PIPER

The University of Rochester Medical Center’s Cancer Center is using a new computerized medical device developed by its researchers to improve the treatment for prostate cancer.

The software-based device is called PIPER (Prostate Implant Planning Engine for Radiotherapy) and was developed and patented by the Medical Center and licensed to RTek Medical Systems LLC, a collaboration between the Medical Center and Real Time Enterprises, Inc.

The PIPER system assists surgeons, radiation oncologists and medical physicists in planning and performing brachytherapy, which is an increasingly popular treatment for prostate cancer. Brachytherapy involves surgically implanting tiny radioactive seeds – roughly the size of a grain of rice – into the prostate to destroy cancer cells over a period of several weeks.

The success of brachytherapy hinges on the placement of the radioactive seeds at precise locations within the prostate to destroy all nearby cancer cells without harming the healthy tissue surrounding the prostate. The PIPER system uses sophisticated optimization algorithms to help clinicians determine how many seeds are necessary and exactly where to place them with the prostate.

Physicians often use computer programs to help them decide how and where to place the seeds, but this system is revolutionary because of its speed and optimization capabilities. Based on an ultrasound scan of a patient’s prostate and other organs, the PIPER system automatically compiles a computer-optimized radiation treatment plan in less than two minutes. This means that radiation-treatment planning can be done in the operating room immediately before surgery, instead of several weeks beforehand, as was standard in the past. A plan created in the operating room just minutes before the procedure can better match the anatomy that surgeons actually confront.

“It is a tremendous advantage to be able to plot seed placements using up-to-the-minute images of the prostate,” says surgeon Edward Messing, M.D., chair of the Department of Urology. Messing has performed scores of brachytherapy procedures at Strong Memorial Hospital.

“When you enter the operating room, the prostate you see then is never the same as the one you saw a few weeks previously,” says Messing, referring to changes in the size and shape of the organ that can result from patient positioning, hormone therapy, and anesthesia. “Using PIPER helps take the guess-work and heavy, time-consuming calculations out of the process. You know exactly where your seeds went and where you want to put the next ones.”

Placement of the seeds with pinpoint precision is difficult because the tiny seeds are difficult to visualize with ultrasound. The PIPER system also helps during the procedure by providing an interactive, ultrasound interface that allows surgeons to track needle locations and determine seed positions in real time. And actual seed placements can be adjusted to match the optimized plan.

“The approach improves the therapeutic outcome by optimizing the treatment of the cancer cells while lessening the effects on adjacent organs and minimizing side effects and complications,” says Ralph Brasacchio, M.D., assistant professor of radiation oncology and co-director of the Prostate Brachytherapy Program.

PIPER was developed by medical physicist Yan Yu, Ph.D., associate professor of radiation oncology at the Wilmot Cancer Center, based on more than six years of research funded by a variety of sources, including the National Cancer Institute and the Whitaker Foundation.