Permanent breast seed implantation (PBSI) is a single visit accelerated partial breast irradiation method that uses needles inserted via a template to distribute Pd-103 radioactive seeds with two-dimensional (2D) ultrasound (US) guidance. This guidance approach is limited by its dependence on the operator and average seed placement errors greater than benchmark values established by dosimetric studies. We propose the use of a three-dimensional (3D) US imaging approach for needle guidance with integrated template tracking. We previously described the preliminary development and validation of the 3D US mechatronic system. The present work demonstrates the accuracy of the integrated system by quantifying agreement between tracking and imaging sub-systems and its use guiding a phantom procedure. Tracking error was measured by inserting a needle a known distance through the template and comparing expected tip position from tracking to observed tip position from imaging. Mean ± standard deviation differences in needle tip position and angle were 2.90 ± 0.76 mm and 1.77 ± 0.98°, respectively, validating the needle tracking accuracy of the developed system. The system was used to guide 15 needles into a patient-specific phantom according to the accompanying treatment plan and micro-CT images taken before and after to evaluate placement accuracy. Seed positions were modelled using needle positions and the resulting dosimetry compared to a procedure specific benchmark. The mean tip difference was 2.08 mm while the mean angular difference was 2.6°, resulting in acceptable dosimetric coverage. These results demonstrate 3D US as a potentially feasible technique for PBSI guidance.
Justin Michael, Jessica R. Rodgers, Daniel Morton, Deidre Batchelar, Michelle Hilts, and Aaron Fenster, "3D ultrasound guidance system for permanent breast seed implantation: integrated system performance and phantom procedure," Proc. SPIE 10576, Medical Imaging 2018: Image-Guided Procedures, Robotic Interventions, and Modeling, 105760U (Presented at SPIE Medical Imaging: February 14, 2018; Published: 13 March 2018); https://doi.org/10.1117/12.2293126.
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