Use Of Transabdominal Ultrasonography Research Articles

Utility of Combined Use of Transabdominal Ultrasonography and Fecal Immunochemical Test Examinations in Ulcerative Colitis.

This study examined the utility of the combined use of transabdominal ultrasonography (TUS) and fecal immunochemical testing (FIT) to detect mucosal inflammation, vis-a-vis the Mayo endoscopic subscore (MES), in ulcerative colitis (UC). Sixty-three UC patients who underwent TUS and FIT were retrospectively enrolled. For TUS, the colon was divided into five segments, and the bowel wall thickness was measured and evaluated. The accuracy of FIT (> 100 ng/ml) in detecting mucosal inflammation (MES>0) was 0.93, whereas that of TUS (BWT>2 mm) in each segment was 0.84-0.97. The combined use of TUS and FIT may be helpful in noninvasive treatment strategies.

Applications of transabdominal ultrasonography in bovine reproduction: A review

The non-invasive nature of ultrasonography makes it an important clinical and research tool in bovine reproduction and obstetrics. Ultrasound techniques are becoming increasingly important in animal reproduction and obstetrics and these techniques are helpful in evaluation of various disease conditions of uterus during advance pregnancy in bovines. Accordingly, understanding the use of ultrasound technology is of utmost importance in animal sciences, since ultrasound examinations are now a routine part of diagnostic workups in reproduction and obstetrics. Up to now, most of studies were conducted to assess the status of fetal and uterine structures by trans-rectal ultrasonography, but sometimes it was found to be inefficient in judging the complete status of fetal and uterine structures during mid and advance pregnancy when the fetus is located deep into the abdominal cavity. So, in modern times transabdominal ultrasonography is getting popularity over trans-rectal ultrasonography in bovines during mid and advance gestation to determine the complete status of pregnant animals. The new information that has been generated by use of transabdominal ultrasonography has thrown light on diagnostic and research aspects and created new areas for research. Transabdominal ultrasonographic examination of the reproductive tract can provide useful information related to fetal viability, diagnosis of mid to late term pregnancies, gestational age, assessment of fetus and fetal organs, placentomes, fetal fluids, uterine wall, umbilicus, and identification of developmental abnormalities. To best of my knowledge this is the first review of applications of transabdominal ultrasonography in bovine reproduction because literature related to transabdominal ultrasonography in bovine reproduction and obstetrics is very scanty.

The Colon Wall Thickness Measured Using Transabdominal Ultrasonography Is Useful for Detecting Mucosal Inflammation in Ulcerative Colitis.

Objective Transabdominal ultrasonography (TUS) is a non-invasive procedure that is reportedly useful for managing ulcerative colitis (UC) and assessing bowel wall thickness (BWT), the most common measure of mucosal inflammation. However, the exact range of BWT that reflects disease activity remains undetermined. The present study clarified the BWT due to disease activity by comparing the use of TUS in each segment of the colon versus using colonoscopy (CS) and determined the usefulness of TUS in patients with UC. Methods We divided the colon into five segments and measured the BWT using TUS. The results were then compared to the Mayo endoscopic subscore (MES) classification to determine the accuracy of BWT measurement. Patients Eighty patients with UC who underwent TUS within 14 days of CS were retrospectively registered. Results We evaluated a total of 268 images depicting each segment among 80 patients with UC. The BWT was positively correlated with endoscopic activity (0.69, p＜0.0001). In each segment, the relationship between a BWT＞2 mm and an MES＞0 had the highest sensitivity, specificity, and accuracy (0.85-1.00, 0.67-0.92, and 0.81-0.97, respectively). Conclusion This study concluded that TUS was a useful method of detecting an MES＞0, which indicates the presence of inflammation and its location among UC patients. MES＞0 was found to be highly accurate when a BWT＞2 mm was considered positive. This non-invasive method may help control disease activity in patients with UC.

