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.
- 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?
- guidance / adjustment
- imaging challenges
- volume based
- Partial information based
- adjustments (human vs machine)
- 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
Breakout report presentation (Noby Hata)