Presentation
Planned for brachytherapy for cervical carcinoma. However, initial insertion attempt of the applicator (tandem and ovoid) by the radiation oncology team was unsuccessful likely due to difficult anatomy. Case was referred for ultrasound guided insertion of brachytherapy applicator under spinal anesthesia.
Patient Data
Patient in lithotomy position after a spinal block was performed. Preliminary transabdominal ultrasound was done, showing an anteverted uterus which was slightly tilted to the left. The procedure was done using a 45-degree titanium intrauterine tube.
The urinary bladder was filled with 100 mL of sterile water via a Foley's catheter. Transabdominal ultrasound was performed concurrently while the applicator was being inserted.
Case Discussion
Post insertion, a plain CT was done to confirm the applicator position (images not provided) prior to starting brachytherapy.
Ultrasound assistance can be helpful to confirm the position of the applicator in real-time, especially in patients with difficult or distorted anatomy. This can prevent overshooting the applicator tip which may cause perforation of the uterine fundus.
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