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Dupere JM, Brost EE, Hainy ME, Lee CU, Urban MW, Stish BJ, Deufel CL. Color VISION for improved ultrasound visualization of brachytherapy needles. Med Phys 2024; 51:4340-4350. [PMID: 38629912 DOI: 10.1002/mp.17083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/08/2024] [Accepted: 04/06/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND High dose rate brachytherapy is commonly used in the treatment of prostate cancer. Treatment planning is often performed under transrectal ultrasound (US) guidance, but brachytherapy needles can be challenging to digitize due to the presence of poor US conspicuity and imaging artifacts. The plan accuracy and quality, however, are dependent on the proper visualization of the needles with millimeter accuracy. PURPOSE This work describes a technique for generating a color overlay of needle locations atop the grayscale US image. Prototype devices were developed to produce vibrations in the brachytherapy needles that generate a high contrast color Doppler (CD) signal that highlights the needle locations with superior contrast and reduced artifacts. Denoted by the acronym color VISION (Vibrationally Induced Shimmering for Identifying an Object's Nature), the technology has the potential to improve applicator conspicuity and facilitate automated applicator digitization. METHODS Three prototype vibrational devices with frequencies between 200-450 Hz were designed in-house and evaluated with needle implants in a phantom and cadaveric male pelvis using: (1) an actuator attached to the front of a prostate needle template; (2) an actuator attached to the top of the needle template; and (3) a hand-held actuator with a stylet, inserted directly into a needle's inner lumen. Acquired images were postprocessed in MATLAB to evaluate the potential for automated digitization. RESULTS All prototype devices produced localized shimmering in implanted brachytherapy needles in both the axial and sagittal planes. The template mounted actuators provided better vibrational coupling and ease of operation than the stylet prototype. The Michelson contrast, or visibility, of the shimmering CD signal was 100% compared with ≤40% for B-mode imaging of a single needle. Proof-of-principle for automated applicator digitization using only the CD signal was demonstrated. CONCLUSIONS The color VISION prototype devices successfully coupled mechanical vibrations into brachytherapy needles to generate US CD shimmering and accurately highlight brachytherapy needle locations. The high contrast and natively registered signal are promising for future work to automate the needle digitization and provide a real-time visual overlay of the applicator on the B-mode US image.
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Affiliation(s)
- Justine M Dupere
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric E Brost
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew E Hainy
- Division of Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine U Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew W Urban
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Manea E, Chitoran E, Rotaru V, Ionescu S, Luca D, Cirimbei C, Alecu M, Capsa C, Gafton B, Prutianu I, Serban D, Simion L. Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix. Bioengineering (Basel) 2024; 11:506. [PMID: 38790373 PMCID: PMC11117609 DOI: 10.3390/bioengineering11050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/09/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.
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Affiliation(s)
- Elena Manea
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Chitoran
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Vlad Rotaru
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Sinziana Ionescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Dan Luca
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Ciprian Cirimbei
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Mihnea Alecu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Cristina Capsa
- Radiology and Medical Imaging Department, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
| | - Bogdan Gafton
- Department of Radiotherapy, Regional Institute of Oncology, 700483 Iasi, Romania; (E.M.)
