title: Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement.
abstract: OBJECTIVE
  This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies.
  
  
  METHODS
  The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series.
  
  
  RESULTS
  Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps >2 mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson χ(2) test=46.19; p<0.0001).
  
  
  CONCLUSIONS
  The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps >2 mm.
  
  
  CONCLUSIONS
  For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre.
authors: Radiotherapy Department, Bristol Haematology and Oncology Centre, Bristol, UK. Pauline.humphrey@uhbristol.nhs.uk
authors: P
authors: P
authors: Humphrey
authors: P
authors: P
authors: Cornes
authors: H
authors: H
authors: Al-Booz
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000532:radiotherapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D015641:Radiography, Interventional; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed; D014625:Vaginal Neoplasms / Q000532:radiotherapy*