Biomedical subjects

M Zaider

Publications and source records attributed to M Zaider.

At least 19 recordsLinked to original sources

PubMed2006

MIDN: a spacecraft microdosimeter mission.

MIDN (MIcroDosimetry iNstrument) is a payload on the MidSTAR-I spacecraft (Midshipman Space Technology Applications Research) under development at the United States Naval Academy. MIDN is a solid-state system being designed and constructed to measure microdosimetric spectra to determine radiation quality factors for space environments. Radiation is a critical threat to the health of astronauts and to the success of missions in low-Earth orbit and space exploration. The system will consist of three separate sensors, one external to the spacecraft, one internal and one embedded in polyethylene. Design goals are mass <3 kg and power <2 W. The MidSTAR-I mission in 2006 will provide an opportunity to evaluate a preliminary version of this system. Its low power and mass makes it useful for the International Space Station and manned and unmanned interplanetary missions as a real-time system to assess and alert astronauts to enhanced radiation environments.

Cosmic Radiation↗

PubMed2006

Miniature semiconductor detectors for in vivo dosimetry.

Silicon mini-semiconductor detectors are found in wide applications for in vivo personal dosimetry and dosimetry and microdosimetry of different radiation oncology modalities. These applications are based on integral and spectroscopy modes of metal oxide semiconductor field effect transistor and silicon p-n junction detectors. The advantages and limitations of each are discussed.

Equipment Design↗

PubMed2005

The three-dimensional scintillation dosimetry method: test for a 106Ru eye plaque applicator.

The need for fast, accurate and high resolution dosimetric quality assurance in radiation therapy has been outpacing the development of new and improved 2D and 3D dosimetry techniques. This paper summarizes the efforts to create a novel and potentially very fast, 3D dosimetry method based on the observation of scintillation light from an irradiated liquid scintillator volume serving simultaneously as a phantom material and as a dose detector medium. The method, named three-dimensional scintillation dosimetry (3DSD), uses visible light images of the liquid scintillator volume at multiple angles and applies a tomographic algorithm to a series of these images to reconstruct the scintillation light emission density in each voxel of the volume. It is based on the hypothesis that with careful design and data processing, one can achieve acceptable proportionality between the local light emission density and the locally absorbed dose. The method is applied to a Ru-106 eye plaque immersed in a 16.4 cm3 liquid scintillator volume and the reconstructed 3D dose map is compared along selected profiles and planes with radiochromic film and diode measurements. The comparison indicates that the 3DSD method agrees, within 25% for most points or within approximately 2 mm distance to agreement, with the relative radiochromic film and diode dose distributions in a small (approximately 4.5 mm high and approximately 12 mm diameter) volume in the unobstructed, high gradient dose region outside the edge of the plaque. For a comparison, the reproducibility of the radiochromic film results for our measurements ranges from 10 to 15% within this volume. At present, the 3DSD method is not accurate close to the edge of the plaque, and further than approximately 10 mm (<10% central axis depth dose) from the plaque surface. Improvement strategies, considered important to provide a more accurate quick check of the dose profiles in 3D for brachytherapy applicators, are discussed.

Brachytherapy↗

PubMed2003

Intraoperative dynamic dosimetry for prostate implants.

This paper describes analytic tools in support of a paradigm shift in brachytherapy treatment planning for prostate cancer--a shift from standard pre-planning to intraoperative planning using dosimetric feedback based on the actual deposited seed positions within the prostate. The method proposed is guided by several desiderata: (a) bringing both planning and evaluation in the operating room (i.e. make post-implant evaluation superfluous) therefore making rectifications--if necessary--still achievable; (b) making planning and implant evaluation consistent by using the same imaging system (ultrasound); and (c) using only equipment commonly found in a hospital operating room. The intraoperative dosimetric evaluation is based on the fusion between ultrasound images and 3D seed coordinates reconstructed from fluoroscopic projections. Automatic seed detection and registration of the fluoroscopic and ultrasound information, two of the three key ingredients needed for the intraoperative dynamic dosimetry optimization (IDDO), are explained in detail. The third one, the reconstruction of 3D coordinates from projections, was reported in a previous article. The algorithms were validated using a custom-designed phantom with non-radioactive (dummy) seeds. Also, fluoroscopic images were taken at the conclusion of an actual permanent prostate implant and compared with data on the same patient obtained from radiographic-based post-implant evaluation. To offset the effect of organ motion the comparison was performed in terms of the proximity function of the two seed distributions. The agreement between the intra- and post-operative seed distributions was excellent.

