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Sample records for permanent iodine-125 brachytherapy

  1. Permanent iodine 125 brachytherapy in patients with progressive or recurrent glioblastoma multiforme

    PubMed Central

    Larson, David A.; Suplica, Jeffrey M.; Chang, Susan M.; Lamborn, Kathleen R.; McDermott, Michael W.; Sneed, Penny K.; Prados, Michael D.; Wara, William M.; Nicholas, M. Kelly; Berger, Mitchel S.

    2004-01-01

    This study reports the initial experience at the University of California San Francisco (UCSF) with tumor resection and permanent, low-activity iodine 125 (125I) brachytherapy in patients with progressive or recurrent glioblastoma multiforme (GM) and compares these results to those of similar patients treated previously at UCSF with temporary brachytherapy without tumor resection. Thirty-eight patients with progressive or recurrent GM were treated at UCSF with repeat craniotomy, tumor resection, and permanent, low-activity 125I brachytherapy between June 1997 and May 1998. Selection criteria were Karnofsky performance score ⩾60, unifocal, contrast-enhancing, well-circumscribed progressive or recurrent GM that was judged to be completely resectable, and no evidence of leptomeningeal or subependymal spread. The median brachytherapy dose 5 mm exterior to the resection cavity was 300 Gy (range, 150–500 Gy). One patient was excluded from analysis. Median survival was 52 weeks from the date of brachytherapy. Age, Karnofsky performance score, and preimplant tumor volume were all statistically significant on univariate analyses. Multivariate analysis for survival showed only age to be significant. Median time to progression was 16 weeks. Both univariate and multivariate analysis of freedom from progression showed only preoperative tumor volume to be significant. Comparison to temporary brachytherapy patients showed no apparent difference in survival time. Chronic steroid requirements were low in patients with minimal postoperative residual tumor. We conclude that permanent 125I brachytherapy for recurrent or progressive GM is well tolerated. Survival time was comparable to that of a similar group of patients treated with temporary brachytherapy. PMID:15134626

  2. Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies

    SciTech Connect

    Mutyala, Subhakar; Stewart, Alexandra; Khan, Atif J.; Cormack, Robert A.; O'Farrell, Desmond; Sugarbaker, David; Devlin, Phillip M.

    2010-03-15

    Purpose: To assess toxicity and outcome following permanent iodine-125 seed implant as an adjunct to surgical resection in cases of advanced thoracic malignancy. Methods and Materials: An institutional review board-approved retrospective review was performed. Fifty-nine patients were identified as having undergone thoracic brachytherapy seed implantation between September 1999 and December 2006. Data for patient demographics, tumor details, and morbidity and mortality were recorded. Results: Fifty-nine patients received 64 implants. At a median follow-up of 17 months, 1-year and 2-year Kaplan-Meier rates of estimated overall survival were 94.1% and 82.0%, respectively. The 1-year and 2-year local control rates were 80.1% and 67.4%, respectively. The median time to develop local recurrence was 11 months. Grades 3 and 4 toxicity rates were 12% at 1 year. Conclusions: This review shows relatively low toxicity for interstitial planar seed implantation after thoracic surgical resection. The high local control results suggest that an incomplete oncologic surgery plus a brachytherapy implant for treating advanced thoracic malignancy merit further investigation.

  3. Stereotactic iodine-125 brachytherapy for brain tumors: temporary versus permanent implantation.

    PubMed

    Ruge, Maximilian I; Kickingereder, Philipp; Grau, Stefan; Treuer, Harald; Sturm, Volker; Voges, Juergen

    2012-01-01

    Stereotactic brachytherapy (SBT) has been described in several publications as an effective, minimal invasive and safe highly focal treatment option in selected patients with well circumscribed brain tumors <4 cm. However, a still ongoing discussion about indications and technique is hindering the definition of a clear legitimation of SBT in modern brain tumor treatment. These controversies encompass the question of how intense the irradiation should be delivered into the target volume (dose rate). For instance, reports about the use of high does rate (HDR) implantation schemes (>40 cGy/h) in combination with adjuvant external beam radiation and/or chemotherapy for the treatment of malignant gliomas and metastases resulted in increased rates of radiation induced adverse tissue changes requiring surgical intervention. Vice versa, such effects have been only minimally observed in numerous studies applying low dose rate (LDR) regiments (3-8 cGy/h) for low grade gliomas, metastases and other rare indications. Besides these observations, there are, however, no data available directly comparing the long term incidences of tissue changes after HDR and LDR and there is, furthermore, no evidence regarding a difference between temporary or permanent LDR implantation schemes. Thus, recommendations for effective and safe implantation schemes have to be investigated and compared in future studies. PMID:22713629

  4. Prostate-Specific Antigen Bounce After Permanent Iodine-125 Prostate Brachytherapy-An Australian Analysis

    SciTech Connect

    Zwahlen, Daniel R.; Smith, Ryan; Andrianopoulos, Nick; Matheson, Bronwyn; Royce, Peter; Millar, Jeremy L.

    2011-01-01

    Purpose: To report on prostate-specific antigen (PSA) 'bounces' after {sup 125}I prostate brachytherapy to review the relationship to biochemical control and correlate both clinical and dosimetric variables. Methods and Materials: We analyzed 194 hormone-naive patients with a follow-up of {>=}3 years. Four bounce definitions were applied: an increase of {>=}0.2 ng/mL (definition I), {>=}0.4 ng/mL (definition II), {>=}15% (definition III), and {>=}35% (definition IV) of a previous value with spontaneous return to the prebounce level or lower. Results: Using definition I, II, III, and IV, a bounce was detected in 50%, 34%, 11%, and 9% of patients, respectively. The median time to onset was 14-16 months, the duration was 12-21.5 months, and the magnitude of the increase was 0.5-2 ng/mL. A magnitude of >2 ng/mL, fulfilling the criteria for biochemical failure (BF) according to the American Society for Therapeutic Radiology and Oncology Phoenix definition, was detected in 11.3%, 16.9%, 47.6%, and 50% using definitions I, II, III, and IV, respectively; 11 patients (5.7%) had true BF. The PSA bounces occurred earlier than BF (p < 0.001). The prediction of BF remains controversial and is probably unrelated to biochemical control. The only statistically significant factor predictive of a PSA bounce was younger age (definitions I and II). Conclusion: PSA bounces are common after brachytherapy. All definitions resulted in a high number of false-positive calls for BF during the first 2 years. The definition of an increase of {>=}0.2 ng/mL should be preferred because of the lowest number of false-positive results for BF. Patients experiencing a PSA bounce during the first 2 years after brachytherapy should undergo surveillance every 3-6 months. Additional investigations are recommended for elevated postimplant PSA levels that have not corrected by 3 years of follow-up.

  5. Phase I Trial of Gross Total Resection, Permanent Iodine-125 Brachytherapy, and Hyperfractionated Radiotherapy for Newly Diagnosed Glioblastoma Multiforme

    SciTech Connect

    Chen, Allen M.; Chang, Susan; Pouliot, Jean; Sneed, Penny K.; Prados, Michael D.; Lamborn, Kathleen R.; Malec, Mary K.; McDermott, Michael W.; Berger, Mitchell S.; Larson, David A.

    2007-11-01

    Purpose: To evaluate the feasibility of gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy for patients with newly diagnosed glioblastoma. Methods and Materials: From April 1999 to May 2002, 21 patients with glioblastoma multiforme were enrolled on a Phase I protocol investigating planned gross total resection and immediate placement of permanent I-125 seeds, followed by postoperative hyperfractionated radiotherapy to a dose of 60 Gy at 100 cGy b.i.d., 5 days per week. Median age and Karnofsky performance status were 50 years (range, 32-65 years) and 90 (range, 70-100), respectively. Toxicity was assessed according to Radiation Therapy Oncology Group criteria. Results: Eighteen patients completed treatment according to protocol. The median preoperative tumor volume on magnetic resonance imaging was 18.6 cm{sup 3} (range, 4.4-41.2 cm{sup 3}). The median brachytherapy dose measured 5 mm radially outward from the resection cavity was 400 Gy (range, 200-600 Gy). Ten patients underwent 12 reoperations, with 11 of 12 reoperations demonstrating necrosis without evidence of tumor. Because of high toxicity, the study was terminated early. Median progression-free survival and overall survival were 57 and 114 weeks, respectively, but not significantly improved compared with historical patients treated at University of California, San Francisco, with gross total resection and radiotherapy without brachytherapy. Conclusions: Treatment with gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy as performed in this study results in high toxicity and reoperation rates, without demonstrated improvement in survival.

  6. In Vivo Dosimetry With a Linear MOSFET Array to Evaluate the Urethra Dose During Permanent Implant Brachytherapy Using Iodine-125

    SciTech Connect

    Bloemen-van Gurp, Esther J.; Haanstra, Bjoerk K.C.; Murrer, Lars H.P.; Gils, Francis C.J.M. van; Dekker, Andre L.A.J.; Mijnheer, Ben J.; Lambin, Philippe

    2009-11-15

    Purpose: To develop a technique to monitor the dose rate in the urethra during permanent implant brachytherapy using a linear MOSFET array, with sufficient accuracy and without significantly extending the implantation time. Methods and Materials: Phantom measurements were performed to determine the optimal conditions for clinical measurements. In vivo measurements were performed in 5 patients during the {sup 125}I brachytherapy implant procedure. To evaluate if the urethra dose obtained in the operating room with the ultrasound transducer in the rectum and the patient in treatment position is a reference for the total accumulated dose; additional measurements were performed after the implantation procedure, in the recovery room. Results: In vivo measurements during and after the implantation procedure agree very well, illustrating that the ultrasound transducer in the rectum and patient positioning do not influence the measured dose in the urethra. In vivo dose values obtained during the implantation are therefore representative for the total accumulated dose in the urethra. In 5 patients, the dose rates during and after the implantation were below the maximum dose rate of the urethra, using the planned seed distribution. Conclusion: In vivo dosimetry during the implantation, using a MOSFET array, is a feasible technique to evaluate the dose in the urethra during the implantation of {sup 125}I seeds for prostate brachytherapy.

  7. Iodine-125 brachytherapy for brain tumours - a review

    PubMed Central

    2012-01-01

    Iodine-125 brachytherapy has been applied to brain tumours since 1979. Even though the physical and biological characteristics make these implants particularly attractive for minimal invasive treatment, the place for stereotactic brachytherapy is still poorly defined. An extensive review of the literature has been performed, especially concerning indications, results and complications. Iodine-125 seeds have been implanted in astrocytomas I-III, glioblastomas, metastases and several other tumour entities. Outcome data given in the literature are summarized. Complications are rare in carefully selected patients. All in all, for highly selected patients with newly diagnosed or recurrent primary or metastatic tumours, this method provides encouraging survival rates with relatively low complication rates and a good quality of life. PMID:22394548

  8. Long-term follow-up of patients of intrahepatic malignancies treated with Iodine-125 brachytherapy

    SciTech Connect

    Nag, Subir . E-mail: nag.1@osu.edu; DeHaan, Megan; Scruggs, Granger; Mayr, Nina; Martin, Edward W.

    2006-03-01

    Purpose: We investigated the role of intraoperative iodine-125 ({sup 125}I) brachytherapy as a treatment option for unresectable primary and metastatic liver tumors. Methods and Materials: Between 1989 and 2002, 64 patients with unresectable or residual disease after surgical resection for intrahepatic malignancies underwent 160-Gy permanent {sup 125}I brachytherapy. Results: The median length of follow-up was 13.2 years. The overall 1-year, 3-year, and 5-year actuarial intrahepatic local control rates were 44%, 22%, and 22%, respectively, with a median time to liver recurrence of 9 months (95% CI, 6-12 months). The 5-year actuarial intrahepatic control was higher for patients with solitary metastasis (38%) than for those with multiple metastases (6%, p = 0.04). The 1-year, 3-year, and 5-year actuarial overall survival rates were 73%, 23%, and 5%, respectively (median, 20 months; 95% CI, 16-24; longest survival, 7.5 years). Overall survival was higher for patients with smaller-volume implants (p = 0.003) and for patients without prior liver resection (p = 0.002). No mortality occurred. Radiation-related complications were minimal. Conclusions: For select patients with unresectable primary and metastatic liver tumors for whom curative surgical resection is not an option, {sup 125}I brachytherapy is a safe and effective alternative to other locally ablative techniques and can provide long-term local control and increased survival.

  9. Urinary and Rectal Toxicity Profiles After Permanent Iodine-125 Implant Brachytherapy in Japanese Men: Nationwide J-POPS Multi-institutional Prospective Cohort Study

    SciTech Connect

    Ohashi, Toshio; Yorozu, Atsunori; Saito, Shiro; Tanaka, Nobumichi; Katayama, Norihisa; Kojima, Shinsuke; Maruo, Shinichiro; Kikuchi, Takashi; Dokiya, Takushi; Fukushima, Masanori; Yamanaka, Hidetoshi

    2015-09-01

    Purpose: To assess, in a nationwide multi-institutional cohort study begun in 2005 and in which 6927 subjects were enrolled by 2010, the urinary and rectal toxicity profiles of subjects who enrolled during the first 2 years, and evaluate the toxicity profiles for permanent seed implantation (PI) and a combination therapy with PI and external beam radiation therapy (EBRT). Methods and Materials: Baseline data for 2339 subjects out of 2354 patients were available for the analyses. Toxicities were evaluated using the National Cancer Institute's Common Terminology Criteria for Adverse Events, and the International Prostate Symptom Scores were recorded prospectively until 36 months after radiation therapy. Results: Grade 2+ acute urinary toxicities developed in 7.36% (172 of 2337) and grade 2+ acute rectal toxicities developed in 1.03% (24 of 2336) of the patients. Grade 2+ late urinary and rectal toxicities developed in 5.75% (133 of 2312) and 1.86% (43 of 2312) of the patients, respectively. A higher incidence of grade 2+ acute urinary toxicity occurred in the PI group than in the EBRT group (8.49% vs 3.66%; P<.01). Acute rectal toxicity outcomes were similar between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late urinary toxicities were 6.04% versus 4.82% for the PI and the EBRT groups, respectively, with no significant differences between the treatment groups. The 3-year cumulative incidence rates for grade 2+ late rectal toxicities were 0.90% versus 5.01% (P<.01) for the PI and the EBRT groups, respectively. The mean of the postimplant International Prostate Symptom Score peaked at 3 months, but it decreased to a range that was within 2 points of the baseline score, which was observed in 1625 subjects (69.47%) at the 1-year follow-up assessment. Conclusions: The acute urinary toxicities observed were acceptable given the frequency and retention, and the late rectal toxicities were more favorable than those of other studies.

  10. Complications associated with preoperative radiation therapy and Iodine-125 brachytherapy for localized prostatic carcinoma

    SciTech Connect

    Flanigan, R.C.; Patterson, J.; Mendiondo, O.A.; Gee, W.F.; Lucas, B.A.; McRoberts, J.W.

    1983-08-01

    Twenty-five consecutive patients with localized adenocarcinoma of the prostate treated with 1,050 rad preoperative radiation therapy and Iodine-125 seed brachytherapy are reviewed. Significant long-term postoperative complications included radiation cystitis (12%), radiation proctitis (4%), genital and leg edema (12%), stress incontinence (8%), total incontinence (4%), and impotence (26%). Complications occurred in 75 per cent of patients who received additional postoperative radiation. Improved staging with CT scan, lymphangiography, and Chiba needle biopsy of any possibly abnormal lymph nodes provided excellent preoperative staging with only 1 patient (6%) upstaged at surgery to Stage D1.

  11. Influence of Dose on Risk of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy

    SciTech Connect

    Roeloffzen, Ellen M.A.; Battermann, Jan J.; Deursen, Marijke J.H. van; Monninkhof, Evelyn M.; Visscher, Mareije I.; Moerland, Marinus A.; Vulpen, Marco van

    2011-07-15

    Purpose: To assess the influence of dose on the risk of acute urinary retention (AUR) after iodine-125 prostate brachytherapy. Methods and Materials: Between January 2005 and December 2008, 714 consecutive patients with localized prostate cancer were treated with iodine-125 prostate brachytherapy at our department. All patients completed four imaging studies: magnetic resonance imaging before and 4 weeks after treatment and intraoperative three-dimensional transrectal ultrasonography before and after implantation. The development of AUR was prospectively recorded. The evaluated treatment and dosimetric parameters included prostate volume, number of needles and seeds used, intra- and postoperative prostate edema, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed dose to the prostate, minimal dose received by 90% of the prostate volume, and percentage of the urethra receiving 100%, 150%, and 200% of the prescribed dose. Logistic regression analysis was used to examine which factors were associated with AUR. Results: Of the 714 patients, 57 (8.0%) developed AUR. On univariate analysis, the following treatment and dosimetric factors were significantly associated with AUR: International Prostate Symptom Score (odds ratio [OR], 2.07, per 10-point increase), preimplant prostate volume (OR, 1.06), postimplant prostate volume (OR, 1.04), number of needles used (OR, 1.09), and number of seeds used (OR, 1.03). On multivariate analysis, the only independent predictive factors for AUR were pretreatment prostate volume (OR, 1.05) and International Prostate Symptom Score (OR, 1.76, per 10-point increase). Patients with a pretreatment prostate volume >35 cm{sup 3} had a 10.4% risk of developing AUR compared with 5.4% for those with a prostate volume of {<=}35 cm{sup 3}. No association was found between any of the dosimetric parameters and the development of AUR. Conclusion: The radiation dose, within the range studied, did not influence the risk of AUR

  12. Magnetic Resonance Imaging-Defined Treatment Margins in Iodine-125 Prostate Brachytherapy

    SciTech Connect

    Crook, Juanita; Patil, Nikhilesh; Ma, Clement; McLean, Michael; Borg, Jette

    2010-07-15

    Purpose: Low-dose-rate prostate brachytherapy achieves a very high and effective intraprostatic dose. Implant quality parameters concentrate on the dose received by the prostate (D90, V100) but not that received by the periprostatic tissue. We calculated implant quality parameters, D90 and V100, for the magnetic resonance imaging (MRI)-defined prostate plus 2, 3, and 5 mm. Methods and Materials: A total of 131 men with early-stage prostate cancer treated with iodine-125 brachytherapy represent all those treated with brachytherapy monotherapy in our institution in 2005. Postplan assessment was performed at 1 month using magnetic resonance (MR)-computed tomography (CT) fusion. The prostate V100 and D90 were calculated with 2-, 3-, and 5-mm margins. Results were compared with those in 8 patients with biopsy-proven local failure occurring in an experience of more than 1,100 implants. Results: Mean prostate V100 (SD) and D90 (SD) were 95.6% (4.1) and 117.2% (12.7). For prostate plus a 2-mm margin the D90 was 107.9% (14.3) and for a 3-mm margin 96.0 % (14.0). For prostate plus a 5-mm margin, the D90 was only 78.4% (11.0). The 8 patients experiencing local failure, despite adequate implants, had a lower mean V100 of 91.2% (SD, 2.8; p = 0.0008) and D90 of 103.7% (SD, 8.3; p = 0.002) and significantly inferior margin coverage. Conclusions: Satisfactory coverage of a 2-mm and 3-mm periprostatic margin is obtained with the described planning approach. Coverage falls off significantly by 5 mm. The 8 patients who experienced local failure had significantly lower doses than the margin cohort. Although the V100 and D90 would be considered acceptable, the fall-off in margin coverage was observed by 3 mm.

  13. A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy

    SciTech Connect

    Crook, Juanita; Patil, Nikhilesh; Wallace, Kris; Borg, Jette; Zhou, David; Ma, Clement; Pond, Greg

    2010-06-01

    Purpose: Nonsteroidal anti-inflammatory medication is used to reduce prostate edema and urinary symptoms following prostate brachytherapy. We hypothesized that a cyclooxygenase-2 (COX-2) inhibitor regimen started 1 week prior to seed implant might diminish the inflammatory response, thus reducing edema, retention rates, and symptom severity. Methods and Materials: From March 2004 to February 2008, 316 men consented to an institutional review board-approved randomized study of a 4-week course of meloxicam, 7.5 mg orally twice per day, starting either on the day of implant or 1 week prior to implant. Brachytherapy was performed using iodine-125 seeds and was preplanned and performed under transrectal ultrasound (TRUS) and fluoroscopic guidance. Prostate volume obtained by MR imaging at 1 month was compared to baseline prostate volume obtained by TRUS planimetry and expressed as an edema factor. The trial endpoints were prostate edema at 1 month, International Prostate Symptom Score (IPSS) questionnaire results at 1 and 3 months, and any need for catheterization. Results: Results for 300 men were analyzed. Median age was 61 (range, 45-79 years), and median TRUS prostate volume was 35.7 cc (range, 18.1-69.5 cc). Median IPSS at baseline was 5 (range, 0-24) and was 15 at 1 month, 16 at 3 months, and 10 at 6 months. Catheterization was required for 7% of patients (6.2% day 0 arm vs. 7.9% day -7 arm; p = 0.65). The median edema factor at 1 month was 1.02 (range, 0.73-1.7). 1.01 day 0 arm vs. 1.05 day -7 arm. Baseline prostate volume remained the primary predictor of postimplant urinary retention. Conclusions: Starting meloxicam 1 week prior to brachytherapy compared to starting immediately after the procedure did not reduce 1-month edema, improve IPSSs at 1 or 3 months, or reduce the need for catheterization.

  14. Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources

    SciTech Connect

    Gutin, P.H.; Phillips, T.L.; Wara, W.M.; Leibel, S.A.; Hosobuchi, Y.; Levin, V.A.; Weaver, K.A.; Lamb, S.

    1984-01-01

    Thirty-seven patients harboring recurrent malignant primary or metastatic brain tumors were treated by 40 implantations of high-activity iodine-125 (/sup 125/I) sources. All patients had been treated with irradiation and most had been treated with chemotherapeutic agents, primarily nitrosoureas. Implantations were performed using computerized tomography (CT)-directed stereotaxy; /sup 125/I sources were held in one or more afterloaded catheters that were removed after the desired dose (minimum tumor dose of 3000 to 12,000 rads) had been delivered. Patients were followed with sequential neurological examinations and CT scans. Results of 34 implantation procedures were evaluable: 18 produced documented tumor regression (response) for 4 to 13+ months; five, performed in deteriorating patients, resulted in disease stability for 4 to 12 months. The overall response rate was 68%. In 11 patients, implantation did not halt clinical deterioration. At exploratory craniotomy 5 to 12 months after implantation, focal radiation necrosis was documented in two patients whose tumor had responded initially and then progressed, and in three patients whose disease had progressed initially (four glioblastomas, one anaplastic astrocytoma); histologically identifiable tumor was documented in two of these patients. All improved after resection of the focal necrotic mass and are still alive 10, 15, 19, 24, and 25 months after the initial implantation procedure; only one patient has evidence of tumor regrowth. The median follow-up period after implantation for the malignant glioma (anaplastic astrocytoma and glioblastoma multiforme) group is 9 months, with 48% of patients still surviving. While direct comparison with the results of chemotherapy is difficult, results obtained in this patient group with interstitial brachytherapy are probably superior to results obtained with chemotherapy.

  15. Outcomes of Iodine-125 Plaque Brachytherapy for Uveal Melanoma With Intraoperative Ultrasonography and Supplemental Transpupillary Thermotherapy

    SciTech Connect

    Badiyan, Shahed N.; Rao, Rajesh C.; Apicelli, Anthony J.; Acharya, Sahaja; Verma, Vivek; Garsa, Adam A.; DeWees, Todd; Speirs, Christina K.; Garcia-Ramirez, Jose; Esthappan, Jacqueline; Grigsby, Perry W.; Harbour, J. William

    2014-03-15

    Purpose: To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB). Methods and Materials: Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded. Statistical analysis was performed using Cox proportional hazards and Kaplan-Meier life table method. Results: The study included 270 men (51%) and 256 women (49%), with a median age of 63 years (mean, 62 years; range, 16-91 years). Median dose to the tumor apex was 94.4 Gy (mean, 97.8; range, 43.9-183.9) and to the tumor base was 257.9 Gy (mean, 275.6; range, 124.2-729.8). Plaque tilt >1 mm away from the sclera at plaque removal was detected in 142 cases (27%). Supplemental TTT was performed in 72 patients (13.7%). One or 2 TTT sessions were required in 71 TTT cases (98.6%). After a median follow-up of 45.9 months (mean, 53.4 months; range, 6-175 months), local tumor recurrence was detected in 19 patients (3.6%). Local tumor recurrence was associated with lower dose to the tumor base (P=.02). Conclusions: Ultrasound-guided plaque localization of I-125 EPB is associated with excellent local tumor control. Detection of plaque tilt by ultrasonography at plaque removal allows supplemental TTT to be used in patients at potentially higher risk for local recurrence while sparing the majority of patients who are at low risk. Most patients require only 1 or 2 TTT sessions.

  16. Treasure of the Past IX: Exposure Standardization of Iodine-125 Seeds Used for Brachytherapy

    PubMed Central

    Loftus, T. P.

    2001-01-01

    A method for calibrating iodine-125 seeds in terms of exposure has been established. The standard free-air ionization chamber, used for measuring soft x rays, was chosen for the measurements. Arrays of four to six seeds were used to enhance the ionization-current-to-background-current ratio. Seeds from an array were measured individually in a re-entrant chamber. The quotient of the exposure rate for the array by the sum of the ionization currents in the re-entrant chamber is the calibration factor for the re-entrant chamber. Calibration factors were established for three types of iodine-125 seeds. The overall uncertainty for the seed exposure calibrations is less than 6%.

  17. Ocular Response of Choroidal Melanoma With Monosomy 3 Versus Disomy 3 After Iodine-125 Brachytherapy

    SciTech Connect

    Marathe, Omkar S.; Wu, Jeffrey; Lee, Steve P.; Yu Fei; Burgess, Barry L.; Leu Min; Straatsma, Bradley R.; McCannel, Tara A.

    2011-11-15

    Purpose: To report the ocular response of choroidal melanoma with monosomy 3 vs. disomy 3 after {sup 125}I brachytherapy. Methods and Materials: We evaluated patients with ciliochoroidal melanoma managed with fine needle aspiration biopsy immediately before plaque application for {sup 125}I brachytherapy between January 1, 2005 and December 31, 2008. Patients with (1) cytopathologic diagnosis of melanoma, (2) melanoma chromosome 3 status identified by fluorescence in situ hybridization, and (3) 6 or more months of follow-up after brachytherapy were sorted by monosomy 3 vs. disomy 3 and compared by Kruskal-Wallis test. Results: Among 40 ciliochoroidal melanomas (40 patients), 15 had monosomy 3 and 25 had disomy 3. Monosomy 3 melanomas had a median greatest basal diameter of 12.00 mm and a median tumor thickness of 6.69 mm before brachytherapy; at a median of 1.75 years after brachytherapy, median thickness was 3.10 mm. Median percentage decrease in tumor thickness was 48.3%. Disomy 3 melanomas had a median greatest basal diameter of 10.00 mm and median tumor thickness of 3.19 mm before brachytherapy; at a median of 2.00 years after brachytherapy, median tumor thickness was 2.37 mm. The median percentage decrease in tumor thickness was 22.7%. Monosomy 3 melanomas were statistically greater in size than disomy 3 melanomas (p < 0.001) and showed a greater decrease in tumor thickness after brachytherapy (p = 0.006). Conclusion: In this study, ciliochoroidal melanomas with monosomy 3 were significantly greater in size than disomy 3 melanoma and showed a significantly greater decrease in thickness at a median of 1.75 years after brachytherapy. The greater decrease in monosomy 3 melanoma thickness after brachytherapy is consistent with other malignancies in which more aggressive pathology has been shown to be associated with a greater initial response to radiotherapy.

  18. Dosimetric and Late Radiation Toxicity Comparison Between Iodine-125 Brachytherapy and Stereotactic Radiation Therapy for Juxtapapillary Choroidal Melanoma

    SciTech Connect

    Krema, Hatem

    2013-07-01

    Purpose: To compare the dose distributions and late radiation toxicities for {sup 125}I brachytherapy (IBT) and stereotactic radiation therapy (SRT) in the treatment of juxtapapillary choroidal melanoma. Methods: Ninety-four consecutive patients with juxtapapillary melanoma were reviewed: 30 have been treated with IBT and 64 with SRT. Iodine-125 brachytherapy cases were modeled with plaque simulator software for dosimetric analysis. The SRT dosimetric data were obtained from the Radionics XKnife RT3 software. Mean doses at predetermined intraocular points were calculated. Kaplan-Meier estimates determined the actuarial rates of late toxicities, and the log–rank test compared the estimates. Results: The median follow-up was 46 months in both cohorts. The 2 cohorts were balanced with respect to pretreatment clinical and tumor characteristics. Comparisons of radiation toxicity rates between the IBT and SRT cohorts yielded actuarial rates at 50 months for cataracts of 62% and 75% (P=.1), for neovascular glaucoma 8% and 47% (P=.002), for radiation retinopathy 59% and 89% (P=.0001), and for radiation papillopathy 39% and 74% (P=.003), respectively. Dosimetric comparisons between the IBT and SRT cohorts yielded mean doses of 12.8 and 14.1 Gy (P=.56) for the lens center, 17.6 and 19.7 Gy (P=.44) for the lens posterior pole, 13.9 and 10.8 Gy (P=.30) for the ciliary body, 61.9 and 69.7 Gy (P=.03) for optic disc center, and 48.9 and 60.1 Gy (P<.0001) for retina at 5-mm distance from tumor margin, respectively. Conclusions: Late radiation-induced toxicities were greater with SRT, which is secondary to the high-dose exposure inherent to the technique as compared with IBT. When technically feasible, IBT is preferred to treat juxtapapillary choroidal melanoma.

  19. Iodine 125 Brachytherapy With Vitrectomy and Silicone Oil in the Treatment of Uveal Melanoma: 1-to-1 Matched Case-Control Series

    SciTech Connect

    McCannel, Tara A. McCannel, Colin A.

    2014-06-01

    Purpose: We initially reported the radiation-attenuating effect of silicone oil 1000 centistokes for iodine 125. The purpose of this report was to compare the clinical outcomes in case patients who had iodine 125 brachytherapy with vitrectomy and silicone oil 1000 centistokes with the outcomes in matched control patients who underwent brachytherapy alone. Methods and Materials: Consecutive patients with uveal melanoma who were treated with iodine 125 plaque brachytherapy and vitrectomy with silicone oil with minimum 1-year follow-up were included. Control patients who underwent brachytherapy alone were matched for tumor size, location, and sex. Baseline patient and tumor characteristics and tumor response to radiation, final visual acuity, macular status, central macular thickness by ocular coherence tomography (OCT), cataract progression, and metastasis at last follow-up visit were compared. Surgical complications were also determined. Results: Twenty case patients met the inclusion criteria. The average follow-up time was 22.1 months in case patients and 19.4 months in control patients. The final logMAR vision was 0.81 in case patients and 1.1 in control patients (P=.071); 8 case patients and 16 control patients had abnormal macular findings (P=.011); and the average central macular thickness by OCT was 293.2 μm in case patients and 408.5 μm in control patients (P=.016). Eleven case patients (55%) and 1 control patient (5%) had required cataract surgery at last follow-up (P=.002). Four patients in the case group and 1 patient in the control group experienced metastasis (P=.18). Among the cases, intraoperative retinal tear occurred in 3 patients; total serous retinal detachment and macular hole developed in 1 case patient each. There was no case of rhegmatogenous retinal detachment, treatment failure, or local tumor dissemination in case patients or control patients. Conclusions: With up to 3 years of clinical follow-up, silicone oil during brachytherapy

  20. Versatile permanent planar implant technique utilizing Iodine-125 seeds imbedded in gelfoam

    SciTech Connect

    Marchese, M.J.; Nori, D.; Anderson, L.L.; Hilaris, B.S.

    1984-05-01

    Tumors attached or adjacent to critical structures can often not be completely resected or resected with adequate surgical margins. Sites involving major blood vessels, the vertebral column or the brain with small residual tumors or suspicious margins often present technical difficulties for standard I-125 or Ir-192 implants. A relatively simple, accurate and inexpensive implant method is decribed using I-125 seeds imbedded in gelfoam to implant permanently into small residual tumors or suspicious margins where standard implant techniques may be unsatisfactory. A method for planning the treatment dose for such an implant is described. Cases involving paraspinal and brain tumors are reported to illustrate the technique.

  1. Comparison of implant quality between loose and intra-operatively linked iodine-125 seeds in prostate cancer brachytherapy.

    PubMed

    Jarusevicius, Laimonas; Inciura, Arturas; Juozaityte, Elona; Vaiciunas, Kestutis; Vaitkus, Antanas; Sniureviciute, Migle

    2012-01-01

    From 2007 to 2010, 230 patients had iodine-125 seeds implanted (loose or intra-operatively linked into seed trains with variable seed-to-seed spacing). The primary aim was to evaluate differences in implant quality by comparing the intra-operative and post-implant dosimetry in patients treated with loose and intra-operatively linked seeds. The secondary aim was to evaluate the "learning curve" for the procedure. The following parameters were compared: the radiation dose to 90% of the prostate volume (D90), the radiation dose to 30% of the urethral volume (DU30), the percentage of the prostate volume receiving 100% or 200% of the prescribed dose (V100 or V200, respectively), the percentage of the rectal volume receiving 100% of the prescribed dose (VR100), and the homogeneity index (HI). We obtained the following results for loose vs. intra-operatively linked seeds: D90 (Gy), 184.7 ± 15.0 vs. 177.9 ± 12.7 (p = 0.002); V100 (%), 95.5 ± 2.4 vs. 94.9 ± 3.2 (p = 0.206); V200 (%), 35.1 ± 7.5 vs. 24.3 plusmn; 6,9 (p < 0.001); DU30 (Gy), 218.6 ± 24.1 vs. 197.4 ± 19.5 (p = 0.001); VR100 (cm³), 0.6 ± 0.47 vs. 0.3 ± 0.3 (p < 0.001); HI (%), 31.8 ± 7.3 vs. 44.0 ± 9.8 (p < 0.001). The advantages of intra-operatively linked seed implantation over loose seed implantation are a more homogeneous prostate dose and lower urethral and rectal doses. The disadvantage is a lower post-implant D90. Sufficient experience with the loose seed implantation procedure was obtained after the first 40 patients. There was essentially no learning curve when a new implantation method using intra-operatively linked seeds was subsequently initiated. PMID:22739013

  2. Long-Term Results of Brachytherapy With Temporary Iodine-125 Seeds in Children With Low-Grade Gliomas

    SciTech Connect

    Korinthenberg, Rudolf; Neuburger, Daniela; Trippel, Michael; Ostertag, Christoph; Nikkhah, Guido

    2011-03-15

    Purpose: To retrospectively review the results of temporary I-125 brachytherapy in 94 children and adolescents with low-grade glioma. Methods and Materials: Treatment was performed in progressive tumors roughly spherical in shape with a diameter of up to 5 cm, including 79 astrocytomas, 5 oligodendrogliomas, 4 oligoastrocytomas, 1 ependymoma, and 5 other tumors. Location was suprasellar/chiasmal in 44, thalamic/basal ganglia in 18, hemispheric in 15, midbrain/pineal region in 13, and lower brainstem in 3. Initially, 8% of patients were free of symptoms, 47% were symptomatic but not disabled, and 30% were slightly, 6% moderately, and 3% severely disabled. Results: 5- and 10-year survival was 97% and 92%. The response to I-125 brachytherapy over the long term was estimated after a median observation period of 38.4 (range, 6.4-171.0) months. At that time, 4 patients were in complete, 27 in partial, and 18 in objective remission; 15 showed stable and 30 progressive tumors. Treatment results did not correlate with age, sex, histology, tumor size, location, or demarcation of the tumor. Secondary treatment became necessary in 36 patients, including 19 who underwent repeated I-125 brachytherapy. At final follow-up, the number of symptom-free patients had risen to 21%. Thirty-eight percent showed symptoms without functional impairment, 19% were slightly and 11% moderately disabled, and only 4% were severely disabled. Conclusions: Response rates similar to those of conventional radiotherapy or chemotherapy can be anticipated with I-125 brachytherapy in tumors of the appropriate size and shape. We believe it to be a useful contribution to the treatment of low-grade gliomas in children.

  3. The Impact of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy on Health-Related Quality of Life

    SciTech Connect

    Roeloffzen, Ellen M.A.; Hinnen, Karel A.; Battermann, Jan J.; Monninkhof, Evelyn M.; Roermund, Joep G.H. van; Gellekom, Marion van; Frank, Steven J.; Vulpen, Marco van

    2010-08-01

    Purpose: To evaluate the impact of acute urinary retention (AUR) in patients treated with {sup 125}I prostate brachytherapy on short- and long-term health-related quality of life (HRQOL); and to assess whether pretreatment HRQOL has additional value in the prediction of AUR. Methods and Materials: For 127 patients treated with {sup 125}I brachytherapy for localized prostate cancer between December 2000 and June 2003, toxicity and HRQOL data were prospectively collected. Patients received a HRQOL questionnaire at five time points: before and 1 month, 6 months, 1 year, and 6 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30), the tumor-specific EORTC prostate cancer module (EORTC QLQ-PR25), and the American Urological Association (AUA) symptom index. Results: Of 127 patients, 13 (10.2%) developed AUR. Patients with AUR had a significantly worse urinary QOL at all time points compared with patients without AUR. The mean difference over time (6 years) between both groups for the EORTC QLQ-PR25 urinary symptom score was 13.0 points (p < 0.001) and for the AUA urinary symptom score was 15.7 points (p = 0.001). Global QOL scores (EORTC QLQ-C30) over time for patients who developed AUR were significantly worse compared with patients without AUR (mean difference 6.7 points; p = 0.043). In multivariate logistic regression analysis, pretreatment International Prostate Symptom Score (p = 0.004) and neoadjuvant hormonal treatment (p = 0.034) were predictors of AUR. Quality of life did not have added predictive value. Conclusion: Acute urinary retention after prostate brachytherapy has a significant negative impact on patient's HRQOL up to 6 years after treatment, in terms of both global QOL measures and urinary symptom scores. Furthermore, our results suggest limited value of pretreatment HRQOL measures for the prediction of AUR.

  4. Biochemical Disease-Free Rate and Toxicity for Men Treated With Iodine-125 Prostate Brachytherapy With D{sub 90} {>=}180 Gy

    SciTech Connect

    Gomez-Iturriaga Pina, Alfonso; Crook, Juanita; Borg, Jette; Ma, Clement

    2010-10-01

    Purpose: Iodine-125 ({sup 125}I) prostate brachytherapy is planned with a prescribed dose of 145 Gy and minimal dose received by 90% of the prostate (D{sub 90}) of 120-125% (174-181 Gy). We examined the clinical outcomes and toxicity profile of men receiving a D{sub 90} (isodose enclosing 90% of the prostate) of {>=}180 Gy. Methods and Materials: Between March 1999 and May 2006, 129 men (17% of our total brachytherapy population) treated with {sup 125}I monotherapy for Stage T1-T2 prostate cancer received a D{sub 90} {>=}180 Gy. Implants were performed using transrectal ultrasonography and fluoroscopic guidance. The 1-month postplan dosimetry used magnetic resonance imaging-computed tomography fusion. The minimal follow-up was 2 years. Toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale, version 3. Results: The median patient age was 63 years (range, 50-76), and the pretreatment prostate-specific antigen level was 5.5 ng/mL (range, 0.6-13.5). The Gleason score was {<=}6 in 125 patients and was 7 in 4 patients. The median follow-up period was 40 months (range, 24-111), and the median D{sub 90} was 186 Gy. The median minimal dose received by 30% of the urethra was 203 Gy, and the median rectal volume receiving a minimum of 100% of the prescribed dose was 0.81 cm{sup 3}. Acute Grade 2 genitourinary toxicity was seen in 5.4% and late Grade 2 in 7%. Late urinary retention (Grade 3) was seen in 2 patients (1.5%). Grade 1 rectal bleeding occurred in 9.3% and Grade 2 in 2.3%. On univariate logistic regression analysis, none of the clinical and dosimetric parameters predicted for rectal bleeding. Of 110 men who were potent before treatment, 81% remained potent 5 years after treatment. Three biochemical failures and only one local failure developed. The 5-year biochemical no evidence of disease rate using the 'nadir plus 2' definition was 96.8%. Conclusion: A D{sub 90} of {>=}180 Gy is associated with

  5. Brachytherapy with Iodine-125 seeds strand for treatment of main portal vein tumor thrombi: an experimental study in a rabbit model

    PubMed Central

    Zhang, Wen; Luo, Jianjun; Liu, Qingxin; Ma, Jingqin; Qu, Xudong; Yang, Minjie; Yan, Zhiping; Wang, Jianhua

    2016-01-01

    This study aims to establish an animal model of implanted main portal vein tumor thrombus (MPVTT) and to evaluate safety and efficacy of brachy therapy with Iodine-125 (125I) seeds strand to treat MPVTT of rabbit. VX2 tumor thrombus was implanted in main portal vein (MPV) of 32 New Zealand white rabbits. These rabbits were randomly divided into treatment group (Group T, T1-T16) and control group (Group C, C1-C16). 125I seeds and blank seeds strand were implanted in MPV of rabbits in Group T and C, respectively. Changes of general condition, body weight and blood laboratory examination were monitored at every time point after procedure. 2 weeks later, 8 rabbits of each group were sacrificed for pathologic examination. The rest of rabbits were dissected postmortem, and therapeutic effects were evaluated on basis of multi-detector computed tomography and histopathology. Ki-67 labeling index (Ki-67 LI) and apoptosis index (AI) were compared between two groups. Overall survival period was recorded. At every time point after brachytherapy, more serious weight loss were detected in Group C. Results of liver function tests and blood cells counts showed no significant difference between two groups. Mean volume of tumor tissue within MPV were 565.40 ± 220.90 mm3 in Group T and 2269.90 ± 437.00 mm3 in Group C (P < 0.001). (Ki-67 LI) and AI were (4.14 ± 1.84)% and (6.51 ± 1.92)% in Group T, compared with (33.82 ± 6.07)% and (0.91 ± 0.26)% in Group C, respectively (P < 0.001). Media survival time of rabbits were 39.50 ± 2.37 days in Group T and 27.38 ± 1.22 days in Group C, respectively (P = 0.001). In conclusion, injecting and suspensory fixing VX2 tumor strip into MPV is a reliable method to establish MPVTT animal model. Brachytherapy with 125I seeds strand was safe and effective to treat VX2 tumor strand inoculated in the MPV of rabbit. PMID:27152237

  6. SU-E-T-55: Biological Equivalent Dose (BED) Comparison Between Permanent Interstitial Brachytherapy and Conventional External Beam Radiotherapy for Prostate Cancer

    SciTech Connect

    Liu, X; Rahimian, J; Cosmatos, H; Goy, B; Heywood, C; Qian, Y

    2014-06-01

    Purpose: The goal of this research is to calculate and compare the Biological Equivalent Dose (BED) between permanent prostate Iodine-125 implant brachytherapy as monotherapy with the BED of conventional external beam radiation therapy (EBRT). Methods: A retrospective study of 605 patients treated with Iodine-125 seed implant was performed in which physician A treated 274 patients and physician B treated 331 patients. All the Brachytherapy treatment plans were created using VariSeed 8 planning system. The Iodine-125 seed source activities and loading patterns varied slightly between the two physicians. The prescription dose is 145 Gy to PTV for each patient. The BED and Tumor Control Probability (TCP) were calculated based on the TG 137 formulas. The BED for conventional EBRT of the prostate given in our institution in 2Gy per fraction for 38 fractions was calculated and compared. Results: Physician A treated 274 patients with an average BED of 123.92±0.87 Gy and an average TCP of 99.20%; Physician B treated 331 patients with an average BED of 124.87±1.12 Gy and an average TCP of 99.30%. There are no statistically significant differences (T-Test) between the BED and TCP values calculated for these two group patients.The BED of the patients undergoing conventional EBRT is calculated to be 126.92Gy. The BED of the patients treated with permanent implant brachytherapy and EBRT are comparable. Our BED and TCP values are higher than the reported values by TG 137 due to higher Iodine-125 seed activity used in our institution. Conclusion: We calculated the BED,a surrogate of the biological response to a permanent prostate brachytherapy using TG 137 formulas and recommendation. The TCP of better than 99% is calculated for these patients. A clinical outcome study of these patients correlating the BED and TCP values with PSA and Gleason Levels as well as patient survival is warranted.

  7. Iodine 125 interstitial irradiation for localized prostate cancer.

    PubMed Central

    Kumar, P. P.; Good, R. R.; Bartone, F. F.

    1990-01-01

    We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced. Images Figure 1 Figure 2 Figure 3 PMID:2319613

  8. Iodine 125 interstitial irradiation for localized prostate cancer

    SciTech Connect

    Kumar, P.P.; Good, R.R.; Bartone, F.F. )

    1990-03-01

    We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced.

  9. Mature Follow-Up for High-Risk Stage I Non-Small-Cell Lung Carcinoma Treated With Sublobar Resection and Intraoperative Iodine-125 Brachytherapy

    SciTech Connect

    Colonias, Athanasios; Betler, James; Trombetta, Mark; Bigdeli, Ghazaleh; Gayou, Olivier; Keenan, Robert; Werts, E. Day; Parda, David S.

    2011-01-01

    Purpose: To update the Allegheny General Hospital experience of high-risk Stage I non-small-cell lung cancer patients treated with sublobar resection and intraoperative {sup 125}I Vicryl mesh brachytherapy. Methods and Materials: Between January 5, 1996 and February 19, 2008, 145 patients with Stage I non-small-cell lung cancer who were not lobectomy candidates because of cardiopulmonary compromise underwent sublobar resection and placement of {sup 125}I seeds along the resection line. The {sup 125}I seeds embedded in Vicryl suture were attached with surgical clips to a sheet of Vicryl mesh, inserted over the target area, and prescribed to a 0.5-cm planar margin. Results: The mean target area, total activity, number of seeds implanted, and prescribed total dose was 33.3 cm{sup 2} (range, 18.0-100.8), 20.2 mCi (range, 11.1-29.7), 46 (range, 30-100), and 117 Gy (range, 80-180), respectively. The median length of the surgical stay was 6 days (range, 1-111), with a perioperative mortality rate of 3.4%. At a median follow-up of 38.3 months (range, 1-133), 6 patients had developed local recurrence (4.1%), 9 had developed regional failure (6.2%), and 25 had distant failure (17.2%). On multivariate analysis, no patient- or tumor-specific factors or surgical or dosimetric factors were predictive of local recurrence. The overall median survival was 30.5 months with a 3- and 5-year overall survival rate of 65% and 35%, respectively. Conclusion: {sup 125}I brachytherapy for high-risk, Stage I non-small-cell lung cancer after sublobar resection is well tolerated and associated with a low local failure rate.

  10. Monte Carlo calculated doses to treatment volumes and organs at risk for permanent implant lung brachytherapy

    NASA Astrophysics Data System (ADS)

    Sutherland, J. G. H.; Furutani, K. M.; Thomson, R. M.

    2013-10-01

    Iodine-125 (125I) and Caesium-131 (131Cs) brachytherapy have been used with sublobar resection to treat stage I non-small cell lung cancer and other radionuclides, 169Yb and 103Pd, are considered for these treatments. This work investigates the dosimetry of permanent implant lung brachytherapy for a range of source energies and various implant sites in the lung. Monte Carlo calculated doses are calculated in a patient CT-derived computational phantom using the EGsnrc user-code BrachyDose. Calculations are performed for 103Pd, 125I, 131Cs seeds and 50 and 100 keV point sources for 17 implant positions. Doses to treatment volumes, ipsilateral lung, aorta, and heart are determined and compared to those determined using the TG-43 approach. Considerable variation with source energy and differences between model-based and TG-43 doses are found for both treatment volumes and organs. Doses to the heart and aorta generally increase with increasing source energy. TG-43 underestimates the dose to the heart and aorta for all implants except those nearest to these organs where the dose is overestimated. Results suggest that model-based dose calculations are crucial for selecting prescription doses, comparing clinical endpoints, and studying radiobiological effects for permanent implant lung brachytherapy.

  11. A permanent breast seed implant as partial breast radiation therapy for early-stage patients: A comparison of palladium-103 and iodine-125 isotopes based on radiation safety considerations

    SciTech Connect

    Keller, Brian; Sankreacha, Raxa; Rakovitch, Eileen; O'Brien, Peter; Pignol, Jean-Philippe . E-mail: Jean-Philippe.Pignol@sw.ca

    2005-06-01

    Purpose: A permanent breast seed implant (PBSI) technique has been developed as a new form of partial adjuvant radiation therapy for early-stage breast cancer. This study compares iodine-125 ({sup 125}I) and palladium-103 ({sup 103}Pd) isotopes by examining the exposure and effective dose (ED) to a patient's partner.Methods and Materials: A low-energy survey meter was used to measure exposure rates as a function of bolus thickness placed over {sup 103}Pd or {sup 125}I seeds. A general mathematical expression for the initial exposure rate at 1 m (x{sub o,1m}) from the skin surface as a function of the implant size, R, and the distance between the skin surface and the implant, d, was derived. Also, a second general equation is proposed to calculate the ED to the patient's partner.Results: The initial exposure rate at 1 meter and the ED are calculated as follows: x{sub o,1m} = (3{alpha})/2R{sup 3}{center_dot}{beta}{sup 3} [e{sup -{beta}}{sup (2R+d)}({beta}R + 1) + e{sup -{beta}}{sup {center_dot}}{sup d}({beta}R - 1)], and ED = aR{sup b} {center_dot} [e{sup -c(2R+d)} {center_dot} (cR + 1) + e{sup -cd} -bar (cR - 1)]. For {sup 125}I, the parameters are: {alpha} = 0.154409, {beta} = 0.388460, a = 197, b = -0.95, and c = 0.38846. For {sup 103}Pd, they are: {alpha} = 0.06877, {beta} = 0.421098, a = 18.6, b -0.78, and c = 0.421098. For implant diameters varying from 2 to 6 cm and skin-to-implant distances varying from 0.7 to 4 cm, the ED is consistently below 2.6 mSv using the {sup 103}Pd isotope, but more than 5 mSv in many instances and possibly up to 20 mSv using {sup 125}I.Conclusions: PBSI using {sup 103}Pd seeds appears safe because the patient's partner ED is consistently below 5 mSv. The{sup 125}I isotope is not recommended for PBSI.

  12. Fast dose kernel interpolation using Fourier transform with application to permanent prostate brachytherapy dosimetry

    SciTech Connect

    Liu, Derek Sloboda, Ron S.

    2014-05-15

    Purpose: Boyer and Mok proposed a fast calculation method employing the Fourier transform (FT), for which calculation time is independent of the number of seeds but seed placement is restricted to calculation grid points. Here an interpolation method is described enabling unrestricted seed placement while preserving the computational efficiency of the original method. Methods: The Iodine-125 seed dose kernel was sampled and selected values were modified to optimize interpolation accuracy for clinically relevant doses. For each seed, the kernel was shifted to the nearest grid point via convolution with a unit impulse, implemented in the Fourier domain. The remaining fractional shift was performed using a piecewise third-order Lagrange filter. Results: Implementation of the interpolation method greatly improved FT-based dose calculation accuracy. The dose distribution was accurate to within 2% beyond 3 mm from each seed. Isodose contours were indistinguishable from explicit TG-43 calculation. Dose-volume metric errors were negligible. Computation time for the FT interpolation method was essentially the same as Boyer's method. Conclusions: A FT interpolation method for permanent prostate brachytherapy TG-43 dose calculation was developed which expands upon Boyer's original method and enables unrestricted seed placement. The proposed method substantially improves the clinically relevant dose accuracy with negligible additional computation cost, preserving the efficiency of the original method.

  13. Iodine-125 radiation of posterior uveal melanoma

    SciTech Connect

    Packer, S.

    1987-12-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

  14. Erectile Function Durability Following Permanent Prostate Brachytherapy

    SciTech Connect

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian S.; Anderson, Richard; Lief, Jonathan H.

    2009-11-01

    Purpose: To evaluate long-term changes in erectile function following prostate brachytherapy. Methods and Materials: This study included 226 patients with prostate cancer and preimplant erectile function assessed by the International Index of Erectile Function-6 (IIEF-6) who underwent brachytherapy in two prospective randomized trials between February 2001 and January 2003. Median follow-up was 6.4 years. Pre- and postbrachytherapy potency was defined as IIEF-6 >= 13 without pharmacologic or mechanical support. The relationship among clinical, treatment, and dosimetric parameters and erectile function was examined. Results: The 7-year actuarial rate of potency preservation was 55.6% with median postimplant IIEF of 22 in potent patients. Potent patients were statistically younger (p = 0.014), had a higher preimplant IIEF (p < 0.001), were less likely to be diabetic (p = 0.002), and were more likely to report nocturnal erections (p = 0.008). Potency preservation in men with baseline IIEF scores of 29-30, 24-28, 18-23, and 13-17 were 75.5% vs. 73.6%, 51.7% vs. 44.8%, 48.0% vs. 40.0%, and 23.5% vs. 23.5% in 2004 vs. 2008. In multivariate Cox regression analysis, preimplant IIEF, hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly predicted for potency preservation. Impact of proximal penile dose was most pronounced for men with IIEF of 18-23 and aged 60-69. A significant minority of men who developed postimplant impotence ultimately regained erectile function. Conclusion: Potency preservation and median IIEF scores following brachytherapy are durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.

  15. Myths and fallacies in permanent prostate brachytherapy

    SciTech Connect

    Butler, Wayne M.; Merrick, Gregory S

    2003-09-30

    Because there are competing modalities to treat early-stage prostate cancer, the constraints or deficiencies of one modality may be erroneously applied to others. Some valid concerns arising from surgery and external beam therapy, which have been falsely transferred to brachytherapy, are constraints based on patient age, clinical and pathological parameters, patient weight, and size of prostate. Although the constraints have a valid basis in one modality, knowledge of the origin and mechanism of the constraint has provided a means to circumvent or overcome it in brachytherapy. Failures as measured by biochemical no-evidence of disease (bNED) survival may be attributed to extracapsular disease extension. Such extension often expresses itself in surrogate parameters such as a high percentage of positive biopsies, perineural invasion, or the dominant pattern in Gleason score histology. Failures due to such factors may be prevented by implanting with consistent extracapsular dosimetric margins. Some presumed limitations on prostate brachytherapy originated from data on patients implanted in the first few years the procedure was being developed. Most of the urinary morbidity and a significant part of the decrease in sexual function observed may be avoided by controlling the dosimetry along the prostatic and membranous urethra and at the penile bulb.

  16. Comparison of Combined X-Ray Radiography and Magnetic Resonance (XMR) Imaging-Versus Computed Tomography-Based Dosimetry for the Evaluation of Permanent Prostate Brachytherapy Implants

    SciTech Connect

    Acher, Peter Rhode, Kawal; Morris, Stephen; Gaya, Andrew; Miquel, Marc; Popert, Rick; Tham, Ivan; Nichol, Janette; McLeish, Kate; Deehan, Charles; Dasgupta, Prokar; Beaney, Ronald; Keevil, Stephen F.

    2008-08-01

    Purpose: To present a method for the dosimetric analysis of permanent prostate brachytherapy implants using a combination of stereoscopic X-ray radiography and magnetic resonance (MR) imaging (XMR) in an XMR facility, and to compare the clinical results between XMR- and computed tomography (CT)-based dosimetry. Methods and Materials: Patients who had received nonstranded iodine-125 permanent prostate brachytherapy implants underwent XMR and CT imaging 4 weeks later. Four observers outlined the prostate gland on both sets of images. Dose-volume histograms (DVHs) were derived, and agreement was compared among the observers and between the modalities. Results: A total of 30 patients were evaluated. Inherent XMR registration based on prior calibration and optical tracking required a further automatic seed registration step that revealed a median root mean square registration error of 4.2 mm (range, 1.6-11.4). The observers agreed significantly more closely on prostate base and apex positions as well as outlining contours on the MR images than on those from CT. Coefficients of variation were significantly higher for observed prostate volumes, D90, and V100 parameters on CT-based dosimetry as opposed to XMR. The XMR-based dosimetry showed little agreement with that from CT for all observers, with D90 95% limits of agreement ranges of 65, 118, 79, and 73 Gy for Observers 1, 2, 3, and 4, respectively. Conclusions: The study results showed that XMR-based dosimetry offers an alternative to other imaging modalities and registration methods with the advantages of MR-based prostate delineation and confident three-dimensional reconstruction of the implant. The XMR-derived dose-volume histograms differ from the CT-derived values and demonstrate less interobserver variability.

