MR Female Pelvis WWO for Brachytherapy Planning BODY Protocol
This study is for radiation planning for endometrial, cervical and vaginal cancer.
- Scan time = Approximately 90 minutes
- 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.
- Reformats of 3D T2 at 1 mm to coronal and sagittal planes
- Generate ADC maps
Last updated: 5/11/2022
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.|
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.