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An Ultrasound-Guided Mechatronics-Assisted System for Semi-Automated Seed Implantation and Tracking in Prostate Brachytherapy
Published in Bin Wei, Brain and Cognitive Intelligence Control in Robotics, 2022
Carlos Rossa, Jay Carriere, Mohsen Khadem, Ronald Sloboda, Nawaid Usmani, Mahdi Tavakoli
In this paper we demonstrate the feasibility of a new framework for accurate radioactive seed implantation and tracking during low dose rate prostate brachytherapy for prostate cancer. A hand-held needle steering apparatus controls the deflection of a seed-carrying needle during insertion such that the needle tip reaches the desired target with minimum deflection. The steering controller evaluates the effects of axial needle rotations at different depths on the needle targeting accuracy via a needle-tissue interaction model. Optimal rotation depths are determined prior to the procedure and can be updated as the needle insertion progresses. The device automatically steers the needle as the surgeon manually inserts it in tissue, keeping the surgeon in control of the procedure. Once the needle reaches the target, the surgeon can deposit the seeds in tissue as in current clinical practice. Hence, the proposed framework does not require major modifications to the operating room setup. Knowing the final needle tip location prior to seed deposition, a method is proposed to track the final seed locations after needle withdrawal, allowing the surgeon to monitor implant quality on the fly.
Prostate cancer high dose-rate brachytherapy: review of evidence and current perspectives
Published in Expert Review of Medical Devices, 2018
Sunil W. Dutta, Clayton E. Alonso, Bruce Libby, Timothy N. Showalter
Prostate brachytherapy, which involves placing a sealed radiation source directly into the prostate, has higher conformality than EBRT, potentially improving the therapeutic ratio [9]. For patients with high risk disease, the Androgen Suppression Combined with Elective Nodal and Dose Escalated Radiation Therapy (ASCENDE-RT) trial demonstrated that patients who received low dose-rate (LDR) brachytherapy boost (compared to 78 Gy EBRT alone) were twice as likely to be free of biochemical failure, with an absolute estimated improvement of 21% with the use of brachytherapy by 9 years follow-up [10]. However, the ASCENDE-RT trial results also showed that patients who received LDR brachytherapy were at substantially higher risk of severe urinary toxicity, such as urethral stricture, potentially counterbalancing the gains in biochemical control [11]. As of a result of the improved cancer control outcomes from ASCENDE-RT and other clinical studies, the American Society of Clinical Oncology (ASCO) and Cancer Care Ontario issued joint guidelines in 2017 to recommend that all eligible patients with intermediate to high risk prostate cancer should be offered brachytherapy [12]. Similarly, the 2017 National Comprehensive Cancer Network (NCCN) guidelines list EBRT plus brachytherapy as a standard treatment option for intermediate to high risk prostate cancer [5].