This poster is published under an open license
. Please read the disclaimer
for further details.
Oncology, Ultrasound, Brachytherapy
T. Akbas, G. Ugurluer, M. Acil, T. Arpaci, M. Serin; Adana/TR
Methods and materials
The clinical and radiologic data of 142 patients who received tandem-based intracavitary brachytherapy after external beam pelvic radiotherapy at the Acibadem Adana Hospital between January 2010 and June 2015 were retrospectively reviewed. Within our hospital,
cervical cancer patients are generally treated with external bean pelvic radiotherapy (45-50.4 Gy) followed by high dose rate tandem-based intracavitary brachytherapy with curative intent.
The whole brachytherapy procedures were performed in a brachytherapy suite with dedicated and specialized staff,
including registered nurses and physicists,
together with the attending radiation oncologist and radiologist.
members of the anesthesia staff were available to assist as needed in the brachytherapy suite.
The procedures were performed under sedation using 3 to 5 mg midazolam followed by 50 mcg fentanyl and 50 mg ketamine intravenously if needed added doses of ketamine were used, and the applicator were placed in the lithotomy position.
Ultrasound guidance was carried out in cooperation with a diagnostic radiologist.
Pre-operative evaluation under anesthesia in our department includes a diagnostic ultrasound to examine uterus,
endometrial rim and as well as residual primary tumor and a pelvic examination for identification of the cervical os.
A Foley catheter was inserted into the bladder followed by retrograde instillation of 250–300 mL of normal saline into the bladder for better visualization.
A diagnostic radiologist proceeds with real-time transabdominal ultrasound imaging.
Scans were performed in the sagittal and axial planes,
and the length of the endometrial cavity,
length of the cervical canal,
echo characteristics of the endometrium (hyperechoic or hypoechoic,
retroversion and deviation were determined.
A Siemens Acuson S2000 portable ultrasound machine was used,
with a curved 6.0-MHz ultrasound transducer (Siemens,
The cervix was grasped with tenaculum for some patients.
The Fletcher-Suit applicator set was used,
tandem angle and length are selected based upon the uterine angle and size under ultrasound guidance.
The tandem was inserted into the uterine cavity,
and optimal position was confirmed using ultrasound imaging in sagittal and axial planes.
A sagittal view of the uterus was maintained to assess the suitability of tandem length and angle.
Axial view of the uterus was also performed to verify that the tandem was at the midline within the endometrial cavity and not too advanced.
Vaginal ovoids were then placed using the maximum possible diameter,
the geometry was confirmed before fixation by vaginal packing using radiopaque lubricated gauze to displace the bladder anteriorly and rectum posteriorly.
Following the packing,
the applicators were controlled for the last time and the ultrasonography was terminated.
All patients underwent CT based conformal treatment planning for the delivery of intracavitary brachytherapy.