{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T16:04:37Z","timestamp":1784217877927,"version":"3.55.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aapm.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rectal spacers are widely used to reduce rectal dose in prostate radiotherapy. However, their use during transrectal ultrasound (TRUS)\u2010guided high\u2010dose\u2010rate (HDR) brachytherapy has been limited by degradation of ultrasound image quality when placed on the day of the procedure, often necessitating CT\u2010based planning or separate\u2010day workflows.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To evaluate the feasibility and dosimetric impact of same\u2010day hyaluronic acid (HA) rectal spacer injection in patients undergoing TRUS\u2010guided HDR prostate brachytherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Following institutional review board approval, a retrospective analysis was performed on 20 patients with clinically localized prostate cancer treated with HDR brachytherapy combined with external beam radiation therapy between April 2023 and March 2024. Ten patients with a prostate\u2013anterior rectal wall distance\u00a0&lt;\u00a05\u00a0mm received HA rectal spacer injection immediately prior to HDR brachytherapy, while ten patients with a distance\u00a0&gt;\u00a05\u00a0mm did not undergo spacer placement. HA spacer (3\u20136 cc) was injected into the perirectal space under sagittal TRUS guidance, followed by catheter placement and real\u2010time TRUS\u2010based treatment planning. A single fraction of 15\u00a0Gy was delivered. Dosimetric parameters were compared using an unpaired two\u2010tailed Student's\n                      <jats:italic>t<\/jats:italic>\n                      \u2010test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HA rectal spacer placement was technically successful in all patients (10\/10) and preserved ultrasound image quality for catheter placement and treatment planning. Spacer placement improved prostate V100 (95.6%\u00a0\u00b1\u00a00.5%\u00a0vs. 94.5%\u00a0\u00b1\u00a00.6%;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and significantly reduced rectal V75 (0.42\u00a0\u00b1\u00a00.25 cc vs. 0.97\u00a0\u00b1\u00a00.34 cc;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). No significant differences were observed in urethral D10 or bladder D0.1cc.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Same\u2010day HA rectal spacer injection is feasible during TRUS\u2010guided HDR prostate brachytherapy and preserves ultrasound image quality, enabling fully real\u2010time treatment planning without the need for CT\u2010based workflows. This approach provides rectal dose reduction while maintaining target coverage and may offer a streamlined alternative to multistep spacer placement strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acm2.70701","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:37:19Z","timestamp":1783525039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Same\u2010day Hyaluronic Acid rectal spacer for TRUS\u2010guided HDR Prostate Brachytherapy: Feasibility and dosimetric outcomes"],"prefix":"10.1002","volume":"27","author":[{"given":"Sook Kien","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damodar","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology 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