Interim Report. Prostate Cancer Fight Foundation Motorcycle Ride for Dad. February 7, Supporting Kingston s university hospitals:

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1 Interim Report Prostate Cancer Fight Foundation Motorcycle Ride for Dad February 7, 2014 Supporting Kingston s university hospitals:

2 Thank you for your continued support of prostate cancer research in Southeastern Ontario through the funding of two research projects at Kingston General Hospital. It is an absolute privilege to be able to share an update on the projects being led by Dr. William Mackillop and Dr. Chandra Joshi, whose important research received funds in 2103 raised by the Kingston-Quinte Chapter of the Motorcycle Ride for Dad. This is definitely one of the favourite events of the year for our staff here at the University Hospitals Kingston Foundation because the difference that is made through the funds raised is so clear. To hear the stories of the incredible team of volunteers involved in the local Ride event and to know how dedicated they are to helping our researchers find answers to better outcomes and better treatments is very rewarding. Together, we are making a difference in the lives of men and their families from across Southeastern Ontario and beyond. Project # 1: Measuring the Quality of Personal Care in Patients Undergoing Radical Radiotherapy for Prostate Cancer Principal investigator: William Mackillop Expected date of completion: Fall 2014 Project description: Funds from Ride for Dad are being used to support data collection from patients undergoing radiotherapy for prostate cancer at the Cancer Centre of Southeastern Ontario at Kingston General Hospital. Patients are given a questionnaire to complete and asked to provide their opinion on the quality of care they receive. They rate the quality of several aspects of care related to: patient centeredness empathy and respectfulness of the health care providers competence of the health care providers communication skills of the health care providers accessibility of the health care providers continuity of care comprehensiveness of care acceptability of the treatment environment

3 privacy and convenience Once data collection is complete, we will work with health care managers and health care professionals to determine how to best summarize the questionnaire results to identify areas of care in need of improvement. This will improve the experience for patients undergoing radiotherapy for prostate cancer. Outcomes for this project include: 1) Information about the reliability of this patient questionnaire; 2) Information about whether patient factors such as age and marital status are related to reports of quality of care; and 3) A report on the quality of personal care received by patients undergoing radiotherapy for prostate cancer. Progress to date: Data collection for this project is almost complete. Funds used to date have supported personnel for this study and the supplies and materials needed to administer the patient questionnaire. We have collected information from 89 patients and, based on our sample size calculations, we only require questionnaire responses from an additional seven patients to achieve the desired level of precision for our analysis. We are currently considering appropriate ways to analyze the data and summarize the questionnaire results in a way that would be most useful to health care managers and health care providers. We are in the process of assembling a group of health care professionals and health care managers to meet with to discuss how to summarize our questionnaire results to produce meaningful reports. Expected timeline for completion: Data collection will continue through the spring, and we expect to have all questionnaire data collected from patients by summer We have started analyzing the data to report on the quality of personal care patients are receiving, and we will meet with health care managers and health care providers shortly after data collection has been completed to gather feedback on the best way to report our questionnaire results. We will also analyze the data to assess the reliability of the patient questionnaire and look at whether patient factors such as age and marital status are related to reports of quality of care once all data collection is complete. We expect this project will be completed in fall 2014.

4 Project # 2: Electromagnetic catheter tracking in trans rectal ultrasound guided high dose rate brachytherapy of prostate cancer Principal Investigator: Chandra P. Joshi Co-Investigators: Carey Shenfield, Gabor Fichtinger Expected date of completion: April 2015 Project description: Brachytherapy is one of the definitive treatment options for low risk prostate cancer. In prostate brachytherapy sealed radioactive source(s) are placed into needle/tubes implanted in the prostate gland to deliver a lethal radiation dose to the cancerous tissue while minimizing radiation to surrounding normal tissues. Trans-rectal ultrasound (TRUS)-based live planning is increasingly being adopted for high dose rate (HDR) prostate brachytherapy. Still, uncertainties in accurate identification and tracking implant tubes in the prostate TRUS images complicate dose planning and delivery. The electromagnetic (EM) catheter tracking method is expected to significantly reduce errors in catheter localization, resulting in improved dose planning and treatment delivery. In this project, we seek to evaluate clinical usability and efficiency of the EM tracking approach for accurate reconstruction of the implant geometry using prostate phantom studies. Outcomes of this study may result in the adoption of EM tracking in catheter localization HDR brachytherapy of prostate cancer.

