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From Point A
to
Image Guided Brachytherapy
I-Chow Joe Hsu, MD
University of California San Francisco
Friday, April 1, 2011
ICRU 38 (1985)
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Radioth and Oncol 74, 235-45, 2005
Friday, April 1, 2011
GYN GEC-ESTRO 2005
Intermediate RiskCTV
CTVat diagnosis
ICRU 3860 Gy
High risk CTV
Clinical finding
at diagnosis
High Risk
CTV
CTVat
brachytherapy
Pt A85 Gy
MRI based
T2 LesionGray Area
Cervix
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At Diagnosis
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At Brachytherapy
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A - Applicator
- Tumor
- Fibroid
A
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Radioth and Oncol 79:80-86, 2006
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Inverse Planning Simulated Annealing
IPSA
Lessard, Med. Phys., 2001(5) p773-9
Dose Objective Parameters Ranges:- No negative values accepted anywhere.
- Weights go from 0 to 200
- Maximum value for Dose (Min or Max) could be up to 5000 cGy
- Margin values are limited to 50 mm.
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IJROBP 63:1270-1274, 2005
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Brachytherapy 7:242-247, 2008
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IJROBP 75:1329-1334, 2009
LC
RC
OS
DFS
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GEC-ESTRO, 2011
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Image Guided BrachytherapyPart 1
• Contouring based on GEC-ESTRO definition
• MRI based whenever possible
• Optimization using IPSA or manual adaptation
• Contouring the ovoids/ring separately
• Control optimization > manual adjustment
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US Guided GYN Procedures
1994
Ultrasound guidance for placement of difficult
intracavitary implants
Rotmensch, J. et al, Gynecol Oncol, 54:159-62
1995
Transrectal and transperineal sonography during guided
intrauterine procedures
Fleischer, A, et al, J Ultrasound Med, 14:135-8
1997
A new technique for performing Syed-Neblett template
interstitial implants for gynecologic malignancies using
transrectal-ultrasound guidance
Stock, R, et al, IJROBP 37:819-25
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1
2
3
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Image Guided BrachytherapyPart 2
• TRUS with EUA prior to implant
• Using US image to compliment clinical exam
• Identify normal structure to help with
orientation
• Identify tumor when possible
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Syed - Neblett Template
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IJROBP 52:538-543, 2002
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Radiother Oncol 74:247-250, 2004
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IJROBP 65:624-630, 2006
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GYN TVUSTVUS
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Image Guided BrachytherapyPart 3
• Image Guided Brachytherapy requires
• Image guided placement of implant - US/CT/MR
• Interstitial implant +/- intracavitary applicator
• 3D image based planning
• Inverse optimization
• Future of Image Guided Brachytherapy
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