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  1. Article ; Online: Uncertainty in magnetic resonance imaging-based prostate postimplant dosimetry: Results of a 10-person human observer study, and comparisons with automatic postimplant dosimetry.

    Sanders, Jeremiah W / Tang, Chad / Kudchadker, Rajat J / Venkatesan, Aradhana M / Mok, Henry / Hanania, Alexander N / Thames, Howard D / Bruno, Teresa L / Starks, Christine / Santiago, Edwin / Cunningham, Mandy / Frank, Steven J

    Brachytherapy

    2023  Volume 22, Issue 6, Page(s) 822–832

    Abstract: Purpose: Uncertainties in postimplant quality assessment (QA) for low-dose-rate prostate brachytherapy (LDRPBT) are introduced at two steps: seed localization and contouring. We quantified how interobserver variability (IoV) introduced in both steps ... ...

    Abstract Purpose: Uncertainties in postimplant quality assessment (QA) for low-dose-rate prostate brachytherapy (LDRPBT) are introduced at two steps: seed localization and contouring. We quantified how interobserver variability (IoV) introduced in both steps impacts dose-volume-histogram (DVH) parameters for MRI-based LDRPBT, and compared it with automatically derived DVH parameters.
    Methods and materials: Twenty-five patients received MRI-based LDRPBT. Seven clinical observers contoured the prostate and four organs at risk, and 4 dosimetrists performed seed localization, on each MRI. Twenty-eight unique manual postimplant QAs were created for each patient from unique observer pairs. Reference QA and automatic QA were also performed for each patient. IoV of prostate, rectum, and external urinary sphincter (EUS) DVH parameters owing to seed localization and contouring was quantified with coefficients of variation. Automatically derived DVH parameters were compared with those of the reference plans.
    Results: Coefficients of variation (CoVs) owing to contouring variability (CoV
    Conclusions: Seed localization introduces substantially less variability in postimplant QA than does contouring for MRI-based LDRPBT. While automatic seed localization may potentially help improve workflow efficiency, it has limited potential for improving the consistency and quality of postimplant dosimetry.
    MeSH term(s) Male ; Humans ; Prostate/diagnostic imaging ; Prostate/pathology ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Prostatic Neoplasms/pathology ; Uncertainty ; Brachytherapy/methods ; Radiotherapy Dosage ; Tomography, X-Ray Computed/methods ; Magnetic Resonance Imaging/methods
    Language English
    Publishing date 2023-09-15
    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.2023.08.001
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  2. Article ; Online: Development and clinical implementation of SeedNet: A sliding-window convolutional neural network for radioactive seed identification in MRI-assisted radiosurgery (MARS).

    Sanders, Jeremiah W / Frank, Steven J / Kudchadker, Rajat J / Bruno, Teresa L / Ma, Jingfei

    Magnetic resonance in medicine

    2019  Volume 81, Issue 6, Page(s) 3888–3900

    Abstract: Purpose: To develop and evaluate a sliding-window convolutional neural network (CNN) for radioactive seed identification in MRI of the prostate after permanent implant brachytherapy.: Methods: Sixty-eight patients underwent prostate cancer low-dose- ... ...

    Abstract Purpose: To develop and evaluate a sliding-window convolutional neural network (CNN) for radioactive seed identification in MRI of the prostate after permanent implant brachytherapy.
    Methods: Sixty-eight patients underwent prostate cancer low-dose-rate (LDR) brachytherapy using radioactive seeds stranded with positive contrast MR-signal seed markers and were scanned using a balanced steady-state free precession pulse sequence with and without an endorectal coil (ERC). A sliding-window CNN algorithm (SeedNet) was developed to scan the prostate images using 3D sub-windows and to identify the implanted radioactive seeds. The algorithm was trained on sub-windows extracted from 18 patient images. Seed detection performance was evaluated by computing precision, recall, F
    Results: SeedNet achieved 97.6 ± 2.2% recall and 97.2 ± 1.9% precision for radioactive seed detection and 0.19 ± 0.04 mm RMSE for seed localization in the images acquired with an ERC. Without the ERC, the recall remained high, but the false-positive rate increased; the RMSE of the seed locations increased marginally. The clinical integration of SeedNet slightly increased the run-time, but the overall run-time was still low.
    Conclusion: SeedNet can be used to perform automated radioactive seed identification in prostate MRI after LDR brachytherapy. Image quality improvement through pulse sequence optimization is expected to improve SeedNet's performance when imaging without an ERC.
    MeSH term(s) Algorithms ; Brachytherapy/instrumentation ; Brachytherapy/methods ; Humans ; Image Processing, Computer-Assisted/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Neural Networks, Computer ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiosurgery/instrumentation ; Radiosurgery/methods ; Retrospective Studies
    Language English
    Publishing date 2019-02-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605774-3
    ISSN 1522-2594 ; 0740-3194
    ISSN (online) 1522-2594
    ISSN 0740-3194
    DOI 10.1002/mrm.27677
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  3. Article ; Online: MRI-assisted radiosurgery: A quality assurance nomogram for palladium-103 and iodine-125 prostate brachytherapy.

