An analysis of intraoperative versus post-operative dosimetry with CT, CT–MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants
Received 7 February 2010; received in revised form 17 May 2010; accepted 7 June 2010. published online 08 July 2010.
Abstract
Background and purpose
To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants.
Materials and methods
Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose–volume histograms were calculated from CT, XMR and CT–MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90.
Results
Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT–MR fusion assessments were: 11Gy (−22, 45), 18Gy (−13, 49) and 20Gy (−17, 58) for Observer 1; and 15Gy (−34, 63), 13Gy (−29, 55) and 14Gy (−27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities.
Conclusion
This is the first study to report Bland–Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume.
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