# CT Angiography-Guided Needle Insertion for Interstitial Brachytherapy in Locally Advanced Cervical Cancer

## TL;DR

CT angiography helps safely guide needle placement during brachytherapy for cervical cancer, avoiding artery punctures and improving treatment accuracy.

## Contribution

This study introduces CT angiography as a novel method for guiding needle insertion in cervical cancer brachytherapy.

## Key findings

- CT angiography successfully avoided arterial puncture in all patients.
- Needle positions were accurately selected to cover brachytherapy targets while avoiding organs at risk.
- The method shows promise for improving safety and precision in interstitial brachytherapy.

## Abstract

CT angiography might be a suitable procedure to avoid arterial puncture in combined intracavitary and interstitial brachytherapy for cervical cancer curatively treated with combined chemoradiation and brachytherapy boost. Data in the literature about this technique are scarce. We introduced this method and collected brachytherapy data from patients treated in our department between May 2021 and April 2024. We analyzed the applicator subtype, needle insertion (planned versus implanted), implanted depth and the role of CT angiography in selecting needle trajectories and insertion depths. None of the patients managed through this protocol experienced atrial puncture and consequent hemorrhage. Needle positions were accurately selected with the aid of CT angiography with proper coverage of brachytherapy targets and avoidance of organs at risk. CT angiography is a promising method for guiding needle insertion during interstitial brachytherapy.