SBIR-STTR Award

A technique is proposed for the development of an intraoperative, 3-dimensional registration of C-arm fluoroscopic images with spatially-registered ultrasound visualization and implant guidance of radioactive implants and on-line implant assessment during the procedure for treatment of prostate cancer. With present techniques using transrectal ultrasound guidance for brachytherapy, intra-operative localization of implanted seeds with respect to soft tissue anatomy is still an unsolved problem. Ultrasound (US) images provide satisfactory differentiation of relevant soft issue, but implanted brachytherapy seeds cannot be clearly identified in the US images. Currently sixty percent of the practitioners use intra-operative C-arm fluoroscopy as a qualitative check of the implants. While seeds can be accurately localized in X-ray, projected transluminal images do not reveal soft tissue anatomy. Hence, there is a standing clinical need to couple relevant information from C-arm with the US-guided delivery system, in a safe, robust, and cost-efficient manner. The goal of the proposed work is to implement intra-operative dosimetric quality assurance in transrectal US-guided prostate brachytherapy with the use of C-arm X-ray fluoroscopy. The specific objective of this program is to incorporate spatial location of implanted seeds determined from C-arm X-ray fluoroscopy images with soft tissue anatomy determined from ultrasound images. This will enable the actual dose distribution to be compared to the dose pre-plan and assessed while the implant process is underway. Thus, immediate therapeutic intervention would be possible to correct for any "cold" regions or minimize "hot" regions near critical structures and exactly "match" the optimal source placement within the treatment volume. The outcome of this research could be of immediate benefit in the treatment of prostate cancer. It would provide the ability to visualize in real time the placement of implants, providing implants which reflect optimal dosimetry. A large group of patients with early-stage disease are candidates.

Thesaurus Terms:
computer assisted patient care, computer program /software, fluoroscopy, neoplasm /cancer radionuclide therapy, prostate neoplasm, radiation dosage, radionuclide implant, technology /technique development, ultrasound imaging /scanning bioimaging /biomedical imaging, biomedical automation, time resolved data X ray, medical implant science, phantom model, radionuclide imaging /scanning

Prostate cancer continues to be a significant health problem, both domestically and worldwide. Numerous studies have demonstrated the efficacy and safety of transperineal prostate brachytherapy in the therapy of prostate cancer. The success of brachytherapy chiefly depends on our ability to intra-operatively tailor the radiation dose to the patient's individual anatomy. Thus the objective of this research is to design, develop, and clinically test a method for intra-operative localization of the implanted seeds in relation to the prostate, to allow for intra-operative dosimetric optimization and exit dosimetry. Brachytherapy is predominantly performed with transrectal ultrasound guidance, which provides adequate real-time visualization of soft tissue anatomy, but does not show the implanted seeds. To overcome this problem, we propose registration of ultrasound to intra-operative C-arm fluoroscopy, where the implanted seeds will be reconstructed from fluoroscopy and superimposed on ultrasound. In particular, we will: (1) Design a system and workflow that is consistent with contemporary practice of prostate brachytherapy. (2) Develop optimized mathematical algorithms for reconstruction of seed implants from C-arm fluoroscopy images, spatial registration of fluoroscopy and ultrasound imaging. (3) Integrate the algorithms with an existing commercial prostate brachytherapy system and implant optimization methods. (4) Conduct Clinical System Performance Evaluation Trial on human patients. We have established the technical feasibility of this approach in a Phase-1 SBIR research grant. We are requesting Phase-2 support to develop a clinical-grade system and evaluate its technical performance on human patients. The resulting system will withstand the scrutiny of subsequent FDA approval and enter wide-spread clinical use via commercial dispersion.

Thesaurus Terms:
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