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[object Object],[object Object],[object Object],[object Object],BRACHYTHERAPY  PRINCIPLE AND METHODS
BRACHYTHERAPY  ,[object Object]
CLINICAL ADVANTAGES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LIMITATIONS & DISADVANTAGES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SELECTION CRITERIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INDICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INDICATIONS... ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLASSIFICATION Classification Schemes Positioning of Radionuclide Dose rate of irradiation Duration of irradiation Loading pattern
CLASSIFICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DOSE RATE(ICRU 38) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ADVANTAGES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MDR BRACHYTHERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SOURCE LOADING TECHNIQUE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AFTER LOADING TECHNIQUE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTERSTITIAL BRACHYTHERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTERSTITIAL BRACHYTHERAPY… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SELECTION CRITERIA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TYPES OF INTERSTITIAL IMPLANTS ACCORDING TO SIZE/LOCATION/PROXIMITY OF TUMOR TO NORMAL STRUCTURES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SYSTEMS OF IMPLANT DOSIMETRY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SYSTEMS OF IMPLANT DOSIMETRY ,[object Object],[object Object],[object Object]
RULES OF INT.IMPLANT SYSTEM PARAMETERS MANCHESTER QUIMBY PARIS COMPUTER Linear strength Variable Constant Constant Constant Source distribution Planar implant:(periphery) Area <25 cm- 2/3 Ra; 25-100 cm- ½ Ra; >100 cm- 1/3 Volume implant::Cylinder:belt-4 parts,core-2,end-1 Sphere:shell-6,core-2 Cube :each side-1,core-2  Uniform  Uniform Uniform Line sources parallel planes Uniform Line sources  Parallel or cylinderic volumes Spacing line source Constant approx. 1 cm apart from each other or from crossing ends Same as Manchester Constant, Selective Separation 8-15 mm Constant Selective Crossing needles Required to enhance dose at implant ends Same Crossing needles not used;active length 30-40% longer Crossing needles not used;active length 30-40% longer
COMPONENTS-CLASSICAL SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object]
PRINCIPLE-MANCHESTER SYSTEM FEATURES DOSE  &  DOSE RATE  6000-8000 R in 6-8 days (1000 R/day; 40 R/hr) UNIT / USE OF RADIUM mg Ra hr – defined as amount of radium to give specified dose in 1 hr DOSE SPECIFICATION CRITERA Effective minimum dose 10% above absolute  minimum dose  LINEAR ACTIVITY Variable: 0.66 and 0.33 mg RaEq/cm
QUIMBY SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PARIS SYSTEM- PRINCIPLES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PARIS SYSTEM FEATURES DOSE AND DOSE RATE 6000 -7000 cGy  in 3-11 days DOSE PRESCRIPTION POINT Average of the minimum doses in the region defined by the source  REFERENCE DOSE & DOSE GRADIENT 85 % of the BASAL DOSE  15 % between the Reference dose and the Basal dose RA SOURCE PLACEMENT Reference isodose volume covers the treated volume
PERMANENT IMPLANTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPUTER SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPUTER DOSIMETRY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPUTER DOSIMTERY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AP X-ray
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Moderator: Prof. S. C. Sharma As sole modality As Boost to EBRT ,[object Object],[object Object],[object Object],Close, positive or unknown margins Elderly, frail, poor health patient EIC Large breasts: unacceptable toxicity Younger patients Deep tumour in large breast Irregularly thick target vol.
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS…
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],CLINICAL APPLICATIONS…
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATION – CA CX ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],Martinez Universal Perineal Interstitial Template (MUPIT ) Syed-Neblett template
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CLINICAL APPLICATIONS… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTRACAVITARY APPLICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PARIS SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
STOCKHOLM SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DRAWBACKS OF PARIS AND STOCKHOLM SYSTEMS ,[object Object],[object Object],[object Object]
MANCHESTER SYSTEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
POINT   A ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
LOADING OF APPLICATORS ,[object Object],[object Object],[object Object],[object Object]
LOADING PATTERN TUBE TYPE LENGTH TUBES RADIUM (mg) UNITS  (FUNDUS to CX) LOADING TUBES (mg) LARGE 6 3 35 6-4-4 15-10-10 MEDIUM 4 2 25 6-4 15-10 SMALL 2 1 20 8 20 VAGINAL OVOIDS TUBES  RADIUM (mg) UNITS LOADING TUBES(mg) LARGE 3 22.5 9 10-10-5  or  20/25 MEDIUM 2 20 8 20 SMALL 1 17.5 7 10-5-5  or  20/15