Ultrasonographic and macroscopic study of pregnancy in golden hamster

BackgroundHamster is widely used as an experimental model in the study of reproductive system. However, pregnancy diagnosis and aging always have been a challenge. ultrasonography have been used in diagnosis of pregnancy in some small laboratory animals, such as rabbits, rats, and mice. Current study describes use of trans-abdominal ultrasonography for pregnancy diagnosis and fetal age estimation in golden hamster. Furthermore, a macroscopic examination was performed to evaluate the embryonic vesicle diameter, crown-rump length, and fetal head diameter. Ten adult female golden hamsters were selected and maintained under controlled light conditions (14 h light/10 h darkness). The estrous cycle was synchronized using eCG and hCG. During estrous (18 h after hCG injection), the hamsters were naturally mated. After seven days of mating, the hamsters were examined daily for pregnancy diagnosis and aging with an ultrasound scanner equipped with an 8.5-MHZ linear probe. On each day of the experiment, at least one of the pregnant hamsters was euthanized and dissected for macroscopic fetal measurements using a digital caliper.ResultsThe gestational sac and crown-rump length were identified and measured by ultrasonographicly on day 7 of pregnancy and head could be visible after day 10 of gestation. Statistical analysis revealed that the ultrasound estimation of gestational age was significantly correlated with the actual age of the fetus (r = 0.98; p < 0.05).ConclusionsReal-time ultrasound can be used for the diagnosis of pregnancy and estimation of fetal age in golden hamster from day 7 of gestation.

The implementation of routine procedural transvaginal sonography to decrease retained products of conception: a quality improvement initiative

BackgroundRetained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.MethodsA retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.ResultsPrior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman’s syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman’s syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm).ConclusionImplementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.

Intra-procedural Transvaginal Sonography to Decrease Retained Products of Conception [35A

INTRODUCTION: Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Incidence of retained POC range from 1.5–3.7%. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease this. METHODS: A retrospective review of first trimester uterine evacuation procedures from 1/2015–2/2017 was performed, noting use of transabdominal ultrasonography (TAUS), retained products of conception (sonographic findings requiring surgical or medical intervention), and complications. A practice change was implemented in May 2018, in which intra-procedural TVUS was routinely performed. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, reoperation, and associated complications. Fisher's exact test was performed. RESULTS: Prior to implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman's and endometritis. Following implementation, 94 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (P=.01), no incidences of re-operation (P=.02), and one case of Asherman's. TVUS led to additional focused curettage in 20/94 (21.3%) of procedures. The endometrium was measured in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm). CONCLUSION: Implementation of routine TVUS during uterine evacuation appears to reduce the incidence of retained POC and associated reoperation rates.

P189 Use of transabdominal ultrasonography for the evaluation of Crohn’s disease activity

Abstract Background Ileocolonoscopy is accepted as the gold standard method for the diagnosis of Crohn’s disease (CD). However, there are cases where it is inadequate due to being invasive, failure to allow endoscopic exploration of the small intestine, and failure to show the extraintestinal pathologies. In the present study, it is aimed to compare clinical, endoscopic scores and computerised tomography enterography (CTE) findings with transabdominal ultrasonography (TAUS) findings in order to evaluate the activity of CD. Methods The study included 79 patients diagnosed with CD. Crohn’s Disease Activity Index (CDAI) and Harvey Bradshaw Index (HBI) were used for the evaluation of the clinical activities of the patients. The patients with CDAI equal to 150 and more and HBI equal to 5 points and more were assessed as clinically active. Colonoscopic disease activity was assessed by The Simple Endoscopic Score for Crohn’ disease (SES-CD), SES-CD score of 3 and higher was defined as endoscopically active. In the evaluation of CTE and TAUS, the measurement of the thickness of the intestinal wall above 3 mm was accepted as pathological. Abscess, mass, fistula and ileus were evaluated as complications. Superior mesenteric artery (SMA) flow velocity was assessed by Color Doppler US. Limberg score was graded from Grades 0 to 4 for Doppler TAUS. Results Of the patients, 57 (72.1%) were male and 22 (27.8%) were female. Age average of the patients was 37.5 years (17–64) and the mean duration of disease was 48.6 months (0–240 months). Increase in the wall thickness in CTE and TAUS, detection of inflammation and complication in mesenteric fatty planes were found to be highly significant (p ˂ 0.0001). Wall thickness increase sensitivity level of TAUS according to CTE was 82%, specificity level was 97%, sensitivity level of the inflammation finding in mesenteric fatty planes was measured as 80%, and specificity level as 95%. A significant correlation was found between the wall thickness increase in CTE and TAUS and inflammation in mesenteric fatty planes via CDAI, HBI and SES-CD scoring (p ˂ 0.05). In addition, there was a significant relationship between the presence of lymphadenopathy in CTE in active patients according to HBI (p ˂ 0.05). According to the CDAI and SES-CD scores, Doppler flow velocity of SMA was significantly higher in the active group than the inactive group (p ˂ 0.05). CDAI, HBI and SES-CD results were found highly significant via the Limberg Scoring results (p &amp;lt; 0.0001). Conclusion In the current study, it is shown that TAUS is a diagnostic tool as effective as CTE in the evaluation of CD activity. In addition, it is an important finding that the flow velocity of SMA increases as correlated with inflammation via the Doppler feature of TAUS.

