From Point A

to

Image Guided Brachytherapy

I-Chow Joe Hsu, MD

University of California San Francisco

Friday, April 1, 2011

ICRU 38 (1985)

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Radioth and Oncol 74, 235-45, 2005

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GYN GEC-ESTRO 2005

Intermediate RiskCTV

CTVat diagnosis

ICRU 3860 Gy

High risk CTV

Clinical finding

at diagnosis

High Risk

CTV

CTVat

brachytherapy

Pt A85 Gy

MRI based

T2 LesionGray Area

Cervix

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At Diagnosis

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At Brachytherapy

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A - Applicator

- Tumor

- Fibroid

A

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Radioth and Oncol 79:80-86, 2006

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Inverse Planning Simulated Annealing

IPSA

Lessard, Med. Phys., 2001(5) p773-9

Dose Objective Parameters Ranges:- No negative values accepted anywhere.

- Weights go from 0 to 200

- Maximum value for Dose (Min or Max) could be up to 5000 cGy

- Margin values are limited to 50 mm.

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IJROBP 63:1270-1274, 2005

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Brachytherapy 7:242-247, 2008

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IJROBP 75:1329-1334, 2009

LC

RC

OS

DFS

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GEC-ESTRO, 2011

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Image Guided BrachytherapyPart 1

• Contouring based on GEC-ESTRO definition

• MRI based whenever possible

• Optimization using IPSA or manual adaptation

• Contouring the ovoids/ring separately

• Control optimization > manual adjustment

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US Guided GYN Procedures

1994

Ultrasound guidance for placement of difficult

intracavitary implants

Rotmensch, J. et al, Gynecol Oncol, 54:159-62

1995

Transrectal and transperineal sonography during guided

intrauterine procedures

Fleischer, A, et al, J Ultrasound Med, 14:135-8

1997

A new technique for performing Syed-Neblett template

interstitial implants for gynecologic malignancies using

transrectal-ultrasound guidance

Stock, R, et al, IJROBP 37:819-25

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1

2

3

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Image Guided BrachytherapyPart 2

• TRUS with EUA prior to implant

• Using US image to compliment clinical exam

• Identify normal structure to help with

orientation

• Identify tumor when possible

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Syed - Neblett Template

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IJROBP 52:538-543, 2002

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Radiother Oncol 74:247-250, 2004

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IJROBP 65:624-630, 2006

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GYN TVUSTVUS

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Image Guided BrachytherapyPart 3

• Image Guided Brachytherapy requires

• Image guided placement of implant - US/CT/MR

• Interstitial implant +/- intracavitary applicator

• 3D image based planning

• Inverse optimization

• Future of Image Guided Brachytherapy

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