Abstract
In 2010, gynecologic malignancies were the 4th leading cause of death in U.S. women and for patients with extensive primary or recurrent disease, treatment with interstitial brachytherapy may be an option.However, brachytherapy requires precise insertion of hollow catheters with introducers into the tumor in order to eradicate the cancer. In this study, a software solution to assist interstitial gynecologic brachytherapy has been investigated and the software has been realized as an own module under (3D) Slicer, which is a free open source software platform for (translational) biomedical research. The developed research module allows on-time processing of intra-operative magnetic resonance imaging (iMRI) data over a direct DICOM connection to a MR scanner. Afterwards follows a multi-stage registration of CAD models of the medical brachytherapy devices (template, obturator) to the patient’s MR images, enabling the virtual placement of interstitial needles to assist the physician during the intervention.
Highlights
In 2010, gynecologic cancer – including cervical, endometrial, and vaginal/vulvar types – is with over 80,000 new cases and over 25,000 deaths the 4th leading cause of death in women in the United States (American Cancer Society 2010)
Brachytherapy enables the placement of radioactive sources direct inside the cancerous tissue that deliver very high doses of radiation and for interstitial gynecologic brachytherapy, catheters are guided into place through holes in a so called template (Figure 1, left) sutured to the patient’s perineum
The presented algorithm was compared to a standard approach, based on the mutual information of image intensity only showing that the registration error can be improved at important tissue interfaces, like the bladder with the clinical target volume (CTV), and the interface of the rectum with the uterus and cervix
Summary
In 2010, gynecologic cancer – including cervical, endometrial, and vaginal/vulvar types – is with over 80,000 new cases and over 25,000 deaths the 4th leading cause of death in women in the United States (American Cancer Society 2010). Brachytherapy enables the placement of radioactive sources direct inside the cancerous tissue that deliver very high doses of radiation and for interstitial gynecologic brachytherapy, catheters are guided into place through holes in a so called template (Figure 1, left) sutured to the patient’s perineum. A method for simultaneous non-rigid registration, segmentation, and tumor detection in MRI-guided cervical cancer radiation therapy using a unified Bayesian framework has recently been introduced by Lu et al (2012). The framework is able to handle the challenges of significant tumor regression and its effect on surrounding tissues and the proposed methods help with the delineation of the target volume and other structures of interest during the treatment of cervical cancer with external beam radiation therapy (EBRT). There, an overall image-guided therapy system for interstitial gynecologic brachytherapy in a multimodality operating suite was introduced)
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