In conclusion, we have demonstrated the feasibility of assessing the quality of prostate brachytherapy via remote independent review as part of a survey of practicing institutions in the United States. Our findings are consistent with optimal tumor coverage with the PD achieved in most of the treated patients. These data cannot be used to make broad generalizations regarding the adequacy of tumor coverage or quality of prostate brachytherapy procedures as performed in the United States, given the small sample size we analyzed. Yet it represents a study demonstrating the feasibility to assess the quality of implant procedures via a remote Selleck Forskolin centrally located review. Such assessments

provide an opportunity for self-assessment and will likely be used in the future as an Gefitinib ic50 important component for license recertification, as this process could be used to demonstrate proficiency of the practitioner. “
“Implant quality is an important determinant of outcome in patients with prostate cancer treated with permanent

seed brachytherapy. Accurate dosimetry provides feedback to the brachytherapy team, fosters technical changes to improve quality, and identifies suboptimal implants that may require corrective measures. Programs with meticulous quality assurance (QA) report higher biochemical control rates than those where poor-quality implants predominate. Recent articles from Zelefsky et al. (1) and Henry et al. (2) report a large variation in implant quality with inferior biochemical control rates in patients with low postimplant D90′s (minimum dose received by 90% of the prostate). Postimplant dosimetry is very dependent on the quality of prostate imaging. Computed tomography (CT) imaging is the accepted standard for evaluation of implant

quality, although the implanted seeds produce artifacts and obscure the outline Rutecarpine of the prostate gland. Prostate volume determination by CT tends to overestimate the prostate volume [3] and [4] when compared with either ultrasound or magnetic resonance imaging (MRI). Contrary to the situation with CT imaging, the presence of brachytherapy seeds does not affect the quality of prostate imaging using MRI, and consequently edge detection is superior to that achievable with CT. The use of MRI has been shown to reduce interobserver variation in prostate delineation for the purpose of external beam planning and in the postimplant setting [5], [6] and [7]. When MRI is used for the purpose of quality assessment after brachytherapy, it is important that the optimal scan sequence be selected. The use of a nonoptimal scan sequence leads to disappointing imaging results that diminish the value of the scan. In the post brachytherapy setting, the chosen imaging modality should sharply define the edges of the prostate while allowing visualization of the implanted seeds.