physics and clinical aspects of interstitial brachytherapy
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The document summarizes interstitial brachytherapy, including indications, contraindications, isotopes used, and details of various planning systems like Paterson-Parker, Quimby, Paris, and computer-based systems. It discusses dose rates, types of implants, applicators, volume definition, and dosimetry parameters like reference isodose and uniformity criteria for different planning approaches.
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physics and clinical aspects of interstitial brachytherapy
- 1. PHYSICS AND CLINICAL ASPECTS OF INTERSTITIAL BRACHYTHERAPY PRESENTED BY Dr. Vimoj J. Nair Junior Resident Department of Radiation Oncology PGIMS, Rohtak, Harayana. Moderated By Dr. Vivek Kaushal Professor & Head DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA
- 3. INTERSTITIAL BRACHYTHERAPY RESIDENTS’ CONCEPT!!!! DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA OUCH!!!
- 9. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA AL- ACTIVE LENGTH PL- PHYSICAL LENGTH When target Volume Involves skin & mucosa DIFFERENT TYPES OF SOURCES IN BRACHYTHERAPY
- 10. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Interstitial applicators- CATHETERS Interstitial applicators- NEEDLES
- 11. INTERSTITAL APPLICATORS DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA GUIDE-GUTTERS - hollow metallic needles consisting of 2 vertical limbs joined by a horizontal flange [First one loaded with hair pin] WIRE + HAIR PIN + CATH- ETHERS
- 13. HOW TO SHOOT?? DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA
- 14. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA SOURCE KEPT AT EQUAL DISTANCE FROM EACH OTHER! NO RULES!!! RESULT - BAD HOMOGENEITY!! HOW TO IMPLANT? INITIAL STRATEGY!! TUMOR RADIOACTIVE SOURCES
- 19. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA VOLUME IMPLANT [CUBE] VOLUME IMPLANT CYLINDER VOLUME IMPLANT SPHERE SINGLE PLANE IMPLANT DOUBLE PLANE IMPLANT
- 20. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Eg- FOR 4 X 4 IMPLANT ELONGATION CORRECTION
- 22. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Arrangement of Needles for Planar Implants Shaded areas for dose calculations [implant volume] Active length crossed ends uncrossed ends
- 26. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA 1 cm spaced, Variable intensity sources non uniformly, more source strength in periphery . CROSSING NEEDLES WHEN REQUIRED UNIFORM DOSE DISTRIBUTION From TABLES – mg-h/900R 1 cm distance 0.66 & 0.33 mgRa/cm sources AREA( Sq.CM ) ACTIVITY PERIPHERY INSIDE. < 25 2 / 3 1 / 3 25 – 100 1 / 2 1 / 2 > 100 1 / 3 2 / 3
- 28. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA 1 cm spaced , UNIFORM STRENGTH [1 MgRa/cm] SOURCES CROSSING NEEDLES WHEN REQUIRED NONUNIFORM DOSE DISTRIBUTION CENTRE HIGH From TABLES – mg-h/1000R PLANAR – STATED DOSE – MAX DOSE VOLUME – STATED DOSE – MIN DOSE
- 31. Calculation of the basal dose rate [BD]: Planar (A, B) or curved surfaces (C). Basal doses calculated midway between each pair of sources and averaged. Calculation of the basal dose rate BD in triangles (A), in squares (B). Basal doses calculated equidistant from each of the adjacent sources.
- 33. UNACCEPTABLE IMPLANT SORRY!! THIS WAS MY FIRST IMPLANT, I’LL IMPROVE BEFORE YOUR TWO MORE SESSIONS ARE OVER! IMPLANTS WITH IMPERFECT GEOMETRY
- 36. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA RULES OF INTERSTITIAL IMPLANT SYSTEMS CHARACTERISTIC PATERSON-PARKER QUIMBY PARIS COMPUTER LINEAR STRENGTH VARIABLE (full intensity, 0.66 mgRa/cm; half intensity,0.33 mgRa/cm) CONSTANT (full intensity, 1mg Ra/cm; half intensity, 0.5 mgRa/cm) CONSTANT (0.6-1.8 mg Ra eq/ cm) CONSTANT (0.2-0.4 mg Ra eq/cm) SOURCE DISTRIBUTION PLANAR IMPLANTS (in periphery) Area <25cm 2 - 2/3 Ra Area 25-100cm 2 - 1/2 Ra Area >100cm 2 - 1/3 Ra UNIFORM UNIFORM UNIFORM VOLUME IMPLANTS CYLINDER: belt , four parts; core , two parts, each end one part SPHERE: shell , six parts; core , two parts CUBE: each side , one part; core , two parts UNIFORM distribution of sources throughout the volume Line sources arranged in parallel Line source arranged in parallel planes or cylindric volumes LINE SOURCE SPACING CONSTANT Approximately 1cm apart from each other or from crossing ends Same as Paterson-Parker CONSTANT [according to implant dimensions - larger spacing used in large volumes;8mm min to 15mm max separation CONSTANT 1-1.5cm, depending on size of implant (larger spacing for larger size implants) CROSSING NEEDLES Crossing needles required to enhance dose at implant ends Same as Paterson-Parker Crossing needles NOT used, active length 30%-40% longer than target length Crossing needles NOT used, active length of sources 30-40% larger than target length
- 41. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Interstitial implants - tongue implant tongue tongue Catheter loop Button
- 52. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA MUPIT ( Martinez Universal Perineal Interstitial Template) GUIDE HOLES
- 53. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA Syed Neblett template
- 54. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA
- 55. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA
- 62. Indication for prostate brachytherapy monotherapy DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA IPSS: International Prostate Symptom Score. Q max ml/s: urinary flow rate. Ash D, Flynn A, Battermann J. ESTRO/EAU Urological Brachytherapy Group; EORTC Radiotherapy Group. ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 2000;57:315 — 21. Recommended Do well Optional Fair PSA (ng/ml) <10 10 — 20 Gleason score 5 — 6 7 Stage T1c — T2a T2b — T2c IPSS 0 — 8 9 — 19 Prostate volume (g) <40 40 — 60 Q max ml/s >15 10-15
- 65. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA
- 67. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA INTERSTITIAL BRACHYTHERAPY SITES LIVER METASTASIS / PERMANENT
- 70. DEPARTMENT OF RADIATION ONCOLOGY, REGIONAL CANCER CENTRE, PGIMS, ROHTAK, HARYANA THANK YOU ALL