Prostate Brachytherapy UK & Ireland 11-12 June 2026

Poster Presentation – Abstracts Archive

UK & Ireland Prostate Brachytherapy Conference 2013

Abstract number 6

Simple Positional Optimisation Allows Optimal Treatment Delivery to Larger Prostate Glands

D Wood
Advanced Practitioner Brachytherapy Christie Medical Physics and Engineering, The Christie Hospital
C Taylor
Consultant Radiographer Prostate Brachytherapy, The Christie Hospital

Aims/Introduction: One limitation of delivering brachytherapy for prostate (LDR/HDR) cancer is the ability to access the prostate in order to place seeds or interstitial needles. Additionally, optimal positioning of the prostate in relation to the rectum and the positioning of the urethra is essential for favourable dosimetric coverage of the prostate and CTV.

Access to of the prostate gland can be limited by factors such as prostate size, position in relation to pubic arch, location of prostate in relation to the rectum, urethral deviation and BPH.

The implementation of a simple optimisation sequence can be incorporated into the pre-treatment positioning process and can maximise the number of patients in which na optimal implant is possible.

Materials/Methods: A two-step procedure is employed for LDR seeds with >90% of studies undertaken by a consultant radiographer.

HDR treatments are delivered in a single fraction of 15Gy and prostate optimisation is similarly performed.

The main elements of position optimisation include:

  • Effective bowel preparation,
  • Ultrasound standoff is degassed
  • Lateral coverage is assessed against arch location and leg position optimised accordingly,
  • Setting of a perpendicular base using the sagittal view by altering probe angle
  • and probe height dropped to lift the prostate in relation to the grid
  • Excess pressure on the rectum decreases the fat plane between the prostate and rectum.

Results: Particular progress has been made in the maximum prostate volume that can be treated. The maximum volume implanted was 69cc and 105cc in I-125 seeds and HDR respectively.

The implantation of larger glands while reducing needle number by utilising higher activity seeds may reduce the need to resort to hormonal downsizing of the prostate gland and its associated morbidity.

In 5 years no patients have been unable to proceed to a satisfactory HDR implant due to the optimisation strategies employed.