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Online adaptive radiotherapy for cervical cancer

Variable bladder planning CT-scan, in-room ultrasound and cone beam imaging, implanted fiducials, non-rigid registration.

Scope and outline
The purpose of the project is to develop sophisticated image-guidance and adaptive techniques for high-precision radiotherapy of cervical cancer, aiming at a reduction of acute and late side effects. Developed procedures should optimally cope with the complex, non-rigid day-to-day variations in the patient anatomy. Current investigations focus on the use of variable bladder planning CT-scans, and in-room imaging with ultrasound and kV X-rays (cone beam). Patients have implanted fiducials.

Sagital cut of the planning and repeat CT scan of a patient. The images illustrate the impact of bladder filling change on the position of the uterus.

Current investigations focus on development of models to predict for individual patients the target shape and position from on-line measured bladder volumes. Input for these models are variable bladder planning CT-scans. Non-rigid registration is used to register the targets in the variable bladder CT-scans (Figure above).

Dr. M.S. Hoogeman and Drs. J.W.M. Mens