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3-D ultrasound offers clearer, 360-degree view for delivery of gynecologic brachytherapy
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Novel 3-D transvaginal ultrasound technology appeared safe and effective in improving delivery of brachytherapy among a small cohort of women with gynecologic cancer, according to study results.
“The short-term goal is to reduce complication rates — ensure that the needles do not go into the bladder or the rectum, which creates complications. In addition, we are hypothesizing that if the needles are placed correctly that they will provide an improved dose pattern distribution to the tumor and surrounding tissue,” Aaron Fenster, PhD, professor at Western University School of Biomedical Engineering in Canada and chief scientific officer for the Centre for Imaging Technology Commercialization, said in a press release.
High-dose-rate interstitial brachytherapy requires precise placement of multiple needles into vaginal tumors to deliver treatment while optimizing dose and avoiding overexposure of nearby organs at risk.
Fenster and colleagues developed 3-D transvaginal ultrasound technology that provides a 360-degree view of surgical tools, surrounding tissue and organs to help guide placement of intraoperative needles during gynecologic brachytherapy. Results of a feasibility study showed that landmark anatomical features and all needles were clearly visible with the 3-D technology system, which uses a conventional ultrasound probe with a template-compatible custom sonolucent vaginal cylinder.
HemOnc Today spoke with Fenster about the technology, the feasibility study and what is next for research.
Question: What was the need for a device like this?
Answer: A radiation oncologist came to us and described a problem with gynecologic brachytherapy. He expressed his concern for guiding needles into a woman’s anatomy without direct, clear imaging guidance. It is quite important to ensure that the needles are accurately inserted for two reasons. For one, we do not want to perforate any organs at risk. Second, we need to ensure that the dose distribution is correct in order to destroy the tumor. This was an issue that was new to my colleagues and me, and we immediately thought of a solution because we had developed a similar brachytherapy approach for men.
Q: How did you conduct the study?
A: We developed a complete approach that could be used as transrectal or transvaginal ultrasound guidance of the needles into the anatomy, as well as verifying where the needles are in the anatomy. We recruited six patients willing to have this type of imaging done.
Q: What did you find?
A: We found that we could produce a sufficient image of the surrounding tissue, and with high quality. We wanted to ensure that we could see the needles accurately, and we could. We found that we needed to make small improvements in our workflow so that we can reduce the time of our procedure. Based upon our results, we are making a small modification to the system. We have requests from other cancer centers to develop the device for them, and we are now making multiple copies of the device.
Q: Do you have plans for additional research?
A: We plan to conduct a multi-institutional trial. Each institution performs this procedure in different ways, so we plan to assess whether we can adapt the device accordingly. The first site selected is in London and the second site may be in Calgary or Toronto (all in Canada). We anticipate to get the studies underway at other institutions within 4 or 5 months.
Q: What could having a device like this mean for clinical practice?
A: It could reduce complications and ensure that the planned dose distribution in the anatomy is as planned. We hypothesize that these advantages will improve treatment outcome. – by Jennifer Southall
Reference:
Rodgers JR, et al. J Med Imaging (Bellingham). 2019;doi:10.1117/1.JMI.6.2.025001.
For more information:
Aaron Fenster, PhD, can be reached at Western University School of Biomedical Engineering, Amit Chakma Engineering Building, Room. 2405, London, Ontario, Canada, N6A 3K7; email: afenster@robarts.ca.
Disclosure: Fenster reports no relevant financial disclosures.