UBC Theses and Dissertations
Characterization of implanted seed orientation and displacement dynamics with application to the design of non-uniform source strength treatment plans for prostate brachytherapy Chng, Nicholas T.
Low dose rate prostate brachytherapy is one of the most effective treatments for prostate cancer currently available. It involves the implantation of approximately one hundred small radioactive sources, or ‘seeds’, into the prostate gland. This is accomplished by depositing the seeds transperineally via 16-30 long needles. In British Columbia, over three thousand patients have been treated since 1998 using this technique, and fewer than 10% have suffered a recurrence to date. One of the principal challenges in low dose rate prostate brachytherapy is the limited reliability with which precise doses to the prostate and surrounding organs can be achieved. This is due both to the difficulty in accurately delivering the seeds to their planned positions, as well as movement of the seeds in the post-implant period during the resolution of procedure-induced edema. This uncertainty can lead to undetected deficits in the dose necessary to control the cancer. As patients with more advanced disease are being considered for brachytherapy, these deficits may have greater consequences on oncological outcomes. Treatment uncertainty also increases the risk of side effects, which have the potential to be severe. The overall aim of this thesis is to improve the scope and accuracy with which the dose distribution of stranded seeds can be measured after implant. This involved the development of an algorithm to uniquely identify seeds in post-implant CT data, along with a method to determine their orientation to improve dosimetric accuracy. An analysis of the displacement and migration patterns of seeds in the interval during the resolution of prostate edema was also undertaken. These results identified dosimetric deficiencies and modes of seed loss which have the potential to be rectified by the use of implants containing seeds of non-uniform strength (‘mixed-activity’ implants). Such treatments use fewer needles and may also reduce the incidence of treatment related urinary morbidity. Although the concept of mixed-activity implants is not novel, the algorithm developed to identify seeds after implant enables the post-implant assurance of their dosimetric quality in a clinically feasible way. This thesis concludes with a study investigating the dosimetric benefits of mixed-activity implants.
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