Tumour-Targeted Treatment Intensification for Prostate Cancer Using Magnetic Resonance Imaging Guidance Jessy Abed, RTT, MHScMRS, Jenny Lee, MMath, Tim.

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Tumour-Targeted Treatment Intensification for Prostate Cancer Using Magnetic Resonance Imaging Guidance Jessy Abed, RTT, MHScMRS, Jenny Lee, MMath, Tim Craig, PhD, Alejandro Berlin, MD, MSc, Cynthia Ménard, MD, Peter Chung, MD Journal of Medical Imaging and Radiation Sciences Volume 48, Issue 4, Pages 336-342 (December 2017) DOI: 10.1016/j.jmir.2017.09.014 Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 1 Multiparametric magnetic resonance imaging (mpMRI) sequences (from left to right). (A) T2-weighted (B) dynamic contrast-enhanced, and (C) apparent diffusion coefficient images taken during the interventional procedure depicting areas of high tumour density in the blue box. (Color version of figure is available online.) Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 2 Radiotherapy plan for a patient treated with VMAT, receiving an integrated boost up to 95 Gy in 38 fractions to the PTV (GTV). Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 3 Cumulative dose-volume histogram (DVH) of target and organs as risk volumes in a patient treated with VMAT, receiving an integrated boost up to 95 Gy in 38 fractions to the PTV (GTV). VMAT, volumetric modulated arc therapy. Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 4 Brachytherapy catheters (hypointense rounded susceptibilities) in the GTV region for the MRI-guided brachytherapy tumour-targeted boost. The colored circles indicate the intended localization of the catheters in the navigation system, reflecting the need to account for deflection for optimal final HDR implant geometry. HDR, high-dose rate; MRI, magnetic resonance imaging. (Color version of figure is available online.) Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 5 The brachytherapy HDR plan showing the dose distribution in the GTV of the prostate. The bottom right is a three-dimensional rendering of the GTV (red) with respect to the urethra (green) and HDR catheters (light blue). HDR, high-dose rate. (Color version of figure is available online.) Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions

Figure 6 Deformable registration process between MR images with and without endorectal coil (ERC). (A) Prostate and GTV defined on biopsy T2 with an ERC; (B) Prostate contours on MR without ERC; (C) MORFEUS maps the prostate with ERC (red) to prostate without ERC, giving the GTV on MRI simulation; (D) mpMRI-defined GTV deformed onto MRI simulation. mpMRI, multiparametric magnetic resonance imaging. Image courtesy of Jenny Lee. (Color version of figure is available online.) Journal of Medical Imaging and Radiation Sciences 2017 48, 336-342DOI: (10.1016/j.jmir.2017.09.014) Copyright © 2017 Canadian Association of Medical Radiation Technologists Terms and Conditions