  17. Comparison of biochemical failure definitions for permanent prostate brachytherapy

    SciTech Connect

    Kuban, Deborah A. . E-mail: dakuban@mdanderson.org; Levy, Larry B.; Potters, Louis; Beyer, David C.; Blasko, John C.; Moran, Brian J.; Ciezki, Jay P.; Zietman, Anthony L.; Zelefsky, Michael J.; Pisansky, Thomas M.; Elshaikh, Mohamed; Horwitz, Eric M.

    2006-08-01

    Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable.

  18. Long-Term Results of an RTOG Phase II Trial (00-19) of External-Beam Radiation Therapy Combined With Permanent Source Brachytherapy for Intermediate-Risk Clinically Localized Adenocarcinoma of the Prostate

    SciTech Connect

    Lawton, Colleen A.; Yan, Yan; Lee, W. Robert; Gillin, Michael; Firat, Selim; Baikadi, Madhava; Crook, Juanita; Kuettel, Michael; Morton, Gerald; Sandler, Howard

    2012-04-01

    Purpose: External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to

  19. Pulmonary embolization of iodine-125 seeds following prostate implantation

    SciTech Connect

    Steinfeld, A.D.; Donahue, B.R.; Plaine, L. )

    1991-02-01

    The optimal treatment of prostatic carcinoma limited to the gland remains controversial. Treatment has included implantation of Iodine-125 seeds via both a suprapubic approach and, more recently, a transperineal technique utilizing ultrasound guidance. We recently have noted a heretofore unreported complication with this latter technique, namely, embolization of seeds to the lungs. Review of the chest x-ray films of 31 patients who underwent suprapubic implants showed no evidence of this phenomenon. One of 5 patients undergoing transperineal implant was found to have seeds lodged in the lung. Complications surrounding the various treatments of localized prostate carcinoma are reviewed.

  20. Determination of the prescription dose for biradionuclide permanent prostate brachytherapy

    SciTech Connect

    Nuttens, V. E.; Lucas, S.

    2008-12-15

    A model based on the linear quadratic model that has been corrected for repopulation, sublethal cell damage repair, and RBE effect has been used to determine the prescription dose for prostate permanent brachytherapy using seeds loaded with a mixture of {sup 103}Pd and {sup 125}I or a mixture of {sup 103}Pd and {sup 131}Cs. The prescription dose was determined by comparing the tumor cell survival fractions between the considered biradionuclide seed implant and one monoradionuclide seed implant chosen from {sup 103}Pd, {sup 125}I, and {sup 131}Cs. Prostate edema is included in the model. The influence of the value of the radiobiological parameters and RBE were also investigated. Two mixtures of radionuclides were considered: {sup 103}Pd{sub 0.75}-{sup 125}I{sub 0.25} and {sup 103}Pd{sub 0.25}-{sup 131}Cs{sub 0.75}, where the subscripts indicate the fractions of total initial internal activity in the biradionuclide seed. These fractions were selected in order to obtain a dose distribution that lies between that of {sup 103}Pd and {sup 125}I/{sup 131}Cs. As expected, the computed prescription dose values are dependent on the model parameters (edema half-life and magnitude, radiobiogical parameters, and RBE). The radionuclide used as a benchmark also has a strong impact on the derived prescribed dose. The large uncertainties in the radiobiological parameters and RBE values produce big errors in the computed prescribed dose. Averaged over the range of all the parameters and depending on the radionuclide used as a benchmark (in subscript), the derived prescription dose for the first mixture (PdI) would be: D{sub Pd}{sup PdI}=142{sub -16}{sup +15} Gy and D{sub I}{sup PdI}=142{sub -8}{sup +6} Gy; and D{sub Pd}{sup PdCs}=128{sub -13}{sup +13} Gy and D{sub Cs}{sup PdCs}=115{sub -7}{sup +6} Gy for the PdCs mixture. The uncertainties could be reduced if the radiobiological parameters and RBE value were known more accurately. However, as edema characteristics are patient

  1. Primary Gleason Grade 4 Impact on Biochemical Recurrence After Permanent Interstitial Brachytherapy in Japanese Patients With Low- or Intermediate-Risk Prostate Cancer

    SciTech Connect

    Uesugi, Tatsuya; Saika, Takashi; Edamura, Kohei; Nose, Hiroyuki; Kobuke, Makoto; Ebara, Shin; Abarzua, Fernand; Katayama, Norihisa; Yanai, Hiroyuki; Nasu, Yasutomo; Kumon, Hiromi

    2012-02-01

    Purpose: To reveal a predictive factor for biochemical recurrence (BCR) after permanent prostate brachytherapy (PPB) using iodine-125 seed implantation in patients with localized prostate cancer classified as low or intermediate risk based on National Comprehensive Cancer Network (NCCN) guidelines. Methods and Materials: From January 2004 to December 2009, 414 consecutive Japanese patients with clinically localized prostate cancer classified as low or intermediate risk based on the NCCN guidelines were treated with PPB. The clinical factors including pathological data reviewed by a central pathologist and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with BCR. Results: Median follow-up was 36.5 months. The 2-, 3-, 4-, and 5-year BCR-free rates using the Phoenix definition were 98.3%, 96.0%, 91.6%, and 87.0%, respectively. On univariate analysis, the Gleason score, especially primary Gleason grade 4 in biopsy specimens, was a strong predicting factor (p < 0.0001), while age, initial prostate-specific antigen (PSA) level, T stage, and minimal dose delivered to 90% of the prostate volume (D90) were insignificant. Multivariate analysis indicated that a primary Gleason grade 4 was the most powerful prognostic factor associated with BCR (hazard ratio = 6.576, 95% confidence interval, 2.597-16.468, p < 0.0001). Conclusions: A primary Gleason grade 4 carried a worse BCR prognosis than the primary grade 3 in patients treated with PPB. Therefore, the indication for PPB in patients with a Gleason sum of 4 + 3 deserves careful and thoughtful consideration.

  2. PSA Kinetics and PSA Bounce Following Permanent Seed Prostate Brachytherapy

    SciTech Connect

    Crook, Juanita Gillan, Caitlin B.Sc.; Yeung, Ivan Ph.D.; Austen, Lynette; McLean, Michael; Lockwood, Gina M.Math.

    2007-10-01

    Purpose: To report the incidence, timing, and magnitude of the benign prostate-specific antigen (PSA) bounce after {sup 125}I prostate brachytherapy and correlate the bounce with clinical and/or dosimetric factors. Methods and Materials: From March 1999 to August 2003, a total of 292 men received {sup 125}I prostate brachytherapy without androgen deprivation or supplemental beam radiotherapy and have PSA follow-up >30 months. Implants were preplanned using transrectal ultrasound (TRUS) and performed under transrectal ultrasound/fluoroscopy guidance using preloaded needles. A PSA bounce is defined as an increase {>=}0.2 ng/ml with spontaneous return to prebounce level or lower. Results: Resolved PSA bounces were seen in 40% of men with follow-up >30 months. Median onset was 15 months, and median magnitude was 0.76 ng/ml. Magnitude >2 ng/ml was seen in 15%. The only clinical or dosimetric factor predictive of bounce in multivariate analysis was younger age. Median time to increasing PSA level indicative of failure was 30 months. Conclusions: Benign PSA bounces are common after {sup 125}I prostate brachytherapy, especially in younger men. An increase >2 ng/ml above the nadir was seen in 15%. Magnitude of increase does not distinguish bounce from failure. Time to the start of the PSA increase can be helpful, but is not absolute. The PSA bounce does not predict subsequent failure. Caution is advised in interpreting an early increasing PSA level in the first 30 months after {sup 125}I brachytherapy in favorable-risk patients.

  3. Alternative Dose for Choroidal Melanoma Treated With an Iodine-125 Radioactive Plaque: A Single-Institution Retrospective Study

    SciTech Connect

    Saconn, Paul A.; Gee, Christopher J.; Greven, Craig M.; McCoy, Thomas P.; Ekstrand, Kenneth E.; Greven, Kathryn M.

    2010-11-01

    Purpose: The Collaborative Ocular Melanoma Study (COMS) established iodine-125 plaque brachytherapy as an accepted standard treatment for medium-size choroidal melanoma. In the COMS, the prescription dose was 85 Gy. This is a retrospective review of our outcomes in patients treated with lower doses than those used in the COMS. Methods and Materials: From 1990 to 2004, 62 patients were treated with iodine-125 plaque brachytherapy for choroidal melanoma. COMS eye plaques were used with dose prescribed to the apex of the tumor. The median and average dose rates at the tumor apex were 63.5 cGy/h and 62.7 cGy/h, respectively. The median and average total doses were 63.0 Gy and 62.5 Gy (range, 56-69 Gy), respectively. The median and mean durations of implant were 100.0 hours and 101.1 hours (range, 71-165 hours). Results: Median follow-up time was 58.2 months. The 5-year outcomes including overall survival, disease-free survival, cause-specific survival, local failure, secondary enucleation rate, and visual acuity (VA) <20/200 were estimated using the Kaplan-Meier method. Overall, there were 7 local failures, 4 distant failures, and 10 secondary enucleations (6 due to local failure and 4 due to treatment complications). Univariate analysis was performed to identify significant prognostic factors associated with disease-free survival (baseline VA in tumor eye, tumor shape), cause-specific survival (diabetic retinopathy), local failure (none found), secondary enucleation rate (diabetic retinopathy, basal tumor dimension) and VA <20/200 (diabetic retinopathy, tumor shape, age, retinal detachment, treatment depth, and history of vision-limiting condition). Conclusions: Our survival and local control outcomes are comparable to those of the COMS. However, VA at 5 years seems to be better. Lower doses of radiation could potentially lead to better visual outcomes.

  4. Iodine-125 Seeds Strand for Treatment of Tumor Thrombus in Inferior Vena Cava: An Experimental Study in a Rabbit Model

    SciTech Connect

    Zhang, Wen Yan, Zhiping Luo, Jianjun Fang, Zhuting Wu, Linlin Liu, QingXin Qu, Xudong Liu, Lingxiao Wang, Jianhua

    2013-10-15

    Objective: The purpose of this study was to establish an animal model of implanted inferior vena cava tumor thrombus (IVCTT) and to evaluate the effect of linear iodine-125 seeds strand in treating implanted IVCTT. Methods: Tumor cell line VX{sub 2} was inoculated subcutaneously into New Zealand rabbit to develop the parent tumor. The tumor strip was inoculated into inferior vena cava (IVC) to establish the IVCTT model. The IVCTT was confirmed by multidetector computed tomography (MDCT) after 2 weeks. Twelve rabbits with IVCTT were randomly divided into two groups. Treatment group (group T; n = 6) underwent Iodine-125 seeds brachytherapy, and the control group (group C; n = 6) underwent blank seeds strand. The blood laboratory examination (including blood routine examination, hepatic and renal function), body weight, survival time, and IVCTT volume by MDCT were monitored. All rabbits were dissected postmortem, and the therapeutic effects were evaluated on the basis of histopathology. The proliferating cell nuclear antigen index (PI) and apoptosis index (AI) of IVCTT were compared between two groups. T test, Wilcoxon rank test, and Kaplan-Meier survival curve analysis were used. Results: The success rate of establishing IVCTT was 100 %. The body weight loss and cachexia of rabbits in group C appeared earlier than in group T. Body weight in the third week, the mean survival time, PI, AI in groups T and C were 2.23 {+-} 0.12 kg, 57.83 {+-} 8.68 days, (16.73 {+-} 5.18 %), (29.47 {+-} 7.18 %), and 2.03 {+-} 0.13 kg, 43.67 {+-} 5.28 days, (63.01 {+-} 2.01 %), (6.02 {+-} 2.93 %), respectively. There were statistically significant differences between group T and group C (P < 0.05). The IVCTT volume of group T was remarkably smaller than that of group C. Conclusions: Injecting and suspensory fixing VX2 tumor strip into IVC is a reliable method to establish IVCTT animal model. The linear Iodine-125 seeds strand brachytherapy was a safe and effective method for treating IVCTT

  5. Characterization of liposomes containing iodine-125-labeled radiographic contrast agents

    SciTech Connect

    Zalutsky, M.R.; Noska, M.A.; Seltzer, S.E.

    1987-02-01

    Multilamellar liposomes were prepared containing either iodine-125-labeled (/sup 125/I) diatrizoate or /sup 125/I labeled iotrol in their aqueous phase. The in vitro permeabilities of liposomes containing both contrast agents were measured in the presence of saline and serum at 37 degrees C. Two different phospholipid compositions were studied: phosphatidylcholine/cholesterol/stearylamine (PC/C/S, 8: 1:1 molar ratio) and distearoylphosphatidylcholine/sphingomyelin (DSPC/SM, 5:2 mole ratio). In saline, similar permeabilities were observed for the four phospholipid-contrast agent combinations. In serum, however, leakage of /sup 125/I activity was 2 to 3 times greater from PC/C/S liposomes than from vesicles composed of DSPC/SM. When PC/C/S liposomes that contained /sup 125/I-diatrizoate were injected into rats, the clearance half-times for /sup 125/I activity from the liver, spleen, and whole body were 4.4 hours, 4.5 hours, and 2.8 hours, respectively. Liposomes composed of DSPC/SM cleared at a significantly slower rate from the liver, spleen, and whole body with half-times of 24.0 hours, 18.4 hours, and 17.2 hours observed from these tissues, respectively.

  6. Comparison of 3 different postimplant dosimetry methods following permanent {sup 125}I prostate seed brachytherapy

    SciTech Connect

    Marcu, Loredana G.; Gowda, Raghu

    2013-10-01

    Postimplant dosimetry (PID) after Iodine-125 ({sup 125}I) implant of the prostate should offer a reliable qualitative assessment. So far, there is no consensus regarding the optimum PID method, though the latest literature is in favor of magnetic resonance imaging (MRI). This study aims to simultaneously compare 3 PID techniques: (1) MRI-computed tomography (CT) fusion; (2) ultrasound (US)-CT fusion; and (3) manual target delineation on CT. The study comprised 10 patients with prostate cancer. CT/MR scans with urinary catheters in place for PID were done either on day 0 or day 1 postimplantation. The main parameter evaluated and compared among methods was target D90. The results show that CT-based D90s are lower than US-CT D90s (median difference,−6.85%), whereas MR-CT PID gives higher D90 than US-CT PID (median difference, 4.25%). Manual contouring on CT images tends to overestimate the prostate volume compared with transrectal ultrasound (TRUS) (median difference, 23.33%), whereas on US images the target is overestimated compared with MR-based contouring (median difference, 13.25%). Although there are certain differences among the results given by various PID techniques, the differences are statistically insignificant for this small group of patients. Any dosimetric comparison between 2 PID techniques should also account for the limitations of each technique, to allow for an accurate quantification of data. Given that PID after permanent radioactive seed implant is mandatory for quality assurance, any imaging method–based PID (MR-CT, US-CT, and CT) available in a radiotherapy department can be indicative of the quality of the procedure.

  7. Ejaculatory Function After Permanent {sup 125}I Prostate Brachytherapy for Localized Prostate Cancer

    SciTech Connect

    Huyghe, Eric Delannes, Martine; Wagner, Fabien M.; Delaunay, Boris; Nohra, Joe; Thoulouzan, Matthieu; Shut-Yee, J. Yeung; Plante, Pierre; Soulie, Michel; Thonneau, Patrick; Bachaud, Jean Marc

    2009-05-01

    Purpose: Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent {sup 125}I prostate brachytherapy for localized prostate cancer. Patients and Methods: Of 270 sexually active men with localized prostate cancer treated with permanent {sup 125}I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. Results: Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). Conclusion: Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

  8. SU-E-T-259: Particle Swarm Optimization in Radial Dose Function Fitting for a Novel Iodine-125 Seed

    SciTech Connect

    Wu, X; Duan, J; Popple, R; Huang, M; Shen, S; Brezovich, I; Cardan, R; Benhabib, S

    2014-06-01

    Purpose: To determine the coefficients of bi- and tri-exponential functions for the best fit of radial dose functions of the new iodine brachytherapy source: Iodine-125 Seed AgX-100. Methods: The particle swarm optimization (PSO) method was used to search for the coefficients of the biand tri-exponential functions that yield the best fit to data published for a few selected radial distances from the source. The coefficients were encoded into particles, and these particles move through the search space by following their local and global best-known positions. In each generation, particles were evaluated through their fitness function and their positions were changed through their velocities. This procedure was repeated until the convergence criterion was met or the maximum generation was reached. All best particles were found in less than 1,500 generations. Results: For the I-125 seed AgX-100 considered as a point source, the maximum deviation from the published data is less than 2.9% for bi-exponential fitting function and 0.2% for tri-exponential fitting function. For its line source, the maximum deviation is less than 1.1% for bi-exponential fitting function and 0.08% for tri-exponential fitting function. Conclusion: PSO is a powerful method in searching coefficients for bi-exponential and tri-exponential fitting functions. The bi- and tri-exponential models of Iodine-125 seed AgX-100 point and line sources obtained with PSO optimization provide accurate analytical forms of the radial dose function. The tri-exponential fitting function is more accurate than the bi-exponential function.

  9. Permanent and removable implants for the brachytherapy of brain tumors

    SciTech Connect

    Gutin, P.H.; Phillips, T.L.; Hosobuchi, Y.

    1981-10-01

    Thirty-seven patients harboring primary or metastatic brain tumors were treated with 40 implantations of radioactive sources (/sup 192/Ir, /sup 198/Au, or /sup 125/I) using stereotactic neurosurgical techniques. Most tumors had recurred after surgery, whole brain irradiation, and treatment with all feasible chemotherapeutic agents. Sixteen of the 40 implants were pregnant; 24 were mounted in plastic catheters for removal after the desired dose had been delivered. One or more sources were placed in each tumor to deliver 3500-7350 rad to the tumor's periphery for /sup 198/Au, 4,000-12,000 rad for /sup 192/Ir, and 3,000-20,000 rad for /sup 125/I. Three of the six patients treated with /sup 192/Ir had objective responses for 2, 4, and 12 months, and two stabilized for 8 and 11 months. Seven of the 11 patients treated with /sup 198/Au were evaluable: three responded for 3, 5, and 37 + months, one deteriorating patient with a recurrent tumor stabilized for 6 months, and two deteriorated despite treatment. One patient received an interstitial ''boost'' dose with /sup 198/Au after whole brain irradiation and stabilized for 15 months before developing spinal metastases. Six patients received permanent implants with low activity /sup 125/I. Three of these patients had blioblastomas or anaplastic astrocytomas; all continued to deteriorate despite the interstitial irradiation, presumably because the dose rat was too low. One patient with a low-grade astrocytoma (optic chiasm) responded dramatically to permanent, low activity /sup 125/I implants (11 + months). Another (hypothalamic glioma) had a permanent /sup 125/I implant, responded, as was stable at 9 months when external irradiation was administered. One patient with a suprasellar ''teratoid'' tumor stabilized for 10 months.

  10. Analysis of iodine-125 interstitial therapy in the treatment of localized carcinoma of the prostate

    SciTech Connect

    Gomella, L.G.; Steinberg, S.M.; Ellison, M.F.; Reeves, W.W.; Flanigan, R.C.; McRoberts, J.W. )

    1991-04-01

    Definitive treatment of localized carcinoma of the prostate has included radical surgery, external beam radiation therapy, and interstitial radiation therapy. The interstitial agent most commonly used is Iodine-125. Forty-eight patients were treated with interstitial radiation therapy using Iodine-125 implants with a median follow-up of 55 months. Forty-three percent of the evaluable patients had progressive disease with approximately 50% progressing at 5 years by Kaplan-Meier analysis. Overall actuarial survival in the group was 80% at 5 years. This and several other studies suggest that control of prostate cancer with Iodine-125 seeds may be suboptimal as compared with other treatment modalities, especially the radical retropubic prostatectomy. Analysis of treatment parameters is presented along with a discussion of the current status and future prospects for treatment of localized carcinoma of the prostate with interstitial radiation therapy.

  11. Improved iodine-125 plaque design in the treatment of choroidal malignant melanoma.

    PubMed Central

    Hill, J C; Sealy, R; Shackleton, D; Stannard, C; Korrubel, J; Hering, E; Loxton, C

    1992-01-01

    The use and development of iodine-125 plaque therapy for choroidal malignant melanoma are described. Since 1975 experience has led to changes in plaque design and insertion techniques. Twenty-one patients were irradiated with local episcleral iodine-125 plaques. Three patients required a second plaque for tumour recurrence. Four eyes were enucleated because of continued tumour growth and a further eye was removed because of glaucoma secondary to radiation retinopathy. Two patients (9.5%) died of metastases. The remaining 19 patients are alive and clinically clear of metastases, with a mean follow up time of 73.1 months (range 43-142 months). PMID:1739723

  12. Long-Term Outcome for Clinically Localized Prostate Cancer Treated With Permanent Interstitial Brachytherapy

    SciTech Connect

    Taira, Al V.; Merrick, Gregory S.; Butler, Wayne M.; Galbreath, Robert W.; Lief, Jonathan; Adamovich, Edward; Wallner, Kent E.

    2011-04-01

    Purpose: To present the largest series of prostate cancer brachytherapy patients treated with modern brachytherapy techniques and postimplant day 0 dosimetric evaluation. Methods and Materials: Between April 1995 and July 2006, 1,656 consecutive patients were treated with permanent interstitial brachytherapy. Risk group stratification was carried out according to the Mt. Sinai guidelines. Median follow-up was 7.0 years. The median day 0 minimum dose covering at least 90% of the target volume was 118.8% of the prescription dose. Cause of death was determined for each deceased patient. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on the evaluated survival parameters. Results: At 12 years, biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) for the entire cohort was 95.6%, 98.2%, and 72.6%, respectively. For low-, intermediate-, and high-risk patients, bPFS was 98.6%, 96.5%, and 90.5%; CSS was 99.8%, 99.3%, and 95.2%; and OS was 77.5%, 71.1%, and 69.2%, respectively. For biochemically controlled patients, the median posttreatment prostate-specific antigen (PSA) concentration was 0.02 ng/ml. bPFS was most closely related to percent positive biopsy specimens and risk group, while Gleason score was the strongest predictor of CSS. OS was best predicted by patient age, hypertension, diabetes, and tobacco use. At 12 years, biochemical failure and cause-specific mortality were 1.8% and 0.2%, 5.1% and 2.1%, and 10.4% and 7.1% for Gleason scores 5 to 6 and 7 and {>=}8, respectively. Conclusions: Excellent long-term outcomes are achievable with high-quality brachytherapy for low-, intermediate-, and high-risk patients. These results compare favorably to alternative treatment modalities including radical prostatectomy.

  13. [Brachytherapy].

    PubMed

    Itami, Jun

    2014-12-01

    Brachytherapy do require a minimal expansion of CTV to obtain PTV and it is called as ultimate high precision radiation therapy. In high-dose rate brachytherapy, applicators will be placed around or into the tumor and CT or MRI will be performed with the applicators in situ. With such image-guided brachytherapy (IGBT) 3-dimensional treatment planning becomes possible and DVH of the tumor and organs at risk can be obtained. It is now even possible to make forward planning satisfying dose constraints. Traditional subjective evaluation of brachytherapy can be improved to the objective one by IGBT. Brachytherapy of the prostate cancer, cervical cancer, and breast cancer with IGBT technique was described. PMID:25596048

  14. Rectal-wall dose dependence on postplan timing after permanent-seed prostate brachytherapy

    SciTech Connect

    Taussky, Daniel; Yeung, Ivan; Williams, Theresa; Pearson, Shannon; McLean, Michael; Pond, Gregory; Crook, Juanita . E-mail: Juanita.crook@rmp.uhn.on.ca

    2006-06-01

    Purpose: Dose to rectal wall after permanent-seed prostate brachytherapy is dependent on distance between posterior prostatic seeds and anterior rectal wall and is influenced by postimplant periprostatic edema. We analyzed the effect of postplan timing on anterior rectal-wall dose. Methods and Materials: Twenty patients received permanent seed {sup 125}I brachytherapy as monotherapy (145 Gy). Implants were preplanned by use of transrectal ultrasound (TRUS) and carried out by use of preloaded needles. Postimplant dosimetry was calculated by use of magnetic resonance imaging-computed tomography fusion on Days 1, 8, and 30. The anterior rectal-wall dose is reported as the isodose enclosing 1.0 or 2.0 cc of rectal wall and as the RV100 in cc. Results: The dose to rectal wall increased progressively over time. The median increase in dose to 1.0 cc of rectal wall (RD [1 cc]) from Day 1 to 30 was 39.2 Gy (p < 0.001). RV100 increased from a median of 0.07 cc on Day 1 to 0.67 cc on Day 30. The most significant predictor of rectal-wall dose (RD [1 cc], RD [2 cc], or RV100) was the time of evaluation (p < 0.001). Conclusion: Although periprostatic edema cannot be quantified by postimplant imaging, the dose to the anterior rectal wall increases significantly over time as prostatic and periprostatic edema resolve. Critical-organ dose reporting and guidelines for minimizing toxicity must take into account the time of the assessment.

  15. Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy

    SciTech Connect

    Masucci, Giuseppina Laura; Donath, David; Tetreault-Laflamme, Audrey; Carrier, Jean-Francois; Hervieux, Yannick; Larouche, Renee Xaviere; Bahary, Jean-Paul; Taussky, Daniel

    2010-11-01

    Purpose: To compare low (mean 0.44, SD {+-} 0.0163 mCi) with high source activity (0.61 {+-} 0.0178 mCi) in I{sup 125} permanent seed brachytherapy regarding seed loss, dosimetric outcome, and toxicity. Methods and Materials: The study included 199 patients with prostate cancer treated by permanent seed brachytherapy alone: the first 105 with seeds of lower activity (first cohort), the following 94 with higher seed activity (second cohort). The V100, V150, V200, and D90 were analyzed on the CT scan 30 days after implantation (CTD30). The V100, V150, and D2 of the rectum were also calculated on CTD30. Seed loss was determined 30 days after implantation. Urinary toxicity was measured with the International Prostate Symptom Score (IPSS) questionnaire. Results: Lower seed activity was associated with lower V150 and V200 (p = 0.01 and p {<=} 0.001, respectively) on CTD30. More patients had a V100 <90% and D90 <140 Gy in the lower activity cohort (p = 0.098 for D90 and p = 0.029 for V100) on CTD30. There was no difference between cohorts in dose to the rectum (p = 0.325-0.516) or difference in patients' IPSS score from baseline (p = 0.0.117-0.618), although there was a trend toward more urinary toxicity at 4 and 8 months for high activity seeds. Seed loss as a percentage of implanted seeds was not different (p = 0.324). Conclusions: Higher seed activity (I{sup 125} {>=} 0.6 mCi) results in at least equal V100 and D90 on CTD30. However, dose inhomogeneity and a trend toward more urinary toxicity at 4 and 8 months after treatment may lead to a higher long-term urinary complications.

  16. Brachytherapy

    MedlinePlus

    ... smaller area in less time than conventional external beam radiation therapy. Brachytherapy is used to treat cancers ... to kill cancer cells and shrink tumors. External beam radiation therapy (EBRT) involves high-energy x-ray ...

  17. Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy

    SciTech Connect

    Beyer, David C. . E-mail: dbeyer@azoncology.com; McKeough, Timothy; Thomas, Theresa

    2005-04-01

    Purpose: To review the impact of prior hormonal therapy on 10-year overall and prostate cancer specific survival after primary brachytherapy. Methods and Materials: A retrospective review was performed on the Arizona Oncology Services tumor registry for 2,378 consecutive permanent prostate brachytherapy cases from 1988 through 2001. Hormonal therapy was administered before the implant in 464 patients for downsizing of the prostate or at the discretion of the referring physician. All deceased patients with known clinical recurrence were considered to have died of prostate cancer, irrespective of the immediate cause of death. Risk groups were defined, with 1,135 favorable (prostate-specific antigen [PSA] < 10, Gleason < 7, Stage T1-T2a), 787 intermediate (single adverse feature), and 456 unfavorable (two or more adverse features) patients. Kaplan-Meier actuarial survival curves were generated for both overall and cause-specific survival from the time of treatment. Multivariate analysis was performed to assess the impact of hormonal intervention in comparison with known risk factors of grade, PSA, and age. Results: With follow-up ranging up to 12.6 years and a median of 4.1 year, a total of 474 patients died, with 67 recorded as due to prostate cancer. Overall and cause-specific 10-year survival rates are 43% and 88%, respectively. Overall survival is 44% for the hormone naive patients, compared with 20% for the hormone-treated cohort (p = 0.02). The cancer-specific survival is 89% vs. 81% for the same groups (p = 0.133). Multivariate analysis confirms the significance of age > 70 years (p = 0.0013), Gleason score {>=} 7 (p = 0.0005), and prior hormone use (p = 0.0065) on overall survival. Conclusions: At 10 years, in prostate cancer patients receiving brachytherapy, overall survival is worse in men receiving neoadjuvant hormonal therapy, compared with hormone naive patients. This does not appear to be due to other known risk factors for survival (i.e., stage, grade

  18. Sequential evaluation of prostate edema after permanent seed prostate brachytherapy using CT-MRI fusion

    SciTech Connect

    Taussky, Daniel; Austen, Lyn; Toi, Ants; Yeung, Ivan; Williams, Theresa; Pearson, Shannon; McLean, Michael; Pond, Gregory; Crook, Juanita . E-mail: juanita.crook@rmp.uhn.on.ca

    2005-07-15

    Purpose: To analyze the extent and time course of prostate edema and its effect on dosimetry after permanent seed prostate brachytherapy. Methods and Materials: Twenty patients scheduled for permanent seed {sup 125}I prostate brachytherapy agreed to a prospective study on postimplant edema. Implants were preplanned using transrectal ultrasonography. Postimplant dosimetry was calculated using computed tomography-magnetic resonance imaging (CT-MRI) fusion on the day of the implant (Day 1) and Days 8 and 30. The prostate was contoured on MRI, and the seeds were located on CT. Factors investigated for an influence on edema were the number of seeds and needles, preimplant prostate volume, transitional zone index (transition zone volume divided by prostate volume), age, and prostate-specific antigen level. Prostate dosimetry was evaluated by the percentage of the prostate volume receiving 100% of the prescribed dose (V{sub 100}) and percentage of prescribed dose received by 90% of the prostate volume (D{sub 90}). Results: Prostate edema was maximal on Day 1, with the median prostate volume 31% greater than preimplant transrectal ultrasound volume (range, 0.93-1.72; p < 0.001) and decreased with time. It was 21% greater than baseline at Day 8 (p = 0.013) and 5% greater on Day 30 (p < 0.001). Three patients still had a prostate volume greater than baseline by Day 30. The extent of edema depended on the transition zone volume (p = 0.016) and the preplan prostate volume (p 0.003). The median V{sub 100} on Day 1 was 93.6% (range, 86.0-98.2%) and was 96.3% (range, 85.7-99.5%) on Day 30 (p = 0.079). Patients with a Day 1 V{sub 100} >93% were less affected by edema resolution, showing a median increase in V{sub 100} of 0.67% on Day 30 compared with 2.77% for patients with a V{sub 100} <93 % on Day 1. Conclusion: Despite the extreme range of postimplant edema, the effect on dosimetry was less than expected. Dose coverage of the prostate was good for all patients during Days 1

  19. Focal partial salvage low-dose-rate brachytherapy for local recurrent prostate cancer after permanent prostate brachytherapy with a review of the literature

    PubMed Central

    Wakumoto, Yoshiaki; Yamaguchi, Nanae; Horie, Shigeo; Sasai, Keisuke

    2016-01-01

    Purpose To investigate the treatment results for focal partial salvage re-implantation against local recurrence after permanent prostate brachytherapy. Material and methods Between January 2010 and September 2015, 12 patients were treated with focal partial salvage re-implantation for local recurrence after low-dose-rate brachytherapy using 125I seeds. The focal clinical target volume (F-CTV) was delineated on positive biopsy areas in a mapping biopsy, combining the cold spots on the post-implant dosimetry for initial brachytherapy. The F-CTV was expanded by 3 mm to create the planning target volume (PTV) as a margin to compensate for uncertainties in image registration and treatment delivery. The prescribed dose to the PTV was 145 Gy. The characteristics and biochemical disease-free survival (BdFS) rates were analyzed. Genitourinary (GU) and gastrointestinal (GI) toxicities were evaluated using the Common Terminology Criteria for Adverse Events version 4. Results The median prostate-specific antigen (PSA) level at re-implantation was 4.09 ng/ml (range: 2.91-8.24 ng/ml). The median follow-up time was 56 months (range: 6-74 months). The median RD2cc and UD10 were 63 Gy and 159 Gy, respectively. The 4-year BdFS rate was 78%, which included non-responders. Biochemical recurrence occurred in two patients after 7 and 31 months, respectively. The former was treated with hormonal therapy after biochemical failure, and the latter underwent watchful waiting (PSA at the last follow-up of 53 months: 7.3 ng/ml) at the patient's request. No patients had grade 3 GU/GI toxicities or died after salvage re-implantation. Conclusions The partial salvage low-dose-rate brachytherapy used to treat local recurrence after permanent prostate brachytherapy is well-tolerated, with high biochemical response rates. This treatment can be not only a method to delay chemical castration but also a curative treatment option in cases of local recurrence of prostate carcinoma after seed implantation

  20. Prostate biopsy after definitive treatment by interstitial iodine 125 implant or external beam radiation therapy

    SciTech Connect

    Schellhammer, P.F.; el-Mahdi, A.M.; Higgins, E.M.; Schultheiss, T.E.; Ladaga, L.E.; Babb, T.J.

    1987-05-01

    The response to definitive radiation therapy of localized carcinoma of the prostate by iodine 125 implantation or external beam radiotherapy was monitored by examining specimens from biopsies performed after treatment. We analyzed 126 biopsy specimens obtained 18 months or more after treatment: 71 were obtained from 109 patients treated by iodine 125 and 55 from 197 patients treated by external beam radiotherapy. Thereafter, the disease status of these patients was examined at minimum 3-year intervals. No significant statistical difference was found between the negative specimen rates of the 2 treatment modalities: 46 of 71 (65 per cent) after iodine 125 implantation and 39 of 55 (71 per cent) after external beam radiotherapy were negative. To analyze the predictive value of biopsy results 103 patients whose prostatic examination results were normal at biopsy or who showed regression of tumor size and tumor induration after radiation were evaluated. The biopsy results from all patients were combined for analysis. Of 77 patients with negative biopsy specimens 16 (21 per cent) have had recurrent disease, compared to 17 of 26 (65 per cent) with positive biopsy specimens (p equals 0.00005). Of the 77 patients with negative biopsy specimens 7 (9 per cent) had local disease recurrence, compared to 12 of 26 (46 per cent) with a positive biopsy specimen (p equals 0.0001). The value of a positive specimen to predict failure remained significant with patients stratified by pre-treatment clinical stage and grade of the disease. Our results show that patients with positive specimens from the prostate who had been judged clinically by rectal examination to have responded to radiation therapy had a significantly increased incidence of local and distant failure compared to patients who had negative biopsy specimens.

  1. [Intraoperative and post-implant dosimetry in patients treated with permanent prostate implant brachytherapy].

    PubMed

    Herein, András; Ágoston, Péter; Szabó, Zoltán; Jorgo, Kliton; Markgruber, Balázs; Pesznyák, Csilla; Polgár, Csaba; Major, Tibor

    2015-06-01

    The purpose of our work was to compare intraoperative and four-week post-implant dosimetry for loose and stranded seed implants for permanent prostate implant brachytherapy. In our institute low-dose-rate (LDR) prostate brachytherapy is performed with encapsulated I-125 isotopes (seeds) using transrectal ultrasound guidance and metal needles. The SPOT PRO 3.1 (Elekta, Sweden) system is used for treatment planning. In this study the first 79 patients were treated with loose seed (LS) technique, the consecutive patients were treated with stranded seed (SS) technique. During intraoperative planning the dose constraints were the same for both techniques. All LSs were placed inside the prostate capsule, while with SS a 2 mm margin around the prostate was allowed for seed positioning. The prescribed dose for the prostate was 145 Gy. This study investigated prostate dose coverage in 30-30 randomly selected patients with LS and SS. Four weeks after the implantation native CT and MRI were done and CT/MRI image fusion was performed. The target was contoured on MRI and the plan was prepared on CT data. To assess the treatment plan dose-volume histograms were used. For the target coverage V100, V90, D90, D100, for the dose inhomogeneity V150, V200, and the dose-homogeneity index (DHI), for dose conformality the conformal index (COIN) were calculated. Intraoperative and postimplant plans were compared. The mean V100 values decreased at four-week plan for SS (97% vs. 84%) and for LS (96% vs. 80%) technique, as well. Decrease was observed for all parameters except for the DHI value. The DHI increased for SS (0.38 vs. 0.41) and for LS (0.38 vs. 0.47) technique, as well. The COIN decreased for both techniques at four-week plan (SS: 0.63 vs. 0.57; LS: 0.67 vs. 0.50). All differences were significant except for the DHI value at SS technique. The percentage changes were not significant, except the COIN value. The dose coverage of the target decreased significantly at four-week plans

  2. Chemoembolization and stenting combined with iodine-125 seed strands for the treatment of hepatocellular carcinoma with inferior vena cava obstruction

    PubMed Central

    LI, WENHUI; DAI, ZHENYU; YAO, LIZHENG; LUO, JIANJUN; YAN, ZHIPING

    2015-01-01

    The aim of the present study was to investigate the efficacy and safety of stenting combined with radioactive iodine-125 seed strands following chemoembolization for the treatment of patients with hepatocellular carcinoma and inferior vena cava (IVC) obstruction. A retrospective analysis was conducted of 52 hepatocellular carcinoma patients with IVC obstruction. All patients received chemoembolization of tumor-supplying arteries and IVC stents, and 18 patients additionally received iodine-125 seed strands, which were fixed to the stents. Improvement of IVC obstruction and the tumor response rates were compared between the two groups with a median follow-up time of 2.5 months. In both groups the stents were successfully deployed. At the 2-month post-procedural follow-up, the mean diameter of the IVC obstruction site, the mean pressure difference between the distal IVC obstructive segment and the right atrium as well as the obstruction scoring did not differ significantly between the two groups. By contrast, the tumor response rate of the iodine-125 seed strand group was 94.4%, whereas for the group without iodine-125 seed strands it was 35.3% (P<0.001). The combination of stent and iodine-125 seed strands was effective and safe for the treatment of hepatocellular carcinoma with IVC obstruction. PMID:26622424

  3. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer

    SciTech Connect

    Rosenthal, Seth A.; Bittner, Nathan H.J.; Demanes, D. Jeffrey; Goldsmith, Brian J.; Horwitz, Eric M.; Ibbott, Geoffrey S.; Lee, W. Robert; Nag, Subir; Suh, W. Warren; Potters, Louis

    2011-02-01

    Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachtherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program.

  4. Intra-operative Iodine-125 prostatic implant following bilateral pelvic lymphadenectomy

    SciTech Connect

    Kwong, E.W.H.; Huh, S.H.; Nobler, M.P.; Smith, H.S.

    1984-05-01

    Sixty-five patients with prostatic adenocarcinoma Stages B and C were treated with intraoperative Iodine-125 prostatic implantation following bilateral pelvic lymphadenectomy. Pelvic nodal metastases were found in 31% of the patients. All the patients have been followed for a period of 1 1/2 to 6 years. Serial digital rectal examination revealed complete regression of the palpable disease in 15% of the patients at 6 months, 47% at 1 year, and 87% at 2 years. Post-operative complications were also evaluated: 13% of the patients became sexually impotent, 11% had impaired potency after the procedure, and 26% of patients complained of dry ejaculation; and 17% developed scrotal and/or penile swelling, which persisted up to 14 months, but usually subsided within 5 months. Two patients developed local recurrence.

  5. Urethra-Sparing, Intraoperative, Real-Time Planned, Permanent-Seed Prostate Brachytherapy: Toxicity Analysis

    SciTech Connect

    Zilli, Thomas; Taussky, Daniel; Donath, David; Le, Hoa Phong; Larouche, Renee-Xaviere; Beliveau-Nadeau, Dominique; Hervieux, Yannick; Delouya, Guila

    2011-11-15

    Purpose: To report the toxicity outcome in patients with localized prostate cancer undergoing {sup 125}I permanent-seed brachytherapy (BT) according to a urethra-sparing, intraoperative (IO), real-time planned conformal technique. Methods and Materials: Data were analyzed on 250 patients treated consecutively for low- or intermediate-risk prostate cancer between 2005 and 2009. The planned goal was urethral V{sub 150} = 0. Acute and late genitourinary (GU), gastrointestinal (GI), and erectile toxicities were scored with the International Prostate Symptom Score (IPSS) questionnaire and Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time for patients with at least 2 years of follow-up (n = 130) was 34.4 months (range, 24-56.9 months). Results: Mean IO urethra V{sub 150} was 0.018% {+-} 0.08%. Mean prostate D{sub 90} and V{sub 100} on day-30 computed tomography scan were 158.0 {+-} 27.0 Gy and 92.1% {+-} 7.2%, respectively. Mean IPSS peak was 9.5 {+-} 6.3 1 month after BT (mean difference from baseline IPSS, 5.3). No acute GI toxicity was observed in 86.8% of patients. The 3-year probability of Grade {>=}2 late GU toxicity-free survival was 77.4% {+-} 4.0%, with Grade 3 late GU toxicity encountered in only 3 patients. Three-year Grade 1 late GI toxicity-free survival was 86.1% {+-} 3.2%. No patient presented Grade {>=}2 late GI toxicity. Of patients with normal sexual status at baseline, 20.7% manifested Grade {>=}2 erectile dysfunction after BT. On multivariate analysis, elevated baseline IPSS (p = 0.016) and high-activity sources (median 0.61 mCi) (p = 0.033) predicted increased Grade {>=}2 late GU toxicity. Conclusions: Urethra-sparing IO BT results in low acute and late GU toxicity compared with the literature. High seed activity and elevated IPSS at baseline increased long-term GU toxicity.

  6. Isotope and Patient Age Predict for PSA Spikes After Permanent Prostate Brachytherapy

    SciTech Connect

    Bostancic, Chelsea; Merrick, Gregory S. . E-mail: gmerrick@urologicresearchinstitute.org; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah; Galbreath, Robert; Lief, Jonathan; Gutman, Sarah E.

    2007-08-01

    Purpose: To evaluate prostate-specific antigen (PSA) spikes after permanent prostate brachytherapy in low-risk patients. Methods and Materials: The study population consisted of 164 prostate cancer patients who were part of a prospective randomized trial comparing {sup 103}Pd and {sup 125}I for low-risk disease. Of the 164 patients, 61 (37.2%) received short-course androgen deprivation therapy. The median follow-up was 5.4 years. On average, 11.1 post-treatment PSA measurements were obtained per patient. Biochemical disease-free survival was defined as a PSA level of {<=}0.40 ng/mL after nadir. A PSA spike was defined as an increase of {>=}0.2 ng/mL, followed by a durable decline to prespike levels. Multiple parameters were evaluated as predictors for a PSA spike. Results: Of the 164 patients, 44 (26.9%) developed a PSA spike. Of the 46 hormone-naive {sup 125}I patients and 57 hormone-naive {sup 103}Pd patients, 21 (45.7%) and 8 (14.0%) developed a PSA spike. In the hormone-naive patients, the mean time between implantation and the spike was 22.6 months and 18.7 months for {sup 125}I and {sup 103}Pd, respectively. In patients receiving neoadjuvant androgen deprivation therapy, the incidence of spikes was comparable between isotopes ({sup 125}I 28.1% and {sup 103}Pd 20.7%). The incidence of spikes was substantially different in patients <65 years vs. {>=}65 years old (38.5% vs. 16.3%). On multivariate Cox regression analysis, patient age (p < 0.001) and isotope (p = 0.002) were significant predictors for spike. Conclusion: In low-risk prostate cancer, PSA spikes are most common in patients implanted with {sup 125}I and/or <65 years of age. Differences in isotope-related spikes are most pronounced in hormone-naive patients.

  7. SU-F-19A-08: Optimal Time Release Schedule of In-Situ Drug Release During Permanent Prostate Brachytherapy

    SciTech Connect

    Cormack, R; Ngwa, W; Makrigiorgos, G; Tangutoori, S; Rajiv, K; Sridhar, S

    2014-06-15

    Purpose: Permanent prostate brachytherapy spacers can be used to deliver sustained doses of radiosentitizing drug directly to the target, in order to enhance the radiation effect. Implantable nanoplatforms for chemo-radiation therapy (INCeRTs) have a maximum drug capacity and can be engineered to control the drug release schedule. The optimal schedule for sensitization during continuous low dose rate irradiation is unknown. This work studies the optimal release schedule of drug for both traditional sensitizers, and those that work by suppressing DNA repair processes. Methods: Six brachytherapy treatment plans were used to model the anatomy, implant geometry and calculate the spatial distribution of radiation dose and drug concentrations for a range of drug diffusion parameters. Three state partial differential equations (cells healthy, damaged or dead) modeled the effect of continuous radiation (radiosensitivities α,β) and cellular repair (time tr) on a cell population. Radiosensitization was modeled as concentration dependent change in α,β or tr which with variable duration under the constraint of fixed total drug release. Average cell kill was used to measure effectiveness. Sensitization by means of both enhanced damage and reduced repair were studied. Results: Optimal release duration is dependent on the concentration of radiosensitizer compared to the saturation concentration (csat) above which additional sensitization does not occur. Long duration drug release when enhancing α or β maximizes cell death when drug concentrations are generally over csat. Short term release is optimal for concentrations below saturation. Sensitization by suppressing repair has a similar though less distinct trend that is more affected by the radiation dose distribution. Conclusion: Models of sustained local radiosensitization show potential to increase the effectiveness of radiation in permanent prostate brachytherapy. INCeRTs with high drug capacity produce the greatest

  8. Effects of iodine-125 seeds on the methylation of SFRP2 and P16 in colorectal cancer

    PubMed Central

    LI, XIAOGANG; LU, PING; LI, BO; ZHANG, WANGFU; LUO, KAIYUAN

    2013-01-01

    The current study investigated the effects of iodine-125 seeds on the gene methylation of SFRP2 and P16 in colorectal cancer. Mouse models of human colorectal cancer were randomly divided into an experimental group (n=25) and a control group (n=25). The control group was implanted with blank seeds (0 MBq) and the experimental group with iodine-125 seeds (14.8 MBq). At 20 days after implantation, the animals were sacrificed. The methylation levels of SFRP2 and P16 were detected using methylation-specific polymerase chain reactions (MSPs). Following iodine-125 seed irradiation, the level of SFRP2 methylation decreased. The methylation index of the experimental group (0.67±0.05) was significantly lower than that of the control group (0.84±0.07; P<0.05). In the experimental group, 10 samples (40%) displayed methylation in the P16 promoter region compared with 14 (56%) in the control group, which was a significant difference (P<0.05). Iodine-125 seeds induce the downregulation of methylated tumor suppressor gene promoters, thereby inhibiting the proliferation and growth of tumor cells. PMID:24223648

  9. Matched-pair analysis and dosimetric variations of two types of software for interstitial permanent brachytherapy for prostate cancer.

    PubMed

    Ishiyama, Hiromichi; Nakamura, Ryuji; Satoh, Takefumi; Tanji, Susumu; Teh, Bin S; Uemae, Mineko; Baba, Shiro; Hayakawa, Kazushige

    2012-01-01

    The purpose of this study was to determine whether identical dosimetric results could be achieved using different planning software for permanent interstitial brachytherapy for prostate cancer. Data from 492 patients treated with brachytherapy were used for matched-pair analysis. Interplant and Variseed were used as software for ultrasound-based treatment planning. Institution, neoadjuvant hormonal therapy, prostate volume, and source strength were used for factors to match the 2 groups. The study population comprised of 126 patients with treatment planning using Interplant software and 127 matched patients using Variseed software. Dosimetric results were compared between the 2 groups. The Variseed group showed significantly higher values for dose covering 90% of prostate volume (pD90), prostate volume covered by 150% of prescription dose (pV150), and dose covering 30% of the urethra (uD30) compared with the Interplant group. Our results showed that use of different software could lead to different dosimetric results, which might affect the clinical outcomes. PMID:21937217

  10. The clinical utility of image-guided iodine-125 seed in patients with unresectable pancreatic cancer.

    PubMed

    Niu, Hongxin; Zhang, Xikun; Wang, Bin; Zhou, Zhao; Wang, Jian; Xu, Zhongfa

    2016-02-01

    In the present study, we investigated the clinical effects of image-guided iodine-125 ((125)I) seed on unresectable pancreatic cancer. Twenty-five patients with unresectable pancreatic cancer were enrolled in this study, including 13 patients with seed implantation and 12 patients as control. The survival status, clinical benefits, objective curative effects, and relevant tumor markers were analyzed to assess the feasibility and safety of interstitial (125)I seed implantation. We found that the clinical benefit rate of the seed implantation group is 92.3 % (12/13), compared with 41.7 % (5/12) in the control, and the difference was statistically significant (p < 0.01). Compared with control, patients with seed implantation had significantly shorter operative time, less bleeding, higher albumin, shorter periods to bowel movement, and normal diet as well as lower risk of complications (p < 0.001). The differences of objective curative effects adverse effects, complications, and median survival between these two groups were not significant statistically (p > 0.05). In conclusion, (125)I seed implantation provides a safe and effective method to inhibit the tumor development, relieve pain, and improve quality of life for unresectable pancreatic cancer. These findings need to be validated by conducting further studies with larger cohorts. PMID:26353858

  11. Distant Metastases Following Permanent Interstitial Brachytherapy for Patients With Clinically Localized Prostate Cancer

    SciTech Connect

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan; Adamovich, Edward; Wallner, Kent E.

    2012-02-01

    Purpose: Recent publications have suggested high-risk patients undergoing radical prostatectomy have a lower risk of distant metastases and improved cause-specific survival (CSS) than patients receiving definitive external beam radiation therapy (XRT). To date, none of these studies has compared distant metastases and CSS in brachytherapy patients. In this study, we evaluate such parameters in a consecutive cohort of brachytherapy patients. Methods and Materials: From April 1995 to June 2007, 1,840 consecutive patients with clinically localized prostate cancer were treated with brachytherapy. Risk groups were stratified according to National Comprehensive Cancer Network ( (www.nccn.org)) guidelines. Subgroups of 658, 893, and 289 patients were assigned to low, intermediate, and high-risk categories. Median follow-up was 7.2 years. Along with brachytherapy implantation, 901 (49.0%) patients received supplemental XRT, and 670 (36.4%) patients received androgen deprivation therapy (median duration, 4 months). The mode of failure (biochemical, local, or distant) was determined for each patient for whom therapy failed. Cause of death was determined for each deceased patient. Multiple parameters were evaluated for impact on outcome. Results: For the entire cohort, metastases-free survival (MFS) and CSS at 12 years were 98.1% and 98.2%, respectively. When rates were stratified by low, intermediate, and high-risk groups, the 12-year MFS was 99.8%, 98.1%, and 93.8% (p < 0.001), respectively. CSS rates were 99.8%, 98.0%, and 95.3% (p < 0.001) for low, intermediate, and high-risk groups, respectively. Biochemical progression-free survival was 98.7%, 95.9% and 90.4% for low, intermediate, and high-risk patients, respectively (p < 0.001). In multivariate Cox-regression analysis, MFS was mostly closely related to Gleason score and year of treatment, whereas CSS was most closely associated with Gleason score. Conclusions: Excellent CSS and MFS rates are achievable with high

  12. Method for the simultaneous preparation of Radon-211, Xenon-125, Xenon-123, Astatine-211, Iodine-125 and Iodine-123

    DOEpatents

    Mirzadeh, Saed; Lambrecht, Richard M.

    1987-01-01

    A method for simultaneously preparing Radon-211, Astatine-211, Xenon-125, Xenon-123, Iodine-125 and Iodine-123 in a process that includes irradiating a fertile metal material then using a one-step chemical procedure to collect a first mixture of about equal amounts of Radon-211 and Xenon-125, and a separate second mixture of about equal amounts of Iodine-123 and Astatine-211.

  13. Iodine-125-labeled cRGD-gold nanoparticles as tumor-targeted radiosensitizer and imaging agent

    NASA Astrophysics Data System (ADS)

    Su, Ning; Dang, Yajie; Liang, Guangli; Liu, Guizhi

    2015-04-01

    Research interests on radiosensitive property of gold nanoparticles (GNPs) are rapidly raised because of the extensively proved in vitro effectiveness and clinical necessity. However, the issue of targeted accumulation of GNPs in tumor tissues hindered the transference to in vivo applications. In this study, hybrid nano-sized cyclic Arg-Gly-Asp-conjugated GNPs (cRGD-GNPs) integrated with radioactive iodine-125 was fabricated as tumor-targeted radiosensitizer. Therapeutic effects, including acute apoptosis (2 days post treatment) and long-term influence (up to 21 days), were investigated on NCI-H446 tumor-bearing mice via Tc-99 m-Annexin V SPECT and volume measurements, respectively. Apoptosis and volume loss were consistent in showing that tumor growth was effectively suppressed via the treatment of 125I-cRGD-GNP sensitized radiotherapy (RT), a more significantly radiosensitive effect than the treatment of non-targeted GNPs with RT, RT treatment alone, and no treatment. SPECT/CT images showed that the uptake of cRGD-GNPs by tumor tissues reached the peak target/non-target value of 4.76 at around 2 h post injection, and dynamic radioactivity monitoring showed that 125I-cRGD-GNPs maintained about 2.5% of injected dosage at 55 h post injection. For long-term influence, a significant radiosensitized RT-induced volume loss was observed. Hence, cyclic RGD conjugation makes the GNP-based radiosensitizer tumor targeting, offering a new modality for enhancing radiotherapeutic efficacy. Additionally, the introduction of I-125 serves as both a therapeutic factor and a radiotracer for in vivo tracking of GNPs.

  14. Source strength assay of iodine-125 seeds sealed within sterile packaging.

    PubMed

    Otani, Yuki; Yamada, Takahiro; Kato, Shingo; Shikama, Naoto; Funakoshi, Kazuto; Kuroda, Isao; Numasaki, Hodaka; Nose, Takayuki; Dokiya, Takushi; Oguchi, Masahiko

    2013-01-01

    Early-stage prostate cancer is widely treated by iodine-125 (I-125) seed implantation. While quality assurance methods are in place to assure consistency in I-125 seed source strength, current methods involve the breaking of the sterilization package, raising issues concerning sterility and time limitations. The purpose of this study was to develop a method of characterizing the total source strength of I-125 seeds within a cartridge that has been sealed within a sterilization package and to evaluate the probability of detecting an out-of-calibration seed (aberrant seed). We defined a protocol to determine the ability of a well-type ionization chamber to detect aberrant I-125 seeds within a cartridge sealed in the sterilization package. A novel jig for a well-type ionization chamber was designed to accommodate the sterilization package. One seed was chosen randomly from two cartridges containing five or 15 seeds (0.544 U source strength) and was exchanged with aberrant seeds of six different source strengths. The source strength was measured at each position within the cartridge. The results indicated that the response of the well chamber was sensitive to changes in the aberrant seed position within the cartridge and the source strength of the aberrant seed. The correlation coefficient between single seed and batch assay results was high (0.998). A novel jig and a measurement method using a well ionization chamber were developed, which allowed for a batch assay characterization of the total source strength of I-125 seeds within a cartridge sealed within sterilization package. This method is simple, time-saving, and offers greater practical application. PMID:23470939

  15. Natural History of Clinically Staged Low- and Intermediate-Risk Prostate Cancer Treated With Monotherapeutic Permanent Interstitial Brachytherapy

    SciTech Connect

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Wallner, Kent E.; Butler, Wayne M.