GUIDELINES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTRACAVITARY APPLICATORS ,[object Object],[object Object]
IDEAL APPLICATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ICRU REPORT NO.38 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CERVICAL BRACHYTHERAPY
ABS.DOSE AT REFERENCE POINTS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
DOSE SCHEDULE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
EXTERNAL RT WITH BRACHYTHERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
POST OP/ VAULT BRACHYTHERAPY  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
POST OP BRACHYTHERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SURFACE MOULDS  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INDICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CIRCULAR MOULDS  ,[object Object],[object Object],[object Object]
SQUARE MOULDS ,[object Object],[object Object],[object Object]
RECTANGULAR MOULDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CIRCULAR MOULDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
INTRALUMINAL BRACHYTHERAPY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIOBIOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIOBIOLOGY – 4 Rs ,[object Object],[object Object],[object Object],[object Object]
RADIOBIOLOGY- LDR ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LDR AND HDR ,[object Object],[object Object]
RADIOACTIVE SOURCES ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IDEAL RADIONUCLIDE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIUM 226 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RADIUM SUBSTITUTES NAME ORIGIN T 1/2 γ ENERGY-MeV β  ENERGY β  FILTRATION HVL (Pb -mm) ERC SPECI. ACTI. DECAY PRODUCT Rn 222 NATURAL 3.83 days 0.83 Stainless steel 12 10.27 Pb 206 Cs 137 FISSION 30.17 yrs 0.662 0.512 1.17 - do - 6.5 3.26 87 Ba 137 Co 60 NEUTRON  ACTIVAT. 5.26  yrs 1.17, 1.33 0.38 - do- 11 13.07 1020 Ni 60 Ir 192 -  do  - 73.8 yrs 0.136- 1.06 0.079-0.068 Platinum 4 4.69 7760 Pt 192 Tn 182 -  do -  115  yrs 0.67 - Platinum 12 6.87 - -  Au 198 - do - 2.7  days 1.088- 0.412 0.96 St. steel 3.3 2.376 - Hg 198 I 125 - do - 59.4  days 0.274, 0.314 No Titanium 0.01 10th 1.403 -  Te 125 Pd 103 -  do - 16.97 days 0.21 No Platinum 0.03 6.87 - Ru 103
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Brachytherapy Final

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  • 8. CLASSIFICATION Classification Schemes Positioning of Radionuclide Dose rate of irradiation Duration of irradiation Loading pattern
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  • 22. RULES OF INT.IMPLANT SYSTEM PARAMETERS MANCHESTER QUIMBY PARIS COMPUTER Linear strength Variable Constant Constant Constant Source distribution Planar implant:(periphery) Area <25 cm- 2/3 Ra; 25-100 cm- ½ Ra; >100 cm- 1/3 Volume implant::Cylinder:belt-4 parts,core-2,end-1 Sphere:shell-6,core-2 Cube :each side-1,core-2 Uniform Uniform Uniform Line sources parallel planes Uniform Line sources Parallel or cylinderic volumes Spacing line source Constant approx. 1 cm apart from each other or from crossing ends Same as Manchester Constant, Selective Separation 8-15 mm Constant Selective Crossing needles Required to enhance dose at implant ends Same Crossing needles not used;active length 30-40% longer Crossing needles not used;active length 30-40% longer
  • 23.
  • 24. PRINCIPLE-MANCHESTER SYSTEM FEATURES DOSE & DOSE RATE 6000-8000 R in 6-8 days (1000 R/day; 40 R/hr) UNIT / USE OF RADIUM mg Ra hr – defined as amount of radium to give specified dose in 1 hr DOSE SPECIFICATION CRITERA Effective minimum dose 10% above absolute minimum dose LINEAR ACTIVITY Variable: 0.66 and 0.33 mg RaEq/cm
  • 25.
  • 26.
  • 27. PARIS SYSTEM FEATURES DOSE AND DOSE RATE 6000 -7000 cGy in 3-11 days DOSE PRESCRIPTION POINT Average of the minimum doses in the region defined by the source REFERENCE DOSE & DOSE GRADIENT 85 % of the BASAL DOSE 15 % between the Reference dose and the Basal dose RA SOURCE PLACEMENT Reference isodose volume covers the treated volume
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  • 58.
  • 59. LOADING PATTERN TUBE TYPE LENGTH TUBES RADIUM (mg) UNITS (FUNDUS to CX) LOADING TUBES (mg) LARGE 6 3 35 6-4-4 15-10-10 MEDIUM 4 2 25 6-4 15-10 SMALL 2 1 20 8 20 VAGINAL OVOIDS TUBES RADIUM (mg) UNITS LOADING TUBES(mg) LARGE 3 22.5 9 10-10-5 or 20/25 MEDIUM 2 20 8 20 SMALL 1 17.5 7 10-5-5 or 20/15
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  • 85. RADIUM SUBSTITUTES NAME ORIGIN T 1/2 γ ENERGY-MeV β ENERGY β FILTRATION HVL (Pb -mm) ERC SPECI. ACTI. DECAY PRODUCT Rn 222 NATURAL 3.83 days 0.83 Stainless steel 12 10.27 Pb 206 Cs 137 FISSION 30.17 yrs 0.662 0.512 1.17 - do - 6.5 3.26 87 Ba 137 Co 60 NEUTRON ACTIVAT. 5.26 yrs 1.17, 1.33 0.38 - do- 11 13.07 1020 Ni 60 Ir 192 - do - 73.8 yrs 0.136- 1.06 0.079-0.068 Platinum 4 4.69 7760 Pt 192 Tn 182 - do - 115 yrs 0.67 - Platinum 12 6.87 - - Au 198 - do - 2.7 days 1.088- 0.412 0.96 St. steel 3.3 2.376 - Hg 198 I 125 - do - 59.4 days 0.274, 0.314 No Titanium 0.01 10th 1.403 - Te 125 Pd 103 - do - 16.97 days 0.21 No Platinum 0.03 6.87 - Ru 103