Algorithms↗

PubMed2002

Optimal needle arrangement for intraoperative planning in permanent I-125 prostate implants.

One limitation of intraoperative planning of permanent prostate implants is that needles must already be in the gland before planning images are acquired. Improperly placed needles often restrict the capability of generating optimal seed placement. We developed guiding principles for the proper layout of needles within the treatment volume. The Memorial Sloan-Kettering Cancer Center planning system employs a genetic algorithm to find the optimal seed implantation pattern consistent with pre-assigned constraints (needle geometry, uniformity, conformity and the avoidance of high doses to urethra and rectum). Ultrasound volumes for twelve patients with 1-125 implants were used to generate six plans per patient (total 72 plans) with different needle arrangements. The plans were evaluated in terms of V100 (percentage prostate volume receiving at least the prescription dose), U135 (percentage urethra volume receiving at least 135% of prescription dose), and CI (conformity index, the ratio of treatment volume to prescription dose volume.) The method termed POSTCTR, in which needles were placed on the periphery of the largest ultrasound slice and posterior central needles were placed as needed, consistently gave superior results for all prostate sizes. Another arrangement, labelled POSTLAT, where the needles were placed peripherally with additional needles in the posterior lateral lobes, also gave satisfactory results. We advocate two needle arrangements, POSTCTR and POSTLAT, with the former giving better results.

Algorithms↗

PubMed2002

Operator-free, film-based 3D seed reconstruction in brachytherapy.

In brachytherapy implants, the accuracy of dose calculation depends on the ability to localize radioactive sources correctly. If performed manually using planar images, this is a time-consuming and often error-prone process-primarily because each seed must be identified on (at least) two films. In principle, three films should allow automatic seed identification and position reconstruction; however, practical implementation of the numerous algorithms proposed so far appears to have only limited reliability. The motivation behind this work is to create a fast and reliable system for real-time implant evaluation using digital planar images obtained from radiotherapy simulators, or mobile x-ray/fluoroscopy systems. We have developed algorithms and code for 3D seed coordinate reconstruction. The input consists of projections of seed positions in each of three isocentric images taken at arbitrary angles. The method proposed here consists of a set of heuristic rules (in a sense, a learning algorithm) that attempts to minimize seed misclassifications. In the clinic, this means that the system must be impervious to errors resulting from patient motion as well as from finite tolerances accepted in equipment settings. The software program was tested with simulated data, a pelvic phantom and patient data. One hundred and twenty permanent prostate implants were examined (105 125I and 15 103Pd) with the number of seeds ranging from 35 to 138 (average 79). The mean distance between actual and reconstructed seed positions is in the range 0.03-0.11 cm. On a Pentium III computer at 600 MHz the reconstruction process takes 10-30 s. The total number of seeds is independently validated. The process is robust and able to account for errors introduced in the clinic.

Algorithms↗

PubMed2002

Solid state microdosimetry in hadron therapy.

A report of recent developments in silicon microdosimetry is presented. SOI based microdosemeters have shown promise as a viable alternative to traditional tissue-equivalent proportional counters. The application of these silicon microdosemeters to such radiation therapy modalities as boron neutron capture therapy (BNCT), boron neutron capture synovectomy (BNCS), proton therapy (PT), and fast neutron therapy (FNT) has been performed. Several shortcomings of the current silicon microdosemeter were identified and will be taken into account in the design of a second-generation device.

Boron Neutron Capture Therapy↗

PubMed2001

The American Brachytherapy Society recommendations for brachytherapy of soft tissue sarcomas.

PURPOSE: This report presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with soft tissue sarcoma. METHODS AND MATERIALS: Members of the ABS with expertise in soft tissue sarcoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. RESULTS: Brachytherapy used alone or in combination with external beam irradiation is an established means of safely providing adjuvant local treatment after resection for soft tissue sarcomas in adults and in children. Brachytherapy options include low dose rate techniques with iridium 192 or iodine 125, fractionated high dose rate brachytherapy, or intraoperative high dose rate therapy. Recommendations are made for patient selection, techniques, dose rates, and dosages. Complications and possible interventions to minimize their occurrence and severity are reviewed. CONCLUSION: Brachytherapy represents an effective means of enhancing the therapeutic ratio, offering both biologic and dosimetric advantage in the treatment of patients with soft tissue sarcoma. The treatment approach used depends upon the institution, physician expertise, and the clinical situation. Guidelines are established for the use of brachytherapy in the treatment of soft tissue sarcomas in adults and in children. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose-reporting policies. These guidelines will be modified, as further clinical results become available.