    2010-02-01

    Purpose: To evaluate the natural history of clinically staged low- and intermediate-risk prostate cancer treated with permanent interstitial seed implants as monotherapy. Methods and Materials: Between April 1995 and May 2005, 463 patients with clinically localized prostate cancer underwent brachytherapy as the sole definitive treatment. Men who received supplemental external beam radiotherapy or androgen deprivation therapy were excluded. Dosimetric implant quality was determined based on the minimum dose that covered 90% of the target volume and the volume of the prostate gland receiving 100% of the prescribed dose. Multiple parameters were evaluated as predictors of treatment outcomes. Results: The 12-year biochemical progression-free survival (bPFS), cause-specific survival, and overall survival rates for the entire cohort were 97.1%, 99.7%, and 75.4%, respectively. Only pretreatment prostate-specific antigen level, percent positive biopsy cores, and minimum dose that covered 90% of the target volume were significant predictors of biochemical recurrence. The bPFS, cause-specific survival, and overall survival rates were 97.4%, 99.6%, and 76.2%, respectively, for low-risk patients and 96.4%, 100%, and 74.0%, respectively, for intermediate-risk patients. The bPFS rate was 98.8% for low-risk patients with high-quality implants versus 92.1% for those with less adequate implants (p < 0.01), and it was 98.3% for intermediate-risk patients with high-quality implants versus 86.4% for those with less adequate implants (p < 0.01). Conclusions: High-quality brachytherapy implants as monotherapy can provide excellent outcomes for men with clinically staged low- and intermediate-risk prostate cancer. For these men, a high-quality implant can achieve results comparable to high-quality surgery in the most favorable pathologically staged patient subgroups.

  16. Metallic artifact mitigation and organ-constrained tissue assignment for Monte Carlo calculations of permanent implant lung brachytherapy

    SciTech Connect

    Sutherland, J. G. H.; Miksys, N.; Thomson, R. M.; Furutani, K. M.

    2014-01-15

    assignment within lung contours are employed in generated phantoms, this erroneous assignment is reduced, generally resulting in higher doses. Lung-constrained tissue assignment also results in increased doses in regions of interest due to a reduction in the erroneous assignment of adipose to voxels within lung contours. Differences in dose metrics calculated for different computational phantoms are sensitive to radionuclide photon spectra with the largest differences for{sup 103}Pd seeds and smallest but still considerable differences for {sup 131}Cs seeds. Conclusions: Despite producing differences in CT images, dose metrics calculated using the STR, fan beam + STR, and 3D median filter techniques produce similar dose metrics. Results suggest that the accuracy of dose distributions for permanent implant lung brachytherapy is improved by applying lung-constrained tissue assignment schemes to metallic artifact corrected images.

  17. Impact of prostate edema on cell survival and tumor control after permanent interstitial brachytherapy for early stage prostate cancers

    PubMed Central

    Chen, Zhe (Jay); Roberts, Kenneth; Decker, Roy; Pathare, Pradip; Rockwell, Sara; Nath, Ravinder

    2011-01-01

    Previous studies have shown that the procedure-induced prostate edema during permanent interstitial brachytherapy (PIB) can cause significant variations in the dose delivered to the prostate gland. Because the clinical impact of edema-induced dose variations depends strongly on the magnitude of the edema, the temporal pattern of its resolution and its interplay with the decay of radioactivity and the underlying biological processes of tumor cells (such as tumor potential doubling time), we investigated the impact of edema-induced dose variations on the tumor cell survival and tumor control probability after PIB with the 131Cs, 125I and 103Pd sources used in current clinical practice. The exponential edema resolution model reported by Waterman et al. (Int. J. Radiat. Oncol. Biol. Phys. 41, 1069–1077–1998) was used to characterize the edema evolutions observed previously during clinical PIB for prostate cancer. The concept of biologically effective dose (BED), taking into account tumor cell proliferation and sublethal damage repair during dose delivery, was used to characterize the effects of prostate edema on cell survival and tumor control probability. Our calculation indicated that prostate edema, if not taken into account appropriately, can increase the cell survival and decrease the probability of local control of PIB. The edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life for radioactive decay and decreasing energy of the photons energy emitted by the source. At the doses currently prescribed for PIB and for prostate cancer cells characterized by nominal radiobiology parameters recommended by AAPM TG-137, PIB using 125I sources was less affected by edema than PIB using 131Cs or 103Pd sources due to the long radioactive decay half-life of 125I. The effect of edema on PIB using 131Cs or 103Pd was similar. The effect of edema on 103Pd PIB was slightly greater, even though the decay half-life of 103Pd (17 days

  18. The impact of prostate edema on cell survival and tumor control after permanent interstitial brachytherapy for early stage prostate cancers

    NASA Astrophysics Data System (ADS)

    (Jay Chen, Zhe; Roberts, Kenneth; Decker, Roy; Pathare, Pradip; Rockwell, Sara; Nath, Ravinder

    2011-08-01

    Previous studies have shown that procedure-induced prostate edema during permanent interstitial brachytherapy (PIB) can cause significant variations in the dose delivered to the prostate gland. Because the clinical impact of edema-induced dose variations strongly depends on the magnitude of the edema, the temporal pattern of its resolution and its interplay with the decay of radioactivity and the underlying biological processes of tumor cells (such as tumor potential doubling time), we investigated the impact of edema-induced dose variations on the tumor cell survival and tumor control probability after PIB with the 131Cs, 125I and 103Pd sources used in current clinical practice. The exponential edema resolution model reported by Waterman et al (1998 Int. J. Radiat. Oncol. Biol. Phys. 41 1069-77) was used to characterize the edema evolutions previously observed during clinical PIB for prostate cancer. The concept of biologically effective dose, taking into account tumor cell proliferation and sublethal damage repair during dose delivery, was used to characterize the effects of prostate edema on cell survival and tumor control probability. Our calculation indicated that prostate edema, if not appropriately taken into account, can increase the cell survival and decrease the probability of local control of PIB. The magnitude of an edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life of radioactive decay and decreasing photon energy emitted by the source. At the doses currently prescribed for PIB and for prostate cancer cells characterized by nominal radiobiology parameters recommended by AAPM TG-137, PIB using 125I sources was less affected by edema than PIB using 131Cs or 103Pd sources due to the long radioactive decay half-life of 125I. The effect of edema on PIB using 131Cs or 103Pd was similar. The effect of edema on 103Pd PIB was slightly greater, even though the decay half-life of 103Pd (17 days) is longer than

  19. Value of perioperative brachytherapy in the management of non-oat cell carcinoma of the lung

    SciTech Connect

    Hilaris, B.S.; Nori, D.; Beattie, E.J. Jr.; Martini, N.

    1983-08-01

    Nearly one-half of all patients with non-oat cell carcinoma of the lung are found to have mediastinal lymph node metastases at the time of initial presentation. There is no consensus today on what constitutes best treatment in patients whose disease is confined to the chest and in whom mediastinal lymph node metastases are the only evident site of tumor spread. The overall survival of these patients is so low that the majority have been either excluded from therapy or have been treated palliatively by external radiation therapy. In an attempt to improve the control of mediastinal lymph node metastases in the operable patients, a pilot study was begun in 1977 at Memorial Hospital to determine the value of perioperative brachytherapy (permanent Iodine-125 implantation of primary lung and a temporary Iridium-192 implantation of the mediastinum) with or without resection followed by a moderate dose of postoperative external beam irradiation. This pilot study has demonstrated that the combination of surgery, perioperative brachytherapy and external beam irradiation in non-oat cell carcinoma of the lung, metastatic to mediastinal lymph nodes, can improve the locoregional control and prolong survival with minimal early or late morbidity.

  20. Migration of a strand of four seeds in low-dose-rate brachytherapy

    PubMed Central

    Dedic-Hagan, Jasmina; Teh, Amy Y M; Liang, Eisen; Collett, Nicholas; Woo, Henry H

    2014-01-01

    We report a case of stranded-seed migration (one strand of four seeds), via the prostatic venous plexus to the internal pudendal vein, in low-dose-rate (LDR) prostate brachytherapy. A 70-year-old man with low-risk prostate adenocarcinoma underwent transperineal permanent seed implantation. A total of 93 iodine-125 seeds were implanted (91 stranded seeds and 2 loose seeds). Immediate postimplantation fluoroscopic image and day 1 postimplantation CT scan indicated all implanted seeds to be within the vicinity of the prostate as planned. Day 30 pelvic X-ray and CT scan revealed migration of a strand of four seeds to the right pelvis (adjacent to ischial spine). At 2 years postimplantation, the patient continues to have good disease control with prostate specific antigen level of 0.69 μg/L, and asymptomatic. To the best of our knowledge, this is the first report of migration of an entire strand of seeds following LDR prostate brachytherapy. PMID:24879735

  1. Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy

    SciTech Connect

    Kudchadker, Rajat J.; Pugh, Thomas J.; Swanson, David A.; Bruno, Teresa L.; Bolukbasi, Yasemin; Frank, Steven J.

    2012-01-01

    Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be achieved consistently using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R{sup 2} = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.

  2. Long-Term Biochemical and Survival Outcome of 921 Patients Treated With I-125 Permanent Prostate Brachytherapy

    SciTech Connect

    Hinnen, Karel A.; Battermann, Jan J.; Roermund, Joep G.H. van; Moerland, Marinus A.; Juergenliemk-Schulz, Ina M.; Frank, Steven J.; Vulpen, Marco van

    2010-04-15

    Purpose: To assess long-term biochemical and survival outcome after permanent prostate brachytherapy (BT). Methods and Materials: Data on 921 patients, treated with permanent interstitial BT monotherapy between 1989 and 2004 for <=T2c Nx/0 Mx/0 prostate cancer were evaluated. All patients were treated with I-125 seeds (prescription dose 144 Gy). Eighty-five patients with a gland volume >=50cc received 6 months of antiandrogen therapy before treatment. Patients were classified into risk groups with 232 defined as low-, 369 intermediate-, and 320 high-risk disease. The median follow-up was 69 months (range, 4-186 months); mean age was 67 years. Results: Average 5- and 10-year biochemical no evidence of disease (bNED) rates were 79% and 57%. Average 10-year bNED rates by risk group were 88% for low-risk, 61% for intermediate-risk, and 30% for high-risk disease. The average 10-year overall and disease-specific survival rates were 59% and 82%. Ten-year overall and disease-specific survival rates by risk group were, respectively, 68% and 96% for low-risk, and 64% 87% for intermediate-risk, and 49% and 69% for high-risk disease. In multivariate Cox regression analysis, both risk group and treatment era were independent predictors of bNED and survival. Conclusions: These data on long-term survival continue to support the use of I-125 monotherapy for prostate cancer in low-risk patients and, in particular, demonstrate its efficacy in intermediate-risk patients.

  3. Iodine-125 seed implantation as an adjunct to surgery in advanced recurrent squamous cell cancer of the head and neck

    SciTech Connect

    Park, R.I.; Liberman, F.Z.; Lee, D.J.; Goldsmith, M.M.; Price, J.C. )

    1991-04-01

    Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine-125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5-year disease-free survival was 41%, with both the overall and no evidence of disease 5-year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine-125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only.

  4. Ruthenium-106 brachytherapy.

    PubMed

    Pe'er, Jacob

    2012-01-01

    Brachytherapy is the most common method for treating uveal melanoma, and currently the ruthenium-106 (Ru-106) and iodine-125 (I-125) applicators are the most frequently used. Ru-106 applicators were introduced by Prof. Peter Lommatzsch in the 1960s, and since then have been used widely by many ocular oncologists, mainly in Europe. The Ru-106 isotope is a beta ray (electron) emitter, and as such it has a limited depth of penetration. This is the reason why many experts use Ru-106 applicators for tumors with a maximal thickness of up to 7.0 mm, although others use it successfully for thicker tumors. The Ru-106 applicators are manufactured commercially and have a half-life of about 1 year. Ru-106 brachytherapy for uveal melanoma provides excellent local control rates and eye preservation with a relatively low recurrence rate. The main advantage of Ru-106 over other isotopes is the better preservation of vision in the treated eye, and less damage to the healthy parts of the eye due to its limited range of radiation. This can also be achieved by positioning the Ru-106 plaque eccentrically, away from the macula and optic nerve head. Ru-106 brachytherapy can be used in combination with other methods of treatment of uveal melanoma, such as local resection or transpupillary thermotherapy, and is sporadically combined with other isotopes, such as gamma-emitting cobalt-60 and I-125. PMID:22042011

  5. Comparison of implant quality between intraoperatively built custom-linked seeds and loose seeds in permanent prostate brachytherapy using sector analysis

    PubMed Central

    Katayama, Norihisa; Takemoto, Mitsuhiro; Takamoto, Atsushi; Ihara, Hiroki; Katsui, Kuniaki; Ebara, Shin; Nasu, Yasutomo; Kanazawa, Susumu

    2016-01-01

    We compared the implant quality of intraoperatively built custom-linked (IBCL) seeds with loose seeds in permanent prostate brachytherapy. Between June 2012 and January 2015, 64 consecutive prostate cancer patients underwent brachytherapy with IBCL seeds (n = 32) or loose seeds (n = 32). All the patients were treated with 144 Gy of brachytherapy alone. Brachytherapy was performed using a dynamic dose calculation technique. Computed tomography/magnetic resonance imaging fusion-based dosimetry was performed 1 month after brachytherapy. Post-implant dose–volume histogram (DVH) parameters, prostate sector dosimetry, operation time, seed migration, and toxicities were compared between the IBCL seed group and the loose seed group. A sector analysis tool was used to divide the prostate into six sectors (anterior and posterior sectors at the base, mid-gland, and apex). V100 (95.3% vs 89.7%; P = 0.014) and D90 (169.7 Gy vs 152.6 Gy; P = 0.013) in the anterior base sector were significantly higher in the IBCL seed group than in the loose seed group. The seed migration rate was significantly lower in the IBCL seed group than in the loose seed group (6% vs 66%; P < 0.001). Operation time per seed was significantly longer in the IBCL seed group than in the loose seed group (1.31 min vs 1.13 min; P = 0.003). Other post-implant DVH parameters and toxicities did not differ significantly between the two groups. Our study showed more dose coverage post-operatively in the anterior base prostate sector and less seed migration in IBCL seed implantation compared with loose seed implantation. PMID:26976125

  6. Radiation dose to the internal pudendal arteries from permanent-seed prostate brachytherapy as determined by time-of-flight MR angiography

    SciTech Connect

    Gillan, Caitlin; Kirilova, Anna; Landon, Angela; Yeung, Ivan; Pond, Gregory; Crook, Juanita . E-mail: juanita.crook@rmp.uhn.on.ca

    2006-07-01

    Purpose: To determine the feasibility of time-of-flight magnetic resonance (MR) angiography to visualize the internal pudendal arteries (IPAs) in potent men undergoing permanent-seed prostate brachytherapy and to calculate the radiation dose received by these arteries. Methods and Materials: Prostate brachytherapy is performed at the University Health Network/Princess Margaret Hospital by use of transrectal ultrasound (TRUS) preplanning and preloaded needles. All patients received {sup 125}I, with a mean seed activity of 0.32 mCi/seed (0.41 U). Postplan evaluation is performed at 1 month by magnetic resonance-computed tomography fusion. Twenty consecutive potent men had time-of-flight MR angiography as part of their postplan evaluation. Results: The mean V100 was 96.5%, and the mean D90 was171.5 Gy. The IPAs were easily visualized for 18 of the 20 men. The mean peak dose received by the IPA was 17 Gy. The highest peak dose received by any patient was 38.2 Gy, with only 1 other patient receiving a peak dose greater than 30 Gy. Eleven of 18 had a measurable portion of at least 1 IPA that received 10% of the prescribed dose (V10 = 14.5 Gy). Only 2 patients had nonzero values for V25. The distal third of the IPA received the highest dose for 16 of the 18 patients. Conclusions: The IPAs can be well visualized in the majority of potent men by use of time-of-flight MR angiography 1 month after brachytherapy. The IPAs receive a low but calculable dose from permanent-seed {sup 125}I brachytherapy. Further research is needed to determine if this outcome has any correlation with subsequent potency.

  7. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer.

    PubMed

    Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-01-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D90 of 34Gy in 8.5Gy per fraction, and 145Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2Gy per fraction, EQD2) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The Dmean (EQD2) of rectum decreased 22.36Gy in HDR and 17.01Gy in LDR from 30.24Gy in VMAT, respectively. The Dmean (EQD2) of bladder decreased 6.91Gy in HDR and 2.53Gy in LDR from 13.46Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD2) was 80.26, 70.23, and 104.91Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR. PMID:27400663

  8. Permanent prostate brachytherapy: Dosimetric results and analysis of a learning curve with a dynamic dose-feedback technique

    SciTech Connect

    Acher, Peter . E-mail: peter.acher@gstt.nhs.uk; Popert, Rick; Nichol, Janette; Potters, Louis; Morris, Stephen; Beaney, Ronald

    2006-07-01

    Purpose: A permanent prostate brachytherapy (PPB) program utilizing intraoperative inverse-planned dynamic dose-feedback was initiated without prior firsthand experience of alternative techniques. The purpose of this study is to assess the dosimetric learning curve associated with this approach. Methods and Materials: A total of 77 patients underwent PPB implants as monotherapy for localized prostate cancer to a prescription dose of 145 Gy with loose 125I seeds between December 2003 and June 2004. Intraoperative and postoperative dosimetric values, total implanted radioactivity, and operating room (OR) times were compared by sequential case number for all cases. Results: The median intraoperative dosimetric values were: D90 (the minimum dose to 90% of the prostate) = 170 Gy (range, 135-203 Gy), V100 (the volume of the prostate that receives 100% of the prescription dose) = 96% (range, 86-100), V150 = 66% (range, 34-86). Median postoperative dosimetric values were as follows: D90 = 168 Gy (range, 132-197 Gy), V100 = 95% (range, 86-99), V150 = 74% (range, 51-84). Median implanted activity was 0.79 mCi per cubic centimeter of prostate (range, 0.541-1.13). There was no significant correlation by case number on any postoperative dosimetric parameter studied. Door-to-door OR time was reduced from median 138 to 97.5 min per case at the end of the series with a correlation coefficient of -0.76 for the initial 28 cases. Conclusion: Satisfactory dosimetric parameters can be achieved from the outset without a learning curve effect in an appropriately trained environment. The learning curve for dynamic dose-feedback PPB in a clinic naive to other techniques is apparent in terms of OR time.

  9. Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

    SciTech Connect

    Bittner, Nathan; Wallner, Kent E.

    2010-11-15

    Purpose: Standard prostate biopsy schemes underestimate Gleason score in a significant percentage of cases. Extended biopsy improves diagnostic accuracy and provides more reliable prognostic information. In this study, we tested the hypothesis that greater biopsy core number should result in improved treatment outcome through better tailoring of therapy. Methods and Materials: From April 1995 to May 2006, 1,613 prostate cancer patients were treated with permanent brachytherapy. Patients were divided into five groups stratified by the number of prostate biopsy cores ({<=}6, 7-9, 10-12, 13-20, and >20 cores). Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were evaluated as a function of core number. Results: The median patient age was 66 years, and the median preimplant prostate-specific antigen was 6.5 ng/mL. The overall 10-year bPFS, CSS, and OS were 95.6%, 98.3%, and 78.6%, respectively. When bPFS was analyzed as a function of core number, the 10-year bPFS for patients with >20, 13-20, 10-12, 7-9 and {<=}6 cores was 100%, 100%, 98.3%, 95.8%, and 93.0% (p < 0.001), respectively. When evaluated by treatment era (1995-2000 vs. 2001-2006), the number of biopsy cores remained a statistically significant predictor of bPFS. On multivariate analysis, the number of biopsy cores was predictive of bPFS but did not predict for CSS or OS. Conclusion: Greater biopsy core number was associated with a statistically significant improvement in bPFS. Comprehensive regional sampling of the prostate may enhance diagnostic accuracy compared to a standard biopsy scheme, resulting in better tailoring of therapy.

  10. Dosimetry of permanent interstitial prostate brachytherapy for an interoperative procedure, using O-arm based CT and TRUS

    PubMed Central

    Sekiguchi, Akane; Satoh, Takefumi; Tsumura, Hideyasu; Takenaka, Kouji; Kawakami, Shogo; Tabata, Ken-ichi; Kobayashi, Kentaro; Iwamura, Masatsugu; Hayakawa, Kazushige

    2016-01-01

    Purpose The aim of this report is dosimetric evaluation for an intraoperative fusion computed tomography (CT) as a superior predictor of 1-month CT based dosimetry in comparison to transrectal ultrasound (TRUS) in permanent interstitial prostate brachytherapy. Material and methods Data of 65 patients treated with seed implantation were analyzed. All procedures has been performed with patients in the lithotomy position inside the O-arm system. An end-fine probe is used as a landmark to fuse TRUS and O-arm-based CT images. There was no difference in the patient's position, probe position, and timing of image acquisition between the two imaging modalities. Dose-volume histogram (DVH) parameters such as the dose to 90% of prostate volume (D90) has been analyzed. Results The area under the curve of the receiver operating characteristic tended to be larger on fusion CT than on TRUS for most DVH parameters (71.85% vs. 59.59% for D90; p = 0.07). Significant relationships between fusion CT and 1-month CT were confirmed using Pearson's correlation coefficients for most DVH parameters (R = 0.48, p < 0.01 for D90), although the relationship between TRUS and 1-month CT was poor. Large dose reduction (35 Gy for D90) was seen from TRUS to fusion CT, especially in patients with high body weight and small prostate volume. Conclusions Intraoperative fusion CT appears to have higher predictive power for 1-month CT-based dosimetry than TRUS. A prospective trial using fusion CT-based planning is warranted. PMID:26985192

  11. Multi-Parametric MRI-Directed Focal Salvage Permanent Interstitial Brachytherapy for Locally Recurrent Adenocarcinoma of the Prostate: A Novel Approach

    PubMed Central

    Wallace, T.; Avital, I.; Stojadinovic, A.; Brücher, B.L.D.M.; Cote, E.; Yu, J.

    2013-01-01

    Even with the technological advances of dose-escalated IMRT with the addition of the latest image guidance technologies, local failures still occur. The combination of MRI-based imaging techniques can yield quantitative information that reflects on the biological properties of prostatic tissues. These techniques provide unique information that can be used for tumor detection in the treated gland. With the advent of these improved imaging modalities, it has become possible to more effectively image local recurrences within the prostate gland. With better imaging, these focal recurrences can be differentially targeted with salvage brachytherapy minimizing rectal and bladder toxicity. Here we report a novel use of MRI-directed focal brachytherapy after local recurrence. This technique offers a unique opportunity to safely and successfully treat recurrent prostate cancer, previously treated with definitive radiation therapy. The use of multi-parametric MRI-directed focal salvage permanent interstitial brachytherapy for locally recurrent adenocarcinoma of the prostate is a promising strategy to avoid more aggressive and expensive treatments that are associated with increased morbidity, potentially improving survival at potentially lower costs. PMID:23412660

  12. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes

    SciTech Connect

    Stone, Nelson N.; Stock, Richard G.; Cesaretti, Jamie A.; Unger, Pam

    2010-02-01

    Purpose: To determine factors that influence local control and systemic relapse in patients undergoing permanent prostate brachytherapy (PPB). Methods and Materials: A total of 584 patients receiving PPB alone or PPB with external beam radiation therapy (19.5%) agreed to undergo prostate biopsy (PB) at 2 years postimplantion and yearly if results were positive or if the prostate-specific antigen (PSA) level increased. Short-term hormone therapy was used with 280 (47.9%) patients. Radiation doses were converted to biologically effective doses (BED) (using alpha/beta = 2). Comparisons were made by chi-square analysis and linear regression. Survival was determined by the Kaplan-Meier method. Results: The median PSA concentration was 7.1 ng/ml, and the median follow-up period was 7.1 years. PB results were positive for 48/584 (8.2%) patients. Positive biopsy results by BED group were as follows: 22/121 (18.2%) patients received a BED of <=150 Gy; 15/244 (6.1%) patients received >150 to 200 Gy; and 6/193 (3.1%; p < 0.001) patients received >200 Gy. Significant associations of positive PB results by risk group were low-risk group BED (p = 0.019), intermediate-risk group hormone therapy (p = 0.011) and BED (p = 0.040), and high-risk group BED (p = 0.004). Biochemical freedom from failure rate at 7 years was 82.7%. Biochemical freedom from failure rate by PB result was 84.7% for negative results vs. 59.2% for positive results (p < 0.001). Cox regression analysis revealed significant associations with BED (p = 0.038) and PB results (p = 0.002) in low-risk patients, with BED (p = 0.003) in intermediate-risk patients, and with Gleason score (p = 0.006), PSA level (p < 0.001), and PB result (p = 0.038) in high-risk patients. Fifty-three (9.1%) patients died, of which eight deaths were due to prostate cancer. Cause-specific survival was 99.2% for negative PB results vs. 87.6% for positive PB results (p < 0.001). Conclusions: Higher radiation doses are required to achieve local

  13. High-activity iodine-125 endocurietherapy for head and neck tumors

    SciTech Connect

    Kumar, P.P.; Good, R.R.; Yonkers, A.J.; Ogren, F.P.

    1989-02-01

    Inoperable solid tumor recurrence within a surgical bed or within a previously irradiated field usually responds poorly to re-treatment with conventional external beam irradiation (EXRT) and/or chemotherapy. We present a new, alternative method of re-treatment used in two patients with recurrent head and neck cancer involving the parotid (adenocarcinoma) and neck nodes (squamous cell carcinoma). These patients were successfully re-treated with high-activity /sup 125/iodine (I-125) permanent implantation.

  14. Selecting Patients for Exclusive Permanent Implant Prostate Brachytherapy: The Experience of the Paris Institut Curie/Cochin Hospital/Necker Hospital Group on 809 Patients

    SciTech Connect

    Cosset, Jean-Marc Flam, Thierry; Thiounn, Nicolas; Gomme, Stephanie; Rosenwald, Jean-Claude; Asselain, Bernard; Pontvert, Dominique; Henni, Mehdi; Debre, Bernard; Chauveinc, Laurent

    2008-07-15

    Purpose: The aim of this study was to analyze overall and relapse-free survival in a cohort of 809 patients, 34% of whom corresponded to a higher-risk group than American Brachytherapy Society (ABS) criteria. Methods and Materials: Between January 1999 and September 2004, 809 patients were treated with permanent loose 125 iodine seed implantation (IsoSeed Bebig, Eckert and Ziegler) by the Paris Institut Curie, Cochin Hospital, and Necker Hospital group. Of these 809 patients, 533 (65.9%) corresponded exactly to ABS criteria. Two hundred and seventy-six patients (34.1%) had a prostate-specific antigen (PSA) level between 10 and 15, or a Gleason score of 7, or both (non-ABS group). Results: Overall 5-year survival was 98%, with no difference between the ABS group and the non-ABS patient subgroups (p 0.62).Five-year relapse-free survival was 97% in the ABS group; it was significantly lower (p = 0.001) in the non-ABS group but remained satisfactory at 94%. On subgroup analysis, the results appeared to be better for the subgroup of patients with PSA 10-15 than for the subgroup with a Gleason score of 7. Conclusions: Our results suggest that selected patients in the intermediate-risk group of localized prostate cancers can be safely proposed as recipients of permanent implant brachytherapy as monotherapy.

  15. High-Risk Prostate Cancer With Gleason Score 8-10 and PSA Level {<=}15 ng/ mL Treated With Permanent Interstitial Brachytherapy

    SciTech Connect

    Fang, L. Christine; Merrick, Gregory S.; Butler, Wayne M.; Galbreath, Robert W.; Murray, Brian C.; Reed, Joshua L.; Adamovich, Edward; Wallner, Kent E.

    2011-11-15

    Purpose: With widespread prostate-specific antigen (PSA) screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by a Gleason score (GS) {>=}8 coupled with a relatively low PSA level. The optimal management of these patients has not been defined. Cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) were evaluated in brachytherapy patients with a GS {>=}8 and a PSA level {<=}15 ng/mL with or without androgen-deprivation therapy (ADT). Methods and Materials: From April 1995 to October 2005, 174 patients with GS {>=}8 and a PSA level {<=}15 ng/mL underwent permanent interstitial brachytherapy. Of the patients, 159 (91%) received supplemental external beam radiation, and 113 (64.9%) received ADT. The median follow-up was 6.6 years. The median postimplant Day 0 minimum percentage of the dose covering 90% of the target volume was 121.1% of prescription dose. Biochemical control was defined as a PSA level {<=}0.40 ng/mL after nadir. Multiple parameters were evaluated for impact on survival. Results: Ten-year outcomes for patients without and with ADT were 95.2% and 92.5%, respectively, for CSS (p = 0.562); 86.5% and 92.6%, respectively, for bPFS (p = 0.204); and 75.2% and 66.0%, respectively, for OS (p = 0.179). The median post-treatment PSA level for biochemically controlled patients was <0.02 ng/mL. Multivariate analysis failed to identify any predictors for CSS, whereas bPFS and OS were most closely related to patient age. Conclusions: Patients with GS {>=}8 and PSA level {<=}15 ng/mL have excellent bPFS and CSS after brachytherapy with supplemental external beam radiotherapy. The use of ADT did not significantly impact bPFS, CSS, or OS.

  16. Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy

    SciTech Connect

    Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Galbreath, Robert W.; Allen, Zachariah A. M.S.; Adamovich, Edward

    2006-07-01

    Purpose: To determine if androgen-deprivation therapy (ADT) has an impact on cause-specific, biochemical progression-free, or overall survival after prostate brachytherapy. Methods and Materials: From April 1995 through June 2002, 938 consecutive patients underwent brachytherapy for clinical Stage T1b to T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. A total of 382 patients (40.7%) received ADT with a duration of 6 months or less in 277 and more than 6 months in 105. The median follow-up was 5.4 years. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific, biochemical progression-free, and overall survival rates for the entire cohort were 96.4%, 95.9%, and 78.1%, respectively. Except for biochemical progression-free survival in high-risk patients, ADT did not statistically impact any of the three survival categories. A Cox linear-regression analysis demonstrated that Gleason score was the best predictor of cause-specific survival, whereas percent-positive biopsies, prostate volume, and risk group predicted for biochemical progression-free survival. Patient age and tobacco use were the strongest predictors of overall survival. One hundred two patients have died, with 80 of the deaths a result of cardiovascular disease (54) and second malignancies (26). To date, only 12 patients have died of metastatic prostate cancer. Conclusions: After brachytherapy, androgen-deprivation therapy did not have an impact on cause-specific or overall survival for any risk group; however, ADT had a beneficial effect on biochemical progression-free survival in high-risk patients. Cardiovascular disease and second malignancies far outweighed prostate cancer as competing causes of death.

  17. Radio-guided occult lesion localisation using iodine 125 Seeds “ROLLIS” to guide surgical removal of an impalpable posterior chest wall melanoma metastasis

    SciTech Connect

    Dissanayake, Shashini; Dissanayake, Deepthi; Taylor, Donna B

    2015-09-15

    Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 ({sup 125}I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

  18. Development of virtual patient models for permanent implant brachytherapy Monte Carlo dose calculations: interdependence of CT image artifact mitigation and tissue assignment.

    PubMed

    Miksys, N; Xu, C; Beaulieu, L; Thomson, R M

    2015-08-01

    This work investigates and compares CT image metallic artifact reduction (MAR) methods and tissue assignment schemes (TAS) for the development of virtual patient models for permanent implant brachytherapy Monte Carlo (MC) dose calculations. Four MAR techniques are investigated to mitigate seed artifacts from post-implant CT images of a homogeneous phantom and eight prostate patients: a raw sinogram approach using the original CT scanner data and three methods (simple threshold replacement (STR), 3D median filter, and virtual sinogram) requiring only the reconstructed CT image. Virtual patient models are developed using six TAS ranging from the AAPM-ESTRO-ABG TG-186 basic approach of assigning uniform density tissues (resulting in a model not dependent on MAR) to more complex models assigning prostate, calcification, and mixtures of prostate and calcification using CT-derived densities. The EGSnrc user-code BrachyDose is employed to calculate dose distributions. All four MAR methods eliminate bright seed spot artifacts, and the image-based methods provide comparable mitigation of artifacts compared with the raw sinogram approach. However, each MAR technique has limitations: STR is unable to mitigate low CT number artifacts, the median filter blurs the image which challenges the preservation of tissue heterogeneities, and both sinogram approaches introduce new streaks. Large local dose differences are generally due to differences in voxel tissue-type rather than mass density. The largest differences in target dose metrics (D90, V100, V150), over 50% lower compared to the other models, are when uncorrected CT images are used with TAS that consider calcifications. Metrics found using models which include calcifications are generally a few percent lower than prostate-only models. Generally, metrics from any MAR method and any TAS which considers calcifications agree within 6%. Overall, the studied MAR methods and TAS show promise for further retrospective MC dose

  19. Development of virtual patient models for permanent implant brachytherapy Monte Carlo dose calculations: interdependence of CT image artifact mitigation and tissue assignment

    NASA Astrophysics Data System (ADS)

    Miksys, N.; Xu, C.; Beaulieu, L.; Thomson, R. M.

    2015-08-01

    This work investigates and compares CT image metallic artifact reduction (MAR) methods and tissue assignment schemes (TAS) for the development of virtual patient models for permanent implant brachytherapy Monte Carlo (MC) dose calculations. Four MAR techniques are investigated to mitigate seed artifacts from post-implant CT images of a homogeneous phantom and eight prostate patients: a raw sinogram approach using the original CT scanner data and three methods (simple threshold replacement (STR), 3D median filter, and virtual sinogram) requiring only the reconstructed CT image. Virtual patient models are developed using six TAS ranging from the AAPM-ESTRO-ABG TG-186 basic approach of assigning uniform density tissues (resulting in a model not dependent on MAR) to more complex models assigning prostate, calcification, and mixtures of prostate and calcification using CT-derived densities. The EGSnrc user-code BrachyDose is employed to calculate dose distributions. All four MAR methods eliminate bright seed spot artifacts, and the image-based methods provide comparable mitigation of artifacts compared with the raw sinogram approach. However, each MAR technique has limitations: STR is unable to mitigate low CT number artifacts, the median filter blurs the image which challenges the preservation of tissue heterogeneities, and both sinogram approaches introduce new streaks. Large local dose differences are generally due to differences in voxel tissue-type rather than mass density. The largest differences in target dose metrics (D90, V100, V150), over 50% lower compared to the other models, are when uncorrected CT images are used with TAS that consider calcifications. Metrics found using models which include calcifications are generally a few percent lower than prostate-only models. Generally, metrics from any MAR method and any TAS which considers calcifications agree within 6%. Overall, the studied MAR methods and TAS show promise for further retrospective MC dose

  20. Mouse model of brachytherapy in consort with enucleation for treatment of malignant intraocular melanoma

    SciTech Connect

    Niederkorn, J.; Sanborn, G.E.; Scarbrough, E.E. )

    1990-06-01

    The efficacy of brachytherapy in the treatment and prevention of metastasis of intraocular melanoma was investigated in a mouse model. A highly metastatic subline of B16 melanoma was transplanted into the anterior segment of C57BL/6 mice and allowed to grow. Brachytherapy was delivered by means of miniature iodine 125 seeds implanted in shallow subcutaneous pockets of the upper eyelid margin of these mice, and 25 Gy of radiation was delivered between days 12 and 14. This brachytherapy reduced both the tumor volume and the number of mitotic figures per high-power field compared with irradiated controls. In a second experiment, 25 Gy of brachytherapy was delivered before enucleation, straddling enucleation, and after enucleation; there was a significant reduction in metastasis when radiation was delivered prior to enucleation. This model may be useful in conducting further studies involving brachytherapy with 125I plaque implants.

  1. Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors

    PubMed Central

    Zhang, Liyun; Lu, Jian; Wang, Zhongmin; Cheng, Yingsheng; Teng, Gaojun; Chen, Kemin

    2016-01-01

    Objective The purpose of this study was to examine the safety and clinical efficacy of computed tomography (CT)-guided radioactive iodine-125 (125I) seed implantation treatment in patients with spinal metastatic tumors. Methods We retrospectively analyzed 20 cases of spinal metastatic tumors, including nine men and eleven women aged 50–79 years (mean age: 61.1 years). We used treatment planning system (TPS) to construct three-dimensional images of the spinal metastatic tumors and to determine what number and dose rate distribution to use for the 125I seeds. The matched peripheral dose of the 125I seed implantation was 90–130 Gy. Twenty-four spinal metastatic tumors were treated by CT-guided radioactive 125I seed implantation. A median of 19 (range: 4–43) 125I seeds were implanted. Results Twenty cases were followed for a median of 15.3 months (range: 7–32 months). The rate of pain relief was 95%. The median control time for all of the patients was 12.5 months. The 3-, 6-, and 12-month cumulative local control rates were 100%, 95%, and 60%, respectively. The median survival time for all of the patients was 16 months. The cumulative 6- and 12-month survival rates were 100% and 78.81%, respectively. No major complications were observed. No 125I seeds were lost or migrated to other tissues or organs. Conclusion CT-guided radioactive 125I seed implantation is a safe, effective, and minimally invasive method for the treatment of patients with spinal metastatic tumors. It is a possible alternative therapy for the treatment of spinal metastases. PMID:26719712

  2. Predictive Factors for Acute and Late Urinary Toxicity After Permanent Prostate Brachytherapy: Long-Term Outcome in 712 Consecutive Patients

    SciTech Connect

    Keyes, Mira Miller, Stacy; Moravan, Veronika; Pickles, Tom; McKenzie, Michael; Pai, Howard; Liu, Mitchell; Kwan, Winkle; Agranovich, Alexander; Spadinger, Ingrid; Lapointe, Vincent; Halperin, Ross; Morris, W. James

    2009-03-15

    Purpose: To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity. Results: The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02). Conclusion: Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low

  3. Evaluation of the dosimetric parameters for 125I brachytherapy determined in prostate medium using CT images.

    PubMed

    Hanada, Takashi; Yorozu, Atsunori; Ohashi, Toshio; Shigematsu, Naoyuki; Maruyama, Koichi

    2010-01-01

    In the present study, the prostate medium determined from the CT images of 149 patients was developed. The dosimetric parameters such as Λ, g(L)(r) and F(r, θ) used in TG-43U1-based calculation for an iodine-125 ((125)I) brachytherapy-source were examined using Monte Carlo code Geant4. Clinical dosimetry parameters such as the D(90) were evaluated among a subgroup of 50 randomly selected patients who had been treated with permanent brachytherapy between January 2008 and December 2008 at the Tokyo Medical Center. The results show a slight difference in the dose rate constant Λ (within 1.0%). The radial dose function g(L)(r) exhibits a prominent difference in the region over 3 cm, and this difference is maintained within 2.9% in the region close to the source. The calculated values of F(r, θ) for the prostate medium were similar to values for water (within 1%), except in the longitudinal axis. A comparison of D(90) values shows a systematic dose overestimation of 2.8 ± 0.7 Gy in water, where the distribution of the differences can be seen with a spread of 1.8 ± 0.3% compared to that in prostate medium. It was concluded that the introduction of any kind of tissue correction for the TG-43U1-based calculation was not necessary to allow for the differences in elemental compositions and densities between water and prostate medium. PACS number: 87.00.00; 87.55.dk; 87.55.K-; 87.56.B-. PMID:20921822

  4. Dosimetric characterization of the GammaClip™{sup 169}Yb low dose rate permanent implant brachytherapy source for the treatment of nonsmall cell lung cancer postwedge resection

    SciTech Connect

    Currier, Blake; Munro, John J. III; Medich, David C.

    2013-08-15

    Purpose: A novel {sup 169}Yb low dose rate permanent implant brachytherapy source, the GammaClip™, was developed by Source Production and Equipment Co. (New Orleans, LA) which is designed similar to a surgical staple while delivering therapeutic radiation. In this report, the brachytherapy source was characterized in terms of “Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO” by Perez-Calatayud et al. [Med. Phys. 39, 2904–2929 (2012)] using the updated AAPM Task Group Report No. 43 formalism.Methods: Monte Carlo calculations were performed using Monte Carlo N-Particle 5, version 1.6 in water and air, the in-air photon spectrum filtered to remove photon energies below 10 keV in accordance with TG-43U1 recommendations and previously reviewed {sup 169}Yb energy cutoff levels [D. C. Medich, M. A. Tries, and J. M. Munro, “Monte Carlo characterization of an Ytterbium-169 high dose rate brachytherapy source with analysis of statistical uncertainty,” Med. Phys. 33, 163–172 (2006)]. TG-43U1 dosimetric data, including S{sub K}, D-dot (r,θ), Λ, g{sub L}(r), F(r, θ), φ{sub an}(r), and φ{sub an} were calculated along with their statistical uncertainties. Since the source is not axially symmetric, an additional set of calculations were performed to assess the resulting axial anisotropy.Results: The brachytherapy source's dose rate constant was calculated to be (1.22 ± 0.03) cGy h{sup −1} U{sup −1}. The uncertainty in the dose to water calculations, D-dot (r,θ), was determined to be 2.5%, dominated by the uncertainties in the cross sections. The anisotropy constant, φ{sub an}, was calculated to be 0.960 ± 0.011 and was obtained by integrating the anisotropy factor between 1 and 10 cm using a weighting factor proportional to r{sup −2}. The radial dose function was calculated at distances between 0.5 and 12 cm, with a maximum value of 1.20 at 5.15 ± 0.03 cm. Radial dose

  5. Dosimetric characterization of the GammaClip™ 169Yb low dose rate permanent implant brachytherapy source for the treatment of nonsmall cell lung cancer postwedge resection

    PubMed Central

    Currier, Blake; Munro, John J.; Medich, David C.

    2013-01-01

    Purpose: A novel 169Yb low dose rate permanent implant brachytherapy source, the GammaClip™, was developed by Source Production & Equipment Co. (New Orleans, LA) which is designed similar to a surgical staple while delivering therapeutic radiation. In this report, the brachytherapy source was characterized in terms of “Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO” by Perez-Calatayud [Med. Phys. 39, 2904–2929 (2012)]10.1118/1.3703892 using the updated AAPM Task Group Report No. 43 formalism. Methods: Monte Carlo calculations were performed using Monte Carlo N-Particle 5, version 1.6 in water and air, the in-air photon spectrum filtered to remove photon energies below 10 keV in accordance with TG-43U1 recommendations and previously reviewed 169Yb energy cutoff levels [D. C. Medich, M. A. Tries, and J. M. Munro, “Monte Carlo characterization of an Ytterbium-169 high dose rate brachytherapy source with analysis of statistical uncertainty,” Med. Phys. 33, 163–172 (2006)]10.1118/1.2147767. TG-43U1 dosimetric data, including SK, \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\dot D(r,\\theta)\\end{document}D˙(r,θ), Λ, gL(r), F(r, θ), ϕan(r), and \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{upgreek} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\bar \\phi _{an}\\end{document}ϕ¯an were calculated along with their statistical uncertainties. Since the source is not axially symmetric, an additional set of calculations were performed to assess the resulting axial anisotropy. Results: The brachytherapy source's dose rate constant was calculated to

  6. Canadian prostate brachytherapy in 2012

    PubMed Central

    Keyes, Mira; Crook, Juanita; Morris, W. James; Morton, Gerard; Pickles, Tom; Usmani, Nawaid; Vigneault, Eric

    2013-01-01

    Prostate brachytherapy can be used as a monotherapy for low- and intermediate-risk patients or in combination with external beam radiation therapy (EBRT) as a form of dose escalation for selected intermediate- and high-risk patients. Prostate brachytherapy with either permanent implants (low dose rate [LDR]) or temporary implants (high dose rate [HDR]) is emerging as the most effective radiation treatment for prostate cancer. Several large Canadian brachytherapy programs were established in the mid- to late-1990s. Prostate brachytherapy is offered in British Columbia, Alberta, Manitoba, Ontario, Quebec and New Brunswick. We anticipate the need for brachytherapy services in Canada will significantly increase in the near future. In this review, we summarize brachytherapy programs across Canada, contemporary eligibility criteria for the procedure, toxicity and prostate-specific antigen recurrence free survival (PRFS), as published from Canadian institutions for both LDR and HDR brachytherapy. PMID:23671495

  7. A radiobiology-based inverse treatment planning method for optimisation of permanent l-125 prostate implants in focal brachytherapy

    NASA Astrophysics Data System (ADS)

    Haworth, Annette; Mears, Christopher; Betts, John M.; Reynolds, Hayley M.; Tack, Guido; Leo, Kevin; Williams, Scott; Ebert, Martin A.

    2016-01-01

    Treatment plans for ten patients, initially treated with a conventional approach to low dose-rate brachytherapy (LDR, 145 Gy to entire prostate), were compared with plans for the same patients created with an inverse-optimisation planning process utilising a biologically-based objective. The ‘biological optimisation’ considered a non-uniform distribution of tumour cell density through the prostate based on known and expected locations of the tumour. Using dose planning-objectives derived from our previous biological-model validation study, the volume of the urethra receiving 125% of the conventional prescription (145 Gy) was reduced from a median value of 64% to less than 8% whilst maintaining high values of TCP. On average, the number of planned seeds was reduced from 85 to less than 75. The robustness of plans to random seed displacements needs to be carefully considered when using contemporary seed placement techniques. We conclude that an inverse planning approach to LDR treatments, based on a biological objective, has the potential to maintain high rates of tumour control whilst minimising dose to healthy tissue. In future, the radiobiological model will be informed using multi-parametric MRI to provide a personalised medicine approach.

  8. Postoperative Nomogram Predicting the 9-Year Probability of Prostate Cancer Recurrence After Permanent Prostate Brachytherapy Using Radiation Dose as a Prognostic Variable

    SciTech Connect

    Potters, Louis; Roach, Mack; Davis, Brian J.; Stock, Richard G.; Ciezki, Jay P.; Zelefsky, Michael J.; Stone, Nelson N.; Fearn, Paul A.; Yu Changhong; Shinohara, Katsuto; Kattan, Michael W.

    2010-03-15

    Purpose: To report a multi-institutional outcomes study on permanent prostate brachytherapy (PPB) to 9 years that includes postimplant dosimetry, to develop a postimplant nomogram predicting biochemical freedom from recurrence. Methods and Materials: Cox regression analysis was used to model the clinical information for 5,931 patients who underwent PPB for clinically localized prostate cancer from six centers. The model was validated against the dataset using bootstrapping. Disease progression was determined using the Phoenix definition. The biological equivalent dose was calculated from the minimum dose to 90% of the prostate volume (D90) and external-beam radiotherapy dose using an alpha/beta of 2. Results: The 9-year biochemical freedom from recurrence probability for the modeling set was 77% (95% confidence interval, 73-81%). In the model, prostate-specific antigen, Gleason sum, isotope, external beam radiation, year of treatment, and D90 were associated with recurrence (each p < 0.05), whereas clinical stage was not. The concordance index of the model was 0.710. Conclusion: A predictive model for a postimplant nomogram for prostate cancer recurrence at 9-years after PPB has been developed and validated from a large multi-institutional database. This study also demonstrates the significance of implant dosimetry for predicting outcome. Unique to predictive models, these nomograms may be used a priori to calculate a D90 that likely achieves a desired outcome with further validation. Thus, a personalized dose prescription can potentially be calculated for each patient.

  9. Feasibility of vibro-acoustography with a quasi-2D ultrasound array transducer for detection and localizing of permanent prostate brachytherapy seeds: A pilot ex vivo study

    SciTech Connect

    Mehrmohammadi, Mohammad; Kinnick, Randall R.; Fatemi, Mostafa; Alizad, Azra; Davis, Brian J.

    2014-09-15

    Purpose: Effective permanent prostate brachytherapy (PPB) requires precise placement of radioactive seeds in and around the prostate. The impetus for this research is to examine a new ultrasound-based imaging modality, vibro-acoustography (VA), which may serve to provide a high rate of PPB seed detection while also effecting enhanced prostate imaging. The authors investigate the ability of VA, implemented on a clinical ultrasound (US) scanner and equipped with a quasi-2D (Q2D) array US transducer, to detect and localize PPB seeds in excised prostate specimens. Methods: Nonradioactive brachytherapy seeds were implanted into four excised cadaver prostates. A clinical US scanner equipped with a Q2D array US transducer was customized to acquire both US and C-scan VA images at various depths. The VA images were then used to detect and localize the implanted seeds in prostate tissue. To validate the VA results, computed tomography (CT) images of the same tissue samples were obtained to serve as the reference by which to evaluate the performance of VA in PPB seed detection. Results: The results indicate that VA is capable of accurately identifying the presence and distribution of PPB seeds with a high imaging contrast. Moreover, a large ratio of the PPB seeds implanted into prostate tissue samples could be detected through acquired VA images. Using CT-based seed identification as the standard, VA was capable of detecting 74%–92% of the implanted seeds. Additionally, the angular independency of VA in detecting PPB seeds was demonstrated through a well-controlled phantom experiment. Conclusions: Q2DVA detected a substantial portion of the seeds by using a 2D array US transducer in excised prostate tissue specimens. While VA has inherent advantages associated with conventional US imaging, it has the additional advantage of permitting detection of PPB seeds independent of their orientation. These results suggest the potential of VA as a method for PPB imaging that

  10. Feasibility of vibro-acoustography with a quasi-2D ultrasound array transducer for detection and localizing of permanent prostate brachytherapy seeds: A pilot ex vivo study

    PubMed Central

    Mehrmohammadi, Mohammad; Alizad, Azra; Kinnick, Randall R.; Davis, Brian J.; Fatemi, Mostafa

    2014-01-01

    Purpose: Effective permanent prostate brachytherapy (PPB) requires precise placement of radioactive seeds in and around the prostate. The impetus for this research is to examine a new ultrasound-based imaging modality, vibro-acoustography (VA), which may serve to provide a high rate of PPB seed detection while also effecting enhanced prostate imaging. The authors investigate the ability of VA, implemented on a clinical ultrasound (US) scanner and equipped with a quasi-2D (Q2D) array US transducer, to detect and localize PPB seeds in excised prostate specimens. Methods: Nonradioactive brachytherapy seeds were implanted into four excised cadaver prostates. A clinical US scanner equipped with a Q2D array US transducer was customized to acquire both US and C-scan VA images at various depths. The VA images were then used to detect and localize the implanted seeds in prostate tissue. To validate the VA results, computed tomography (CT) images of the same tissue samples were obtained to serve as the reference by which to evaluate the performance of VA in PPB seed detection. Results: The results indicate that VA is capable of accurately identifying the presence and distribution of PPB seeds with a high imaging contrast. Moreover, a large ratio of the PPB seeds implanted into prostate tissue samples could be detected through acquired VA images. Using CT-based seed identification as the standard, VA was capable of detecting 74%–92% of the implanted seeds. Additionally, the angular independency of VA in detecting PPB seeds was demonstrated through a well-controlled phantom experiment. Conclusions: Q2DVA detected a substantial portion of the seeds by using a 2D array US transducer in excised prostate tissue specimens. While VA has inherent advantages associated with conventional US imaging, it has the additional advantage of permitting detection of PPB seeds independent of their orientation. These results suggest the potential of VA as a method for PPB imaging that

  11. A detailed radiobiological and dosimetric analysis of biochemical outcomes in a case-control study of permanent prostate brachytherapy patients

    SciTech Connect

    Butler, Wayne M.; Stewart, Renee R.; Merrick, Gregory S.

    2009-03-15

    the harmonic mean and expressions of the generalized EUD. In this case-control study of prostate brachytherapy biochemical failures and nonfailures, there were no radiobiological parameters derived from detailed DVH-based analysis that predicted for biochemical control. This may indicate that in our approach, implant dosimetry is at or near the limits of clinically effective dose escalation.

  12. AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: Report of Task Group 137

    PubMed Central

    Nath, Ravinder; Bice, William S.; Butler, Wayne M.; Chen, Zhe; Meigooni, Ali S.; Narayana, Vrinda; Rivard, Mark J.; Yu, Yan

    2009-01-01

    During the past decade, permanent radioactive source implantation of the prostate has become the standard of care for selected prostate cancer patients, and the techniques for implantation have evolved in many different forms. Although most implants use 125I or 103Pd sources, clinical use of 131Cs sources has also recently been introduced. These sources produce different dose distributions and irradiate the tumors at different dose rates. Ultrasound was used originally to guide the planning and implantation of sources in the tumor. More recently, CT and∕or MR are used routinely in many clinics for dose evaluation and planning. Several investigators reported that the tumor volumes and target volumes delineated from ultrasound, CT, and MR can vary substantially because of the inherent differences in these imaging modalities. It has also been reported that these volumes depend critically on the time of imaging after the implant. Many clinics, in particular those using intraoperative implantation, perform imaging only on the day of the implant. Because the effects of edema caused by surgical trauma can vary from one patient to another and resolve at different rates, the timing of imaging for dosimetry evaluation can have a profound effect on the dose reported (to have been delivered), i.e., for the same implant (same dose delivered), CT at different timing can yield different doses reported. Also, many different loading patterns and margins around the tumor volumes have been used, and these may lead to variations in the dose delivered. In this report, the current literature on these issues is reviewed, and the impact of these issues on the radiobiological response is estimated. The radiobiological models for the biological equivalent dose (BED) are reviewed. Starting with the BED model for acute single doses, the models for fractionated doses, continuous low-dose-rate irradiation, and both homogeneous and inhomogeneous dose distributions, as well as tumor cure

  13. AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: Report of Task Group 137

    SciTech Connect

    Nath, Ravinder; Bice, William S.; Butler, Wayne M.; Chen Zhe; Meigooni, Ali S.; Narayana, Vrinda; Rivard, Mark J.; Yu Yan

    2009-11-15

    During the past decade, permanent radioactive source implantation of the prostate has become the standard of care for selected prostate cancer patients, and the techniques for implantation have evolved in many different forms. Although most implants use {sup 125}I or {sup 103}Pd sources, clinical use of {sup 131}Cs sources has also recently been introduced. These sources produce different dose distributions and irradiate the tumors at different dose rates. Ultrasound was used originally to guide the planning and implantation of sources in the tumor. More recently, CT and/or MR are used routinely in many clinics for dose evaluation and planning. Several investigators reported that the tumor volumes and target volumes delineated from ultrasound, CT, and MR can vary substantially because of the inherent differences in these imaging modalities. It has also been reported that these volumes depend critically on the time of imaging after the implant. Many clinics, in particular those using intraoperative implantation, perform imaging only on the day of the implant. Because the effects of edema caused by surgical trauma can vary from one patient to another and resolve at different rates, the timing of imaging for dosimetry evaluation can have a profound effect on the dose reported (to have been delivered), i.e., for the same implant (same dose delivered), CT at different timing can yield different doses reported. Also, many different loading patterns and margins around the tumor volumes have been used, and these may lead to variations in the dose delivered. In this report, the current literature on these issues is reviewed, and the impact of these issues on the radiobiological response is estimated. The radiobiological models for the biological equivalent dose (BED) are reviewed. Starting with the BED model for acute single doses, the models for fractionated doses, continuous low-dose-rate irradiation, and both homogeneous and inhomogeneous dose distributions, as well as

  14. Vibro-acoustography with 1.75D ultrasound array transducer for detection and localization of permanent prostate brachytherapy seeds: ex vivo study

    NASA Astrophysics Data System (ADS)

    Mehrmohammadi, Mohammad; Alizad, Azra; Kinnick, Randall R.; Davis, Brian J.; Fatemi, Mostafa

    2013-03-01

    Effective brachytherapy procedures require precise placement of radioactive seeds in the prostate. Currently, transrectal ultrasound (TRUS) imaging is one of the main intraoperative imaging modalities to assist physicians in placement of brachytherapy seeds. However, the seed detection rate with TRUS is poor mainly because ultrasound imaging is highly sensitive to variations in seed orientation. The purpose of this study is to investigate the abilities of a new acoustic radiation force imaging modality, vibro-acoustography (VA), equipped with a 1.75D array transducer and implemented on a customized clinical ultrasound scanner, to image and localize brachytherapy seeds in prostatic tissue. To perform experiments, excised cadaver prostate specimens were implanted with dummy brachytherapy seeds, and embedded in tissue mimicking gel to simulate the properties of the surrounding soft tissues. The samples were scanned using the VA system and the resulting VA signals were used to reconstruct VA images at several depths inside the tissue. To further evaluate the performance of VA in detecting seeds, X-ray computed tomography (CT) images of the same tissue sample, were obtained and used as a gold-standard to compare the number of seeds detected by the two methods. Our results indicate that VA is capable of imaging of brachytherapy seeds with accuracy and high contrast, and can detect a large percentage of the seeds implanted within the tissue samples.

