Skip to main content
banner image
No data available.
Please log in to see this content.
You have no subscription access to this content.
No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.
The full text of this article is not currently available.
1.F. M. Khan and B. J. Gerbi, Treatment Planning in Radiation Oncology (Lippincott Williams & Wilkins, Philadelphia, PA, 2007).
2.C. Polgar, T. Major, J. Fodor, Z. Sulyok, A. Somogyi, K. Lovey, G. Nemeth, and M. Kasler, “Accelerated partial-breast irradiation using high-dose-rate interstitial brachytherapy: 12-year update of a prospective clinical study,” Radiother. Oncol. 94, 274279 (2010).
3.Y. Yamada, L. Rogers, D. J. Demanes, G. Morton, B. R. Prestidge, J. Pouliot, G. N. Cohen, M. Zaider, M. Ghilezan, I. C. Hsu, and American Brachytherapy Society, “American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy,” Brachytherapy 11, 2032 (2012).
4.A. N. Viswanathan, J. Szymonifka, C. M. Tempany-Afdhal, D. A. O’farrell, and R. A. Cormack, “A prospective trial of real-time magnetic resonance-guided catheter placement in interstitial gynecologic brachytherapy,” Brachytherapy 12, 240247 (2013).
5.S. Mesko, U. Swamy, S. J. Park, L. Borja, J. Wang, D. J. Demanes, and M. Kamrava, “Early clinical outcomes of ultrasound-guided CT-planned high-dose-rate interstitial brachytherapy for primary locally advanced cervical cancer,” Brachytherapy 14, 626632 (2015).
6.A. N. Viswanathan, R. Cormack, C. L. Holloway, C. Tanaka, D. O’Farrell, P. M. Devlin, and C. Tempany, “Magnetic resonance-guided interstitial therapy for vaginal recurrence of endometrial cancer,” Int. J. Radiat. Oncol., Biol., Phys. 66, 9199 (2006).
7.C. Kirisits, M. J. Rivard, D. Baltas, F. Ballester, M. De Brabandere, R. van der Laarse, Y. Niatsetski, P. Papagiannis, T. P. Hellebust, J. Perez-Calatayud, K. Tanderup, J. L. Venselaar, and F. A. Siebert, “Review of clinical brachytherapy uncertainties: Analysis guidelines of GEC-ESTRO and the AAPM,” Radiother. Oncol. 110, 199212 (2014).
8.K. Tanderup, A. N. Viswanathan, C. Kirisits, and S. J. Frank, “Magnetic resonance image guided brachytherapy,” Semin. Radiat. Oncol. 24, 181191 (2014).
9.C. Haie-Meder, R. Potter, E. Van Limbergen, E. Briot, M. De Brabandere, J. Dimopoulos, I. Dumas, T. P. Hellebust, C. Kirisits, S. Lang, S. Muschitz, J. Nevinson, A. Nulens, P. Petrow, N. Wachter-Gerstner, and G. E. C. E. W. G. Gynaecological, “Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV,” Radiother. Oncol. 74, 235245 (2005).
10.J. C. Dimopoulos, C. Kirisits, P. Petric, P. Georg, S. Lang, D. Berger, and R. Potter, “The Vienna applicator for combined intracavitary and interstitial brachytherapy of cervical cancer: Clinical feasibility and preliminary results,” Int. J. Radiat. Oncol., Biol., Phys. 66, 8390 (2006).
11.T. P. Hellebust, C. Kirisits, D. Berger, J. Perez-Calatayud, M. De Brabandere, A. De Leeuw, I. Dumas, R. Hudej, G. Lowe, R. Wills, K. Tanderup, and G. E. C. E. W. G. Gynaecological, “Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group: Considerations and pitfalls in commissioning and applicator reconstruction in 3D image-based treatment planning of cervix cancer brachytherapy,” Radiother. Oncol. 96, 153160 (2010).
12.S. Haack, S. K. Nielsen, J. C. Lindegaard, J. Gelineck, and K. Tanderup, “Applicator reconstruction in MRI 3D image-based dose planning of brachytherapy for cervical cancer,” Radiother. Oncol. 91, 187193 (2009).