Adult↗

PubMed2001

On the determination of an effective planning volume for permanent prostate implants.

PURPOSE: In current practice, planning for prostate brachytherapy is based on the state of the prostate at a particular instant in time. Because treatment occurs over an extended period, changes in the prostate volume (gland shrinkage) and seed displacement lead to disagreement between planned dosimetry to the prostate and the dose actually received by the prostate. Discrepancies between planned and actual dose to the rectum and urethra also occur. The purpose of this study is to investigate the possibility of defining an "effective planning volume" that compensates for changes in prostate volume and seed displacement. METHODS AND MATERIALS: Waterman's formula is used to estimate prostate shrinkage and seed displacement. The prostate volume and potential seed positions at days 0, 6, 12, 18, 24, and 30 are used in formulating time-dependent dosimetric treatment planning models. Both single-period and multi-period models are proposed and analyzed. A state-of-the-art computational engine generates unbiased, high-quality treatment plans in a matter of minutes. Plans are evaluated using coverage and conformity indices computed at specific times over a period of 30 days. The models allow dose to urethra and rectum to be strictly controlled at specific instants in time, or throughout the 30-day horizon. RESULTS: For plans generated from the single-period models-based on projected prostate volumes and potential seed positions on days t = 0, 6, 12, 18, 24, 30, respectively-as t increases, the conformity index improves while the coverage worsens. In particular, the best coverage and worst conformity are achieved for the plan generated using t = 0 (day 0) information. This plan provides over 99% coverage over the entire 30-day period, and while it has initial conformity index 1.24, the conformity index climbs to 1.58 by day 30. Conversely, the worst coverage and best conformity are achieved when the plan is generated using projected information from t = 30 (day 30). Plans based on projected data at day 30 yield an initial coverage of only 84%, with conformity scores less than 1.34 over the entire 30-day period. Among the multi-period plans, with the exception of the two-period plan obtained using day 0 and projected day 6 data, the average coverage is 98% while conformity indices below 1.46 are maintained throughout the 30-day horizon. Excessive dose to the urethra and rectum is observed when only day 0 dosimetric and volumetric data are imposed in the planning procedure. In this case, by day 30, 89% of urethra volume receives dose in excess of 120% of the remaining prescription dose. Similarly, 40% of rectum volume receives dose in excess of the prescribed upper dose bound of 78% of the remaining prescription dose. When multi-period dosimetric constraints for urethra and rectum are imposed, dose to these structures is controlled throughout the 30-day period. CONCLUSIONS: A planning method that takes into account prostate shrinkage and seed displacement over time can be used to adjust the balance between coverage and conformity. Incorporating projected future volumetric information is useful in providing more conformal plans, in some cases improving conformity by as much as 21% while sacrificing roughly 7% of initial coverage. Evidence of possible morbidity reduction to urethra and rectum via the use of multi-period dosimetric constraints on these structures is demonstrated. Among all plans considered, the plan obtained via the six-period model provides the best coverage and conformity over the 30-day horizon.

Brachytherapy↗

PubMed2001

Solid state microdosimetry.

A review of solid state microdosimetry is presented with an emphasis on silicon-based devices. The historical foundations and basics of microdosimetry are briefly provided. Various methods of experimental regional microdosimetry are discussed to facilitate a comparison with the more recent development of silicon microdosimetry. In particular, the performance characteristics of a proportional gas counter and a silicon microdosimeter are compared. Recent improvements in silicon microdosimetry address the issues of requirement specification, non-spherical shape, tissue equivalence, sensitive volume definition (charge collection complexity) and low noise requirements which have previously impeded the implementation of silicon-based microdosimetry. A prototype based on silicon-on-insulator technology is described along with some example results from clinical high LET radiotherapy facilities. A brief summary of the applications of microdosimetry is included.

Equipment Design↗

PubMed2001

Distribution of the number of clonogens surviving fractionated radiotherapy: a long-standing problem revisited.

