title: Effect of bladder distension on dose distribution of intracavitary brachytherapy for cervical cancer: three-dimensional computed tomography plan evaluation.
abstract: OBJECTIVE
  To quantify the effect of bladder volume on the dose distribution during intracavitary brachytherapy for cervical cancer.
  
  
  METHODS
  The study was performed on 10 women with cervical cancer who underwent brachytherapy treatment. After insertion of the brachytherapy applicator, the patients were transferred to the computed tomography unit. Two sets of computed tomography slices were taken, including the pelvis, one with an empty bladder and one after the bladder was filled with saline. The target and critical organs were delineated by the radiation oncologist and checked by the expert radiologist. The radiotherapy plan was run on the Plato planning system, version 14.1, to determine the dose distributions, dose-volume histograms, and maximal dose points. The doses and organ volumes were compared with the Wilcoxon signed ranks test on a personal computer using the Statistical Package for Social Sciences, version 11.0, statistical program.
  
  
  RESULTS
  No significant difference regarding the dose distribution and target volumes between an empty or full bladder was observed. Bladder fullness significantly affected the dose to the small intestine, rectum, and bladder. The median of maximal doses to the small intestine was significantly greater with an empty bladder (493 vs. 284 cGy). Although dosimetry revealed lower doses for larger volumes of bladder, the median maximal dose to the bladder was significantly greater with a full bladder (993 vs. 925 cGy). The rectal doses were also affected by bladder distension. The median maximal dose was significantly lower in the distended bladder (481vs. 628 cGy).
  
  
  CONCLUSIONS
  Bladder fullness changed the dose distributions to the bladder, rectum, and small intestine. The clinical importance of these changes is not known and an increase in the use of three-dimensional brachytherapy planning will highlight the answer to this question.
authors.affiliation: Department of Radiation Oncology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey. mcengiz@hacettepe.edu.tr
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cengiz
authors.forename: Salih
authors.initials: S
authors.lastname: Gürdalli
authors.forename: Ugur
authors.initials: U
authors.lastname: Selek
authors.forename: Ferah
authors.initials: F
authors.lastname: Yildiz
authors.forename: Yücel
authors.initials: Y
authors.lastname: Saglam
authors.forename: Enis
authors.initials: E
authors.lastname: Ozyar
authors.forename: I Lale
authors.initials: IL
authors.lastname: Atahan
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D012809:Colon, Sigmoid / Q000528:radiation effects; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007421:Intestine, Small / Q000528:radiation effects; D008875:Middle Aged; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D012007:Rectum / Q000528:radiation effects; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden; D001743:Urinary Bladder / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy*