Figure 1.

An adaptive robotic brachytherapy image/plan/begin-delivery/image/plan/finish-delivery information workflow. This workflow begins with the acquisition of an MR or CT set of images of the patient. These images are then transferred via DICOM format to a treatment planning system where the anatomy is contoured and the needle and seed locations (i.e. a dose plan) are determined. The dose plan is transferred to the robot control unit which executes the instructions necessary to position the robot to insert the needles and deliver the seeds. Prior to placing all the seeds, an adaptive planning would entail returning to the beginning of the workflow to re-image the patient, determine the actual position of the already-placed seeds, and re-plan the remaining seeds if necessary to fine tune the dose distribution. Note, ultrasound is not included in the figure because adaptive brachytherapy requires the visualization of already-placed seeds. Identifying and locating seeds using ultrasound images is extremely difficult: Post-implant dosimetry is routinely done using CT imaging.