  15. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study

    SciTech Connect

    Buron, Catherine; Le Vu, Beatrice; Cosset, Jean-Marc; Peiffert, Didier; Delannes, Martine; Flam, Thierry; Guerif, Stephane; Salem, Naji; Chauveinc, Laurent; Livartowski, Alain . E-mail: alain.livartowski@curie.net

    2007-03-01

    Purpose: To prospectively compare health-related quality of life (HRQOL), patient-reported treatment-related symptoms, and costs of iodine-125 permanent implant interstitial brachytherapy (IB) with those of radical prostatectomy (RP) during the first 2 years after these treatments for localized prostate cancer. Methods and Materials: A total of 435 men with localized low-risk prostate cancer, from 11 French hospitals, treated with IB (308) or RP (127), were offered to complete the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire QLQ-C30 version 3 (EORTC QLQ-C30) and the prostate cancer specific EORTC QLQ-PR25 module before and at the end of treatment, 2, 6, 12, 18, and 24 months after treatment. Repeated measures analysis of variance and analysis of covariance were conducted on HRQOL changes. Comparative cost analysis covered initial treatment, hospital follow-up, outpatient and production loss costs. Results: Just after treatment, the decrease of global HRQOL was less pronounced in the IB than in the RP group, with a 13.5 points difference (p < 0.0001). A difference slightly in favor of RP was observed 6 months after treatment (-7.5 points, p = 0.0164) and was maintained at 24 months (-8.2 points, p = 0.0379). Impotence and urinary incontinence were more pronounced after RP, whereas urinary frequency, urgency, and urination pain were more frequent after IB. Mean societal costs did not differ between IB ( Euro 8,019 at T24) and RP ( Euro 8,715 at T24, p = 0.0843) regardless of the period. Conclusions: This study suggests a similar cost profile in France for IB and RP but with different HRQOL and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs.

  16. Differences in the intracellular processing of the radiolabel following the uptake of iodine-125- and technetium-99m-neogalactosyl albumin by the isolated perfused rat liver

    SciTech Connect

    Gore, S.; Morris, A.I.; Gilmore, I.T.; Maltby, P.J.; Thornback, J.R.; Billington, D. )

    1991-03-01

    Neogalactosyl albumin (NGA) is a synthetic ligand to the asialoglycoprotein receptor (hepatic binding protein), which has been proposed as a useful receptor binding radiopharmaceutical for the noninvasive assessment of liver function. We have compared the uptake and intracellular processing of iodine-125- (125I) and technetium-99m- ({sup 99m}Tc) NGA following its administration as a 1-min pulse (147 pmol) to the isolated perfused rat liver. Approximately 40% of a pulse of either {sup 125}I- or {sup 99m}Tc-NGA were taken up first pass by the liver. Of the {sup 125}I taken up by the liver, 82% was released after 15-20 min at the sinusoidal pole of the hepatocyte, predominantly as small molecular weight metabolites. A further 8% of the {sup 125}I-associated radioactivity was secreted as intact NGA into bile by the non-lysosomal (direct) pathway while 6% remained in the liver 1 hr after the pulse. In contrast, of the {sup 99m}Tc taken up by the liver, only 4% reappeared in the perfusate while 40% was secreted into bile by the lysosomal (indirect) pathway and 55% remained in the liver 1 hr after the pulse. Since labeled metabolites of {sup 99m}Tc-NGA do not appear in plasma, this permits kinetic modeling with {sup 99m}Tc-NGA without correction for labeled metabolites. Thus, {sup 99m}Tc-NGA is an excellent candidate as a receptor-binding radiopharmaceutical.

  17. Plastic optical fibre sensor for in-vivo radiation monitoring during brachytherapy

    NASA Astrophysics Data System (ADS)

    Woulfe, P.; Sullivan, F. J.; Lewis, E.; O'Keeffe, S.

    2015-09-01

    An optical fibre sensor is presented for applications in real-time in-vivo monitoring of the radiation dose a cancer patient receives during seed implantation in Brachytherapy. The sensor is based on radioluminescence whereby radiation sensitive scintillation material is embedded in the core of a 1mm plastic optical fibre. Three scintillation materials are investigated: thallium-doped caesium iodide (CsI:Tl), terbium-doped gadolinium oxysulphide (Gd2O2S:Tb) and europium-doped lanthanum oxysulphide (La2O2S:Eu). Terbium-doped gadolinium oxysulphide was identified as being the most suitable scintillator and further testing demonstrates its measureable response to different activities of Iodine-125, the radio-active source commonly used in Brachytherapy for treating prostate cancer.

  18. Rectal toxicity profile after transperineal interstitial permanent prostate brachytherapy: Use of a comprehensive toxicity scoring system and identification of rectal dosimetric toxicity predictors

    SciTech Connect

    Shah, Jinesh N.; Ennis, Ronald D. . E-mail: rennis@chpnet.org

    2006-03-01

    Purpose: To better understand rectal toxicity after prostate brachytherapy, we employed the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0), a comprehensive system with distinct and separately reported gastrointestinal adverse event items (unlike Radiation Therapy Oncology Group morbidity scoring), to evaluate item-specific postimplant rectal toxicities. Methods and Materials: We analyzed 135 patients treated with brachytherapy {+-} hormonal therapy, using CTCAE v3.0 to score acute/late rectal toxicities (median follow-up, 41 months). Dosimetric parameters were evaluated for ability to predict toxicities. Results: Use of CTCAE yielded a novel rectal toxicity profile consisting of diarrhea, incontinence, urgency, proctitis, pain, spasms, and hemorrhage event rates. No item had a <5% Grade 1-2 acute toxicity rate (except spasms). Rectal dosimetry predicted late toxicities: for diarrhea, 5% Grade 1 toxicity rate for %V{sub 25} (percent of rectal volume receiving 25% of prescribed prostate dose) {<=} 25% vs. 60% for %V{sub 25} > 25% (p < 0.001); for maximum toxicity, 10% Grade 1 toxicity rate for %V{sub 1} {<=} 40% vs. 44% for %V{sub 1} > 40% (p = 0.007). Conclusions: A comprehensive understanding of item-specific postimplant rectal toxicities was obtained using CTCAE. Rectal %V{sub 25} > 25% and %V{sub 1} > 40% predicted worse late diarrhea and maximum toxicity, respectively.

  19. Dosimetry of a thyroid uptake detected in seed migration survey following a patient's iodine-125 prostate implant and in vitro measurements of intentional seed leakages

    SciTech Connect

    Chen Qinsheng; Russell, John L. Jr.; Macklis, Roger R.; Weinhous, Martin S.; Blair, Henry F.

    2006-07-15

    As a quality control procedure, a post-implant seed migration survey has been accomplished on 340 prostate cancer patients since November 2001. Pulmonary seed embolization and intracardiac seed embolization have been detected. A case of thyroid uptake due to leaking iodine-125 (I-125) sources was also seized. In order to determine the dose to the thyroid, a dosimetry method was developed to link in vivo measurements and the cumulated dose to the thyroid. The calculated source leakage half-life in the case was approximately 15 days based on the measurements and the estimated cumulated dose to thyroid was 204 cGy. It is concluded that one seed was leaking. In order to verify the in vivo measurements, intentional in vitro seed leakage tests were performed. A seed was cut open and placed in a sealed glass container filled with a given volume of saline. The I-125 concentration in the saline was subsequently measured over a period of six months. Consistent in vivo and in vitro results were obtained. Recent incidents of seed leaks reported from other centers have drawn practitioners' attention to this problem. In order to make the measurements more useful, the seed leakage tests were expanded to include I-125 seeds from six other vendors. The results show that the leakage half-lives of those seeds varied from nine days to a half-year. Two seed models demonstrated least leakage. Since the measurements lasted for six months, the escape of iodine resulted from oxidation of iodide in the saline was a concern for the measurement accuracy. As a reference, another set of leakage tests were performed by adding sodium thiosulfate salt (Na{sub 2}S{sub 2}O{sub 3}{center_dot}5H{sub 2}O) to the saline. Sodium thiosulfate is a reducing agent that prevents the conversion of iodide to iodate so as to minimize I-125 evaporation. As a result, significantly shortened leakage half-lives were observed in this group. Seed agitation was also performed and no significant deviations of the

  20. Long-term Results of the UCSF-LBNL Randomized Trial: Charged Particle With Helium Ion Versus Iodine-125 Plaque Therapy for Choroidal and Ciliary Body Melanoma

    SciTech Connect

    Mishra, Kavita K.; Quivey, Jeanne M.; Daftari, Inder K.; Weinberg, Vivian; Cole, Tia B.; Patel, Kishan; Castro, Joseph R.; Phillips, Theodore L.; Char, Devron H.

    2015-06-01

    Purpose: Relevant clinical data are needed given the increasing national interest in charged particle radiation therapy (CPT) programs. Here we report long-term outcomes from the only randomized, stratified trial comparing CPT with iodine-125 plaque therapy for choroidal and ciliary body melanoma. Methods and Materials: From 1985 to 1991, 184 patients met eligibility criteria and were randomized to receive particle (86 patients) or plaque therapy (98 patients). Patients were stratified by tumor diameter, thickness, distance to disc/fovea, anterior extension, and visual acuity. Tumors close to the optic disc were included. Local tumor control, as well as eye preservation, metastases due to melanoma, and survival were evaluated. Results: Median follow-up times for particle and plaque arm patients were 14.6 years and 12.3 years, respectively (P=.22), and for those alive at last follow-up, 18.5 and 16.5 years, respectively (P=.81). Local control (LC) for particle versus plaque treatment was 100% versus 84% at 5 years, and 98% versus 79% at 12 years, respectively (log rank: P=.0006). If patients with tumors close to the disc (<2 mm) were excluded, CPT still resulted in significantly improved LC: 100% versus 90% at 5 years and 98% versus 86% at 12 years, respectively (log rank: P=.048). Enucleation rate was lower after CPT: 11% versus 22% at 5 years and 17% versus 37% at 12 years, respectively (log rank: P=.01). Using Cox regression model, likelihood ratio test, treatment was the most important predictor of LC (P=.0002) and eye preservation (P=.01). CPT was a significant predictor of prolonged disease-free survival (log rank: P=.001). Conclusions: Particle therapy resulted in significantly improved local control, eye preservation, and disease-free survival as confirmed by long-term outcomes from the only randomized study available to date comparing radiation modalities in choroidal and ciliary body melanoma.

  1. WE-A-17A-09: Exploiting Electromagnetic Technologies for Real-Time Seed Drop Position Validation in Permanent Implant Brachytherapy

    SciTech Connect

    Racine, E; Hautvast, G; Binnekamp, D; Beaulieu, L

    2014-06-15

    Purpose: To report on preliminary results validating the performance of a specially designed LDR brachytherapy needle prototype possessing both electromagnetic (EM) tracking and seed drop detection abilities. Methods: An EM hollow needle prototype has been designed and constructed in collaboration with research partner Philips Healthcare. The needle possesses conventional 3D tracking capabilities, along with a novel seed drop detection mechanism exploiting local changes of electromagnetic properties generated by the passage of seeds in the needle's embedded sensor coils. These two capabilities are exploited by proprietary engineering and signal processing techniques to generate seed drop position estimates in real-time treatment delivery. The electromagnetic tracking system (EMTS) used for the experiment is the NDI Aurora Planar Field Generator. The experiment consisted of dropping a total of 35 seeds in a prismatic agarose phantom, and comparing the 3D seed drop positions of the EMTS to those obtained by an image analysis of subsequent micro-CT scans. Drop position error computations and statistical analysis were performed after a 3D registration of the two seed distributions. Results: Of the 35 seeds dropped in the phantom, 32 were properly detected by the needle prototype. Absolute drop position errors among the detected seeds ranged from 0.5 to 4.8 mm with mean and standard deviation values of 1.6 and 0.9 mm, respectively. Error measurements also include undesirable and uncontrollable effects such as seed motion upon deposition. The true accuracy performance of the needle prototype is therefore underestimated. Conclusion: This preliminary study demonstrates the potential benefits of EM technologies in detecting the passage of seeds in a hollow needle as a means of generating drop position estimates in real-time treatment delivery. Such tools could therefore represent a potentially interesting addition to existing brachytherapy protocols for rapid dosimetry

  2. Clinical application and validation of an iterative forward projection matching algorithm for permanent brachytherapy seed localization from conebeam-CT x-ray projections

    SciTech Connect

    Pokhrel, Damodar; Murphy, Martin J.; Todor, Dorin A.; Weiss, Elisabeth; Williamson, Jeffrey F.

    2010-09-15

    Purpose: To experimentally validate a new algorithm for reconstructing the 3D positions of implanted brachytherapy seeds from postoperatively acquired 2D conebeam-CT (CBCT) projection images. Methods: The iterative forward projection matching (IFPM) algorithm finds the 3D seed geometry that minimizes the sum of the squared intensity differences between computed projections of an initial estimate of the seed configuration and radiographic projections of the implant. In-house machined phantoms, containing arrays of 12 and 72 seeds, respectively, are used to validate this method. Also, four {sup 103}Pd postimplant patients are scanned using an ACUITY digital simulator. Three to ten x-ray images are selected from the CBCT projection set and processed to create binary seed-only images. To quantify IFPM accuracy, the reconstructed seed positions are forward projected and overlaid on the measured seed images to find the nearest-neighbor distance between measured and computed seed positions for each image pair. Also, the estimated 3D seed coordinates are compared to known seed positions in the phantom and clinically obtained VariSeed planning coordinates for the patient data. Results: For the phantom study, seed localization error is (0.58{+-}0.33) mm. For all four patient cases, the mean registration error is better than 1 mm while compared against the measured seed projections. IFPM converges in 20-28 iterations, with a computation time of about 1.9-2.8 min/iteration on a 1 GHz processor. Conclusions: The IFPM algorithm avoids the need to match corresponding seeds in each projection as required by standard back-projection methods. The authors' results demonstrate {approx}1 mm accuracy in reconstructing the 3D positions of brachytherapy seeds from the measured 2D projections. This algorithm also successfully localizes overlapping clustered and highly migrated seeds in the implant.

  3. Comparison of Intraoperatively Built Custom Linked Seeds Versus Loose Seed Gun Applicator Technique Using Real-Time Intraoperative Planning for Permanent Prostate Brachytherapy

    SciTech Connect

    Zauls, A. Jason; Ashenafi, Michael S.; Onicescu, Georgiana; Clarke, Harry S.; Marshall, David T.

    2011-11-15

    Purpose: To report our dosimetric results using a novel push-button seed delivery system that constructs custom links of seeds intraoperatively. Methods and Materials: From 2005 to 2007, 43 patients underwent implantation using a gun applicator (GA), and from 2007 to 2008, 48 patientsunderwent implantation with a novel technique allowing creation of intraoperatively built custom links of seeds (IBCL). Specific endpoint analyses were prostate D90% (pD90%), rV100% > 1.3 cc, and overall time under anesthesia. Results: Final analyses included 91 patients, 43 GA and 48 IBCL. Absolute change in pD90% ({Delta}pD90%) between intraoperative and postoperative plans was evaluated. Using GA method, the {Delta}pD90% was -8.1Gy and -12.8Gy for I-125 and Pd-103 implants, respectively. Similarly, the IBCL technique resulted in a {Delta}pD90% of -8.7Gy and -9.8Gy for I-125 and Pd-103 implants, respectively. No statistically significant difference in {Delta}pD90% was found comparing methods. The GA method had two intraoperative and 10 postoperative rV100% >1.3 cc. For IBCL, five intraoperative and eight postoperative plans had rV100% >1.3 cc. For GA, the mean time under anesthesia was 75 min and 87 min for Pd-103 and I-125 implants, respectively. For IBCL, the mean time was 86 and 98 min for Pd-103 and I-125. There was a statistical difference between the methods when comparing mean time under anesthesia. Conclusions: Dosimetrically relevant endpoints were equivalent between the two methods. Currently, time under anesthesia is longer using the IBCL technique but has decreased over time. IBCL is a straightforward brachytherapy technique that can be implemented into clinical practice as an alternative to gun applicators.

  4. 10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

    SciTech Connect

    Crook, Juanita; Borg, Jette; Evans, Andrew; Toi, Ants; Saibishkumar, E.P.; Fung, Sharon; Ma, Clement

    2011-08-01

    Purpose: To report outcomes for 1,111 men treated with iodine-125 brachytherapy (BT) at a single institution. Methods and Materials: A total of 1,111 men (median age, 63) were treated with iodine-125 prostate BT for low- or intermediate-risk prostate cancer between March 1999 and November 2008. Median prostate-specific antigen (PSA) level was 5.4 ng/ml (range, 0.9-26.1). T stage was T1c in 66% and T2 in 34% of patients. Gleason score was 6 in 90.1% and 7 or 8 in 9.9% of patients. Neoadjuvant hormonal therapy (2-6 months course) was used in 10.1% of patients and combined external radiotherapy (45 Gy) with BT (110 Gy) in 4.1% (n = 46) of patients. Univariate and multivariate Cox proportional hazards were used to determine predictors of failure. Results: Median follow-up was 42 months (range, 6-114), but for biochemical freedom from relapse, a minimum PSA test follow-up of 30 months was required (median 54; n = 776). There were 27 failures, yielding an actuarial 7-year disease-free survival rate of 95.2% (96 at risk beyond 84 months). All failures underwent repeat 12-core transrectal ultrasound -guided biopsies, confirming 8 local failures. On multivariate analysis, Gleason score was the only independent predictor of failure (p = 0.001; hazard ratio, 4.8 (1.9-12.4). Median International Prostate Symptom score from 12 to 108 months ranged between 3 and 9. Of the men reporting baseline potency, 82.8% retained satisfactory erectile function beyond 5 years. Conclusion: Iodine-125 prostate BT is a highly effective treatment option for favorable- and intermediate-risk prostate cancer and is associated with maintenance of good urinary and erectile functions.

  5. Optical fibre luminescence sensor for real-time LDR brachytherapy dosimetry

    NASA Astrophysics Data System (ADS)

    Woulfe, P.; Sullivan, F. J.; O'Keeffe, S.

    2016-05-01

    An optical fibre sensor for monitoring low dose radiation is presented. The sensor is based on a scintillation material embedded within the optical fibre core, which emits visible light when exposed to low level ionising radiation. The incident level of ionising radiation can be determined by analysing the optical emission. An optical fibre sensor is presented, based on radioluminescence whereby radiation sensitive scintillation material, terbium doped gadolinium oxysulphide (Gd2O2S:Tb), is embedded in a cavity of 250μm of a 500μm plastic optical fibre. The sensor is designed for in-vivo monitoring of the radiation dose during radio-active seed implantation for brachytherapy, in prostate cancer treatment, providing oncologists with real-time information of the radiation dose to the target area and/or nearby critical structures. The radiation from the brachytherapy seeds causes emission of visible light from the scintillation material through the process of radioluminescence, which penetrates the fibre, propagating along the optical fibre for remote detection using a multi-pixel photon counter. The sensor demonstrates a high sensitivity to Iodine-125, the radioactive source most commonly used in brachytherapy for treating prostate cancer.

  6. Episcleral plaque brachytherapy using ‘BARC I-125 Ocu-Prosta seeds’ in the treatment of intraocular tumors: A single-institution experience in India

    PubMed Central

    Shah, Parag K; Narendran, V; Selvaraj, U; Guhan, P; Saxena, Sanjay K; Dash, Ashutosh; Astrahan, Melvin

    2012-01-01

    Context: To analyze the results of episcleral plaque brachytherapy using indigenous Bhabha Atomic Research Centre (BARC) Iodine-125 Ocu-Prosta seeds for the management of intraocular tumors from a single institute. AIM: To report our initial experience and learning curve on the use of ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors such as choroidal melanomas, retinoblastomas and vasoproliferative tumors (VPT). Materials and Methods: We retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between May 2008 to March 2012. Nine cases had choroidal melanomas; three had retinoblastomas while one case had VPT. Results: For choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm, respectively, which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow-up of 24 months (range 10-43 months). Retinoblastoma and VPT also showed good regression after brachytherapy. Conclusion: Plaque radiotherapy using 125I seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. Patients in our studies experienced excellent local tumor control. With the availability of indigenous ‘BARC I-125 Ocu-Prosta seeds’ locally, cost effective ophthalmic brachytherapy can be performed in India. PMID:22824598

  7. Long-Term Results of a Prospective, Phase II Study of Long-Term Androgen Ablation, Pelvic Radiotherapy, Brachytherapy Boost, and Adjuvant Docetaxel in Patients With High-Risk Prostate Cancer

    SciTech Connect

    DiBiase, Steven J.; Hussain, Arif; Kataria, Ritesh; Amin, Pradip; Bassi, Sunakshi; Dawson, Nancy; Kwok, Young

    2011-11-01

    Purpose: We report the long-term results of a prospective, Phase II study of long-term androgen deprivation (AD), pelvic radiotherapy (EBRT), permanent transperineal prostate brachytherapy boost (PB), and adjuvant docetaxel in patients with high-risk prostate cancer. Methods and Materials: Eligibility included biopsy-proven prostate adenocarcinoma with the following: prostate-specific antigen (PSA) > 20 ng/ml; or Gleason score of 7 and a PSA >10 ng/ml; or any Gleason score of 8 to 10; or stage T2b to T3 irrespective of Gleason score or PSA. Treatment consisted of 45 Gy of pelvic EBRT, followed 1 month later by PB with either iodine-125 or Pd-103. One month after PB, patients received three cycles of docetaxel chemotherapy (35 mg/m{sup 2} per week, Days 1, 8, and 15 every 28 days). All patients received 2 years of AD. Biochemical failure was defined as per the Phoenix definition (PSA nadir + 2). Results: From August 2000 to March 2004, 42 patients were enrolled. The median overall and active follow-ups were 5.6 years (range, 0.9-7.8 years) and 6.3 years (range, 4-7.8 years), respectively. Grade 2 and 3 acute genitourinary (GU) and gastrointestinal (GI) toxicities were 50.0% and 14.2%, respectively, with no Grade 4 toxicities noted. Grade 3 and 4 acute hematologic toxicities were 19% and 2.4%, respectively. Of the patients, 85.7% were able to complete the planned multimodality treatment. The 5- and 7-year actuarial freedom from biochemical failures rates were 89.6% and 86.5%, and corresponding rates for disease-free survival were 76.2% and 70.4%, respectively. The 5- and 7-year actuarial overall survival rates were 83.3% and 80.1%, respectively. The 5- and 7-year actuarial rates of late Grade 2 GI/GU toxicity (no Grade 3-5) was 7.7%. Conclusions: The trimodality approach of using 2 years of AD, external radiation, brachytherapy, and upfront docetaxel in high-risk prostate cancer is well tolerated, produces encouraging long-term results, and should be validated in a

  8. Equivalent Biochemical Control and Improved Prostate-Specific Antigen Nadir After Permanent Prostate Seed Implant Brachytherapy Versus High-Dose Three-Dimensional Conformal Radiotherapy and High-Dose Conformal Proton Beam Radiotherapy Boost

    SciTech Connect

    Jabbari, Siavash; Weinberg, Vivian K.; Shinohara, Katsuto; Speight, Joycelyn L.; Gottschalk, Alexander R.; Hsu, I.-C.; Pickett, Barby; McLaughlin, Patrick W.; Sandler, Howard M.; Roach, Mack

    2010-01-15

    Purpose: Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT. Patients and Methods: A total of 249 patients were treated with PPI at the University of California, San Francisco, and the outcomes were compared with those from a 3D-CRT cohort and the published results of a high-dose CPBRT boost (CPBRTB) trial. For each comparison, subsets of the PPI cohort were selected with patient and disease criteria similar to those of the reference group. Results: With a median follow-up of 5.3 years, the bNED rate at 5 and 7 years achieved with PPI was 92% and 86%, respectively, using the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, and 93% using the PSA nadir plus 2 ng/mL definition. Using the ASTRO definition, a 5-year bNED rate of 78% was achieved for the 3D-CRT patients compared with 94% for a comparable PPI subset and 93% vs. 92%, respectively, using the PSA nadir plus 2 ng/mL definition. The median PSA nadir for patients treated with PPI and 3D-CRT was 0.10 and 0.40 ng/mL, respectively (p < .0001). For the CPBRT comparison, the 5-year bNED rate after a CPBRTB was 91% using the ASTRO definition vs. 93% for a similar group of PPI patients. A greater proportion of PPI patients achieved a lower PSA nadir compared with those achieved in the CPBRTB trial (PSA nadir <=0.5 ng/mL, 91% vs. 59%, respectively). Conclusion: We have demonstrated excellent outcomes in low- to intermediate-risk patients treated with PPI, suggesting at least equivalent 5-year bNED rates and a greater proportion of men achieving lower PSA nadirs compared with 3D-CRT or

  9. Feasibility and Clinical Value of CT-guided (125)I Brachytherapy for Bilateral Lung Recurrences from Colorectal Carcinoma.

    PubMed

    Wang, Guobao; Zhang, Fujun; Yang, Bin; Xue, Jingbing; Peng, Sheng; Zhong, Zhihui; Zhang, Tao; Lu, Mingjian; Gao, Fei

    2016-03-01

    Purpose To prospectively evaluate the feasibility and clinical value of computed tomography (CT)-guided iodine 125 ((125)I) brachytherapy to treat bilateral lung recurrences from colorectal carcinoma. Materials and Methods This study was approved by Sun Yat-sen University Cancer Center Institutional Review Board and all patients provided informed written consent. Seventy-two patients with bilateral lung recurrences from colorectal carcinoma were enrolled and randomly divided into two groups. Thirty-three were percutaneously treated with CT-guided (125)I brachytherapy (group A) and the other 39 were only given symptomatic and supportive treatments (group B). Follow-up contrast agent-enhanced CT scans were reviewed and efficacy of treatment was evaluated. (125)I brachytherapy was considered a success if it achieved the computerized treatment planning system criteria 1 month after procedure. Analyses included Kaplan-Meier, Mantel-Cox log-rank test, and Cox proportional hazards regression. Results In group A, 37 (125)I brachytherapy procedures were performed in 33 patients with 126 lung metastatic lesions and the success rate was 87.9% (29 of 33 patients). The local control rate of 3, 6, 12, 24, and 36 months was 75.8%, 51.5%, 33.3%, 24.2%, and 9.1%, respectively. A small amount of pulmonary hematoma occurred in five patients, and six patients presented with pneumothorax with pulmonary compression of 30%-40%. No massive bleeding or radiation pneumonitis occurred. The mean overall survival (OS) of group A was significantly longer than that of group B, and (125)I brachytherapy was an independent factor that affected the OS (group A, 18.8 months; group B, 8.6 months; hazard ratio, 0.391 [95% confidence interval: 0.196, 0.779]; P = .008). Conclusion CT-guided (125)I brachytherapy is feasible and safe for the treatment of bilateral lung recurrences from colorectal carcinoma. (©) RSNA, 2015. PMID:26406550

  10. Prostate brachytherapy

    MedlinePlus

    Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate; High dose radiation (HDR) ... radiation safety precautions. If you have a permanent implant, your provider may tell you to limit the ...

  11. A Monte Carlo investigation of lung brachytherapy treatment planning

    NASA Astrophysics Data System (ADS)

    Sutherland, J. G. H.; Furutani, K. M.; Thomson, R. M.

    2013-07-01

    Iodine-125 (125I) and Caesium-131 (131Cs) brachytherapy have been used in conjunction with sublobar resection to reduce the local recurrence of stage I non-small cell lung cancer compared with resection alone. Treatment planning for this procedure is typically performed using only a seed activity nomogram or look-up table to determine seed strand spacing for the implanted mesh. Since the post-implant seed geometry is difficult to predict, the nomogram is calculated using the TG-43 formalism for seeds in a planar geometry. In this work, the EGSnrc user-code BrachyDose is used to recalculate nomograms using a variety of tissue models for 125I and 131Cs seeds. Calculated prescription doses are compared to those calculated using TG-43. Additionally, patient CT and contour data are used to generate virtual implants to study the effects that post-implant deformation and patient-specific tissue heterogeneity have on perturbing nomogram-derived dose distributions. Differences of up to 25% in calculated prescription dose are found between TG-43 and Monte Carlo calculations with the TG-43 formalism underestimating prescription doses in general. Differences between the TG-43 formalism and Monte Carlo calculated prescription doses are greater for 125I than for 131Cs seeds. Dose distributions are found to change significantly based on implant deformation and tissues surrounding implants for patient-specific virtual implants. Results suggest that accounting for seed grid deformation and the effects of non-water media, at least approximately, are likely required to reliably predict dose distributions in lung brachytherapy patients.

  12. Secondary sarcoma of bone post-prostate brachytherapy: A case report

    PubMed Central

    Ye, Allison Y.; Conway, Jessica; Peacock, Michael; Clarkson, Paul W.; Lee, Cheng-Han; Simmons, Christine; Weir, Lorna; McKenzie, Michael

    2014-01-01

    Malignancies associated with brachytherapy for prostate cancer are largely unreported in the literature. We report a case of post-brachytherapy osteogenic sarcoma in the pelvis 6 years after permanent 125I implant for intermediate-risk prostate cancer. The patient was treated with neoadjuvant chemotherapy, limb-sparing surgical resection and postoperative radiation therapy for unexpected positive margins. PMID:25024811

  13. Stereotactic interstitial brachytherapy of malignant astrocytomas with remarks on postimplantation computed tomographic appearance

    SciTech Connect

    Willis, B.K.; Heilbrun, M.P.; Sapozink, M.D.; McDonald, P.R.

    1988-09-01

    Seventeen patients were treated with stereotactically implanted high activity iodine-125 seeds, 12 patients for recurrent malignant astrocytomas (Protocol I) and 5 patients for newly diagnosed glioblastomas (Protocol II). Total radiation dosage to the recurrent tumors in Protocol I, including prior external beam irradiation, averaged 13,500 cGy. In the follow-up period of 6 to 50 months, the survival rate was 93% at 6 months, 60% at 12 months, 50% at 18 months, and 38% at 24 months after implantation. In Protocol II, brachytherapy was used as an interstitial radiation boost to the conventional treatment of newly diagnosed glioblastomas. External beam therapy and interstitial brachytherapy provided 11,000 cGy to these tumors. In the follow-up period of 15 to 27 months, there was a 100% survival at 12 months, 75% at 18 months, and 25% at 24 months after implantation. Eight of our 17 patients required reoperation for persistent or recurrent mass lesions at 6 to 15 months postimplantation; 7 were found to harbor masses of radionecrosis containing nests of anaplastic astrocytes; 1 had frank tumor recurrence. Median survival in this group of patients requiring reoperation was 18.7 months postimplantation. In a review of postimplantation computed tomographic scans, significant mass effect and crossover of hypodensity or enhancement into the corpus callosum or opposite hemisphere were found to have prognostic significance; persistent areas of contrast enhancement and excessive peritumoral hypodensity did not.

  14. Concurrent versus sequential application of ferromagnetic hyperthermia and 125I brachytherapy of melanoma in an animal model.

    PubMed Central

    Mieler, W F

    1997-01-01

    OBJECTIVE: To determine the efficacy of concurrent versus sequential ferromagnetic hyperthermia (FMH), combined with Iodine-125 (125I) brachytherapy, in the treatment of uveal melanoma in a rabbit model. MATERIALS AND METHODS: A Greene melanoma cell line was implanted in rabbit eyes to establish a tumor model comparable to a uveal melanoma. Seventy-one tumor-containing rabbit eyes were treated with 125I brachytherapy at 20, 25, 35, 45, or 55 Gray (Gy)(38 eyes), and with either concurrent (15 eyes) or sequential (18 eyes) FMH, delivered at 48.2 degrees C for 1 hour. An additional 13 eyes were treated with FMH alone at 48.2 degrees C, either in a single heat application (5 eyes), or in a repetitive mode (8 eyes). The radiation and heat were delivered via an episcleral plaque. All tumors were followed with indirect ophthalmoscopy and echography. RESULTS: Tumors treated with 125I brachytherapy alone exhibited complete tumor regression in 50% of eyes at 42 Gy with none of the tumors responding to less than 35 Gy. FMH alone at 48.2 degrees C applied in one cycle limited tumor growth in 20% of eyes, while all eyes treated with repetitive heating exhibited complete tumor control. With concurrent application of FMH and 125I, the 50% tumor control rate occurred at 9.5 Gy, thus resulting in a thermal enhancement ratio (TER) of 4.4. With sequential treatment, the 50% tumor control rate was at 30 Gy, with a resultant TER of 1.4. No complications related to 125I brachytherapy were noted in any eyes, while transient retinal whitening was seen with the FMH. CONCLUSION: This study documents the enhanced synergistic interaction of concurrent FMH and 125I brachytherapy, compared to sequential treatment, in this rabbit melanoma model. PMID:9440189

  15. Brachytherapy Application With In Situ Dose Painting Administered by Gold Nanoparticle Eluters

    SciTech Connect

    Sinha, Neeharika; Cifter, Gizem; Sajo, Erno; Kumar, Rajiv; Sridhar, Srinivas; Nguyen, Paul L.; Cormack, Robert A.; Makrigiorgos, G. Mike; Ngwa, Wilfred

    2015-02-01

    Purpose: Recent studies show promise that administering gold nanoparticles (GNP) to tumor cells during brachytherapy could significantly enhance radiation damage to the tumor. A new strategy proposed for sustained administration of the GNP in prostate tumors is to load them into routinely used brachytherapy spacers for customizable in situ release after implantation. This in silico study investigated the intratumor biodistribution and corresponding dose enhancement over time due to GNP released from such GNP-loaded brachytherapy spacers (GBS). Method and Materials: An experimentally determined intratumoral diffusion coefficient (D) for 10-nm nanoparticles was used to estimate D for other sizes by using the Stokes-Einstein equation. GNP concentration profiles, obtained using D, were then used to calculate the corresponding dose enhancement factor (DEF) for each tumor voxel, using dose painting-by-numbers approach, for times relevant to the considered brachytherapy sources' lifetimes. The investigation was carried out as a function of GNP size for the clinically applicable low-dose-rate brachytherapy sources iodine-125 (I-125), palladium-103 (Pd-103), and cesium-131 (Cs-131). Results: Results showed that dose enhancement to tumor voxels and subvolumes during brachytherapy can be customized by varying the size of GNP released or eluted from the GBS. For example, using a concentration of 7 mg/g GNP, significant DEF (>20%) could be achieved 5 mm from a GBS after 5, 12, 25, 46, 72, 120, and 195 days, respectively, for GNP sizes of 2, 5, 10, 20, 30, and 50 nm and for 80 nm when treating with I-125. Conclusions: Analyses showed that using Cs-131 provides the highest dose enhancement to tumor voxels. However, given its relatively longer half-life, I-125 presents the most flexibility for customizing the dose enhancement as a function of GNP size. These findings provide a useful reference for further work toward development of potential new brachytherapy application with

  16. The dosimetry of brachytherapy-induced erectile dysfunction

    SciTech Connect

    Merrick, Gregory S.; Butler, Wayne M

    2003-12-31

    There is emerging evidence that brachytherapy-induced erectile dysfunction (ED) is technique-related and may be minimized by careful attention to source placement. Herein, we review the relationship between radiation doses to the prostate gland/surrounding structures and the development of brachytherapy-induced ED. The permanent prostate brachytherapy literature was reviewed using MEDLINE searches to ensure completeness. Although the site-specific structure associated with brachytherapy-induced ED remains unknown, there is an increasing body of data implicating the proximal penis. With day 0 CT-based dosimetry, the dose to 50% (D{sub 50}) and 25% (D{sub 25}) of the bulb of the penis should be maintained below 40% and 60% mPD, respectively, while the crura D{sub 50} should be maintained below 28% mPD to maximize post-brachytherapy potency. To date, there is no data to suggest that either radiation doses to the neurovascular bundles or choice of isotope is associated with brachytherapy-induced ED, while conflicting data has been reported regarding radiation dose to the prostate and the use of supplemental external beam radiation therapy. Although the etiology of brachytherapy-induced ED is likely multifactorial, the available data supports the proximal penis as an important site-specific structure. Refinements in implant technique, including preplanning and intraoperative seed placement, will result in lower radiation doses to the proximal penis with potential improvement in potency preservation.

  17. [Brachytherapy for oesophageal cancer].

    PubMed

    Wong, S; Hennequin, C; Quero, L

    2013-04-01

    The main indication of oesophageal brachytherapy is palliative: it can improve dysphagia in patients with a tumor not suitable for surgery or chemoradiotherapy. A randomized clinical trial showed that survival without dysphagia and quality of life was improved by endoluminal brachytherapy in comparison to self-expansible metallic stents. It also increases the duration of palliation after laser deobstruction. Its role as a curative treatment of locally advanced tumors is still discussed: in combination with external beam radiotherapy, it seems that brachytherapy increased the rate of severe toxicity (haemorrhages, fistula, stenosis). In superficial lesions, brachytherapy with or without external beam radiotherapy seems logical but large prospective studies are missing in this setting. PMID:23603254

  18. Plaque Brachytherapy for Uveal Melanoma: A Vision Prognostication Model

    SciTech Connect

    Khan, Niloufer; Khan, Mohammad K.; Bena, James; Macklis, Roger; Singh, Arun D.

    2012-11-01

    Purpose: To generate a vision prognostication model after plaque brachytherapy for uveal melanoma. Methods and Materials: All patients with primary single ciliary body or choroidal melanoma treated with iodine-125 or ruthenium-106 plaque brachytherapy between January 1, 2005, and June 30, 2010, were included. The primary endpoint was loss of visual acuity. Only patients with initial visual acuity better than or equal to 20/50 were used to evaluate visual acuity worse than 20/50 at the end of the study, and only patients with initial visual acuity better than or equal to 20/200 were used to evaluate visual acuity worse than 20/200 at the end of the study. Factors analyzed were sex, age, cataracts, diabetes, tumor size (basal dimension and apical height), tumor location, and radiation dose to the tumor apex, fovea, and optic disc. Univariate and multivariable Cox proportional hazards were used to determine the influence of baseline patient factors on vision loss. Kaplan-Meier curves (log rank analysis) were used to estimate freedom from vision loss. Results: Of 189 patients, 92% (174) were alive as of February 1, 2011. At presentation, visual acuity was better than or equal to 20/50 and better than or equal to 20/200 in 108 and 173 patients, respectively. Of these patients, 44.4% (48) had post-treatment visual acuity of worse than 20/50 and 25.4% (44) had post-treatment visual acuity worse than 20/200. By multivariable analysis, increased age (hazard ratio [HR] of 1.01 [1.00-1.03], P=.05), increase in tumor height (HR of 1.35 [1.22-1.48], P<.001), and a greater total dose to the fovea (HR of 1.01 [1.00-1.01], P<.001) were predictive of vision loss. This information was used to develop a nomogram predictive of vision loss. Conclusions: By providing a means to predict vision loss at 3 years after treatment, our vision prognostication model can be an important tool for patient selection and treatment counseling.

  19. Salvage brachytherapy for locally recurrent prostate cancer after external beam radiotherapy.

    PubMed

    Yamada, Yasuhiro; Okihara, Koji; Iwata, Tsuyoshi; Masui, Koji; Kamoi, Kazumi; Yamada, Kei; Miki, Tsuneharu

    2015-01-01

    External beam radiotherapy (EBRT) is a standard treatment for prostate cancer. Despite the development of novel radiotherapy techniques such as intensity-modulated conformal radiotherapy, the risk of local recurrence after EBRT has not been obviated. Various local treatment options (including salvage prostatectomy, brachytherapy, cryotherapy, and high-intensity focused ultrasound [HIFU]) have been employed in cases of local recurrence after primary EBRT. Brachytherapy is the first-line treatment for low-risk and selected intermediate-risk prostate tumors. However, few studies have examined the use of brachytherapy to treat post-EBRT recurrent prostate cancer. The purpose of this paper is to analyze the current state of our knowledge about the effects of salvage brachytherapy in patients who develop locally recurrent prostate cancer after primary EBRT. This article also introduces our novel permanent brachytherapy salvage method. PMID:26112477

  20. ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.

    PubMed

    Afsharpour, H; Landry, G; D'Amours, M; Enger, S; Reniers, B; Poon, E; Carrier, J-F; Verhaegen, F; Beaulieu, L

    2012-06-01

    Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms. The scientific community has expressed the need for an accurate dosimetry platform in brachytherapy. The purpose of this paper is to present ALGEBRA, a Monte Carlo platform for dosimetry in brachytherapy which is sufficiently fast and accurate for clinical and research purposes. ALGEBRA is based on the GEANT4 Monte Carlo code and is capable of handling the DICOM RT standard to recreate a virtual model of the treated site. Here, the performance of ALGEBRA is presented for the special case of LDR brachytherapy in permanent prostate and breast seed implants. However, the algorithm is also capable of handling other treatments such as HDR brachytherapy. PMID:22572100

  1. ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy

    NASA Astrophysics Data System (ADS)

    Afsharpour, H.; Landry, G.; D'Amours, M.; Enger, S.; Reniers, B.; Poon, E.; Carrier, J.-F.; Verhaegen, F.; Beaulieu, L.

    2012-06-01

    Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms. The scientific community has expressed the need for an accurate dosimetry platform in brachytherapy. The purpose of this paper is to present ALGEBRA, a Monte Carlo platform for dosimetry in brachytherapy which is sufficiently fast and accurate for clinical and research purposes. ALGEBRA is based on the GEANT4 Monte Carlo code and is capable of handling the DICOM RT standard to recreate a virtual model of the treated site. Here, the performance of ALGEBRA is presented for the special case of LDR brachytherapy in permanent prostate and breast seed implants. However, the algorithm is also capable of handling other treatments such as HDR brachytherapy.

  2. A novel perineal shield for low-dose-rate prostate brachytherapy

    PubMed Central

    Schwartz, David; Safdieh, Joseph; Polubarov, Alex; Telivala, Tejas; Worth, Matthew; Schreiber, David

    2015-01-01

    Purpose To study the impact on radiation exposure to staff through the use of an original perineal shield during low-dose-rate prostate brachytherapy. Material and methods We designed a 1 mm thick stainless steel shield that duplicates and is able to slide directly over a standard commercialized prostate brachytherapy grid. We then analyzed the post-procedure exposure in 15 consecutive patients who underwent Iodine-125 seed placement. Measurements were performed with and without the shield in place at fixed locations relative to the grid template. Endpoints were analyzed using the paired two-sample t-test, with statistical significance defined as a p-value < 0.05. Results The exposure at the midline grid template ranged from 0.144-0.768 mSv/hr without the shield, and 0.038-0.144 mSv/hr with the shield (p < 0.0001). The exposure 10 cm left of the grid template was 0.134-0.576 mSv/hr without the shield, and 0.001-0.012 mSv/hr with the shield (p < 0.0001). The exposure 10 cm right of the grid template was 0.125-0.576 mSv/hr without the shield, and 0.001-0.012 mSv/hr with the shield (p < 0.0001). The median reduction of exposure at the grid was 76% midline, 98.5% left, and 99% right. Similarly, each individual dose rate was recorded at 25 cm from the perineum, both with and without shield. The median reduction of exposure 25 cm from the perineum was 73.7% midline, 77.7% left and 81.6% right (p < 0.0001). Conclusions Our novel shield took seconds to install and was non-restrictive during the procedure, and provided at least a four-fold reduction in radiation exposure to the brachytherapist. PMID:26207107

  3. Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

    SciTech Connect

    Thaker, Nikhil G.; Kudchadker, Rajat J.; Swanson, David A.; Albert, Jeffrey M.; Bruno, Teresa L.; Prestidge, Bradley R.; Crook, Juanita M.; Cox, Brett W.; Potters, Louis; Moran, Brian J.; Keyes, Mira; Kuban, Deborah A.; Frank, Steven J.

    2014-11-01

    Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ({sup 125}I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB.

  4. Dosimetric audit in brachytherapy

    PubMed Central

    Bradley, D A; Nisbet, A

    2014-01-01

    Dosimetric audit is required for the improvement of patient safety in radiotherapy and to aid optimization of treatment. The reassurance that treatment is being delivered in line with accepted standards, that delivered doses are as prescribed and that quality improvement is enabled is as essential for brachytherapy as it is for the more commonly audited external beam radiotherapy. Dose measurement in brachytherapy is challenging owing to steep dose gradients and small scales, especially in the context of an audit. Several different approaches have been taken for audit measurement to date: thimble and well-type ionization chambers, thermoluminescent detectors, optically stimulated luminescence detectors, radiochromic film and alanine. In this work, we review all of the dosimetric brachytherapy audits that have been conducted in recent years, look at current audits in progress and propose required directions for brachytherapy dosimetric audit in the future. The concern over accurate source strength measurement may be essentially resolved with modern equipment and calibration methods, but brachytherapy is a rapidly developing field and dosimetric audit must keep pace. PMID:24807068

  5. [Safety in brachytherapy].

    PubMed

    Marcié, S; Marinello, G; Peiffert, D; Lartigau, É

    2013-04-01

    No technique can now be used without previously considering the safety of patients, staff and public and risk management. This is the case for brachytherapy. The various aspects of brachytherapy are discussed for both the patient and the staff. For all, the risks must be minimized while achieving a treatment of quality. It is therefore necessary to establish a list as comprehensive as possible regardless of the type of brachytherapy (low, high, pulsed dose-rate). Then, their importance must be assessed with the help of their criticality. Radiation protection of personnel and public must take into account the many existing regulation texts. Four axes have been defined for the risk management for patients: organization, preparation, planning and implementation of treatment. For each axis, a review of risks is presented, as well as administrative, technical and medical dispositions for staff and the public. PMID:23465784

  6. Restenosis: Intracoronary Brachytherapy.

    PubMed

    Drachman, Douglas E.; Simon, Daniel I.

    2002-04-01

    Though interventional strategies have revolutionized the management of patients with symptomatic coronary artery disease, in-stent restenosis has emerged as the single most important limitation of long-term success following percutaneous coronary intervention. Once present, in-stent restenosis is extraordinarily difficult to treat, with conventional revascularization techniques failing in 50% to 80% of patients. Intracoronary radiation, or brachytherapy, targets cellular proliferation within the culprit neointima. Clinical trials have demonstrated that brachytherapy is a highly effective treatment for in-stent restenosis, reducing angiographic restenosis by 50% to 60% and the need for target vessel revascularization by 40% to 50%. The benefits of intracoronary brachytherapy may be particularly pronounced in certain patient subgroups (eg, those with diabetes, long lesions, or lesions in saphenous vein bypass grafts), but comes at the cost of an increased rate of late stent thrombosis and the need for extended antiplatelet therapy. The role of brachytherapy in the arsenal of the interventional cardiologist will continue to evolve, particularly in light of the unprecedented recent advances with the use of drug-eluting stents for restenosis prevention. PMID:11858773

  7. Directional interstitial brachytherapy from simulation to application

    NASA Astrophysics Data System (ADS)

    Lin, Liyong

    Organs at risk (OAR) are sometimes adjacent to or embedded in or overlap with the clinical target volume (CTV) to be treated. The purpose of this PhD study is to develop directionally low energy gamma-emitting interstitial brachytherapy sources. These sources can be applied between OAR to selectively reduce hot spots in the OARs and normal tissues. The reduction of dose over undesired regions can expand patient eligibility or reduce toxicities for the treatment by conventional interstitial brachytherapy. This study covers the development of a directional source from design optimization to construction of the first prototype source. The Monte Carlo code MCNP was used to simulate the radiation transport for the designs of directional sources. We have made a special construction kit to assemble radioactive and gold-shield components precisely into D-shaped titanium containers of the first directional source. Directional sources have a similar dose distribution as conventional sources on the treated side but greatly reduced dose on the shielded side, with a sharp dose gradient between them. A three-dimensional dose deposition kernel for the 125I directional source has been calculated. Treatment plans can use both directional and conventional 125I sources at the same source strength for low-dose-rate (LDR) implants to optimize the dose distributions. For prostate tumors, directional 125I LDR brachytherapy can potentially reduce genitourinary and gastrointestinal toxicities and improve potency preservation for low risk patients. The combination of better dose distribution of directional implants and better therapeutic ratio between tumor response and late reactions enables a novel temporary LDR treatment, as opposed to permanent or high-dose-rate (HDR) brachytherapy for the intermediate risk T2b and high risk T2c tumors. Supplemental external-beam treatments can be shortened with a better brachytherapy boost for T3 tumors. In conclusion, we have successfully finished the

  8. Longitudinal Magnetic Resonance Imaging Features of Glioblastoma Multiforme Treated With Radiotherapy With or Without Brachytherapy

    SciTech Connect

    Aiken, Ashley H. Chang, Susan M.; Larson, David; Butowski, Nicholas; Cha, Soonmee

    2008-12-01

    Purpose: To compare temporal patterns of recurrent contrast enhancement in patients with glioblastoma multiforme (GBM) treated with brachytherapy plus external beam radiotherapy (EBRT) vs. EBRT alone. Methods and Materials: We evaluated serial MRI scans for 15 patients who received brachytherapy followed by EBRT (6000 cGy) and 20 patients who received standard EBRT alone (5940-6000 cGy). Brachytherapy consisted of permanent, low-activity {sup 125}I seeds placed around the resection cavity at the time of initial gross total resection. Contrast enhancement (linear, nodular, feathery, or solid), serial progression, and location of contrast enhancement were described. Results: In the EBRT group, 14 patients demonstrated focal nodular contrast enhancement along the resection cavity within 4 months. The 6 remaining EBRT patients developed either transient linear enhancement or no abnormal enhancement. In the brachytherapy plus EBRT group, 7 patients initially developed linear rim enhancement within 4 months that progressed to feathery contrast enhancement over the course of 1 to 2 years. Histopathology confirmed radiation necrosis in all 7 patients. The remaining 8 brachytherapy patients eventually developed focal nodular contrast enhancement along the resection cavity and tumor recurrence. Conclusions: Our data suggest that longitudinal MRI features differ between GBM patients treated with EBRT vs. brachytherapy plus EBRT. In both groups, nodular enhancement adjacent to or remote from the resection cavity strongly suggested tumor recurrence. Feathery enhancement, which progressed from linear rim enhancement immediately adjacent to the cavity, seen only in brachytherapy patients, strongly indicated radiation necrosis.

  9. A novel ytterbium-169 brachytherapy source and delivery system for use in conjunction with minimally invasive wedge resection of early-stage lung cancer

    PubMed Central

    Leonard, Kara Lynne; DiPetrillo, Thomas A.; Munro, John J.; Wazer, David E.

    2011-01-01

    PURPOSE To describe a novel source–delivery system for intraoperative brachytherapy in patients with early-stage lung cancer that is readily adaptable to a video-assisted thoracoscopic surgery approach and can be precisely delivered to achieve optimal dose distribution. METHODS AND MATERIALS Radioactive ytterbium-169 (169Yb) was sealed within a titanium tube 0.28 mm in diameter and then capped and resealed by titanium wires laser welded to the tube to serve as the legs of a tissue-fastening system. Dose simulations were performed using Monte Carlo computer code (Los Alamos National Laboratory, Los Alamos, NM) to mimic the geometric and elemental compositions of the source, fastening apparatus, and surroundings. RESULTS Five test source capsules were subjected to a tensile load to failure. Failure in each capsule occurred in the wire of the fastener leg; there were no weld failures. Monte Carlo simulations and subsequent dose measurement showed the perturbation by the source legs in the deployed (bent over) position to be small (4–5%) for 169Yb and much less than that for iodine-125 (32%). CONCLUSION We have developed a 169Yb brachytherapy source–delivery system that can be used in conjunction with commercially available surgical stapling instruments, facilitates the precise placement of brachytherapy sources relative to the surgical margin, assures the seeds remain fixed in their precise position for the duration of the treatment, overcomes the technical difficulties of manipulating the seeds through the narrow surgical incision associated with video-assisted thoracoscopic surgery, and reduces the radiation dose to the clinicians. PMID:20705525

  10. Dosimetric and technical aspects of intraoperative I-125 brachytherapy for stage I non-small cell lung cancer

    NASA Astrophysics Data System (ADS)

    Johnson, Mark; Colonias, Athanasios; Parda, David; Trombetta, Mark; Gayou, Olivier; Reitz, Bodo; Miften, Moyed

    2007-03-01

    Initial treatment outcome data from our institution for stage I non-small cell lung cancer (NSCLC) patients have shown that sublobar resection in combination with iodine-125 (I-125) brachytherapy is associated with recurrence rates of 2.0%, compared to 18.6% with sublobar resection alone. In this work, the technical and dosimetric aspects required to execute this procedure from the radiation oncology perspective as well as an analysis of the dose distributions of patients treated with this technique are presented. In this treatment technique, I-125 seeds in vicryl suture are embedded into vicryl mesh and surgically inserted providing a 2.0 cm margin on each side of the resection staple line. A nomogram is developed to determine the suture spacing in the vicryl mesh, as a function of seed activity in order to deliver 120 Gy at a distance of 0.5 cm above and below the seed array. Post-operative dosimetry consists of a CT-based planning and dose volume analysis. Dose distributions, dose volume histograms and mean dose data for lung are analysed in a group of patients. Dosimetric results show significant lung sparing with only a small volume of lung irradiated for all patients with mean lung dose values ranging from 1.5 Gy to 5.4 Gy. Lung brachytherapy with I-125 at the time of sublobar resection is a highly conformal option of dose delivery for stage I NSCLC patients with compromised physiologic reserve. Patient-related toxicity clinically measured by loss of pulmonary function and radiation-induced pneumonitis have not been linked to this procedure.

  11. Salvage Brachytherapy for Biochemically Recurrent Prostate Cancer following Primary Brachytherapy

    PubMed Central

    Lacy, John M.; Wilson, William A.; Bole, Raevti; Chen, Li; Meigooni, Ali S.; Rowland, Randall G.; Clair, William H. St.

    2016-01-01

    Purpose. In this study, we evaluated our experience with salvage brachytherapy after discovery of biochemical recurrence after a prior brachytherapy procedure. Methods and Materials. From 2001 through 2012 twenty-one patients treated by brachytherapy within University of Kentucky or from outside centers developed biochemical failure and had no evidence of metastases. Computed tomography (CT) scans were evaluated; patients who had an underseeded portion of their prostate were considered for reimplantation. Results. The majority of the patients in this study (61.9%) were low risk and median presalvage PSA was 3.49 (range 17.41–1.68). Mean follow-up was 61 months. At last follow-up after reseeding, 11/21 (52.4%) were free of biochemical recurrence. There was a trend towards decreased freedom from biochemical recurrence in low risk patients (p = 0.12). International Prostate Symptom Scores (IPSS) increased at 3-month follow-up visits but decreased and were equivalent to baseline scores at 18 months. Conclusions. Salvage brachytherapy after primary brachytherapy is possible; however, in our experience the side-effect profile after the second brachytherapy procedure was higher than after the first brachytherapy procedure. In this cohort of patients we demonstrate that approximately 50% oncologic control, low risk patients appear to have better outcomes than others. PMID:27092279

  12. Sexual Function and the Use of Medical Devices or Drugs to Optimize Potency After Prostate Brachytherapy

    SciTech Connect

    Whaley, J. Taylor; Levy, Lawrence B.; Swanson, David A.; Pugh, Thomas J.; Kudchadker, Rajat J.; Bruno, Teresa L.; Frank, Steven J.

    2012-04-01

    Purpose: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. Methods and Materials: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. Results: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. Conclusions: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

  13. Anisotropy Characterization of I-125 Seed with Attached Encapsulated Cobalt Chloride Complex Contrast Agent Markers for MRI-Based Prostate Brachytherapy

    SciTech Connect

    Frank, Steven J.; Tailor, Ramesh C.; Kudchadker, Rajat J.; Martirosyan, Karen S.; Stafford, R. Jason; Elliott, Andrew M.; Swanson, David A.; Sing, David; Choi, Jonathan; Mourtada, Firas; Ibbott, Geoffrey S.