    Hanania, Alexander N / Kudchadker, Rajat J / Bruno, Teresa L / Tang, Chad / Anscher, Mitchell S / Frank, Steven J

    Brachytherapy

    2019  Volume 19, Issue 1, Page(s) 38–42

    Abstract: Purpose: We sought to develop an activity nomogram for magnetic resonance (MR)-planned permanent seed prostate brachytherapy to improve quality assurance through a secondary dosimetric check.: Methods and materials: Patients undergoing MRI-assisted ... ...

    Abstract Purpose: We sought to develop an activity nomogram for magnetic resonance (MR)-planned permanent seed prostate brachytherapy to improve quality assurance through a secondary dosimetric check.
    Methods and materials: Patients undergoing MRI-assisted radiosurgery (MARS), whereby MRI is used for preoperative planning and postimplant dosimetry, were reviewed from May 2016 to September 2018. Planned activity (U) was fitted by MR-prostate volume (cc) via simple linear regression. Resulting monotherapy nomograms were compared with institutional nomograms from an ultrasound-planned cohort. Dosimetric coverage and external urinary sphincter (EUS) dose were also assessed for MR-planned patients.
    Results: We identified 183 patients treated with MARS: 146 patients received palladium-103 (
    Conclusions: We developed a quality assurance nomogram for MR-planned prostate brachytherapy. When compared with ultrasound-planned, MR-planned monotherapy resulted in a lower activity-to-volume ratio while maintaining dosimetric coverage, likely secondary to EUS-sparing and reduced planning target margins.
    MeSH term(s) Brachytherapy/methods ; Brachytherapy/standards ; Humans ; Iodine Radioisotopes ; Magnetic Resonance Imaging ; Male ; Nomograms ; Organ Size ; Palladium ; Prostate/pathology ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Quality Assurance, Health Care ; Radiation Dosage ; Radioisotopes ; Radiometry ; Radiosurgery ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods ; Radiotherapy Planning, Computer-Assisted/standards ; Ultrasonography ; Urethra
    Chemical Substances Iodine Radioisotopes ; Radioisotopes ; Palladium (5TWQ1V240M) ; Palladium-103 (68QTV136DF) ; Iodine-125 (GVO776611R)
    Language English
    Publishing date 2019-12-04
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2098608-7
    ISSN 1873-1449 ; 1538-4721
    ISSN (online) 1873-1449
    ISSN 1538-4721
    DOI 10.1016/j.brachy.2019.10.002
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  4. Article ; Online: Computer-aided segmentation on MRI for prostate radiotherapy, Part I: Quantifying human interobserver variability of the prostate and organs at risk and its impact on radiation dosimetry.

    Sanders, Jeremiah W / Mok, Henry / Hanania, Alexander N / Venkatesan, Aradhana M / Tang, Chad / Bruno, Teresa L / Thames, Howard D / Kudchadker, Rajat J / Frank, Steven J

    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

    2021  Volume 169, Page(s) 124–131

    Abstract: Background and purpose: Quantifying the interobserver variability (IoV) of prostate and periprostatic anatomy delineation on prostate MRI is necessary to inform its use for treatment planning, treatment delivery, and treatment quality assessment.: ... ...