Use of transabdominal ultrasonography in the acute abdomen: Has it really revolutionised our colic work‐ups?

Use of transabdominal ultrasonography in the acute abdomen: Has it really revolutionised our colic work‐ups?

Integrating trans-abdominal ultrasonography with fecal steroid metabolite monitoring to accurately diagnose pregnancy and predict the timing of parturition in the red panda (Ailurus fulgens styani).

Red pandas (Ailurus fulgens styani) exhibit a variable gestation length and may experience a pseudopregnancy indistinguishable from true pregnancy; therefore, it is not possible to deduce an individual's true pregnancy status and parturition date based on breeding dates or fecal progesterone excretion patterns alone. The goal of this study was to evaluate the use of transabdominal ultrasonography for pregnancy diagnosis in red pandas. Two to three females were monitored over 4 consecutive years, generating a total of seven profiles (four pregnancies, two pseudopregnancies, and one lost pregnancy). Fecal samples were collected and assayed for progesterone (P4) and estrogen conjugate (EC) to characterize patterns associated with breeding activity and parturition events. Animals were trained for voluntary transabdominal ultrasound and examinations were performed weekly. Breeding behaviors and fecal EC data suggest that the estrus cycle of this species is 11-12 days in length. Fecal steroid metabolite analyses also revealed that neither P4 nor EC concentrations were suitable indicators of pregnancy in this species; however, a secondary increase in P4 occurred 69-71 days prior to parturition in all pregnant females, presumably coinciding with embryo implantation. Using ultrasonography, embryos were detected as early as 62 days post-breeding/50 days pre-partum and serial measurements of uterine lumen diameter were documented throughout four pregnancies. Advances in reproductive diagnostics, such as the implementation of ultrasonography, may facilitate improved husbandry of pregnant females and allow for the accurate prediction of parturition.

Transabdominal ultrasonography for pregnancy diagnosis and estimation of gestational age in dromedary camels.

The objective of this study was to evaluate the use of transabdominal ultrasonography as a method for pregnancy diagnosis and establish some foetal biometrics guidelines of pregnancy staging. Transabdominal ultrasonography was performed weekly on six pregnant camels from the 4th to the 19th week and at 2-week intervals from the 20th to the 52nd week of gestation. Six areas were selected for examination: caudal abdominal (CAA), inside the thigh, above the base of the udder; middle abdominal (MIA), from the base of the udder to the umbilicus; and cranial abdominal (CRA), from the umbilicus to the xiphoid cartilage. Several foetal parameters including orbital diameter (ORD), biparietal diameter (BPD), abdominal diameter (ABD), chest depth (CHD) and ruminal diameter (RUD) were measured using standardized scan plans. The relationships between the gestational age and the foetal parameters were evaluated. From the 6th to the 12th week, the conceptus was always observed through the left CAA approach. Between the 13th and 27th week, the foetus was entirely visualized by the MIA examination. From the 28th to the 52nd week, the conceptus was mainly detected through the left CRA approach. The foetal parameters were measured frequently during mid- and late gestation. All regression and correlation coefficients were highly significant (p<0.0001). In conclusion, transabdominal ultrasonography was shown to be a reliable technique for pregnancy diagnosis and estimation of gestational age in dromedary camels.

