Intra-operative 3D guidance in prostate brachytherapy using a non-isocentric C-arm

Authors:
A. Jain;A. Deguet;I. Iordachita;G. Chintalapani;J. Blevins;Y. Le;E. Armour;C. Burdette;D. Song;G. Fichtinger
Affiliations:
Johns Hopkins University and Philips Research North America;Johns Hopkins University;Johns Hopkins University;Johns Hopkins University;Acoustic MedSystems Inc.;Johns Hopkins University;Johns Hopkins University;Acoustic MedSystems Inc.;Johns Hopkins University;Johns Hopkins University
Venue:
MICCAI'07 Proceedings of the 10th international conference on Medical image computing and computer-assisted intervention
Year:
2007

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Abstract

Intra-operative guidance in Transrectal Ultrasound (TRUS) guided prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate. Seeds were reconstructed using a typical C-arm, and exported to a commercial brachytherapy system for dosimetry analysis. Technical obstacles for 3D reconstruction on a non-isocentric C-arm included pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction; and C-arm to TRUS registration. In precision-machined hard phantoms with 40-100 seeds, we correctly reconstructed 99.8% seeds with a mean 3D accuracy of 0.68 mm. In soft tissue phantoms with 45-87 seeds and clinically realistic 15° C-arm motion, we correctly reconstructed 100% seeds with an accuracy of 1.3 mm. The reconstructed 3D seed positions were then registered to the prostate segmented from TRUS. In a Phase-1 clinical trial, so far on 4 patients with 66-84 seeds, we achieved intraoperative monitoring of seed distribution and dosimetry. We optimized the 100% prescribed iso-dose contour by inserting an average of 3.75 additional seeds, making intra-operative dosimetry possible on a typical C-arm, at negligible additional cost to the existing clinical installation.