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Title: Definition and visualisation of regions of interest in post-prostatectomy image-guided intensity modulated radiotherapy

Standard post-prostatectomy radiotherapy (PPRT) image verification uses bony anatomy alignment. However, the prostate bed (PB) moves independently of bony anatomy. Cone beam computed tomography (CBCT) can be used to soft tissue match, so radiation therapists (RTs) must understand pelvic anatomy and PPRT clinical target volumes (CTV). The aims of this study are to define regions of interest (ROI) to be used in soft tissue matching image guidance and determine their visibility on planning CT (PCT) and CBCT. Published CTV guidelines were used to select ROIs. The PCT scans (n = 23) and CBCT scans (n = 105) of 23 post-prostatectomy patients were reviewed. Details on ROI identification were recorded. Eighteen patients had surgical clips. All ROIs were identified on PCTs at least 90% of the time apart from mesorectal fascia (MF) (87%) due to superior image quality. When surgical clips are present, the seminal vesicle bed (SVB) was only seen in 2.3% of CBCTs and MF was unidentifiable. Most other structures were well identified on CBCT. The anterior rectal wall (ARW) was identified in 81.4% of images and penile bulb (PB) in 68.6%. In the absence of surgical clips, the MF and SVB were always identified; the ARW was identifiedmore » in 89.5% of CBCTs and PB in 73.7%. Surgical clips should be used as ROIs when present to define SVB and MF. In the absence of clips, SVB, MF and ARW can be used. RTs must have a strong knowledge of soft tissue anatomy and PPRT CTV to ensure coverage and enable soft tissue matching.« less
Authors:
;  [1] ;  [2] ; ; ;  [1]
  1. Radiation Oncology Department, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales (Australia)
  2. (Australia)
Publication Date:
OSTI Identifier:
22402351
Resource Type:
Journal Article
Resource Relation:
Journal Name: Journal of Medical Radiation Sciences (Print); Journal Volume: 61; Journal Issue: 3; Other Information: PMCID: PMC4175845; PMID: 26229653; OAI: oai:pubmedcentral.nih.gov:4175845; Copyright (c) 2014 The Authors. Journal of Medical Radiation Sciences published by Wiley Publishing Asia Pty Ltd on behalf of Australian Institute of Radiography and New Zealand Institute of Medical Radiation Technology.; This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
Australia
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ALIGNMENT; ANATOMY; BULBS; COMPUTERIZED TOMOGRAPHY; CONES; FASCIA; IMAGES; PATIENTS; PLANNING; PROSTATE; RADIOTHERAPY; RECOMMENDATIONS; VERIFICATION; VISIBILITY