Anatomic-Based Three-Dimensional Planning Precludes Use of Catheter-Delivered Contrast for Treatment of Prostate Cancer

Melisa Boersma, Gregory P Swanson, Diana Baacke, Tony Eng

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Retrograde urethrography is a standard method to identify the prostatic apex during planning for prostate cancer radiotherapy. This is an invasive and uncomfortable procedure. With modern three-dimensional computed tomography planning, we explored whether retrograde urethrography was still necessary to accurately identify the prostatic apex. Methods and Materials: Fifteen patients underwent computed tomography simulation with and without bladder, urethral, and rectal contrast. The prostatic base and apex were identified on both scans, using contrast and anatomy, respectively. The anatomic location of the prostatic apex as defined by these methods was confirmed in another 57 patients with postbrachytherapy imaging. Results: The prostatic base and apex were within a mean of 3.8 mm between the two scans. In every case, the beak of the retrograde urethrogram abutted the line drawn parallel to, and bisecting, the pubic bone on the lateral films. With these anatomic relationships defined, in the postbrachytherapy patients, the distance from the prostatic apex to the point at which the urethra traversed the pelvic floor was an average of 11.7 mm. On lateral films, we found that the urethra exited the pelvis an average of 16.6 mm below the posterior-most fusion of the pubic symphysis. On axial images, this occurred at a mean separation of the ischia of about 25 mm. Conclusion: With a knowledge of the anatomic relationships and modern three-dimensional computed tomography planning equipment, the prostatic apex can be easily and consistently identified, obviating the need to subject patients to retrograde urethrography.

Original languageEnglish (US)
Pages (from-to)51-57
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume71
Issue number1
DOIs
StatePublished - May 1 2008

Fingerprint

planning
Prostatic Neoplasms
apexes
Catheters
cancer
Tomography
Urethra
Ischium
Pubic Bone
Pubic Symphysis
Beak
tomography
Pelvic Floor
Therapeutics
Pelvis
Anatomy
Urinary Bladder
Radiotherapy
pelvis
bladder

Keywords

  • Prostate cancer
  • Radiotherapy
  • Retrograde urethrography
  • Treatment planning

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Anatomic-Based Three-Dimensional Planning Precludes Use of Catheter-Delivered Contrast for Treatment of Prostate Cancer. / Boersma, Melisa; Swanson, Gregory P; Baacke, Diana; Eng, Tony.

In: International Journal of Radiation Oncology Biology Physics, Vol. 71, No. 1, 01.05.2008, p. 51-57.

Research output: Contribution to journalArticle

@article{0700bab6dd8841248db3886879583438,
title = "Anatomic-Based Three-Dimensional Planning Precludes Use of Catheter-Delivered Contrast for Treatment of Prostate Cancer",
abstract = "Purpose: Retrograde urethrography is a standard method to identify the prostatic apex during planning for prostate cancer radiotherapy. This is an invasive and uncomfortable procedure. With modern three-dimensional computed tomography planning, we explored whether retrograde urethrography was still necessary to accurately identify the prostatic apex. Methods and Materials: Fifteen patients underwent computed tomography simulation with and without bladder, urethral, and rectal contrast. The prostatic base and apex were identified on both scans, using contrast and anatomy, respectively. The anatomic location of the prostatic apex as defined by these methods was confirmed in another 57 patients with postbrachytherapy imaging. Results: The prostatic base and apex were within a mean of 3.8 mm between the two scans. In every case, the beak of the retrograde urethrogram abutted the line drawn parallel to, and bisecting, the pubic bone on the lateral films. With these anatomic relationships defined, in the postbrachytherapy patients, the distance from the prostatic apex to the point at which the urethra traversed the pelvic floor was an average of 11.7 mm. On lateral films, we found that the urethra exited the pelvis an average of 16.6 mm below the posterior-most fusion of the pubic symphysis. On axial images, this occurred at a mean separation of the ischia of about 25 mm. Conclusion: With a knowledge of the anatomic relationships and modern three-dimensional computed tomography planning equipment, the prostatic apex can be easily and consistently identified, obviating the need to subject patients to retrograde urethrography.",
keywords = "Prostate cancer, Radiotherapy, Retrograde urethrography, Treatment planning",
author = "Melisa Boersma and Swanson, {Gregory P} and Diana Baacke and Tony Eng",
year = "2008",
month = "5",
day = "1",
doi = "10.1016/j.ijrobp.2007.09.041",
language = "English (US)",
volume = "71",
pages = "51--57",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Anatomic-Based Three-Dimensional Planning Precludes Use of Catheter-Delivered Contrast for Treatment of Prostate Cancer

