Needle Optimization for Use in Transrectal Ultrasound Guided Hybrid HDR GYN Brachytherapy

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Date

2025

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Abstract

Introduction:Interstitial (IS) high-dose rate (HDR) gynecological (GYN) brachytherapy implants are complex procedures that are time consuming, highly physician-dependent, and prone to needle placement uncertainties, often prompting reinsertion and increasing patient trauma. To address these challenges, previous experiments evaluated the feasibility and efficacy of using an intraoperative 3D transrectal-ultrasound (TRUS) guidance system (Artemis, Eigen Health) to guide needle insertions using real-time US imaging with registered target structures from pre-implant MR images. To further advance clinical implementation, this research introduces a quality assurance (QA) and commissioning framework to characterize this technology for a new clinical application, along with a needle path optimization tool to assist in applicator placement planning. Materials and Methods: A comprehensive QA and commissioning protocol was developed and validated to characterize and ensure the reliability of TRUS-guidance and needle tracking in HDR GYN brachytherapy. The protocol was based on guidelines recommended by American Association of Physicists in Medicine (AAPM) task group (TG) report 128, and included additional tests designed to investigate the needle tracking capabilities of the system. To facilitate this, previously developed in-house phantoms underwent design optimization and were constructed for use with the protocol. Additionally, a previously identified “lateral stretching” effect was investigated in a series of experiments. A dose-informed, inversely optimized needle path planning algorithm was developed to assist in interstitial applicator placement planning. From a set of candidate needle tracks, the algorithm uses iterative dwell-time optimization to facilitate AAPM TG-43-based dose calculations to direct optimal needle path selection.

Results:Validation of the QA and commissioning protocol showed effective characterization of the Artemis system, with results meeting recommended tolerances and demonstrating accuracy and reliability of TRUS-guidance in HDR GYN brachytherapy. Optimization of in-house phantom designs improved the usability of the phantoms as a qualitative tool for assessing a TRUS-based guidance system and facilitate integration into the QA and commissioning protocol. Investigation of the “lateral stretching” effect identified the underlying causes and effective mitigation strategies, effectively eliminating the issue. Furthermore, results from the needle path planning algorithm met clinically relevant target dose criteria, highlighting its potential as a valuable tool for applicator placement planning. Conclusion: Development of a protocol that effectively characterizes the Artemis system brings closer its clinical implementation into a GYN brachytherapy practice, with potential for enhancing treatment efficacy and reducing complications. Further, the rigor with which the protocol was designed and validated allows the protocol to be generalized to any TRUS-based needle guidance system. Additionally, further refinement of the needle path planning algorithm holds promise for clinical integration to prospectively inform needle placement. This research provides critical steps for the advancement of TRUS-guided HDR GYN brachytherapy, paving the way for future clinical trials and implementation into a clinical HDR brachytherapy workflow.

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Physics, Medicine, Brachytherapy, Optimization, Phantoms, Quality Assurance

Citation

Citation

Sanford, Ryan James (2025). Needle Optimization for Use in Transrectal Ultrasound Guided Hybrid HDR GYN Brachytherapy. Master's thesis, Duke University. Retrieved from https://hdl.handle.net/10161/32864.

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