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  1. Article ; Online: In Reply to Onal et al.

    Deek, Matthew P / Stish, Bradley J / Tran, Phuoc T

    International journal of radiation oncology, biology, physics

    2021  Volume 110, Issue 5, Page(s) 1547–1548

    Language English
    Publishing date 2021-07-16
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2021.04.003
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    Zs.A 1218: Show issues Location:
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  2. Article ; Online: Color VISION for improved ultrasound visualization of brachytherapy needles.

    Dupere, Justine M / Brost, Eric E / Hainy, Matthew E / Lee, Christine U / Urban, Matthew W / Stish, Bradley J / Deufel, Christopher L

    Medical physics

    2024  

    Abstract: Background: High dose rate brachytherapy is commonly used in the treatment of prostate cancer. Treatment planning is often performed under transrectal ultrasound (US) guidance, but brachytherapy needles can be challenging to digitize due to the presence ...

    Abstract Background: High dose rate brachytherapy is commonly used in the treatment of prostate cancer. Treatment planning is often performed under transrectal ultrasound (US) guidance, but brachytherapy needles can be challenging to digitize due to the presence of poor US conspicuity and imaging artifacts. The plan accuracy and quality, however, are dependent on the proper visualization of the needles with millimeter accuracy.
    Purpose: This work describes a technique for generating a color overlay of needle locations atop the grayscale US image. Prototype devices were developed to produce vibrations in the brachytherapy needles that generate a high contrast color Doppler (CD) signal that highlights the needle locations with superior contrast and reduced artifacts. Denoted by the acronym color VISION (Vibrationally Induced Shimmering for Identifying an Object's Nature), the technology has the potential to improve applicator conspicuity and facilitate automated applicator digitization.
    Methods: Three prototype vibrational devices with frequencies between 200-450 Hz were designed in-house and evaluated with needle implants in a phantom and cadaveric male pelvis using: (1) an actuator attached to the front of a prostate needle template; (2) an actuator attached to the top of the needle template; and (3) a hand-held actuator with a stylet, inserted directly into a needle's inner lumen. Acquired images were postprocessed in MATLAB to evaluate the potential for automated digitization.
    Results: All prototype devices produced localized shimmering in implanted brachytherapy needles in both the axial and sagittal planes. The template mounted actuators provided better vibrational coupling and ease of operation than the stylet prototype. The Michelson contrast, or visibility, of the shimmering CD signal was 100% compared with ≤40% for B-mode imaging of a single needle. Proof-of-principle for automated applicator digitization using only the CD signal was demonstrated.
    Conclusions: The color VISION prototype devices successfully coupled mechanical vibrations into brachytherapy needles to generate US CD shimmering and accurately highlight brachytherapy needle locations. The high contrast and natively registered signal are promising for future work to automate the needle digitization and provide a real-time visual overlay of the applicator on the B-mode US image.
    Language English
    Publishing date 2024-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 188780-4
    ISSN 2473-4209 ; 0094-2405
    ISSN (online) 2473-4209
    ISSN 0094-2405
    DOI 10.1002/mp.17083
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    Zs.A 1210: Show issues Location:
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  3. Article ; Online: Improving ultrasound-based brachytherapy needle conspicuity by applying an echogenic coating.

    Brost, Eric E / Stish, Bradley J / Lee, Christine U / Urban, Matthew W / Deufel, Christopher L

    Medical physics

    2022  Volume 50, Issue 3, Page(s) 1418–1427

    Abstract: Background: Applicator conspicuity in ultrasound-guided brachytherapy procedures is commonly impaired by imaging artifacts or non-ideal imaging geometry, which can slow down applicator position digitization and increase the geometric uncertainty of the ... ...

