title: Usefulness of modified BRB technique in treatment to ablate uterine fibroids with magnetic resonance image-guided high-intensity focused ultrasound.
abstract: OBJECTIVE
  If bowels and other structures are in the pathway of high-intensity focused ultrasound (HIFU) beam during magnetic resonance image-guided HIFU (MRgFUS) therapy, filling to the bladder and the rectum and then emptying the bladder (i.e., the BRB technique) is used to avoid them. A modified BRB technique might be useful method to using a uterine elevator method or by inducing uterus downward traction to lower the position of the uterus.
  
  
  METHODS
  A total of 156 patients who had undergone MRgFUS surgery treatment for uterine fibroids from March 2015 to February 2016 were included in this retrospective study. Of the 156 patients, 40 were treated using a uterine elevator while 29 were treated using downward traction of uterus. HIFU was performed using Philips Achieva 1.5 Tesla MR and Sonalleve HIFU system.
  
  
  RESULTS
  MRgFUS surgery was feasible with modified BRB technique in 69 cases. Using uterine elevator method, the intensity of HIFU for group with antefletxio uteri was significantly lower than that for the group without antefletxio uteri (105.37±17.62 vs. 118.71±26.88 W). The group with downward traction of uterus induced was found to have significantly lower intensity of HIFU compared to the group without downward traction of uterus induced (110.26±22.60 vs. 130.51±27.81 W).
  
  
  CONCLUSIONS
  Modified BRB technique was useful in avoiding bowels and other structures located in HIFU beam pathway during MRgFUS treatment to ablate uterine fibroids.
authors.affiliation: Department of Obstetrics and Gynecology, Hwamyung Ilsin Christian Hospital, Busan, Korea.
authors.forename: Jae-Heok
authors.initials: JH
authors.lastname: Jeong
authors.affiliation: Department of Obstetrics and Gynecology, Hwamyung Ilsin Christian Hospital, Busan, Korea.
authors.forename: Kil-Pyo
authors.initials: KP
authors.lastname: Hong
authors.affiliation: Department of Obstetrics and Gynecology, Hwamyung Ilsin Christian Hospital, Busan, Korea.
authors.forename: Yu-Ri
authors.initials: YR
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Hwamyung Ilsin Christian Hospital, Busan, Korea.
authors.forename: Jae-Eun
authors.initials: JE
authors.lastname: Ha
authors.affiliation: Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Kyu-Sup
authors.identifier: 0000-0003-3900-6621
authors.initials: KS
authors.lastname: Lee
keywords: BRB; High-intensity focused ultrasound; Magnetic resonance image-guided high-intensity focused ultrasound; Uterine fibroids