Article Text

Download PDFPDF
Intraoperative Ultrasound Guidance During Intracavitary Brachytherapy Applicator Placement in Cervical Cancer: The University of Alabama at Birmingham Experience
  1. Philip E. Schaner, PhD, MD*,
  2. Jimmy J. Caudell, PhD, MD,
  3. Jennifer F. De Los Santos, MD,
  4. Sharon A. Spencer, MD,
  5. Sui Shen, PhD and
  6. Robert Y. Kim, MD
  1. *Department of Radiation Oncology, Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Hanover, NH;
  2. Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; and
  3. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL.
  1. Address correspondence and reprint requests to Robert Y. Kim, MD, Department of Radiation Oncology, 619 19th St S, Birmingham, AL 35249. E-mail: rkim{at}


Objective The objective of this study was to evaluate the University of Alabama at Birmingham experience with routine intraoperative ultrasound (IUS)–guided tandem placement for cervical cancer.

Methods Between 1999 and 2008, 243 cervical cancer patients underwent IUS-guided tandem placement. One hundred thirty-nine patients received low-dose-rate brachytherapy, and 104 received high-dose-rate brachytherapy. Three hundred fifty-six IUS-guided procedures were performed. Clinical and imaging data were retrospectively analyzed to evaluate complications requiring reinsertion of tandem placement in the context of IUS.

Results All 243 cervical cancer patients completed intracavitary brachytherapy. Five (1.4%) of 356 IUS-guided applicator placements resulted in uterine perforation. All of these patients underwent successful tandem insertion on the second attempt, and no significant clinical sequelae occurred. Intraoperative ultrasound enabled direct uterine visualization and facilitated real-time feedback for selection of a suitable tandem length and curvature; no suboptimal placements requiring return to the operating room occurred (excluding perforation).

Conclusions In this large series, IUS guidance substantially increased the rate of successful applicator placement and diminished the rate of uterine perforation relative to historical controls. We strongly recommend the use of IUS guidance during operative intrauterine tandem placement for cervical cancer.

  • Ultrasound
  • Cervical cancer
  • Brachytherapy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Drs Schaner and Caudell contributed equally to this article.

  • The authors declare no conflicts of interest.