Medical Physics

EM-enhanced US-based seed detection for prostate brachytherapy

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Purpose: Intraoperative dosimetry in low-dose-rate (LDR) permanent prostate brachytherapy requires accurate localization of the implanted seeds with respect to the prostate anatomy. Transrectal Ultrasound (TRUS) imaging, which is the main imaging modality used during the procedure, is not sufficiently robust for accurate seed localization. We present a method for integration of electromagnetic (EM) tracking into LDR prostate brachytherapy procedure by fusing it with TRUS imaging for seed localization. Method: Experiments were conducted on five tissue mimicking phantoms in a controlled environment. The seeds were implanted into each phantom using an EM-tracked needle, which allowed recording of seed drop locations. After each needle, we reconstructed a 3D ultrasound (US) volume by compounding a series of 2D US images acquired during retraction of an EM-tracked TRUS probe. Then, a difference image was generated by nonrigid registration and subtraction of two consecutive US volumes. A US-only seed detection method was used to detect seed candidates in the difference volume, based on the signature of the seeds. Finally, the EM-based positions of the seeds were used to detect the false positives of the US-based seed detection method and also to estimate the positions of the missing seeds. After the conclusion of the seed implant process, we acquired a CT image. The ground truth for seed locations was obtained by localizing the seeds in the CT image and registering them to the US coordinate system. Results: Compared to the ground truth, the US-only detection algorithm achieved a localization error mean of 1.7 mm with a detection rate of 85%. By contrast, the EM-only seed localization method achieved a localization error mean of 3.7 mm with a detection rate of 100%. By fusing EM-tracking information with US imaging, we achieved a localization error mean of 1.8 mm while maintaining a 100% detection rate without any false positives. Conclusions: Fusion of EM-tracking and US imaging for prostate brachytherapy can combine high localization accuracy of US-based seed detection with the robustness and high detection rate of EM-based seed localization. Our phantom experiments serve as a proof of concept to demonstrate the potential value of integrating EM-tracking into LDR prostate brachytherapy.