The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. - - PowerPoint PPT Presentation

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The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. - - PowerPoint PPT Presentation

Aug 22, 2023 403 likes •777 views

The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. Treatment Planning Bashar Al-Qaisieh Treatment Planning Objectives: Delivery of prescription dose to target volume and minimise dose to nearby normal tissues

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The Real Time Image Guided HDR Brachytherapy for Prostate Cancer. Treatment Planning

Bashar Al-Qaisieh

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Treatment Planning Objectives:

Delivery of prescription dose to target volume and minimise dose to nearby normal tissues

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Prostate HDR Treatment Planning Involves:

  • Pre-treatment QA:
  • equipment functionality and connectivity
  • Patient setup:
  • measurement of US probe and template position with respect to patient
  • Needle Insertion:
  • optimal position
  • Contouring:
  • position of applicators with respect to PTV and OAR
  • Dosimetry Planning:
  • needle reconstruction
  • source activation
  • optimisation
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Bashar.Al-Qaisieh@leedsth.nhs.uk

Patient Setup

  • Position of the US probe in the stepper unit
  • Position of template with respect to the US

probe

  • Position of anatomy with respect to the

template and US probe

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual”, “Live” & “Post” Operation Functions

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Image Capture- Set Base

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Image Capture

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Contouring

  • Option 1:
  • Contour Prostate, Urethra, Rectum
  • Utilise to produce a “virtual” plan
  • Utilise at later stages after needle insertion
  • Option 2:
  • Calculate volume estimate from H,W,L measurement

(SJIO)

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Contouring- Option 1

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Contouring- Option 2 HWL Volume Estimate

10 20 30 40 50 15 20 25 30 35 40 45

Virtual height (mm) Live height (mm)

10 20 30 40 50 60 70 25 30 35 40 45 50 55

Virtual width (mm) Live width (mm)

Regression line Recorded live width 95% 90% 85% 80% 10 20 30 40 50 60 70 80 20 25 30 35 40 45 50 55 60

Virtual length (mm) Live length (mm)

Regression line Recorded live length 95% 90% 85% 80%
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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Contouring- Option 2

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion

  • Option 1:
  • Forward
  • Manual and Geometric
  • SJIO
  • Option 2:
  • Inverse
  • HIPO
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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 1:Forward

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 1:Forward SJIO

  • Reference transverse

plane for peripheral needles

  • Base and Apex for

middle needles

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 1:Forward SJIO

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 1:Forward SJIO

  • All needles inserted

to same depth of at least 1.0cm beyond the base to account for needle dead end for metal needle

1 cm

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 2:HIPO

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Virtual” Needle Insertion-Option 2:HIPO

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Image Capture

  • All needles

pushed to at least 1.0 cm deep from the base.

  • Needles Locked

to the template.

  • Take final base

measurement

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Needle Tip Tracking

  • All needle tips are updated at the same depth

(base). Convert needles from “V” to “L”

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Needle Tip Tracking

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Image Capture

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Contouring Guidance

  • Update “Virtual”

contours to match “Live” image set

  • Prostate dimension

pre needle insertion

  • Record of needle

position with respect to the prostate as a surrogate

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Contouring and PTV Margins

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Contouring

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Needles Free Length measurement and “Live” Tracking

Measured Recorded TPS

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Needles “Live” Tracking

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Bashar.Al-Qaisieh@leedsth.nhs.uk

“Live” Source Activation

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Planning Aims and Optimisation Options

  • Prostate:

– 15Gy=100% isodose – V100%>95% – V150%<45% – V200%<15% – D90>100%

  • PTV:

– V100%>95%

  • Rectum:

– D2cc<11.8Gy – V100%=0.0cc

  • Urethra:

– D10%<17.5Gy – D0.1cc<17.5Gy

Morton et al 2009, GEC-ESTRO 2013

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Inverse Optimisation-DVHO

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Bashar.Al-Qaisieh@leedsth.nhs.uk

TG 43 Dose Calculation

0.5 1.0 1.5 2.0 2.5 3.0 1 2 3 4 5 6 7 8 9 10

r

Depth Dose Distance (cm)

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Inverse Optimisation-DVHO

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Bashar.Al-Qaisieh@leedsth.nhs.uk

DVH output

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Good Job…well done!!!

  • Oncologist check
  • Approve plan
  • Print and transfer to treatment machine
  • Handover to physics to independent check
  • Handover to radiographers
  • Have a cup of coffee!!
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Bashar.Al-Qaisieh@leedsth.nhs.uk

Timing According to Individual Planners

Planner (no cases) Time from probe in to patient treated Needle insertion Needle reconstruction Planning A (4) 02:22 00:24 00:14 00:10 B (4) 02:54 00:28 00:29 00:13 C (2) 02:54 00:38 00:16 00:24 D (7) 02:53 00:25 00:16 00:15 E (3) 02:52 00:36 00:21 00:14

Data from 20 implants- 2012

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Bashar.Al-Qaisieh@leedsth.nhs.uk

Thank You