Implementing MRI-based target delineation for cervical cancer treatment within a rapid workflow environment for image-guided brachytherapy: A practical approach for centers without in-room MRI

Trifiletti, Daniel M.; Libby, Bruce; Feuerlein, Sebastian; Kim, Sang Woo; Garda, Allison E.; Watkins, W.T.; Erickson, Sarah H.; Ornan, Afshan; Showalter, Timothy N.

doi:10.1016/j.brachy.2015.07.005

Cited by 25 publications

(19 citation statements)

References 17 publications

(24 reference statements)

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“…Trifiletti and colleagues discussed yet another method, in which patients have a Smit sleeve placed after their first BT fraction, and an MRI is obtained with the Smit sleeve, but without the applicator in place. For subsequent fractions, CT is performed with the applicator in place, and these CT scans are fused to the MRI using the Smit sleeve for rigid body registration [55]. Other groups have published methods to facilitate implementation of MRI into a cervical BT program [56, 57].…”

Section: Discussionmentioning

confidence: 99%

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Harkenrider¹,

Shea²,

Wood³

et al. 2017

jcb

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PurposeAdaptive magnetic resonance imaging (MRI)-based brachytherapy results in improved local control and decreased high-grade toxicities compared to historical controls. Incorporating MRI into the workflow of a department can be a major challenge when initiating an MRI-based brachytherapy program. This project aims to describe the goals, challenges, and solutions when initiating an MRI-based cervical cancer brachytherapy program at our institution.Material and methodsWe describe the 6-month multi-disciplinary planning phase to initiate an MRI-based brachytherapy program. We describe the specific challenges that were encountered prior to treating our first patient.ResultsWe describe the solutions that were realized and executed to solve the challenges that we faced to establish our MRI-based brachytherapy program. We emphasize detailed coordination of care, planning, and communication to make the workflow feasible. We detail the imaging and radiation physics solutions to safely deliver MRI-based brachytherapy. The focus of these efforts is always on the delivery of optimal, state of the art patient care and treatment delivery within the context of our available institutional resources.ConclusionsPrevious publications have supported a transition to MRI-based brachytherapy, and this can be safely and efficiently accomplished as described in this manuscript.

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Section: Discussionmentioning

confidence: 99%

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Harkenrider¹,

Shea²,

Wood³

et al. 2017

jcb

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show abstract

“…The gross tumour volume was delineated by MRI and overlaid on the CT images for each brachytherapy fraction for dose optimization. The contouring and fusion process adds less than an hour of time to the brachytherapy course . The high‐risk clinical target volume (HR‐CTV) is then contoured on the CT dataset, with effort to include the full MRI‐defined tumour volume within the HR‐CTV for each fraction of brachytherapy.…”

Section: Methodsmentioning

confidence: 99%

“…This approach of manual optimization from a starting point of a traditional Point A‐based plan was in place at our institution since the inception of HDR brachytherapy. Further technical details for this method have been previously described showing the change in treatment volumes of individual patients from the first fraction compared with fractions 2–5 after implementing MRI‐based target volume delineation . Figure is a representative example of a patient in the MRI group, comparing the first fraction HR‐CTV, compared with MRI‐based target volumes.…”

Section: Methodsmentioning

confidence: 99%

“…The contouring and fusion process adds less than an hour of time to the brachytherapy course. 10 The high-risk clinical target volume (HR-CTV) is then contoured on the CT dataset, with effort to include the full MRI-defined tumour volume within the HR-CTV for each fraction of brachytherapy. The physician's intent was to define the HR-CTV as the cervix, cervical tumour and grey zones at time of brachytherapy.…”

Section: Brachytherapy Workflowmentioning

confidence: 99%

“…Further technical details for this method have been previously described showing the change in treatment volumes of individual patients from the first fraction compared with fractions 2-5 after implementing MRI-based target volume delineation. 10 Figure 1 is a representative example of a patient in the MRI group, comparing the first fraction HR-CTV, compared with MRI-based target volumes. Prior to the implementation of co-registered MRI scans for cervical cancer brachytherapy, MRI was not performed at time of brachytherapy to evaluate response to chemotherapy and radiation therapy at our centre.…”

Section: Brachytherapy Workflowmentioning

confidence: 99%

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Integration of MRI target delineation into rapid workflow cervical cancer brachytherapy: Impact on clinical outcomes

et al. 2018

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Clinical implementation, logistics and workflow guide for MRI image based interstitial HDR brachytherapy for gynecological cancers

Zhang

Donnelly

Strauss

et al. 2019

J Applied Clin Med Phys

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Interstitial brachytherapy (IBT) is often utilized to treat women with bulky endometrial or cervical cancers not amendable to intracavitary treatments. A modern trend in IBT is the utilization of magnetic resonance imaging (MRI) with a high dose rate (HDR) afterloader for conformal 3D image‐based treatments. The challenging part of this procedure is to properly complete many sequenced and co‐related physics preparations. We presented the physics preparations and clinical workflow required for implementing MRI‐based HDR IBT (MRI‐HDR‐IBT) of gynecologic cancer patients in a high‐volume brachytherapy center. The present document is designed to focus on the clinical steps required from a physicist’s standpoint. Those steps include: (a) testing IBT equipment with MRI scanner, (b) preparation of templates and catheters, (c) preparation of MRI line markers, (d) acquisition, importation and registration of MRI images, (e) development of treatment plans and (f) treatment evaluation and documentation. The checklists of imaging acquisition, registration and plan development are also presented. Based on the TG‐100 recommendations, a workflow chart, a fault tree analysis and an error‐solution table listing the speculated errors and solutions of each step are provided. Our workflow and practice indicated the MRI‐HDR‐IBT is achievable in most radiation oncology clinics if the following equipment is available: MRI scanner, CT (computed tomography) scanner, MRI/CT compatible templates and applicators, MRI line markers, HDR afterloader and a brachytherapy treatment planning system capable of utilizing MRI images. The OR/procedure room availability and anesthesiology support are also important. The techniques and approaches adopted from the GEC‐ESTRO (Groupe Européen de Curiethérapie ‐ European Society for Therapeutic Radiology and Oncology) recommendations and other publications are proven to be feasible. The MRI‐HDR‐IBT program can be developed over time and progressively validated through clinical experience, this document is expected to serve as a reference workflow guideline for implementing and performing the procedure.

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Implementing MRI-based target delineation for cervical cancer treatment within a rapid workflow environment for image-guided brachytherapy: A practical approach for centers without in-room MRI

Cited by 25 publications

References 17 publications

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

How one institution overcame the challenges to start an MRI-based brachytherapy program for cervical cancer

Integration of MRI target delineation into rapid workflow cervical cancer brachytherapy: Impact on clinical outcomes

Clinical implementation, logistics and workflow guide for MRI image based interstitial HDR brachytherapy for gynecological cancers

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