13.N. Milickovic, S. Giannouli, D. Baltas, M. Lahanas, C. Kolotas, N. Zamboglou, and N. Uzunoglu, “Catheter autoreconstruction in computed tomography based brachytherapy treatment planning,” Med. Phys. 27, 10471057 (2000).
14.A. Y. Fung and M. Zaider, “Accuracy in catheter reconstruction in computed tomography planning of high dose rate prostate brachytherapy,” Med. Phys. 27, 21652167 (2000).
15.A. L. Damato, K. Townamchai, M. Albert, R. J. Bair, R. A. Cormack, J. Jang, A. Kovacs, L. J. Lee, K. S. Mak, K. L. Mirabeau-Beale, K. W. Mouw, J. G. Phillips, J. L. Pretz, A. L. Russo, J. H. Lewis, and A. N. Viswanathan, “Dosimetric consequences of interobserver variability in delineating the organs at risk in gynecologic interstitial brachytherapy,” Int. J. Radiat. Oncol., Biol., Phys. 89, 674681 (2014).
16.W. Wang, C. L. Dumoulin, A. N. Viswanathan, Z. T. Tse, A. Mehrtash, W. Loew, I. Norton, J. Tokuda, R. T. Seethamraju, T. Kapur, A. L. Damato, R. A. Cormack, and E. J. Schmidt, “Real-time active MR-tracking of metallic stylets in MR-guided radiation therapy,” Magn. Reson. Med. 73, 18031811 (2015).
17.A. L. Damato, A. N. Viswanathan, S. M. Don, J. L. Hansen, and R. A. Cormack, “A system to use electromagnetic tracking for the quality assurance of brachytherapy catheter digitization,” Med. Phys. 41, 101702(7pp.) (2014).
18.E. Poulin, E. Racine, D. Binnekamp, and L. Beaulieu, “Fast, automatic, and accurate catheter reconstruction in HDR brachytherapy using an electromagnetic 3D tracking system,” Med. Phys. 42, 12271232 (2015).
19.R. Potter, C. Haie-Meder, E. Van Limbergen, I. Barillot, M. De Brabandere, J. Dimopoulos, I. Dumas, B. Erickson, S. Lang, A. Nulens, P. Petrow, J. Rownd, C. Kirisits, and G. E. W. Group, “Recommendations from Gynaecological (GYN) GEC ESTRO Working Group (II): Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiology,” Radiother. Oncol. 78, 6777 (2006).
20.K. Tanderup, N. Nesvacil, R. Potter, and C. Kirisits, “Uncertainties in image guided adaptive cervix cancer brachytherapy: Impact on planning and prescription,” Radiother. Oncol. 107, 15 (2013).
21.A. A. De Leeuw, M. A. Moerland, C. Nomden, R. H. Tersteeg, J. M. Roesink, and I. M. Jurgenliemk-Schulz, “Applicator reconstruction and applicator shifts in 3D MR-based PDR brachytherapy of cervical cancer,” Radiother. Oncol. 93, 341346 (2009).
22.T. Kapur, J. Egger, A. Damato, E. J. Schmidt, and A. N. Viswanathan, “3-T MR-guided brachytherapy for gynecologic malignancies,” Magn. Reson. Imaging 30, 12791290 (2012).
23.C. L. Dumoulin, S. P. Souza, and R. D. Darrow, “Real-time position monitoring of invasive devices using magnetic resonance,” Magn. Reson. Med. 29, 411415 (1993).
24.D. Wang, W. Strugnell, G. Cowin, D. M. Doddrell, and R. Slaughter, “Geometric distortion in clinical MRI systems. Part I: Evaluation using a 3D phantom,” Magn. Reson. Imaging 22, 12111221 (2004).
25.M. E. Ladd, P. Erhart, J. F. Debatin, B. J. Romanowski, P. Boesiger, and G. C. McKinnon, “Biopsy needle susceptibility artifacts,” Magn. Reson. Med. 36, 646651 (1996).
26.P. R. Seevinck, H. de Leeuw, C. Bos, and C. J. Bakker, “Highly localized positive contrast of small paramagnetic objects using 3D center-out radial sampling with off-resonance reception,” Magn. Reson. Med. 65, 146156 (2011).

