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• W4253053400 abstract "Purpose/Objective(s)Postplan Quality Assessment (QA) is a vital tool in the assurance of high quality Prostate Brachytherapy (BT). Although a dose-response relationship exists for the dosimetric quantifier (DQ) D90, the validity of postplan QA using CT imaging has been questioned due to inter-observer contour variability. MRI allows more reproducible and robust prostate definition. We compared the CT postplans of 4 experienced brachytherapists with MRI-determined prostate volumes.Materials/Methods50 patients had CT and MRI 1 month post Iodine-125 prostate BT. CT scans were contoured by the treating physician and dosimetry calculated as per provincial protocol. The prostate was contoured independently on MRI by one observer with extensive experience in MRI postplan QA. The scans were then fused and dosimetric parameters compared.ResultsOf the first 30 patients analyzed, 14 had hormonal manipulation (13 with LHRH agonist, 1 with dutaseride) for an average of 25 weeks (range 12 to 44) before BT. Four patients received pelvic radiotherapy completed 1 month before BT. CT volumes were significantly larger than US (p < 0.0001) and MRI (p < 0.0001) volumes, but US and MRI volumes only differed in patients with hormonal manipulation (p = 0.049). The average magnitude of difference between the V100-CT vs. MRI is 3.1% (SD: 2.6, range, -10.3% to +10.1%), and D90-CT vs. MRI is 10.5 Gy (SD: 10.9, range: -37.6 to +41.6 Gy). The mean distance between the CT and MRI prostate base was 0.22 cm (SD: 0.2 cm, range 0.6 beyond to 0.4 below MRI base), and at the apex 0.54 cm (SD: 0.4, range 0.6 cm above to 1.4 cm beyond MRI apex). The CT prostate volume included 87% of the MRI prostate (range: 75-95%) but also included normal tissue (mean, 7.7 cc; range: 2.9 to17.1cc), an average increase of 24.6% over the MRI prostate volume (range: 9.2 to 49.8%). The differences in dosimetric parameters calculated from CT vs. MRI were not significantly affected by the use of hormonal manipulation. Results for all 50 cases will be presented.ConclusionsAlthough the standard DQs for postplan QA, on average, are not significantly different for CT vs. MR-based QA, 33% over-estimated D90 by > 10 Gy, re-categorizing 2 implants as inadequate and 3 as borderline. On average, only 87% of the MRI prostate is included in the CT contours while a large volume of normal tissue is erroneously included. Utilization of CT alone in QA alters the appreciation of true implant conformality, which inhibits recognition of substandard implants and weakens the utility of postplan QA as a technique improvement tool. Purpose/Objective(s)Postplan Quality Assessment (QA) is a vital tool in the assurance of high quality Prostate Brachytherapy (BT). Although a dose-response relationship exists for the dosimetric quantifier (DQ) D90, the validity of postplan QA using CT imaging has been questioned due to inter-observer contour variability. MRI allows more reproducible and robust prostate definition. We compared the CT postplans of 4 experienced brachytherapists with MRI-determined prostate volumes. Postplan Quality Assessment (QA) is a vital tool in the assurance of high quality Prostate Brachytherapy (BT). Although a dose-response relationship exists for the dosimetric quantifier (DQ) D90, the validity of postplan QA using CT imaging has been questioned due to inter-observer contour variability. MRI allows more reproducible and robust prostate definition. We compared the CT postplans of 4 experienced brachytherapists with MRI-determined prostate volumes. Materials/Methods50 patients had CT and MRI 1 month post Iodine-125 prostate BT. CT scans were contoured by the treating physician and dosimetry calculated as per provincial protocol. The prostate was contoured independently on MRI by one observer with extensive experience in MRI postplan QA. The scans were then fused and dosimetric parameters compared. 