Use of a tampon to enhance vaginal localization in computed tomography

Wn, Cohen; Seidelmann, FE; Bryan, PJ

doi:10.2214/ajr.128.6.1064

Cited by 27 publications

(5 citation statements)

References 4 publications

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“…Solid materials such as tampons can cause deformation of surrounding structures and lead to air artefacts. In addition, due to their stiffness, they cannot completely fill all anatomical spaces [14]. On the other hand, waterbased composite materials completely fill the vaginal lumen and provide a clear evaluation of the vagina and cervix contours without causing anatomical distortion.…”

Section: Discussionmentioning

confidence: 99%

Our clinical experience in pelvic magnetic resonance imaging with vaginal contrast

et al. 2023

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Section: Discussionmentioning

confidence: 99%

Our clinical experience in pelvic magnetic resonance imaging with vaginal contrast

et al. 2023

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“…Early studies showed that sufficient gas remained trapped in the tampon fibres after insertion to distend the anatomy and provide good negative contrast on computed tomography (CT) imaging. 4 This decades old method is still widely used in RO departments for CT simulation scanning; however, a tampon often does not reveal the true shape and extent of the natural vaginal anatomy. 5 Our current departmental procedure for gynaecological planning involves two CT scans: One CT scan acquired with a full bladder, followed by an empty bladder CT scan with tampon in-situ.…”

Section: Introductionmentioning

confidence: 99%

“…In the radiation oncology (RO) setting, tampons have historically been used at simulation appointments to assist with vaginal wall delineation for patients with gynaecological cancers. Early studies showed that sufficient gas remained trapped in the tampon fibres after insertion to distend the anatomy and provide good negative contrast on computed tomography (CT) imaging 4 . This decades old method is still widely used in RO departments for CT simulation scanning; however, a tampon often does not reveal the true shape and extent of the natural vaginal anatomy 5 …”

Section: Introductionmentioning

confidence: 99%

Viscous Aqueous Gel Illustrating Natural Anatomy: The VAGINA method in gynaecological MRI simulation

Skehan,

Richardson,

O'Connor

et al. 2023

J of Medical Radiation Sci

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Accurately defining gross tumour volume (GTV) and organs at risk (OAR) is key to successful radiation therapy (RT) treatment outcomes for patients with gynaecological cancers. With improved access to magnetic resonance imaging (MRI) for RT simulation and planning, the optimisation and tailoring of proven diagnostic MRI techniques towards RT specific planning goals is fast evolving. Modifying MRI techniques for radiation oncology (RO) with the priority of anatomy visualisation and spatial location over diagnosis and disease characterisation relies heavily on successful collaboration between radiology and radiation oncology staff. This ‘How I Do It’ paper describes a qualitative analysis of the adaptation of a diagnostic MRI vaginal opacification technique into an RT specific MRI simulation procedure using aqueous ultrasound gel for improving natural anatomical visualisation of the vaginal canal. This technique is explained and could be introduced in other RO departments for dedicated RT planning scans in MR‐Sim sessions with minimal difficulty. We found 10‐15 cc of aqueous gel delivered vaginally produced optimal MRI planning images for most patients. With this small amount of gel and careful application technique, the full extent of the vaginal vault and cervix can be well visualised on T2 Weighted (T2W) imaging, while tending not to unfold the natural fornices of the collapsed vagina, representing a significant improvement in image quality from the outdated tampon procedure.

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“…The vagina is a potential space which has capacity for expansion between its superior and lateral walls. This can be achieved using solid 6,7 or liquid materials such as aque ous gel. 8 Following gel insertion, the vagina appears as a clear structure of high signal intensity on T2weighted images, with increased definition of the cervix, fornices and anterior rectal wall.…”

Section: Introductionmentioning

confidence: 99%

“…14 It has also been found to cause less artefact than solid alter natives. 3,6 The protocol adopted at our centre was for a jun ior gynaecologist to insert aqueous ultrasound gel into a patient's vagina prior to scan using a bladder syringe. Unfortunately, patients were often neither informed about the use of gel, nor offered the option of selfadministration.…”

Section: Introductionmentioning

confidence: 99%

Patient acceptability and quality of self-administered intravaginal gel for pelvic MRI

Hughes

Kalkur

Zhang

et al. 2021

Journal of Endometriosis and Pelvic Pain Disorders

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Background: MRI of the pelvis can be limited for infiltrating lesions or those of same signal intensity as surrounding structures. Vaginal distension using aqueous gel counters this by defining the fornices, cervix and anterior rectal wall. This increases the accuracy of diagnosis and staging of various pelvic pathology, however, there is currently neither a universally accepted protocol for using gel nor focus on patient self-administration. Aims: To improve patient expectations regarding pelvic MRI with intravaginal gel, as well as the service we provide should they prefer self-administration and this produces vaginal distension of radiological quality equivalent to doctor-administration. Methods: Illustrated information explaining the benefits of gel and the technique of self-administration was sent to patients scheduled for pelvic MRI between March 2020 and April 2021 at our study centre. This included a questionnaire to assess understanding and preference for self-administration. Vaginal distension achieved on imaging was analysed using TeraRecon and compared between self and doctor-administered cases. Results: 38 of 45 patients opted for self-administration of gel. Those who identified as White British were more likely to self-administer. There was comparable quality of vaginal distension between self and doctor administered cases, with no significant difference between orthogonal measurements and retained gel volume. Conclusion: Self-administration of intravaginal gel for pelvic MRI is acceptable to patients and frees a doctor of this duty. It is a well tolerated technique which produces high quality vaginal distention on imaging. We recommend wider use of intravaginal and even rectal gel in the investigation of complex endometriosis and pelvic tumours.

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Use of a tampon to enhance vaginal localization in computed tomography

Cited by 27 publications

References 4 publications

Our clinical experience in pelvic magnetic resonance imaging with vaginal contrast

Our clinical experience in pelvic magnetic resonance imaging with vaginal contrast

Viscous Aqueous Gel Illustrating Natural Anatomy: The VAGINA method in gynaecological MRI simulation

Patient acceptability and quality of self-administered intravaginal gel for pelvic MRI

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