title: Reproducibility and interoperator reliability of obtaining images and measurements of the cervix and uterus with brachytherapy treatment applicators in situ using transabdominal ultrasound.
abstract: OBJECTIVE
  To validate interoperator reliability of brachytherapy radiation therapists (RTs) in obtaining an ultrasound image and measuring the cervix and uterine dimensions using transabdominal ultrasound.
  
  
  METHODS
  Patients who underwent MRI with applicators in situ after the first insertion were included in the study. Imaging was performed by three RTs (RT1, RT2, and RT3) with varying degrees of ultrasound experience. All RTs were required to obtain a longitudinal planning image depicting the applicator in the uterine canal and measure the cervix and uterus. The MRI scan, taken 1 hour after the ultrasound, was used as the reference standard against which all measurements were compared. Measurements were analyzed with intraclass correlation coefficient and Bland-Altman plots.
  
  
  RESULTS
  All RTs were able to obtain a suitable longitudinal image for each patient in the study. Mean differences (SD) between MRI and ultrasound measurements obtained by RTs ranged from 3.5 (3.6) to 4.4 (4.23) mm and 0 (3.0) to 0.9 (2.5) mm on the anterior and posterior surface of the cervix, respectively. Intraclass correlation coefficient for absolute agreement between MRI and RTs was >0.9 for all posterior measurement points in the cervix and ranged from 0.41 to 0.92 on the anterior surface. Measurements were not statistically different between RTs at any measurement point.
  
  
  CONCLUSIONS
  RTs with variable training attained high levels of interoperator reliability when using transabdominal ultrasound to obtain images and measurements of the uterus and cervix with brachytherapy applicators in situ. Access to training and use of a well-defined protocol assist in achieving these high levels of reliability.
authors.affiliation: Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia. Electronic address: sylvia.vandyk@petermac.org.
authors.forename: Sylvia
authors.initials: S
authors.lastname: van Dyk
authors.affiliation: Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Garth
authors.affiliation: Radiation Therapy Services, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Amanda
authors.initials: A
authors.lastname: Oates
authors.affiliation: Rural Clinical School, University of Queensland, Toowoomba, Queensland, Australia.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Kondalsamy-Chennakesavan
authors.affiliation: Department of Medical Imaging and Radiation Science, Monash University, Clayton, Victoria, Australia.
authors.forename: Michal
authors.initials: M
authors.lastname: Schneider
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Bernshaw
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, Melbourne University, Melbourne, Victoria, Australia.
authors.forename: Kailash
authors.initials: K
authors.lastname: Narayan
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009929:Organ Size; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000592:standards*; D015203:Reproducibility of Results; D018084:Ultrasonography, Interventional / Q000592:standards*; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*
keywords: Brachytherapy; Cervix cancer; Reliability; Ultrasound