Use of transabdominal ultrasonography to preoperatively determine T-stage of proven colon cancers.

Although noninvasive and highly informative, transabdominal ultrasonography (US) is not yet an accepted means of staging colorectal cancer preoperatively. This prospective study evaluated the diagnostic accuracy of US in preoperative staging of patients with resectable colon cancers. A total of 98 patients with primary colon cancer diagnosed by colonoscopy at our institute between January, 2011 and June, 2014 underwent preoperative ultrasonographic tumor staging. Depth of tumor infiltration (T-stage) was assessed by standard means (i.e., extent of mural involvement), analyzing agreement in US and histopathology determinations. All but two colon cancers (at splenic flexure) were detected by US (98%, 96/98). Compared with histopathology, overall accuracy of US in determining T-stage was 64% (61/96), indicating moderate reproducibility (κ coefficient 0.48; 95% CI 0.35-0.62; p < 0.001). Using a three-tier approach of graded muscularis propria (MP) involvement (Tis/T1, below MP; T2, within MP; and T3/T4, beyond MP), diagnostic agreement increased to 89% (85/96), with good agreement (κ coefficient 0.77; 95% CI 0.64-0.90; p < 0.001). No tumor characteristics or patient demographics influenced diagnostic agreement at any site in the colon. Given the potential to yield valuable information while limiting patient discomfort, US should be reconsidered as a means of assessing colon cancer.

ULTRASONOGRAPHIC CHARACTERISTICS OF THE ABDOMINAL ESOPHAGUS AND CARDIA IN DOGS

Differential diagnoses for regurgitation and vomiting in dogs include diseases of the gastroesophageal junction. The purpose of this cross-sectional study was to describe ultrasonographic characteristics of the abdominal esophagus and gastric cardia in normal dogs and dogs with clinical disease involving this region. A total of 126 dogs with no clinical signs of gastrointestinal disease and six dogs with clinical diseases involving the gastroesophageal junction were included. For seven euthanized dogs, ultrasonographic features were also compared with gross pathology and histopathology. Cardial and abdominal esophageal wall thicknesses were measured ultrasonographically for all normal dogs and effects of weight, sex, age, and stomach filling were tested. Five layers could be identified in normal esophageal and cardial walls. The inner esophageal layer was echogenic, corresponding to the cornified mucosa and glandular portion of the submucosa. The cardia was characterized by a thick muscularis, and a transitional zone between echogenic esophageal and hypoechoic gastric mucosal layers. Mean (±SD) cardial wall thicknesses for normal dogs were 7.6 mm (±1.6), 9.7 mm (±1.8), 10.8 mm (±1.6), 13.3 mm (±2.5) for dogs in the <10 kg, 10-19.9 kg, 20-29.9 kg and ≥30 kg weight groups, respectively. Mean (±SD) esophageal wall thicknesses were: 4.1 mm (±0.6), 5.1 mm (±1.3), 5.6 mm (±1), and 6.4 mm (±1.1) for the same weight groups, respectively. Measurements of wall thickness were significantly correlated with dog weight group. Ultrasonography assisted diagnosis in all six clinically affected dogs. Findings supported the use of transabdominal ultrasonography as a diagnostic test for dogs with suspected gastroesophageal disease.

