MR Female Pelvis WWO for Brachytherapy Planning BODY Protocol

Scan Notes

This study is for radiation planning for endometrial, cervical and vaginal cancer.

  • Scan time = Approximately 90 minutes
  • Radiology Rn to give Glucagon 1mg IV just prior to imaging
  • NPO for 4 hours prior
  • Void prior to exam start

Vaginal Gel Instructions:

  • The clinician will indicate if vaginal gel or syed device is needed. 
  • Patient or brachytherapy physician will be placing intra-vaginal ultrasound gel while on MR table, using 60 cc slip-tip syringe. 
  • Instruct patient to place syringe tip deep, close to cervix. 
  • Patient or brachytherapy physician will fill vagina with gel while slowly removing syringe.
  • The goal is to completely fill the vaginal vault near cervix with gel containing as little air as possible.

Post Processing:

  • Reformats of 3D T2 at 1 mm to coronal and sagittal planes
  • Generate ADC maps

Last updated: 3/20/2021
Charge as Pelvis WWO
Scanner preference: MR2
Coil: Torso Coil

Plane Mode S/G (mm) FS FOV Scan Range Notes Comments
SAG T2 SSTSE 4,0 - 350 mm Sacrum to anterior abdominal wall. L4 to buttocks. CONFIRM GOOD COIL PLACEMENT
AX T2 3D TSE 2 mm slice interpolated to 1 mm - 270 mm/ Fit to Patient Entire Vagina, Cervix, or Uterus depending on area of interest Anterior sat band. Reformat other 2 planes at 1 mm. Do not reduce slices; SNR is dependent on 3D volume.
AX T2 OBLIQUE TSE/HI-RES 3,0 - 200-240 mm/ Fit to Patient. Matrix 512 x 256-512. Entire Vagina, Cervix, or Uterus depending on area of interest CALL Rad FOR PLANNING! Use all planes to obtain true axial to organ of interest (see images below). Resulting image should be a true "doughnut" of organ. Reminder: obliques, especially for cervical cancer, are planned off of TWO PLANES.
COR T2 OBLIQUE TSE/HI-RES 3,0 - 200-240 mm/Fit to Patient Minimize to relevant anatomy CALL Rad FOR PLANNING! Obtain true coronal to organ of interest. L-R phase direction Reminder: obliques, especially for cervical cancer, are planned off of TWO PLANES.
SAG T2 OBLIQUE TSE/HI-RES 3,0 - 200-240 mm/ Fit to Patient. Matrix 512 x 256-512. Minimize to relevant anatomy CALL Rad FOR PLANNING! Obtain true sagittal to organ of interest. Anterior Sat band to minimize wall motion. Phase A-P. Reminder: obliques, especially for cervical cancer, are planned off of TWO PLANES.
AX T1 3D THRIVE HIGH RESOLUTION pre YES 200-240mm/Fit to Patient HIGH RESOLUTION THRIVEs
HAND INJECT CONTRAST
AX T1 3D THRIVE HIGH RESOLUTION postcontrast YES 200-240mm/Fit to Patient HIGH RESOLUTION THRIVEs
SAG T1 3D THRIVE HIGH RESOLUTION postcontrast YES HIGH RESOLUTION THRIVEs
COR T1 3D THRIVE HIGH RESOLUTION Postcontrast YES HIGH RESOLUTION THRIVEs
AX T2 OBLIQUE DWI 5,0 SPIR Match AX OBLIQUE Match AX OBLIQUE Trigger & track. Free-breathing sequence, so please position slices accordingly. B=0, 500, 1000.
Example image for MRI Techs to utilize for planning sequence angulation and coverage for Brachytherapy exams
Planning guidance for MR techs

Figure 14. Value of double oblique high-resolution T2-weighted FRFSE MR images for de­picting parametrial invasion.

(a) Sag T2: mass in the posterior cervical lip (arrow) and the acquisition plane (dashed line) of oblique axial images, which were obtained perpendicular to the long axis of the cervix (solid line).

(b) Ax oblique T2: obtained on the basis of Sag T2 shows the mass in the posterior cervical lip with possible tumor infiltration into the left parametrium (arrow).

(c) Cor T2; cervix, which angles to the left of the midline (arrow), and the angle of acquisi­tion (dashed line) of the double oblique axial image perpendicular to the long axis of the later­ally deviated cervix (solid line).

(d) Double oblique T2: along the axis of the cervix on the basis of the sagittal and coronal images shows an intact cervical stroma (arrow) between the tumor and the parametrium, excluding parametrial invasion at left. Double oblique images are valuable in eliminating the effects of volume averaging.