Image fusion software offers brachytherapy guidance

Smart computing may be the ticket to image-guided surgery, particularly for sites that can't afford expensive technology. Researchers at Johns Hopkins University have come up with one such possibility - software that combines data from two widely used imaging technologies to enhance prostate brachytherapy.

The software, Registration of Ultrasound and Fluoroscopy (RUF), provides the means for radiation oncologists to see precisely where and how radioactive seeds are implanted in the prostate. RUF uses data obtained with C-arm fluoroscopy to determine the locations of the seeds in the prostate, then registers those seeds in the context of ultrasound images, providing a means to optimize the implants intraoperatively.

With this software, surgeons might be able to make necessary adjustments on the fly, or "step-by-step, needle-by-needle," said Gabor Fichtinger, Ph.D., director of engineering at the Johns Hopkins Engineering Research Center for Computer-Integrated Surgical Systems and Technologies in Baltimore.

Key objectives the Hopkins researchers hope to achieve in developing this software include ensuring optimal distribution of radiation, enabling optimization of dosing plans, and allowing intraoperative surgical modifications to help mitigate unintentional deviations from the original surgical plan.

Fichtinger's team will get a handle on how well they've done this fall, when clinical trials of the RUF system begin at Johns Hopkins. If these trials are successful, Fichtinger estimates that RUF could be widely available for use during prostate brachytherapy within several years.

Its adoption could mean more effective treatment with image-guided brachytherapy for the 230,000 men who are newly diagnosed with prostate cancer each year. About 50,000 brachytherapy treatments are conducted in the U.S. every year at about 3500 radiology centers nationwide. Typically, these procedures are done without immediate knowledge of whether the seeds have been placed correctly, a problem that Fichtinger's RUF software could overcome.