Providing MR Imaging for Cervical Cancer Brachytherapy: Lessons for Radiologists

Abstract

Brachytherapy (BT), the use of a locally placed or implanted radioactive source for treatment of an adjacent tumor, is an important component in the treatment of patients with both early- and advanced-stage cervical cancer and is increasingly part of the standard treatment protocol. When it is feasible, many radiation oncologists choose to include a magnetic resonance (MR) imaging examination for planning BT treatment (ie, an MR imaging examination after placement of the applicator but before radiation dosing). MR imaging provides excellent soft-tissue contrast and allows radiation oncologists to individualize the radiation dose to the target volume and minimize the dose to adjacent organs that are at risk for radiation damage. However, traditionally, the radiology department has not performed imaging studies for planning, and the requirements are different compared with those of standard diagnostic imaging. In addition, many applicators are available for use in BT treatment of cervical cancer, and each must considered separately to determine MR safety and to define the best imaging parameters. Starting and supporting a robust gynecologic BT program includes implementing imaging protocols that are helpful to both radiation oncologists and diagnostic radiologists. By becoming more familiar with this treatment modality and the logistics of imaging patients undergoing BT, radiologists can provide imaging support for colleagues in the radiation oncology department and better care for patients. RSNA, 2018.

Comparative analysis of the value of amide proton transfer-weighted imaging and diffusion kurtosis imaging in evaluating the histological grade of cervical squamous carcinoma

“…Magnetic resonance imaging (MRI) has the characteristics of high-resolution soft tissue and multidirectional imaging [6,7] and plays an important role in the staging and evaluation of cervical cancer. However, the conventional MRI scan sequence can only reflect the anatomical features of soft tissue, hardly revealing the microstructure information.…”

Magnetic resonance imaging in cervical cancer interventional radiotherapy (brachytherapy): a pictorial essay focused on radiologist management

“…After EBRT, cervical and uterine tissues change after radiation, and for this reason, a uterine perforation can occur. US-guided insertion and post-applicator MRI enable accurate detection of this complication [ 37 , 38 ].…”

Comparison of initial computed tomography-based target delineation and subsequent magnetic resonance imaging-based target delineation for cervical cancer brachytherapy

“…For cervical brachytherapy planning, magnetic resonance imaging (MRI) is preferable to computed tomography (CT) for target delineation [1]. The advantages to MRI-guided brachytherapy are numerous, including excellent soft tissue contrast between residual tumor, cervix, and organs at risk (OARs) [2]. However, due to logistical and financial restrictions, in-room MRI is sometimes not routinely available in brachytherapy centers [3].…”