Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis

Ning, Matthew S.; Venkatesan, Aradhana M.; Stafford, R. Jason; Bui, Thao Phuong; Carlson, Richard; Bailard, Neil S.; Vedam, Sastry; Davis, Rasheda; Olivieri, Nicholas D.; Guzman, Alexis B.; Incalcaterra, James R.; McKelvey, Florence A.; Thaker, Nikhil G.; Rauch, Gaiane M.; Tang, Chad; Frank, Steven J.; Joyner, Melissa; Lin, Lilie L.; Jhingran, Anuja; Eifel, Patricia J.; Klopp, Ann H.

doi:10.1016/j.brachy.2019.09.010

“…Despite the widespread use of the CT-based planning for both intracavitary and interstitial brachytherapy (83), MRI has been accepted as the "gold standard" imaging modality (84,85).…”

Section: D-based Brachytherapymentioning

confidence: 99%

“…For interstitial gynecological HDR brachytherapy, efforts are being made to eliminate the need for CT during the treatment procedure (85). As previously mentioned, due to the lack of MR compatible catheters, the correct source track is not easily identified and reconstructed on T2W MRI images.…”

Section: Cervical Cancermentioning

confidence: 99%

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Shaaer

2023

Preprint

0

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Interstitial high dose rate (HDR) brachytherapy is a well-established treatment for prostate and gynecological cancers. HDR brachytherapy involves delivery of a high dose of radiation to the target with minimum dose to the surrounding tissue. Magnetic resonance imaging (MRI) has been explored as a main imaging modality for accurate target identification. Superior soft tissue resolution has been reported with MRI, increasing the accuracy of brachytherapy procedure. Clinical HDR brachytherapy workflows employing MRI are seeing increases in adoption. However, these require additional resources and patient transfers, which increases the planning time and the risk of catheters displacement. In addition, interstitial catheter reconstruction during interstitial brachytherapy procedure is challenging. Thus, accurate and efficient methods of incorporating the MRI imaging in interstitial HDR brachytherapy procedures need to be considered. In this thesis, a robust MRI-based algorithm and workflow were developed for treatment planning of interstitial HDR brachytherapy for prostate and gynecological cancers. An in-house MRI-to Ultrasound image registration algorithm was developed and evaluated for accurate identification of dominant intraprostatic lesions. The dosimetric impact of the registration was also assessed. Furthermore, an in-house MR-line marker was used in evaluating the feasibility of MR-only interstitial gynecological HDR brachytherapy workflow. The impact of the MR-only workflow on the target coverage and normal tissue sparing was evaluated. The dosimetric difference between the conventional approach and the proposed MR-only approaches was also compared and reported. Finally, a deep learning-assisted algorithm was developed for robust catheter reconstruction. The algorithm was benchmarked against the manual reconstruction and their efficiency was evaluated. Based on the results, the MRI-based innovations developed in this work are feasible for implementation in clinical brachytherapy workflows for treatment planning of prostate and gynecological cancers.

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“…Despite the widespread use of the CT-based planning for both intracavitary and interstitial brachytherapy (83), MRI has been accepted as the "gold standard" imaging modality (84,85).…”

Section: D-based Brachytherapymentioning

confidence: 99%

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Shaaer

2023

Preprint

0

View full text Add to dashboard Cite

Interstitial high dose rate (HDR) brachytherapy is a well-established treatment for prostate and gynecological cancers. HDR brachytherapy involves delivery of a high dose of radiation to the target with minimum dose to the surrounding tissue. Magnetic resonance imaging (MRI) has been explored as a main imaging modality for accurate target identification. Superior soft tissue resolution has been reported with MRI, increasing the accuracy of brachytherapy procedure. Clinical HDR brachytherapy workflows employing MRI are seeing increases in adoption. However, these require additional resources and patient transfers, which increases the planning time and the risk of catheters displacement. In addition, interstitial catheter reconstruction during interstitial brachytherapy procedure is challenging. Thus, accurate and efficient methods of incorporating the MRI imaging in interstitial HDR brachytherapy procedures need to be considered. In this thesis, a robust MRI-based algorithm and workflow were developed for treatment planning of interstitial HDR brachytherapy for prostate and gynecological cancers. An in-house MRI-to Ultrasound image registration algorithm was developed and evaluated for accurate identification of dominant intraprostatic lesions. The dosimetric impact of the registration was also assessed. Furthermore, an in-house MR-line marker was used in evaluating the feasibility of MR-only interstitial gynecological HDR brachytherapy workflow. The impact of the MR-only workflow on the target coverage and normal tissue sparing was evaluated. The dosimetric difference between the conventional approach and the proposed MR-only approaches was also compared and reported. Finally, a deep learning-assisted algorithm was developed for robust catheter reconstruction. The algorithm was benchmarked against the manual reconstruction and their efficiency was evaluated. Based on the results, the MRI-based innovations developed in this work are feasible for implementation in clinical brachytherapy workflows for treatment planning of prostate and gynecological cancers.

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“…26,27,29,34, The use of ioMR imaging, however, has high initial costs and prolongs the operation time. [64][65][66][67][68][69] Multi-theater layouts are generally used for high-magnetic-field MR scanners: in a single-theater type, the scanner is installed within the operating room to minimize the transfer distance to and fro the operating table; 28,42,44,70,71 in a multi-theater type, the MR scanner is housed in separate room or an area that may be closed off when the scanner is not in use (Fig. 4).…”

Section: Iomr Imaging Theater Layout and Cost Performancementioning

confidence: 99%

Intraoperative MR Imaging during Glioma Resection

Matsumae

¹

,

Nishiyama

²

,

Kuroda

³

2022

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One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motorevoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.

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Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis

Cited by 14 publications

References 40 publications

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Improving Reproducibility and Efficiency of Interstitial HDR Brachytherapy Through MRI-based Targeted Innovations

Intraoperative MR Imaging during Glioma Resection

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