AU - Boersma, Melisa

AU - Swanson, Gregory P

AU - Baacke, Diana

AU - Eng, Tony

PY - 2008/5/1

Y1 - 2008/5/1

N2 - Purpose: Retrograde urethrography is a standard method to identify the prostatic apex during planning for prostate cancer radiotherapy. This is an invasive and uncomfortable procedure. With modern three-dimensional computed tomography planning, we explored whether retrograde urethrography was still necessary to accurately identify the prostatic apex. Methods and Materials: Fifteen patients underwent computed tomography simulation with and without bladder, urethral, and rectal contrast. The prostatic base and apex were identified on both scans, using contrast and anatomy, respectively. The anatomic location of the prostatic apex as defined by these methods was confirmed in another 57 patients with postbrachytherapy imaging. Results: The prostatic base and apex were within a mean of 3.8 mm between the two scans. In every case, the beak of the retrograde urethrogram abutted the line drawn parallel to, and bisecting, the pubic bone on the lateral films. With these anatomic relationships defined, in the postbrachytherapy patients, the distance from the prostatic apex to the point at which the urethra traversed the pelvic floor was an average of 11.7 mm. On lateral films, we found that the urethra exited the pelvis an average of 16.6 mm below the posterior-most fusion of the pubic symphysis. On axial images, this occurred at a mean separation of the ischia of about 25 mm. Conclusion: With a knowledge of the anatomic relationships and modern three-dimensional computed tomography planning equipment, the prostatic apex can be easily and consistently identified, obviating the need to subject patients to retrograde urethrography.

AB - Purpose: Retrograde urethrography is a standard method to identify the prostatic apex during planning for prostate cancer radiotherapy. This is an invasive and uncomfortable procedure. With modern three-dimensional computed tomography planning, we explored whether retrograde urethrography was still necessary to accurately identify the prostatic apex. Methods and Materials: Fifteen patients underwent computed tomography simulation with and without bladder, urethral, and rectal contrast. The prostatic base and apex were identified on both scans, using contrast and anatomy, respectively. The anatomic location of the prostatic apex as defined by these methods was confirmed in another 57 patients with postbrachytherapy imaging. Results: The prostatic base and apex were within a mean of 3.8 mm between the two scans. In every case, the beak of the retrograde urethrogram abutted the line drawn parallel to, and bisecting, the pubic bone on the lateral films. With these anatomic relationships defined, in the postbrachytherapy patients, the distance from the prostatic apex to the point at which the urethra traversed the pelvic floor was an average of 11.7 mm. On lateral films, we found that the urethra exited the pelvis an average of 16.6 mm below the posterior-most fusion of the pubic symphysis. On axial images, this occurred at a mean separation of the ischia of about 25 mm. Conclusion: With a knowledge of the anatomic relationships and modern three-dimensional computed tomography planning equipment, the prostatic apex can be easily and consistently identified, obviating the need to subject patients to retrograde urethrography.

KW - Prostate cancer

KW - Radiotherapy

KW - Retrograde urethrography

KW - Treatment planning

UR - http://www.scopus.com/inward/record.url?scp=41749090464&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41749090464&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2007.09.041

DO - 10.1016/j.ijrobp.2007.09.041

M3 - Article

C2 - 18164852

AN - SCOPUS:41749090464

VL - 71

SP - 51

EP - 57

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 1

ER -