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Iulian Prutianu
- “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Morpho-Functional Sciences I—Histology, University of Medicine and Pharmacy “Gr. T. Popa”, 700483 Iasi, Romania
| | - Dragos Serban
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- Surgery Department IV, Bucharest Clinical Emergency Hospital, 050098 Bucharest, Romania
| | - Laurentiu Simion
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania
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Ndarukwa S, Flores JA, Rosenblatt E, Berger D, Akbarov K, Hedden N, Chopra S, Hande V, Rubio AP. Brachytherapy Workflow Practices: Analysis of Different Workflow Scenarios in Patients With Cervical Cancer and Impact on IGBT Implementation-An IAEA Study. JCO Glob Oncol 2024; 10:e2300336. [PMID: 38386958 PMCID: PMC10898675 DOI: 10.1200/go.23.00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The workflow of brachytherapy (BT) is an essential aspect of treatment to consider in image-guided brachytherapy (IGBT). It has an overarching effect influencing patient throughput and the number of cancer treatments that can be performed as it occupies equipment, space, and personnel. There is limited research addressing this issue. Under the International Atomic Energy Agency's Coordinated Research Activity titled IGBT for cervix cancer: An implementation study, our study analyzes various scenarios in the clinical workflow of BT delivery for cervical cancer. It aims to determine the extent to which these scenarios allow the routine implementation of IGBT. With this information, current barriers and individualized adaptations to efficient workflows can be identified to enhance the global application of IGBT, leading to better cervical cancer treatment. MATERIALS AND METHODS A web-based poll of questions regarding practices in BT workflow was presented to 62 participants from low-, lower middle-, upper middle-, and high-income countries (19 countries). RESULTS This study highlighted diversity in BT practices across countries, income levels, and regions. It identified variations in workflow, patient throughput, and resource availability, which can have implications for the efficiency and quality of BT treatments. Scenario A, utilizing multiple locations for the steps of the BT procedure, was the most commonly used. The availability of resources, such as imaging devices and trained personnel, varied among the participating centers and remained challenging for IGBT implementation and sustainability. CONCLUSION The design of the BT facility plays a vital role in improving efficiency, with a dedicated BT suite contributing to an efficient workflow but limiting patient throughput, especially for high-volume centers. Although IGBT is effective, its implementation requires consideration of various logistical challenges and should be individualized.
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Affiliation(s)
- Sandra Ndarukwa
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jerickson Abbie Flores
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Rosenblatt
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Daniel Berger
- Section of Dosimetry and Medical Radiation Physics, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Kamal Akbarov
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Natasha Hedden
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Supriya Chopra
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Varsha Hande
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Alfredo Polo Rubio
- City Cancer Challenge, Technical Cooperation and Capacity Development, Geneva, Switzerland
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Banerjee S, Sarkar S, Mahantshetty U, Shishak S, Kaliyaperumal V, Bisht SS, Gupta D, Narang K, Mayank M, Srinivasan V, Anand V, Patro KC, Prasad RR, Kataria T. Current status and future readiness of Indian radiation oncologists to embrace prostate high-dose-rate brachytherapy: An Indian Brachytherapy Society survey. J Contemp Brachytherapy 2023; 15:391-398. [PMID: 38230402 PMCID: PMC10789157 DOI: 10.5114/jcb.2023.134168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/07/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose This survey aimed to understand the practice pattern and attitude of Indian doctors towards prostate brachytherapy. Material and methods A 21-point questionnaire was designed in Google form and sent to radiation oncologists practicing in India, using texts, mails, and social media. Responses were collated, and descriptive statistical analysis was performed. Results A total of 212 radiation oncologists from 136 centers responded to the survey questionnaire, with majority (66%) being post-specialty training > 6 years. We found that about 44.3% (n = 94) of respondents do not practice interstitial brachytherapy for any site, and majority (83.3%, n = 175) do not practice high-dose-rate (HDR) prostate brachytherapy. Only 2.8% (n = 6) of doctors preferred boost by brachytherapy compared with 38.1% (n = 80) of respondents, who favored stereotactic body radiation therapy (SBRT) boost. When asked about the indication of HDR prostate brachytherapy in Indian setting, 32.5% (n = 67) of respondents favored monotherapy, 46.1% (n = 95) of oncologists thought boost as a good indication, and 21.4% (n = 44) preferred re-irradiation/salvage setting. The most cited reason for prostate brachytherapy not being popularly practiced in India was lack of training (84.8%, n = 179). It was also noted that out of 80 respondents who practiced SBRT for prostate boost, 37 would prefer HDR brachytherapy boost if given adequate training and facilities. Conclusions The present survey provided insight on practice of prostate brachytherapy in India. It is evident that majority of radiation oncologists do not practice HDR prostate brachytherapy due to lack of training and infrastructure. Indian physicians are willing to learn and start prostate brachytherapy procedures if dedicated training and workshops are organized.
