RADIATION ONCOLOGY 932 Providing MR Imaging for Cervical Cancer Brachytherapy: Lessons for Radiologists 1 Brachytherapy (BT), the use of a locally placed or implanted radio- active source for treatment of an adjacent tumor, is an important component in the treatment of patients with both early- and ad- vanced-stage cervical cancer and is increasingly part of the standard treatment protocol. When it is feasible, many radiation oncologists choose to include a magnetic resonance (MR) imaging examina- tion for planning BT treatment (ie, an MR imaging examination after placement of the applicator but before radiation dosing). MR imaging provides excellent soft-tissue contrast and allows radiation oncologists to individualize the radiation dose to the target volume and minimize the dose to adjacent organs that are at risk for radia- tion damage. However, traditionally, the radiology department has not performed imaging studies for planning, and the requirements are different compared with those of standard diagnostic imaging. In addition, many applicators are available for use in BT treatment of cervical cancer, and each must considered separately to determine MR safety and to define the best imaging parameters. Starting and supporting a robust gynecologic BT program includes implement- ing imaging protocols that are helpful to both radiation oncologists and diagnostic radiologists. By becoming more familiar with this treatment modality and the logistics of imaging patients undergoing BT, radiologists can provide imaging support for colleagues in the radiation oncology department and better care for patients. © RSNA, 2018 • radiographics.rsna.org Thomas Sullivan, MD Joseph H. Yacoub, MD Matthew M. Harkenrider, MD William Small, Jr, MD Murat Surucu, PhD Steven M. Shea, PhD Abbreviations: BT = brachytherapy, ESTRO = European Society for Radiotherapy and Oncol- ogy, FIGO = International Federation of Gy- necology and Obstetrics, FSE = fast spin echo, GEC = Groupe Européen de Curiethérapie, GRE = gradient echo, HDR = high dose rate, 3D = three dimensional RadioGraphics 2018; 38:932–944 https://doi.org/10.1148/rg.2018170033 Content Codes: 1 From the Departments of Radiology (T.S., J.H.Y., S.M.S.) and Radiation Oncology (M.M.H., W.S., M.S.), Loyola University Chi- cago, Stritch School of Medicine, Health Sci- ences Division, 2160 S 1st Ave, Maywood, IL 60153. Presented as an education exhibit at the 2016 RSNA Annual Meeting. Received March 6; revision requested August 25 and received October 6; accepted October 13. For this jour- nal-based SA-CME activity, the author W.S. has provided disclosures (see end of article); all other authors, the editor, and the reviewers have dis- closed no relevant relationships. Address corre- spondence to S.M.S. (e-mail: stshea@lumc.edu). © RSNA, 2018 After completing this journal-based SA-CME activity, participants will be able to: ■ Explain the role of MR imaging in cer- vical BT. ■ Implement imaging protocols helpful for both radiation oncologists and diag- nostic radiologists. ■ Assess a properly placed applicator, identify hardware, and interpret a BT planning MR imaging study. See www.rsna.org/education/search/RG. SA-CME LEARNING OBJECTIVES Introduction Although the incidence of cervical cancer has declined significantly in the last 40 years (primarily because of improved screening), nearly 12 000 new cases are diagnosed every year (1). Cancers of the cervix are staged by using the International Federation of Gynecology and Obstetrics (FIGO) staging system for prognosis and epidemiologic reporting (2) (Table 1). Cervical cancer treatment plans are tailored to each patient on the basis of many factors, including tumor size, local extent, and nodal status. Brachytherapy (BT) is an important part of an increasingly standardized treatment plan. Typically, this plan also includes an ini- tial course of platinum-based chemotherapy and external-beam ra- diation therapy. BT is offered routinely after external-beam radiation therapy for all stages of cervical cancer for which definitive nonsurgi- cal treatment is indicated. This change is attributed to the emergence of evidence of prolonged survival when both radiation therapy mo- dalities (external-beam radiation therapy and high-dose-rate [HDR] BT) are combined with cisplatin-based chemotherapy (3). This copy is for personal use only. To order printed copies, contact reprints@rsna.org