    Abstract Background and purpose: Quantifying the interobserver variability (IoV) of prostate and periprostatic anatomy delineation on prostate MRI is necessary to inform its use for treatment planning, treatment delivery, and treatment quality assessment.
    Materials and methods: Twenty five prostate cancer patients underwent MRI-based low-dose-rate prostate brachytherapy (LDRPBT). The patients were scanned with a 3D T2-weighted sequence for treatment planning and a 3D T2/T1-weighted sequence for quality assessment. Seven observers involved with the LDRPBT workflow delineated the prostate, external urinary sphincter (EUS), seminal vesicles, rectum, and bladder on all 50 MRIs. IoV was assessed by measuring contour similarity metrics, differences in organ volumes, and differences in dosimetry parameters between unique observer pairs. Measurements from a group of 3 radiation oncologists (G1) were compared against those from a group consisting of the other 4 clinical observers (G2).
    Results: IoV of the prostate was lower for G1 than G2 (Matthew's correlation coefficient [MCC], G1 vs. G2: planning-0.906 vs. 0.870, p < 0.001; postimplant-0.899 vs. 0.861, p < 0.001). IoV of the EUS was highest of all the organs for both groups, but was lower for G1 (MCC, G1 vs. G2: planning-0.659 vs. 0.402, p < 0.001; postimplant-0.684 vs. 0.398, p < 0.001). Large differences in prostate dosimetry parameters were observed (G1 maximum absolute prostate ΔD90: planning-76.223 Gy, postimplant-36.545 Gy; G1 maximum absolute prostate ΔV100: planning-13.927%, postimplant-8.860%).
    Conclusions: While MRI is optimal in the management of prostate cancer with radiation therapy, significant interobserver variability of the prostate and external urinary sphincter still exist.
    MeSH term(s) Brachytherapy ; Computers ; Humans ; Magnetic Resonance Imaging ; Male ; Observer Variation ; Organs at Risk/diagnostic imaging ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted
    Language English
    Publishing date 2021-12-16
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 605646-5
    ISSN 1879-0887 ; 0167-8140
    ISSN (online) 1879-0887
    ISSN 0167-8140
    DOI 10.1016/j.radonc.2021.12.011
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  5. Article ; Online: Computer-aided segmentation on MRI for prostate radiotherapy, part II: Comparing human and computer observer populations and the influence of annotator variability on algorithm variability.

    Sanders, Jeremiah W / Mok, Henry / Hanania, Alexander N / Venkatesan, Aradhana M / Tang, Chad / Bruno, Teresa L / Thames, Howard D / Kudchadker, Rajat J / Frank, Steven J

    Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

    2021  Volume 169, Page(s) 132–139

    Abstract: Background and purpose: Comparing deep learning (DL) algorithms to human interobserver variability, one of the largest sources of noise in human-performed annotations, is necessary to inform the clinical application, use, and quality assurance of DL for ...

    Abstract Background and purpose: Comparing deep learning (DL) algorithms to human interobserver variability, one of the largest sources of noise in human-performed annotations, is necessary to inform the clinical application, use, and quality assurance of DL for prostate radiotherapy.
    Materials and methods: One hundred fourteen DL algorithms were developed on 295 prostate MRIs to segment the prostate, external urinary sphincter (EUS), seminal vesicles (SV), rectum, and bladder. Fifty prostate MRIs of 25 patients undergoing MRI-based low-dose-rate prostate brachytherapy were acquired as an independent test set. Groups of DL algorithms were created based on the loss functions used to train them, and the spatial entropy (SE) of their predictions on the 50 test MRIs was computed. Five human observers contoured the 50 test MRIs, and SE maps of their contours were compared with those of the groups of the DL algorithms. Additionally, similarity metrics were computed between DL algorithm predictions and consensus annotations of the 5 human observers' contours of the 50 test MRIs.
    Results: A DL algorithm yielded statistically significantly higher similarity metrics for the prostate than did the human observers (H) (prostate Matthew's correlation coefficient, DL vs. H: planning-0.931 vs. 0.903, p < 0.001; postimplant-0.925 vs. 0.892, p < 0.001); the same was true for the 4 organs at risk. The SE maps revealed that the DL algorithms and human annotators were most variable in similar anatomical regions: the prostate-EUS, prostate-SV, prostate-rectum, and prostate-bladder junctions.
    Conclusions: Annotation quality is an important consideration when developing, evaluating, and using DL algorithms clinically.
    MeSH term(s) Algorithms ; Computers ; Humans ; Magnetic Resonance Imaging ; Male ; Observer Variation ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiotherapy Planning, Computer-Assisted
    Language English
    Publishing date 2021-12-31
    Publishing country Ireland
    Document type Journal Article
    ZDB-ID 605646-5
    ISSN 1879-0887 ; 0167-8140
    ISSN (online) 1879-0887
    ISSN 0167-8140
    DOI 10.1016/j.radonc.2021.12.033
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  6. Article ; Online: Comparison of prostate distortion by inflatable and rigid endorectal MRI coils in permanent prostate brachytherapy imaging.