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Affiliation(s)
- Susovan Banerjee
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Soumya Sarkar
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Homi Bhaba Cancer Hospital and Research Centre, Tata Memorial Centre, Vizag, India
| | - Sorun Shishak
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | | | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - Mayur Mayank
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
| | - V Srinivasan
- Department of Radiation Oncology, MIOT International Hospital, Chennai, India
| | - Vivek Anand
- Department of Radiation Oncology, PD Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Kanhu Charan Patro
- Department of Radiation Oncology, Mahatma Gandhi Cancer Hospital, Vizag, India
| | - Rajiv Ranjan Prasad
- Division of Radiation Oncology, Jay Prabha Medanta Super Specialty Hospital, Kankarbagh, Patrakar Nagar, Patna, Bihar, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta – The Medicity, Sector 38, Gurgaon, Haryana, India
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Lee CT, Koleoso O, Deng M, Veltchev I, Lin T, Hallman MA, Horwitz EM, Wong JK. A dosimetric analysis of rectal hydrogel spacer use in patients with recurrent prostate cancer undergoing salvage high-dose-rate brachytherapy. Brachytherapy 2023; 22:586-592. [PMID: 37393186 PMCID: PMC10527788 DOI: 10.1016/j.brachy.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/18/2023] [Accepted: 06/01/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE We hypothesize rectal hydrogel spacer (RHS) improves rectal dosimetry in patients undergoing salvage high-dose-rate brachytherapy (HDR-BT) for intact, recurrent prostate cancer (PC). METHODS AND MATERIALS A prospectively collected institutional database was queried for recurrent PC patients treated with salvage HDR-BT from September 2015 to November 2021. Patients were offered RHS beginning June 2019. Dosimetric variables were compared between RHS and no-RHS groups for the average of two fractions using Wilcoxon rank-sum tests. Primary outcomes were rectal volume receiving 75% of prescription dose (V75%) and prostate volume receiving 100% of prescription dose (V100%). Generalized estimating equation (GEE) model was used to evaluate the association between other planning variables and rectal V75%. RESULTS Forty-one PC patients received salvage HDR-BT, of whom 20 had RHS. All patients received 2400cGy in 2 fractions. Median RHS volume was 6.2cm3 (Standard deviation [SD]: ± 3.5cm3). Median follow-up was 4 months and 17 months in the RHS and no-RHS groups, respectively. Median rectal V75% with and without RHS were 0.0cm3 (IQR: 0.0-0.0cm3) and 0.06cm3 (IQR: 0.0-0.14cm3), respectively (p<0.001). Median prostate V100% with and without RHS were 98.55% (IQR: 97.86-99.22%) and 97.78% (IQR: 97.50-98.18%), respectively (p = 0.007). RHS, rectum, and prostate volumes did not significantly affect rectal V75% per GEE modeling. There was 10% G1-2 and 5% G3 rectal toxicity in RHS group. There was 9.5% G1-2 and no G3+ rectal toxicities in the no-RHS group. CONCLUSIONS Absolute improvement in rectal V75% and prostate V100% was significant with RHS in PC patients undergoing salvage HDR-BT, but clinical benefit is marginal.
