Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society



      To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients.


      An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting.


      Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference.


      Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.



      ABS (American Brachytherapy Society), CT (computed tomography), CTV (clinical target volume), DWI (diffusion-weighted imaging), EBRT (external beam radiotherapy), FIGO (International Federation of Gynecology and Obstetrics), GEC-ESTRO (Gynaecological Groupe Européen de Curiethérapie-European Society for Radiotherapy & Oncology), HR-CTV (high-risk clinical target volume), ICRU (International Commission on Radiation Units and Measurements), IMRT (intensity modulated radiotherapy), MRI (magnetic resonance imaging), OAR (organ at risk), RT (radiotherapy), SAR (Society of Abdominal Radiology), TAUS (transabdominal ultrasound), TRUS (transrectal ultrasound), UOC DFP (Uterine and Ovarian Cancer Disease Focused Panel), US (ultrasound)
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