Applicator reconstruction and applicator shifts in 3D MR-based PDR brachytherapy of cervical cancer

Abstract Purpose To evaluate the methods of applicator reconstruction in 3D MR-based planning for brachytherapy of cervical cancer, and to investigate applicator shifts and changes in DVH parameters during PDR treatment. Methods For each application MR scans with applicator in situ were made: three T2-weighted (4.5 mm slices) Turbo Spin Echo (TSE) scans and a balanced Steady State Free Precession scan (1.5 mm). Three observers tested two applicator reconstruction methods: (A) directly on the bSSFP scan and (B) on a resampled combination of the three T2-weighted scans. For 10 patients MR imaging was repeated on the second day of each PDR fraction to determine applicator shifts and changes in DVH parameters. Results For both applicator reconstruction methods the interobserver variation for the DVH parameters was comparable (average