Assessment of inter- and intra-fractional volume of bladder and body contour by mega-voltage computed tomography in helical tomotherapy for pelvic malignancy

  • Kim, Sunghyun (Department of Radiation Oncology, Yonsei University Wonju College of Medicine) ;
  • You, Sei Hwan (Department of Radiation Oncology, Yonsei University Wonju College of Medicine) ;
  • Eum, Young Ju (Department of Radiation Oncology, Yonsei University Wonju College of Medicine)
  • Received : 2018.04.11
  • Accepted : 2018.07.31
  • Published : 2018.09.30


Purpose: We describe the daily bladder volume change observed by mega-voltage computed tomography (MVCT) during pelvic radiotherapy with potential predictors of increased bladder volume variations. Materials and Methods: For 41 patients who received pelvic area irradiation, the volumes of bladder and pelvic body contour were measured twice a day with pre- and post-irradiation MVCT from the 1st to the 10th fraction. The median prescription dose was 20 Gy (range, 18 to 30 Gy) up to a 10th fraction. The upper and lower margin of MVCT scanning was consistent during the daily treatments. The median age was 69 years (range, 33 to 86 years) and 10 patients (24.4%) were treated postoperatively. Results: Overall bladder volume on planning computed tomography was 139.7 ± 92.8 mL. Generally, post-irradiation bladder volume (POSTBV) was larger than pre-irradiation bladder volume (PREBV) (p < 0.001). The mean PREBV and POSTBV was reduced after 10 fraction treatments by 21.3% (p = 0.028) and 25.4% (p = 0.007), respectively. The MVCT-scanned body contour volumes had a tendency to decrease as the treatment sessions progressed (p = 0.043 at the 8th fraction and p = 0.044 at the 10th fraction). There was a statistically significant correlation between bladder filling time and PREBV (p = 0.001). Conclusion: Daily MVCT-based bladder volume assessment was feasible both intra- and inter-fractionally.


  1. Nairz O, Merz F, Deutschmann H, et al. A strategy for the use of image-guided radiotherapy (IGRT) on linear accelerators and its impact on treatment margins for prostate cancer patients. Strahlenther Onkol 2008;184:663-7.
  2. Tsai CL, Wu JK, Wang CW, Hsu FM, Lai MK, Cheng JC. Using cone-beam computed tomography to evaluate the impact of bladder filling status on target position in prostate radiotherapy. Strahlenther Onkol 2009;185:588-95.
  3. Moiseenko V, Liu M, Kristensen S, Gelowitz G, Berthelet E. Effect of bladder filling on doses to prostate and organs at risk: a treatment planning study. J Appl Clin Med Phys 2006;8:55-68.
  4. Chang JS, Yoon HI, Cha HJ, et al. Bladder filling variations during concurrent chemotherapy and pelvic radiotherapy in rectal cancer patients: early experience of bladder volume assessment using ultrasound scanner. Radiat Oncol J 2013;31:41-7.
  5. Ahmad R, Hoogeman MS, Quint S, Mens JW, de Pree I, Heijmen BJ. Inter-fraction bladder filling variations and time trends for cervical cancer patients assessed with a portable 3-dimensional ultrasound bladder scanner. Radiother Oncol 2008;89:172-9.
  6. Stam MR, van Lin EN, van der Vight LP, Kaanders JH, Visser AG. Bladder filling variation during radiation treatment of prostate cancer: can the use of a bladder ultrasound scanner and biofeedback optimize bladder filling? Int J Radiat Oncol Biol Phys 2006;65:371-7.
  7. O'Doherty UM, McNair HA, Norman AR, et al. Variability of bladder filling in patients receiving radical radiotherapy to the prostate. Radiother Oncol 2006;79:335-40.
  8. Hynds S, McGarry CK, Mitchell DM, et al. Assessing the daily consistency of bladder filling using an ultrasonic Bladderscan device in men receiving radical conformal radiotherapy for prostate cancer. Br J Radiol 2011;84:813-8.
  9. Orio PF 3rd, Merrick GS, Allen ZA, et al. cExternal beam radiation results in minimal changes in post void residual urine volumes during the treatment of clinically localized prostate cancer. Radiat Oncol 2009;4:26.
  10. Nakamura N, Shikama N, Takahashi O, et al. Variability in bladder volumes of full bladders in definitive radiotherapy for cases of localized prostate cancer. Strahlenther Onkol 2010;186:637-42.
  11. Kalz J, Sterzing F, Schubert K, Sroka-Perez G, Debus J, Herfarth K. Dosimetric comparison of image guidance by megavoltage computed tomography versus bone alignment for prostate cancer radiotherapy. Strahlenther Onkol 2009;185:241-7.
  12. Fiorino C, Di Muzio N, Broggi S, et al. Evidence of limited motion of the prostate by carefully emptying the rectum as assessed by daily MVCT image guidance with helical tomotherapy. Int J Radiat Oncol Biol Phys 2008;71:611-7.
  13. Yeung TP, Yartsev S, Rodrigues G, Bauman G. Evaluation of image-guidance strategies with helical tomotherapy for localised prostate cancer. J Med Imaging Radiat Oncol 2011;55:220-8.
  14. Kupelian PA, Langen KM, Zeidan OA, et al. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2006;66:876-82.
  15. Fiorino C, Foppiano F, Franzone P, et al. Rectal and bladder motion during conformal radiotherapy after radical prostatectomy. Radiother Oncol 2005;74:187-95.
  16. Lebesque JV, Bruce AM, Kroes AP, Touw A, Shouman RT, van Herk M. Variation in volumes, dose-volume histograms, and estimated normal tissue complication probabilities of rectum and bladder during conformal radiotherapy of T3 prostate cancer. Int J Radiat Oncol Biol Phys 1995;33:1109-19.
  17. Verit A, Yeni E, Unal D, Kafali H, Ozturk A, Ozardali I. Idiopathic retroperitoneal fibrosis mimicking a pelvic tumor: a case of pericystitis plastica. Yonsei Med J 2003;44:548-50.
  18. Pinkawa M, Asadpour B, Gagel B, Piroth MD, Holy R, Eble MJ. Prostate position variability and dose-volume histograms in radiotherapy for prostate cancer with full and empty bladder. Int J Radiat Oncol Biol Phys 2006;64:856-61.