    Martin, Geoffrey V / Kudchadker, Rajat J / Bruno, Teresa L / Frank, Steven J / Wang, Jihong

    Brachytherapy

    2017  Volume 17, Issue 2, Page(s) 298–305

    Abstract: Purpose: To study the deformation of the prostate by a rigid reusable endorectal coil and a balloon-type endorectal coil (BTC) during MRI of the prostate in brachytherapy imaging.: Methods and materials: The prostate gland was contoured on 157 MRI ... ...

    Abstract Purpose: To study the deformation of the prostate by a rigid reusable endorectal coil and a balloon-type endorectal coil (BTC) during MRI of the prostate in brachytherapy imaging.
    Methods and materials: The prostate gland was contoured on 157 MRI scans from 52 prostate cancer patients undergoing brachytherapy. The curvature of the posterior prostate surface deformation was computed as a measure of prostate distortion and compared between scans with a BTC, rigid endorectal coil (REC), or no endorectal coil. For the nine patients who had MRIs with all three endorectal scenarios, a mean prostate deformation vector was also calculated between scenarios using deformable image registration. These measures of prostate distortion were compared with the prostate anterior-to-posterior to left-to-right ratio (AP/LR) on the largest prostate axial slice.
    Results: Significant differences in prostate curvature were found between scans without an endorectal coil versus a REC versus a BTC (p < 0.001). The mean prostate deformation was 3.9 mm due to the BTC and 2.0 mm for the REC (p = 0.012). The mean AP/LR ratio was 0.62 with a BTC versus 0.76 without a coil or 0.73 with a REC (p < 0.001), but no difference existed between scans with a REC versus no coil (p = 0.7). The AP/LR ratio showed moderate correlation with prostate curvature (r = 0.48), and with mean prostate deformation (r = -0.64 to 0.68).
    Conclusions: The REC caused minimal deformation of the prostate compared with a BTC with adequate MR image quality, and calculation of the cross-sectional AP/LR ratio on the largest axial prostate slice can serve as a simple measure of prostate distortion.
    MeSH term(s) Brachytherapy ; Cross-Sectional Studies ; Humans ; Magnetic Resonance Imaging/instrumentation ; Magnetic Resonance Imaging/methods ; Male ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy
    Language English
    Publishing date 2017-11-21
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 2098608-7
    ISSN 1873-1449 ; 1538-4721
    ISSN (online) 1873-1449
    ISSN 1538-4721
    DOI 10.1016/j.brachy.2017.09.014
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  7. Article ; Online: Machine Segmentation of Pelvic Anatomy in MRI-Assisted Radiosurgery (MARS) for Prostate Cancer Brachytherapy.

    Sanders, Jeremiah W / Lewis, Gary D / Thames, Howard D / Kudchadker, Rajat J / Venkatesan, Aradhana M / Bruno, Teresa L / Ma, Jingfei / Pagel, Mark D / Frank, Steven J

    International journal of radiation oncology, biology, physics

    2020  Volume 108, Issue 5, Page(s) 1292–1303

    Abstract: Purpose: To investigate machine segmentation of pelvic anatomy in magnetic resonance imaging (MRI)-assisted radiosurgery (MARS) for prostate cancer using prostate brachytherapy MRIs acquired with different pulse sequences and image contrasts.: Methods ...

