Reconstruction and navigation system for intraoperative brachytherapy using the flab technique for colorectal tumor bed irradiation

Purpose: To present the development of a new navigation and reconstruction system based on an electromagnetic free-hand tracker and on CT imaging for treatment planning of intraoperative high-dose-rate brachytherapy (IORT-HDR B) in the sacral region. Our aim is to improve accuracy and to enable indiv idualized treatment planning and dose documentation to be performed for IOR T-HDRB using a flab technique. Methods and Materials: The material consists of an electromagnetic 3D track er system, a PC workstation with Microsoft Windows NT 4.0 operating system, and a recognition program for continuous speech. In addition, we designed an external reference system constructed of titanium and Perspex, which is positioned in the pelvis, and a special digitizer pen for reconstruction of the flab geometry. The flab design incorporates a series of silicon 10-mm- diameter spherical pellets. Measurements were made with a pelvic phantom in order to study the accuracy of the system. The reconstruction results are stored and can be exported,ia network or floppy to our different treatment planning systems. Results: Our results for the reconstruction of a flab with six catheters an d a total of 100 spherical pellets give mean errors in the range (2.5 +/- 0 .6) mm to (3.5 +/- 0.8) mm depending on the positions of the pelvic phantom and transmitter relative to the operation table. These errors are calculat ed by comparing the reconstruction results of our system with those using a CT-based reconstruction of the flab geometry. For the accuracy of the navi gation system for the pelvic phantom, we obtained mean errors in the range (2.2 +/- 0.7) mm to (3.1 +/- 1.0) mm, Conclusions: The new system we have developed enables navigation and recons truction within the surgical environment with a clinically acceptable level of accuracy. It offers the possibility of individualized treatment plannin g and effective documentation of the 3D dose distribution in IORT-HDRB usin g a flab technique. (C) 2000 Elsevier Science Inc.