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Affiliation(s)
- Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
| | - Olufela Koleoso
- Doctor of Osteopathic Medicine Program, Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Mengying Deng
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA
| | - Iavor Veltchev
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Teh Lin
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Mark A Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - J Karen Wong
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
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Zhao JZ, Ni R, Chow R, Rink A, Weersink R, Croke J, Raman S. Artificial intelligence applications in brachytherapy: A literature review. Brachytherapy 2023; 22:429-445. [PMID: 37248158 DOI: 10.1016/j.brachy.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/02/2023] [Accepted: 04/07/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Artificial intelligence (AI) has the potential to simplify and optimize various steps of the brachytherapy workflow, and this literature review aims to provide an overview of the work done in this field. METHODS AND MATERIALS We conducted a literature search in June 2022 on PubMed, Embase, and Cochrane for papers that proposed AI applications in brachytherapy. RESULTS A total of 80 papers satisfied inclusion/exclusion criteria. These papers were categorized as follows: segmentation (24), registration and image processing (6), preplanning (13), dose prediction and treatment planning (11), applicator/catheter/needle reconstruction (16), and quality assurance (10). AI techniques ranged from classical models such as support vector machines and decision tree-based learning to newer techniques such as U-Net and deep reinforcement learning, and were applied to facilitate small steps of a process (e.g., optimizing applicator selection) or even automate the entire step of the workflow (e.g., end-to-end preplanning). Many of these algorithms demonstrated human-level performance and offer significant improvements in speed. CONCLUSIONS AI has potential to augment, automate, and/or accelerate many steps of the brachytherapy workflow. We recommend that future studies adhere to standard reporting guidelines. We also stress the importance of using larger sample sizes and reporting results using clinically interpretable measures.
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Affiliation(s)
- Jonathan Zl Zhao
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ruiyan Ni
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Ronald Chow
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Alexandra Rink
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Robert Weersink
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Jennifer Croke
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Srinivas Raman
- Princess Margaret Hospital Cancer Centre, Radiation Medicine Program, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
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Kaliyaperumal V, Banerjee S, Kataria T, Abraham SK, Kamaraj D, Tamilselvan S, Gupta D, Bisht SS, Narang K, Shishak S. Commissioning and Dosimetric Results of an Indigenously Developed Intra-Vaginal Template for Interstitial Plus Intracavitary High dose Rate Image-Guided Brachytherapy of Advanced Cervix Cancer. J Med Phys 2022; 47:322-330. [PMID: 36908497 PMCID: PMC9997539 DOI: 10.4103/jmp.jmp_50_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/23/2022] [Accepted: 10/16/2022] [Indexed: 01/12/2023] Open
Abstract
Aim The goal of this study is to discuss the commissioning and dosimetric parameters achieved during the clinical implementation of an indigenously developed intracavitary (IC) plus interstitial (IS) template for high dose rate (HDR) image-guided brachytherapy (IGBT) in cancer (Ca) cervix. We want to discuss our achieved values of cumulative equi-effective doses (EQD2) for high-risk clinical target volume (HRCTV) and organ at risk (OAR) and compare it with available published results. Materials and Methods Medanta anterior oblique/lateral oblique template has a total of 19 needles including the central tandem. For commissioning the template with needles, the indigenously made acrylic phantom was used. Oblique and straight needles were placed inside the acrylic phantom and a computed tomography (CT) scan was performed. Sixteen patients were treated in HDR IGBT using this template after external-beam radiotherapy. The IGBT plans were evaluated based on EQD2 of target coverage i.e., dose received by 98% (D98%_HRCTV), 90% (D90%_HRCTV), and 50% (D50%_HRCTV) volume of HRCTV, and dose received by 2 cc (D2cc) and 0.1 cc (D0.1cc) of OAR using linear quadratic (LQ) radiobiological model. Results The autoradiographic in radiochromic film shows that the distance between the needle tip and the middle of the source position is 6 mm. The mean D98%_HRCTV and D90%_HRCTV was 76.8 Gy (range: 70-87.7 Gy, P < 0.01) and 84.49 Gy (range: 76.6-96.7 Gy, P < 0.01), respectively. Mean EQD2 of D2cc of the bladder, rectum, and sigmoid was 85.6 Gy (range: 77.5-99.6 Gy, P < 0.03), 74.3 Gy (range: 70.9-76.7 Gy, P < 0.05), and 58.3 Gy (range: 50.6-67.9 Gy, P = 0.01), respectively. The mean total reference air kerma at a 1 m distance is 0.489cGy (range: 0.391-0.681cGy). Conclusions The indigenously developed template could attain satisfactory standards in terms of set parameters for commissioning and acceptable dose volume relations in our clinical use for treating the advanced Ca cervix patients who need IC + IS type of HDR IGBT. The comparative analysis with contemporary applicators was acceptable.
