Abstract
Purpose
Brachytherapy is an important mode of breast cancer treatment; however, improvements in both treatment planning and delivery are needed. In order to meet these specific needs, integration of pre-operative imaging, supplemented by computerized surgical planning and mathematical optimization were used to develop and test an intra-operative immobilization and catheter guidance system.
Method
A custom template specific to each patient with optimally placed guide holes for catheter insertion was designed and fabricated. Creation of the template is based on a virtual reality reconstruction of the patient’s anatomy from computed tomography imaging. The template fits on the patient’s breast, immobilizing the soft tissue, and provides pre-planned catheter insertion holes for guidance to the tumor site. Agar-based phantom and target models were used for quantitative validation of the template by ascertaining the precision and accuracy of the templates.
Results
Tests were performed on agar-based tissue models using computed tomography imaging for template planning and validation. Planned catheter tracks were compared to post-insertion image data and distance measurements from target location were used to create an error measure. Initial results yielded an average error of 4.5mm. Once the workflow and template design were improved, an average error of 2.6mm was observed, bringing the error close to a clinically acceptable range.
Conclusion
Use of a patient-specific template for breast brachytherapy is feasible and may improve the procedure accuracy and outcome.
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References
Tice JA (2008) “Brachytherapy as primary radiation following breast-conserving surgery for stage i or ii breast cancer”. Tech Rep. California Technology Assessment Forum
Wong R, Ngan RKC, Tang F (2005) Wide-volume partial breast interstitial brachytherapy alone after lumpectomy in breast-conserving treatment for early breast cancer. J HK Coll Radiology 8: 256–260
Devlin, PM (eds) (2007) Brachytherapy Applications and Techniques, ch Breast Brachytherapy. Lippincott Williams and Wilkins, Philadelphia, PA
Verhey LJ (1995) Immobilizing and positioning patients for radiotherapy. Semin Radiat Oncol 5(2): 100–114
Mitchell J, Formenti SC, DeWyngaert JK (2010) Interfraction and intrafraction setup variability for prone breast radiation therapy. Int J Radiat Oncol Biology Phys 76(5): 1571–1577
McKinnon R, Christie D, Peres H, Burke M, Le T, Lah M (2009) The prone technique for breast irradiation—is it ready for clinical trials?. The Breast 18(1): 30–34
Kudchadker R, Ha C, Stokes C, Kirsner S, Wilder R (2006) “2834: Breast dose reduction in women undergoing mediastinal radiotherapy using a custom prone immobilization device”. Int J Radiat Oncol 66(3, Supplement 1), S679–S679. Proceedings of the 48th annual meeting of the American society for therapeutic radiology and oncology, 48th annual meeting of the American society for therapeutic radiology and oncology
Hafez MA, Chelule KL, Seedhom BB, Sherman KP (2006) Computer-assisted total knee arthroplasty using patient-specific templating. Clin Orthop Relat Res 444: 184–192
Kunz M, Rudan JF, Xenoyannis GL, Ellis RE (2010) Computer-assisted hip resurfacing using individualized drill templates. J of Arthroplast 25(4): 600–606
Owen BD, Christensen GE, Reinhardt JM, Ryken TC (2007) Rapid prototype patient-specific drill template for cervical pedicle screw placement. Comput Aided Surg 12(5): 303–308
Lu S, Xu YQ, Zhang YZ, Xie L, Guo H, Li DP (2009) A novel computer-assisted drill guide template for placement of C2 laminar screws. Eur Spine J 18: 379–1385
Radermacher K, Portheine F, Anton M et al (1998) Computer assisted orthopaedic surgery with image based individual templates. Clin Orthop Relat Res 354: 28–38
Berry E, Cuppone M, Porada S et al (2005) Personalised image-based templates for intra-operative guidance. Proc Inst Mech Eng 219: 111–118
Lombardi A, Berend K, Adams J (2008) Patient-specific approach in total knee arthroplasty. Orthopedics 31(9): 927–930
Rajon DA, Bova FJ, Chi YY, Friedman WA (2009) Rapid fabrication of custom patient biopsy guides. J Appl Clin Med Phys 10(4): 2897
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Pompeu-Robinson, A., Kunz, M., Falkson, C.B. et al. Immobilization and catheter guidance for breast brachytherapy. Int J CARS 7, 65–72 (2012). https://doi.org/10.1007/s11548-011-0600-6
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DOI: https://doi.org/10.1007/s11548-011-0600-6