Brachytherapy Flashcards
use of radioactive sources in close proximity to target area for radiotherapy
brachytherapy
other names for brachytherapy
internal radiation therapy
sealed therapy
radium therapy
curie therapy
plesiotherapy
endocurie therapy
Advantage of brachytherapy
improved localized dose to target
Disadvantage of brachytherapy
only good for well-localized tumors, small lesions, labor intensive
Contraindications of brachy
- if tumor not clearly delineated
- active infection
- if evidence of bone involvement
earliest form of radiotherapy 19th century
radium
ideal brachytherapy source
pure gamma emitter
medium gamma energy
high specific activity
stable daughter product
long half live (temporary implants)
medium half life (permanent implants)
- 226 Ra
Half life:
Proton E.:
HVL:
226 - Radium
1600 years
0.047-2.45 MeV
8.0 mm Hg
- 222 Rn
Half life:
Proton E.:
HVL:
222 - Radon
3.83 yrs
0.047-2.45 MeV
8.0 mm Hg
- 60 Co
Half life:
Proton E.:
HVL:
60- Cobalt
5,26 yrs
1.17, 1.33 MeV
11.0 mmHg
- 137- Ce
Half life:
Proton E.:
HVL:
137- Cesium
30.0 yrs
0.662 MeV
5.5 mmHg
- 192 -Ir
Half life:
Proton E.:
HVL:
192 - Iridium
74.2 yrs
0.36-1.06 MeV
2.5 mmHg
- 198 - Au
Half life:
Proton E.:
HVL:
198- Gold
2.7 yrs
0.412 MeV
2.5 mmHg
- 125 - I
Half life:
Proton E.:
HVL:
125 - Iodine
60.2 years
0.028 MeV
0.025 mmHg
- 103-Pd
Half life:
Proton E.:
HVL:
103 -Paladium
17.0 yrs
0.21 MeV
0.008 mmHg
first radioisotope used clinically in 1903
Radium
Reasons why radon and radium is not used anymore
a. wide energy spectrum - high dose close to source (difficult shielding)
b. Radon - daughter product is a noble gas (contamination risk)
c. long half life means disposal is difficult
main substitute for radium
used in gynecological applications
137 Ce
measure estimate radioactive decay
decay correction
decay correction for 137 Cs [..]
must be replaced every [..]
every 6 mos
10-15 yrs
most important source for HDR (high dose rate) applications
192 Ir
decay correction for 192 Ir [..]
must be replaced every [..]
for each treatment
3-4 mos
radioisotope with very low energy-shielding is easy and easily absorbed
mostly used in the form of seeds
125 I
replacement for I 125
permanent implant
dose rate 2.5 larger than 125 I
103 Pd
energy for 103 Pd
22 kV
energy for 103 Pd
22 keV
permanent implant
short enough to let activity decay in patient
energy [..]
Gold 198
412 keV
wire, low dose rate radioisotope
interstitial implant
Iridium 192
[source shapes and forms] balls of approx 3mm diameters
pellets
[source shapes and forms] small cylinders about 1mm diam and 4mm length
seeds
[source shapes and forms] b/w 15 and 45 mm active length
needles
[source shapes and forms] about 14 mm length, used for gynecological implants
tubes
[source shapes and forms] shaped as it is, approx. 60mm active length
hairpin
[source shapes and forms] any length, customized in the hospital inactive ends may be added
wire
[source shapes and forms] high activity miniature cylinder sources approx 1mm diam, 10 mm length
HDR Sources
small containers for activity
usually 125 I, 103 Pd or 198 Au for permanent implant
seeds
implants in operating theater, directly introduced to ROI
usually 192 Ir for temporary implants
needles and hairpins
radioisotope used for LDR interstitial implants
cutting manual technique
192 Ir wire
[applicators] treatm. of superficial lesions with radioactive sources in close contact with skin
Surface Moulds
introduction of radioactivity using an applicator placed in a body cavity
intracavitary implants
intracavitary implant usually used in:
gynecological
bronchus
esophagus
rectum
most common application for cervix cancer
either monotherapy or addition to EBT
gynecological implants
often used in palliative to open air ways
HDR brachytherapy
most often single catheter
bronchus implants
implants of needles of flexible catheters directly in the target area
requires surgery - often major
interstitial implants
interstitial implants are commonly used in:
breast
head and neck
sarcomas
typically a boost
often utilizes templates to improve source positioning
breast implants
[implant technique] pt. discharged with implant in place
permanent implants
[implant technique] implant removed before pt. is discharged from hospital
temporary implants
treats breast ca from within breast in 5 days with fewr side fx than standard 6 or 7 wks
uses special balloon catheter in lumpectomy cavity and inflated with saline solution
Mammosite
other name for mammosite
balloon catheter radiation
Adv. of mammosite
completed in 5-7 days
surgical scar but no skin thickening or burns
v. small portion and healthy tissue unaffected
Disadv. of mammosite
avoid showers for a week
saline filled balloon feels odd
infections can occur
used in operating theatre
useful for incomplete removal of ca
intraoperative brachytherapy