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Affiliation(s)
- Venkatesan Kaliyaperumal
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Susan K Abraham
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Dayanithi Kamaraj
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Singaravelu Tamilselvan
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
| | - Sorun Shishak
- Division of Radiation Oncology, Medanta Cancer Institute, Medanta the Medicity, Gurgaon, Haryana, India
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Yang H, Shan C, Kolen AF, de With PHN. Medical instrument detection in ultrasound: a review. Artif Intell Rev 2022. [DOI: 10.1007/s10462-022-10287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
AbstractMedical instrument detection is essential for computer-assisted interventions, since it facilitates clinicians to find instruments efficiently with a better interpretation, thereby improving clinical outcomes. This article reviews image-based medical instrument detection methods for ultrasound-guided (US-guided) operations. Literature is selected based on an exhaustive search in different sources, including Google Scholar, PubMed, and Scopus. We first discuss the key clinical applications of medical instrument detection in the US, including delivering regional anesthesia, biopsy taking, prostate brachytherapy, and catheterization. Then, we present a comprehensive review of instrument detection methodologies, including non-machine-learning and machine-learning methods. The conventional non-machine-learning methods were extensively studied before the era of machine learning methods. The principal issues and potential research directions for future studies are summarized for the computer-assisted intervention community. In conclusion, although promising results have been obtained by the current (non-) machine learning methods for different clinical applications, thorough clinical validations are still required.
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Grajales D, Kadoury S, Shams R, Barkati M, Delouya G, Béliveau-Nadeau D, Nicolas B, Le WT, Benhacene-Boudam MK, Juneau D, DaSilva JN, Carrier JF, Hautvast G, Ménard C. Performance of an integrated multimodality image guidance and dose-planning system supporting tumor-targeted HDR brachytherapy for prostate cancer. Radiother Oncol 2021; 166:154-161. [PMID: 34861267 DOI: 10.1016/j.radonc.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in high-dose-rate brachytherapy to treat prostate cancer hinge on improved accuracy in navigation and targeting while optimizing a streamlined workflow. Multimodal image registration and electromagnetic (EM) tracking are two technologies integrated into a prototype system in the early phase of clinical evaluation. We aim to report on the system's accuracy and workflow performance in support of tumor-targeted procedures. MATERIALS AND METHODS In a prospective study, we evaluated the system in 43 consecutive procedures after clinical deployment. We measured workflow efficiency and EM catheter reconstruction accuracy. We also evaluated the system's MRI-TRUS registration accuracy with/without deformation, and with/without y-axis rotation for urethral alignment at initialization. RESULTS The cohort included 32 focal brachytherapy and 11 integrated boost whole-gland implants. Mean procedure time excluding dose delivery was 38 min (range: 21-83) for focal, and 56 min (range: 38-89) for whole-gland implants; stable over time. EM catheter reconstructions achieved a mean difference between computed and measured free-length of 0.8 mm (SD 0.8, no corrections performed), and mean axial manual corrections 1.3 mm (SD 0.7). EM also enabled the clinical use of a non or partially visible catheter in 21% of procedures. Registration accuracy improved with y-axis rotation for urethral alignment at initialization and with the elastic registration (mTRE 3.42 mm, SD 1.49). CONCLUSION The system supported tumor-targeting and was implemented with no demonstrable learning curve. EM reconstruction errors were small, correctable, and improved with calibration and control of external distortion sources; increasing confidence in the use of partially visible catheters. Image registration errors remained despite rotational alignment and deformation, and should be carefully considered.
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Affiliation(s)
- David Grajales
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Samuel Kadoury
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | - Maroie Barkati
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Guila Delouya
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Benedicte Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | | | - Daniel Juneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean N DaSilva
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean-Francois Carrier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Cynthia Ménard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada.
