Brachytherapy · 2026
Integrating ultrasound into cervical brachytherapy planning: A technical note with an illustrative case.
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Ong Patricia, Jainar Carl Jay, Chua Vannesza Hendricke, Cabrera Stellar Marie, Bacorro Warren, Yu Kelvin Ken
Аннотация
PURPOSE: To describe the feasibility of ultrasound as an alternative imaging modality for intracavitary brachytherapy in cervical cancer, particularly in resource-limited settings. This technical note describes the integration of ultrasound into two-dimensional (2D) and three-dimensional (3D) cervical brachytherapy workflows, illustrated through a representative case, demonstrating how ultrasound-derived anatomical measurement may assist applicator placement and dose optimization.
MATERIALS AND METHODS: Ultrasound was used to guide applicator insertion, reducing uterine perforation risk and confirming tandem position. In the 2D workflow, ultrasound measurements of the cervix width, uterine fundus width, and tandem-to-wall distance guided optimization of the initial point A plan. In the 3D workflow, baseline ultrasound measurements obtained during the first CT-planned fraction were recorded. In subsequent fractions, ultrasound was used to reproduce the initial applicator geometry, potentially avoiding repeat CT-based adaptive planning when measurements were consistent.
RESULTS: A representative case was used to illustrate the workflows. The initial 2D plan exceeded bladder and rectal limits. Ultrasound-planned 2D optimization reduced D2cc from 855 to 639 cGy and rectum D2cc from 533 to 421 cGy while maintaining high-risk clinical target volume D90% of 772 cGy. In the 3D workflow, ultrasound was used to reproduce the initial applicator geometry across fractions, enabling reproducible positioning and achieving dosimetry comparable to fully CT-guided plans (bladder D2cc: 639 vs 618 cGy; rectum D2cc: 421 vs 398 cGy; high-risk clinical target volume D90%: 772 vs 744 cGy).
CONCLUSION: In this representative case, ultrasound guidance may facilitate patient-specific 2D dose optimization and reproducible applicator positioning, facilitating optimization of bladder and rectal doses. Further studies are warranted to validate these findings.
MATERIALS AND METHODS: Ultrasound was used to guide applicator insertion, reducing uterine perforation risk and confirming tandem position. In the 2D workflow, ultrasound measurements of the cervix width, uterine fundus width, and tandem-to-wall distance guided optimization of the initial point A plan. In the 3D workflow, baseline ultrasound measurements obtained during the first CT-planned fraction were recorded. In subsequent fractions, ultrasound was used to reproduce the initial applicator geometry, potentially avoiding repeat CT-based adaptive planning when measurements were consistent.
RESULTS: A representative case was used to illustrate the workflows. The initial 2D plan exceeded bladder and rectal limits. Ultrasound-planned 2D optimization reduced D2cc from 855 to 639 cGy and rectum D2cc from 533 to 421 cGy while maintaining high-risk clinical target volume D90% of 772 cGy. In the 3D workflow, ultrasound was used to reproduce the initial applicator geometry across fractions, enabling reproducible positioning and achieving dosimetry comparable to fully CT-guided plans (bladder D2cc: 639 vs 618 cGy; rectum D2cc: 421 vs 398 cGy; high-risk clinical target volume D90%: 772 vs 744 cGy).
CONCLUSION: In this representative case, ultrasound guidance may facilitate patient-specific 2D dose optimization and reproducible applicator positioning, facilitating optimization of bladder and rectal doses. Further studies are warranted to validate these findings.