50 patients had CT and MRI 1 month post Iodine-125 prostate BT. CT scans were contoured by the treating physician and dosimetry calculated as per provincial protocol. The prostate was contoured independently on MRI by one observer with extensive experience in MRI postplan QA. The scans were then fused and dosimetric parameters compared. ResultsOf the first 30 patients analyzed, 14 had hormonal manipulation (13 with LHRH agonist, 1 with dutaseride) for an average of 25 weeks (range 12 to 44) before BT. Four patients received pelvic radiotherapy completed 1 month before BT. CT volumes were significantly larger than US (p < 0.0001) and MRI (p < 0.0001) volumes, but US and MRI volumes only differed in patients with hormonal manipulation (p = 0.049). The average magnitude of difference between the V100-CT vs. MRI is 3.1% (SD: 2.6, range, -10.3% to +10.1%), and D90-CT vs. MRI is 10.5 Gy (SD: 10.9, range: -37.6 to +41.6 Gy). The mean distance between the CT and MRI prostate base was 0.22 cm (SD: 0.2 cm, range 0.6 beyond to 0.4 below MRI base), and at the apex 0.54 cm (SD: 0.4, range 0.6 cm above to 1.4 cm beyond MRI apex). The CT prostate volume included 87% of the MRI prostate (range: 75-95%) but also included normal tissue (mean, 7.7 cc; range: 2.9 to17.1cc), an average increase of 24.6% over the MRI prostate volume (range: 9.2 to 49.8%). The differences in dosimetric parameters calculated from CT vs. MRI were not significantly affected by the use of hormonal manipulation. Results for all 50 cases will be presented. Of the first 30 patients analyzed, 14 had hormonal manipulation (13 with LHRH agonist, 1 with dutaseride) for an average of 25 weeks (range 12 to 44) before BT. Four patients received pelvic radiotherapy completed 1 month before BT. CT volumes were significantly larger than US (p < 0.0001) and MRI (p < 0.0001) volumes, but US and MRI volumes only differed in patients with hormonal manipulation (p = 0.049). The average magnitude of difference between the V100-CT vs. MRI is 3.1% (SD: 2.6, range, -10.3% to +10.1%), and D90-CT vs. MRI is 10.5 Gy (SD: 10.9, range: -37.6 to +41.6 Gy). The mean distance between the CT and MRI prostate base was 0.22 cm (SD: 0.2 cm, range 0.6 beyond to 0.4 below MRI base), and at the apex 0.54 cm (SD: 0.4, range 0.6 cm above to 1.4 cm beyond MRI apex). The CT prostate volume included 87% of the MRI prostate (range: 75-95%) but also included normal tissue (mean, 7.7 cc; range: 2.9 to17.1cc), an average increase of 24.6% over the MRI prostate volume (range: 9.2 to 49.8%). The differences in dosimetric parameters calculated from CT vs. MRI were not significantly affected by the use of hormonal manipulation. Results for all 50 cases will be presented. ConclusionsAlthough the standard DQs for postplan QA, on average, are not significantly different for CT vs. MR-based QA, 33% over-estimated D90 by > 10 Gy, re-categorizing 2 implants as inadequate and 3 as borderline. On average, only 87% of the MRI prostate is included in the CT contours while a large volume of normal tissue is erroneously included. Utilization of CT alone in QA alters the appreciation of true implant conformality, which inhibits recognition of substandard implants and weakens the utility of postplan QA as a technique improvement tool. Although the standard DQs for postplan QA, on average, are not significantly different for CT vs. MR-based QA, 33% over-estimated D90 by > 10 Gy, re-categorizing 2 implants as inadequate and 3 as borderline. On average, only 87% of the MRI prostate is included in the CT contours while a large volume of normal tissue is erroneously included. Utilization of CT alone in QA alters the appreciation of true implant conformality, which inhibits recognition of substandard implants and weakens the utility of postplan QA as a technique improvement tool." @default.
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• W4253053400 date "2010-11-01" @default.
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• W4253053400 title "Implications of CT-imaging for Postplan Quality Assessment in Prostate Brachytherapy" @default.
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