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Illustrating the Workflow of a Robust, CT-Based HDR Prostate Brachytherapy Program

R Manigold, University of Nevada Las Vegas, NV


(Sunday, 7/14/2019)  

Room: ePoster Forums

Purpose: To illustrate a robust CT-based HDR prostate brachytherapy workflow that has been modified over the years to utilize available resources in an effort to be as efficient as possible to cut down total patient procedure time while maintaining quality plans.

Methods: In order to reduce total HDR prostate treatment time, a targeted approach was used in conjunction with parallel-processing, mitigation of errors/concern/uncertainty, and the development of tools and ideal setups to streamline the process. A free-hand (non-stepper) approach for the implanting physician is not only preferred, but allows for more freedom during the implant, as well as quicker setup/tear down times in the OR. Parallel-processing was utilized following CT by having the physician contour in a secondary contouring system while physics/dosimetry began digitization of the needles, and another capable member of the department began connecting transfer tubes. Needle migration concern is eliminated by using a pneumatic floating patient support sled in order to safely and quickly transport the patient to and from CT. The use of prescription, structure, optimization, and plan objective templates is utilized to streamline planning and ensure consistent plan quality. Custom report templates and spreadsheets are used to allow for quick second checks.

Results: Examining between 139 and 293 of the implants (due to OR data availability) gave results of 38±8 minutes for implant time, 96±18 minutes from OR arrival until CT scan was imported, 55±15 minutes for treatment planning, 13.5±7 minutes for final treatment preparation, and 187±26 minutes for total procedure time (from OR arrival until treatment finish).

Conclusion: By parallel-processing to minimize time-intensive tasks, utilizing available features, developing tools and setups in a targeted approach, this study indicates that it is possible to have an efficient CT-based prostate HDR workflow that can rival the times of US-based prostate HDR or even LDR prostate.


Not Applicable / None Entered.


Not Applicable / None Entered.

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