Inter-fraction bladder filling variations and time trends for cervical cancer patients assessed with a portable 3-dimensional ultrasound bladder scanner☆

Abstract 

Background and Purpose

For cervical cancer patients, bladder filling variations may result in inadequate EBRT target coverage, unless large safety margins are used. For a group of patients who received full bladder instructions, inter-fraction variations and time trends in bladder volume were quantified, and a 3D ultrasound (US) scanner was tested for on-line bladder volume measurements.

Methods and materials

For 24 patients, the bladder volume was measured with US at the time of the planning CT scan, and twice weekly during the course of RT. Comparisons of US with planning CT were used to assess the bladder scanner accuracy. Patients were treated in prone on a belly board, EPID images were acquired to correlate set-up errors with bladder filling variations.

Results

Measured US and CT bladder volumes were strongly correlated (R=0.97, slope 1.1± 0.1). The population mean bladder volume at planning of 378±209ml (1SD) reduced to 109±88ml (1SD) in week 6, a reduction by 71% (average reduction 46ml/week), revealing a large inter-fraction time trend. Intra-patient variation in bladder volume during RT was 168ml (1SD) (range 70–266ml). Rotation around the LR axis was significantly correlated with bladder volume changes.

Conclusions

Despite a full bladder instruction, bladder volumes reduced dramatically during treatment, implying large time trends in target position of these patients. The portable US scanner provides a quick and reliable measurement of the bladder volume, which might assist future online treatment adaptation.

Keywords: Bladder volume, Cervix cancer, Patient positioning, 3D portable Ultrasound, Radiotherapy, IGRT