Impact of the filling status of the bladder and rectum on their integral dose distribution and the movement of the uterus in the treatment planning of gynaecological cancer

The association of the uterine motion with bladder volume during radiotherapy in gynecological malignancies

“…[11] Very few studies have documented the changes in uterine position during the radiotherapy course. An association between bladder filling and uterine movement was reported by Buchali et al [12] that indicated no major AP change in cervical position. A maximum mean displacement in AP direction was seen in our study.…”

In vivodosimetry: trends and prospects for brachytherapy

“…5,40 These investigations point towards the importance of geometric variations induced by organ and applicator movements, 41 which complicate and potentially compromise accumulated dose calculations in the organs. Interand intrafraction deformations of prostate, bladder and rectum have been studied, [42][43][44][45][46] and the dosimetric impact owing to more general anatomical variations has been evaluated in a multicentre comparison of cervix BT. 41 Organ-applicator movements occurring between patient imaging and treatment delivery stages have been identified as a major source of uncertainty 33,[47][48][49][50][51][52][53] and their impact further analysed.…”

“…42,43,49 If the tools assure a stable dosemeter position, further patient images and dosemeter reconstructions are not required, hence a less resourcedemanding implementation of IVD can be provided.…”

“…Alternatively for rectal wall dosimetry, the inflatable balloons discussed in this section could be filled with water, rather than air, in order to avoid non-equilibrium conditions, as was done for the endorectal balloon by Wootton et al 111 It is important to note that the positions of IVD probes inserted into BT source applicators, or embedded in the surface of inflatable balloons attached to intracavitary applicators, are correlated with the applicator positions, hence most dosemeters (with the exception of RADPOS) would not be able to reveal inter-or intrafraction organ-applicator movements, for example, caused by perineal oedema, 51 vaginal packing and/or source applicator clamping effects [47][48][49]52 or varying filling status of the rectum and/or bladder. 42,43,49 On the other hand, dosemeters inserted into catheters positioned in OARs are minimally correlated with source applicator movements, hence they could allow for the detection of organ-applicator movements. Examples are rectal dosemeter probes or dosemeters embedded in the surface of endorectal balloons or urethral catheters.…”

Clinical Application of Ultrasound Imaging in Radiation Therapy

“…Daily ultrasound imaging can help ensure that the change in target volume with respect to bladder filling is accounted for by PTV margin and if not then the margins should be adjusted for individual patient to avoid geographical miss. Although many published data show that uterus/cervix positions can be at different locations depending on bladder filling (Ahmad et al, 2011;Buchali et al, 1999;Chan et al, 2004;Han et al, 2006;Huh et al, 2004;Jhingran et al, 2010;Kerkhof et al, 2009;Taylor & Powell, 2008;Van de Bunt et al, 2008), one study reported recently that motion of the vagina after the hysterectomy varies in a random manner daily and found no correlation with changes in bladder and rectum volumes (Jurgenliemk-Schulz et al ,2011). Also some studies claimed that uterus and cervix motion are weakly correlated with bladder and rectum filling status because change in target motion not only depends on adjacent bladder and rectal filling but also depends on tumor regression and deformation with a patientspecific correlation (Huh et al, 2004;Van de Bunt et al, 2008).…”