Diagnosis of prostate adenoma and the relationship between the site of prostate adenoma and bladder outlet obstruction

The objective of this study was to evaluate the accuracy of using intravesical prostatic protrusion (IPP) as a parameter for the diagnosis of prostate adenoma (PA), as well as to determine the relationship between the site of PA and bladder outlet obstruction. IPP was determined with the use of transabdominal ultrasonography (TAUS). A total of 77 consecutive adult men aged 30-85 years with haematuria or undergoing checkup for bladder tumour were enrolled. International Prostate Symptom Score (IPSS), and the results of uroflowmetry, TAUS and cystourethroscopy were assessed. All cases of IPP were classified into grades 0 (no IPP), 1 (1-5 mm), 2 (6-10 mm) or 3 (> 10 mm). PA diagnosis was confirmed using flexible cystourethroscopy. The sites of PA were classified as U0 (no adenoma), U1 (lateral lobes), U2 (middle lobe) or U3 (lateral and middle lobes). Of the 77 patients, 11 (14.3%) had no IPP. PA was confirmed using cystourethroscopy for all patients with IPP and for 7 of the 11 patients without IPP. Of the 37 patients with prostate volume < 20 g, 29 (78.4%) had IPP. Sensitivity, specificity, as well as positive and negative predictive values for diagnosing PA using only IPP were 90.4%, 100.0%, 100.0% and 36.4%, respectively. Higher sensitivity (95.9%) and negative predictive value (50.0%) were obtained when PA was used together with peak urinary flow rate (Qmax) < 20.0 mL/s. The mean Qmax of patients classified as U1 (n = 39) was 16.0 mL/s, while the mean Qmax in those classified as U2 (n = 12) and U3 (n = 22) was 11.9 mL/s and 8.9 mL/s, respectively. All patients with IPP had PA, and PA in the middle lobe was more obstructive than those in lateral lobes. Patients without IPP may still have PA.

Ultrasonographic and laparoscopic evaluation of the reproductive tract of the captive female African lion (Panthera leo)

The use of transabdominal ultrasonography to assess the oestrous cycle has not been previously described in the African lion (Panthera leo). Twelve sexually mature lionesses and five female cubs had their reproductive organs assessed by transabdominal ultrasound. Ovarian findings were compared to laparoscopic findings while performing laparoscopic ovariectomy or salpingectomy. Vaginal cytology was performed and serum progesterone levels were determined. By combining all data the oestrous cycle stage of each lion was determined. One lion was far pregnant and was not operated on. In adults a uterine body could be seen ultrasonographically in 67% of lions while mural structures could be distinguished in 44% of lions. Five uterine horns could be seen in 3 lions. In 12 adults 10 ovaries were found of which eight had discernable follicles or luteal structures. During laparoscopy 12 active ovaries were seen with luteal structures seen in 11 ovaries and follicles in 2 ovaries. Using laparoscopy as the gold standard, ultrasonography had a sensitivity of 66% and specificity of 83% to detect ovarian reproductive activity. Two uterine cysts and a cluster of periovarian cysts were seen in three different lions. Three lions were pregnant, two were in oestrus, three in a luteal phase (dioestrus), and four were in anoestrus. Transabdominal ultrasound in combination with serum progesterone levels and vaginal cytology can be used to assess ovarian cyclical activity with reasonable accuracy in captive bred lions.

Use of transabdominal ultrasonography to determine the location of cryptorchid testes in the horse

Transrectal ultrasonography is a reliable technique to identify intra-abdominal testes, but can be hazardous or impractical in fractious, juvenile or small equids. The transabdominal approach therefore requires validation. To evaluate the sensitivity and specificity of transabdominal ultrasonography to localise cryptorchid testes. Thirty-eight horses admitted for cryptorchidism underwent transabdominal ultrasonography to locate errant testes. Location of the testes was confirmed during surgery (n = 37) or necropsy (n = 1). Horses weighed 175-760 kg. Twenty-two testes were located within the abdomen, 19 in the inguinal space and 3 in a subcutaneous location. In 2 horses, a thick winter coat prevented adequate contact between the probe and the skin, and visualisation of their inguinal testis and one abdominal testis was missed during transabdominal ultrasonography. Excluding the 2 horses with excessive hair, the sensitivity of transabdominal ultrasonography to locate errant testes was 97.6% (93.2% when all horses were included), and its specificity 100%. Transabdominal ultrasonography is a reliable, safe and immediate technique to diagnose cryptorchidism precisely in horses of all ages, sizes and temperaments. Transabdominal ultrasonography provides an immediate definitive diagnosis of adominal cryptorchidism and should enhance selection of an appropriate surgical approach for their removal.

