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3T MR-guided Brachytherapy for Gynecologic Malignancies

Institution:
1Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Publication Date:
Nov-2012
Journal:
Magn Reson Imaging
Volume Number:
30
Issue Number:
9
Pages:
1279-90
Citation:
Magn Reson Imaging. 2012 Nov;30(9):1279-90.
Links:
http://dx.doi.org/10.1016/j.mri.2012.06.003
PubMed ID:
22898699
PMCID:
PMC3468320
Keywords:
Brachytherapy, Segmentation, Bias Correction
Appears in Collections:
NCIGT, NA-MIC, SPL
Sponsors:
K07 CA117979/CA/NCI NIH HHS/United States
P41 EB015898/EB/NIBIB NIH HHS/United States
P41 RR019703/RR/NCRR NIH HHS/United States
R03 EB013792/EB/NIBIB NIH HHS/United States
U54 EB005149/EB/NIBIB NIH HHS/United States
Generated Citation:
Kapur T., Egger J., Damato A., Schmidt E.J., Viswanathan A.N. 3T MR-guided Brachytherapy for Gynecologic Malignancies. Magn Reson Imaging. 2012 Nov;30(9):1279-90. PMID: 22898699. PMCID: PMC3468320.
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Gynecologic malignancies are a leading cause of death in women worldwide. Standard treatment for many primary and recurrent gynecologic cancer cases includes external-beam radiation followed by brachytherapy. Magnetic resonance (MR) imaging is beneficial in diagnostic evaluation, in mapping the tumor location to tailor radiation dose and in monitoring the tumor response to treatment. Initial studies of MR guidance in gynecologic brachytherapy demonstrate the ability to optimize tumor coverage and reduce radiation dose to normal tissues, resulting in improved outcomes for patients. In this article, we describe a methodology to aid applicator placement and treatment planning for 3 Tesla (3-T) MR-guided brachytherapy that was developed specifically for gynecologic cancers. This methodology has been used in 18 cases from September 2011 to May 2012 in the Advanced Multimodality Image Guided Operating (AMIGO) suite at Brigham and Women's Hospital. AMIGO comprises state-of-the-art tools for MR imaging, image analysis and treatment planning. An MR sequence using three-dimensional (3D)-balanced steady-state free precession in a 3-T MR scanner was identified as the best sequence for catheter identification with ballooning artifact at the tip. 3D treatment planning was performed using MR images. Items in development include software designed to support virtual needle trajectory planning that uses probabilistic bias correction, graph-based segmentation and image registration algorithms. The results demonstrate that 3-T MR image guidance has a role in gynecologic brachytherapy. These novel developments have the potential to improve targeted treatment to the tumor while sparing the normal tissues.

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