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Quantitative and qualitative application of clinical drawings for image-guided brachytherapy in cervical cancer patients. J Contemp Brachytherapy 2021; 13:512-518. [PMID: 34759975 PMCID: PMC8565630 DOI: 10.5114/jcb.2021.110273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-THR)/intermediate-risk clinical target volume (CTV-TIR) in brachytherapy (BRT), using modified clinical drawings. Material and methods 42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-THR and CTV-TIR) were compared both qualitatively and quantitatively. Results and conclusions We found qualitative and quantitative correlation of the dimensions of final CTV-THR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-THR volume during brachytherapy.
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11
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Tan H, Rossa C. Electrical Impedance Tomography for Robot-Aided Internal Radiation Therapy. Front Bioeng Biotechnol 2021; 9:698038. [PMID: 34235139 PMCID: PMC8256893 DOI: 10.3389/fbioe.2021.698038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
High dose rate brachytherapy (HDR) is an internal based radiation treatment for prostate cancer. The treatment can deliver radiation to the site of dominant tumor growth within the prostate. Imaging methods to delineate the dominant tumor are imperative to ensure the maximum success of HDR. This paper investigates the feasibility of using electrical impedance tomography (EIT) as the main imaging modality during robot-aided internal radiation therapy. A procedure utilizing brachytherapy needles in order to perform EIT for the purpose of robot-aided prostate cancer imaging is proposed. It is known that cancerous tissue exhibits different conductivity than healthy tissue. Using this information, it is hypothesized that a conductivity map of the tissue can be used to locate and delineate cancerous nodules via EIT. Multiple experiments were conducted using eight brachytherapy needle electrodes. Observations indicate that the imaging procedure is able to observe differences in tissue conductivity in a setting that approximates transperineal HDR and confirm that brachytherapy needles can be used as electrodes for this purpose. The needles can access the tissue at a specific depth that traditional EIT surface electrodes cannot. The results indicate the feasibility of using brachytherapy needles for EIT for the purpose internal radiation therapy.
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Affiliation(s)
- Hao Tan
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
| | - Carlos Rossa
- Faculty of Engineering and Applied Science, Ontario Tech University, Oshawa, ON, Canada
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12
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Banerjee S, Goyal S, Mishra S, Gupta D, Bisht SS, K V, Narang K, Kataria T. Artificial intelligence in brachytherapy: a summary of recent developments. Br J Radiol 2021; 94:20200842. [PMID: 33914614 DOI: 10.1259/bjr.20200842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Artificial intelligence (AI) applications, in the form of machine learning and deep learning, are being incorporated into practice in various aspects of medicine, including radiation oncology. Ample evidence from recent publications explores its utility and future use in external beam radiotherapy. However, the discussion on its role in brachytherapy is sparse. This article summarizes available current literature and discusses potential uses of AI in brachytherapy, including future directions. AI has been applied for brachytherapy procedures during almost all steps, starting from decision-making till treatment completion. AI use has led to improvement in efficiency and accuracy by reducing the human errors and saving time in certain aspects. Apart from direct use in brachytherapy, AI also contributes to contemporary advancements in radiology and associated sciences that can affect brachytherapy decisions and treatment. There is a renewal of interest in brachytherapy as a technique in recent years, contributed largely by the understanding that contemporary advances such as intensity modulated radiotherapy and stereotactic external beam radiotherapy cannot match the geometric gains and conformality of brachytherapy, and the integrated efforts of international brachytherapy societies to promote brachytherapy training and awareness. Use of AI technologies may consolidate it further by reducing human effort and time. Prospective validation over larger studies and incorporation of AI technologies for a larger patient population would help improve the efficiency and acceptance of brachytherapy. The enthusiasm favoring AI needs to be balanced against the short duration and quantum of experience with AI in limited patient subsets, need for constant learning and re-learning to train the AI algorithms, and the inevitability of humans having to take responsibility for the correctness and safety of treatments.