    Abstract Background: Applicator conspicuity in ultrasound-guided brachytherapy procedures is commonly impaired by imaging artifacts or non-ideal imaging geometry, which can slow down applicator position digitization and increase the geometric uncertainty of the delivered dose distribution.
    Purpose: The purpose of this study was to improve the conspicuity of high-dose rate (HDR) brachytherapy needles under B-mode ultrasound imaging by applying an echogenic surface coating. Our hypothesis was that an echogenic coating would reduce artifacts and improve needle visualization within regions of signal degradation.
    Methods: In this study, 17-gauge, 25-cm long titanium HDR brachytherapy needles were coated with acoustically reflective microspheres over a 2.5 cm region starting from the needle tip. Three coating thicknesses (27 μm, 40 μm, 64 μm) were compared against an uncoated control needle. The coated and uncoated needles were imaged using B-mode ultrasound in a tissue-equivalent prostate phantom and in a cadaverous male pelvis using a transrectal probe. Needle conspicuity was assessed under multiple conditions: a single needle implant, an implant with multiple needles between the probe and the needle of interest, and an angled needle implant. All images were assessed qualitatively for needle conspicuity and the presence of artifacts and quantitatively using grey-scale image intensity values.
    Results: The 64 μm echogenic coating reduced the magnitude of reverberation artifacts by 31 ± 14% and comet tail artifacts by 40%-70%. The echogenic coating also improved needle contrast, measured by the relative differences in signal intensity compared with the adjacent environment, when needles were angled up to 30° with respect to the transducer probe in the cadaver. The improvements in conspicuity and artifact reduction increased with increasing coating thickness. The performance of the needles coated with the 64 μm thickness was qualitatively superior and yielded high-contrast, well-circumscribed signals in the cadaverous male pelvis, even under situations where a needle was acoustically shadowed by multiple other needles.
    Conclusions: An echogenic surface coating reduced imaging artifacts and improved needle conspicuity under realistic clinical conditions for ultrasound-based prostate or gynecological brachytherapy. The improved conspicuity has the potential to improve the efficiency of needle placement and the accuracy of needle position digitization during brachytherapy procedures.
    MeSH term(s) Male ; Humans ; Brachytherapy/methods ; Ultrasonography ; Needles ; Prostate/diagnostic imaging ; Phantoms, Imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy
    Language English
    Publishing date 2022-12-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 188780-4
    ISSN 2473-4209 ; 0094-2405
    ISSN (online) 2473-4209
    ISSN 0094-2405
    DOI 10.1002/mp.16138
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  4. Article ; Online: A new way to visualize prostate brachytherapy needles using ultrasound color Doppler and needle surface modifications.

    Dupere, Justine M / Brost, Eric E / Uthamaraj, Susheil / Lee, Christine U / Urban, Matthew W / Stish, Bradley J / Deufel, Christopher L

    Brachytherapy

    2023  Volume 22, Issue 6, Page(s) 761–768

    Abstract: Purpose: Suboptimal ultrasound conspicuity of the brachytherapy applicator can lead to inaccurate image reconstructions of the applicator resulting in decreased tumor control or increased normal tissue dose. This feasibility study aims to improve ... ...

    Abstract Purpose: Suboptimal ultrasound conspicuity of the brachytherapy applicator can lead to inaccurate image reconstructions of the applicator resulting in decreased tumor control or increased normal tissue dose. This feasibility study aims to improve ultrasound conspicuity of high-dose rate (HDR) brachytherapy needles by modifying the surface of the needles to produce a color Doppler twinkling signature.
    Materials and methods: Surface modifications of standard 17-gauge titanium HDR brachytherapy needles included laser-scribing, application of polymethyl methacrylate (PMMA), and coating with a commercially available echogenic coating. Laser-scribing was performed with variable widths (0.1-1 mm) and depths (10-100 μm). The echogenic coating was applied with 3 different thicknesses (27, 40, and 64 μm). Unmodified and modified needles were imaged under B-mode and color Doppler ultrasound in phantom and cadaver, and the signal strength was recorded.
    Results: Laser-scribed, PMMA-coated, and echogenic-coated brachytherapy needles produced a twinkling signature along the needle shaft on color Doppler ultrasound. Twinkling was observed with laser-scribe depths >20 μm and widths >0.1 mm and from echogenic coatings 40 μm and 64 μm thick. Twinkling was not observed with unmodified needles. The twinkling signature had a spectral composition with a uniform magnitude between the velocities of 2 to 16 cm/s.
    Conclusions: Color Doppler ultrasound of surface-modified brachytherapy applicators may improve applicator conspicuity aiding applicator placement and digitization. HDR brachytherapy needles may be modified to produce the twinkling signature via laser-scribing, PMMA rings, or applying an echogenic coating.
    MeSH term(s) Male ; Humans ; Brachytherapy/methods ; Polymethyl Methacrylate ; Prostate ; Ultrasonography ; Needles
    Chemical Substances Polymethyl Methacrylate (9011-14-7)
    Language English
    Publishing date 2023-08-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2098608-7
    ISSN 1873-1449 ; 1538-4721
    ISSN (online) 1873-1449
    ISSN 1538-4721
    DOI 10.1016/j.brachy.2023.07.002
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  5. Article ; Online: Reply to N. Fossati et al.