    Abstract Purpose: To investigate machine segmentation of pelvic anatomy in magnetic resonance imaging (MRI)-assisted radiosurgery (MARS) for prostate cancer using prostate brachytherapy MRIs acquired with different pulse sequences and image contrasts.
    Methods and materials: Two hundred 3-dimensional (3D) preimplant and postimplant prostate brachytherapy MRI scans were acquired with a T2-weighted sequence, a T2/T1-weighted sequence, or a T1-weighted sequence. One hundred twenty deep machine learning models were trained to segment the prostate, seminal vesicles, external urinary sphincter, rectum, and bladder using the MRI scans acquired with T2-weighted and T2/T1-weighted image contrast. The deep machine learning models consisted of 18 fully convolutional networks (FCNs) with different convolutional encoders. Both 2-dimensional and 3D U-Net FCNs were constructed for comparison. Six objective functions were investigated: cross-entropy, Jaccard distance, focal loss, and 3 variations of Tversky distance. The performance of the models was compared using similarity metrics, including pixel accuracy, Jaccard index, Dice similarity coefficient (DSC), 95% Hausdorff distance, relative volume difference, Matthews correlation coefficient, precision, recall, and average symmetrical surface distance. We selected the highest-performing architecture and investigated how the amount of training data, use of skip connections, and data augmentation affected segmentation performance. In addition, we investigated whether segmentation on T1-weighted MRI was possible with FCNs trained on only T2-weighted and T2/T1-weighted image contrast.
    Results: Overall, an FCN with a DenseNet201 encoder trained via cross-entropy minimization yielded the highest combined segmentation performance. For the 53 3D test MRI scans acquired with T2-weighted or T2/T1-weighted image contrast, the DSCs of the prostate, external urinary sphincter, seminal vesicles, rectum, and bladder were 0.90 ± 0.04, 0.70 ± 0.15, 0.80 ± 0.12, 0.91 ± 0.06, and 0.96 ± 0.04, respectively, after model fine-tuning. For the 5 T1-weighted images, the DSCs of these organs were 0.82 ± 0.07, 0.17 ± 0.15, 0.46 ± 0.21, 0.87 ± 0.06, and 0.88 ± 0.05, respectively.
    Conclusions: Machine segmentation of the prostate and surrounding anatomy on 3D MRIs acquired with different pulse sequences for MARS low-dose-rate prostate brachytherapy is possible with a single FCN.
    MeSH term(s) Brachytherapy/methods ; Cohort Studies ; Deep Learning ; Entropy ; Humans ; Image Processing, Computer-Assisted/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Neural Networks, Computer ; Pelvis/anatomy & histology ; Pelvis/diagnostic imaging ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiosurgery/methods ; Rectum/diagnostic imaging ; Retrospective Studies ; Seminal Vesicles/diagnostic imaging ; Urethra/diagnostic imaging ; Urinary Bladder/diagnostic imaging
    Language English
    Publishing date 2020-07-04
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2020.06.076
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  8. Article ; Online: Fully Balanced SSFP Without an Endorectal Coil for Postimplant QA of MRI-Assisted Radiosurgery (MARS) of Prostate Cancer: A Prospective Study.

    Sanders, Jeremiah W / Venkatesan, Aradhana M / Levitt, Chad A / Bathala, Tharakeswara / Kudchadker, Rajat J / Tang, Chad / Bruno, Teresa L / Starks, Christine / Santiago, Edwin / Wells, Michelle / Weaver, Carl P / Ma, Jingfei / Frank, Steven J

    International journal of radiation oncology, biology, physics

    2020  Volume 109, Issue 2, Page(s) 614–625

    Abstract: Purpose: To investigate fully balanced steady-state free precession (bSSFP) with optimized acquisition protocols for magnetic resonance imaging (MRI)-based postimplant quality assessment of low-dose-rate (LDR) prostate brachytherapy without an ... ...

