What is the role of ultrasonography in image-guided radiotherapy (IGRT) for the treatment of prostate cancer?

Updated: Nov 29, 2018
  • Author: Isamettin Andrew Aral, MD, MS; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Transabdominal ultrasonography is an accepted noninvasive method for obtaining detailed imaging of pelvic contents. It is regularly used by gynecologists and urologists in the daily assessment of their patients and has been adapted to the management of target localization in patients undergoing radiation-based treatments.

In an attempt to displace normal tissue(s) from the radiation treatment portals and to facilitate the immobilization of the gland, patients are asked to undergo their daily treatments with a full urinary bladder and a relatively empty distal bowel. The increased volume within the bladder provides a good window for prostate target localization using ultrasonography.

Several commercially available systems allow the operator to identify the target’s localization on the basis of CT data. Ultrasonographic images of the prostate are obtained on a daily basis to identify the gland’s relative position. If the gland is not identified in the anticipated location, a series of calculated shifts are proposed to correct the image. After repositioning of the patient, repeat imaging can confirm that the target is correctly localized. [21]

Limitations of this technology include the need to train staff to interpret ultrasonographic images, day-to-day variations in image quality, and the potential for organ movement while the ultrasound transducer is applied to the patient’s lower abdominal wall. Although this added procedure is still used in many clinical centers, it increases the time patients are required to remain in the treatment position.


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