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Affiliation(s)
- Susovan Banerjee
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shikha Goyal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Saumyaranjan Mishra
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shyam Singh Bisht
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Venketesan K
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Tejinder Kataria
- Division of Radiation Oncology, Medanta- The Medicity, Gurgaon, Haryana, India
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Low dose rate permanent seed brachytherapy: tracing its evolution and current status. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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14
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Dosimetric considerations when utilizing Venezia, Capri, Rotte double tandem, and tandem and ring with interstitial needles for the treatment of gynecological cancers with high dose rate brachytherapy. Med Dosim 2020; 45:21-27. [DOI: 10.1016/j.meddos.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/29/2019] [Accepted: 04/16/2019] [Indexed: 11/19/2022]
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Chernavsky NE, Morcos M, Wu P, Viswanathan AN, Siewerdsen JH. Technical assessment of a mobile CT scanner for image-guided brachytherapy. J Appl Clin Med Phys 2019; 20:187-200. [PMID: 31578811 PMCID: PMC6806478 DOI: 10.1002/acm2.12738] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/30/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The imaging performance and dose of a mobile CT scanner (Brainlab Airo®, Munich, Germany) is evaluated, with particular consideration to assessment of technique protocols for image-guided brachytherapy. METHOD Dose measurements were performed using a 100-mm-length pencil chamber at the center and periphery of 16- and 32-cm-diameter CTDI phantoms. Hounsfield unit (HU) accuracy and linearity were assessed using materials of specified electron density (Gammex RMI, Madison, WI), and image uniformity, noise, and noise-power spectrum (NPS) were evaluated in a 20-cm-diameter water phantom as well as an American College of Radiology (ACR) CT accreditation phantom (Model 464, Sun Nuclear, Melbourne, FL). Spatial resolution (modulation transfer function, MTF) was assessed with an edge-spread phantom and visually assessed with respect to line-pair patterns in the ACR phantom and in structures of interest in anthropomorphic phantoms. Images were also obtained on a diagnostic CT scanner (Big Bore CT simulator, Philips, Amsterdam, Netherlands) for qualitative and quantitative comparison. The manufacturer's metal artifact reduction (MAR) algorithm was assessed in an anthropomorphic body phantom containing surgical instrumentation. Performance in application to brachytherapy was assessed with a set of anthropomorphic brachytherapy phantoms - for example, a vaginal cylinder and interstitial ring and tandem. RESULT Nominal dose for helical and axial modes, respectively, was 56.4 and 78.9 mGy for the head protocol and 17.8 and 24.9 mGy for the body protocol. A high degree of HU accuracy and linearity was observed for both axial and helical scan modes. Image nonuniformity (e.g., cupping artifact) in the transverse (x,y) plane was less than 5 HU, but stitching artifacts (~5 HU) in the longitudinal (z) direction were observed in axial scan mode. Helical and axial modes demonstrated comparable spatial resolution of ~5 lp/cm, with the MTF reduced to 10% at ~0.38 mm-1 . Contrast-to-noise ratio was suitable to soft-tissue visualization (e.g., fat and muscle), but windmill artifacts were observed in helical mode in relation to high-frequency bone and metal. The MAR algorithm provided modest improvement to image quality. Overall, image quality appeared suitable to relevant clinical tasks in intracavitary and interstitial (e.g., gynecological) brachytherapy, including visualization of soft-tissue structures in proximity to the applicators. CONCLUSION The technical assessment highlighted key characteristics of dose and imaging performance pertinent to incorporation of the mobile CT scanner in clinical procedures, helping to inform clinical deployment and technique protocol selection in brachytherapy. For this and other possible applications, the work helps to identify protocols that could reduce radiation dose and/or improve image quality. The work also identified areas for future improvement, including reduction of stitching, windmill, and metal artifacts.