    2011-07-01

    We have developed a novel MRI marker for prostate brachytherapy. The purpose of this study was to evaluate the changes in anisotropy when cobalt chloride complex contrast agent encapsulated contrast agent markers (C4-ECAM) were placed adjacent to an iodine-125 (I-125) titanium seed, and to verify that the C4-ECAMs were visible on magnetic resonance imaging (MRI) after radiation exposure. Two C4-ECAMs were verified to be MRI visible in a phantom before radiation exposure. The C4-ECAMs were then attached to each end of a 12.7-U (10-mCi) I-125 titanium seed in a polymer tube. Anisotropy was measured and analyzed with the seed alone and with attached C4-ECAMs by suspending thermoluminescent dosimeters in a water phantom in 2 circles surrounding the radioactive source with radius of 1 or 2 cm. A T1-weighted MRI evaluation of C4-ECAMs was then performed after exposure to the amount of radiation typically delivered during 1 month of prostate brachytherapy. Measured values of the anisotropy function F(r, {theta}) for the I-125 seed with and without the C4-ECAMs were mutually statistically indistinguishable (standard error of the mean <4.2%) and agreed well with published TG-43 values for the bare seed. As expected, the anisotropy function {phi}{sub an}(r) for the 2 datasets (with and without C4-ECAMs) derived from the measured F(r, {theta}) did not exhibit statistically measurable difference. Both datasets showed agreement with the published TG-43 {phi}{sub an}(r) for the bare seed. The C4-ECAMs were well visualized by MRI after 1 month of radiation exposure. There were no changes in anisotropy when the C4-ECAMs were placed next to an I-125 radioactive seed, and the C4-ECAMs were visualized after radiation exposure.

  14. Anisotropy characterization of I-125 seed with attached encapsulated cobalt chloride complex contrast agent markers for MRI-based prostate brachytherapy.

    PubMed

    Frank, Steven J; Tailor, Ramesh C; Kudchadker, Rajat J; Martirosyan, Karen S; Stafford, R Jason; Elliott, Andrew M; Swanson, David A; Sing, David; Choi, Jonathan; Mourtada, Firas; Ibbott, Geoffrey S

    2011-01-01

    We have developed a novel MRI marker for prostate brachytherapy. The purpose of this study was to evaluate the changes in anisotropy when cobalt chloride complex contrast agent encapsulated contrast agent markers (C4-ECAM) were placed adjacent to an iodine-125 (I-125) titanium seed, and to verify that the C4-ECAMs were visible on magnetic resonance imaging (MRI) after radiation exposure. Two C4-ECAMs were verified to be MRI visible in a phantom before radiation exposure. The C4-ECAMs were then attached to each end of a 12.7-U (10-mCi) I-125 titanium seed in a polymer tube. Anisotropy was measured and analyzed with the seed alone and with attached C4-ECAMs by suspending thermoluminescent dosimeters in a water phantom in 2 circles surrounding the radioactive source with radius of 1 or 2 cm. A T1-weighted MRI evaluation of C4-ECAMs was then performed after exposure to the amount of radiation typically delivered during 1 month of prostate brachytherapy. Measured values of the anisotropy function F(r, θ) for the I-125 seed with and without the C4-ECAMs were mutually statistically indistinguishable (standard error of the mean <4.2%) and agreed well with published TG-43 values for the bare seed. As expected, the anisotropy function ϕ(an)(r) for the 2 datasets (with and without C4-ECAMs) derived from the measured F(r, θ) did not exhibit statistically measurable difference. Both datasets showed agreement with the published TG-43 ϕ(an)(r) for the bare seed. The C4-ECAMs were well visualized by MRI after 1 month of radiation exposure. There were no changes in anisotropy when the C4-ECAMs were placed next to an I-125 radioactive seed, and the C4-ECAMs were visualized after radiation exposure. PMID:20537886

  15. Evaluation of the MIM Symphony treatment planning system for low-dose-rate- prostate brachytherapy.

    PubMed

    Dhanesar, Sandeep K; Lim, Tze Y; Du, Weiliang; Bruno, Teresa L; Frank, Steven J; Kudchadker, Rajat J

    2015-01-01

    MIM Symphony is a recently introduced low-dose-rate prostate brachytherapy treatment planning system (TPS). We evaluated the dosimetric and planning accuracy of this new TPS compared to the universally used VariSeed TPS. For dosimetric evaluation of the MIM Symphony version 5.4 TPS, we compared dose calculations from the MIM Symphony TPS with the formalism recommended by the American Association of Physicists in Medicine Task Group 43 report (TG-43) and those generated by the VariSeed version 8.0 TPS for iodine-125 (I-125; Models 6711 and IAI-125A), palladium-103 (Pd-103; Model 200), and cesium-131 (Cs-131; Model Cs-1). Validation was performed for both line source and point source approximations. As part of the treatment planning validation, first a QA phantom (CIRS Brachytherapy QA Phantom Model 045 SN#D7210-3) containing three ellipsoid objects with certified volumes was scanned in order to check the volume accuracy of the contoured structures in MIM Symphony. Then the DICOM data containing 100 patient plans from the VariSeed TPS were imported into the MIM Symphony TPS. The 100 plans included 25 each of I-125 pre-implant plans, Pd-103 pre-implant plans, I-125 Day 30 plans (i.e., from 1 month after implantation), and Pd-103 Day 30 plans. The dosimetric parameters (including prostate volume, prostate D90 values, and rectum V100 values) of the 100 plans were calculated independently on the two TPSs. Other TPS tests that were done included verification of source input and geometrical accuracy, data transfer between different planning systems, text printout, 2D dose plots, DVH printout, and template grid accuracy. According to the line source formalism, the dosimetric results between the MIM Symphony TPS and TG-43 were within 0.5% (0.02 Gy) for r > 1 cm. In the line source approximation validation, MIM Symphony TPS values agreed with VariSeed TPS values to within 0.5% (0.09 Gy) for r > 1 cm. Similarly, in point source approximation validation, the MIM Symphony values

  16. Essure Permanent Birth Control

    MedlinePlus

    ... Implants and Prosthetics Essure Permanent Birth Control Essure Permanent Birth Control Share Tweet Linkedin Pin it More sharing options ... evaluation of the Essure System Essure is a permanent birth control method for women (female sterilization). Implantation of Essure ...

  17. Iodine-125 metaraminol: A new platelet specific labeling agent

    SciTech Connect

    Ohmomo, Y.; Yokoyama, A.; Kawaii, K.; Horiuchi, K.; Saji, H.; Torizuka, K.

    1984-01-01

    In the search for a platelet specific labeling agent, Metaraminol (MA), which is a sympatomimetic amine used for the treatment of hypotension, cardiogenic shock and well recognized as a drug actively incorporated and accumulated in platelet, attracted the authors' attention. Using the classical chloramine-T iodination method, a high labeling efficiency near 98%, reaching a specific activity up to about 1000 Ci/mmole was obtained. Upon the harvest of platelet, only as platelet rich plasma (PRP), the labeling with this radiopharmaceutical was easily performed by incubation at 37/sup 0/C for 10 min. Labeling efficiency as high as 63.0 +- 3.1% at 24 x 10/sup 8/ cells/ml was obtained. In in-vitro studies, the unaltered state of I-125 MA labeled platelet, with their cellular functions fully retained was demonstrated. Pharmacological study indicated a specific incorporation of I-125 MA by active transport system similar to that of 5-HT, along with passive diffusion. Then the in-vivo study carried out in rabbits with induced thrombi on the femoral artery, showed rather rapid disappearance of the I-125 MA labeled autologous platelet radioactivity, from circulating blood reaching as high thrombus-to-blood activity ratio as 19.8+-4.3 within 30 min post-administration. This new platelet labeling agent, I-125 MA, has many advantages over the use of IN-111 oxine and holds considerable promise for thrombus imaging with single photon emission CT upon the availability of I-123 MA.

  18. Brachytherapy dosimeter with silicon photomultipliers

    NASA Astrophysics Data System (ADS)

    Moutinho, L. M.; Castro, I. F. C.; Peralta, L.; Abreu, M. C.; Veloso, J. F. C. A.

    2015-07-01

    In-vivo and in-situ measurement of the radiation dose administered during brachytherapy faces several technical challenges, requiring a very compact, tissue-equivalent, linear and highly sensitive dosimeter, particularly in low-dose rate brachytherapy procedures, which use radioactive seeds with low energy and low dose deposition rate. In this work we present a scintillating optical fiber dosimeter composed of a flexible sensitive probe and a dedicated electronic readout system based on silicon photomultiplier photodetection, capable of operating both in pulse and current modes. The performance of the scintillating fiber optic dosimeter was evaluated in low energy regimes, using an X-ray tube operating at voltages of 40-50 kV and currents below 1 mA, to assess minimum dose response of the scintillating fiber. The dosimeter shows a linear response with dose and is capable of detecting mGy dose variations like an ionization chamber. Besides fulfilling all the requirements for a dosimeter in brachytherapy, the high sensitivity of this device makes it a suitable candidate for application in low-dose rate brachytherapy. According to Peralta and Rego [1], the BCF-10 and BCF-60 scintillating optical fibers used in dosimetry exhibit high variations in their sensitivity for photon beams in the 25-100 kVp energy range. Energy linearity for energies below 50 keV needs to be further investigated, using monochromatic X-ray photons.

  19. Image-based brachytherapy for cervical cancer

    PubMed Central

    Vargo, John A; Beriwal, Sushil

    2014-01-01

    Cervical cancer is the third most common cancer in women worldwide; definitive radiation therapy and concurrent chemotherapy is the accepted standard of care for patients with node positive or locally advanced tumors > 4 cm. Brachytherapy is an important part of definitive radiotherapy shown to improve overall survival. While results for two-dimensional X-ray based brachytherapy have been good in terms of local control especially for early stage disease, unexplained toxicities and treatment failures remain. Improvements in brachytherapy planning have more recently paved the way for three-dimensional image-based brachytherapy with volumetric optimization which increases tumor control, reduces toxicity, and helps predict outcomes. Advantages of image-based brachytherapy include: improved tumor coverage (especially for large volume disease), decreased dose to critical organs (especially for small cervix), confirmation of applicator placement, and accounting for sigmoid colon dose. A number of modalities for image-based brachytherapy have emerged including: magnetic resonance imaging (MRI), computed tomography (CT), CT-MRI hybrid, and ultrasound with respective benefits and outcomes data. For practical application of image-based brachytherapy the Groupe Europeen de Curietherapie-European Society for Therapeutic Radiology and Oncology Working Group and American Brachytherapy Society working group guideline serve as invaluable tools, additionally here-in we outline our institutional clinical integration of these guidelines. While the body of literature supporting image-based brachytherapy continues to evolve a number of uncertainties and challenges remain including: applicator reconstruction, increasing resource/cost demands, mobile four-dimensional targets and organs-at-risk, and accurate contouring of “grey zones” to avoid marginal miss. Ongoing studies, including the prospective EMBRACE (an international study of MRI-guided brachytherapy in locally advanced

  20. Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol

    PubMed Central

    Bucci, Joseph; Chin, Yaw Sinn; Malouf, David; Howie, Andrew; Enari, Komiti Ese

    2016-01-01

    Background The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way. Objective The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT. Methods The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years. Results To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled

  1. Prostate Brachytherapy With Oblique Needles to Treat Large Glands and Overcome Pubic Arch Interference

    SciTech Connect

    Ryu, Bon; Bax, Jeff; Edirisinge, Chandima; Lewis, Craig; Chen, Jeff; D'Souza, David; Fenster, Aaron; Wong, Eugene

    2012-08-01

    Purpose: First, to show that low-dose-rate prostate brachytherapy plans using oblique needle trajectories are more successful than parallel trajectories for large prostates with pubic arch interference (PAI); second, to test the accuracy of delivering an oblique plan by using a three-dimensional (3D) transrectal ultrasonography (TRUS)-guided mechatronic system. Methods and Materials: Prostates were contoured for 5 subjects' 3D TRUS images showing a maximum PAI of {<=}1 cm and a prostate volume of <50 cc. Two planning studies were done. First, prostate contours were artificially enlarged to 45 to 80 cc in 5- to 10-cc increments for a single subject. Second, all subject prostate contours were enlarged to 60 cc. For each study, three types of plans were manually created for comparison: a parallel needle template (PT) plan, a parallel needle no-template (PNT) plan, and an oblique needle no-template (OBL) plan. Needle positions and angles were not discretized for nontemplate plans. European Society for Therapeutic Radiology and Oncology dose-volume histogram guidelines, iodine-125 (145-Gy prescription, 0.43 U), and needle angles of <15 Degree-Sign were used. An OBL plan was delivered to a pubic arch containing a 60-cc prostate phantom that mimicked the anatomy of the subject with the greatest PAI (23% by volume). Results: In the increasing-prostate volume study, OBL plans were successful for prostates of {<=}80 cc, and PT plans were successful for prostates of <65 cc. In paired, one-sided t tests for the 60-cc volume study, OBL plans showed dosimetric improvements for all organs compared to both of the parallel type plans (p < 0.05); PNT plans showed a benefit only in planning target volumes receiving more than 100 Gy compared to PT plans. A computed tomography scan of the phantom showed submillimeter seed placement accuracy in all directions. Conclusion: OBL plans were significantly better than parallel plans, and an OBL plan was accurately delivered to a 60-cc

  2. Prostate Brachytherapy in Men {>=}75 Years of Age

    SciTech Connect

    Merrick, Gregory S. Wallner, Kent E.; Galbreath, Robert W.; Butler, Wayne M.; Brammer, Sarah G.; Allen, Zachariah A.; Adamovich, Edward

    2008-10-01

    Purpose: To evaluate cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in prostate cancer patients aged {>=}75 years undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and August 2004, 145 consecutive patients aged {>=}75 years underwent permanent prostate brachytherapy. Median follow-up was 5.8 years. Biochemical progression-free survival was defined by a prostate-specific antigen level {<=}0.40 ng/mL after nadir. Patients with metastatic prostate cancer or hormone-refractory disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on survival. Results: Nine-year CSS, bPFS, and OS rates for the entire cohort were 99.3%, 97.1%, and 64.5%, respectively. None of the evaluated parameters predicted for CSS, whereas bPFS was most closely predicted by percentage positive biopsies. Overall survival and non-cancer deaths were best predicted by tobacco status. Thirty-seven patients have died, with 83.8% of the deaths due to cardiovascular disease (22 patients) or second malignancies (9 patients). To date, only 1 patient (0.7%) has died of metastatic prostate cancer. Conclusions: After brachytherapy, high rates of CSS and bPFS are noted in elderly prostate cancer patients. Overall, approximately 65% of patients are alive at 9 years, with survival most closely related to tobacco status. We believe our results support an aggressive locoregional approach in appropriately selected elderly patients.

  3. Afterloading: The Technique That Rescued Brachytherapy

    SciTech Connect

    Aronowitz, Jesse N.

    2015-07-01

    Although brachytherapy had been established as a highly effective modality for the treatment of cancer, its application was threatened by mid-20th century due to appreciation of the radiation hazard to health care workers. This review examines how the introduction of afterloading eliminated exposure and ushered in a brachytherapy renaissance.

  4. Dose to the Bladder Neck Is the Most Important Predictor for Acute and Late Toxicity After Low-Dose-Rate Prostate Brachytherapy: Implications for Establishing New Dose Constraints for Treatment Planning

    SciTech Connect

    Hathout, Lara; Folkert, Michael R.; Kollmeier, Marisa A.; Yamada, Yoshiya; Cohen, Gil'ad N.; Zelefsky, Michael J.

    2014-10-01

    Purpose: To identify an anatomic structure predictive for acute (AUT) and late (LUT) urinary toxicity in patients with prostate cancer treated with low-dose-rate brachytherapy (LDR) with or without external beam radiation therapy (EBRT). Methods and Materials: From July 2002 to January 2013, 927 patients with prostate cancer (median age, 66 years) underwent LDR brachytherapy with Iodine 125 (n=753) or Palladium 103 (n=174) as definitive treatment (n=478) and as a boost (n=449) followed by supplemental EBRT (median dose, 50.4 Gy). Structures contoured on the computed tomographic (CT) scan on day 0 after implantation included prostate, urethra, bladder, and the bladder neck, defined as 5 mm around the urethra between the catheter balloon and the prostatic urethra. AUT and LUT were assessed with the Common Terminology Criteria for Adverse Events, version4. Clinical and dosimetric factors associated with AUT and LUT were analyzed with Cox regression and receiver operating characteristic analysis to calculate area under the receiver operator curve (ROC) (AUC). Results: Grade ≥2 AUT and grade ≥2 LUT occurred in 520 patients (56%) and 154 patients (20%), respectively. No grade 4 toxicities were observed. Bladder neck D2cc retained a significant association with AUT (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.03-1.04; P<.0001) and LUT (HR, 1.01; 95% CI, 1.00-1.03; P=.014) on multivariable analysis. In a comparison of bladder neck with the standard dosimetric variables by use of ROC analysis (prostate V100 >90%, D90 >100%, V150 >60%, urethra D20 >130%), bladder neck D2cc >50% was shown to have the strongest prognostic power for AUT (AUC, 0.697; P<.0001) and LUT (AUC, 0.620; P<.001). Conclusions: Bladder neck D2cc >50% was the strongest predictor for grade ≥2 AUT and LUT in patients treated with LDR brachytherapy. These data support inclusion of bladder neck constraints into brachytherapy planning to decrease urinary toxicity.

  5. Study of Dosimetric and Thermal Properties of a Newly Developed Thermo-brachytherapy Seed for Treatment of Solid Tumors

    NASA Astrophysics Data System (ADS)

    Gautam, Bhoj R.

    Studies on the curative effects of hyperthermia and radiation therapy on treatment of cancer show strong evidence of synergistic enhancement when both radiation and hyperthermia treatment modalities are applied simultaneously. A variety of tissue heating approaches developed to date still fail to overcome essential limitations such as inadequate temperature control, temperature non-uniformity, and prolonged time delay between hyperthermia and radiation treatments. We propose a new self-regulating Thermo-brachytherapy (TB) seed, which serves as a source of both radiation and heat for concurrent administration of brachytherapy and hyperthermia. The proposed seed is based on the BestRTM Iodine-125 seed model 2301, where the tungsten marker core and the air gap are replaced with ferromagnetic material. The ferromagnetic core produces heat when subjected to an alternating electromagnetic (EM) field and effectively shuts off after reaching the Curie temperature (TC) of the ferromagnetic material, thus establishing temperature self-regulation. The seed has a ferromagnetic Ni-Cu alloy core having a Curie transition at a temperature of 52 °C. This study summarizes the design and development of the self regulating ferromagnetic core TB seed for the concurrent hyperthermia and brachytherapy treatments. An experimental study of the magnetic properties of the Ni1-xCu x (0.28≤ x ≤0.3) alloys, and the simulation studies of radiation and thermal distribution properties of the seed have been performed. A preliminary experiment for the ferromagnetic induction heating of Ni-Cu needles has been carried out to ensure the practical feasibility of the induction heating. Radiation dose characterizing parameters (dose rate constant and other TG-43 factors) were calculated using the Monte Carlo method. For the thermal characteristics, we studied a model consisting of single or multiple seeds placed in the central region of a cylindrical phantom using a finite-element analysis method

  6. Testicular shielding in penile brachytherapy

    PubMed Central

    Bindal, Arpita; Tambe, Chandrashekhar M.; Ghadi, Yogesh; Murthy, Vedang; Shrivastava, Shyam Kishore

    2015-01-01

    Purpose Penile cancer, although rare, is one of the common genitourinary cancers in India affecting mostly aged uncircumcised males. For patients presenting with small superficial lesions < 3 cm restricted to glans, surgery, radical external radiation or brachytherapy may be offered, the latter being preferred as it allows organ and function preservation. In patients receiving brachytherapy, testicular morbidity is not commonly addressed. With an aim to minimize and document the doses to testis after adequate shielding during radical interstitial brachytherapy for penile cancers, we undertook this study in 2 patients undergoing brachytherapy and forms the basis of this report. Material and methods Two patients with early stage penile cancer limited to the glans were treated with radical high-dose-rate (HDR) brachytherapy using interstitial implant. A total of 7-8 tubes were implanted in two planes, parallel to the penile shaft. A total dose of 44-48 Gy (55-60 Gy EQD2 doses with α/β = 10) was delivered in 11-12 fractions of 4 Gy each delivered twice daily. Lead sheets adding to 11 mm (4-5 half value layer) were interposed between the penile shaft and scrotum. The testicular dose was measured using thermoluminescent dosimeters. For each patient, dosimetry was done for 3 fractions and mean calculated. Results The cumulative testicular dose to left and right testis was 31.68 cGy and 42.79 cGy for patient A, and 21.96 cGy and 23.28 cGy for patient B. For the same patients, the mean cumulative dose measured at the posterior aspect of penile shaft was 722.15 cGy and 807.72 cGy, amounting to 16.4% and 16.8% of the prescribed dose. Hence, the application of lead shield 11 mm thick reduced testicular dose from 722-808 cGy to 21.96-42.57 cGy, an “absolute reduction” of 95.99 ± 1.5%. Conclusions With the use of a simple lead shield as described, we were able to effectively reduce testicular dose from “spermicidal” range to “oligospermic” range with possible

  7. Dynamic rotating-shield brachytherapy

    SciTech Connect

    Liu, Yunlong; Flynn, Ryan T.; Kim, Yusung; Yang, Wenjun; Wu, Xiaodong

    2013-12-15

    Purpose: To present dynamic rotating shield brachytherapy (D-RSBT), a novel form of high-dose-rate brachytherapy (HDR-BT) with electronic brachytherapy source, where the radiation shield is capable of changing emission angles during the radiation delivery process.Methods: A D-RSBT system uses two layers of independently rotating tungsten alloy shields, each with a 180° azimuthal emission angle. The D-RSBT planning is separated into two stages: anchor plan optimization and optimal sequencing. In the anchor plan optimization, anchor plans are generated by maximizing the D{sub 90} for the high-risk clinical-tumor-volume (HR-CTV) assuming a fixed azimuthal emission angle of 11.25°. In the optimal sequencing, treatment plans that most closely approximate the anchor plans under the delivery-time constraint will be efficiently computed. Treatment plans for five cervical cancer patients were generated for D-RSBT, single-shield RSBT (S-RSBT), and {sup 192}Ir-based intracavitary brachytherapy with supplementary interstitial brachytherapy (IS + ICBT) assuming five treatment fractions. External beam radiotherapy doses of 45 Gy in 25 fractions of 1.8 Gy each were accounted for. The high-risk clinical target volume (HR-CTV) doses were escalated such that the D{sub 2cc} of the rectum, sigmoid colon, or bladder reached its tolerance equivalent dose in 2 Gy fractions (EQD2 with α/β= 3 Gy) of 75 Gy, 75 Gy, or 90 Gy, respectively.Results: For the patients considered, IS + ICBT had an average total dwell time of 5.7 minutes/fraction (min/fx) assuming a 10 Ci{sup 192}Ir source, and the average HR-CTV D{sub 90} was 78.9 Gy. In order to match the HR-CTV D{sub 90} of IS + ICBT, D-RSBT required an average of 10.1 min/fx more delivery time, and S-RSBT required 6.7 min/fx more. If an additional 20 min/fx of delivery time is allowed beyond that of the IS + ICBT case, D-RSBT and S-RSBT increased the HR-CTV D{sub 90} above IS + ICBT by an average of 16.3 Gy and 9.1 Gy, respectively

  8. Adjuvant stereotactic permanent seed breast implant: A boost series in view of partial breast irradiation

    SciTech Connect

    Jansen, Nicolas . E-mail: nicolas.jansen@chu.ulg.ac.be; Deneufbourg, Jean-Marie; Nickers, Philippe

    2007-03-15

    Purpose: The aim of this study was to use permanent seed implants in the breast and describe our experience with 15 cases, using iodine seed implants as a tumor bed boost. Methods and Materials: Breasts were fixed with a thermoplastic sheet, a template bridge applied, the thorax scanned and the images rotated to be perpendicular to the implant axis. Skin, heart, and lung were delineated. A preplan was made, prescribing 50 Gy to the clinical target volume (CTV), consisting in this boost series of nearly a quadrant. Iodine (125) seeds were stereotactically implanted through the template, and results were checked with a postplan computed tomographic (CT) scan. Results: The breast was immobilized reproducibly. Simulation, scanning, and implant were performed without difficulties. Preplan CTV D90% (the dose delivered to 90% of the CTV) was 66 Gy, and postoperative fluoroscopic or CT scan checks were satisfactory. Pre- and postplan dose-volume histogram showed good organ sparing: mean postplan skin, heart, and lung V30 Gy (the organ volume receiving a dose of 30 Gy) of 2 {+-} 2.2 mL, 0.24 {+-} 0.34 mL, and 3.5 {+-} 5 mL, respectively. No short-term toxicity above Grade 1 was noted, except for transient Grade 3 neuropathy in 1 patient. Conclusions: Seeds remained in the right place, as assessed by fluoroscopy, absence of significant pre- to postplan dose-volume histogram change for critical organs, and total irradiated breast volume. The method could be proposed as a boost when high dosimetric selectivity is required (young patients after cardiotoxic chemotherapy for left-sided cancer). This boost series was a preliminary step before testing partial breast irradiation by permanent seed implant in a prospective trial.

  9. Rare earth permanent magnets

    SciTech Connect

    Major-Sosias, M.A.

    1993-10-01

    Permanent magnets were discovered centuries ago from what was known as {open_quotes}lodestone{close_quotes}, a rock containing large quantities of the iron-bearing mineral magnetite (Fe{sub 3}O{sub 4}). The compass was the first technological use for permanent magnetic materials; it was used extensively for navigational purposes by the fifteenth century. During the twentieth century, as new applications for permanent magnets were developed, interest and research in permanent magnetic materials soared. Four major types of permanent magnets have been developed since the turn of the century.

  10. A Monte Carlo study on the effect of seed design on the interseed attenuation in permanent prostate implants.

    PubMed

    Afsharpour, Hossein; D'Amours, Michel; Coté, Benoit; Carrier, Jean-François; Verhaegen, Frank; Beaulieu, Luc

    2008-08-01

    Standard algorithms for postimplant analysis of transperineal interstitial permanent prostate brachytherapy (TIPPB) are based on AAPM Task Group 43 formalism (TG-43), which makes use of a world entirely made of water. This entails an assignment of the prostate, surrounding organs at risk, as well as all brachytherapy seeds present in a permanent prostate implant to water. Brachytherapy seeds are generally made from high atomic number materials. Because of the simultaneous presence of many brachytherapy seeds in a TIPPB, there is a shielding effect causing an attenuation of energy of the emitted photons generally called the "interseed attenuation" (ISA). This study investigates the impact of seed designs and compositions on the interseed attenuation. For this purpose, six brachytherapy seeds covering a wide variety of seed design and composition were modeled with the GEANT4 Monte Carlo (MC) toolkit. MC has allowed calculation of the contribution of each major component (encapsulation and internal components) of a given seed model to ISA separately. The impact of ISA on real clinical implant configurations was also explored. Two clinical postimplant geometries with different brachytherapy seeds were studied with MC simulations. The change in the clinical parameter D90 was observed. This study shows that Nucletron SelectSeed (similar to the Oncura model 6711), ProstaSeed, and Best Medical model 2335 are the most attenuating designs with 4.8%, 3.9%, and 4.6% of D90 reduction, respectively. The least attenuating seed is a 103Pd seed encapsulated in a polymer shell, the IBt OptiSeed with 1.5%. Finally, based on this systematic study, a new seed design is proposed that is predicted to be the most waterlike brachytherapy seed and thus TG-43 compatible. PMID:18777927

  11. Permanent contraception for women.

    PubMed

    Micks, Elizabeth A; Jensen, Jeffrey T

    2015-11-01

    Permanent methods of contraception are used by an estimated 220 million couples worldwide, and are often selected due to convenience, ease of use and lack of side effects. A variety of tubal occlusion techniques are available for female permanent contraception, and procedures can be performed using a transcervical or transabdominal approach. This article reviews currently available techniques for female permanent contraception and discusses considerations when helping patients choose a contraceptive method and tubal occlusion technique. PMID:26626698

  12. Oscillating Permanent Magnets.

    ERIC Educational Resources Information Center

    Michaelis, M. M.; Haines, C. M.

    1989-01-01

    Describes several ways to partially levitate permanent magnets. Computes field line geometries and oscillation frequencies. Provides several diagrams illustrating the mechanism of the oscillation. (YP)

  13. Characterization of Low-Energy Photon-Emitting Brachytherapy Sources with Modified Strengths for Applications in Focal Therapy

    NASA Astrophysics Data System (ADS)

    Reed, Joshua L.

    Permanent implants of low-energy photon-emitting brachytherapy sources are used to treat a variety of cancers. Individual source models must be separately characterized due to their unique geometry, materials, and radionuclides, which all influence their dose distributions. Thermoluminescent dosimeters (TLDs) are often used for dose measurements around low-energy photon-emitting brachytherapy sources. TLDs are typically calibrated with higher energy sources such as 60Co, which requires a correction for the change in the response of the TLDs as a function of photon energy. These corrections have historically been based on TLD response to x ray bremsstrahlung spectra instead of to brachytherapy sources themselves. This work determined the TLD intrinsic energy dependence for 125I and 103Pd sources relative to 60Co, which allows for correction of TLD measurements of brachytherapy sources with factors specific to their energy spectra. Traditional brachytherapy sources contain mobile internal components and large amounts of high-Z material such as radio-opaque markers and titanium encapsulations. These all contribute to perturbations and uncertainties in the dose distribution around the source. The CivaString is a new elongated 103Pd brachytherapy source with a fixed internal geometry, polymer encapsulation, and lengths ranging from 1 to 6 cm, which offers advantages over traditional source designs. This work characterized the CivaString source and the results facilitated the formal approval of this source for use in clinical treatments. Additionally, the accuracy of a superposition technique for dose calculation around the sources with lengths >1 cm was verified. Advances in diagnostic techniques are paving the way for focal brachytherapy in which the dose is intentionally modulated throughout the target volume to focus on subvolumes that contain cancer cells. Brachytherapy sources with variable longitudinal strength (VLS) are a promising candidate for use in focal

  14. Permanent magnet assembly

    DOEpatents

    Chell, Jeremy; Zimm, Carl B.

    2006-12-12

    A permanent magnet assembly is disclosed that is adapted to provide a magnetic field across an arc-shaped gap. Such a permanent magnet assembly can be used, for example, to provide a time-varying magnetic field to an annular region for use in a magnetic refrigerator.

  15. Clinical implementation of a new electronic brachytherapy system for skin brachytherapy

    PubMed Central

    Ballester-Sánchez, Rosa; Celada-Álvarez, Francisco Javier; Candela-Juan, Cristian; García-Martínez, Teresa; Llavador-Ros, Margarita; Botella-Estrada, Rafael; Barker, Christopher A.; Ballesta, Antonio; Tormo-Micó, Alejandro; Rodríguez, Silvia; Perez-Calatayud, Jose

    2014-01-01

    Although surgery is usually the first-line treatment for nonmelanoma skin cancers, radiotherapy (RT) may be indicated in selected cases. Radiation therapy as primary therapy can result in excellent control rates, cosmetics, and quality of life. Brachytherapy is a radiation treatment modality that offers the most conformal option to patients. A new modality for skin brachytherapy is electronic brachytherapy. This involves the placement of a high dose rate X-ray source directly in a skin applicator close to the skin surface, and therefore combines the benefits of brachytherapy with those of low energy X-ray radiotherapy. The Esteya electronic brachytherapy system is specifically designed for skin surface brachytherapy procedures. The purpose of this manuscript is to describe the clinical implementation of the new Esteya electronic brachytherapy system, which may provide guidance for users of this system. The information covered includes patient selection, treatment planning (depth evaluation and margin determination), patient marking, and setup. The justification for the hypofractionated regimen is described and compared with others protocols in the literature. Quality assurance (QA) aspects including daily testing are also included. We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment. We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers. PMID:25834587

  16. Incidence of Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy

    SciTech Connect

    Hamilton, Sarah Nicole; Tyldesley, Scott; Hamm, Jeremy; Jiang, Wei Ning; Keyes, Mira; Pickles, Tom; Lapointe, Vince; Kahnamelli, Adam; McKenzie, Michael; Miller, Stacy; Morris, W. James

    2014-11-15

    Purpose: To compare the second malignancy incidence in prostate cancer patients treated with brachytherapy (BT) relative to radical prostatectomy (RP) and to compare both groups with the cancer incidence in the general population. Methods and Materials: From 1998 to 2010, 2418 patients were treated with Iodine 125 prostate BT monotherapy at the British Columbia Cancer Agency, and 4015 referred patients were treated with RP. Cancer incidence was compared with the age-matched general population using standardized incidence ratios (SIRs). Pelvic malignancies included invasive and noninvasive bladder cancer and rectal cancer. Cox multivariable analysis was performed with adjustment for covariates to determine whether treatment (RP vs BT) was associated with second malignancy risk. Results: The median age at BT was 66 years and at RP 62 years. The SIR comparing BT patients with the general population was 1.06 (95% confidence interval [CI] 0.91-1.22) for second malignancy and was 1.53 (95% CI 1.12-2.04) for pelvic malignancy. The SIR comparing RP patients with the general population was 1.11 (95% CI 0.98-1.25) for second malignancy and was 1.11 (95% CI 0.82-1.48) for pelvic malignancy. On multivariable analysis, older age (hazard ratio [HR] 1.05) and smoking (HR 1.65) were associated with increased second malignancy risk (P<.0001). Radical prostatectomy was not associated with a decreased second malignancy risk relative to BT (HR 0.90, P=.43), even when excluding patients who received postprostatectomy external beam radiation therapy (HR 1.13, P=.25). Older age (HR 1.09, P<.0001) and smoking (HR 2.17, P=.0009) were associated with increased pelvic malignancy risk. Radical prostatectomy was not associated with a decreased pelvic malignancy risk compared with BT (HR 0.57, P=.082), even when excluding postprostatectomy external beam radiation therapy patients (HR 0.87, P=.56). Conclusions: After adjustment for covariates, BT patients did not have an increased second

  17. Late Urinary Side Effects 10 Years After Low-Dose-Rate Prostate Brachytherapy: Population-Based Results From a Multiphysician Practice Treating With a Standardized Protocol and Uniform Dosimetric Goals

    SciTech Connect

    Keyes, Mira Miller, Stacy; Pickles, Tom; Halperin, Ross; Kwan, Winkle; Lapointe, Vincent; McKenzie, Michael; Spadinger, Ingrid; Pai, Howard; Chan, Elisa K.; Morris, W. James

    2014-11-01

    Purpose: To determine late urinary toxicity (>12 months) in a large cohort of uniformly treated low-dose-rate prostate brachytherapy patients. Methods and Materials: From 1998 to 2009, 2709 patients with National Comprehensive Cancer Network–defined low-risk and low-tier intermediate-risk prostate cancer were treated with Iodine 125 ({sup 125}I) low-dose-rate prostate brachytherapy; 2011 patients with a minimum of 25 months of follow-up were included in the study. Baseline patients, treatment, implant factors, and late urinary toxicity (Radiation Therapy Oncology Group [RTOG] grading system and International Prostate Symptom Score [IPSS]) were recorded prospectively. Time to IPSS resolution, late RTOG genitourinary toxicity was examined with Kaplan-Meier and log-rank tests. Cox proportional hazards regression was done for individual covariates and multivariable models. Results: Median follow-up was 54.5 months (range, 2-13 years). Actuarial toxicity rates reached 27% and 10% (RTOG ≥2 and ≥3, respectively) at 9-13 years. Symptoms resolved quickly in the majority of patients (88% in 6-12 months). The prevalence of RTOG 0, 1, 2, 3, and 4 toxicity with a minimum of 7 years' follow-up was 70%, 21%, 6.4%, 2.3%, and 0.08%, respectively. Patients with a larger prostate volume, higher baseline IPSS, higher D90, acute toxicity, and age >70 years had more late RTOG ≥2 toxicity (all P≤.02). The IPSS resolved slower in patients with lower baseline IPSS and larger ultrasound prostate volume, those not receiving androgen deprivation therapy, and those with higher D90. The crude rate of RTOG 3 toxicity was 6%. Overall the rate of transurethral resection of the prostate was 1.9%; strictures, 2%; incontinence, 1.3%; severe symptoms, 1.8%; late catheterization, 1.3%; and hematuria, 0.8%. The majority (80%) resolved their symptoms in 6-12 months. Conclusion: Long-term urinary toxicity after brachytherapy is low. Although actuarial rates increase with longer follow

  18. Dosimetric Characteristics for Brachytherapy Sources

    SciTech Connect

    DeWerd, Larry A.; Davis, Stephen D.

    2011-05-05

    Brachytherapy sources are characterized by the dosimetric parameters in a protocol such as the American Association of Physicists in Medicine Task Group 43. The air-kerma strength is measured and traceable to a primary standard. Then the parameters such as dose-rate constant, radial dose function, and anisotropy function are measured and related back to the primary standard. This is normally accomplished with thermoluminescent dosimeters (TLDs). Since radial dose function and anisotropy function are relative parameters, some of the dosimetric corrections are negligible. For the dose-rate constant, parameters such as the energy dependence compared with a calibration beam such as {sup 60}Co need to be accounted for. A description of the primary standard measurements and TLD measurements will be discussed.

  19. Dosimetric Characteristics for Brachytherapy Sources

    NASA Astrophysics Data System (ADS)

    DeWerd, Larry A.; Davis, Stephen D.

    2011-05-01

    Brachytherapy sources are characterized by the dosimetric parameters in a protocol such as the American Association of Physicists in Medicine Task Group 43. The air-kerma strength is measured and traceable to a primary standard. Then the parameters such as dose-rate constant, radial dose function, and anisotropy function are measured and related back to the primary standard. This is normally accomplished with thermoluminescent dosimeters (TLDs). Since radial dose function and anisotropy function are relative parameters, some of the dosimetric corrections are negligible. For the dose-rate constant, parameters such as the energy dependence compared with a calibration beam such as 60Co need to be accounted for. A description of the primary standard measurements and TLD measurements will be discussed.

  20. Brachytherapy next generation: robotic systems.

    PubMed

    Popescu, Tiberiu; Kacsó, Alex Cristian; Pisla, Doina; Kacsó, Gabriel

    2015-12-01

    In a field dominated by external beam radiation therapy (EBRT), both the therapeutic and technical possibilities of brachytherapy (BT) are underrated, shadowed by protons and intensity modulated radiotherapy. Decreasing expertise and indications, as well as increasing lack of specific BT training for radiation therapy (RT) residents led to the real need of shortening its learning curve and making it more popular. Developing robotic BT devices can be a way to mitigate the above issues. There are many teams working at custom-made robotic BT platforms to perfect and overcome the limitations of the existing systems. This paper provides a picture of the current state-of-the-art in robotic assisted BT, as it also conveys the author's solution to the problem, a parallel robot that uses CT-guidance. PMID:26816510

  1. Brachytherapy next generation: robotic systems

    PubMed Central

    Popescu, Tiberiu; Kacsó, Alex Cristian; Pisla, Doina

    2015-01-01

    In a field dominated by external beam radiation therapy (EBRT), both the therapeutic and technical possibilities of brachytherapy (BT) are underrated, shadowed by protons and intensity modulated radiotherapy. Decreasing expertise and indications, as well as increasing lack of specific BT training for radiation therapy (RT) residents led to the real need of shortening its learning curve and making it more popular. Developing robotic BT devices can be a way to mitigate the above issues. There are many teams working at custom-made robotic BT platforms to perfect and overcome the limitations of the existing systems. This paper provides a picture of the current state-of-the-art in robotic assisted BT, as it also conveys the author's solution to the problem, a parallel robot that uses CT-guidance. PMID:26816510

  2. 10 CFR 35.406 - Brachytherapy sources accountability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Brachytherapy sources accountability. 35.406 Section 35.406 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.406 Brachytherapy sources accountability. (a) A licensee shall maintain accountability at all...

  3. {sup 106}Ruthenium Brachytherapy for Retinoblastoma

    SciTech Connect

    Abouzeid, Hana; Moeckli, Raphael; Gaillard, Marie-Claire; Beck-Popovic, Maja; Pica, Alessia; Zografos, Leonidas; Balmer, Aubin; Pampallona, Sandro; Munier, Francis L.

    2008-07-01

    Purpose: To evaluate the efficacy of {sup 106}Ru plaque brachytherapy for the treatment of retinoblastoma. Methods and Materials: We reviewed a retrospective, noncomparative case series of 39 children with retinoblastoma treated with {sup 106}Ru plaques at the Jules-Gonin Eye Hospital between October 1992 and July 2006, with 12 months of follow-up. Results: A total of 63 tumors were treated with {sup 106}Ru brachytherapy in 41 eyes. The median patient age was 27 months. {sup 106}Ru brachytherapy was the first-line treatment for 3 tumors (4.8%), second-line treatment for 13 (20.6%), and salvage treatment for 47 tumors (74.6%) resistant to other treatment modalities. Overall tumor control was achieved in 73% at 1 year. Tumor recurrence at 12 months was observed in 2 (12.5%) of 16 tumors for which {sup 106}Ru brachytherapy was used as the first- or second-line treatment and in 15 (31.9%) of 47 tumors for which {sup 106}Ru brachytherapy was used as salvage treatment. Eye retention was achieved in 76% of cases (31 of 41 eyes). Univariate and multivariate analyses revealed no statistically significant risk factors for tumor recurrence. Radiation complications included retinal detachment in 7 (17.1%), proliferative retinopathy in 1 (2.4%), and subcapsular cataract in 4 (9.7%) of 41 eyes. Conclusion: {sup 106}Ru brachytherapy is an effective treatment for retinoblastoma, with few secondary complications. Local vitreous seeding can be successfully treated with {sup 106}Ru brachytherapy.

  4. Brachytherapy in the Treatment of Cholangiocarcinoma

    SciTech Connect

    Shinohara, Eric T.; Guo Mengye; Mitra, Nandita; Metz, James M.

    2010-11-01

    Purpose: To examine the role of brachytherapy in the treatment of cholangiocarcinomas in a relatively large group of patients. Methods and Materials: Using the Surveillance, Epidemiology and End Results database, a total of 193 patients with cholangiocarcinoma treated with brachytherapy were identified for the period 1988-2003. The primary analysis compared patients treated with brachytherapy (with or without external-beam radiation) with those who did not receive radiation. To try to account for confounding variables, propensity score and sensitivity analyses were used. Results: There was a significant difference between patients who received radiation (n = 193) and those who did not (n = 6859) with regard to surgery (p < 0.0001), race (p < 0.0001), stage (p < 0.0001), and year of diagnosis (p <0.0001). Median survival for patients treated with brachytherapy was 11 months (95% confidence interval [CI] 9-13 months), compared with 4 months for patients who received no radiation (p < 0.0001). On multivariable analysis (hazard ratio [95% CI]) brachytherapy (0.79 [0.66-0.95]), surgery (0.50 [0.46-0.53]), year of diagnosis (1998-2003: 0.66 [0.60-0.73]; 1993-1997: (0.96 [0.89-1.03; NS], baseline 1988-1992), and extrahepatic disease (0.84 [0.79-0.89]) were associated with better overall survival. Conclusions: To the authors' knowledge, this is the largest dataset reported for the treatment of cholangiocarcinomas with brachytherapy. The results of this retrospective analysis suggest that brachytherapy may improve overall survival. However, because of the limitations of the Surveillance, Epidemiology and End Results database, these results should be interpreted cautiously, and future prospective studies are needed.

  5. Brachytherapy and Local Excision for Sphincter Preservation in T1 and T2 Rectal Cancer

    SciTech Connect

    Grimard, Laval Stern, Hartley; Spaans, Johanna N. M.Sc.

    2009-07-01

    Purpose: To report long-term results of brachytherapy after local excision (LE) in the treatment of T1 and T2 rectal cancer at risk of recurrence due to residual subclinical disease. Methods and Materials: Between 1989 and 2007, 32 patients undergoing LE and brachytherapy were followed prospectively for a mean of 6.2 years. Estimates of local recurrence (LR), disease-specific survival (DSS), and overall survival (OS) were generated. Treatment-related toxicity and the effect of known prognostic factors were determined. Results: There were 8 LR (3 T1, 5 T2), of which 5 were salvaged surgically. Median time to the 8 LR was 14 months, and the 5-year rate of local control was 76%. Although there have been 9 deaths to date, only 5 were from disease. Five-year DSS and OS rates were 85% and 78%, respectively. There were 4 cases of Grade 2-3 radionecrosis and 1 case of mild stool incontinence. The sphincter was preserved in 27 of 32 patients. Conclusion: Local excision and adjuvant brachytherapy for T1 and T2 rectal cancer is an appealing treatment alternative to immediate radical resection, particularly in the frail and elderly who are unable to undergo major surgery, as well as for patients wanting to avoid a permanent colostomy.

  6. Prostate brachytherapy postimplant dosimetry: Automatic plan reconstruction of stranded implants

    SciTech Connect

    Chng, N.; Spadinger, I.; Morris, W. J.; Usmani, N.; Salcudean, S.

    2011-01-15

    Purpose: Plan reconstruction for permanent implant prostate brachytherapy is the process of determining the correspondence between planned and implanted seeds in postimplant analysis. Plan reconstruction informs many areas of brachytherapy quality assurance, including the verification of seed segmentation, misplacement and migration assessment, implant simulations, and the dosimetry of mixed-activity or mixed-species implants. Methods: An algorithm has been developed for stranded implants which uses the interseed spacing constraints imposed by the suture to improve the accuracy of reconstruction. Seventy randomly selected clinical cases with a mean of 23.6 (range 18-30) needles and mean density of 2.0 (range 1.6-2.6) 2.0 (range 1.6-2.6) seeds/cm{sup 3} were automatically reconstructed and the accuracy compared to manual reconstructions performed using a custom 3D graphical interface. Results: Using the automatic algorithm, the mean accuracy of the assignment relative to manual reconstruction was found to be 97.7{+-}0.5%. Fifty-two of the 70 cases (74%) were error-free; of seeds in the remaining cases, 96.7{+-}0.3% were found to be attributed to the correct strand and 97.0{+-}0.3% were correctly connected to their neighbors. Any necessary manual correction using the interface is usually straightforward. For the clinical data set tested, neither the number of seeds or needles, average density, nor the presence of clusters was found to have an effect on reconstruction accuracy using this method. Conclusions: Routine plan reconstruction of stranded implants can be performed with a high degree of accuracy to support postimplant dosimetry and quality analyses.

  7. Image guided Brachytherapy: The paradigm of Gynecologic and Partial Breast HDR Brachytherapy

    NASA Astrophysics Data System (ADS)

    Diamantopoulos, S.; Kantemiris, I.; Konidari, A.; Zaverdinos, P.

    2015-09-01

    High dose rate (HDR) brachytherapy uses high strength radioactive sources and temporary interstitial implants to conform the dose to target and minimize the treatment time. The advances of imaging technology enable accurate reconstruction of the implant and exact delineation of high-risk CTV and the surrounding critical structures. Furthermore, with sophisticated treatment planning systems, applicator devices and stepping source afterloaders, brachytherapy evolved to a more precise, safe and individualized treatment. At the Radiation Oncology Department of Metropolitan Hospital Athens, MRI guided HDR gynecologic (GYN) brachytherapy and accelerated partial breast irradiation (APBI) with brachytherapy are performed routinely. Contouring and treatment planning are based on the recommendations of the GEC - ESTRO Working group. The task of this presentation is to reveal the advantages of 3D image guided brachytherapy over 2D brachytherapy. Thus, two patients treated at our department (one GYN and one APBI) will be presented. The advantage of having adequate dose coverage of the high risk CTV and simultaneous low doses to the OARs when using 3D image- based brachytherapy will be presented. The treatment techniques, equipment issues, as well as implantation, imaging and treatment planning procedures will be described. Quality assurance checks will be treated separately.

  8. AB012. Brachytherapy for localized prostate cancer

    PubMed Central

    Xu, Yong; Yang, Yong

    2016-01-01

    Background To evaluate the security and effect of brachytherapy for localized prostate cancer. Methods Forty five patients with Tl–T2 prostate cancer were treated with real-time transperineal ultrasound-guide 125I seeds prostate implantation. Results The median operation time was 90 min, the median number of I seeds used was 56. The follow up time was 12–48 months, the cases of PSA <1 µg/L were 29, PSA 1–2 µg/L were 11 and PSA ≥2 µg/L were 5. Conclusions Brachytherapy for localized prostate cancer is safe and effective.

  9. Permanent versus disconnectable FPSOs

    NASA Astrophysics Data System (ADS)

    Luo, Yong; Wang, Hong-Wei

    2009-06-01

    Floating production storage and offloading (FPSO) vessels offer a cost-effective field development solution, especially in deepwater areas lacking an adequate pipeline network. Most FPSOs are permanently moored, i.e. the complete system is designed to withstand any kind of extreme environment at the field location. FPSOs that can be quickly disconnected from their moorings and risers have also been designed and deployed. The key feature of this type of disconnectable FPSO is that it can be disconnect and so avoid dangerous environmental conditions such as icebergs, hurricanes in the Gulf of Mexico and typhoons in the South China Sea. In this paper, the concept of disconnectable FPSOs for deepwater field development is presented. Key technologies and their engineering analyses are highlighted. The merits and demerits of disconnectable vs permanent FPSOs are then evaluated. The paper concludes that both permanent and disconnectable FPSOs are versatile floating systems and their selection depends on safety, technological, cost and operational considerations.

  10. Overview: Five decades of brachytherapy

    SciTech Connect

    Ellis, F.

    1986-01-01

    Brachytherapy started in 1930. Ra-226 was the radioisotope for cancer therapy at that time and much has been learned about its properties since then. One of the major findings at that time was output. When the author started, there was no T factor. People did not know how many R units were produced by 1.0 mg of radium filtered by 0.5 mm of platinum at 1.0 cm. So one was in a bit of chaos from that point of view. Eventually, that was settled in the 1930's. It was very exciting to find out that, although the national laboratories of the U.S., England, France and Germany had had values of this T factor varying from about five to seven (when they're only supposed to have less than 1% error); the value was really 8.3 and it was quite a landmark. This led to an improved knowledge of dose and effects. Developments over the next five decades are discussed in detail.

  11. High Intensity Focused Ultrasound (HIFU) as a Salvage Treatment for Recurrent Prostate Cancer after Brachytherapy — a Feasibility Study

    NASA Astrophysics Data System (ADS)

    Chapman, Alexander T.; Rivens, Ian H.; Thompson, Alan C.; ter Haar, Gail R.

    2007-05-01

    HIFU may be an effective salvage treatment for patients who develop local recurrence after permanent low-dose brachytherapy. It has been suggested that the presence of seeds in the prostate may obstruct the HIFU beam or alter the heating characteristics of the prostate tissue. Acoustic field measurements were made using a membrane hydrophone and lesioning experiments were carried out in ex vivo bovine liver. These revealed a significant effect of the seeds on the HIFU focal region as well as a reduction in lesion length when seeds were placed in a pre-focal position. Further work is needed to evaluate the full effects of implanted brachytherapy seeds on the clinical delivery of HIFU.

  12. Comparison of High-Dose Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis

    SciTech Connect

    Coen, John J.; Zietman, Anthony L.; Rossi, Carl J.; Grocela, Joseph A.; Efstathiou, Jason A.; Yan, Yan; Shipley, William U.

    2012-01-01

    Purpose: To report a case-matched analysis comparing high-dose external-beam radiation (EBRT) for prostate cancer delivered on Proton Radiation Oncology Group (PROG) 95-09, a randomized trial, with permanent prostate brachytherapy over the same era. Methods: From 1996 to 1999, 196 patients were accrued to the high-dose arm (79.2 Gray equivalent (GyE) using photons and protons) of PROG 95-09 at the Massachusetts General Hospital and Loma Linda University Medical Center. Entry criteria specified T1-2 and prostate-specific antigen {<=}15 ng/mL. When Gleason score >7 was excluded, 177 men were left for case matching. At Massachusetts General Hospital, 203 similar patients were treated by a single brachytherapist from 1997 to 2002. Minimum follow-up was 3 years. Case matching, based on T stage, Gleason score, prostate-specific antigen, and age resulted in 141 matches (282 patients). Median follow-up was 8.6 and 7.4 years for EBRT and brachytherapy, respectively. The primary endpoint was biochemical failure (BF). Results: Using the Phoenix definition, the 8-year BF rates were 7.7% and 16.1% for EBRT and brachytherapy, respectively (p = 0.42). A stratified analysis was performed by risk group. In the EBRT group, 113 and 28 patients were low and intermediate risk, respectively. In the brachytherapy group, 118 and 23 were. When stratified by risk group, the BF rates were similar by either technique. Conclusions: High-dose EBRT and brachytherapy result in similar BF rates for men with localized prostate cancer. Comparative quality-of-life and cost-effectiveness studies are warranted.

  13. Alkaline "Permanent" Paper.

    ERIC Educational Resources Information Center

    Pacey, Antony

    1991-01-01

    Discussion of paper manufacturing processes and their effects on library materials focuses on the promotion of alkaline "permanent" paper, with less acid, by Canadian library preservation specialists. Standards for paper acidity are explained; advantages of alkaline paper are described, including decreased manufacturing costs; and recyclability is…

  14. Evaluation of brachytherapy lung implant dose distributions from photon-emitting sources due to tissue heterogeneities

    SciTech Connect

    Yang Yun; Rivard, Mark J.

    2011-11-15

    Purpose: Photon-emitting brachytherapy sources are used for permanent implantation to treat lung cancer. However, the current brachytherapy dose calculation formalism assumes a homogeneous water medium without considering the influence of radiation scatter or tissue heterogeneities. The purpose of this study was to determine the dosimetric effects of tissue heterogeneities for permanent lung brachytherapy. Methods: The MCNP5 v1.40 radiation transport code was used for Monte Carlo (MC) simulations. Point sources with energies of 0.02, 0.03, 0.05, 0.1, 0.2, and 0.4 MeV were simulated to cover the range of pertinent brachytherapy energies and to glean dosimetric trends independent of specific radionuclide emissions. Source positions from postimplant CT scans of five patient implants were used for source coordinates, with dose normalized to 200 Gy at the center of each implant. With the presence of fibrosis (around the implant), cortical bone, lung, and healthy tissues, dose distributions and {sub PTV}DVH were calculated using the MCNP *FMESH4 tally and the NIST mass-energy absorption coefficients. This process was repeated upon replacing all tissues with water. For all photon energies, 10{sup 9} histories were simulated to achieve statistical errors (k = 1) typically of 1%. Results: The mean PTV doses calculated using tissue heterogeneities for all five patients changed (compared to dose to water) by only a few percent over the examined photon energy range, as did PTV dose at the implant center. The {sub PTV}V{sub 100} values were 81.2%, 90.0% (as normalized), 94.3%, 93.9%, 92.7%, and 92.2% for 0.02, 0.03, 0.05, 0.1, 0.2, and 0.4 MeV source photons, respectively. Relative to water, the maximum bone doses were higher by factors of 3.7, 5.1, 5.2, 2.4, 1.2, and 1.0 The maximum lung doses were about 0.98, 0.94, 0.91, 0.94, 0.97, and 0.99. Relative to water, the maximum healthy tissue doses at the mediastinal position were higher by factors of 9.8, 2.2, 1.3, 1.1, 1.1, and

  15. Early voiding dysfunction associated with prostate brachytherapy.

    PubMed

    Wagner; Nag; Young; Bahnson

    2000-12-15

    Introduction: Transperineal prostate brachytherapy is gaining popularity as a treatment for clinically localized carcinoma of the prostate. Very little prospective data exists addressing the issue of complications associated with this procedure. We present an analysis of the early voiding dysfunction associated with prostate brachytherapy. Materials and Methods: Forty-six consecutive patients who underwent Palladium-103 (Pd-103) seed placement for clinically localized prostate carcinoma were evaluated prospectively for any morbidity associated with the procedure. Twenty-three patients completed an International Prostate Symptom Score (IPSS) questionnaire preoperatively, at their first postoperative visit, and at their second postoperative visit. The total IPSS, each of the seven individual components, and the "bother" score were evaluated separately for each visit, and statistical significance was determined. Results: Urinary retention occurred in 7/46 patients (15%). Of these, 5 were able to void spontaneously after catheter removal. One patient is maintained with a suprapubic tube, and one patient is currently on continuous intermittent catheterization. Baseline IPSS was 7.1 and this went to 20.0 at the first postoperative visit (p<0.001). By the second postoperative visit, the IPSS was 8.0. Conclusions: In our experience, prostate brachytherapy for localized carcinoma of the prostate is associated with a 15% catheterization rate and a significant increase in the IPSS (7.1 to 20.0). This increase in the IPSS seems to be self-limited. Patients need to be educated on these issues prior to prostate brachytherapy. PMID:11113369

  16. Gadolinium-153 as a brachytherapy isotope

    NASA Astrophysics Data System (ADS)

    Enger, Shirin A.; Fisher, Darrell R.; Flynn, Ryan T.

