Determining inter-fractional motion of the uterus using 3D ultrasound imaging during radiotherapy for cervical cancer

Abstract

Uterine positional changes can reduce the accuracy of radiotherapy for cervical cancer patients. The purpose of this study was to; 1) Quantify the inter-fractional uterine displacement using a novel 3D ultrasound (US) imaging system, and 2) Compare the result with the bone match shift determined by Cone- Beam CT (CBCT) imaging.Five cervical cancer patients were enrolled in the study. Three of them underwent weekly CBCT imaging prior to treatment and bone match shift was applied. After treatment delivery they underwent a weekly US scan. The transabdominal scans were conducted using a Clarity US system (Clarity® Model 310C00). Uterine positional shifts based on soft-tissue match using US was performed and compared to bone match shifts for the three directions. Mean value (±1 SD) of the US shifts were (mm); anterior-posterior (A/P): (3.8±5.5), superior-inferior (S/I) (-3.5±5.2), and left-right (L/R): (0.4±4.9). The variations were larger than the CBCT shifts. The largest inter-fractional displacement was from -2 mm to +14 mm in the AP-direction for patient 3. Thus, CBCT bone matching underestimates the uterine positional displacement due to neglecting internal uterine positional change to the bone structures. Since the US images were significantly better than the CBCT images in terms of soft-tissue visualization, the US system can provide an optional image-guided radiation therapy (IGRT) system. US imaging might be a better IGRT system than CBCT, despite difficulty in capturing the entire uterus. Uterine shifts based on US imaging contains relative uterus-bone displacement, which is not taken into consideration using CBCT bone match.