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Affiliation(s)
| | - Marc Morcos
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Pengwei Wu
- Department of Biomedical EngineeringJohns Hopkins UniversityBaltimoreMDUSA
| | - Akila N. Viswanathan
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins UniversityBaltimoreMDUSA
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Richart J, Carmona-Meseguer V, García-Martínez T, Herreros A, Otal A, Pellejero S, Tornero-López A, Pérez-Calatayud J. Review of strategies for MRI based reconstruction of endocavitary and interstitial applicators in brachytherapy of cervical cancer. Rep Pract Oncol Radiother 2018; 23:547-561. [PMID: 30534019 PMCID: PMC6277512 DOI: 10.1016/j.rpor.2018.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/04/2018] [Accepted: 06/23/2018] [Indexed: 12/14/2022] Open
Abstract
Brachytherapy plays an essential role in the curative intent management of locally advanced cervical cancer. The introduction of the magnetic resonance (MR) as a preferred image modality and the development of new type of applicators with interstitial components have further improved its benefits. The aim of this work is to review the current status of one important aspect in the cervix cancer brachytherapy procedure, namely catheter reconstruction. MR compatible intracavitary and interstitial applicators are described. Considerations about the use of MR imaging (MRI) regarding appropriate strategies for applicator reconstruction, technical requirements, MR sequences, patient preparation and applicator commissioning are included. It is recommendable to perform the reconstruction process in the same image study employed by the physician for contouring, that is, T2 weighted (T2W) sequences. Nevertheless, a clear identification of the source path inside the catheters and the applicators is a challenge when using exclusively T2W sequences. For the intracavitary component of the implant, sometimes the catheters may be filled with some substance that produces a high intensity signal on MRI. However, this strategy is not feasible for plastic tubes or titanium needles, which, moreover, induce magnetic susceptibility artifacts. In these situations, the use of applicator libraries available in the treatment planning system (TPS) is useful, since they not only include accurate geometrical models of the intracavitary applicators, but also recent developments have made possible the implementation of the interstitial component. Another strategy to improve the reconstruction process is based on the incorporation of MR markers, such as small pellets, to be used as anchor points. Many institutions employ computed tomography (CT) as a supporting image modality. The registration of CT and MR image sets should be carefully performed, and its uncertainty previously assessed. Besides, an important research work is being carried out regarding the use of ultrasound and electromagnetic tracking technologies.
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Affiliation(s)
- José Richart
- Hospital Clínica Benidorm, Medical Physics Department, Alicante, Spain
| | - Vicente Carmona-Meseguer
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
| | | | - Antonio Herreros
- Hospital Clínic, Department of Radiation Oncology, Medical Physics Section, Barcelona, Spain
| | - Antonio Otal
- Hospital Arnau de Vilanova, Medical Physics Department, Lleida, Spain
| | - Santiago Pellejero
- Complejo Hospitalario de Navarra, Medical Physics Department, Pamplona, Spain
| | - Ana Tornero-López
- Hospital Dr. Negrín, Medical Physics Department, Las Palmas de Gran Canaria, Spain
| | - José Pérez-Calatayud
- Hospital La Fe-IRIMED, Department of Radiation Oncology, Medical Physics Section, Valencia, Spain
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Zhu S, Yang X, Xu KM, Jeong JJ, Khan MK. High-resolution, ultrasound-guided, high-dose-rate, surface brachytherapy for basal cell carcinoma of the skin: A case report. Adv Radiat Oncol 2018; 3:591-594. [PMID: 30370359 PMCID: PMC6200898 DOI: 10.1016/j.adro.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Simeng Zhu
- University of Florida, College of Medicine, Gainesville, Florida
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
- Department of Radiation Oncology and Winship Cancer Institute, Emory University School of Medicine, 1365 Clifton Road NE, A1233, Atlanta, GA 30322, Tel: (404)-778-8622.
| | - Karen M. Xu
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Mohammad K. Khan
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
- Corresponding authors. Department of Radiation Oncology, Emory University School of Medicine, Winship Cancer Institute, 1365 Clifton Road NE, Office A1312, Atlanta, GA 30345.
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