    2013-02-01

    The purpose of this work was to present the fundamental dosimetric characteristics of a hypothetical 153Gd brachytherapy source using the AAPM TG-43U1 dose-calculation formalism. Gadolinium-153 is an intermediate-energy isotope that emits 40-100 keV photons with a half-life of 242 days. The rationale for considering 153Gd as a brachytherapy source is for its potential of patient specific shielding and to enable reduced personnel shielding requirements relative to 192Ir, and as an isotope for interstitial rotating shield brachytherapy (I-RSBT). A hypothetical 153Gd brachytherapy source with an active core of 0.84 mm diameter, 10 mm length and specific activity of 5.55 TBq of 153Gd per gram of Gd was simulated with Geant4. The encapsulation material was stainless steel with a thickness of 0.08 mm. The radial dose function, anisotropy function and photon spectrum in water were calculated for the 153Gd source. The simulated 153Gd source had an activity of 242 GBq and a dose rate in water 1 cm off axis of 13.12 Gy h-1, indicating that it would be suitable as a low-dose-rate or pulsed-dose-rate brachytherapy source. The beta particles emitted have low enough energies to be absorbed in the source encapsulation. Gadolinium-153 has an increasing radial dose function due to multiple scatter of low-energy photons. Scattered photon dose takes over with distance from the source and contributes to the majority of the absorbed dose. The anisotropy function of the 153Gd source decreases at low polar angles, as a result of the long active core. The source is less anisotropic at polar angles away from the longitudinal axes. The anisotropy function increases with increasing distance. The 153Gd source considered would be suitable as an intermediate-energy low-dose-rate or pulsed-dose-rate brachytherapy source. The source could provide a means for I-RSBT delivery and enable brachytherapy treatments with patient specific shielding and reduced personnel shielding requirements relative to

  17. Gadolinium-153 as a brachytherapy isotope.

    PubMed

    Enger, Shirin A; Fisher, Darrell R; Flynn, Ryan T

    2013-02-21

    The purpose of this work was to present the fundamental dosimetric characteristics of a hypothetical (153)Gd brachytherapy source using the AAPM TG-43U1 dose-calculation formalism. Gadolinium-153 is an intermediate-energy isotope that emits 40-100 keV photons with a half-life of 242 days. The rationale for considering (153)Gd as a brachytherapy source is for its potential of patient specific shielding and to enable reduced personnel shielding requirements relative to (192)Ir, and as an isotope for interstitial rotating shield brachytherapy (I-RSBT). A hypothetical (153)Gd brachytherapy source with an active core of 0.84 mm diameter, 10 mm length and specific activity of 5.55 TBq of (153)Gd per gram of Gd was simulated with Geant4. The encapsulation material was stainless steel with a thickness of 0.08 mm. The radial dose function, anisotropy function and photon spectrum in water were calculated for the (153)Gd source. The simulated (153)Gd source had an activity of 242 GBq and a dose rate in water 1 cm off axis of 13.12 Gy h(-1), indicating that it would be suitable as a low-dose-rate or pulsed-dose-rate brachytherapy source. The beta particles emitted have low enough energies to be absorbed in the source encapsulation. Gadolinium-153 has an increasing radial dose function due to multiple scatter of low-energy photons. Scattered photon dose takes over with distance from the source and contributes to the majority of the absorbed dose. The anisotropy function of the (153)Gd source decreases at low polar angles, as a result of the long active core. The source is less anisotropic at polar angles away from the longitudinal axes. The anisotropy function increases with increasing distance. The (153)Gd source considered would be suitable as an intermediate-energy low-dose-rate or pulsed-dose-rate brachytherapy source. The source could provide a means for I-RSBT delivery and enable brachytherapy treatments with patient specific shielding and reduced personnel

  18. Brachytherapy in pelvic malignancies: a review for radiologists.

    PubMed

    Vicens, Rafael A; Rodriguez, Joshua; Sheplan, Lawrence; Mayo, Cody; Mayo, Lauren; Jensen, Corey

    2015-10-01

    Brachytherapy, also known as sealed source or internal radiation therapy, involves placement of a radioactive source immediately adjacent to or within tumor, thus enabling delivery of a localized high dose of radiation. Compared with external beam radiation which must first pass through non-target tissues, brachytherapy results in less radiation dose to normal tissues. In the past decade, brachytherapy use has markedly increased, thus radiologists are encountering brachytherapy devices and their associated post-treatment changes to increasing degree. This review will present a variety of brachytherapy devices that radiologists may encounter during diagnostic pelvic imaging with a focus on prostate and gynecologic malignancies. The reader will become familiar with the function, correct position, and potential complications of brachytherapy devices in an effort to improve diagnostic reporting and communication with clinicians. PMID:25820802

  19. Study of Dosimetric and Thermal Properties of a Newly Developed Thermo-brachytherapy Seed for Treatment of Solid Tumors

    NASA Astrophysics Data System (ADS)

    Gautam, Bhoj R.

    Studies on the curative effects of hyperthermia and radiation therapy on treatment of cancer show strong evidence of synergistic enhancement when both radiation and hyperthermia treatment modalities are applied simultaneously. A variety of tissue heating approaches developed to date still fail to overcome essential limitations such as inadequate temperature control, temperature non-uniformity, and prolonged time delay between hyperthermia and radiation treatments. We propose a new self-regulating Thermo-brachytherapy (TB) seed, which serves as a source of both radiation and heat for concurrent administration of brachytherapy and hyperthermia. The proposed seed is based on the BestRTM Iodine-125 seed model 2301, where the tungsten marker core and the air gap are replaced with ferromagnetic material. The ferromagnetic core produces heat when subjected to an alternating electromagnetic (EM) field and effectively shuts off after reaching the Curie temperature (TC) of the ferromagnetic material, thus establishing temperature self-regulation. The seed has a ferromagnetic Ni-Cu alloy core having a Curie transition at a temperature of 52 °C. This study summarizes the design and development of the self regulating ferromagnetic core TB seed for the concurrent hyperthermia and brachytherapy treatments. An experimental study of the magnetic properties of the Ni1-xCu x (0.28≤ x ≤0.3) alloys, and the simulation studies of radiation and thermal distribution properties of the seed have been performed. A preliminary experiment for the ferromagnetic induction heating of Ni-Cu needles has been carried out to ensure the practical feasibility of the induction heating. Radiation dose characterizing parameters (dose rate constant and other TG-43 factors) were calculated using the Monte Carlo method. For the thermal characteristics, we studied a model consisting of single or multiple seeds placed in the central region of a cylindrical phantom using a finite-element analysis method

  20. Variable Permanent Magnet Quadrupole

    SciTech Connect

    Mihara, T.; Iwashita, Y.; Kumada, M.; Spencer, C.M.; /SLAC

    2007-05-23

    A permanent magnet quadrupole (PMQ) is one of the candidates for the final focus lens in a linear collider. An over 120 T/m strong variable permanent magnet quadrupole is achieved by the introduction of saturated iron and a 'double ring structure'. A fabricated PMQ achieved 24 T integrated gradient with 20 mm bore diameter, 100 mm magnet diameter and 20 cm pole length. The strength of the PMQ is adjustable in 1.4 T steps, due to its 'double ring structure': the PMQ is split into two nested rings; the outer ring is sliced along the beam line into four parts and is rotated to change the strength. This paper describes the variable PMQ from fabrication to recent adjustments.

  1. Permanent Peripheral Neuropathy

    PubMed Central

    Higgins, Elizabeth

    2014-01-01

    The health risks and side effects of fluoroquinolone use include the risk of tendon rupture and myasthenia gravis exacerbation, and on August 15, 2013, the Food and Drug Administration updated its warning to include the risk of permanent peripheral neuropathy. We present a case of fluoroquinolone-induced peripheral neuropathy in a patient treated for clinically diagnosed urinary tract infection with ciprofloxacin antibiotic. PMID:26425618

  2. Permanent magnet design methodology

    NASA Technical Reports Server (NTRS)

    Leupold, Herbert A.

    1991-01-01

    Design techniques developed for the exploitation of high energy magnetically rigid materials such as Sm-Co and Nd-Fe-B have resulted in a revolution in kind rather than in degree in the design of a variety of electron guidance structures for ballistic and aerospace applications. Salient examples are listed. Several prototype models were developed. These structures are discussed in some detail: permanent magnet solenoids, transverse field sources, periodic structures, and very high field structures.

  3. PSA Bounce and Biochemical Failure After Brachytherapy for Prostate Cancer: A Study of 820 Patients With a Minimum of 3 Years of Follow-Up

    SciTech Connect

    Caloglu, Murat; Ciezki, Jay P.; Reddy, Chandana A.; Angermeier, Kenneth; Ulchaker, James; Chehade, Nabil; Altman, Andrew; Magi-Galuzzi, Christina; Klein, Eric A.

    2011-07-01

    Purpose: To determine clinical or dosimetric factors associated with a prostate-specific antigen (PSA) bounce, as well as an association between a PSA bounce and biochemical relapse-free survival (bRFS), in patients treated with iodine-125 brachytherapy. Methods and Materials: A variety of clinical and treatment factors were examined in 820 patients who had a minimum of 3 years of PSA follow-up with T1-T2cN0M0 prostate cancer. Four different PSA threshold values were used for defining a PSA bounce: a PSA rise of {>=}0.2, {>=}0.4, {>=}0.6, and {>=}0.8 ng/mL. Results: A PSA bounce of {>=}0.2, {>=}0.4, {>=}0.6, and {>=}0.8 ng/mL was noted in 247 patients (30.1%), 161 (19.6%), 105 (12.8%), and 78 (9.5%), respectively. The median time to the first PSA rise was 17.4, 16.25, 16.23, and 15.71 months, respectively, vs. 34.35 months for a biochemical failure (p < 0.0001). A PSA rise of {>=}0.2 ng/mL was the only definition for which there was a significant difference in bRFS between bounce and non-bounce patients. The 5-year bRFS rate of patients having a PSA bounce of {>=}0.2 was 97.7% vs. 91% for those who did not have a PSA bounce (p = 0.0011). On univariate analysis for biochemical failure, age, risk group, and PSAs per year had a statistically significant correlation with PSA bounce of {>=}0.2 ng/mL. On multivariate analysis, age and PSAs per year remained statistically significant (p < 0.0001 and p = 0.0456, respectively). Conclusions: A bounce definition of a rise {>=}0.2 ng/mL is a reliable definition among several other definitions. The time to first PSA rise is the most valuable factor for distinguishing between a bounce and biochemical failure.

  4. Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy

    PubMed Central

    2014-01-01

    Intensity modulated brachytherapy (IMBT) is a modern development of classical interventional radiation therapy (brachytherapy), which allows the application of a high radiation dose sparing severe adverse events, thereby further improving the treatment outcome. Classical indications in head and neck (H&N) cancers are the face, the oral cavity, the naso- and oropharynx, the paranasal sinuses including base of skull, incomplete resections on important structures, and palliation. The application type can be curative, adjuvant or perioperative, as a boost to external beam radiation as well as without external beam radiation and with palliative intention. Due to the frequently used perioperative application method (intraoperative implantation of inactive applicators and postoperative performance of radiation), close interdisciplinary cooperation between surgical specialists (ENT-, dento-maxillary-facial-, neuro- and orbital surgeons), as well interventional radiotherapy (brachytherapy) experts are obligatory. Published results encourage the integration of IMBT into H&N therapy, thereby improving the prognosis and quality of life of patients. PMID:25834586

  5. 10 CFR 35.400 - Use of sources for manual brachytherapy.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Use of sources for manual brachytherapy. 35.400 Section 35.400 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.400 Use of sources for manual brachytherapy. A licensee shall use only brachytherapy sources...

  6. Liquids with permanent porosity.

    PubMed

    Giri, Nicola; Del Pópolo, Mario G; Melaugh, Gavin; Greenaway, Rebecca L; Rätzke, Klaus; Koschine, Tönjes; Pison, Laure; Gomes, Margarida F Costa; Cooper, Andrew I; James, Stuart L

    2015-11-12

    Porous solids such as zeolites and metal-organic frameworks are useful in molecular separation and in catalysis, but their solid nature can impose limitations. For example, liquid solvents, rather than porous solids, are the most mature technology for post-combustion capture of carbon dioxide because liquid circulation systems are more easily retrofitted to existing plants. Solid porous adsorbents offer major benefits, such as lower energy penalties in adsorption-desorption cycles, but they are difficult to implement in conventional flow processes. Materials that combine the properties of fluidity and permanent porosity could therefore offer technological advantages, but permanent porosity is not associated with conventional liquids. Here we report free-flowing liquids whose bulk properties are determined by their permanent porosity. To achieve this, we designed cage molecules that provide a well-defined pore space and that are highly soluble in solvents whose molecules are too large to enter the pores. The concentration of unoccupied cages can thus be around 500 times greater than in other molecular solutions that contain cavities, resulting in a marked change in bulk properties, such as an eightfold increase in the solubility of methane gas. Our results provide the basis for development of a new class of functional porous materials for chemical processes, and we present a one-step, multigram scale-up route for highly soluble 'scrambled' porous cages prepared from a mixture of commercially available reagents. The unifying design principle for these materials is the avoidance of functional groups that can penetrate into the molecular cage cavities. PMID:26560299

  7. Liquids with permanent porosity

    NASA Astrophysics Data System (ADS)

    Giri, Nicola; Del Pópolo, Mario G.; Melaugh, Gavin; Greenaway, Rebecca L.; Rätzke, Klaus; Koschine, Tönjes; Pison, Laure; Gomes, Margarida F. Costa; Cooper, Andrew I.; James, Stuart L.

    2015-11-01

    Porous solids such as zeolites and metal-organic frameworks are useful in molecular separation and in catalysis, but their solid nature can impose limitations. For example, liquid solvents, rather than porous solids, are the most mature technology for post-combustion capture of carbon dioxide because liquid circulation systems are more easily retrofitted to existing plants. Solid porous adsorbents offer major benefits, such as lower energy penalties in adsorption-desorption cycles, but they are difficult to implement in conventional flow processes. Materials that combine the properties of fluidity and permanent porosity could therefore offer technological advantages, but permanent porosity is not associated with conventional liquids. Here we report free-flowing liquids whose bulk properties are determined by their permanent porosity. To achieve this, we designed cage molecules that provide a well-defined pore space and that are highly soluble in solvents whose molecules are too large to enter the pores. The concentration of unoccupied cages can thus be around 500 times greater than in other molecular solutions that contain cavities, resulting in a marked change in bulk properties, such as an eightfold increase in the solubility of methane gas. Our results provide the basis for development of a new class of functional porous materials for chemical processes, and we present a one-step, multigram scale-up route for highly soluble ‘scrambled’ porous cages prepared from a mixture of commercially available reagents. The unifying design principle for these materials is the avoidance of functional groups that can penetrate into the molecular cage cavities.

  8. The evolution of brachytherapy treatment planning

    SciTech Connect

    Rivard, Mark J.; Venselaar, Jack L. M.; Beaulieu, Luc

    2009-06-15

    Brachytherapy is a mature treatment modality that has benefited from technological advances. Treatment planning has advanced from simple lookup tables to complex, computer-based dose-calculation algorithms. The current approach is based on the AAPM TG-43 formalism with recent advances in acquiring single-source dose distributions. However, this formalism has clinically relevant limitations for calculating patient dose. Dose-calculation algorithms are being developed based on Monte Carlo methods, collapsed cone, and solving the linear Boltzmann transport equation. In addition to improved dose-calculation tools, planning systems and brachytherapy treatment planning will account for material heterogeneities, scatter conditions, radiobiology, and image guidance. The AAPM, ESTRO, and other professional societies are working to coordinate clinical integration of these advancements. This Vision 20/20 article provides insight into these endeavors.

  9. Radiochromic dye film studies for brachytherapy applications.

    PubMed

    Martínez-Dávalos, A; Rodríguez-Villafuerte, M; Díaz-Perches, R; Arzamendi-Pérez, S

    2002-01-01

    Commercial radiochromic dye films have been used in recent years to quantify absorbed dose in several medical applications. In this study we present the characterisation of the GafChromic MD-55-2 dye film, a double sensitive layer film suitable for photon irradiation in brachytherapy applications. Dose measurements were carried out with a low dose rate 137Cs brachytherapy source, which produces very steep dose gradients in its vicinity, and therefore requires the capability of producing high spatial resolution isodose curves. Quantification of the dose rate in water per unit air kerma strength was obtained using a high-resolution transmission commercial scanner (Agfa DuoScan T1200 with the capability of digitising up to 600 x 1200 pixels per inch using 36 bits per pixel, together with optical density measurements. The Monte Carlo calculations and experimental measurements compared well in the 0-50 Gy dose interval used in this study. PMID:12382798

  10. Permanent Turbidity-Standards

    PubMed Central

    Roessler, William G.; Brewer, Carl R.

    1967-01-01

    Permanent turbidity reference standards suitable for measurement of microbial suspensions were prepared by suspending finely divided titanium dioxide in aryl sulfonamide-formaldehyde or methylstyrene resins. Turbidities of these standards, adjusted to a useful range for microbiological and immunological studies, were compared with other reference standards in use today. Tube holders for a Coleman Photonephelometer and a Nepho-Colorimeter were modified to eliminate the water well and to allow use of optically standardized 10-, 16-, or 18-mm test tubes. The standards and the tube holders have been used satisfactorily for more than 12 years. Images Fig. 5 Fig. 6 PMID:6077410

  11. Sensitivity of low energy brachytherapy Monte Carlo dose calculations to uncertainties in human tissue composition

    SciTech Connect

    Landry, Guillaume; Reniers, Brigitte; Murrer, Lars; Lutgens, Ludy; Bloemen-Van Gurp, Esther; Pignol, Jean-Philippe; Keller, Brian; Beaulieu, Luc; Verhaegen, Frank

    2010-10-15

    Purpose: The objective of this work is to assess the sensitivity of Monte Carlo (MC) dose calculations to uncertainties in human tissue composition for a range of low photon energy brachytherapy sources: {sup 125}I, {sup 103}Pd, {sup 131}Cs, and an electronic brachytherapy source (EBS). The low energy photons emitted by these sources make the dosimetry sensitive to variations in tissue atomic number due to the dominance of the photoelectric effect. This work reports dose to a small mass of water in medium D{sub w,m} as opposed to dose to a small mass of medium in medium D{sub m,m}. Methods: Mean adipose, mammary gland, and breast tissues (as uniform mixture of the aforementioned tissues) are investigated as well as compositions corresponding to one standard deviation from the mean. Prostate mean compositions from three different literature sources are also investigated. Three sets of MC simulations are performed with the GEANT4 code: (1) Dose calculations for idealized TG-43-like spherical geometries using point sources. Radial dose profiles obtained in different media are compared to assess the influence of compositional uncertainties. (2) Dose calculations for four clinical prostate LDR brachytherapy permanent seed implants using {sup 125}I seeds (Model 2301, Best Medical, Springfield, VA). The effect of varying the prostate composition in the planning target volume (PTV) is investigated by comparing PTV D{sub 90} values. (3) Dose calculations for four clinical breast LDR brachytherapy permanent seed implants using {sup 103}Pd seeds (Model 2335, Best Medical). The effects of varying the adipose/gland ratio in the PTV and of varying the elemental composition of adipose and gland within one standard deviation of the assumed mean composition are investigated by comparing PTV D{sub 90} values. For (2) and (3), the influence of using the mass density from CT scans instead of unit mass density is also assessed. Results: Results from simulation (1) show that variations

  12. Brachytherapy needle deflection evaluation and correction

    SciTech Connect

    Wan Gang; Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron

    2005-04-01

    In prostate brachytherapy, an 18-gauge needle is used to implant radioactive seeds. This thin needle can be deflected from the preplanned trajectory in the prostate, potentially resulting in a suboptimum dose pattern and at times requiring repeated needle insertion to achieve optimal dosimetry. In this paper, we report on the evaluation of brachytherapy needle deflection and bending in test phantoms and two approaches to overcome the problem. First we tested the relationship between needle deflection and insertion depth as well as whether needle bending occurred. Targeting accuracy was tested by inserting a brachytherapy needle to target 16 points in chicken tissue phantoms. By implanting dummy seeds into chicken tissue phantoms under 3D ultrasound guidance, the overall accuracy of seed implantation was determined. We evaluated methods to overcome brachytherapy needle deflection with three different insertion methods: constant orientation, constant rotation, and orientation reversal at half of the insertion depth. Our results showed that needle deflection is linear with needle insertion depth, and that no noticeable bending occurs with needle insertion into the tissue and agar phantoms. A 3D principal component analysis was performed to obtain the population distribution of needle tip and seed position relative to the target positions. Our results showed that with the constant orientation insertion method, the mean needle targeting error was 2.8 mm and the mean seed implantation error was 2.9 mm. Using the constant rotation and orientation reversal at half insertion depth methods, the deflection error was reduced. The mean needle targeting errors were 0.8 and 1.2 mm for the constant rotation and orientation reversal methods, respectively, and the seed implantation errors were 0.9 and 1.5 mm for constant rotation insertion and orientation reversal methods, respectively.

  13. Rotating-shield brachytherapy for cervical cancer

    NASA Astrophysics Data System (ADS)

    Yang, Wenjun; Kim, Yusung; Wu, Xiaodong; Song, Qi; Liu, Yunlong; Bhatia, Sudershan K.; Sun, Wenqing; Flynn, Ryan T.

    2013-06-01

    In this treatment planning study, the potential benefits of a rotating shield brachytherapy (RSBT) technique based on a partially-shielded electronic brachytherapy source were assessed for treating cervical cancer. Conventional intracavitary brachytherapy (ICBT), intracavitary plus supplementary interstitial (IS+ICBT), and RSBT treatment plans for azimuthal emission angles of 180° (RSBT-180) and 45° (RSBT-45) were generated for five patients. For each patient, high-risk clinical target volume (HR-CTV) equivalent dose in 2 Gy fractions (EQD2) (α/β = 10 Gy) was escalated until bladder, rectum, or sigmoid colon tolerance EQD2 values were reached. External beam radiotherapy dose (1.8 Gy × 25) was accounted for, and brachytherapy was assumed to have been delivered in 5 fractions. IS+ICBT provided a greater HR-CTV D90 (minimum EQD2 to the hottest 90%) than ICBT. D90 was greater for RSBT-45 than IS+ICBT for all five patients, and greater for RSBT-180 than IS+ICBT for two patients. When the RSBT-45/180 plan with the lowest HR-CTV D90 that was greater than the D90 the ICBT or IS+ICBT plan was selected, the average (range) of D90 increases for RSBT over ICBT and IS+ICBT were 16.2 (6.3-27.2)and 8.5 (0.03-20.16) Gy, respectively. The average (range) treatment time increase per fraction of RSBT was 34.56 (3.68-70.41) min over ICBT and 34.59 (3.57-70.13) min over IS+ICBT. RSBT can increase D90 over ICBT and IS+ICBT without compromising organ-at-risk sparing. The D90 and treatment time improvements from RSBT depend on the patient and shield emission angle.

  14. Magnetite nanoparticles for nonradionuclide brachytherapy1

    PubMed Central

    Safronov, Victor; Sozontov, Evgeny; Polikarpov, Mikhail

    2015-01-01

    Magnetite nanoparticles possess several properties that can make them useful for targeted delivery of radiation to tumors for the purpose of brachytherapy. Such particles are biodegradable and magnetic and can emit secondary radiation when irradiated by an external source. In this work, the dose distribution around a magnetite particle of 10 nm diameter being irradiated by monochromatic X-rays with energies in the range 4–60 keV is calculated. PMID:26089761

  15. Design and optimization of a brachytherapy robot

    NASA Astrophysics Data System (ADS)

    Meltsner, Michael A.

    Trans-rectal ultrasound guided (TRUS) low dose rate (LDR) interstitial brachytherapy has become a popular procedure for the treatment of prostate cancer, the most common type of non-skin cancer among men. The current TRUS technique of LDR implantation may result in less than ideal coverage of the tumor with increased risk of negative response such as rectal toxicity and urinary retention. This technique is limited by the skill of the physician performing the implant, the accuracy of needle localization, and the inherent weaknesses of the procedure itself. The treatment may require 100 or more sources and 25 needles, compounding the inaccuracy of the needle localization procedure. A robot designed for prostate brachytherapy may increase the accuracy of needle placement while minimizing the effect of physician technique in the TRUS procedure. Furthermore, a robot may improve associated toxicities by utilizing angled insertions and freeing implantations from constraints applied by the 0.5 cm-spaced template used in the TRUS method. Within our group, Lin et al. have designed a new type of LDR source. The "directional" source is a seed designed to be partially shielded. Thus, a directional, or anisotropic, source does not emit radiation in all directions. The source can be oriented to irradiate cancerous tissues while sparing normal ones. This type of source necessitates a new, highly accurate method for localization in 6 degrees of freedom. A robot is the best way to accomplish this task accurately. The following presentation of work describes the invention and optimization of a new prostate brachytherapy robot that fulfills these goals. Furthermore, some research has been dedicated to the use of the robot to perform needle insertion tasks (brachytherapy, biopsy, RF ablation, etc.) in nearly any other soft tissue in the body. This can be accomplished with the robot combined with automatic, magnetic tracking.

  16. Cryogenic Permanent Magnet Undulators

    SciTech Connect

    Chavanne, J.; Lebec, G.; Penel, C.; Revol, F.; Kitegi, C.

    2010-06-23

    For an in-vacuum undulator operated at small gaps the permanent magnet material needs to be highly resistant to possible electron beam exposure. At room temperature, one generally uses Sm{sub 2}Co{sub 17} or high coercivity NdFeB magnets at the expense of a limited field performance. In a cryogenic permanent magnet undulator (CPMU), at a temperature of around 150 K, any NdFeB grade reveals a coercivity large enough to be radiation resistant. In particular, very high remanence NdFeB material can be used to build undulators with enhanced field and X-ray brilliance at high photon energy provided that the pre-baking of the undulator above 100 deg. C can be eliminated. The ESRF has developed a full scale 2 m long CPMU with a period of 18 mm. This prototype has been in operation on the ID6 test beamline since January 2008. A significant effort was put into the characterization of NdFeB material at low temperature, the development of dedicated magnetic measurement systems and cooling methods. The measured heat budget with beam is found to be larger than expected without compromising the smooth operation of the device. Leading on from this first experience, new CPMUs are currently being considered for the upgrade of the ESRF.

  17. 10 CFR 35.432 - Calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Calibration measurements of brachytherapy sources. 35.432... § 35.432 Calibration measurements of brachytherapy sources. (a) Before the first medical use of a... licensee making its own measurements as required in paragraph (a) of this section, the licensee may...

  18. Ultrasound use in gynecologic brachytherapy: Time to focus the beam.

    PubMed

    van Dyk, Sylvia; Schneider, Michal; Kondalsamy-Chennakesavan, Srinivas; Bernshaw, David; Narayan, Kailash

    2015-01-01

    There is wide disparity in the practice of brachytherapy for cervical cancer around the world. Although select well-resourced centers advocate use of MRI for all insertions, planar X-ray imaging remains the most commonly used imaging modality to assess intracavitary implants, particularly where the burden of cervical cancer is high. Incorporating soft tissue imaging into brachytherapy programs has been shown to improve the technical accuracy of implants, which in turn has led to improved local control and decreased toxicity. These improvements have a positive effect on the quality of life of patients undergoing brachytherapy for cervical cancer. Finding an accessible soft tissue imaging modality is essential to enable these improvements to be available to all patients. A modality that has good soft tissue imaging capabilities, is widely available, portable, and economical, is needed. Ultrasound fulfils these requirements and offers the potential of soft tissue image guidance to a much wider brachytherapy community. Although use of ultrasound is the standard of care in brachytherapy for prostate cancer, it only seems to have limited uptake in gynecologic brachytherapy. This article reviews the role of ultrasound in gynecologic brachytherapy and highlights the potential applications for use in brachytherapy for cervical cancer. PMID:25620161

  19. 10 CFR 35.432 - Calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Calibration measurements of brachytherapy sources. 35.432 Section 35.432 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy... Association of Physicists in Medicine that are made in accordance with paragraph (a) of this section. (c)...

  20. 10 CFR 35.432 - Calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Calibration measurements of brachytherapy sources. 35.432 Section 35.432 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy... Association of Physicists in Medicine that are made in accordance with paragraph (a) of this section. (c)...

  1. 10 CFR 35.432 - Calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Calibration measurements of brachytherapy sources. 35.432 Section 35.432 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy... Association of Physicists in Medicine that are made in accordance with paragraph (a) of this section. (c)...

  2. 10 CFR 35.432 - Calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Calibration measurements of brachytherapy sources. 35.432 Section 35.432 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy... Association of Physicists in Medicine that are made in accordance with paragraph (a) of this section. (c)...

  3. Penile brachytherapy: Results for 49 patients

    SciTech Connect

    Crook, Juanita M. . E-mail: juanita.crook@rmp.uhn.on.ca; Jezioranski, John; Grimard, Laval; Esche, Bernd; Pond, G.

    2005-06-01

    Purpose: To report results for 49 men with squamous cell carcinoma (SCC) of the penis treated with primary penile interstitial brachytherapy at one of two institutions: the Ottawa Regional Cancer Center, Ottawa, and the Princess Margaret Hospital, Toronto, Ontario, Canada. Methods and Materials: From September 1989 to September 2003, 49 men (mean age, 58 years; range, 22-93 years) had brachytherapy for penile SCC. Fifty-one percent of tumors were T1, 33% T2, and 8% T3; 4% were in situ and 4% Tx. Grade was well differentiated in 31%, moderate in 45%, and poor in 2%; grade was unspecified for 20%. One tumor was verrucous. All tumors in Toronto had pulsed dose rate (PDR) brachytherapy (n = 23), whereas those in Ottawa had either Iridium wire (n 22) or seeds (n = 4). Four patients had a single plane implant with a plastic tube technique, and all others had a volume implant with predrilled acrylic templates and two or three parallel planes of needles (median, six needles). Mean needle spacing was 13.5 mm (range, 10-18 mm), mean dose rate was 65 cGy/h (range, 33-160 cGy/h), and mean duration was 98.8 h (range, 36-188 h). Dose rates for PDR brachytherapy were 50-61.2 cGy/h, with no correction in total dose, which was 60 Gy in all cases. Results: Median follow-up was 33.4 months (range, 4-140 months). At 5 years, actuarial overall survival was 78.3% and cause-specific survival 90.0%. Four men died of penile cancer, and 6 died of other causes with no evidence of recurrence. The cumulative incidence rate for never having experienced any type of failure at 5 years was 64.4% and for local failure was 85.3%. All 5 patients with local failure were successfully salvaged by surgery; 2 other men required penectomy for necrosis. The soft tissue necrosis rate was 16% and the urethral stenosis rate 12%. Of 8 men with regional failure, 5 were salvaged by lymph node dissection with or without external radiation. All 4 men with distant failure died of disease. Of 49 men, 42 had an intact

  4. Dose heterogeneity correction for low-energy brachytherapy sources using dual-energy CT images

    NASA Astrophysics Data System (ADS)

    Mashouf, S.; Lechtman, E.; Lai, P.; Keller, B. M.; Karotki, A.; Beachey, D. J.; Pignol, J. P.

    2014-09-01

    Permanent seed implant brachytherapy is currently used for adjuvant radiotherapy of early stage prostate and breast cancer patients. The current standard for calculation of dose around brachytherapy sources is based on the AAPM TG-43 formalism, which generates the dose in a homogeneous water medium. Recently, AAPM TG-186 emphasized the importance of accounting for tissue heterogeneities. We have previously reported on a methodology where the absorbed dose in tissue can be obtained by multiplying the dose, calculated by the TG-43 formalism, by an inhomogeneity correction factor (ICF). In this work we make use of dual energy CT (DECT) images to extract ICF parameters. The advantage of DECT over conventional CT is that it eliminates the need for tissue segmentation as well as assignment of population based atomic compositions. DECT images of a heterogeneous phantom were acquired and the dose was calculated using both TG-43 and TG-43 × \\text{ICF} formalisms. The results were compared to experimental measurements using Gafchromic films in the mid-plane of the phantom. For a seed implant configuration of 8 seeds spaced 1.5 cm apart in a cubic structure, the gamma passing score for 2%/2 mm criteria improved from 40.8% to 90.5% when ICF was applied to TG-43 dose distributions.

  5. Local tumor control after {sup 106}Ru brachytherapy of choroidal melanoma

    SciTech Connect

    Damato, Bertil . E-mail: Bertil@damato.co.uk; Patel, Imran; Campbell, Ian R.; Mayles, Helen M.; Errington, R. Douglas

    2005-10-01

    Purpose To report on local tumor control after {sup 106}Ru brachytherapy for choroidal melanoma. Methods and Materials A total of 458 patients with choroidal melanoma were treated at a single institution between January 1993 and December 2001. The tumors had a median longest basal dimension of 10.6 mm and a median height of 3.2 mm. The brachytherapy was administered using a 15- or 20-mm plaque. For posterior tumors, the plaque was positioned eccentrically with its posterior edge aligned with the posterior tumor margin to reduce the radiation dose to the optic disk and fovea. A minimal scleral dose sufficient to cause visible choroidal atrophy provided a permanent ophthalmoscopic record of the distribution of choroidal irradiation. If radiotherapy to the posterior tumor was uncertain, adjunctive transpupillary thermotherapy was administered 6 months postoperatively. Results The actuarial rates of tumor recurrence were 1%, 2%, and 3% at 2, 5, and 7 years, respectively. Local tumor recurrence correlated with the longest basal tumor dimension (Cox univariate analysis, p = 0.02, risk ratio 1.41, 95% confidence interval 1.06-1.88). Seven of the nine eyes with recurrent tumor were salvaged with additional conservative therapy. Conclusion The low rate of local tumor recurrence suggests that ruthenium plaque radiotherapy is effective with good case selection and if special measures are taken to ensure that the plaque is positioned correctly.

  6. Graded permanent magnets

    NASA Astrophysics Data System (ADS)

    Skomski, R.; Hadjipanayis, G. C.; Sellmyer, D. J.

    2009-04-01

    The effect of semihard magnetic phases and interfaces on the performance of nanostructured two-phase permanent magnets is investigated by model calculations. In addition to the trivial coercivity increase due to the replacement of soft regions by semihard regions, there is a coercivity enhancement even if the volume-averaged anisotropy is kept constant during the introduction of the semihard phase. A variational approach is used to derive analytical results for representative anisotropy profiles. The improvement is operative on length scales slightly larger than that of the soft phase in hard-soft composites, but the main challenge is to find semihard light or heavy transition metal phases with a high magnetization. There are several Fe- and Co-based phases, but most are thin-film systems and difficult to use in bulk magnets. Very hard nanostructured magnets may also be created from soft phases with negative but large anisotropy constants (hard-magnetic soft-soft magnets).

  7. Poster — Thur Eve — 41: Considerations for Patients with Permanently Implant Radioactive Sources Requiring Unrelated Surgery

    SciTech Connect

    Basran, P. S; Beckham, WA; Baxter, P

    2014-08-15

    Permanent implant of sealed radioactive sources is an effective technique for treating cancer. Typically, the radioactive sources are implanted in and near the disease, depositing dose locally over several months. There may be instances where these patients must undergo unrelated surgical procedures when the radioactive material remains active enough to pose risks. This work explores these risks, discusses strategies to mitigate those risks, and describes a case study for a permanent I-125 prostate brachytherapy implant patient who developed colo-rectal cancer and required surgery 6 months after brachytherapy. The first consideration is identifying the risk from unwarranted radiation to the patient and staff before, during, and after the surgical procedure. The second is identifying the risk the surgical procedure may have on the efficacy of the brachytherapy implant. Finally, there are considerations for controlling for radioactive substances from a regulatory perspective. After these risks are defined, strategies to mitigate those risks are considered. These strategies may include applying the concepts of ALARA, the use of protective equipment and developing a best practice strategy with the operating room team. We summarize this experience with some guidelines: If the surgical procedure is near (ex: 5 cm) of the implant; and, the surgical intervention may dislodge radioisotopes enough to compromise treatment or introduces radiation safety risks; and, the radioisotope has not sufficiently decayed to background levels; and, the surgery cannot be postponed, then a detailed analysis of risk is advised.

  8. 78 FR 41125 - Interim Enforcement Policy for Permanent Implant Brachytherapy Medical Event Reporting

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-09

    ... Register on August 6, 2008 (73 FR 45635). The vast majority of commenters offered no objection to... stakeholders opposed this approach, the Commission disapproved the staff's recommendation and directed the... existence of a medical event. This approach will allow for an effective and objective criterion for...

  9. Achieving permanency for LGBTQ youth.

    PubMed

    Jacobs, Jill; Freundlich, Madelyn

    2006-01-01

    This article brings together two significant efforts in the child welfare field: achieving permanence for youth in out-of-home care and meeting the needs of lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth. During the past several years, a national movement has taken place to assure all children and youth have a permanent family connection before leaving the child welfare system; however, LGBTQ youth are not routinely included in the permanency discussions. At the same time, efforts in addressing the needs of LGBTQ youth have increased, but permanency is rarely mentioned as a need. This article offers models of permanence and practices to facilitate permanence with LGBTQ youth and their families. It also offers a youth-driven, individualized process, using youth development principles to achieve relational, physical, and legal permanence. Reunification efforts are discussed, including services, supports, and education required for youth to return to their family of origin. For those who cannot return home, other family resources are explored. The article also discusses cultural issues as they affect permanence for LGBTQ youth, and, finally, addresses the need for ongoing support services to sustain and support permanency. PMID:16846117

  10. Three-Dimensional Imaging in Gynecologic Brachytherapy: A Survey of the American Brachytherapy Society

    SciTech Connect

    Viswanathan, Akila N.; Erickson, Beth A.

    2010-01-15

    Purpose: To determine current practice patterns with regard to three-dimensional (3D) imaging for gynecologic brachytherapy among American Brachytherapy Society (ABS) members. Methods and Materials: Registered physician members of the ABS received a 19-item survey by e-mail in August 2007. This report excludes physicians not performing brachytherapy for cervical cancer. Results: Of the 256 surveys sent, we report results for 133 respondents who perform one or more implantations per year for locally advanced cervical cancer. Ultrasound aids 56% of physicians with applicator insertion. After insertion, 70% of physicians routinely obtain a computed tomography (CT) scan. The majority (55%) use CT rather than X-ray films (43%) or magnetic resonance imaging (MRI; 2%) for dose specification to the cervix. However, 76% prescribe to Point A alone instead of using a 3D-derived tumor volume (14%), both Point A and tumor volume (7%), or mg/h (3%). Those using 3D imaging routinely contour the bladder and rectum (94%), sigmoid (45%), small bowel (38%), and/or urethra (8%) and calculate normal tissue dose-volume histogram (DVH) analysis parameters including the D2cc (49%), D1cc (36%), D0.1cc (19%), and/or D5cc (19%). Respondents most commonly modify the treatment plan based on International Commission on Radiation Units bladder and/or rectal point dose values (53%) compared with DVH values (45%) or both (2%). Conclusions: More ABS physician members use CT postimplantation imaging than plain films for visualizing the gynecologic brachytherapy apparatus. However, the majority prescribe to Point A rather than using 3D image based dosimetry. Use of 3D image-based treatment planning for gynecologic brachytherapy has the potential for significant growth in the United States.

  11. Recent developments and best practice in brachytherapy treatment planning

    PubMed Central

    2014-01-01

    Brachytherapy has evolved over many decades, but more recently, there have been significant changes in the way that brachytherapy is used for different treatment sites. This has been due to the development of new, technologically advanced computer planning systems and treatment delivery techniques. Modern, three-dimensional (3D) imaging modalities have been incorporated into treatment planning methods, allowing full 3D dose distributions to be computed. Treatment techniques involving online planning have emerged, allowing dose distributions to be calculated and updated in real time based on the actual clinical situation. In the case of early stage breast cancer treatment, for example, electronic brachytherapy treatment techniques are being used in which the radiation dose is delivered during the same procedure as the surgery. There have also been significant advances in treatment applicator design, which allow the use of modern 3D imaging techniques for planning, and manufacturers have begun to implement new dose calculation algorithms that will correct for applicator shielding and tissue inhomogeneities. This article aims to review the recent developments and best practice in brachytherapy techniques and treatments. It will look at how imaging developments have been incorporated into current brachytherapy treatment and how these developments have played an integral role in the modern brachytherapy era. The planning requirements for different treatments sites are reviewed as well as the future developments of brachytherapy in radiobiology and treatment planning dose calculation. PMID:24734939

  12. Multihelix rotating shield brachytherapy for cervical cancer

    SciTech Connect

    Dadkhah, Hossein; Kim, Yusung; Flynn, Ryan T.; Wu, Xiaodong

    2015-11-15

    Purpose: To present a novel brachytherapy technique, called multihelix rotating shield brachytherapy (H-RSBT), for the precise angular and linear positioning of a partial shield in a curved applicator. H-RSBT mechanically enables the dose delivery using only linear translational motion of the radiation source/shield combination. The previously proposed approach of serial rotating shield brachytherapy (S-RSBT), in which the partial shield is rotated to several angular positions at each source dwell position [W. Yang et al., “Rotating-shield brachytherapy for cervical cancer,” Phys. Med. Biol. 58, 3931–3941 (2013)], is mechanically challenging to implement in a curved applicator, and H-RSBT is proposed as a feasible solution. Methods: A Henschke-type applicator, designed for an electronic brachytherapy source (Xoft Axxent™) and a 0.5 mm thick tungsten partial shield with 180° or 45° azimuthal emission angles and 116° asymmetric zenith angle, is proposed. The interior wall of the applicator contains six evenly spaced helical keyways that rigidly define the emission direction of the partial radiation shield as a function of depth in the applicator. The shield contains three uniformly distributed protruding keys on its exterior wall and is attached to the source such that it rotates freely, thus longitudinal translational motion of the source is transferred to rotational motion of the shield. S-RSBT and H-RSBT treatment plans with 180° and 45° azimuthal emission angles were generated for five cervical cancer patients with a diverse range of high-risk target volume (HR-CTV) shapes and applicator positions. For each patient, the total number of emission angles was held nearly constant for S-RSBT and H-RSBT by using dwell positions separated by 5 and 1.7 mm, respectively, and emission directions separated by 22.5° and 60°, respectively. Treatment delivery time and tumor coverage (D{sub 90} of HR-CTV) were the two metrics used as the basis for evaluation and

  13. A Novel MRI Marker for Prostate Brachytherapy

    SciTech Connect

    Frank, Steven J. Stafford, R. Jason; Bankson, James A.; Li Chun; Swanson, David A.; Kudchadker, Rajat J.; Martirosyan, Karen S.

    2008-05-01

    Purpose: Magnetic resonance imaging (MRI) is the optimal imaging modality for the prostate and surrounding critical organ structures. However, on MRI, the titanium radioactive seeds used for brachytherapy appear as black holes (negative contrast) and cannot be accurately localized. We sought to develop an encapsulated contrast agent marker (ECAM) with high-signal intensity on MRI to permit accurate localization of radioactive seeds with MRI during and after prostate brachytherapy. Methods and Materials: We investigated several agents with paramagnetic and superparamagnetic properties. The agents were injected into titanium, acrylic, and glass seeds, which were linked together in various combinations and imaged with MRI. The agent with the greatest T1-weighted signal was tested further in a canine prostate and agarose phantom. Studies were performed on a 1.5-T clinical MRI scanner. Results: The cobalt-chloride complex contrast (C4) agent with stoichiometry (CoCl{sub 2}){sub 0.8}(C{sub 2}H{sub 5}NO{sub 2}){sub 0.2} had the greatest T1-weighted signal (positive contrast) with a relaxivity ratio >1 (r{sub 2}/r{sub 1} = 1.21 {+-} 0.29). Acrylic-titanium and glass-titanium seed strands were clearly visualized with the encapsulated contrast agent marker. Conclusion: We have developed a novel ECAM that permits positive identification of the radioactive seeds used for prostate brachytherapy on MRI. Preclinical in vitro phantom studies and in vivo canine studies are needed to further optimize MRI sequencing techniques to facilitate MRI-based dosimetry.

  14. Phantom size in brachytherapy source dosimetric studies.

    PubMed

    Pérez-Calatayud, J; Granero, D; Ballester, F

    2004-07-01

    An important point to consider in a brachytherapy dosimetry study is the phantom size involved in calculations or experimental measurements. As pointed out by Williamson [Med. Phys. 18, 776-786 (1991)] this topic has a relevant influence on final dosimetric results. Presently, one-dimensional (1-D) algorithms and newly-developed 3-D correction algorithms are based on physics data that are obtained under full scatter conditions, i.e., assumed infinite phantom size. One can then assume that reference dose distributions in source dosimetry for photon brachytherapy should use an unbounded phantom size rather than phantom-like dimensions. Our aim in this paper is to study the effect of phantom size on brachytherapy for radionuclide 137Cs, 192Ir, 125I and 103Pd, mainly used for clinical purposes. Using the GEANT4 Monte Carlo code, we can ascertain effects on derived dosimetry parameters and functions to establish a distance dependent difference due to the absence of full scatter conditions. We have found that for 137Cs and 192Ir, a spherical phantom with a 40 cm radius is the equivalent of an unbounded phantom up to a distance of 20 cm from the source, as this size ensures full scatter conditions at this distance. For 125I and 103Pd, the required radius for the spherical phantom in order to ensure full scatter conditions at 10 cm from the source is R = 15 cm. A simple expression based on fits of the dose distributions for various phantom sizes has been developed for 137Cs and 192Ir in order to compare the dose rate distributions published for different phantom sizes. Using these relations it is possible to obtain radial dose functions for unbounded medium from bounded phantom ones. PMID:15305460

  15. Permanent dots in radiation therapy.

    PubMed

    Uyeda, L M

    1987-01-01

    Currently the word tattoo is used to describe the permanent marks used on patients in radiation therapy. This article offers alternative wording and the reasons why a new term is suggested. Guidelines for the standardization and administration of permanent marks concludes the article. PMID:3588884

  16. Permanent-Magnet Meissner Bearing

    NASA Technical Reports Server (NTRS)

    Robertson, Glen A.

    1994-01-01

    Permanent-magnet meissner bearing features inherently stable, self-centering conical configuration. Bearing made stiffer or less stiff by selection of magnets, springs, and spring adjustments. Cylindrical permanent magnets with axial magnetization stacked coaxially on rotor with alternating polarity. Typically, rare-earth magnets used. Magnets machined and fitted together to form conical outer surface.

  17. Brachytherapy in the treatment of cervical cancer: a review

    PubMed Central

    Banerjee, Robyn; Kamrava, Mitchell

    2014-01-01

    Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Consequently, advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This review provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer. PMID:24920937

  18. Fast GPU-based Monte Carlo simulations for LDR prostate brachytherapy

    NASA Astrophysics Data System (ADS)

    Bonenfant, Éric; Magnoux, Vincent; Hissoiny, Sami; Ozell, Benoît; Beaulieu, Luc; Després, Philippe

    2015-07-01

    The aim of this study was to evaluate the potential of bGPUMCD, a Monte Carlo algorithm executed on Graphics Processing Units (GPUs), for fast dose calculations in permanent prostate implant dosimetry. It also aimed to validate a low dose rate brachytherapy source in terms of TG-43 metrics and to use this source to compute dose distributions for permanent prostate implant in very short times. The physics of bGPUMCD was reviewed and extended to include Rayleigh scattering and fluorescence from photoelectric interactions for all materials involved. The radial and anisotropy functions were obtained for the Nucletron SelectSeed in TG-43 conditions. These functions were compared to those found in the MD Anderson Imaging and Radiation Oncology Core brachytherapy source registry which are considered the TG-43 reference values. After appropriate calibration of the source, permanent prostate implant dose distributions were calculated for four patients and compared to an already validated Geant4 algorithm. The radial function calculated from bGPUMCD showed excellent agreement (differences within 1.3%) with TG-43 accepted values. The anisotropy functions at r = 1 cm and r = 4 cm were within 2% of TG-43 values for angles over 17.5°. For permanent prostate implants, Monte Carlo-based dose distributions with a statistical uncertainty of 1% or less for the target volume were obtained in 30 s or less for 1 × 1 × 1 mm3 calculation grids. Dosimetric indices were very similar (within 2.7%) to those obtained with a validated, independent Monte Carlo code (Geant4) performing the calculations for the same cases in a much longer time (tens of minutes to more than a hour). bGPUMCD is a promising code that lets envision the use of Monte Carlo techniques in a clinical environment, with sub-minute execution times on a standard workstation. Future work will explore the use of this code with an inverse planning method to provide a complete Monte Carlo-based planning solution.

  19. Fast GPU-based Monte Carlo simulations for LDR prostate brachytherapy.

    PubMed

    Bonenfant, Éric; Magnoux, Vincent; Hissoiny, Sami; Ozell, Benoît; Beaulieu, Luc; Després, Philippe

    2015-07-01

    The aim of this study was to evaluate the potential of bGPUMCD, a Monte Carlo algorithm executed on Graphics Processing Units (GPUs), for fast dose calculations in permanent prostate implant dosimetry. It also aimed to validate a low dose rate brachytherapy source in terms of TG-43 metrics and to use this source to compute dose distributions for permanent prostate implant in very short times. The physics of bGPUMCD was reviewed and extended to include Rayleigh scattering and fluorescence from photoelectric interactions for all materials involved. The radial and anisotropy functions were obtained for the Nucletron SelectSeed in TG-43 conditions. These functions were compared to those found in the MD Anderson Imaging and Radiation Oncology Core brachytherapy source registry which are considered the TG-43 reference values. After appropriate calibration of the source, permanent prostate implant dose distributions were calculated for four patients and compared to an already validated Geant4 algorithm. The radial function calculated from bGPUMCD showed excellent agreement (differences within 1.3%) with TG-43 accepted values. The anisotropy functions at r = 1 cm and r = 4 cm were within 2% of TG-43 values for angles over 17.5°. For permanent prostate implants, Monte Carlo-based dose distributions with a statistical uncertainty of 1% or less for the target volume were obtained in 30 s or less for 1 × 1 × 1 mm(3) calculation grids. Dosimetric indices were very similar (within 2.7%) to those obtained with a validated, independent Monte Carlo code (Geant4) performing the calculations for the same cases in a much longer time (tens of minutes to more than a hour). bGPUMCD is a promising code that lets envision the use of Monte Carlo techniques in a clinical environment, with sub-minute execution times on a standard workstation. Future work will explore the use of this code with an inverse planning method to provide a complete Monte Carlo-based planning solution. PMID

  20. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part I. Electronic brachytherapy source

    PubMed Central

    Fulkerson, Regina K.; Micka, John A.; DeWerd, Larry A.

    2014-01-01

    Purpose: Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate (HDR) 192Ir sources, as well as electronic brachytherapy sources. Part I of this paper will discuss the applicators used with electronic brachytherapy sources; Part II will discuss those used with HDR 192Ir sources. Although the use of these applicators has gained in popularity, the dosimetric characteristics including depth dose and surface dose distributions have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Existing dosimetry protocols available from the AAPM bookend the cross-over characteristics of a traditional brachytherapy source (as described by Task Group 43) being implemented as a low-energy superficial x-ray beam (as described by Task Group 61) as observed with the surface applicators of interest. Methods: This work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with HDR electronic brachytherapy sources (Part I) and 192Ir sources (Part II). Air-kerma rate measurements for the electronic brachytherapy sources were completed with an Attix Free-Air Chamber, as well as several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally, relative dose

  1. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part I. Electronic brachytherapy source

    SciTech Connect

    Fulkerson, Regina K. Micka, John A.; DeWerd, Larry A.

    2014-02-15

    Purpose: Historically, treatment of malignant surface lesions has been achieved with linear accelerator based electron beams or superficial x-ray beams. Recent developments in the field of brachytherapy now allow for the treatment of surface lesions with specialized conical applicators placed directly on the lesion. Applicators are available for use with high dose rate (HDR){sup 192}Ir sources, as well as electronic brachytherapy sources. Part I of this paper will discuss the applicators used with electronic brachytherapy sources; Part II will discuss those used with HDR {sup 192}Ir sources. Although the use of these applicators has gained in popularity, the dosimetric characteristics including depth dose and surface dose distributions have not been independently verified. Additionally, there is no recognized method of output verification for quality assurance procedures with applicators like these. Existing dosimetry protocols available from the AAPM bookend the cross-over characteristics of a traditional brachytherapy source (as described by Task Group 43) being implemented as a low-energy superficial x-ray beam (as described by Task Group 61) as observed with the surface applicators of interest. Methods: This work aims to create a cohesive method of output verification that can be used to determine the dose at the treatment surface as part of a quality assurance/commissioning process for surface applicators used with HDR electronic brachytherapy sources (Part I) and{sup 192}Ir sources (Part II). Air-kerma rate measurements for the electronic brachytherapy sources were completed with an Attix Free-Air Chamber, as well as several models of small-volume ionization chambers to obtain an air-kerma rate at the treatment surface for each applicator. Correction factors were calculated using MCNP5 and EGSnrc Monte Carlo codes in order to determine an applicator-specific absorbed dose to water at the treatment surface from the measured air-kerma rate. Additionally

  2. Image-guided high-dose-rate brachytherapy in inoperable endometrial cancer

    PubMed Central

    Petsuksiri, J; Chansilpa, Y; Hoskin, P J

    2014-01-01

    Inoperable endometrial cancer may be treated with curative aim using radical radiotherapy alone. The radiation techniques are external beam radiotherapy (EBRT) alone, EBRT plus brachytherapy and brachytherapy alone. Recently, high-dose-rate brachytherapy has been used instead of low-dose-rate brachytherapy. Image-guided brachytherapy enables sufficient coverage of tumour and reduction of dose to the organs at risk, thus increasing the therapeutic ratio of treatment. Local control rates with three-dimensional brachytherapy appear better than with conventional techniques (about 90–100% and 70–90%, respectively). PMID:24807067

  3. Improving photoacoustic imaging contrast of brachytherapy seeds

    NASA Astrophysics Data System (ADS)

    Pan, Leo; Baghani, Ali; Rohling, Robert; Abolmaesumi, Purang; Salcudean, Septimiu; Tang, Shuo

    2013-03-01

    Prostate brachytherapy is a form of radiotherapy for treating prostate cancer where the radiation sources are seeds inserted into the prostate. Accurate localization of seeds during prostate brachytherapy is essential to the success of intraoperative treatment planning. The current standard modality used in intraoperative seeds localization is transrectal ultrasound. Transrectal ultrasound, however, suffers in image quality due to several factors such speckle, shadowing, and off-axis seed orientation. Photoacoustic imaging, based on the photoacoustic phenomenon, is an emerging imaging modality. The contrast generating mechanism in photoacoustic imaging is optical absorption that is fundamentally different from conventional B-mode ultrasound which depicts changes in acoustic impedance. A photoacoustic imaging system is developed using a commercial ultrasound system. To improve imaging contrast and depth penetration, absorption enhancing coating is applied to the seeds. In comparison to bare seeds, approximately 18.5 dB increase in signal-to-noise ratio as well as a doubling of imaging depth are achieved. Our results demonstrate that the coating of the seeds can further improve the discernibility of the seeds.

