The data presented in this report demonstrate acceptable quality outcomes based on dosimetric parameters assessed from the postimplantation scans and consistent with the finding of others [11], [12] and [13]. Although urethral dose assessments were not possible in the absence of a urinary catheter selleck inhibitor for anatomic visualization, the target coverage and rectal dose assessments indicate that implant procedures were generally performed well. Nevertheless, we observed that nearly 20% of evaluated cases had %V100 less than 80%, which we used as an indicator of suboptimal dose

coverage of the prostate. Published reports of single-institutional dosimetric outcomes suggest that the percentage of cases with suboptimal dose coverage using this parameter ranges from 6% to 25% [14], [15], [16], [17], [18], [19], [20], [21], [22] and [23]. We were not able to identify any patterns or predictors of suboptimal target coverage with the PD from particular institutions, or patterns within institutional strata (academic vs. nonacademic), number of implant procedures performed yearly, prostate size, or other patient-related

characteristics. Our general impression in such cases of suboptimal coverage was that the seed location was predominately placed more inferiorly with resultant cold areas at the base and at times superior displacements with colder areas at the Meloxicam prostate apex. MAPK inhibitor The incidence of higher rectal doses was noted in 13% of evaluated

cases ( Fig. 4) and no obvious predictors for higher rectal dosing were identified. We recognize the limitations of this study, which include its retrospective nature and the relatively small cohort of postimplantation studies that were available for analysis. In addition, there are known uncertainties associated with the exact delineation of target volumes from a CT scan used for postimplantation dosimetric analysis in particular at the prostatic base and apex as well as the anterior aspect of the gland with implanted seeds causing image artifact. Furthermore, we acknowledge that accuracy may have been further enhanced if multiple blinded observers would have been used to contour and recontour the images instead of as performed in this study with one investigator and along with a second physician to check for the accuracy of target delineation. Our results nevertheless highlight the fact that not all implantation procedures will produce optimal dose delivery. In general, greater experience among practitioners has been shown to correlate with reduced incidence of poorly performed implant procedures. Yet we recognize that even with significant procedural experience, suboptimal target coverage with the PD can be observed even among the most experienced practitioners.