The Bladder (GYN)

Contouring Accuracy Program

© 2018 ProKnow Systems, LLC. All Rights Reserved.

 Outline
1. Refresher Course on the Bladder
A. What is the Bladder?
B. “Did You Know?”
2. Locating the Bladder in Medical Images
A. Window and Level Considerations
B. Superior and Inferior Limits
3. Special Considerations for Radiation Therapy
A. Side Effects
B. Some Publications

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 1A. What is the Bladder?
From thefreedictionary.com

“  A membranous sac that

serves as a reservoir for
urine.
 Fed via a ureter from
each kidney, and empties
urine via the urethra.
 Lined by a specialized
layer of epithelium (the
urothelium) and is
surrounded by two thick
layers of smooth muscle.
Here’s an educational video
lecture on the bladder
provided by Kenhub.
Image courtesy of thefreedictionary.com

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 1B. “Did You Know…?”
Scientists from the Georgia Institute of
Biology did a very interesting study
that was published under the title,
“Duration of urination does not change
with body size.”
At the Atlanta Zoo, this team observed
the hydrodynamics of urination across
five orders of magnitude in body mass.
Using high-speed video and flow-rate
measurement, they found something
interesting: animals of all sizes pee for
the same length of time, about 21
seconds!

Here is a link to the PDF, and here is a link to the article on the web.
And most importantly, here is some of their pretty cool high-tech
video of animals peeing.
It’s science.

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 2A. Window and Level Considerations (CT)

The bladder is usually very Window Width: 350 Window Width: 500
Level: 50 Level: 0
easy to see with an average CT
pixel near or above that of
water, and surrounded by
lower density fat.
A narrow window (i.e., high
contrast) centered at a level
just above water (i.e., near but
greater than zero) will make it
even more obvious.
Sometimes contrast in the
bladder is helpful (for instance,
delineating adjacent vagina on
CT), but it can also make it
difficult if there is similar
density small bowel contrast.

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 2B. Superior and Inferior Limits
Inferior: Base of bladder
Superior: Dome of bladder
Note: Empty bladder will not have the typical shape so the
superior surface will be as determined by the image
pixels.

Empty Bladder Full Bladder

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 3A. Radiation Side Effects

ACUTE CHRONIC

URGENCY CHRONIC CYSTITIS (SEE LEFT)

FREQUENCY PAIN

DYSURIA INCONTINENCE

HEMATURIA STRICTURE

FISTULA

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 3B. Some Publications
 Pederson et al., Late toxicity after intensity-modulated
radiation therapy for localized prostate cancer: an
exploration of dose-volume histogram parameters to limit
genitourinary and gastrointestinal toxicity, Int J Radiat
Oncol Biol Phys. 2012 Jan 1;82(1):235-41
 Pointreau Y, Atean I, and Durdux C., Normal tissue
tolerance to external beam radiation therapy: bladder,
Cancer Radiother. 2010 Jul;14(4-5):363-8
 Viswanathan et al., Radiation dose–volume effects of the
urinary bladder, Int J Radiat Oncol Biol Phys. 2010 Mar 1;
76(3 Suppl): S116–S122
 Cheung et al., Investigation of bladder dose and volume
factors influencing late urinary toxicity after external
beam radiotherapy for prostate cancer, Int J Radiat Oncol
Biol Phys. 2007 Mar 15;67(4):1059-65

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