    Pisansky, Thomas M / Stish, Bradley J

    Journal of clinical oncology : official journal of the American Society of Clinical Oncology

    2016  Volume 35, Issue 4, Page(s) 470–471

    MeSH term(s) Humans ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Salvage Therapy
    Chemical Substances Prostate-Specific Antigen (EC 3.4.21.77)
    Language English
    Publishing date 2016-11-07
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 604914-x
    ISSN 1527-7755 ; 0732-183X
    ISSN (online) 1527-7755
    ISSN 0732-183X
    DOI 10.1200/JCO.2016.70.6119
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  6. Article ; Online: Safety and Efficacy of CT-Guided Percutaneous Biopsy of Suspicious Subcentimeter Pelvic and Retroperitoneal Lymph Nodes Detected by

    Kapplinger, Jamie D / Lima, Livia M Frota / Packard, Annie T / Nathan, Mark A / Young, Jason R / Stish, Bradley J / Hough, David M

    AJR. American journal of roentgenology

    2022  Volume 220, Issue 5, Page(s) 718–725

    Abstract: BACKGROUND. ...

    Abstract BACKGROUND.
    MeSH term(s) Male ; Humans ; Middle Aged ; Aged ; Positron Emission Tomography Computed Tomography/methods ; Retrospective Studies ; Choline ; Neoplasm Recurrence, Local/pathology ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/pathology ; Lymph Nodes/diagnostic imaging ; Lymph Nodes/pathology ; Tomography, X-Ray Computed ; Positron-Emission Tomography/methods ; Pelvis/diagnostic imaging ; Pelvis/pathology ; Biopsy
    Chemical Substances Choline (N91BDP6H0X)
    Language English
    Publishing date 2022-12-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82076-3
    ISSN 1546-3141 ; 0361-803X ; 0092-5381
    ISSN (online) 1546-3141
    ISSN 0361-803X ; 0092-5381
    DOI 10.2214/AJR.22.28321
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  7. Article ; Online: Approaching automated applicator digitization from a new angle: Using sagittal images to improve deep learning accuracy and robustness in high-dose-rate prostate brachytherapy.

    Weishaupt, Luca Leon / Sayed, Hisham Kamal / Mao, Ximeng / Choo, Richard / Stish, Bradley J / Enger, Shirin A / Deufel, Christopher

    Brachytherapy

    2022  Volume 21, Issue 4, Page(s) 520–531

    Abstract: Purpose: To automate the segmentation of treatment applicators on computed tomography (CT) images for high-dose-rate (HDR) brachytherapy prostate patients implanted with titanium needles with the goals of improving plan quality and reducing the patient' ... ...

    Abstract Purpose: To automate the segmentation of treatment applicators on computed tomography (CT) images for high-dose-rate (HDR) brachytherapy prostate patients implanted with titanium needles with the goals of improving plan quality and reducing the patient's time under anesthesia.
    Methods: The investigation was performed using 57 retrospective, interstitial prostate treatments randomly assigned to training (n = 27), validation (n = 10), and testing (n = 20). Unique to this work, the CT image set was reformatted into 2D sagittal slices instead of the default axial orientation. A deep learning-based segmentation was performed using a 2D U-Net architecture followed by a density-based linkage clustering algorithm to classify individual catheters in 3D. Potential confounders, such as gold seeds and conjoined applicators with intersecting needle geometries, were corrected using a customized polynomial fitting algorithm. The geometric agreement of the automated digitization was evaluated against the clinically treated manual digitization to measure tip and shaft errors in the reconstruction.
    Results: The proposed algorithm achieved tip and shaft agreements of -0.1 ± 0.6 mm (range -1.8 mm to 1.4 mm) and 0.13 ± 0.09 mm (maximum 0.96 mm), respectively on a data set with 20 patients and 353 total needles. Our method was able to separate all intersecting applicators reliably. The time to generate the automated applicator digitization averaged approximately 1 min.
    Conclusions: Using sagittal instead of axial images for 2D segmentation of interstitial brachytherapy applicators produced submillimeter agreement with manual segmentation. The automated digitization of interstitial applicators in prostate brachytherapy has the potential to improve quality and consistency while reducing the patient's time under anesthesia.
    MeSH term(s) Brachytherapy/methods ; Deep Learning ; Humans ; Male ; Prostate ; Retrospective Studies ; Tomography, X-Ray Computed/methods
    Language English
    Publishing date 2022-04-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2098608-7
    ISSN 1873-1449 ; 1538-4721
    ISSN (online) 1873-1449
    ISSN 1538-4721
    DOI 10.1016/j.brachy.2022.02.005
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  8. Article: Use of focal radiotherapy boost for prostate cancer and perceived barriers toward its implementation: a survey.