The use of transabdominal ultrasonography in the diagnosis and management of splenic lesions in three horses

The use of transabdominal ultrasonography in the diagnosis and management of splenic lesions in three horses

Metabolic Syndrome as a Risk Factor for Developing Benign Prostatic Hyperplasia-A Simple, Non-invasive Method of Transabdominal Ultrasonography for BPH-

The aim of this study was to clarify the effects of metabolic syndrome on benign prostatic hyperplasia (BPH) by use of transabdominal ultrasonography in healthy males, the subjects of this study were 333 Japanese men. All subjects were divided to two groups; 146 subjects in the smaller group (prostatic anteroposterior size<28.0 mm, mean age; 45.3yrs) and 187 subjects in the larger group (prostatic anteroposterior size ≥28.0 mm, mean age; 51.3yrs), respectively. The levels of age, systolic blood pressure (S-BP), diastolic blood pressure (D-BP), fasting insulin (FIRI), plasma triglyceride (TG), γ-glutamyltranspeptidase (γ-GPT), Fe, plasma prostate-special antigen (PSA), insulin resistance (HOMA-IR) and pancreas β cell function (HOMA-β) were significantly higher in the larger group than those in the smaller group, however plasma high density lipoprotein cholesterol (HDL-ch) level was significantly lower in the larger group than that in the smaller group. The prostatic anteroposterior size was significantly and positively related with age (r=0.31, p<0.0001), HOMA-IR (r=0.14, p=0.027), body mass index (r=0.10, p=0.049), S-BP (r=0.11, p=0.046) and D-BP (r=0.12, p=0.032) in all subjects. These data firstly indicated that metabolic syndrome was as a risk factor for developing BPH, secondly revealed that the transabdominal ultrasonography was able to use as the standard clinical tool for the useful assessment of prostatic size in daily medical health examinations.

Analysis of acute toxicity with use of transabdominal ultrasonography for prostate positioning during intensity-modulated radiotherapy

Objectives To analyze the effects of the B-mode ultrasound acquisition and targeting (BAT) system for positioning of patients with prostate cancer receiving intensity-modulated radiotherapy on acute gastrointestinal (GI) and genitourinary (GU) toxicity. Methods The records of 50 consecutive patients treated using the BAT system were reviewed. Additionally, a comparison (no-BAT) group (ie, a group without a BAT study) treated in a similar manner was identified. The no-BAT group consisted of 49 patients treated immediately before the BAT group. For the two groups, the target definitions and dose prescriptions were identical, the treatment plan acceptance criteria were identical, and intensity-modulated radiotherapy was used for all patients. The daily BAT movements were charted in each of the three principal directions. Acute toxicity was scored for all patients according to the Radiation Therapy Oncology Group GI and GU acute toxicity scales. Results The GU toxicity rates for the BAT versus no-BAT groups were grade 0 in 20% versus 14%; grade 1 in 38% versus 47%; grade 2 in 38% versus 39%; and grade 3 in 4% versus 0%, respectively ( P = 0.284). The corresponding GI toxicity rates were grade 0 in 42% versus 27%; grade 1 in 28% versus 29%; and grade 2 in 30% versus 45% ( P = 0.040). The incidence of GU and GI toxicity did not correlate with the directions or size of the BAT moves. Regression analysis revealed that for acute GI toxicity, the only variable reaching statistical significance was BAT use; no variable, including BAT use, reached statistical significance for acute GU toxicity. Conclusions The use of the BAT system did not change the rate of acute GU toxicity but did reduce the rate of acute GI toxicity.