    Abstract Purpose: To investigate fully balanced steady-state free precession (bSSFP) with optimized acquisition protocols for magnetic resonance imaging (MRI)-based postimplant quality assessment of low-dose-rate (LDR) prostate brachytherapy without an endorectal coil (ERC).
    Methods and materials: Seventeen patients at a major academic cancer center who underwent MRI-assisted radiosurgery (MARS) LDR prostate cancer brachytherapy were imaged with moderate, high, or very high spatial resolution fully bSSFP MRIs without using an ERC. Between 1 and 3 signal averages (NEX) were acquired with acceleration factors (R) between 1 and 2, with the goal of keeping scan times between 4 and 6 minutes. Acquisitions with R >1 were reconstructed with parallel imaging and compressed sensing (PICS) algorithms. Radioactive seeds were identified by 3 medical dosimetrists. Additionally, some of the MRI techniques were implemented and tested at a community hospital; 3 patients underwent MARS LDR prostate brachytherapy and were imaged without an ERC.
    Results: Increasing the in-plane spatial resolution mitigated partial volume artifacts and improved overall seed and seed marker visualization at the expense of reduced signal-to-noise ratio (SNR). The reduced SNR as a result of imaging at higher spatial resolution and without an ERC was partially compensated for by the multi-NEX acquisitions enabled by PICS. Resultant image quality was superior to the current clinical standard. All 3 dosimetrists achieved near-perfect precision and recall for seed identification in the 17 patients. The 3 postimplant MRIs acquired at the community hospital were sufficient to identify 208 out of 211 seeds implanted without reference to computed tomography (CT).
    Conclusions: Acquiring postimplant prostate brachytherapy MRI without an ERC has several advantages including better patient tolerance, lower costs, higher clinical throughput, and widespread access to precision LDR prostate brachytherapy. This prospective study confirms that the use of an ERC can be circumvented with fully bSSFP and advanced MRI scan techniques in a major academic cancer center and community hospital, potentially enabling postimplant assessment of MARS LDR prostate brachytherapy without CT.
    MeSH term(s) Brachytherapy/instrumentation ; Humans ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiosurgery/instrumentation ; Radiotherapy Dosage ; Radiotherapy, Image-Guided/instrumentation ; Rectum ; Signal-To-Noise Ratio
    Language English
    Publishing date 2020-09-24
    Publishing country United States
    Document type Clinical Trial ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 197614-x
    ISSN 1879-355X ; 0360-3016
    ISSN (online) 1879-355X
    ISSN 0360-3016
    DOI 10.1016/j.ijrobp.2020.09.040
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  9. Article ; Online: Development, implementation, and outcomes of a simulation-based medical education (SBME) prostate brachytherapy workshop for radiation oncology residents.

    Mesko, Shane / Chapman, Bhavana V / Tang, Chad / Kudchadker, Rajat J / Bruno, Teresa L / Sanders, Jeremiah / Das, Prajnan / Pinnix, Chelsea C / Thaker, Nikhil G / Frank, Steven J

    Brachytherapy

    2020  Volume 19, Issue 6, Page(s) 738–745

    Abstract: Purpose: Despite a preponderance of data demonstrating strong clinical outcomes and cost-effectiveness, prostate brachytherapy use and competency continue to decline. Enhanced resident education may help reverse this trend. We therefore developed and ... ...

    Abstract Purpose: Despite a preponderance of data demonstrating strong clinical outcomes and cost-effectiveness, prostate brachytherapy use and competency continue to decline. Enhanced resident education may help reverse this trend. We therefore developed and implemented a simulation-based medical education course for low-dose-rate prostate brachytherapy (LDR-PB).
    Materials and methods: A 1-week LDR-PB course comprised four 1-h lectures on clinical outcomes, physics, radiobiology, and anatomy/contouring, followed by a 4.5-h simulation session on ultrasound-guided prostate phantom implantation, was developed for radiation oncology residents at an academic institution. A 10-statement Likert-scale survey and 20-question multiple-choice test were administered 1 week before and 4 weeks after the course.
    Results: Precourse and postcourse instruments were completed by 24 and 20 residents, respectively. The median number of prior LDR-PB cases after at least one genitourinary rotation was 10.5 (range 5-20). Overall mean test scores were significantly improved (55% before the course vs 68% after the course; p = 0.010). Mean Likert scores significantly increased on nine of 10 survey statements and were significantly increased overall (2.4 before the course vs 3.3 after the course, p < 0.001). When asked about interest in performing brachytherapy after residency, 37.5% of residents "agreed" or "strongly agreed" before the course vs 50% after the course (p = 0.41). Those with higher postresidency brachytherapy interest (scores of 4-5 vs 1-3) had significantly more LDR-PB cases (11.2 vs 5.3 cases; p = 0.005).
    Conclusions: A 1-week simulation-based medical education course for LDR-PB can improve didactic performance and self-reported technical competence/confidence, and may increase overall enthusiasm for brachytherapy. Future studies at our institution will incorporate evaluation of implant quality and assessment of procedural competence into this framework. Residency programs should dedicate resources to this essential component of radiation oncology.
    MeSH term(s) Attitude of Health Personnel ; Brachytherapy/methods ; Clinical Competence ; Computer Simulation ; Curriculum ; Humans ; Internship and Residency/methods ; Male ; Phantoms, Imaging ; Prostatic Neoplasms/radiotherapy ; Radiation Oncology/education ; Radiotherapy Planning, Computer-Assisted ; Self Efficacy ; Simulation Training ; Surveys and Questionnaires
    Language English
    Publishing date 2020-09-17
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2098608-7
    ISSN 1873-1449 ; 1538-4721
    ISSN (online) 1873-1449
    ISSN 1538-4721
    DOI 10.1016/j.brachy.2020.08.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Quality comparison between three-dimensional T2-weighted SPACE and two-dimensional T2-weighted turbo spin echo magnetic resonance images for the brachytherapy planning evaluation of prostate and periprostatic anatomy.