  4. Adjuvant brachytherapy in the treatment of soft-tissue sarcomas.

    PubMed

    Crownover, R L; Marks, K E

    1999-06-01

    For many patients with STS, administering adjuvant radiation treatments in the form of interstitial brachytherapy provides an excellent alternative to a protracted course of EBRT. Ideal patients are those with intermediate- or high-grade tumors amenable to en bloc resection. Attractive features of this approach include an untainted pathologic specimen, expeditious completion of treatment, reduction in wound complications, and improved functional outcome. Brachytherapy can permit definitive reirradiation by tightly localizing the high dose radiation exposure. It is also useful in patients who are known to have or be at high risk of metastatic disease, for whom the rapid completion of local treatment allows systemic therapy to begin quickly. Introduction of HDR techniques has shifted the delivery of brachytherapy from inpatient solitary confinement to an outpatient setting. Early reports using HDR brachytherapy for treatment of adult and pediatric STS are quite encouraging. The clinical equivalence between hyperfractionated HDR schedules and traditional LDR techniques is gaining acceptance. PMID:10432432

  5. Patient release criteria for low dose rate brachytherapy implants.

    PubMed

    Boyce, Dale E; Sheetz, Michael A

    2013-04-01

    A lack of consensus regarding a model governing the release of patients following sealed source brachytherapy has led to a set of patient release policies that vary from institution to institution. The U.S. Nuclear Regulatory Commission has issued regulatory guidance on patient release in NUREG 1556, Volume 9, Rev. 2, Appendix U, which allows calculation of release limits following implant brachytherapy. While the formalism presented in NUREG is meaningful for the calculation of release limits in the context of relatively high energy gamma emitters, it does not estimate accurately the effective dose equivalent for the common low dose rate brachytherapy sources Cs, I, and Pd. NUREG 1556 states that patient release may be based on patient-specific calculations as long as the calculation is documented. This work is intended to provide a format for patient-specific calculations to be used for the consideration of patients' release following the implantation of certain low dose rate brachytherapy isotopes. PMID:23439145

  6. Brachytherapy in India – a long road ahead

    PubMed Central

    Mahantshetty, Umesh; Shrivastava, Shyamkishore

    2014-01-01

    Brachytherapy can play a very important role in the definitive cure by radiation therapy in India. However, except for in a handful of centres, the majority of hospitals use it only for intracavitary treatment. The most probable reasons for such are the lack of logistical resources in terms of trained personal and supporting staff, rather than lack of radiotherapy machines and equipment. In this article, the authors look into the various aspects of brachytherapy in India: from its beginning to present days. The authors point out the resources available, shortcomings, and some possible solutions to make use of brachytherapy more popular and effective. Apart from presenting a picture of the present scenario, the article pays attention to the positive signs of brachytherapy becoming more popular in the near future. PMID:25337139

  7. Image-Based Brachytherapy for the Treatment of Cervical Cancer

    SciTech Connect

    Harkenrider, Matthew M. Alite, Fiori; Silva, Scott R.; Small, William

    2015-07-15

    Cervical cancer is a disease that requires considerable multidisciplinary coordination of care and labor in order to maximize tumor control and survival while minimizing treatment-related toxicity. As with external beam radiation therapy, the use of advanced imaging and 3-dimensional treatment planning has generated a paradigm shift in the delivery of brachytherapy for the treatment of cervical cancer. The use of image-based brachytherapy, most commonly with magnetic resonance imaging (MRI), requires additional attention and effort by the treating physician to prescribe dose to the proper volume and account for adjacent organs at risk. This represents a dramatic change from the classic Manchester approach of orthogonal radiographic images and prescribing dose to point A. We reviewed the history and currently evolving data and recommendations for the clinical use of image-based brachytherapy with an emphasis on MRI-based brachytherapy.

  8. Periodic permanent magnet focused klystron

    SciTech Connect

    Ferguson, Patrick; Read, Michael; Ives, R Lawrence

    2015-04-21

    A periodic permanent magnet (PPM) klystron has beam transport structures and RF cavity structures, each of which has permanent magnets placed substantially equidistant from a beam tunnel formed about the central axis, and which are also outside the extent of a cooling chamber. The RF cavity sections also have permanent magnets which are placed substantially equidistant from the beam tunnel, but which include an RF cavity coupling to the beam tunnel for enhancement of RF carried by an electron beam in the beam tunnel.

  9. High versus Low-Dose Rate Brachytherapy for Cervical Cancer

    PubMed Central

    Patankar, Sonali S.; Tergas, Ana I.; Deutsch, Israel; Burke, William M.; Hou, June Y.; Ananth, Cande V.; Huang, Yongmei; Neugut, Alfred I.; Hershman, Dawn L.; Wright, Jason D.

    2015-01-01

    Objectives Brachytherapy plays an important role in the treatment of cervical cancer. While small trials have shown comparable survival outcomes between high (HDR) and low-dose rate (LDR) brachytherapy, little data is available in the US. We examined the utilization of HDR brachytherapy and analyzed the impact of type of brachytherapy on survival for cervical cancer. Methods Women with stage IB2–IVA cervical cancer treated with primary (external beam and brachytherapy) radiotherapy between 2003–2011 and recorded in the National Cancer Database (NCDB) were analyzed. Generalized linear mixed models and Cox proportional hazards regression were used to examine predictors of HDR brachytherapy use and the association between HDR use and survival. Results A total of 10,564 women including 2681 (25.4%) who received LDR and 7883 (74.6%) that received HDR were identified. Use of HDR increased from 50.2% in 2003 to 83.9% in 2011 (P<0.0001). In a multivariable model, year of diagnosis was the strongest predictor of use of HDR. While patients in the Northeast were more likely to receive HDR therapy, there were no other clinical or socioeconomic characteristics associated with receipt of HDR. In a multivariable Cox model, survival was similar between the HDR and LDR groups (HR=0.93; 95% 0.83–1.03). Similar findings were noted in analyses stratified by stage and histology. Kaplan-Meier analyses demonstrated no difference in survival based on type of brachytherapy for stage IIB (P=0.68), IIIB (P=0.17), or IVA (P=0.16) tumors. Conclusions The use of HDR therapy has increased rapidly. Overall survival is similar for LDR and HDR brachytherapy. PMID:25575481

  10. Parameterization of brachytherapy source phase space file for Monte Carlo-based clinical brachytherapy dose calculation

    NASA Astrophysics Data System (ADS)

    Zhang, M.; Zou, W.; Chen, T.; Kim, L.; Khan, A.; Haffty, B.; Yue, N. J.

    2014-01-01

    A common approach to implementing the Monte Carlo method for the calculation of brachytherapy radiation dose deposition is to use a phase space file containing information on particles emitted from a brachytherapy source. However, the loading of the phase space file during the dose calculation consumes a large amount of computer random access memory, imposing a higher requirement for computer hardware. In this study, we propose a method to parameterize the information (e.g., particle location, direction and energy) stored in the phase space file by using several probability distributions. This method was implemented for dose calculations of a commercial Ir-192 high dose rate source. Dose calculation accuracy of the parameterized source was compared to the results observed using the full phase space file in a simple water phantom and in a clinical breast cancer case. The results showed the parameterized source at a size of 200 kB was as accurate as the phase space file represented source of 1.1 GB. By using the parameterized source representation, a compact Monte Carlo job can be designed, which allows an easy setup for parallel computing in brachytherapy planning.

  11. The evolution of computerized treatment planning for brachytherapy: American contributions

    PubMed Central

    Rivard, Mark J.

    2014-01-01

    Purpose To outline the evolution of computerized brachytherapy treatment planning in the United States through a review of technological developments and clinical practice refinements. Material and methods A literature review was performed and interviews were conducted with six participants in the development of computerized treatment planning for brachytherapy. Results Computerized brachytherapy treatment planning software was initially developed in the Physics Departments of New York's Memorial Hospital (by Nelson, Meurk and Balter), and Houston's M. D. Anderson Hospital (by Stovall and Shalek). These public-domain programs could be used by institutions with adequate computational resources; other clinics had access to them via Memorial's and Anderson's teletype-based computational services. Commercial brachytherapy treatment planning programs designed to run on smaller computers (Prowess, ROCS, MMS), were developed in the late 1980s and early 1990s. These systems brought interactive dosimetry into the clinic and surgical theatre. Conclusions Brachytherapy treatment planning has evolved from systems of rigid implant rules to individualized pre- and intra-operative treatment plans, and post-operative dosimetric assessments. Brachytherapy dose distributions were initially calculated on public domain programs on large regionally located computers. With the progression of computer miniaturization and increase in processor speeds, proprietary software was commercially developed for microcomputers that offered increased functionality and integration with clinical practice. PMID:25097560

  12. Predictors of Metastatic Disease After Prostate Brachytherapy

    SciTech Connect

    Forsythe, Kevin; Burri, Ryan; Stone, Nelson; Stock, Richard G.

    2012-06-01

    Purpose: To identify predictors of metastatic disease after brachytherapy treatment for prostate cancer. Methods and Materials: All patients who received either brachytherapy alone (implant) or brachytherapy in combination with external beam radiation therapy for treatment of localized prostate cancer at The Mount Sinai Hospital between June 1990 and March 2007 with a minimum follow-up of 2 years were included. Univariate and multivariable analyses were performed on the following variables: risk group, Gleason score (GS), clinical T stage, pretreatment prostate-specific antigen level, post-treatment prostate-specific antigen doubling time (PSA-DT), treatment type (implant vs. implant plus external beam radiation therapy), treatment era, total biological effective dose, use of androgen deprivation therapy, age at diagnosis, and race. PSA-DT was analyzed in the following ordinate groups: 0 to 90 days, 91 to 180 days, 180 to 360 days, and greater than 360 days. Results: We included 1,887 patients in this study. Metastases developed in 47 of these patients. The 10-year freedom from distant metastasis (FFDM) rate for the entire population was 95.1%. Median follow-up was 6 years (range, 2-15 years). The only two significant predictors of metastatic disease by multivariable analyses were GS and PSA-DT (p < 0.001 for both variables). Estimated 10-year FFDM rates for GS of 6 or less, GS of 7, and GS of 8 or greater were 97.9%, 94.3%, and 76.1%, respectively (p < 0.001). Estimated FFDM rates for PSA-DT of 0 to 90 days, 91 to 180 days, 181 to 360 days, and greater than 360 days were 17.5%, 67.9%, 74%, and 94.8%, respectively (p < 0.001). Estimated 10-year FFDM rates for the low-, intermediate-, and high-risk groups were 98.6%, 96.2%, and 86.7%, respectively. A demographic shift to patients presenting with higher-grade disease in more recent years was observed. Conclusions: GS and post-treatment PSA-DT are both statistically significant independent predictors of metastatic

  13. An overview of interstitial brachytherapy and hyperthermia

    SciTech Connect

    Brandt, B.B.; Harney, J.

    1989-11-01

    Interstitial thermoradiotherapy, an experimental cancer treatment that combines interstitial radiation implants (brachytherapy) and interstitial hyperthermia, is in the early stages of investigation. In accordance with the procedure used in a current national trial protocol, a 60-minute hyperthermia treatment is administered after catheters are placed into the tumor area while the patient is under general anesthesia. This is immediately followed by loading of radioactive Iridium-192 seeds into the catheters for a defined period of time. Once the prescribed radiation dose is delivered, the radioactive sources are removed and a second, 60-minute hyperthermia treatment is administered. Clinical trials with hyperthermia in combination with radiation have increased in recent years. Nurses caring for these patients need to become more knowledgeable about this investigational therapy. This paper provides an overview of the biologic rationale for this therapy, as well as a description of the delivery method and clinical application. Specific related nursing interventions are defined in a nursing protocol.23 references.

  14. Harmony search optimization for HDR prostate brachytherapy

    NASA Astrophysics Data System (ADS)

    Panchal, Aditya

    In high dose-rate (HDR) prostate brachytherapy, multiple catheters are inserted interstitially into the target volume. The process of treating the prostate involves calculating and determining the best dose distribution to the target and organs-at-risk by means of optimizing the time that the radioactive source dwells at specified positions within the catheters. It is the goal of this work to investigate the use of a new optimization algorithm, known as Harmony Search, in order to optimize dwell times for HDR prostate brachytherapy. The new algorithm was tested on 9 different patients and also compared with the genetic algorithm. Simulations were performed to determine the optimal value of the Harmony Search parameters. Finally, multithreading of the simulation was examined to determine potential benefits. First, a simulation environment was created using the Python programming language and the wxPython graphical interface toolkit, which was necessary to run repeated optimizations. DICOM RT data from Varian BrachyVision was parsed and used to obtain patient anatomy and HDR catheter information. Once the structures were indexed, the volume of each structure was determined and compared to the original volume calculated in BrachyVision for validation. Dose was calculated using the AAPM TG-43 point source model of the GammaMed 192Ir HDR source and was validated against Varian BrachyVision. A DVH-based objective function was created and used for the optimization simulation. Harmony Search and the genetic algorithm were implemented as optimization algorithms for the simulation and were compared against each other. The optimal values for Harmony Search parameters (Harmony Memory Size [HMS], Harmony Memory Considering Rate [HMCR], and Pitch Adjusting Rate [PAR]) were also determined. Lastly, the simulation was modified to use multiple threads of execution in order to achieve faster computational times. Experimental results show that the volume calculation that was

  15. Paddle-based rotating-shield brachytherapy

    SciTech Connect

    Liu, Yunlong; Xu, Weiyu; Flynn, Ryan T.; Kim, Yusung; Bhatia, Sudershan K.; Buatti, John M.; Dadkhah, Hossein; Wu, Xiaodong

    2015-10-15

    Purpose: The authors present a novel paddle-based rotating-shield brachytherapy (P-RSBT) method, whose radiation-attenuating shields are formed with a multileaf collimator (MLC), consisting of retractable paddles, to achieve intensity modulation in high-dose-rate brachytherapy. Methods: Five cervical cancer patients using an intrauterine tandem applicator were considered to assess the potential benefit of the P-RSBT method. The P-RSBT source used was a 50 kV electronic brachytherapy source (Xoft Axxent™). The paddles can be retracted independently to form multiple emission windows around the source for radiation delivery. The MLC was assumed to be rotatable. P-RSBT treatment plans were generated using the asymmetric dose–volume optimization with smoothness control method [Liu et al., Med. Phys. 41(11), 111709 (11pp.) (2014)] with a delivery time constraint, different paddle sizes, and different rotation strides. The number of treatment fractions (fx) was assumed to be five. As brachytherapy is delivered as a boost for cervical cancer, the dose distribution for each case includes the dose from external beam radiotherapy as well, which is 45 Gy in 25 fx. The high-risk clinical target volume (HR-CTV) doses were escalated until the minimum dose to the hottest 2 cm{sup 3} (D{sub 2cm{sup 3}}) of either the rectum, sigmoid colon, or bladder reached their tolerance doses of 75, 75, and 90 Gy{sub 3}, respectively, expressed as equivalent doses in 2 Gy fractions (EQD2 with α/β = 3 Gy). Results: P-RSBT outperformed the two other RSBT delivery techniques, single-shield RSBT (S-RSBT) and dynamic-shield RSBT (D-RSBT), with a properly selected paddle size. If the paddle size was angled at 60°, the average D{sub 90} increases for the delivery plans by P-RSBT on the five cases, compared to S-RSBT, were 2.2, 8.3, 12.6, 11.9, and 9.1 Gy{sub 10}, respectively, with delivery times of 10, 15, 20, 25, and 30 min/fx. The increases in HR-CTV D{sub 90}, compared to D-RSBT, were 16

  16. Automatic Brachytherapy Seed Placement Under MRI Guidance

    PubMed Central

    Patriciu, Alexandru; Petrisor, Doru; Muntener, Michael; Mazilu, Dumitru; Schär, Michael; Stoianovici, Dan

    2011-01-01

    The paper presents a robotic method of performing low dose rate prostate brachytherapy under magnetic resonance imaging (MRI) guidance. The design and operation of a fully automated MR compatible seed injector is presented. This is used with the MrBot robot for transperineal percutaneous prostate access. A new image-registration marker and algorithms are also presented. The system is integrated and tested with a 3T MRI scanner. Tests compare three different registration methods, assess the precision of performing automated seed deployment, and use the seeds to assess the accuracy of needle targeting under image guidance. Under the ideal conditions of the in vitro experiments, results show outstanding image-guided needle and seed placement accuracy. PMID:17694871

  17. Quantitative radiommunoassay for DNA-binding antibodies. [Iodine 131, Iodine 125

    SciTech Connect

    Smith, L.H.; Guyer, R.L.; Minami, R.M.; Teplitz, R.L.

    1981-09-01

    A radioimmunoassay (RIA) is described for the measurement of serum immunoglobulins capable of binding to double-standard or single-standard DNA. DNA attached to Sephadex G-50 by ultraviolet radiation was used as a solid- phase immunoabsorbent for DNA-binding proteins from serum. Goat anti-human (GAH) IgG (/sup 125/I-labeled) were used to detect the human immunoglobulins bound onto the washed DNA-Sephadex. The quantities of immunoglobulins bound were determined by comparison with a standard curve constructed by dilution of a plasma from an systemic lupus erythematosus (SLE) patient containing known amounts of bound, DNA-specific IgM and IgG. Another RIA was employed for measuring levels of IgG and IgM. In combination with measurements of the total serum IgM and IgG, the RIA allowed for the determination of the fraction of the total serum IgM or IgG that was specific for double- or single-standard DNA. For a pool of normal human sera the quantities were as follows: 0.04% of the total IgM and 0.001% of the total IgG bound double-standard DNA; 0.22% of the total IgM and 0.05% of the total IgG bound single-stranded DNA. This capability is important because information regarding the quantitative measurement of antibodies to DNA and their class determination may be of significance in monitoring the status of subjects with SLE.

  18. Iodine-125-labeled triiodothyronine in rat brain: evidence for localization in discrete neural systems

    SciTech Connect

    Dratman, M.B.; Futaesaku, Y.; Crutchfield, F.L.; Berman, N.; Payne, B.; Sar, M.; Stumpf, W.E.

    1982-01-15

    Autoradiograms prepared from adult rat brains demonstrate that nerve cells and neuropil in different brain regions selectively concentrate and retain intravenously administered triiodothyronine, by mechanisms susceptible to saturation with excess triiodothyronine. A neuroregulatory role for thyroid hormones, strongly supported by the observations, may account for their marked effects on behavior and the activity of the autonomic nervous system.

  19. Chemical and biological consequences of the radioactive decay of iodine-125 in plasmid DNA

    SciTech Connect

    Linz, U.; Stoecklin, G.

    1985-02-01

    Doubly labeled (U-/sup 14/C, 5-/sup 125/I)iododeoxycytidine (IdC) triphosphate was synthesized and incorporated enzymatically into defined positions of the plasmid pBR322. After storage under various conditions, the stable end products were analyzed using radio-GC, radio-HPLC, and electron microscopy. In addition, solutions of /sup 14/C-IdC-labeled DNA containing Na/sup 125/I as an internal radiation source were studied to investigate the influence of internal radiolysis. Transmutation of the covalently bound /sup 125/I leads to complete destruction of the labeled nucleotide, giving rise to /sup 14/CO/sub 2/ and /sup 14/CO as major products. Electron microscopy studies reveal that decay-induced double strand breaks (dsb) occur both at the site of decay and in areas as far as hundreds of base pairs apart from that site. Number and distribution of the breaks is strongly dependent on solvent and DNA configuration. A direct correlation exists between the extent of fragmentation of the nucleotide and the mean number of dsb.

  20. Serial Intravitreal Bevacizumab Injections Slow the Progression of Radiation Maculopathy Following Iodine-125 Plaque Radiotherapy

    PubMed Central

    Stacey, Andrew W.; Demirci, Hakan

    2016-01-01

    Background and Objective: To assess the outcomes of intravitreal bevacizumab injection in the management of radiation maculopathy secondary to plaque radiotherapy, and to identify optimal treatment strategies. Study Design: A retrospective review of all choroidal melanoma patients at one referral center who were treated with plaque radiotherapy, subsequently developed radiation maculopathy, and received intravitreal bevacizumab. Results: A total of 31 patients were identified. The mean visual acuity decreased three Snellen lines in the year leading up to the first bevacizumab injection. After initiating injection therapy, the mean visual acuity remained stable for 9 months. The change in visual acuity of patients who received injections within 90 days of previous injections was significantly better than the visual acuity of those who received injections more than 90 days apart (p=0.0003). Patients who demonstrated late-phase macular leakage on fluorescein angiography at the time of the first bevacizumab injection had better long-term visual acuity outcomes than patients who had no evidence of macular leakage (average of one line improvement of vision vs. ten line loss of vision, p=0.03). Conclusions: Intravitreal bevacizumab injection was effective in stabilizing visual acuity in patients with radiation maculopathy. Patients benefited most from injections administered every 90 days or sooner. Fluorescein angiography can help identify patients who will respond favorably to treatment. PMID:27053973

  1. Diagnostic methods for deep vein thrombosis: venous Doppler examination, phleborheography, iodine-125 fibrinogen uptake, and phlebography

    SciTech Connect

    Comerota, A.J.; White, J.V.; Katz, M.L.

    1985-10-08

    Since clinical diagnosis of DVT is often inaccurate, it has become accepted that an objective means of diagnosing clot in the deep venous system becomes critically important in the management of these patients. The venous Doppler examination monitors the velocity of blood flowing through a particular vein. Doppler probes in the 5 to 10 mHz range are routinely used. Respiratory variation is a normal finding due to a diminished flow signal during inspiration, followed by a progressive increase in flow signal during expiration. Characteristics of the spontaneous flow signals are the most important part of interpreting the venous Doppler examination. In addition, the response to distal or proximal compression (augmentation) adds important information to the interpretation; however, the response during any augmentation maneuver depends on the rapidity of compression, the force of compression, the quantity of blood in the veins at the time of compression, and the distance between the Doppler probe and the compression point. Phleborheography is a six-channel volumetric plethysmographic technique that monitors volume changes in the lower extremities associated with respiration and foot and calf compression.

  2. Iodine-125 prostate implants for recurrent carcinomas after external beam irradiation: preliminary results

    SciTech Connect

    Goffinet, D.R.; Martinez, A.; Freiha, F.; Pooler, D.M.; Pistenma, D.A.; Cumes, D.; Bagshaw, M.A.

    1980-06-01

    Fourteen patients with locally recurrent prostate carcinomas after external beam irradiation received /sup 125/I seed implants at Stanford between 1975 and 1979. Clinical local control was obtained in 11 of the 14 patients for follow-up periods of 6 to 36 months. Eight remain without evidence of disease, but 2 of the 3 patients whose pelvic lymph nodes were involved by carcinoma have developed distant metastases. Complications, consisting of either cystoproctitis, urinary incontinence, or the development of a vesicorectal fistula occurred in 4 of the 14 patients. These complications were noted only in those patients who had implantation of high intensity /sup 125/I seeds (>0.50 mCi) into large prostatic volumes (greater than or equal to 50cc). No complications occurred in patients who received lower intensity /sup 125/I seed implants in smaller prostatic volumes. We conclude that /sup 125/I seed implants may be used in a second attempt to obtain local control after a local relapse following external beam irradiation, if the use of high intensity /sup 125/I sources and/or the implantation of large prostate volumes are avoided.

  3. 10 CFR 35.2432 - Records of calibration measurements of brachytherapy sources.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Records of calibration measurements of brachytherapy... Records § 35.2432 Records of calibration measurements of brachytherapy sources. (a) A licensee shall maintain a record of the calibrations of brachytherapy sources required by § 35.432 for 3 years after...

  4. 10 CFR 35.490 - Training for use of manual brachytherapy sources.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 10 Energy 1 2014-01-01 2014-01-01 false Training for use of manual brachytherapy sources. 35.490 Section 35.490 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.490 Training for use of manual brachytherapy sources. Except as provided in § 35.57, the licensee shall require an authorized user of...

  5. 10 CFR 35.490 - Training for use of manual brachytherapy sources.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Training for use of manual brachytherapy sources. 35.490 Section 35.490 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.490 Training for use of manual brachytherapy sources. Except as provided in § 35.57, the licensee shall require an authorized user of...

  6. 10 CFR 35.490 - Training for use of manual brachytherapy sources.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 10 Energy 1 2012-01-01 2012-01-01 false Training for use of manual brachytherapy sources. 35.490 Section 35.490 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.490 Training for use of manual brachytherapy sources. Except as provided in § 35.57, the licensee shall require an authorized user of...

  7. 10 CFR 35.490 - Training for use of manual brachytherapy sources.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 10 Energy 1 2013-01-01 2013-01-01 false Training for use of manual brachytherapy sources. 35.490 Section 35.490 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.490 Training for use of manual brachytherapy sources. Except as provided in § 35.57, the licensee shall require an authorized user of...

  8. 10 CFR 35.490 - Training for use of manual brachytherapy sources.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 10 Energy 1 2011-01-01 2011-01-01 false Training for use of manual brachytherapy sources. 35.490 Section 35.490 Energy NUCLEAR REGULATORY COMMISSION MEDICAL USE OF BYPRODUCT MATERIAL Manual Brachytherapy § 35.490 Training for use of manual brachytherapy sources. Except as provided in § 35.57, the licensee shall require an authorized user of...

  9. A Novel Device for Intravaginal Electronic Brachytherapy

    SciTech Connect

    Schneider, Frank Fuchs, Holger; Lorenz, Friedlieb; Steil, Volker; Ziglio, Francesco; Kraus-Tiefenbacher, Uta; Lohr, Frank; Wenz, Frederik

    2009-07-15

    Purpose: Postoperative intravaginal brachytherapy for endometrial carcinoma is usually performed with {sup 192}Ir high-dose rate (HDR) afterloading. A potential alternative is treatment with a broadband 50kV X-ray point source, the advantage being its low energy and the consequential steep dose gradient. The aim of this study was to create and evaluate a homogeneous cylindrical energy deposition around a newly designed vaginal applicator. Methods and Materials: To create constant isodose layers along the cylindrical plastic vaginal applicator, the source (INTRABEAM system) was moved in steps of 17-19.5 mm outward from the tip of the applicator. Irradiation for a predetermined time was performed at each position. The axial shift was established by a stepping mechanism that was mounted on a table support. The total dose/dose distribution was determined using film dosimetry (Gafchromic EBT) in a 'solid water' phantom. The films were evaluated with Mathematica 5.2 and OmniPro-I'mRT 1.6. The results (dose D0/D5/D10 in 0/5/10 mm tissue depth) were compared with an {sup 192}Ir HDR afterloading plan for multiple sampling points around the applicator. Results: Three different dose distributions with lengths of 3.9-7.3 cm were created. The irradiation time based on the delivery of 5/7 Gy to a 5 mm tissue depth was 19/26 min to 27/38 min. D0/D5/D10 was 150%/100%/67% for electronic brachytherapy and 140%/100%/74% for the afterloading technique. The deviation for repeated measurements in the phantom was <7%. Conclusions: It is possible to create a homogeneous cylindrical dose distribution, similar to {sup 192}Ir HDR afterloading, through the superimposition of multiple spherical dose distributions by stepping a kilovolt point source.

  10. Photoacoustic imaging of prostate brachytherapy seeds

    PubMed Central

    Su, Jimmy L.; Bouchard, Richard R.; Karpiouk, Andrei B.; Hazle, John D.; Emelianov, Stanislav Y.

    2011-01-01

    Brachytherapy seed therapy is an increasingly common way to treat prostate cancer through localized radiation. The current standard of care relies on transrectal ultrasound (TRUS) for imaging guidance during the seed placement procedure. As visualization of individual metallic seeds tends to be difficult or inaccurate under TRUS guidance, guide needles are generally tracked to infer seed placement. In an effort to improve seed visualization and placement accuracy, the use of photoacoustic (PA) imaging, which is highly sensitive to metallic objects in soft tissue, was investigated for this clinical application. The PA imaging properties of bare (i.e., embedded in pure gelatin) and tissue-embedded (at depths of up to 13 mm) seeds were investigated with a multi-wavelength (750 to 1090 nm) PA imaging technique. Results indicate that, much like ultrasonic (US) imaging, an angular dependence (i.e., seed orientation relative to imaging transducer) of the PA signal exists. Despite this shortcoming, however, PA imaging offers improved contrast, over US imaging, of a seed in prostate tissue if sufficient local fluence is achieved. Additionally, although the PA signal of a bare seed is greatest for lower laser wavelengths (e.g., 750 nm), the scattering that results from tissue tends to favor the use of higher wavelengths (e.g., 1064 nm, which is the primary wavelength of Nd:YAG lasers) when the seed is located in tissue. A combined PA and US imaging approach (i.e., PAUS imaging) shows strong potential to visualize both the seed and the surrounding anatomical environment of the prostate during brachytherapy seed placement procedures. PMID:21833361

  11. [Salvage 125I brachytherapy of locally recurrent prostate cancer].

    PubMed

    Gesztesi, László; Ágoston, Péter; Major, Tibor; Gődény, Mária; Andi, Judit; Lengyel, Zsolt; Polgár, Csaba

    2014-09-01

    The purpose of the study is to report a case of salvage low dose rate (LDR) prostate brachytherapy in a patient with locally recurrent prostate cancer, four years after his first treatment with combined external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. A 61-year-old man was treated with 1x10 Gy HDR brachytherapy and a total of 60 Gy EBRT for an organ confined intermediate risk carcinoma of the prostate in 2009. The patient's tumor had been in regression with the lowest PSA level of 0.09 ng/ml, till the end of 2013. After slow but continuous elevation, his PSA level had reached 1.46 ng/ml by February 2014. Pelvis MRI and whole body acetate PET/CT showed recurrent tumor in the dorsal-right region of the prostate. Bone scan was negative. After discussing the possible salvage treatment options with the patient, he chose LDR brachytherapy. In 2014, in spinal anesthesia 21 125I "seeds" were implanted with transrectal ultrasound guidance into the prostate. The prescribed dose to the whole prostate was 100 Gy, to the volume of the recurrent tumor was 140 Gy. The patient tolerated the salvage brachytherapy well. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. PSA level decreased from the pre-salvage value of 1.46 ng/ml to 0.42 ng/ml by one month and 0.18 ng/ml by two months after the brachytherapy. No gastrointestinal side effects appeared, the patient's urination became slightly more frequent. In selected patients, salvage LDR brachytherapy can be a good choice for curative treatment of locally recurrent prostate cancer, after primary radiation therapy. Multiparametric MRI is fundamental, acetate PET/CT can play an important role when defining the localization of the recurrent tumor. PMID:25260087

  12. Analysis of monotherapy prostate brachytherapy in patients with prostate cancer. Initial PSA and Gleason are important for recurrence?

    PubMed Central

    Galego, Pedro; Silva, Fernando C.; Pinheiro, Luís Campos

    2015-01-01

    Purpose To evaluate the clinical outcome of a cohort of localized prostate cancer patients treate with 125-I permanent brachytherapy at the São José Hospital – CHLC, Lisbon. Materials and Methods A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry “real-time” system between September 2003 and September 2013. Results The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion) was observed in 18 patients (4.2%). Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10) and Gleason values (7 and <7), there was no statistical difference (P=0.830) of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P<0.05), demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse. Conclusions Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment. PMID:26005979

  13. Lodestone: Nature's own permanent magnet

    NASA Technical Reports Server (NTRS)

    Wasilewski, P.

    1976-01-01

    Magnetic hysteresis and microstructural details are presented which explain why the class of magnetic iron ores defined as proto-lodestones, can behave as permanent magnets, i.e. lodestones. Certain of these proto-lodestones which are not permanent magnets can be made into permanent magnets by charging in a field greater than 1000 oersted. This fact, other experimental observations, and field evidence from antiquity and the middle ages, which seems to indicate that lodestones are found as localized patches within massive ore bodies, suggests that lightning might be responsible for the charging of lodestones. The large remanent magnetization, high values of coercive force, and good time stability for the remanent magnetization are all characteristics of proto-lodestone iron ores which behave magnetically as fine scale ( 10 micrometer) intergrowths when subjected to magnetic hysteresis analysis. The magnetic results are easily understood by analysis of the complex proto lodestone microstructural patterns observable at the micrometer scale and less.

  14. How Permanent Is Permanent Placement for Substance-Exposed Infants?

    ERIC Educational Resources Information Center

    Twomey, Jean E.; Lester, Barry M.

    2007-01-01

    The authors describe a study of families in the Family Drug Treatment Court (FTDC), an effort to promote permanent placement for substance-exposed infants within time requirements mandated by the 1997 Adoption and Safe Families Act (ASFA). The purpose of the study was to evaluate parent functioning after FTDC involvement, infant developmental…

  15. Utilization and Outcomes of Breast Brachytherapy in Younger Women

    SciTech Connect

    Smith, Grace L.; Huo, Jinhai; Giordano, Sharon H.; Hunt, Kelly K.; Buchholz, Thomas A.; Smith, Benjamin D.

    2015-09-01

    Purpose: To directly compare (1) radiation treatment utilization patterns; (2) risks of subsequent mastectomy; and (3) costs of radiation treatment in patients treated with brachytherapy versus whole-breast irradiation (WBI), in a national, contemporary cohort of women with incident breast cancer, aged 64 years and younger. Methods and Materials: Using MarketScan health care claims data, we identified 45,884 invasive breast cancer patients (aged 18-64 years), treated from 2003 to 2010 with lumpectomy, followed by brachytherapy (n=3134) or whole-breast irradiation (n=42,750). We stratified patients into risk groups according to age (Age<50 vs Age≥50) and endocrine therapy status (Endocrine− vs Endocrine+). “Endocrine+” patients filled an endocrine therapy prescription within 1 year after lumpectomy. Pathologic hormone receptor status was not available in this dataset. In brachytherapy versus WBI patients, utilization trends and 5-year subsequent mastectomy risks were compared. Stratified, adjusted subsequent mastectomy risks were calculated using proportional hazards regression. Results: Brachytherapy utilization increased from 2003 to 2010: in patients Age<50, from 0.6% to 4.9%; patients Age≥50 from 2.2% to 11.3%; Endocrine− patients, 1.3% to 9.4%; Endocrine+ patients, 1.9% to 9.7%. Age influenced treatment selection more than endocrine status: 17% of brachytherapy patients were Age<50 versus 32% of WBI patients (P<.001); whereas 41% of brachytherapy patients were Endocrine–versus 44% of WBI patients (P=.003). Highest absolute 5-year subsequent mastectomy risks occurred in Endocrine−/Age<50 patients (24.4% after brachytherapy vs 9.0% after WBI (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.37-3.47); intermediate risks in Endocrine−/Age≥50 patients (8.6% vs 4.9%; HR 1.76, 95% CI 1.26-2.46); and lowest risks in Endocrine+ patients of any age: Endocrine+/Age<50 (5.5% vs 4.5%; HR 1.18, 95% CI 0.61-2.31); Endocrine+/Age≥50 (4.2% vs 2

  16. Semipermanent and permanent injectable fillers.

    PubMed

    Jones, Derek H

    2009-10-01

    Today, an impressive array of injectable dermal fillers for facial soft-tissue augmentation is available in the United States. These agents, most of which were introduced in the last half decade, represent a variety of semipermanent and permanent fillers across several categories. Physicians can choose between semipermanent fillers, such as hyaluronic acid derivatives (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLA), and longer-lasting, so-called "permanent fillers," such as polymethyl methacrylate microspheres (PMMA), highly purified forms of liquid silicone, and hydrogel polymers. PMID:19850193

  17. Treatment planning of a skin-sparing conical breast brachytherapy applicator using conventional brachytherapy software

    SciTech Connect

    Yang Yun; Melhus, Christopher S.; Sioshansi, Shirin; Rivard, Mark J.

    2011-03-15

    Purpose: AccuBoost is a noninvasive image-guided technique for the delivery of partial breast irradiation to the tumor bed and currently serves as an alternate to conventional electron beam boost. To irradiate the target volume while providing dose sparing to the skin, the round applicator design was augmented through the addition of an internally truncated conical shield and the reduction of the source to skin distance. Methods: Brachytherapy dose distributions for two types of conical applicators were simulated and estimated using Monte Carlo (MC) methods for radiation transport and a conventional treatment planning system (TPS). MC-derived and TPS-generated dose volume histograms (DVHs) and dose distribution data were compared for both the conical and round applicators for benchmarking purposes. Results: Agreement using the gamma-index test was {>=}99.95% for distance to agreement and dose accuracy criteria of 2 mm and 2%, respectively. After observing good agreement, TPS DVHs and dose distributions for the conical and round applicators were obtained and compared. Brachytherapy dose distributions generated using Pinnacle{sup 3} for ten CT data sets showed that the parallel-opposed beams of the conical applicators provided similar PTV coverage to the round applicators and reduced the maximum dose to skin, chest wall, and lung by up to 27%, 42%, and 43%, respectively. Conclusions: Brachytherapy dose distributions for the conical applicators have been generated using MC methods and entered into the Pinnacle{sup 3} TPS via the Tufts technique. Treatment planning metrics for the conical AccuBoost applicators were significantly improved in comparison to those for conventional electron beam breast boost.

  18. Brachytherapy for malignancies of the vagina in the 3D era

    PubMed Central

    Glaser, Scott M.

    2015-01-01

    Vaginal cancer is an uncommon malignancy and can be either recurrent or primary. In both cases, brachytherapy places a central role in the overall treatment course. Recent technological advances have led to more advanced brachytherapy techniques, which in turn have translated to improved outcomes for patients with malignancies of the vagina. The aim of this manuscript is to outline the incorporation of modern brachytherapy into the treatment of patients with vaginal cancer including patient selection along with the role of brachytherapy in conjunction with other treatment modalities, various brachytherapy techniques, treatment planning, dose fractionation schedules, and normal tissue tolerance. PMID:26622234

  19. Prostate brachytherapy in patients with median lobe hyperplasia.

    PubMed

    Wallner, K; Smathers, S; Sutlief, S; Corman, J; Ellis, W

    2000-06-20

    Our aim was to document the technical and clinical course of prostate brachytherapy patients with radiographic evidence of median lobe hyperplasia (MLH). Eight patients with MLH were identified during our routine brachytherapy practice, representing 9% of the 87 brachytherapy patients treated during a 6-month period. No effort was made to avoid brachytherapy in patients noted to have MLH on diagnostic work-up. Cystoscopic evaluation was not routinely performed. Postimplant axial computed tomographic (CT) images of the prostate were obtained at 0.5 cm intervals. Preimplant urinary obstructive symptoms were quantified by the criteria of the American Urologic Association (AUA). Each patient was contacted during the writing of this report to update postimplant morbidity information. There was no apparent association between the degree of MLH and preimplant prostate volume or AUA score. Intraoperatively, we were able to visualize MLH by transrectal ultrasound and did not notice any particular difficulty placing sources in the MLH tissue or migration of sources out of the tissue. The prescription isodose covered from 81% to 99% of the postimplant CT-defined target volume, achieving adequate dose to the median lobe tissue in all patients. Two of the eight patients developed acute, postimplant urinary retention. The first patient required intermittent self-catheterization for 3 months and then resumed spontaneous urination. MLH does not appear to be a strong contraindication to prostate brachytherapy, and prophylactic resection of hypertrophic tissue in such patients is probably not warranted. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 152-156 (2000). PMID:10900427

  20. An algorithm for efficient metal artifact reductions in permanent seed implants

    SciTech Connect

    Xu Chen; Verhaegen, Frank; Laurendeau, Denis; Enger, Shirin A.; Beaulieu, Luc

    2011-01-15

    Purpose: In permanent seed implants, 60 to more than 100 small metal capsules are inserted in the prostate, creating artifacts in x-ray computed tomography (CT) imaging. The goal of this work is to develop an automatic method for metal artifact reduction (MAR) from small objects such as brachytherapy seeds for clinical applications. Methods: The approach for MAR is based on the interpolation of missing projections by directly using raw helical CT data (sinogram). First, an initial image is reconstructed from the raw CT data. Then, the metal objects segmented from the reconstructed image are reprojected back into the sinogram space to produce a metal-only sinogram. The Steger method is used to determine precisely the position and edges of the seed traces in the raw CT data. By combining the use of Steger detection and reprojections, the missing projections are detected and replaced by interpolation of non-missing neighboring projections. Results: In both phantom experiments and patient studies, the missing projections have been detected successfully and the artifacts caused by metallic objects have been substantially reduced. The performance of the algorithm has been quantified by comparing the uniformity between the uncorrected and the corrected phantom images. The results of the artifact reduction algorithm are indistinguishable from the true background value. Conclusions: An efficient algorithm for MAR in seed brachytherapy was developed. The test results obtained using raw helical CT data for both phantom and clinical cases have demonstrated that the proposed MAR method is capable of accurately detecting and correcting artifacts caused by a large number of very small metal objects (seeds) in sinogram space. This should enable a more accurate use of advanced brachytherapy dose calculations, such as Monte Carlo simulations.

  1. Monte Carlo characterization of biocompatible beta-emitting 90Y glass seed incorporated with the radionuclide 153Sm as a SPECT marker for brachytherapy applications.

    PubMed

    Hadadi, Asghar; Sadeghi, Mahdi; Sardari, Dariush; Khanchi, Alireza; Shirazi, Alireza

    2013-01-01

    A glass seed consisting of the β--emitting radionuclide 90Y incorporated with radionuclide 153Sm as SPECT marker is proposed for potential application in brachytherapy in order to reduce the undesirable dose to healthy adjacent organs. The aim of this work is to determine the dosimetric characteristics, as suggested in the AAPM TG-60/TG-149 reports, for this seed using Monte Carlo simulation. Monte Carlo codes MCNP5, EGSnrc, and FLUKA were used to calculate the absorbed dose distribution around the seed. Dosimetric parameters, such as reference absorbed dose rate, radial dose function, and one-dimensional (1D) and two-dimensional (2D) anisotropy functions, were obtained. The computational results from these three codes are in agreement within 5.4% difference on average. The absorbed dose rate at the reference point was estimated to be 5.01 cGy h-1 μCi-1 and self absorption of YAS glass seed amounted to 30.51%. The results showed that, with thermal neutron bombardment of 5 hours in a typical flux, sufficient activity for applications in brachytherapy may be achieved. With a 5 mCi initial activity, the total dose of a YAS glass seed was estimated to be 1.38 Gy at 1.0 cm from the seed center. Comparing with gamma emitting seeds, the 90Y seed could reduce undesirable doses to adjacent organs, because of the rapid dose falloff of beta ray. Because of the high R90 value of 5.5 mm, fewer number of 90Y seeds will be required for an interstitial brachytherapy treatment using permanent implant, in comparison with other beta-emitting seeds. The results would be helpful in the development of the radioactive implants using 90Y glass seeds for the brachytherapy treatment. PMID:24036862

  2. Magnetic Fields: Visible and Permanent.

    ERIC Educational Resources Information Center

    Winkeljohn, Dorothy R.; Earl, Robert D.

    1983-01-01

    Children will be able to see the concept of a magnetic field translated into a visible reality using the simple method outlined. Standard shelf paper, magnets, iron filings, and paint in a spray can are used to prepare a permanent and well-detailed picture of the magnetic field. (Author/JN)

  3. Microfilm Permanence and Archival Quality

    ERIC Educational Resources Information Center

    Avedon, Don M.

    1972-01-01

    The facts about microfilm permanence and archival quality are presented in simple terms. The major factors, including the film base material, the film emulsion, processing, and storage conditions are reviewed. The designations on the edge of the film are explained and a list of refernces provided. (14 references) (Author)

  4. Frictionless Bearing Uses Permanent Magnets

    NASA Technical Reports Server (NTRS)

    1965-01-01

    The purpose of this innovation was to develop a frictionless bearing for high speed, light load applications. The device involves the incorporation of permanent magnets in the bearing design. The repulsion of like magnetic poles provides concentric support of the inner member so that no metallic contact occurs between the bearing surfaces.

  5. Interstitial rotating shield brachytherapy for prostate cancer

    SciTech Connect

    Adams, Quentin E. Xu, Jinghzu; Breitbach, Elizabeth K.; Li, Xing; Rockey, William R.; Kim, Yusung; Wu, Xiaodong; Flynn, Ryan T.; Enger, Shirin A.

    2014-05-15

    Purpose: To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT). Methods: A wire-mounted 62 GBq{sup 153}Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 μm thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535 μm thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0–5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%. Results: The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D{sub 98%}), I-RSBT reduced urethral D{sub 0.1cc} below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D{sub 1cc} was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D{sub 1cc} was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq {sup 153}Gd sources. Conclusions: For the case considered, the proposed{sup 153}Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29

  6. Brachytherapy in the treatment of skin cancer: an overview.

    PubMed

    Skowronek, Janusz

    2015-10-01

    The incidence of skin cancer worldwide is constantly growing and it is the most frequently diagnosed tumor. Brachytherapy (BT) in particular localizations is a valuable tool of the exact radiation depot inside the tumor mass. In localizations such as the face, skull skin and inoperable tumors, relapses after surgery, radiotherapy are usually not suitable for primary or secondary invasive treatment. Brachytherapy is a safe procedure for organs at risk according to rapid fall of a dose outside the axis of the applicator with satisfactory dose localization inside the target. The complications rate is acceptable and treatment costs are low. In some tumors (great skin lesions in the scalp, near eyes or on the nose) BT allows for a great dose reduction in surrounding healthy tissues. Brachytherapy provides minimal dose delivery to surrounding healthy tissue, thus enabling good functional and cosmetic results. Treatment is possible almost in all cases on an outpatient basis. PMID:26759545

  7. Patient-specific Monte Carlo dose calculations for 103Pd breast brachytherapy

    NASA Astrophysics Data System (ADS)

    Miksys, N.; Cygler, J. E.; Caudrelier, J. M.; Thomson, R. M.

    2016-04-01

    This work retrospectively investigates patient-specific Monte Carlo (MC) dose calculations for 103Pd permanent implant breast brachytherapy, exploring various necessary assumptions for deriving virtual patient models: post-implant CT image metallic artifact reduction (MAR), tissue assignment schemes (TAS), and elemental tissue compositions. Three MAR methods (thresholding, 3D median filter, virtual sinogram) are applied to CT images; resulting images are compared to each other and to uncorrected images. Virtual patient models are then derived by application of different TAS ranging from TG-186 basic recommendations (mixed adipose and gland tissue at uniform literature-derived density) to detailed schemes (segmented adipose and gland with CT-derived densities). For detailed schemes, alternate mass density segmentation thresholds between adipose and gland are considered. Several literature-derived elemental compositions for adipose, gland and skin are compared. MC models derived from uncorrected CT images can yield large errors in dose calculations especially when used with detailed TAS. Differences in MAR method result in large differences in local doses when variations in CT number cause differences in tissue assignment. Between different MAR models (same TAS), PTV {{D}90} and skin {{D}1~\\text{c{{\\text{m}}3}}} each vary by up to 6%. Basic TAS (mixed adipose/gland tissue) generally yield higher dose metrics than detailed segmented schemes: PTV {{D}90} and skin {{D}1~\\text{c{{\\text{m}}3}}} are higher by up to 13% and 9% respectively. Employing alternate adipose, gland and skin elemental compositions can cause variations in PTV {{D}90} of up to 11% and skin {{D}1~\\text{c{{\\text{m}}3}}} of up to 30%. Overall, AAPM TG-43 overestimates dose to the PTV ({{D}90} on average 10% and up to 27%) and underestimates dose to the skin ({{D}1~\\text{c{{\\text{m}}3}}} on average 29% and up to 48%) compared to the various MC models derived using the post-MAR CT images studied

  8. Current state of the art brachytherapy treatment planning dosimetry algorithms

    PubMed Central

    Pantelis, E; Karaiskos, P

    2014-01-01

    Following literature contributions delineating the deficiencies introduced by the approximations of conventional brachytherapy dosimetry, different model-based dosimetry algorithms have been incorporated into commercial systems for 192Ir brachytherapy treatment planning. The calculation settings of these algorithms are pre-configured according to criteria established by their developers for optimizing computation speed vs accuracy. Their clinical use is hence straightforward. A basic understanding of these algorithms and their limitations is essential, however, for commissioning; detecting differences from conventional algorithms; explaining their origin; assessing their impact; and maintaining global uniformity of clinical practice. PMID:25027247

  9. Dosimetric characteristics of a new unit for electronic skin brachytherapy

    PubMed Central

    Garcia-Martinez, Teresa; Chan, Jan-Pieter; Perez-Calatayud, Jose

    2014-01-01

    Purpose Brachytherapy with radioactive high dose rate (HDR) 192Ir source is applied to small skin cancer lesions, using surface applicators, i.e. Leipzig or Valencia type. New developments in the field of radiotherapy for skin cancer include electronic brachytherapy. This technique involves the placement of an HDR X-ray source close to the skin, therefore combining the benefits of brachytherapy with the reduced shielding requirements and targeted energy of low energy X-rays. Recently, the Esteya® Electronic Brachytherapy System (Esteya EBS, Elekta AB-Nucletron, Stockholm, Sweden) has been developed specifically for HDR brachytherapy treatment of surface lesions. The system provides radionuclide free HDR brachytherapy by means of a small 69.5 kV X-ray source. The purpose of this study is to obtain the dosimetric characterization required for clinical implementation, providing the detailed methodology to perform the commissioning. Material and methods Flatness, symmetry and penumbra, percentage of depth dose (PDD), kV stability, HVL, output, spectrum, linearity, and leakage have been evaluated for a set of applicators (from 10 mm to 30 mm in diameter). Results Flatness and symmetry resulted better than 5% with around 1 mm of penumbra. The depth dose gradient is about 7%/mm. A kV value of 68.4 ± 1.0 kV (k = 1) was obtained, in good agreement with manufacturer data (69.5 kV). HVL was 1.85 mm Al. Dose rate for a typical 6 Gy to 7 Gy prescription resulted about 3.3 Gy/min and the leakage value was < 100 µGy/min. Conclusions The new Esteya® Electronic Brachytherapy System presents excellent flatness and penumbra as with the Valencia applicator case, combined with an improved PDD, allowing treatment of lesions of up to a depth of 5 mm in combination with reduced treatment duration. The Esteya unit allows HDR brachytherapy superficial treatment within a minimally shielded environment due its low energy. PMID:24790622

  10. Imaging method for monitoring delivery of high dose rate brachytherapy

    DOEpatents

    Weisenberger, Andrew G; Majewski, Stanislaw

    2012-10-23

    A method for in-situ monitoring both the balloon/cavity and the radioactive source in brachytherapy treatment utilizing using at least one pair of miniature gamma cameras to acquire separate images of: 1) the radioactive source as it is moved in the tumor volume during brachytherapy; and 2) a relatively low intensity radiation source produced by either an injected radiopharmaceutical rendering cancerous tissue visible or from a radioactive solution filling a balloon surgically implanted into the cavity formed by the surgical resection of a tumor.

  11. A quality management program in intravascular brachytherapy.

    PubMed

    Chakri, Abderrahim; Thomadsen, Bruce

    2002-12-01

    While simple, intravascular brachytherapy (IVB) presents a considerable potential for harm to the patient. The medical physicist maintains the responsibility to minimize the likelihood of operational problems or dosimetric errors. The principals for safe operation remain the same as with any radiotherapy treatment: to deliver the correct dose, to the correct location, safety. To develop an effective and comprehensive quality management (QM) program for IVB, a physicist should utilize proven risk assessment techniques rather than simply thinking of things to check, and follow guidances such as ISO9001:2000. The proposed QM program includes the following: Procedures designed to assure the safety of the patient. Identification of the patient; tests of the integrity and patency for the delivery catheter, operation of the source train, and patency of the catheter in the treatment position; a check for recovery preparations; and verification of source recovery. Procedures to assure positional accuracy of the treatment: Verification of the positioning the catheter in the artery and of the sources in the catheter. Procedures to assure dosimetry accuracy: Acceptance testing of the device, including verification of the source strength and uniformity, and of the treatment duration tables; verification of the treatment prescription and duration for each patient; and control measures that minimize the likelihood of errors removing the source at the correct time. PMID:12512720

  12. Radiotherapy and brachytherapy for recurrent colorectal cancer

    SciTech Connect

    Nag, S. )

    1991-05-01

    Radical surgical excision of locoregional recurrence of colorectal carcinoma usually produces the best survival and should be attempted whenever possible. However, recurrences are often unresectable; hence palliative local therapy may be indicated. There are several options for the radiation therapy of local, unresectable, recurrent, or metastatic colorectal cancer. Whole pelvis irradiation of 4,000-5,000 cGy followed by a coned-down boost of 1,000-1,500 cGy generally provides good symptomatic palliation in 80-90% of patients, but long-term control or cure is rarely achieved. External beam irradiation of 2,000-3,000 cGy to the whole liver with or without concurrent chemotherapy may be used for palliation of metastatic disease to the liver. A combination of intraoperative radiation therapy applied directly to the tumor bed and external beam irradiation may improve local control and survival rates. Multiple options are available for the intraoperative use of brachytherapy which can deliver high radiation doses to the residual tumor, or tumor bed, sparing normal tissue.

  13. SU-E-T-546: Use of Implant Volume for Quality Assurance of Low Dose Rate Brachytherapy Treatment Plans

    SciTech Connect

    Wilkinson, D; Kolar, M

    2014-06-01

    Purpose: To analyze the application of volume implant (V100) data as a method for a global check of low dose rate (LDR) brachytherapy plans. Methods: Treatment plans for 335 consecutive patients undergoing permanent seed implants for prostate cancer and for 113 patients treated with plaque therapy for ocular melanoma were analyzed. Plaques used were 54 COMS (10 to 20 mm, notched and regular) and 59 Eye Physics EP917s with variable loading. Plots of treatment time x implanted activity per unit dose versus v100 ^.667 were made. V100 values were obtained using dose volume histograms calculated by the treatment planning systems (Variseed 8.02 and Plaque Simulator 5.4). Four different physicists were involved in planning the prostate seed cases; two physicists for the eye plaques. Results: Since the time and dose for the prostate cases did not vary, a plot of implanted activity vs V100 ^.667 was made. A linear fit with no intercept had an r{sup 2} = 0.978; more than 94% of the actual activities fell within 5% of the activities calculated from the linear fit. The greatest deviations were in cases where the implant volumes were large (> 100 cc). Both COMS and EP917 plaque linear fits were good (r{sup 2} = .967 and .957); the largest deviations were seen for large volumes. Conclusions: The method outlined here is effective for checking planning consistency and quality assurance of two types of LDR brachytherapy treatment plans (temporary and permanent). A spreadsheet for the calculations enables a quick check of the plan in situations were time is short (e.g. OR-based prostate planning)

  14. Verification of Oncentra brachytherapy planning using independent calculation

    NASA Astrophysics Data System (ADS)

    Safian, N. A. M.; Abdullah, N. H.; Abdullah, R.; Chiang, C. S.

    2016-03-01

    This study was done to investigate the verification technique of treatment plan quality assurance for brachytherapy. It is aimed to verify the point doses in 192Ir high dose rate (HDR) brachytherapy between Oncentra Masterplan brachytherapy treatment planning system and independent calculation software at a region of rectum, bladder and prescription points for both pair ovoids and full catheter set ups. The Oncentra TPS output text files were automatically loaded into the verification programme that has been developed based on spreadsheets. The output consists of source coordinates, desired calculation point coordinates and the dwell time of a patient plan. The source strength and reference dates were entered into the programme and then dose point calculations were independently performed. The programme shows its results in a comparison of its calculated point doses with the corresponding Oncentra TPS outcome. From the total of 40 clinical cases that consisted of two fractions for 20 patients, the results that were given in term of percentage difference, it shows an agreement between TPS and independent calculation are in the range of 2%. This programme only takes a few minutes to be used is preferably recommended to be implemented as the verification technique in clinical brachytherapy dosimetry.

  15. Introduction of Transperineal Image-Guided Prostate Brachytherapy

    SciTech Connect

    Aronowitz, Jesse N.

