Image-based brachytherapy for cervical cancer

Figure 1 Uterine perforation despite perfect geometric applicator placement relative to bone anatomy. A: Shows the uterine perforation with retroverted uterus (red) diagnosed on magnetic resonance imaging (MRI) imaging for brachytherapy planning; B: Shows appropriate tandem placement (yellow arrow) ameliorated by placing the applicator under ultra-sound guidance and confirmed by MRI image-based planning.

Figure 2 Conventional 2D point dose brachytherapy planning over doses critical organs for small cervix. Magnetic resonance imaging planning images showing over-dosage of critical organs with point-A image based prescription (A) for patient with small cervix which is improved with image-based brachytherapy (B).

Figure 3 Sigmoid colon sparing with image-based planning. Magnetic resonance imaging planning images showing point A optimized plan with high doses to adjacent sigmoid colon (A), which is reduced with image-based 3D optimization (B).

Figure 4 Use of the vienna applicator to improve posterior disease coverage for locally-advanced cervical cancer. A and B: 3D reconstruction of Vienna applicator showing posterior needles; C and D axial magnetic resonance imaging (MRI) showing advanced disease with posterior extension, and improved coverage with combined interstitial and intracavitary MRI image-based planning.