{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:12:24Z","timestamp":1788019944037,"version":"build-2784847793"},"reference-count":42,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,4,20]],"date-time":"2017-04-20T00:00:00Z","timestamp":1492646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000038","name":"Natural Sciences and Engineering Research Council of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Treatment for gynecologic cancers, such as cervical, recurrent endometrial, and vaginal malignancies, commonly includes external\u2010beam radiation and brachytherapy. In high\u2010dose\u2010rate (HDR) interstitial gynecologic brachytherapy, radiation treatment is delivered via hollow needles that are typically inserted through a template on the perineum with a cylinder placed in the vagina for stability. Despite the need for precise needle placement to minimize complications and provide optimal treatment, there is no standard intra\u2010operative image\u2010guidance for this procedure. While some image\u2010guidance techniques have been proposed, including magnetic resonance (MR) imaging, X\u2010ray computed tomography (CT), and two\u2010dimensional (2D) transrectal ultrasound (TRUS), these techniques have not been widely adopted. In order to provide intra\u2010operative needle visualization and localization during interstitial brachytherapy, we have developed a three\u2010dimensional (3D) TRUS system. This study describes the 3D TRUS system and reports on the system validation and results from a proof\u2010of\u2010concept patient study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To obtain a 3D TRUS image, the system rotates a conventional 2D endocavity transducer through 170 degrees in 12\u00a0s, reconstructing the 2D frames into a 3D image in real\u2010time. The geometry of the reconstruction was validated using two geometric phantoms to ensure the accuracy of the linear measurements in each of the image coordinate directions and the volumetric accuracy of the system. An agar phantom including vaginal and rectal canals, as well as a model uterus and tumor, was designed and used to test the visualization and localization of the interstitial needles under idealized conditions by comparing the needles' positions between the 3D TRUS scan and a registered MR image. Five patients undergoing HDR interstitial gynecologic brachytherapy were imaged using the 3D TRUS system following the insertion of all needles. This image was manually, rigidly registered to the clinical postinsertion CT scan based on the vaginal cylinder of the needle template. The positions of the tips and the trajectory of the needle paths were compared between the modalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The observed geometric errors of the system were \u2264\u00a00.3\u00a0mm in each of the three coordinate planes of the 3D US image and the mean measured volumetric error was 0.10\u00a0cm<jats:sup>3<\/jats:sup>. In the phantom study, the mean needle tip difference was 1.54\u00a0\u00b1\u00a00.71 mm and the mean trajectory difference was 0.94\u00a0\u00b1\u00a00.89 degrees (<jats:italic>n<\/jats:italic>\u00a0=\u00a014). In the <jats:italic>in\u00a0vivo<\/jats:italic> study, a total of 73 needles were placed, of which 88% of needles were visible and 79% of tips were identifiable in the 3D TRUS images. Six of the nine needles that were not visible were due to shadowing artifacts created by the presence of the vaginal cylinder of the needle template. The mean distance between corresponding needle tips in the two modalities was 3.82\u00a0\u00b1\u00a01.86\u00a0mm and the mean trajectory difference was 3.04\u00a0\u00b1\u00a01.63 degrees for the five patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In this proof\u2010of\u2010concept study, the 3D TRUS system allowed for localization of needles not obscured by shadowing artifacts, providing a method for visualizing needles intra\u2010operatively during HDR interstitial brachytherapy of gynecologic cancers and providing the potential for 3D image\u2010guidance.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.12221","type":"journal-article","created":{"date-parts":[[2017,3,15]],"date-time":"2017-03-15T13:27:07Z","timestamp":1489584427000},"page":"1899-1911","source":"Crossref","is-referenced-by-count":25,"title":["Toward a 3D transrectal ultrasound system for verification of needle placement during high\u2010dose\u2010rate interstitial gynecologic brachytherapy"],"prefix":"10.1002","volume":"44","author":[{"given":"Jessica Robin","family":"Rodgers","sequence":"first","affiliation":[{"name":"Biomedical Engineering Graduate Program The University of Western Ontario London ON N6A 3K7 Canada"},{"name":"Robarts Research Institute The University of Western Ontario London ON N6A 5B7 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Surry","sequence":"additional","affiliation":[{"name":"Department of Medical Physics London Regional Cancer Program London ON N6A 5W9 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology Odette Cancer Centre Sunnybrook Health Sciences Centre Toronto ON M4N 3M5 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"D'Souza","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology London Regional Cancer Program London ON N6A 5W9 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Fenster","sequence":"additional","affiliation":[{"name":"Biomedical Engineering Graduate Program The University of Western Ontario London ON N6A 3K7 Canada"},{"name":"Robarts Research Institute The University of Western Ontario London ON N6A 5B7 Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,20]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"World Cancer Report 2014","author":"Stewart BW","year":"2014"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2011.07.003"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-68958-4_24"},{"key":"e_1_2_8_5_1","first-page":"417","volume-title":"GEC ESTRO Handb. 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