Related Experiment Video
Updated: Apr 9, 2026
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Prospective operational feasibility, safety, and workflow of magnetic resonance-guided tracking technology for
Michael Roumeliotis1, Majd Antaki2, Gayoung Kim1
1Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.
Purpose:
To evaluate the feasibility, safety, and workflow of the development and prospective implementation of magnetic resonance-guided position-location tracking technology (MR-tracking [MRT]) for interstitial gynecologic brachytherapy.
Methods And Materials:
Between 2018 and 2023, patients undergoing template-based (Syed/Neblett) interstitial brachytherapy were included in the analysis. The 2 cohorts for analysis were (1) prospectively enrolled patients who received MRT for real-time visualization, and (2) standard procedure implants performed without MRT technology. The 2 cohorts were compared for overall procedural time with an ad hoc inferiority analysis, and implant quality was assessed by the resultant clinically delivered dosimetry with a Student's t test.
Results:
Eighteen (18) patients who consented to treatment with MRT visualization were compared to a cohort of 62 patients undergoing standard interstitial brachytherapy. The MRT system was successfully used without interruption from device-related events in all 18 patients. The mean (standard deviation) procedure time was 96 (±27) min and 100 (±26) min for the MRT and standard implants, supporting the noninferiority conclusion of the MRT implants (p = 0.03). For the patient subgroup including primary vaginal or recurrent endometrial without a uterus, we reported significantly improved clinical target volume (CTV) coverage (p = 0.02) for the MRT cohort, (CTV D90 = 75.2 Gy) compared to the standard procedure cohort (CTV D90 = 66.4 Gy), suggesting the physician was able to better target the tumor volume during needle insertion. Differences in organ-at-risk doses were not statistically significant.
Conclusions:
The prospective study establishes the feasibility of MRT integration with the successful demonstration of device reliability in a complex clinical setting. The integration of MRT as an investigational technology did not negatively impact overall procedure time and may have had a positive effect on resultant dosimetry for a subgroup of patients. Future clinical investigations should include prospective use of the technology in a matched-cohort trial.
