ABSTRACT
PURPOSE: High-dose-rate brachytherapy of the prostate is commonly performed using transrectal ultrasound (US) guidance, with CT imaging used for needle reconstruction and treatment planning. Transrectal ultrasound images can, however, be used for the entire process, allowing treatment without changes in the patient position. This study assesses needle reconstruction accuracy using US images. METHODS AND MATERIALS: Prostate phantoms were implanted with 10-18 needles. Three-dimensional US images were acquired, and needles were reconstructed using specialized software. A CT scan was also obtained. The image sets were registered and needle reconstruction errors were assessed. A dose plan was obtained using the US images and the dwell times were transferred to the CT reconstruction to obtain the true "delivered dose," which was evaluated using standard dosimetric parameters. RESULTS: Two sources of error were identified. First, reconstruction based on the bright echoes in the US images introduces a systematic error because these echoes correspond to the proximal wall of the needle, and not the center of the needle channel. If left uncorrected, this shift can lead to an underestimate of urethral doses. Second, incorrect needle tip identification can occur in the cranial-caudal direction. Errors up to 5.8mm were observed. A measurement of needle lengths protruding beyond the template can be used to compensate for this. CONCLUSIONS: Factors limiting the accuracy of US-based needle reconstruction have been identified. Once recognized, these errors can be corrected for, resulting in accurate implant geometry. This facilitates a treatment technique combining excellent anatomic definition, minimal prostate motion, and accurate dose planning and delivery.
Subject(s)
Brachytherapy/instrumentation , Brachytherapy/methods , Needles , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/radiotherapy , Ultrasonography, Interventional/methods , Computer Systems , Humans , Male , Phantoms, Imaging , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Radiotherapy Dosage , Reproducibility of Results , Sensitivity and Specificity , Ultrasonography, Interventional/instrumentationABSTRACT
PURPOSE: To investigate the therapeutic usefulness and cost-effectiveness of prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC) who had achieved a complete remission. METHODS: A retrospective chart review was undertaken of all patients diagnosed in Saskatchewan with SCLC between 1987 and 1998 inclusive. Patients who achieved a complete remission were divided into two groups, depending on whether they underwent PCI (PCI+ and PCI-, respectively). The quality-of-life-adjusted survival was estimated by the Q-TWiST method (quality time without symptoms and toxicity). The mean incremental costs per month of incremental OS were calculated in a cost-effectiveness analysis. RESULTS: Among the 98 complete remission patients, the median OS for PCI+ and PCI- patients was 20.0 and 19.0 months, respectively (p > 0.05, nonsignificant). The median disease-free survival was 14.7 and 10.0 months, respectively (p < 0.05). The difference in the mean Q-TWiST survival was significant (p < 0.01). The mean marginal cost was $18,834/PCI+ patient and $17,885/PCI- patient (p > 0.05, nonsignificant). The cost-effectiveness ratio was $70/mo of incremental OS if u(tox) and u(rel) (the utility coefficients to reflect the value of time in health states of toxicity and relapse) were assumed to be 1.0. CONCLUSION: PCI is a cost-effective treatment that improves the quality-of-life-adjusted survival for patients with a complete remission of SCLC.
