomen and breast are reviewed. A companion review paper (O'Shea et al 2015 Phys. Med. Biol. submitted) will extensively discuss the use of US imaging for intra-fraction motion quantification and novel applications of US technology to RT.

Dose perturbation due to catheter materials in high-dose-rate interstitial (192)Ir brachytherapy

PURPOSE

Catheters made of either metal or plastic are currently used in brachytherapy treatment to insert radiative sources into patients. However, the radiation dose perturbations due to catheter attenuation are not taken into account in treatment planning. The purpose of this work is to quantify the effects of catheter composition on dose distribution and study their impacts on the overall treatment with high-dose-rate (192)Ir sources.

METHODS AND MATERIALS

Dose perturbations are first studied in a simplified case consisting of two parallel catheters. The catheter wall is either composed of stainless steel or polyoxymethylene. The attenuations are studied as the distance between the two catheters is varied from 5 to 30 mm. Dose perturbations resulting from irradiation are evaluated with a Monte Carlo GEANT4 dose calculation algorithm. The dose differences are further investigated with seven typical high-dose-rate prostate treatment plans involving 17 catheters.

RESULTS

The dose differences compared with water in the simplified case reach -4.3 ± 0.1% for stainless steel and 1.7 ± 0.5% for polyoxymethylene at 10 mm above the source when the catheters are separated by a distance of 5 mm. Dose perturbations are reduced in real treatment plans because of the contributions of the many dwell positions. Stainless steel and polyoxymethylene catheters induce on an average a dose difference of -1.3 ± 0.3% and 0.1 ± 0.2%, respectively in the target.

CONCLUSIONS

The dose differences reported in this work do not warrant any changes in the clinical procedures.