Since 1934, the Sir Mortimer B. Davis - Jewish General Hospital, a McGill University teaching hospital, has provided "Care for All," serving patients from diverse religious, linguistic and cultural backgrounds in Montreal, throughout Quebec and beyond.

As one of the province's largest acute-care hospitals, the JGH has achieved a reputation for excellence in key medical specialties by continually expanding and upgrading its facilities for clinical treatment and teaching, as well as research at the Lady Davis Institute for Medical Research.

Dr. Roberge is an assistant professor at McGill University and a Radiation Oncologist at the McGill Univeristy Health Centre specializing in CNS and GU malignancies.

Case: Suspected bladder tumor

Clinical objective:

Verify suspected bladder metastasis and localize for treatment planning

Background:

89 year old woman with renal cell carcinoma referred to radiation oncology for assessment. Patient not considered candidate for surgery. Cystoscope performed in response to patient complaint of haematuria revealing a urinary bladder mass.

Method:

Patient positioned supine in normal treatment position and scanned using standard protocol on AcQSim CT-Sim. Contrast media not used due to poor kidney function test. Patient realigned to external lasers and scanned using Clarity U/S-Sim and saved to the server. At the server, the Clarity images were reconstructed into axial slices to match the slice spacing and offset of the CT images and then sent to the AcQSim viewing station via DICOM. As images are implicitly registered to the CT by virtue of Clarity sharing the common coordinate system of the CT, an image registration procedure is not required. The fused images were evaluated on the AcQSim console.

Discussion:

Multiple fused views were possible of the pancreas, kidney, and bladder. The CT images alone were not able to clearly resolve the bladder mass. With the addition of ultrasound, the tumor was readily identifiable.

Conclusion:

Visualization and localization of the metastatic bladder mass was easily achieved with the use of 3D ultrasound. A revised treatment plan was created based on the advanced disease. The CT with the aid of fused ultrasound was deemed suitable to accurately define the GTV volume in the bladder. A palliative course of radiation treatment was decided and the haematuria was resolved.