PURPOSE: A long-standing problem is addressed: what form of the probability distribution for the number of clonogenic tumor cells remaining after fractionated radiotherapy should be used in the analysis aimed at evaluating the efficacy of cancer treatment? Over a period of years, a lack of theoretical results leading to a closed-form analytic expression for this distribution, even under very simplistic models of cell kinetics in the course of fractionated radiotherapy, was the most critical deterrent to the development of relevant methods of data analysis. MATERIALS AND METHODS: Rigorous mathematical results associated with a model of fractionated irradiation of tumors based on the iterated birth and death stochastic process are discussed. RESULTS: A formula is presented for the exact distribution of the number of clonogenic tumor cells at the end of treatment. It is shown that, under certain conditions, this distribution can be approximated by a Poisson distribution. An explicit formula for the parameter of the limiting Poisson distribution is given and sample computations aimed at evaluation of the convergence rate are reported. Another useful limit that retains a dose-response relationship in the distribution of the number of clonogens has been found. Practical implications of the key theoretical findings are discussed in the context of survival data analysis. CONCLUSIONS: This study answers some challenging theoretical questions that have been under discussion over a number of years. The results presented in this work provide mechanistic motivation for parametric regression models designed to analyze data on the efficacy of radiation therapy.

Humans↗

PubMed2001

A survival model for fractionated radiotherapy with an application to prostate cancer.

This paper explores the applicability of a mechanistic survival model, based on the distribution of clonogens surviving a course of fractionated radiation therapy, to clinical data on patients with prostate cancer. The study was carried out using data on 1,100 patients with clinically localized prostate cancer who were treated with three-dimensional conformal radiation therapy. The patients were stratified by radiation dose (group 1: <67.5 Gy; group 2: 67.5-72.5 Gy; group 3: 72.5-77.5 Gy; group 4: 77.5-87.5 Gy) and prognosis category (favourable, intermediate and unfavourable as defined by pre-treatment PSA and Gleason score). A relapse was recorded when tumour recurrence was diagnosed or when three successive prostate specific antigen (PSA) elevations were observed from a post-treatment nadir PSA level. PSA relapse-free survival was used as the primary end point. The model, which is based on an iterated Yule process, is specified in terms of three parameters: the mean number of tumour clonogens that survive the treatment, the mean of the progression time of post-treatment tumour development and its standard deviation. The model parameters were estimated by the maximum likelihood method. The fact that the proposed model provides an excellent description both of the survivor function and of the hazard rate is prima facie evidence of the validity of the model because closeness of the two survivor functions (empirical and model-based) does not generally imply closeness of the corresponding hazard rates. The estimated cure probabilities for the favourable group are 0.80, 0.74 and 0.87 (for dose groups 1-3, respectively); for the intermediate group: 0.25, 0.51, 0.58 and 0.78 (for dose groups 1-4, respectively) and for the unfavourable group: 0.0, 0.27, 0.33 and 0.64 (for dose groups 1-4, respectively). The distribution of progression time to tumour relapse was found to be independent of prognosis group but dependent on dose. As the dose increases the mean progression time decreases (41, 28.5, 26.2 and 14.7 months for dose groups 1-4, respectively). This analysis confirms that, in terms of cure rate, dose escalation has a significant positive effect only in the intermediate and unfavourable groups. It was found that progression time is inversely proportional to dose, which means that patients recurring in higher dose groups have shorter recurrence times, yet these groups have better survival, particularly long-term. The explanation for this seemingly illogical observation lies in the fact that less aggressive tumours, potentially recurring after a long period of time, are cured by higher doses and do not contribute to the recurrence pattern. As a result, patients in higher dose groups are less likely to recur; however, if they do, they tend to recur earlier. The estimated hazard rates for prostate cancer pass through a clear-cut maximum, thus revealing a time period with especially high values of instantaneous cancer-specific risk; the estimates appear to be nonproportional across dose strata.

Disease-Free Survival↗

PubMed2001

The measurement of three dimensional dose distribution of a ruthenium-106 ophthalmological applicator using magnetic resonance imaging of BANG polymer gels.

The BANG (MGS Research Inc., Guilford, CT) polymer gel has been used as a dosimeter to determine the three-dimensional (3D) dose distribution of a ruthenium-106 (Ru-106) ophthalmologic applicator. An eye phantom made of the BANG gel was irradiated with the Ru-106 source for up to 1 h. The phantom and a set of calibration vials were scanned simultaneously in a GE 1.5 T MR imager using the Hahn spin-echo pulse sequence with a TR of 2000 ms and two TEs of 20 ms and 100 ms. The T(2) values were evaluated on a pixel-by-pixel basis using custom-built software on a DEC alpha workstation and converted to dose using calibration data. Depth doses and isodose lines of the Ru-106 eye-plaque were generated. It is concluded that the BANG gel dosimetry offers the potential for measuring the 3D dose distributions of an ophthalmologic applicator, with high spatial resolution and relatively good accuracy.