5 Progress summary of preliminary work: As stated in the grant, the initial phase of the project involves evaluating the accuracy of catheter identification/tracking on images acquired for geometric reconstruction and dose calculations of a high dose rated (HDR) brachytherapy prostate implant. All HDR brachytherapy prostate interstitial catheter implants are performed under trans-rectal ultrasound (TRUS) image guidance. While the TRUS images aid in the catheter implantation procedure itself, most of the places worldwide use CT images (acquired after the implant procedure) to reconstruct implant geometry using catheter tracking, and contouring of prostate and other important anatomical structures. These images are then used for HDR Iridium-192 source positioning and its dwell times inside the implanted catheters to calculate a most desirable radiation dose pattern. This entire process is called treatment planning, which, once approved, is used for actual treatment delivery. Recently, a potent new TRUS-based live-planning approach has emerged where TRUS images acquired after the implant procedure (instead of CT images) are used for treatment planning, dose calculations, and verifying catheter positions prior to treatment. The entire TRU- based process is completed within approximately 1.5 hrs. This is considerably shorter than the CT image- based planning process which is partly due to the fact that CT-based planning systems are currently not equipped to partake of live prostate brachytherapy treatment planning. The TRUS-based live treatment planning systems cost about C$180,000. These systems solely perform prostate brachytherapy planning unlike CT-based planning systems which are also used for brachytherapy planning of other sites e.g. cervix, breast, skin etc. In the preliminary part of this work, we have attempted to evaluate the possibility of utilizing TRUS images on a CT image-based treatment planning computer. This necessitated conversion of TRUS images to a format that is usable with a CT-based planning system. In simple words, this means that TRUS image data is used as CT image data so that they can be used by the treatment planning system. Figure 1: Commercial CIRS 053 Prostate training phantom (CIRS, VA, USA)

6 As we mimic the TRUS images as CT images, it is very important that integrity and accuracy of the image information is not compromised during image format conversion. To evaluate this, TRUS and CT images of a commercial prostate phantom (see Figure 1) were acquired. The TRUS images were converted into CT-image format and important structures such as prostate and urethra were contoured on both actual CT and converted-trus images. Dimensions of contoured structures on converted-trus images were compared with contour dimensions on actual CT images and manufacturer s specifications. The treatment planning system accepted the TRUS images converted in CT image format very well. However, limited agreements were observed between structure dimensions measured on actual CT and converted-trus images. This limited agreement can be attributed to relatively coarser TRUS image acquisition and shows a potential for improvement with relatively high resolution TRUS image acquisition e.g. employing relatively shorter inter-slice distances. This will be tested in a subsequent repeat of the experiment. Figure 2: (a) CT images and (b) converted TRUS (in CT format ) images of the CIRS 053 prostate phantom with prostate and urethra contour Progress status: We are actively recruiting a graduate student but have yet been successful in limited initial progress of the project. Recently we have been able to recruit a co-op student, Stephen Macgregor, for the period of Jan-Apr Stephen has recently completed his BSc in Physics; he will be helping us in initiating the work on the electromagnetic (EM) catheter tracking aspect of the project from the first week of Feb Outcome of this work will be presented in the next progress report. Thank you for your ongoing support of prostate cancer research and awareness in Southeastern Ontario. We look forward to the 2014 Motorcycle Ride for Dad and to continuing to work with you on the fight against prostate cancer.