    Zhong, Allison Y / Lui, Asona J / Katz, Matthew S / Berlin, Alejandro / Kamran, Sophia C / Kishan, Amar U / Murthy, Vedang / Nagar, Himanshu / Seible, Daniel / Stish, Bradley J / Tree, Alison C / Seibert, Tyler M

    medRxiv : the preprint server for health sciences

    2023  

    Abstract: Background: In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to ... ...

    Abstract Background: In a recent phase III randomized control trial (FLAME), delivering a focal radiotherapy (RT) boost to tumors visible on MRI was shown to improve outcomes for prostate cancer patients without increasing toxicity. The aim of this study was to assess how widely this technique is being applied in current practice as well as physicians' perceived barriers toward its implementation.
    Methods: An online survey assessing the use of intraprostatic focal boost was conducted in December 2022 and February 2023. The survey link was distributed to radiation oncologists worldwide via email list, group text platform, and social media.
    Results: The survey initially collected 205 responses from various countries over a two-week period in December 2022. The survey was then reopened for one week in February 2023 to allow for more participation, leading to a total of 263 responses. The highest-represented countries were the United States (42%), Mexico (13%), and the United Kingdom (8%). The majority of participants worked at an academic medical center (52%) and considered their practice to be at least partially genitourinary (GU)-subspecialized (74%). 57% of participants reported
    Conclusion: Despite level 1 evidence from the FLAME trial, most radiation oncologists surveyed are not routinely offering focal RT boost. Adoption of this technique might be accelerated by increased access to high-quality MRI, better registration algorithms of MRI to CT simulation images, physician education on benefit-to-harm ratio, and training on contouring prostate lesions on MRI.
    Language English
    Publishing date 2023-06-08
    Publishing country United States
    Document type Preprint
    DOI 10.1101/2023.02.01.23285345
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  9. Article ; Online: A pooled patient-reported outcomes analysis of moderately hypofractionated proton beam therapy and photon-based intensity modulated radiation therapy for low- or intermediate-risk prostate cancer.

    Lukez, Alexander / Handorf, Elizabeth / Mendenhall, Nancy P / Henderson, Randal H / Stish, Bradley J / Davis, Brian J / Hallman, Mark / Horwitz, Eric M / Vapiwala, Neha / Wong, Jessica Karen

    The Prostate

    2023  Volume 84, Issue 4, Page(s) 395–402

    Abstract: Background: We sought to characterize and compare late patient-reported outcomes (PROs) after moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) for localized prostate cancer (PC).: Methods: This ... ...

    Abstract Background: We sought to characterize and compare late patient-reported outcomes (PROs) after moderately hypofractionated intensity modulated radiation therapy (IMRT) and proton beam therapy (PBT) for localized prostate cancer (PC).
    Methods: This multi-institutional analysis included low- or intermediate-risk group PC patients treated with moderately hypofractionated radiation to an intact prostate stratified by treatment modality: IMRT or PBT. The primary outcomes were prospectively collected patient-reported late gastrointestinal (GI) and genitourinary (GU) toxicity assessed by International Prostate Symptom Score (IPSS) and Expanded PC Index Composite (EPIC). Multivariable regression analysis (MVA) controlling for age, race, and risk group tested the effect of time, treatment, and their interaction.
    Results: 287 IMRT and 485 PBT patients were included. Intermediate risk group (81.2 vs. 68.2%; p < 0.001) and median age at diagnosis (70 vs. 67 years; p < 0.001) were higher in the IMRT group. On MVA, there was no significant difference between modalities. PBT IPSS did not differ from IMRT IPSS at 12 months (odds ratio [OR], 1.19; p = 0.08) or 24 months (OR, 0.99; p = 0.94). PBT EPIC overall GI function at 12 months (OR, 3.68; p = 0.085) and 24 months (OR 2.78; p = 0.26) did not differ from IMRT EPIC overall GI function. At 24 months, urinary frequency was no different between PBT and IMRT groups (OR 0.35; p = 0.096).
    Conclusions: This multi-institutional analysis of low- or intermediate-risk PC treated with moderately hypofractionated PBT and IMRT demonstrated low rates of late patient-reported GI and GU toxicities. After covariate adjustment, late GI and GU PROs were not significantly different between PBT or IMRT cohorts.
    MeSH term(s) Male ; Humans ; Radiotherapy, Intensity-Modulated/adverse effects ; Proton Therapy/adverse effects ; Prostatic Neoplasms/radiotherapy ; Prostate/radiation effects ; Patient Reported Outcome Measures
    Language English
    Publishing date 2023-12-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604707-5
    ISSN 1097-0045 ; 0270-4137
    ISSN (online) 1097-0045
    ISSN 0270-4137
    DOI 10.1002/pros.24660
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  10. Article ; Online: Treatment modalities and survival outcomes in prostate cancer parenchymal brain metastasis.

