Measurement uncertainty and prostate seed brachytherapy gregory

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Leishman Associates

Health & Medicine Business

Measurement uncertainty and
prostate seed brachytherapy
Presented by Kent Gregory
Department of Medical Physics
Royal Adelaide Hospital
Kent Gregory, John E. Pattison, Giovanni Bibbo

What is a prostate seed implant?
c/o NY Times website

Post-implant: in OR
melbourneprostate.org

Post-implant: some hours later
melbourneprostate.org

How is implant quality assessed?
One indicator is the value of D90…

How is implant quality assessed?
Interpreting D90 values…
•>130 Gray = good treatment
•110-130 Gray = closer assessment
•<110 Gray = may need top-up

Most implants are assessed using CT
images…

However RAH ‘Fuses’ Ultrasound contours
onto CT images

Schiffler Cancer Centre (USA)
~1500 implants between 1995 and 2006, 55 biochemical failures to 2008

The correlation between D90 value and
biochemical failure seems poor.
Q1. What factors contribute to D90 uncertainty?
Q2. What is the uncertainty of D90?
Q3. Can we make better use of clinical resources?

Q1: What factors contribute to D90 uncertainty?
• Seed activity
• Hardware cal.
• Seed placement
• Fusion match
• CT contouring
• 30 mins (1 MP)
• 15 mins (2 MPs)
• 60 mins (3 medical + 5 staff)
• 15 min (1 MP)
• 20 min (1 medical, 1 MP)

Q2: What is the uncertainty of D90?
• Seed activity
• Hardware cal.
• Seed placement
• Fusion match
• CT contouring
• 2%
• 2%
• 3%
• ? %
• 10%
Han et al., Med Phys, Vol.
30, No. 6, June 2003

CT contouring results
80
90
100
110
120
130
140
150
160
170
180
0
1
2
3
4
5
6
7
8
9
10
Patient
D90 (Gray)

CT contouring & KG fusion
80
90
100
110
120
130
140
150
160
170
180
0
1
2
3
4
5
6
7
8
9
10
Patient
D90 (Gray)

CT contouring & all fusion
80
90
100
110
120
130
140
150
160
170
180
0
1
2
3
4
5
6
7
8
9
10
Patient
D90 (Gray)

Q2: What is the uncertainty of D90?
• Seed activity
• Hardware cal.
• Seed placement
• Fusion match
• CT contouring
• 2%
• 2%
• 3%
• 9% + Oedema
• 10%
Han et al., Med Phys, Vol.
30, No. 6, June 2003

Conclusions
• Even preliminary analysis of data indicates
D90 values have large uncertainties, due
mainly to the contouring or fusion step
• Lower D90 uncertainty may be achieved if
MR images are used
• D90 uncertainty may be improved if more
time is invested getting MR images, and less
time with seed placement

Thank you!
Acknowledgements
•A/Prof Loredana Marcu
(Senior Medical Physicist, Royal Adelaide Hospital)
•Dr Raghu Gowda
(Radiation Oncologist , Royal Adelaide Hospital)
•And the rest of the Brachytherapy team at
RAH

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