Brachytherapy↗

PubMed2001

Change on the horizontal and vertical meridians of the cornea after cataract surgery.

PURPOSE: To compare the course and magnitude of change on the horizontal and vertical meridians of the cornea after 5 different incisions for cataract: extracapsular cataract extraction (ECCE), 6 mm superior scleral tunnel (6Sup), 3 mm superior scleral tunnel (3Sup), 3 mm temporal scleral tunnel (3Temp), and 3 mm temporal corneal incision (3Cor). METHODS: Retrospective chart review of 665 cases of preoperative regular astigmatism. The preoperative keratometry (K) reading was subtracted from the postoperative K reading to determine mean net change on each meridian at 1 day, 1 week, 2 weeks, 1 month, 1.5 months, 2 months, 4 months, 6 months and 12 months and at 6 month intervals thereafter. After the superior incisions, the temporal changes on each meridian are well described by an analytic model with an initial and final plateau. The changes after the temporal incisions are described by a linear equation. RESULTS: After each superior incision, the steepness and length of the transition from the initial to final plateau for each meridian depend on incision length. Considering the uncertainty of measuring K, the corneal meridians stabilized 4.5 months after ECCE, 1.2 months after 6Sup, and 0.3 months after 3Sup. No significant change was detected on the horizontal and vertical meridians after 3Temp and 3Cor. CONCLUSION: The magnitude and the duration of changes on the horizontal and vertical meridians of the cornea after cataract surgery depend on both incision length and location. Small temporal incisions induce less change than superior incisions.

Adult↗

PubMed2000

An independent dose-to-point calculation program for the verification of high-dose-rate brachytherapy treatment planning.

PURPOSE: We describe computer software that performs, quickly and accurately, secondary dose calculations for high-dose-rate (HDR) treatment plans, including those employed for prostate treatments. METHODS: The program takes as primary input the data file used by the HDR remote afterloader console for treatment. Dosimetric calculations are performed using the Meisberger polynomial and the anisotropy table for the HDR Iridium-192 source. For standard applicators, treatment geometry is automatically reconstructed and the dose is calculated at relevant reference point(s). Template-based treatment plans (e.g., prostate) require additional user input; the dose calculation is then performed at user-selected reference points. A total dwell time calculation for volume and planar implants using the Manchester tables was also implemented. RESULTS: For fixed-geometry HDR procedures, secondary dose calculations are within 2% of the treatment plan, and results are available for review instantly. For more general applications, the calculated and planned doses are typically within 3% at the prescription isodose line. The Manchester-based dwell time calculation is within 10% of the planned time.

Algorithms↗

PubMed2000

Postimplantation dosimetric analysis of permanent transperineal prostate implantation: improved dose distributions with an intraoperative computer-optimized conformal planning technique.

PURPOSE: To compare the target coverage and dose to normal tissues after I-125 transperineal permanent implantation (TPI) of the prostate in 90 patients treated with one of three different transperineal techniques. METHODS AND MATERIALS: Detailed postimplant dosimetric evaluations of permanent I-125 implantation procedures were performed on 30 consecutive patients treated between 1995-1996 who underwent TPI using a preplanning CT-based technique, on 30 consecutive patients treated in 1997-1998 who underwent an ultrasound-guided approach with intraoperative determination of seed distribution based on an I-125 nomogram, and on 30 consecutive patients in 1998-1999 who underwent TPI with intraoperative computer-based 3-dimensional conformal optimization. For all three techniques, postimplant CT scans were obtained 4-6 hours after TPI. Dosimetric parameters included V(100), V(90), V(150), D(100), D(90), D(80), as well as maximal and average doses to the urethra and rectal wall. These parameter outcomes are reported as a percentage of the prescription dose. RESULTS: The intraoperative 3D-optimized technique (I-3D) provided superior target coverage with the prescription dose for all dosimetric variables evaluated compared to the other treatment techniques. The median V(100), V(90), and D(90) values for the I-3D technique were 96%, 98%, and 116%, respectively. In contrast, the V(100), V(90), and D(90) values for the CT preplan and ultrasound manual optimization approaches were 86%, 89%, and 88%, respectively and 88%, 92%, and 94%, respectively (I-3D versus other techniques: p < 0.001). The superior target coverage with the I-3D technique was also associated with a higher cumulative implant activity required by the optimization program. A multivariate analysis determined that the treatment technique (I-3D versus other approaches) was an independent predictor of improved target coverage for each parameter analyzed (p < 0.001). In addition, higher cumulative implant activities and smaller prostate target volumes were independent predictors of improved target coverage. The maximum and average urethral doses were significantly lower with the I-3D technique compared to the other techniques; a modest increase in the average rectal dose was also observed with this approach. CONCLUSION: Three-dimensional intraoperative computer optimized TPI consistently provided superior target coverage with the prescription dose and significantly lower urethral doses compared to two other techniques used. These data provide proof-of-principle that improved therapeutic ratios can be achieved with the integration of more sophisticated intraoperative planning for TPI and may potentially have a profound impact on the outcome of patients treated with this modality.

