2006 IGT Workshop Radiation Therapy Breakout

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Questions to be answered in the report-out session

  • Identify 3 main challenges in this area
  • Identify 3 specific problems that can be solved by a collaborative effort between academic and industry partners
  • Identify a problem that the NCIGT can help address in the next year




User:Shoge RAD breakout notes:

  • Review of BWH program
    • seed placement
    • treated 472 men, 2 cases a week
    • mri guided biopsy program
    • mr is used throughout (both) program(s)
    • will shift to 3T in a few weeks
  • Typical proceedure
    • segment: peripheral zone (CTV), urethra, rectal (180° angular coverage)
    • two 18g needles: preloaded w/ sources/spacers,
      • location conf, then drop the seeds
    • Joy: guidance allows plan modification during treatment
      • not uncommon to add additional needles, seed points
    • review deviations, to confirm proper coverage:
      • goal: 100% peripheral zone coverage; if miss, miss in a particular region.
      • harder to visualize seed placement as treatment proceeds (signal voids from needle track)
  • 3D data set
    • body coil
    • extern phase array (cardiac coil?)
    • T1/T2, Dyn Contrast Enhanced, DWI (line scan), MRSI,
    • Challenge: how to combine all of this data.
  • corregistration: seeds in MR compare w/ CT,
    • reg algorithm uses fiducials (the seeds).
    • distortion? not much
    • Would like to ellliminate the CT from the proceedure.
    • Problem: 100 seeds from CT, can we accurately register with 50 seeds visible in MR.
  • (Brac) Outcome validation
    • O.R. time, staff costs
    • patient experience
    • 'controls' is a challege. rectal toxicity data; compared to similarly matched pool of patients (temporally correlated); manage side-effects;
    • patient reported scores on Quality of Life are higher than ultrasound guided placement.
      • procedure time is a bit longer
      • shortest is between 3-4 hours (multi disciplinary team)
      • MR set up time, anathesia takes 1 to 1 1/2 hour of that time.
  • Biopsy
    • register 1.5 T image from weeks ago, 0.5 T image from 5 min before proceedure, w/ real-time image during
    • target range is within 2-3 mm
    • segmentation is keystone; manual segmentation; regisitration is straightforward.
  • review of case history(s)
    • prostate cancer is slow growing
    • grading? staging?
  • Imaging
    • structure
    • guidance / adjustment
  • imaging challenges
    • volume based
    • Partial information based
    • adjustments (human vs machine)
  • challenges:
    • have MR scanning driven by location of needle under discussion by all MDs during procedure
    • training seed placement based on biopsy tests
      • seed registration in mri
    • multimodal integration and validation of targets
    • software interfaces
      • API hooks into internal commercial systems
      • current image analysis SW is inadequate for multiple images
      • impossible to get manual segmentation of all images; semi-automated segmentation... calibration of algorithms (absolute accuracy)
    • Closed bore (3T) environment
      • integration of robots into MRT

  • national repository of data %BR% need multi-modality images of same patient (constant geometry)
  • during implants: update/adjust dosimetry for optimal delivery

Summary Report

Breakout report presentation (Noby Hata)