    Bathala, Tharakeswara K / Venkatesan, Aradhana M / Ma, Jingfei / Bhosale, Priyadarshini / Wei, Wei / Kudchadker, Rajat J / Wang, Jihong / Anscher, Mitchell S / Tang, Chad / Bruno, Teresa L / Frank, Steven J / Szklaruk, Janio

    Brachytherapy

    2020  Volume 19, Issue 4, Page(s) 484–490

    Abstract: Purpose: The purpose of this study was to compare an isotropic three-dimensional (3D) T2-weighted sequence sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with an axial two-dimensional T2-weighted turbo ... ...

    Abstract Purpose: The purpose of this study was to compare an isotropic three-dimensional (3D) T2-weighted sequence sampling perfection with application-optimized contrasts by using flip angle evolution (SPACE) with an axial two-dimensional T2-weighted turbo spin echo (TSE) sequence with regard to overall image quality and the delineation of normal prostate and periprostatic anatomy for low-dose-rate prostate cancer brachytherapy planning evaluation.
    Methods and materials: Patients (n = 69) with prostate cancer who had pelvic magnetic resonance imaging (MRI) for low-dose-rate brachytherapy treatment planning were included. Three radiologists independently assessed the visibility of nine anatomic structures on each sequence by using a 5-point scale and overall image quality by using a 4-point scale. The significance of the differences in diagnostic performance was tested with a Wilcoxon signed rank test.
    Results: No significant intersequence differences were found for most (7/9) anatomical structures and overall image quality. The mean scores for visibility of anatomical structures on the 3D SPACE and 2D TSE sequences, respectively, were as follows: the zonal anatomy (3.7; 3.9, p = 0.05), prostate capsule (3.9; 4.0, p = 0.08), neurovascular bundle (2.9; 2.9, p = 0.9), rectoprostatic angle (3.8; 3.8, p = 0.35), rectum (4.2; 4.3, p = 0.26), urethra (3.8; 3.9, p = 0.12), urinary bladder (4.6; 4.6, p = 0.61), and overall image quality (2.9; 2.9, p = 0.33). 3D SPACE was superior for delineation of the genitourinary diaphragm (3.8; 3.6, p = 0.003), whereas 2D TSE was superior for delineation of the seminal vesicles (3.5; 4.0, p < 0.0001).
    Conclusions: Anatomic delineation of the prostatic and periprostatic anatomy provided by the 3D SPACE sequence is as robust in quality as that provided by a conventional 2D TSE sequence with superior delineation of the genitourinary diaphragm. For MRI-based brachytherapy treatment planning, the 3D SPACE sequence with subcentimeter isotropic resolution can replace the 2D TSE sequence and be incorporated into standard MRI protocols.
    MeSH term(s) Aged ; Anatomic Landmarks/diagnostic imaging ; Blood Vessels/diagnostic imaging ; Brachytherapy ; Contrast Media ; Humans ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging/methods ; Magnetic Resonance Imaging/standards ; Male ; Middle Aged ; Peripheral Nerves/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiotherapy Planning, Computer-Assisted ; Rectum/diagnostic imaging ; Retrospective Studies ; Seminal Vesicles/diagnostic imaging ; Urethra/diagnostic imaging ; Urinary Bladder/diagnostic imaging
    Chemical Substances Contrast Media
    Language English
    Publishing date 2020-05-10
    Publishing country United States
    Document type Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; 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.2020.04.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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