Algorithms↗

PubMed2000

Treatment-plan optimization for soft-tissue sarcoma brachytherapy using a genetic algorithm.

PURPOSE: To describe a treatment-plan optimization system for temporary implant of soft-tissue sarcomas using a genetic algorithm, and evaluate its potential advantages over manual planning. METHODS AND MATERIALS: A planning system that optimizes the distribution of radioactive seeds needed for adequate coverage of the target in the treatment of soft-tissue sarcomas has been designed and implemented. The treatment-planning procedures include simulation, film digitization, target-volume definition, optimized planning, and plan evaluation. The input to the optimization program consists of seed coordinates reconstructed from isocentric films, prescription points, and a list of available seed activities. The optimization is performed using a genetic algorithm. RESULTS: Case studies are presented, which compare plans generated by computer optimization or by trial and error (manually). As expected, computer-optimized plans are often (but not always) superior to manual plans. This is particularly evident for situations where (unavoidably) catheters are far apart or irregularly spaced, in which case the advantages of optimized planning in terms of tumor coverage can be quite dramatic. When the target volume is well contained, the optimized plan minimizes the dose to normal tissue. Computer-based optimization has the additional advantage of being much faster than manual planning; this is valuable because it often reduces the total time the patient will spend in the hospital before implantation. CONCLUSION: Optimized planning with a genetic algorithm and seeds of different activities significantly improves planning efficiency and generally results in improved plan quality. The utility of this optimization system is not limited to sarcoma implants.

Adult↗

PubMed2000

Treatment planning for prostate implants using magnetic-resonance spectroscopy imaging.

PURPOSE: Recent studies have demonstrated that magnetic-resonance spectroscopic imaging (MRSI) of the prostate may effectively distinguish between regions of cancer and normal prostatic epithelium. This diagnostic imaging tool takes advantage of the increased choline plus creatine versus citrate ratio found in malignant compared to normal prostate tissue. The purpose of this study is to describe a novel brachytherapy treatment-planning optimization module using an integer programming technique that will utilize biologic-based optimization. A method is described that registers MRSI to intraoperative-obtained ultrasound images and incorporates this information into a treatment-planning system to achieve dose escalation to intraprostatic tumor deposits. METHODS: MRSI was obtained for a patient with Gleason 7 clinically localized prostate cancer. The ratios of choline plus creatine to citrate for the prostate were analyzed, and regions of high risk for malignant cells were identified. The ratios representing peaks on the MR spectrum were calculated on a spatial grid covering the prostate tissue. A procedure for mapping points of interest from the MRSI to the ultrasound images is described. An integer-programming technique is described as an optimization module to determine optimal seed distribution for permanent interstitial implantation. MRSI data are incorporated into the treatment-planning system to test the feasibility of dose escalation to positive voxels with relative sparing of surrounding normal tissues. The resultant tumor control probability (TCP) is estimated and compared to TCP for standard brachytherapy-planned implantation. RESULTS: The proposed brachytherapy treatment-planning system is able to achieve a minimum dose of 120% of the 144 Gy prescription to the MRS positive voxels using (125)I seeds. The preset dose bounds of 100-150% to the prostate and 100-120% to the urethra were maintained. When compared to a standard plan without MRS-guided optimization, the estimated TCP for the MRS-optimized plan is superior. The enhanced TCP was more pronounced for smaller volumes of intraprostatic tumor deposits compared to estimated TCP values for larger lesions. CONCLUSIONS: Using this brachytherapy-optimization system, we could demonstrate the feasibility of MRS-optimized dose distributions for (125)I permanent prostate implants. Based on probability estimates of anticipated improved TCP, this approach may have an impact on the ability to safely escalate dose and potentially improve outcome for patients with organ-confined but aggressive prostatic cancers. The magnitude of the TCP enhancement, and therefore the risks of ignoring the MR data, appear to be more substantial when the tumor is well localized; however, the gain achievable in TCP may depend quite considerably on the MRS tumor-detection efficiency.

Algorithms↗