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2005 Surgical Planning Laboratory, ARRSlide *

Contouring PZ, urethra and rectum Axial T2W image Treatment plan

2005 Surgical Planning Laboratory, ARRSlide *

Needle PlacementNeedle InsertionRT ImagingCor,Sag,AxRadio logicEvaluationDosimetric EvaluationPlace SeedsDose EvaluationPlan ModificationRepositionNeedleNext NeedleAdditional Needles Necessary?Feedbacks:AnatomicGeometricDosimetricYesYesNoNo

2005 Surgical Planning Laboratory, ARRSlide *

Brachytherapy planning Software** US PATENT OFFICERadiation seed implant method and apparatus. JCR098-01pA: 2001, Nov 1.

2005 Surgical Planning Laboratory, ARRSlide *

MR-guided prostate biopsy programClinical needTRUS high false negativeMR Bx Target +Sextant/octantNeed target validation methodNeed free-hand or Robot assisted approachTARGET3D-Slicer adapted for prostate procedures and target definition, trajectory planning and guidance

2005 Surgical Planning Laboratory, ARRSlide *

MR guided biopsy protocolPre-biopsyMR imagingDefine any targetsT2WContrastMRSILSDIT2 mapsBiopsyOpen MRTTransperinealTargeted samplingSystematic sampling (Sextant/Octant)Site specific pathology

2005 Surgical Planning Laboratory, ARRSlide *

MRI/MRSI : Data SummaryUp to1024ProstatespectraData from UCSF Kurhanewicz et al

2005 Surgical Planning Laboratory, ARRSlide *

Multi-parametric and multi- modal data problem

2005 Surgical Planning Laboratory, ARRSlide *

[11C] Choline PET/MRIPETFUSIONMRICourtesy of J. Czernin, MD Ahmanson Biological Imaging Center, David Geffen School of Medicine at UCLA

2005 Surgical Planning Laboratory, ARRSlide *

Prostate IGT Research projectsRegistration & SegmentationMulti-modal image displaySeed definition-seed based dosimetryClinical outcomesCancer diagnosis, control, toxicity and QOLTarget definitionMulti-parametric data analysis and summationOptimized biopsyDavatzikos et al-mathematical statistical modelRobotic assist device /closed bore systemsFichtinger, Burdette et alMRg Prostate cancer FUSHynynen et al

2005 Surgical Planning Laboratory, ARRSlide *

Interfractional Motion from Serial CT Movement AP ~1cm*Courtesy of Andrew Zitman MD (MGH) IGT requires dynamic imaging to monitor delivery: Rapid image processing & registration

2005 Surgical Planning Laboratory, ARRSlide *

Recent case: Rising PSA 4 years after brachytherapy

2005 Surgical Planning Laboratory, ARRSlide *

MR/MRSI guided biopsy & Rx

AdenocarcinomaAnterior TZ

2005 Surgical Planning Laboratory, ARRSlide *

MR guided brachytherapy: Clinical validation / outcomesOutcomes. Albert* et al Cancer (2003)Grade 3 rectal bleeding 8% vs. 30% (combined)4yr freedom from Radiation cystitis: 100 vs. 95%No urethral strictures or TURP to dateCancer control DAmico et al (2003) 93% 5 yr PSA control, similar to a surgically managed population over the same time frameQOL: Szot* et al RSNA 2004Significant improvement over US in both GU and sexual function* R25 training grant fellows

2005 Surgical Planning Laboratory, ARRSlide *

Non-invasive Focused ultrasound surgeryHigh intensity FUS first proposed by Lele in 1962Sound waves heat tissue through molecular vibrationDelay due to lack of targeting, guidance and temperature monitoringTested in animals-nude mouse model- Vaezy S et alFeasible for treating Breast Fibroadenomas-Hynenen K, et al Feasible for treating uterine Leiomyomas-Tempany et al

2005 Surgical Planning Laboratory, ARRSlide *

Future directions; MR guided Focused Ultrasound Surgery for Prostate cancer*

FUS THERMO-COAGULATIONnecrosisReal timeMR thermometry*R01: CA-109246-01 A1 Tempany

This movie loop shows the movement of the soft tissues after reasonable image registration of the bony anatomy from 6 serial volumetric CT studies. We have seen the standard deviations from previous speakers, and this is just a graphic illustration of what this really is about. These displays also provide information on structures for which COM data are not given.