    Mahmoud, Ahmed M / Childs, Daniel S / Ahmed, Mohamed E / Tuba Kendi, A / Johnson, Geoffrey B / Orme, Jacob J / Stish, Bradley J / Phillips, Ryan M / Park, Sean S / Davis, Brian J / Andrews, Jack R / Kwon, Eugene D

    The Prostate

    2023  Volume 84, Issue 3, Page(s) 237–244

    Abstract: Background: Prostate cancer (PCa) parenchymal brain metastases are uncommon and troubling observations in the course of the disease. Our study aims to evaluate the prevalence of brain metastases among PCa patients while reporting various therapeutic ... ...

    Abstract Background: Prostate cancer (PCa) parenchymal brain metastases are uncommon and troubling observations in the course of the disease. Our study aims to evaluate the prevalence of brain metastases among PCa patients while reporting various therapeutic modalities, clinical features, and oncological outcomes.
    Methods: We retrospectively identified 34 patients with parenchymal brain metastasis out of 4575 patients using a prospectively maintained database that contains clinicopathologic characteristics of PCa patients between January 2012 and December 2021. Based on the three treatment modalities used, the patients were divided into three groups: stereotactic radiosurgery (SRS), whole brain radiotherapy (WBRT), and systemic therapy alone. The Kaplan-Meier curve was used to calculate overall survival [OS] probability and the Cox proportional hazards regression model was used to compare between groups.
    Results: At the time of brain metastasis diagnosis, the median age was 66 years, the median (interquartile range [IQR]) prostate-specific antigen (PSA) was 2.2 (0.1-26.6) ng/ml and the median (IQR) months from initial PCa diagnosis to brain metastasis development was 70.8 (27.6-100.9). The median (IQR) primary Gleason score was 8 (7-9) and over a median (IQR) follow-up time of 2.2 (1.2-16.5) months, 76.5% (n = 26) of the patients died. Thirteen (38.2%) patients had solitary lesion, whereas 21 (61.8%) had ≥2 lesions. The lesions were supratentorial in 19 (55.9%) patients, infratentorial in six (17.6%), and both sides in nine (26.5%). Among all 34 patients, 10 (29.4%) were treated with SRS, seven (20.6%) with WBRT, and 17 (50%) with systemic therapy alone. OS varied greatly between the three treatment modalities (log-rank test, p = 0.049). Those who were treated with SRS and WBRT had better OS compared with patients who were treated with systemic therapy alone (hazard ratio: 0.37, 95% confidence interval: 0.16-0.86, p = 0.022).
    Conclusions: In our single-institutional study, we confirmed that PCa brain metastasis is associated with poor survival outcomes and more advanced metastatic disease. Furthermore, we found that SRS and WBRT for brain metastasis in patients with recurrent PCa appear to be associated with improved OS as compared with systemic therapy alone and are likely secondary to selection bias.
    MeSH term(s) Male ; Humans ; Infant ; Retrospective Studies ; Treatment Outcome ; Brain Neoplasms/therapy ; Brain Neoplasms/secondary ; Radiosurgery ; Prostatic Neoplasms/surgery
    Language English
    Publishing date 2023-10-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604707-5
    ISSN 1097-0045 ; 0270-4137
    ISSN (online) 1097-0045
    ISSN 0270-4137
    DOI 10.1002/pros.24643
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