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Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program.

Owrangi AM, Prisciandaro JI, Soliman A, Ravi A, Song WY - J Contemp Brachytherapy (2015)

Bottom Line: Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer.It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized.A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA ; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT
Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized. A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times.

No MeSH data available.


Related in: MedlinePlus

Example of patient care-path flowchart adapted from the Cancer Care Ontario guideline [60] for MRI-guided brachytherapy
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Figure 0001: Example of patient care-path flowchart adapted from the Cancer Care Ontario guideline [60] for MRI-guided brachytherapy

Mentions: Most MRI scanners come with conventional reconstruction software and basic image processing tools, which might be sufficient for the adjustment of T1-weighted (T1w) and T2-weighted (T2w) images. The Groupe Européen de Curiethérapie – European Society for Radiotherapy & Oncology (GEC-ESTRO) recommends the use of MR imaging both at the time of diagnosis and brachytherapy with T2w pulse sequences [17]. An example flowchart for patients undergoing MRI-guided brachytherapy is shown in Figure 1. To assess the tumor extension, paratransverse, paracoronal, and parasagittal images along the axis of the cervical canal or applicator have been suggested [17]; however, due to the comparatively longer acquisition time of T2w pulse sequences, it is more susceptible to internal organ motion artifacts than pulse sequences with shorter acquisition times. Antiperistalsis/ antispasmodic agents such as glucagon (scopolamine butylbromide) and buscopan are commonly used for pelvic MRI imaging to reduce image artifacts, especially for longer scan sequences [29, 30]. On the other hand, parallel MRI has been established in diagnostic imaging to accelerate image acquisition, which will, therefore, reduce the chance of potential motion artifacts; however, this technique may introduce image artifacts if acquisition parameters are not properly optimized. As suggested by the recent American Association of Physicists in Medicine (AAPM) Task Group 118 [31], understanding the advantages, challenges, and limitations of parallel MRI is necessary to maximize the benefits from this technology by reducing the scan time, while preserving an acceptable image quality.


Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program.

Owrangi AM, Prisciandaro JI, Soliman A, Ravi A, Song WY - J Contemp Brachytherapy (2015)

Example of patient care-path flowchart adapted from the Cancer Care Ontario guideline [60] for MRI-guided brachytherapy
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663219&req=5

Figure 0001: Example of patient care-path flowchart adapted from the Cancer Care Ontario guideline [60] for MRI-guided brachytherapy
Mentions: Most MRI scanners come with conventional reconstruction software and basic image processing tools, which might be sufficient for the adjustment of T1-weighted (T1w) and T2-weighted (T2w) images. The Groupe Européen de Curiethérapie – European Society for Radiotherapy & Oncology (GEC-ESTRO) recommends the use of MR imaging both at the time of diagnosis and brachytherapy with T2w pulse sequences [17]. An example flowchart for patients undergoing MRI-guided brachytherapy is shown in Figure 1. To assess the tumor extension, paratransverse, paracoronal, and parasagittal images along the axis of the cervical canal or applicator have been suggested [17]; however, due to the comparatively longer acquisition time of T2w pulse sequences, it is more susceptible to internal organ motion artifacts than pulse sequences with shorter acquisition times. Antiperistalsis/ antispasmodic agents such as glucagon (scopolamine butylbromide) and buscopan are commonly used for pelvic MRI imaging to reduce image artifacts, especially for longer scan sequences [29, 30]. On the other hand, parallel MRI has been established in diagnostic imaging to accelerate image acquisition, which will, therefore, reduce the chance of potential motion artifacts; however, this technique may introduce image artifacts if acquisition parameters are not properly optimized. As suggested by the recent American Association of Physicists in Medicine (AAPM) Task Group 118 [31], understanding the advantages, challenges, and limitations of parallel MRI is necessary to maximize the benefits from this technology by reducing the scan time, while preserving an acceptable image quality.

Bottom Line: Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer.It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized.A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada ; Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA ; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

ABSTRACT
Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized. A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times.

No MeSH data available.


Related in: MedlinePlus