Brachytherapy for the next century: use of image-based treatment planning.

Three-dimensional treatment planning systems used extensively for external-beam treatments have recently been applied for use in brachytherapy. Localization of structures in 3D from imaging studies integrated into computerized systems for planning of implants and evaluation allows 3D dose distributions to be indexed to the patient's anatomy. Correlation of target volume and dose distribution permits planning of conformal dose distributions, which maximizes the dose to the target volume while avoiding dose to normal tissue. Imaging during the implantation process can improve the delivery of the dose distribution planned prior to implantation, which may translate into improved outcome. Postimplant imaging scans can be compared to preimplant planning, providing feedback on the error in source placement and ultimately improving implantation. Application of image-based planning and delivery for ultrasound-guided transperineal prostate implantation is widespread. The first part of this report will discuss in detail a major research effort at our institution to understand and improve the prostate implant process. In the last half of our report, we will describe 3D treatment planning for gynecological implants. Problems with traditional implant planning and delivery procedures (perhaps still used today) and how image-based treatment planning and delivery can improve the implant process will be presented.