On the question of 3D seed reconstruction in prostate brachytherapy: the determination of x-ray source and film locations.

Inaccuracy in seed placement during permanent prostate implants may lead to significant dosimetric deviations from the intended plan. In two recent publications (Todor et al 2002 Phys. Med. Biol. 47 2031-48, Todor et al 2003 Phys. Med. Biol. 48 1153-71), methodology was described for identifying intraoperatively the positions of seeds already implanted, thus allowing reoptimization of the treatment plan and correcting for such seed misplacement. Seed reconstruction is performed using fluoroscopic images and an important (and non-trivial) component of this approach is the ability to accurately determine the position of the gantry relative to the treatment volume. We describe the methodology for acquiring this information, based on the known geometry of six markers attached to the ultrasound probe. This method does not require the C-arm unit to be isocentric and films can be taken with the gantry set at any arbitrary position. This is significant because the patient positioning on the operating table (in the lithotomy position) restricts the range of angles at which films can be taken to a quite narrow (typically +/- 10 degrees) interval and, as a general rule, the closer the angles the larger the uncertainty in the seed location reconstruction along the direction from the x-ray source to the film.