Data & Media loading...


Article metrics loading...



In gynecologic cancers, magnetic resonance (MR)imaging is the modality of choice for visualizing tumors and their surroundings because of superior soft-tissue contrast. Real-time MR guidance of catheter placement in interstitial brachytherapy facilitates target coverage, and would be further improved by providing intraprocedural estimates of dosimetric coverage. A major obstacle to intraprocedural dosimetry is the time needed for catheter trajectory reconstruction. Herein the authors evaluate an active MR tracking (MRTR) system which provides rapid catheter tip localization and trajectory reconstruction. The authors assess the reliability and spatial accuracy of the MRTR system in comparison to standard catheter digitization using magnetic resonance imaging (MRI) and CT.

The MRTR system includes a stylet with microcoils mounted on its shaft, which can be inserted into brachytherapy catheters and tracked by a dedicated MRTR sequence. Catheter tip localization errors of the MRTR system and their dependence on catheter locations and orientation inside the MR scanner were quantified with a water phantom. The distances between the tracked tip positions of the MRTR stylet and the predefined ground-truth tip positions were calculated for measurements performed at seven locations and with nine orientations. To evaluate catheter trajectory reconstruction, fifteen brachytherapy catheters were placed into a gel phantom with an embedded catheter fixation framework, with parallel or crossed paths. The MRTR stylet was then inserted sequentially into each catheter. During the removal of the MRTR stylet from within each catheter, a MRTR measurement was performed at 40 Hz to acquire the instantaneous stylet tip position, resulting in a series of three-dimensional (3D) positions along the catheter’s trajectory. A 3D polynomial curve was fit to the tracked positions for each catheter, and equally spaced dwell points were then generated along the curve. High-resolution 3D MRI of the phantom was performed followed by catheter digitization based on the catheter’s imaging artifacts. The catheter trajectory error was characterized in terms of the mean distance between corresponding dwell points in MRTR-generated catheter trajectory and MRI-based catheter digitization. The MRTR-based catheter trajectory reconstruction process was also performed on three gynecologic cancer patients, and then compared with catheter digitization based on MRI and CT.

The catheter tip localization error increased as the MRTR stylet moved further off-center and as the stylet’s orientation deviated from the main magnetic field direction. Fifteen catheters’ trajectories were reconstructed by MRTR. Compared with MRI-based digitization, the mean 3D error of MRTR-generated trajectories was 1.5 ± 0.5 mm with an in-plane error of 0.7 ± 0.2 mm and a tip error of 1.7 ± 0.5 mm. MRTR resolved ambiguity in catheter assignment due to crossed catheter paths, which is a common problem in image-based catheter digitization. In the patient studies, the MRTR-generated catheter trajectory was consistent with digitization based on both MRI and CT.

The MRTR system provides accurate catheter tip localization and trajectory reconstruction in the MR environment. Relative to the image-based methods, it improves the speed, safety, and reliability of the catheter trajectory reconstruction in interstitial brachytherapy. MRTR may enable in-procedural dosimetric evaluation of implant target coverage.


Full text loading...


Access Key

  • FFree Content
  • OAOpen Access Content
  • SSubscribed Content
  • TFree Trial Content
752b84549af89a08dbdd7fdb8b9568b5 journal.articlezxybnytfddd