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• W3094551497 abstract "According to the ABR and AAPM national guidelines, implant-day evaluation of I125 prostate implants is acceptable, but post-implant evaluation at 1 month±1 week is recommended. Implant-day dosimetric evaluation using CT imaging reduces economic burden and increases patient convenience, but low tissue contrast and seed artifacts confound prostate contouring. We report the dosimetric parameters evaluated on implant-day scans to improve CT contouring techniques with anatomic guidelines and compare them to post-implant MR-CT dosimetry to evaluate implant-day scans as a predictor for final dosimetry. Implant-day and post-implant dosimetry was performed and compared on 50 patients from a single institution who underwent I125 prostate implantation using a heavy peripheral dose planning technique. The prostate volume was contoured on CT and ultrasound (US) by an expert. CT contouring was done using anatomic based contouring guidelines, pre-implant MR images post-implant US images. Implant-day dosimetry was obtained 2-4 hours post-procedure. Post-implant dosimetry was based on CT and MR scans obtained at 1 month±1 week. Pre-implant, implant-day, and post-implant prostate volume was compared. Implant-day and post-implant V200, V150, V100, D99 and D90 were compared. The average pre-implant US volume (37.6±14.7 cc) was significantly smaller than the implant-day US volume (7.6±5.0 cc). The average CT implant-day volume was higher than the post-implant MR by 6.5±5.6 cc. D90/prescription-dose ranged from 0.8 to 1.5 on implant-day and from 0.9 to 1.1 post-implant. Dose volume parameters for implant-day and post-implant are shown in the table below. 27/50 patients had a decreased D90 on post-implant versus implant-day dosimetry, and 23/50 had increased D90. Post-implant D90 decreased in 27/50 patients and increased in 23/50 patients as compared to implant-day dosimetry. Average implant-day and post-implant V150, V100 and D90 were comparable but do not reflect the dosimetric complexity on an individual level as these parameters depend on both contouring expertise and seed motion. Although swelling is already present immediately following implantation, for many, swelling increased further at the final evaluation, explaining the lower D90. In a small subset, however, there was less swelling at post-implantation with lower D90. This suggests that there may be unfavorable seed redistribution as swelling resolves. In spite of these profound differences in individuals, implant-day dosimetry is still a predictor for outright implant failure. The change in D90 in this study was always within the acceptable range reflecting a consistently mature program performance.Abstract 4114; TableStructureDose Volume ParameterMean ± SDP-valueImplant-DayPost-ImplantProstateVolume cc43.8±14.537.3±14.6xV200 %31.9±10.035.9±11.10.0009V150 %63.6±14.065.1±12.9xV100 %94.1±5.992.8±5.2xD99/Rx dose0.85±0.150.79±0.140.006D90/Rx dose1.15±0.161.12±0.16x Open table in a new tab" @default.
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• W3094551497 date "2020-11-01" @default.
• W3094551497 modified "2023-10-16" @default.
• W3094551497 title "Comparison of Implant-Day and Post-Implant Dosimetry for Ultrasound Guided I125 Permanent Prostate Implants" @default.
• W3094551497 doi "https://doi.org/10.1016/j.ijrobp.2020.07.536" @default.
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