Vaginal Motion and Bladder and Rectal Volumes During Pelvic Intensity-Modulated Radiation Therapy After Hysterectomy Anuja Jhingran, M.D., Mohammad Salehpour,

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Vaginal Motion and Bladder and Rectal Volumes During Pelvic Intensity-Modulated Radiation Therapy After Hysterectomy Anuja Jhingran, M.D., Mohammad Salehpour, Ph.D., Marianne Sam, B.S., Larry Levy, M.S., Patricia J. Eifel, M.D. International Journal of Radiation Oncology • Biology • Physics Volume 82, Issue 1, Pages 256-262 (January 2012) DOI: 10.1016/j.ijrobp.2010.08.024 Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 1 Bladder volumes during treatment for each of the 24 patients in the study. Horizontal lines represent the bladder volumes on the initial full-bladder and empty-bladder computed tomography scans used for treatment planning; open circles indicate the bladder volumes calculated from intratreatment scans. International Journal of Radiation Oncology • Biology • Physics 2012 82, 256-262DOI: (10.1016/j.ijrobp.2010.08.024) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 2 Rectal volumes during treatment for each of the 24 patients in the study. Horizontal lines represent the rectal volumes on the initial full-bladder computed tomography scan used for treatment planning; open circles indicate the rectal volumes calculated from intratreatment scans. International Journal of Radiation Oncology • Biology • Physics 2012 82, 256-262DOI: (10.1016/j.ijrobp.2010.08.024) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 3 Correlations between bladder or rectal volumes and the posterior–anterior and inferior–superior positions of markers inserted in the vaginal apices of 16 patients. Numbers on the y axis represent the organ volumes in cubic centimeters. The correlation coefficient (r) is indicated for each comparison; significant correlation coefficients are shown in red and marked with an asterisk (∗). The significant correlation coefficient corresponds to a p value less than or equal to 0.05. International Journal of Radiation Oncology • Biology • Physics 2012 82, 256-262DOI: (10.1016/j.ijrobp.2010.08.024) Copyright © 2012 Elsevier Inc. Terms and Conditions

Fig. 4 Fused bladder, rectal, and vaginal contours for 2 patients in the study. Left, empty and full bladder contours are shown in solid and hatched red, respectively. The cephalad extent of the full bladder vaginal contour (yellow) extends approximately 2 cm superior to that of the empty bladder contour (green). Right, dramatic anterior deviation of the vagina with a change in rectal filling; the yellow vaginal contour corresponds to the relatively empty (solid blue) rectal contour, and the anteriorly displaced green vaginal contour corresponds to the expanded blue outline of the rectum on the second scan. In both cases, the superior extent of the vaginal apex was determined by the location of fiducial markers. International Journal of Radiation Oncology • Biology • Physics 2012 82, 256-262DOI: (10.1016/j.ijrobp.2010.08.024) Copyright © 2012 Elsevier Inc. Terms and Conditions