    2014-07-15

    The modern prostate brachytherapy procedure is characterized by ultrasound guidance, template assistance, and a return to a “closed” transperineal approach. This review traces the introduction and evolution of these elements and charts the development of the procedure from the ashes of previous, failed efforts.

  16. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radionuclide brachytherapy source. 892.5730 Section 892.5730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5730 Radionuclide...

  17. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Radionuclide brachytherapy source. 892.5730 Section 892.5730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5730 Radionuclide...

  18. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Radionuclide brachytherapy source. 892.5730 Section 892.5730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5730 Radionuclide...

  19. 21 CFR 892.5730 - Radionuclide brachytherapy source.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Radionuclide brachytherapy source. 892.5730 Section 892.5730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES RADIOLOGY DEVICES Therapeutic Devices § 892.5730 Radionuclide...

  20. Photoacoustic imaging of prostate brachytherapy seeds with transurethral light delivery

    NASA Astrophysics Data System (ADS)

    Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

    2014-03-01

    We present a novel approach to photoacoustic imaging of prostate brachytherapy seeds utilizing an existing urinary catheter for transurethral light delivery. Two canine prostates were surgically implanted with brachyther- apy seeds under transrectal ultrasound guidance. One prostate was excised shortly after euthanasia and fixed in gelatin. The second prostate was imaged in the native tissue environment shortly after euthanasia. A urinary catheter was inserted in the urethra of each prostate. A 1-mm core diameter optical fiber coupled to a 1064 nm Nd:YAG laser was inserted into the urinary catheter. Light from the fiber was either directed mostly parallel to the fiber axis (i.e. end-fire fire) or mostly 90° to the fiber axis (i.e. side-fire fiber). An Ultrasonix SonixTouch scanner, transrectal ultrasound probe with curvilinear (BPC8-4) and linear (BPL9-5) arrays, and DAQ unit were utilized for synchronized laser light emission and photoacoustic signal acquisition. The implanted brachytherapy seeds were visualized at radial distances of 6-16 mm from the catheter. Multiple brachytherapy seeds were si- multaneously visualized with each array of the transrectal probe using both delay-and-sum (DAS) and short-lag spatial coherence (SLSC) beamforming. This work is the first to demonstrate the feasibility of photoacoustic imaging of prostate brachytherapy seeds using a transurethral light delivery method.

  1. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  2. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  3. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  4. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  5. 21 CFR 886.4445 - Permanent magnet.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Permanent magnet. 886.4445 Section 886.4445 Food... DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4445 Permanent magnet. (a) Identification. A permanent magnet is a nonelectric device that generates a magnetic field intended to find and remove...

  6. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 2 2011-04-01 2009-04-01 true Permanent offices. 401.3 Section 401.3 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District...

  7. 22 CFR 401.3 - Permanent offices.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 2 2010-04-01 2010-04-01 true Permanent offices. 401.3 Section 401.3 Foreign Relations INTERNATIONAL JOINT COMMISSION, UNITED STATES AND CANADA RULES OF PROCEDURE General § 401.3 Permanent offices. The permanent offices of the Commission shall be at Washington, in the District...

  8. Teaching Object Permanence: An Action Research Study

    ERIC Educational Resources Information Center

    Bruce, Susan M.; Vargas, Claudia

    2013-01-01

    "Object permanence," also known as "object concept" in the field of visual impairment, is one of the most important early developmental milestones. The achievement of object permanence is associated with the onset of representational thought and language. Object permanence is important to orientation, including the recognition of landmarks.…

  9. Gadolinium neutron capture brachytherapy (GdNCB), a new treatment method for intravascular brachytherapy.

    PubMed

    Enger, Shirin A; Rezaei, Arash; Munck af Rosenschöld, Per; Lundqvist, Hans

    2006-01-01

    Restenosis is a major problem after balloon angioplasty and stent implantation. The aim of this study is to introduce gadolinium neutron capture brachytherapy (GdNCB) as a suitable modality for treatment of stenosis. The utility of GdNCB in intravascular brachytherapy (IVBT) of stent stenosis is investigated by using the GEANT4 and MCNP4B Monte Carlo radiation transport codes. To study capture rate, Kerma, absorbed dose and absorbed dose rate around a Gd-containing stent activated with neutrons, a 30 mm long, 5 mm diameter gadolinium foil is chosen. The input data is a neutron spectrum used for clinical neutron capture therapy in Studsvik, Sweden. Thermal neutron capture in gadolinium yields a spectrum of high-energy gamma photons, which due to the build-up effect gives an almost flat dose delivery pattern to the first 4 mm around the stent. The absorbed dose rate is 1.33 Gy/min, 0.25 mm from the stent surface while the dose to normal tissue is in order of 0.22 Gy/min, i.e., a factor of 6 lower. To spare normal tissue further fractionation of the dose is also possible. The capture rate is relatively high at both ends of the foil. The dose distribution from gamma and charge particle radiation at the edges and inside the stent contributes to a nonuniform dose distribution. This will lead to higher doses to the surrounding tissue and may prevent stent edge and in-stent restenosis. The position of the stent can be verified and corrected by the treatment plan prior to activation. Activation of the stent by an external neutron field can be performed days after catherization when the target cells start to proliferate and can be expected to be more radiation sensitive. Another advantage of the nonradioactive gadolinium stent is the possibility to avoid radiation hazard to personnel. PMID:16485408

  10. Gadolinium neutron capture brachytherapy (GdNCB), a new treatment method for intravascular brachytherapy

    SciTech Connect

    Enger, Shirin A.; Rezaei, Arash; Munck af Rosenschoeld, Per; Lundqvist, Hans

    2006-01-15

    Restenosis is a major problem after balloon angioplasty and stent implantation. The aim of this study is to introduce gadolinium neutron capture brachytherapy (GdNCB) as a suitable modality for treatment of stenosis. The utility of GdNCB in intravascular brachytherapy (IVBT) of stent stenosis is investigated by using the GEANT4 and MCNP4B Monte Carlo radiation transport codes. To study capture rate, Kerma, absorbed dose and absorbed dose rate around a Gd-containing stent activated with neutrons, a 30 mm long, 5 mm diameter gadolinium foil is chosen. The input data is a neutron spectrum used for clinical neutron capture therapy in Studsvik, Sweden. Thermal neutron capture in gadolinium yields a spectrum of high-energy gamma photons, which due to the build-up effect gives an almost flat dose delivery pattern to the first 4 mm around the stent. The absorbed dose rate is 1.33 Gy/min, 0.25 mm from the stent surface while the dose to normal tissue is in order of 0.22 Gy/min, i.e., a factor of 6 lower. To spare normal tissue further fractionation of the dose is also possible. The capture rate is relatively high at both ends of the foil. The dose distribution from gamma and charge particle radiation at the edges and inside the stent contributes to a nonuniform dose distribution. This will lead to higher doses to the surrounding tissue and may prevent stent edge and in-stent restenosis. The position of the stent can be verified and corrected by the treatment plan prior to activation. Activation of the stent by an external neutron field can be performed days after catherization when the target cells start to proliferate and can be expected to be more radiation sensitive. Another advantage of the nonradioactive gadolinium stent is the possibility to avoid radiation hazard to personnel.

  11. Three-dimensional ultrasound system for guided breast brachytherapy

    SciTech Connect

    De Jean, Paul; Beaulieu, Luc; Fenster, Aaron

    2009-11-15

    Breast-conserving surgery combined with subsequent radiation therapy is a standard procedure in breast cancer treatment. The disadvantage of whole-breast beam irradiation is that it requires 20-25 treatment days, which is inconvenient for patients with limited mobility or who reside far from the treatment center. However, interstitial high-dose-rate (HDR) brachytherapy is an irradiation method requiring only 5 treatment days and that delivers a lower radiation dose to the surrounding healthy tissue. It involves delivering radiation through {sup 192}Ir seeds placed inside the catheters, which are inserted into the breast. The catheters are attached to a HDR afterloader, which controls the seed placement within the catheters and irradiation times to deliver the proper radiation dose. One disadvantage of using HDR brachytherapy is that it requires performing at least one CT scan during treatment planning. The procedure at our institution involves the use of two CT scans. Performing CT scans requires moving the patient from the brachytherapy suite with catheters inserted in their breasts. One alternative is using three-dimensional ultrasound (3DUS) to image the patient. In this study, the authors developed a 3DUS translation scanning system for use in breast brachytherapy. The new system was validated using CT, the current clinical standard, to image catheters in a breast phantom. Once the CT and 3DUS images were registered, the catheter trajectories were then compared. The results showed that the average angular separation between catheter trajectories was 2.4 deg., the average maximum trajectory separation was 1.0 mm, and the average mean trajectory separation was found to be 0.7 mm. In this article, the authors present the 3DUS translation scanning system's capabilities as well as its potential to be used as the primary treatment planning imaging modality in breast brachytherapy.

  12. Permanent-File-Validation Utility Computer Program

    NASA Technical Reports Server (NTRS)

    Derry, Stephen D.

    1988-01-01

    Errors in files detected and corrected during operation. Permanent File Validation (PFVAL) utility computer program provides CDC CYBER NOS sites with mechanism to verify integrity of permanent file base. Locates and identifies permanent file errors in Mass Storage Table (MST) and Track Reservation Table (TRT), in permanent file catalog entries (PFC's) in permit sectors, and in disk sector linkage. All detected errors written to listing file and system and job day files. Program operates by reading system tables , catalog track, permit sectors, and disk linkage bytes to vaidate expected and actual file linkages. Used extensively to identify and locate errors in permanent files and enable online correction, reducing computer-system downtime.

  13. Repeat Brachytherapy for Patients With Residual or Recurrent Tumors of Oral Cavity

    SciTech Connect

    Yoshimura, Ryo-ichi; Shibuya, Hitoshi; Hayashi, Keiji; Nakagawa, Keiko; Toda, Kazuma; Watanabe, Hiroshi; Kaida, Atushi; Miura, Masahiko

    2012-07-15

    Purpose: To analyze data from patients receiving repeat brachytherapy (re-BT) for the treatment of residual or recurrent tumor in the oral cavity. Methods and Materials: Between January 2003 and December 2007, 62 patients who had undergone definitive BT as an initial treatment of oral cancer subsequently underwent re-BT for the treatment of residual or recurrent tumors at the diagnostic radiology and oncology department (Tokyo Medical and Dental University Hospital). Re-BT was performed 0.9-73 months (median, 5.7) after the initial BT. Au-198 grains were used as the re-BT source in all 62 patients, and an area of 0.8-6.3 cm{sup 2} (median, 3.1) was permanently irradiated with 60-110 Gy (median, 83) according to the system of Paterson-Parker. Results: The 2-year local control and overall survival rate was 53% and 66%, respectively, and local control significantly affected overall survival. Both local control and overall survival were affected by the initial tumor characteristics and the macroscopic appearance of the residual or recurrent tumor. Grade 3 or 4 complications were seen in 5 patients. The incidence of mandibular and mucosal complications was significantly related to a biologic effective dose of {alpha}/{beta} of 3 Gy to the surface of the gingiva and mucosa, respectively. Conclusion: Re-BT using Au-198 grains for the treatment of residual or recurrent tumor after definitive BT in the oral cavity is effective and well tolerated.

  14. Results of brachytherapy for cancer of the tongue with special emphasis on local prognosis

    SciTech Connect

    Horiuchi, J.; Okuyama, T.; Shibuya, H.; Takeda, M.

    1982-05-01

    One hundred and sixty-six patients with squamous cell carcinoma of the tongue were treated with radiation. Treatment modalities were mainly interstitial implant with or without external beam irradiation, except for early lesions, which were treated with intraoral electron beam therapy. Analysis was made on the local prognosis of the lesion to clarify the indications for interstitial therapy, especially the combined program with external beam therapy, and the time-dose relationship of the brachytherapy. Local recurrence-free rates (two years) were 94% in T1, 77% in T2 and 32% in T3 lesions, respectively. For T1 and surperficial or exophytic T2 lesions, the local recurrence-free rate was excellent with the interstitial therapy alone using either permanent implants of gold grain or radium implants. Therefore, prior external beam therapy seemed to be unnecessary for these lesions. When the treated area was less than 10 cm/sup 2/, subsequent complications were not likely even if the TDF (time-dose factor) value was high. Most of the patients who received combined external beam and interstitial therapy showed infiltrative T2 and a majority of the T3 lesions. In these patients, it was apparent that most of the total dose should be given from the interstitial implant after a small prior dose with external irradiation, because these lesions could not be cured even if the external dose was increased.

  15. Bioevaluation of 125I Ocu-Prosta seeds for application in prostate cancer brachytherapy

    PubMed Central

    Mukherjee, Archana; Sarma, Haladhar Dev; Saxena, Sanjay; Kumar, Yogendra; Chaudhari, Pradip; Goda, Jayant Sastri; Adurkar, Pranjal; Dash, Ashutosh; Samuel, Grace

    2014-01-01

    Background & objectives: In recent years, brachytherapy involving permanent radioactive seed implantation has emerged as an effective modality for the management of cancer of prostate. 125I-Ocu-Prosta seeds were indigenously developed and studies were carried out to assess the safety of the indigenously developed 125I-Ocu-Prosta seeds for treatment of prostate cancer. Methods: Animal experiments were performed to assess the likelihood of in vivo release of 125I from radioactive seeds and migration of seeds implanted in the prostate gland of the rabbit. In vivo release of 125I activity was monitored by serial blood sampling from the auricular vein and subsequent measurement of 125I activity. Serial computed tomography (CT) scans were done at regular intervals till 6 months post implant to assess the physical migration of the seeds. Results: The laser welded seeds maintained their hermeticity and prevented the in vivo release of 125I activity into the blood as no radioactivity was detected during follow up blood measurements. Our study showed that the miniature 125I seeds were clearly resolved in CT images. Seeds remained within the prostate gland during the entire study period. Moreover, the seed displacement was minimal even within the prostate gland. Interpretation & conclusions: Our findings have demonstrated that indigenously developed 125I-Ocu-Prosta seeds may be suitable for application in treatment of prostate cancer. PMID:24927341

  16. Monte Carlo calculations and experimental measurements of dosimetric parameters of the IRA-103Pd brachytherapy source.

    PubMed

    Sadeghi, Mahdi; Raisali, Gholamreza; Hosseini, S Hamed; Shavar, Arzhang

    2008-04-01

    This article presents a brachytherapy source having 103Pd adsorbed onto a cylindrical silver rod that has been developed by the Agricultural, Medical, and Industrial Research School for permanent implant applications. Dosimetric characteristics (radial dose function, anisotropy function, and anisotropy factor) of this source were experimentally and theoretically determined in terms of the updated AAPM Task group 43 (TG-43U1) recommendations. Monte Carlo simulations were used to calculate the dose rate constant. Measurements were performed using TLD-GR200A circular chip dosimeters using standard methods employing thermoluminescent dosimeters in a Perspex phantom. Precision machined bores in the phantom located the dosimeters and the source in a reproducible fixed geometry, providing for transverse-axis and angular dose profiles over a range of distances from 0.5 to 5 cm. The Monte Carlo N-particle (MCNP) code, version 4C simulation techniques have been used to evaluate the dose-rate distributions around this model 103Pd source in water and Perspex phantoms. The Monte Carlo calculated dose rate constant of the IRA-103Pd source in water was found to be 0.678 cGy h(-1) U(-1) with an approximate uncertainty of +/-0.1%. The anisotropy function, F(r, theta), and the radial dose function, g(r), of the IRA- 103Pd source were also measured in a Perspex phantom and calculated in both Perspex and liquid water phantoms. PMID:18491522

  17. Attitude and practice of brachytherapy in India: a study based on the survey amongst attendees of Annual Meeting of Indian Brachytherapy Society

    PubMed Central

    Sharma, Daya Nand; Julka, Pramod Kumar; Rath, Goura Kishor

    2015-01-01

    Purpose We performed a survey amongst attendees of the 4th Annual Meeting of Indian Brachytherapy Society to study the patterns of brachytherapy practice and attitude towards brachytherapy use. Material and methods A 19-point questionnaire was designed and e-mailed to the attendees immediately after the conference. Descriptive analysis of the responses were done and satisfaction index was used as a tool for evaluation of the program effectiveness. Binomial test was used to assess the difference between distributions of responses and Mann-Whitney U test was used to assess the correlation between responses. P value (2-tailed) of < 0.05 was taken significant for all statistical analysis. Results Of a total of 202 attendees, 90 responded to the survey (response rate: 44.5%). Seventy-two percent belonged to an academic institute while 28% belonged to non-academic institutes. Eighty-six percent were radiation oncologists and 10% were medical physicists. Eighty-nine percent respondents used high-dose-rate, 14% – pulse-dose-rate, and 13% used low-dose-rate brachytherapy facility. Orthogonal X-rays, computed tomography, and magnetic resonance imaging was used for brachytherapy planning by 56%, 69%, and 14%, respectively. Ninety-three percent of them thought that lack of training is a hurdle in practicing brachytherapy and 92% opined that brachytherapy dedicated meetings can change their perception about brachytherapy. Seventy percent respondents admitted to make some changes in their practice patterns after attending this meeting. Ninety-seven percent of them would like to attend future meetings and 98% felt the need to include live workshops, hands on demonstrations, and video presentations in the scientific programme. Conclusions The survey highlights a positive attitude towards increasing brachytherapy use, and may serve as an important guiding tool in designing teaching and training programmes; thus overcoming the hurdles in successful and widespread use of a quality

  18. Method of making permanent magnets

    DOEpatents

    McCallum, R.W.; Dennis, K.W.; Lograsso, B.K.; Anderson, I.E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles. Wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties. 13 figures.

  19. Method of making permanent magnets

    DOEpatents

    McCallum, R. William; Dennis, Kevin W.; Lograsso, Barbara K.; Anderson, Iver E.

    1993-09-07

    A method for making an isotropic permanent magnet comprises atomizing a melt of a rare earth-transition metal alloy (e.g., an Nd--Fe--B alloy enriched in Nd and B) under conditions to produce protectively coated, rapidly solidified, generally spherical alloy particles wherein a majority of the particles are produced/size classified within a given size fraction (e.g., 5 to 40 microns diameter) exhibiting optimum as-atomized magnetic properties and subjecting the particles to concurrent elevated temperature and elevated isotropic pressure for a time effective to yield a densified, magnetically isotropic magnet compact having enhanced magnetic properties and mechanical properties.

  20. Quality Assurance Issues for Computed Tomography-, Ultrasound-, and Magnetic Resonance Imaging-Guided Brachytherapy

    SciTech Connect

    Cormack, Robert A.

    2008-05-01

    The requirements of quality assurance (QA) for both brachytherapy and imaging devices are well-defined, but image-guided brachytherapy has raised new issues. Image guidance in brachytherapy involves the transition from reference point dosimetry using films to volumetric imaging such as computed tomography, ultrasonography, and magnetic resonance imaging for treatment planning and guidance of applicator, needle, or seed placement. The QA of these devices might not reflect the conditions of use in brachytherapy or the requirements of brachytherapy treatment planning. Image interpretation becomes much more important with image-guided brachytherapy. The success of a procedure could depend on the interpretation of a single image in a calibration phase done under the time pressures of the operative setting. This change has implications at the level of treatment, the process, and the field of brachytherapy as a whole. The QA concerns arising from brachytherapy procedures using ultrasound, computed tomography, and magnetic resonance imaging guidance are discussed, as are the problems associated with using imaging in an interventional setting. This report was intended to indicate the QA concerns arising from the convergence of brachytherapy and imaging-highlighting areas in which technical improvements are needed.

  1. Improved dosimetry techniques for intravascular brachytherapy

    NASA Astrophysics Data System (ADS)

    Sehgal, Varun

    Coronary artery disease leads to the accumulation of atheromatous plaque leading to coronary stenosis. Coronary intervention techniques such as balloon angioplasty and atherectomy are used to address coronary stenosis and establish a stable lumen thus enhancing blood flow to the myocardium. Restenosis or re-blockage of the arteries is a major limitation of the above mentioned interventional techniques. Neointimal hyperplasia or proliferation of cells in response to the vascular injury as a result of coronary intervention is considered to be one of the major causes of restenosis. Recent studies indicated that irradiation of the coronary lesion site, with radiation doses ranging from 15 to 30 Gy, leads to diminishing neointimal hyperplasia with subsequent reduction in restenosis. The radiation dose is given by catheter-based radiation delivery systems using beta-emitters 90Sr/90Y, 32P and gamma-emitting 192Ir among others. However the dose schema used for dose prescription for these sources are relatively simplistic, and are based on calculations using uniform homogenous water or tissue media and simple cylinder geometry. Stenotic coronary vessels are invariably lined with atheromatous plaque of heterogeneous composition, the radiation dose distribution obtained from such dosimetry data can cause significant variations in the actual dose received by a given patient. Such discrepancies in dose calculation can introduce relatively large uncertainties in the limits of dose window for effective and safe application of intravascular brachytherapy, and consequently in the clinical evaluation of the efficacy of this modality. In this research study we investigated the effect of different geometrical and material heterogeneities, including residual plaque, catheter non-centering, lesion eccentricity and cardiac motion on the radiation dose delivered at the lesion site. Correction factors including dose perturbation factors and dose variation factors have been calculated

  2. Energy Differential Response of Cancer Cells for Low Dose Irradiation:Impact of Monoenergetic Brachytherapy Sources

    SciTech Connect

    Gueye, Paul; Prilepskiy, Yuriy; Keppel, Cynthia; Britten, R

    2010-06-01

    Purpose: The purpose of this work was to evaluate the energy differential response of cancer cells under identical dose exposure to asses the relevancy of mono-energetic sources for Brachytherapy treatments. Method and Materials: An electron energy spectrum impinging on lived breast cancer cell lines (MDA321) was obtained by placing a 19.65 {micro}Ci {sup 90}Sr/{sup 90}Y radioactive source in front of a non-uniform magnetic field constructed from two 5.08 x 5.0 cm x 2.54 cm neodimium ion permanent dipole magnets with a 1 cm separation gap. The cell lines were placed on the exit pole face of the magnet and were subsequently irradiated with different electron energies ranging from about 0.75 MeV to 1.85 MeV. The energy distribution was accurately measured with a scintillating fiber detector system that provided a 0.5% agreement with ICRU and a 5% energy resolution. The dosimetry was performed using a series of data acquired with a {sup 9}Sr/{sup 90}Y 4.5 mCi SIA-6 eye applicator, 6-21 MeV fixed energies from a Varian 2100 EX linac, EBT Gafchromic and Kodak ERT2 films, and an ion chamber detector. The accuracy of the dose rate obtained at different locations along and away from the magnet inside the cell containers was within 10.7%. Results: The cell lines were irradiated with a 0.5-4 Gy dose range. The data indicate a very strong differential energy response for electrons around 1 MeV (more lethal) compare to those with lesser or greater energy and a survival rate of at most 10% at very low dose (0.5-2 Gy). Conclusion: Mono-energetic Brachytherapy sources may provide a new pathway for radio-therapy treatment optimizations following a dedicated study showing very unusual high lethality in a specific energy window for MDA321 breast cancer cells.

  3. Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity

    SciTech Connect

    Allen, Zachariah A.; Merrick, Gregory S. . E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian; Anderson, Richard L.; Murray, Brian C.; Galbreath, Robert W.

    2005-07-15

    Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha

  4. Monte Carlo study of LDR seed dosimetry with an application in a clinical brachytherapy breast implant

    SciTech Connect

    Furstoss, C.; Reniers, B.; Bertrand, M. J.; Poon, E.; Carrier, J.-F.; Keller, B. M.; Pignol, J. P.; Beaulieu, L.; Verhaegen, F.

    2009-05-15

    A Monte Carlo (MC) study was carried out to evaluate the effects of the interseed attenuation and the tissue composition for two models of {sup 125}I low dose rate (LDR) brachytherapy seeds (Medi-Physics 6711, IBt InterSource) in a permanent breast implant. The effect of the tissue composition was investigated because the breast localization presents heterogeneities such as glandular and adipose tissue surrounded by air, lungs, and ribs. The absolute MC dose calculations were benchmarked by comparison to the absolute dose obtained from experimental results. Before modeling a clinical case of an implant in heterogeneous breast, the effects of the tissue composition and the interseed attenuation were studied in homogeneous phantoms. To investigate the tissue composition effect, the dose along the transverse axis of the two seed models were calculated and compared in different materials. For each seed model, three seeds sharing the same transverse axis were simulated to evaluate the interseed effect in water as a function of the distance from the seed. A clinical study of a permanent breast {sup 125}I implant for a single patient was carried out using four dose calculation techniques: (1) A TG-43 based calculation, (2) a full MC simulation with realistic tissues and seed models, (3) a MC simulation in water and modeled seeds, and (4) a MC simulation without modeling the seed geometry but with realistic tissues. In the latter, a phase space file corresponding to the particles emitted from the external surface of the seed is used at each seed location. The results were compared by calculating the relevant clinical metrics V{sub 85}, V{sub 100}, and V{sub 200} for this kind of treatment in the target. D{sub 90} and D{sub 50} were also determined to evaluate the differences in dose and compare the results to the studies published for permanent prostate seed implants in literature. The experimental results are in agreement with the MC absolute doses (within 5% for EBT

  5. [Permanent vascular access for haemodialysis].

    PubMed

    Manafov, E N; Batrashov, V A; Sergeev, O G; Yudaev, S S

    2015-01-01

    The presence of a permanent vascular access (PVA) is the pledge of successful treatment of patients being on chronic haemodialysis (CD). Creation and maintenance of a functioning PVA is the priority task of vascular and endovascular surgeons, nephrologists and specialists of haemodialysis departments. According to the KDOQI guidelines, the most preferable type of PVA is a native arteriovenous fistula (AVF). As an alternative it is possible to use a synthetic prosthesis for creating an arteriovenous shunt (AVS) or implantation of a central venous catheter (CVC). Various complications of vascular accesses leading to their loss create the necessity of forming just another PVA, thus negatively influencing the life span and quality of life of this cohort of patients. Improving surgical technique and approaches to treatment, as well as carrying out dynamic monitoring of the condition of the created PVA make it possible to considerably decrease the incidence rate of such complications and to improve the quality of medical care rendered. PMID:26451410

  6. Trends in the Utilization of Brachytherapy in Cervical Cancer in the United States

    SciTech Connect

    Han, Kathy; Milosevic, Michael; Fyles, Anthony; Pintilie, Melania; Viswanathan, Akila N.

    2013-09-01

    Purpose: To determine the trends in brachytherapy use in cervical cancer in the United States and to identify factors and survival benefits associated with brachytherapy treatment. Methods and Materials: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 7359 patients with stages IB2-IVA cervical cancer treated with external beam radiation therapy (EBRT) between 1988 and 2009. Propensity score matching was used to adjust for differences between patients who received brachytherapy and those who did not from 2000 onward (after the National Cancer Institute alert recommending concurrent chemotherapy). Results: Sixty-three percent of the 7359 women received brachytherapy in combination with EBRT, and 37% received EBRT alone. The brachytherapy utilization rate has decreased from 83% in 1988 to 58% in 2009 (P<.001), with a sharp decline of 23% in 2003 to 43%. Factors associated with higher odds of brachytherapy use include younger age, married (vs single) patients, earlier years of diagnosis, earlier stage and certain SEER regions. In the propensity score-matched cohort, brachytherapy treatment was associated with higher 4-year cause-specific survival (CSS; 64.3% vs 51.5%, P<.001) and overall survival (OS; 58.2% vs 46.2%, P<.001). Brachytherapy treatment was independently associated with better CSS (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.57-0.71), and OS (HR 0.66; 95% CI, 0.60 to 0.74). Conclusions: This population-based analysis reveals a concerning decline in brachytherapy utilization and significant geographic disparities in the delivery of brachytherapy in the United States. Brachytherapy use is independently associated with significantly higher CSS and OS and should be implemented in all feasible cases.

  7. Torque Performance and Permanent Magnet Arrangement for Interior Permanent Magnet Synchronous Motor

    NASA Astrophysics Data System (ADS)

    Matsumoto, Naohisa; Sanada, Masayuki; Morimoto, Shigeo; Takeda, Yoji

    The use of the interior permanent magnet synchronous motor (IPMSM) has increased in the industrial field because of its excellent characteristics, such as high efficiency, wide range of speed operation and flexibility of the rotor structure. Therefore, the IPMSM, especially one using the rare earth permanent magnet, is being actively studied. In the IPMSM using the rare earth permanent magnet, typically the permanent magnet is deeply embedded in the rotor. However, torque performances are significantly influenced by the rotor structures. This paper describes the torque performances for a single-layer IPMSM using the rare earth permanent magnet when the permanent magnet arrangements are changed.

  8. Review of advanced catheter technologies in radiation oncology brachytherapy procedures

    PubMed Central

    Zhou, Jun; Zamdborg, Leonid; Sebastian, Evelyn

    2015-01-01

    The development of new catheter and applicator technologies in recent years has significantly improved treatment accuracy, efficiency, and outcomes in brachytherapy. In this paper, we review these advances, focusing on the performance of catheter imaging and reconstruction techniques in brachytherapy procedures using magnetic resonance images and electromagnetic tracking. The accuracy of catheter reconstruction, imaging artifacts, and other notable properties of plastic and titanium applicators in gynecologic treatments are reviewed. The accuracy, noise performance, and limitations of electromagnetic tracking for catheter reconstruction are discussed. Several newly developed applicators for accelerated partial breast irradiation and gynecologic treatments are also reviewed. New hypofractionated high dose rate treatment schemes in prostate cancer and accelerated partial breast irradiation are presented. PMID:26203277

  9. Image-Guided Radiotherapy and -Brachytherapy for Cervical Cancer

    PubMed Central

    Dutta, Suresh; Nguyen, Nam Phong; Vock, Jacqueline; Kerr, Christine; Godinez, Juan; Bose, Satya; Jang, Siyoung; Chi, Alexander; Almeida, Fabio; Woods, William; Desai, Anand; David, Rick; Karlsson, Ulf Lennart; Altdorfer, Gabor

    2015-01-01

    Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT), and 2-dimensional intracavitary brachytherapy. Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron-emission tomography and magnetic resonance imaging has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT) may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT), allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer. PMID:25853092

  10. Cataract extraction after brachytherapy for malignant melanoma of the choroid

    SciTech Connect

    Fish, G.E.; Jost, B.F.; Snyder, W.I.; Fuller, D.G.; Birch, D.G. )

    1991-05-01

    Thirteen eyes of 55 consecutive patients treated with brachytherapy for malignant melanoma of the choroid developed postirradiation cataracts. Cataract development was more common in older patients and in patients with larger and more anterior tumors. Eleven eyes had extracapsular cataract extraction and intraocular lens implantation. Initial visual improvement occurred in 91% of eyes, with an average improvement of 5.5 lines. Visual acuity was maintained at 20/60 or better in 55% of the eyes over an average period of follow-up of 24 months (range, 6 to 40 months). These data suggest that, visually, cataract extraction can be helpful in selected patients who develop a cataract after brachytherapy for malignant melanoma of the choroid.

  11. [Basic principles and results of brachytherapy in gynecological oncology].

    PubMed

    Kanaev, S V; Turkevich, V G; Baranov, S B; Savel'eva, V V

    2014-01-01

    The fundamental basics of contact radiation therapy (brachytherapy) for gynecological cancer are presented. During brachytherapy the principles of conformal radiotherapy should be implemented, the aim of which is to sum the maximum possible dose of radiation to the tumor and decrease the dose load in adjacent organs and tissues, which allows reducing the frequency of radiation damage at treatment of primary tumors. It is really feasible only on modern technological level, thanks to precision topometry preparation, optimal computer dosimetrical and radiobiological planning of each session and radiotherapy in general. Successful local and long-term results of the contact radiation therapy for cancer of cervix and endometrium are due to optimal anatomical and topometrical ratio of the tumor localization, radioactive sources, and also physical and radiobiological laws of distribution and effects of ionizing radiation, the dose load accounting rules. PMID:25552060

  12. Image-guided radiotherapy and -brachytherapy for cervical cancer.

    PubMed

    Dutta, Suresh; Nguyen, Nam Phong; Vock, Jacqueline; Kerr, Christine; Godinez, Juan; Bose, Satya; Jang, Siyoung; Chi, Alexander; Almeida, Fabio; Woods, William; Desai, Anand; David, Rick; Karlsson, Ulf Lennart; Altdorfer, Gabor

    2015-01-01

    Conventional radiotherapy for cervical cancer relies on clinical examination, 3-dimensional conformal radiotherapy (3D-CRT), and 2-dimensional intracavitary brachytherapy. Excellent local control and survival have been obtained for small early stage cervical cancer with definitive radiotherapy. For bulky and locally advanced disease, the addition of chemotherapy has improved the prognosis but toxicity remains significant. New imaging technology such as positron-emission tomography and magnetic resonance imaging has improved tumor delineation for radiotherapy planning. Image-guided radiotherapy (IGRT) may decrease treatment toxicity of whole pelvic radiation because of its potential for bone marrow, bowel, and bladder sparring. Tumor shrinkage during whole pelvic IGRT may optimize image-guided brachytherapy (IGBT), allowing for better local control and reduced toxicity for patients with cervical cancer. IGRT and IGBT should be integrated in future prospective studies for cervical cancer. PMID:25853092

  13. Augmented railgun using a permanent magnet

    SciTech Connect

    Katsuki, S.; Akiyama, H.; Eguchi, N.; Sueda, T.; Soejima, M.; Maeda, S.; Sato, K.N.

    1995-08-01

    The use of a permanent magnet instead of an electromagnet has been proposed for the augmentation of the magnetic field of a railgun driven by a current of approximately 20 kA. A permanent magnet has the following advantages in comparison with conventional augmentations using additional turns: (1) simple configuration of the system, (2) temporally and spatially constant magnetic fields, and (3) high efficiency. Here, the operation of a conventional railgun and that of an augmented railgun using a permanent magnet are compared experimentally, and the usefulness of the permanent magnet is described. {copyright} {ital 1995} {ital American} {ital Institute} {ital of} {ital Physics}.

  14. Integral-transport-based deterministic brachytherapy dose calculations

    NASA Astrophysics Data System (ADS)

    Zhou, Chuanyu; Inanc, Feyzi

    2003-01-01

    We developed a transport-equation-based deterministic algorithm for computing three-dimensional brachytherapy dose distributions. The deterministic algorithm has been based on the integral transport equation. The algorithm provided us with the capability of computing dose distributions for multiple isotropic point and/or volumetric sources in a homogenous/heterogeneous medium. The algorithm results have been benchmarked against the results from the literature and MCNP results for isotropic point sources and volumetric sources.

  15. Brachytherapy dosimetry parameters calculated for a new 103Pd source.

    PubMed

    Rivard, Mark J; Melhus, Christopher S; Kirk, Bernadette L

    2004-09-01

    A new brachytherapy source having 103Pd adsorbed onto silver beads has been designed. The dose distributions of this source have been characterized using version 5 of the MCNP Monte Carlo radiation transport code available from Oak Ridge National Laboratory. These results are presented in terms of the updated AAPM Task Group No. 43 (TG-43U1) formalism, dosimetry parameters, and recommended calculation methodology. PMID:15487726

  16. Serum Testosterone Kinetics After Brachytherapy for Clinically Localized Prostate Cancer

    SciTech Connect

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan H.; Allen, Zachariah A.; Wallner, Kent E.

    2012-01-01

    Purpose: To evaluate temporal changes in testosterone after prostate brachytherapy and investigate the potential impact of these changes on response to treatment. Methods and Materials: Between January 2008 and March 2009, 221 consecutive patients underwent Pd-103 brachytherapy without androgen deprivation for clinically localized prostate cancer. Prebrachytherapy prostate-specific antigen (PSA) and serum testosterone were obtained for each patient. Repeat levels were obtained 3 months after brachytherapy and at least every 6 months thereafter. Multiple clinical, treatment, and dosimetric parameters were evaluated to determine an association with temporal testosterone changes. In addition, analysis was conducted to determine if there was an association between testosterone changes and treatment outcomes or the occurrence of a PSA spike. Results: There was no significant difference in serum testosterone over time after implant (p = 0.57). 29% of men experienced an increase {>=}25%, 23% of men experienced a decrease {>=}25%, and the remaining 48% of men had no notable change in testosterone over time. There was no difference in testosterone trends between men who received external beam radiotherapy and those who did not (p = 0.12). On multivariate analysis, preimplant testosterone was the only variable that consistently predicted for changes in testosterone over time. Men with higher than average testosterone tended to experience drop in testosterone (p < 0.001), whereas men with average or below average baseline testosterone had no significant change. There was no association between men who experienced PSA spike and testosterone temporal trends (p = 0.50) nor between initial PSA response and testosterone trends (p = 0.21). Conclusion: Prostate brachytherapy does not appear to impact serum testosterone over time. Changes in serum testosterone do not appear to be associated with PSA spike phenomena nor with initial PSA response to treatment; therefore, PSA response

  17. Cable attachment for a radioactive brachytherapy source capsule

    DOEpatents

    Gross, Ian G; Pierce, Larry A

    2006-07-18

    In cancer brachytherapy treatment, a small californium-252 neutron source capsule is attached to a guide cable using a modified crimping technique. The guide cable has a solid cylindrical end, and the attachment employs circumferential grooves micromachined in the solid cable end. The attachment was designed and tested, and hardware fabricated for use inside a radioactive hot cell. A welding step typically required in other cable attachments is avoided.

  18. Computerized Tomography: Its Role in Interstitial Brachytherapy of Pelvic Malignancies

    PubMed Central

    Kumar, P. Pradeep; Taylor, Judith; Jones, E.O.; McAnulty, Bruce

    1986-01-01

    The advantages of computerized tomography (CT) in the treatment planning of external beam radiation therapy have been shown in several studies. The authors extended the use of CT to the interstitial brachytherapy treatment planning of pelvic malignancies. CT was found to be invaluable in localizing pelvic tumors, selecting implant techniques, and checking the accuracy of the implant. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5 PMID:3950985

  19. Brachytherapy in Lip Carcinoma: Long-Term Results

    SciTech Connect

    Guibert, Mireille; David, Isabelle; Vergez, Sebastien; Rives, Michel; Filleron, Thomas; Bonnet, Jacques; Delannes, Martine

    2011-12-01

    Purpose: The aim of this study was to evaluate the effectiveness of low-dose-rate brachytherapy for local control and relapse-free survival in squamous cell and basal cell carcinomas of the lips. We compared two groups: one with tumors on the skin and the other with tumors on the lip. Patients and methods: All patients had been treated at Claudius Regaud Cancer Centre from 1990 to 2008 for squamous cell or basal cell carcinoma. Low-dose-rate brachytherapy was performed with iridium 192 wires according to the Paris system rules. On average, the dose delivered was 65 Gy. Results: 172 consecutive patients were included in our study; 69 had skin carcinoma (squamous cell or basal cell), and 92 had squamous cell mucosal carcinoma. The average follow-up time was 5.4 years. In the skin cancer group, there were five local recurrences and one lymph node recurrence. In the mucosal cancer group, there were ten local recurrences and five lymph node recurrences. The 8-year relapse-free survival for the entire population was 80%. The 8-year relapse-free survival was 85% for skin carcinoma 75% for mucosal carcinoma, with no significant difference between groups. The functional results were satisfactory for 99% of patients, and the cosmetic results were satisfactory for 92%. Maximal toxicity observed was Grade 2. Conclusions: Low-dose-rate brachytherapy can be used to treat lip carcinomas at Stages T1 and T2 as the only treatment with excellent results for local control and relapse-free survival. The benefits of brachytherapy are also cosmetic and functional, with 91% of patients having no side effects.

  20. 3-T MR-guided brachytherapy for gynecologic malignancies.

    PubMed

    Kapur, Tina; Egger, Jan; Damato, Antonio; Schmidt, Ehud J; Viswanathan, Akila N

    2012-11-01

    Gynecologic malignancies are a leading cause of death in women worldwide. Standard treatment for many primary and recurrent gynecologic cancer cases includes external-beam radiation followed by brachytherapy. Magnetic resonance (MR) imaging is beneficial in diagnostic evaluation, in mapping the tumor location to tailor radiation dose and in monitoring the tumor response to treatment. Initial studies of MR guidance in gynecologic brachytherapy demonstrate the ability to optimize tumor coverage and reduce radiation dose to normal tissues, resulting in improved outcomes for patients. In this article, we describe a methodology to aid applicator placement and treatment planning for 3 Tesla (3-T) MR-guided brachytherapy that was developed specifically for gynecologic cancers. This methodology has been used in 18 cases from September 2011 to May 2012 in the Advanced Multimodality Image Guided Operating (AMIGO) suite at Brigham and Women's Hospital. AMIGO comprises state-of-the-art tools for MR imaging, image analysis and treatment planning. An MR sequence using three-dimensional (3D)-balanced steady-state free precession in a 3-T MR scanner was identified as the best sequence for catheter identification with ballooning artifact at the tip. 3D treatment planning was performed using MR images. Items in development include software designed to support virtual needle trajectory planning that uses probabilistic bias correction, graph-based segmentation and image registration algorithms. The results demonstrate that 3-T MR image guidance has a role in gynecologic brachytherapy. These novel developments have the potential to improve targeted treatment to the tumor while sparing the normal tissues. PMID:22898699

  1. Study of dose calculation on breast brachytherapy using prism TPS

    NASA Astrophysics Data System (ADS)

    Fendriani, Yoza; Haryanto, Freddy

    2015-09-01

    PRISM is one of non-commercial Treatment Planning System (TPS) and is developed at the University of Washington. In Indonesia, many cancer hospitals use expensive commercial TPS. This study aims to investigate Prism TPS which been applied to the dose distribution of brachytherapy by taking into account the effect of source position and inhomogeneities. The results will be applicable for clinical Treatment Planning System. Dose calculation has been implemented for water phantom and CT scan images of breast cancer using point source and line source. This study used point source and line source and divided into two cases. On the first case, Ir-192 seed source is located at the center of treatment volume. On the second case, the source position is gradually changed. The dose calculation of every case performed on a homogeneous and inhomogeneous phantom with dimension 20 × 20 × 20 cm3. The inhomogeneous phantom has inhomogeneities volume 2 × 2 × 2 cm3. The results of dose calculations using PRISM TPS were compared to literature data. From the calculation of PRISM TPS, dose rates show good agreement with Plato TPS and other study as published by Ramdhani. No deviations greater than ±4% for all case. Dose calculation in inhomogeneous and homogenous cases show similar result. This results indicate that Prism TPS is good in dose calculation of brachytherapy but not sensitive for inhomogeneities. Thus, the dose calculation parameters developed in this study were found to be applicable for clinical treatment planning of brachytherapy.

  2. Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow.

    PubMed

    Shah, Chirag; Wobb, Jessica; Manyam, Bindu; Khan, Atif; Vicini, Frank

    2016-02-01

    Accelerated partial breast irradiation (APBI) represents an evolving technique that is a standard of care option in appropriately selected woman following breast conserving surgery. While multiple techniques now exist to deliver APBI, interstitial brachytherapy represents the technique used in several randomized trials (National Institute of Oncology, GEC-ESTRO). More recently, many centers have adopted applicator-based brachytherapy to deliver APBI due to the technical complexities of interstitial brachytherapy. The purpose of this article is to review methods to evaluate and select patients for APBI, as well as to define potential workflow mechanisms that allow for the safe and effective delivery of APBI. Multiple consensus statements have been developed to guide clinicians on determining appropriate candidates for APBI. However, recent studies have demonstrated that these guidelines fail to stratify patients according to the risk of local recurrence, and updated guidelines are expected in the years to come. Critical elements of workflow to ensure safe and effective delivery of APBI include a multidisciplinary approach and evaluation, optimization of target coverage and adherence to normal tissue guideline constraints, and proper quality assurance methods. PMID:26985202

  3. Accelerated partial breast irradiation utilizing brachytherapy: patient selection and workflow

    PubMed Central

    Wobb, Jessica; Manyam, Bindu; Khan, Atif; Vicini, Frank

    2016-01-01

    Accelerated partial breast irradiation (APBI) represents an evolving technique that is a standard of care option in appropriately selected woman following breast conserving surgery. While multiple techniques now exist to deliver APBI, interstitial brachytherapy represents the technique used in several randomized trials (National Institute of Oncology, GEC-ESTRO). More recently, many centers have adopted applicator-based brachytherapy to deliver APBI due to the technical complexities of interstitial brachytherapy. The purpose of this article is to review methods to evaluate and select patients for APBI, as well as to define potential workflow mechanisms that allow for the safe and effective delivery of APBI. Multiple consensus statements have been developed to guide clinicians on determining appropriate candidates for APBI. However, recent studies have demonstrated that these guidelines fail to stratify patients according to the risk of local recurrence, and updated guidelines are expected in the years to come. Critical elements of workflow to ensure safe and effective delivery of APBI include a multidisciplinary approach and evaluation, optimization of target coverage and adherence to normal tissue guideline constraints, and proper quality assurance methods. PMID:26985202

  4. Implicit active contours for automatic brachytherapy seed segmentation in fluoroscopy

    NASA Astrophysics Data System (ADS)

    Moult, Eric; Burdette, Clif; Song, Danny; Fichtinger, Gabor; Fallavollita, Pascal

    2012-02-01

    Motivation: In prostate brachytherapy, intra-operative dosimetry would be ideal to allow for rapid evaluation of the implant quality while the patient is still in the treatment position. Such a mechanism, however, requires 3-D visualization of the currently deposited seeds relative to the prostate. Thus, accurate, robust, and fully-automatic seed segmentation is of critical importance in achieving intra-operative dosimetry. Methodology: Implanted brachytherapy seeds are segmented by utilizing a region-based implicit active contour approach. Overlapping seed clusters are then resolved using a simple yet effective declustering technique. Results: Ground-truth seed coordinates were obtained via a published segmentation technique. A total of 248 clinical C-arm images from 16 patients were used to validate the proposed algorithm resulting in a 98.4% automatic detection rate with a corresponding 2.5% false-positive rate. The overall mean centroid error between the ground-truth and automatic segmentations was measured to be 0.42 pixels, while the mean centroid error for overlapping seed clusters alone was measured to be 0.67 pixels. Conclusion: Based on clinical data evaluation and validation, robust, accurate, and fully-automatic brachytherapy seed segmentation can be achieved through the implicit active contour framework and subsequent seed declustering method.

  5. Radiobiology for eye plaque brachytherapy and evaluation of implant duration and radionuclide choice using an objective function

    SciTech Connect

    Gagne, Nolan L.; Leonard, Kara L.; Rivard, Mark J.

    2012-06-15

    Purpose: Clinical optimization of Collaborative Ocular Melanoma Study (COMS) eye plaque brachytherapy is currently limited to tumor coverage, consensus prescription dosage, and dose calculations to ocular structures. The biologically effective dose (BED) of temporary brachytherapy treatments is a function of both chosen radionuclide R and implant duration T. This study endeavored to evaluate BED delivered to the tumor volume and surrounding ocular structures as a function of plaque position P, prescription dose, R, and T. Methods: Plaque-heterogeneity-corrected dose distributions were generated with MCNP5 for the range of currently available COMS plaques loaded with sources using three available low-energy radionuclides. These physical dose distributions were imported into the PINNACLE{sup 3} treatment planning system using the TG-43 hybrid technique and used to generate dose volume histograms for a T = 7 day implant within a reference eye geometry including the ciliary body, cornea, eyelid, foveola, lacrimal gland, lens, optic disc, optic nerve, retina, and tumor at eight standard treatment positions. The equation of Dale and Jones was employed to create biologically effective dose volume histograms (BEDVHs), allowing for BED volumetric analysis of all ROIs. Isobiologically effective prescription doses were calculated for T = 5 days down to 0.01 days, with BEDVHs subsequently generated for all ROIs using correspondingly reduced prescription doses. Objective functions were created to evaluate the BEDVHs as a function of R and T. These objective functions are mathematically accessible and sufficiently general to be applied to temporary or permanent brachytherapy implants for a variety of disease sites. Results: Reducing T from 7 to 0.01 days for a 10 mm plaque produced an average BED benefit of 26%, 20%, and 17% for {sup 103}Pd, {sup 125}I, and {sup 131}Cs, respectively, for all P; 16 and 22 mm plaque results were more position-dependent. {sup 103}Pd produced a 16

  6. A compilation of current regulations, standards and guidelines in remote afterloading brachytherapy

    SciTech Connect

    Tortorelli, J.P.; Simion, G.P.; Kozlowski, S.D.

    1994-10-01

    Over a dozen government and professional organizations in the United States and Europe have issued regulations and guidance concerning quality management in the practice of remote afterloading brachytherapy. Information from the publications of these organizations was collected and collated for this report. This report provides the brachytherapy licensee access to a broad field of quality management information in a single, topically organized document.

  7. Novel treatment options for nonmelanoma skin cancer: focus on electronic brachytherapy

    PubMed Central

    Kasper, Michael E; Chaudhary, Ahmed A

    2015-01-01

    Nonmelanoma skin cancer (NMSC) is an increasing health care issue in the United States, significantly affecting quality of life and impacting health care costs. Radiotherapy has a long history in the treatment of NMSC. Shortly after the discovery of X-rays and 226Radium, physicians cured patients with NMSC using these new treatments. Both X-ray therapy and brachytherapy have evolved over the years, ultimately delivering higher cure rates and lower toxicity. Electronic brachytherapy for NMSC is based on the technical and clinical data obtained from radionuclide skin surface brachytherapy and the small skin surface applicators developed over the past 25 years. The purpose of this review is to introduce electronic brachytherapy in the context of the history, data, and utilization of traditional radiotherapy and brachytherapy. PMID:26648763

  8. Air kerma and absorbed dose standards for reference dosimetry in brachytherapy

    PubMed Central

    2014-01-01

    This article reviews recent developments in primary standards for the calibration of brachytherapy sources, with an emphasis on the currently most common photon-emitting radionuclides. The introduction discusses the need for reference dosimetry in brachytherapy in general. The following section focuses on the three main quantities, i.e. reference air kerma rate, air kerma strength and absorbed dose rate to water, which are currently used for the specification of brachytherapy photon sources and which can be realized with primary standards from first principles. An overview of different air kerma and absorbed dose standards, which have been independently developed by various national metrology institutes over the past two decades, is given in the next two sections. Other dosimetry techniques for brachytherapy will also be discussed. The review closes with an outlook on a possible transition from air kerma to absorbed dose to water-based calibrations for brachytherapy sources in the future. PMID:24814696

  9. CT-guided permanent brachytherapy for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC).

    PubMed

    Martínez-Monge, Rafael; Pagola, María; Vivas, Isabel; López-Picazo, José María

    2008-08-01

    Seven patients with early stage T1N0M0 NSCLC who had medical contraindications for surgical resection were treated with CT-guided percutaneous implantation of (103)Pd or (125)I seeds. After the procedure, two patients developed pneumothorax and hemo/pneumothorax that was managed with aspirative drainage. One patient developed a focal pneumonitis 3 months after the procedure. After a median follow-up of 13 months (4.6-41.0+ months), no patient has developed local or regional failure. PMID:18243409

  10. Dosimetry Modeling for Focal Low-Dose-Rate Prostate Brachytherapy

    SciTech Connect

    Al-Qaisieh, Bashar; Mason, Josh; Bownes, Peter; Henry, Ann; Dickinson, Louise; Ahmed, Hashim U.; Emberton, Mark; Langley, Stephen

    2015-07-15

    Purpose: Focal brachytherapy targeted to an individual lesion(s) within the prostate may reduce side effects experienced with whole-gland brachytherapy. The outcomes of a consensus meeting on focal prostate brachytherapy were used to investigate optimal dosimetry of focal low-dose-rate (LDR) prostate brachytherapy targeted using multiparametric magnetic resonance imaging (mp-MRI) and transperineal template prostate mapping (TPM) biopsy, including the effects of random and systematic seed displacements and interseed attenuation (ISA). Methods and Materials: Nine patients were selected according to clinical characteristics and concordance of TPM and mp-MRI. Retrospectively, 3 treatment plans were analyzed for each case: whole-gland (WG), hemi-gland (hemi), and ultra-focal (UF) plans, with 145-Gy prescription dose and identical dose constraints for each plan. Plan robustness to seed displacement and ISA were assessed using Monte Carlo simulations. Results: WG plans used a mean 28 needles and 81 seeds, hemi plans used 17 needles and 56 seeds, and UF plans used 12 needles and 25 seeds. Mean D90 (minimum dose received by 90% of the target) and V100 (percentage of the target that receives 100% dose) values were 181.3 Gy and 99.8% for the prostate in WG plans, 195.7 Gy and 97.8% for the hemi-prostate in hemi plans, and 218.3 Gy and 99.8% for the focal target in UF plans. Mean urethra D10 was 205.9 Gy, 191.4 Gy, and 92.4 Gy in WG, hemi, and UF plans, respectively. Mean rectum D2 cm{sup 3} was 107.5 Gy, 77.0 Gy, and 42.7 Gy in WG, hemi, and UF plans, respectively. Focal plans were more sensitive to seed displacement errors: random shifts with a standard deviation of 4 mm reduced mean target D90 by 14.0%, 20.5%, and 32.0% for WG, hemi, and UF plans, respectively. ISA has a similar impact on dose-volume histogram parameters for all plan types. Conclusions: Treatment planning for focal LDR brachytherapy is feasible. Dose constraints are easily met with a notable

  11. Leadership in a (permanent) crisis.

    PubMed

    Heifetz, Ronald; Grashow, Alexander; Linsky, Marty

    2009-01-01

    The current economic crisis is not just another rough spell. Today's mix of urgency, high stakes, and uncertainty will continue even after the recession ends. The immediate crisis--which we will get through with policy makers' expert technical adjustments--sets the stage for a sustained, or even permanent, crisis, a relentless series of challenges no one has encountered before. Instead of hunkering down and relying on their familiar expertise to deal with the sustained crisis, people in positions of authority--whether they are CEOs or managers heading up a company initiative--must practice what the authors call adaptive leadership. They must, of course, tackle the underlying causes of the crisis, but they must also simultaneously make the changes that will allow their organizations to thrive in turbulent environments. Adaptive leadership is an improvisational and experimental art, requiring some new practices. Like Julie Gilbert, who overcame internal resistance to reorient Best Buy toward female purchasers, adaptive leaders get things done to meet today's challenges and then modify those things to thrive in tomorrow's world. They also embrace disequilibrium, using turbulence as an opportunity to build crucial new capacities, as Paul Levy did to rescue Beth Israel Deaconess Medical Center from a profound financial crisis. Finally, adaptive leaders, such as Egon Zehnder, the founder of an executive search firm, draw out the leadership skills that reside deep in the organization, recognizing the interdependence of all employees and mobilizing everyone to generate solutions. PMID:19630256

  12. WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR

    SciTech Connect

    Craciunescu, O; Todor, D; Leeuw, A de

    2014-06-15

    In recent years, with the advent of high/pulsed dose rate afterloading technology, advanced treatment planning systems, CT/MRI compatible applicators, and advanced imaging platforms, image-guided adaptive brachytherapy treatments (IGABT) have started to play an ever increasing role in modern radiation therapy. The most accurate way to approach IGABT treatment is to provide the infrastructure that combines in a single setting an appropriate imaging device, a treatment planning system, and a treatment unit. The Brachytherapy Suite is not a new concept, yet the modern suites are incorporating state-of-the-art imaging (MRI, CBCT equipped simulators, CT, and /or US) that require correct integration with each other and with the treatment planning and delivery systems. Arguably, an MRI-equipped Brachytherapy Suite is the ideal setup for real-time adaptive brachytherapy treatments. The main impediment to MRI-IGABT adoption is access to MRI scanners. Very few radiation oncology departments currently house MRI scanners, and even fewer in a dedicated Brachytherapy Suite. CBCT equipped simulators are increasingly offered by manufacturers as part of a Brachytherapy Suite installation. If optimized, images acquired can be used for treatment planning, or can be registered with other imaging modalities. This infrastructure is relevant for all forms of brachytherapy, especially those utilizing multi-fractionated courses of treatment such as prostate and cervix. Moreover, for prostate brachytherapy, US imaging systems can be part of the suite to allow for real-time HDR/LDR treatments. Learning Objectives: Understand the adaptive workflow of MR-based IGBT for cervical cancer. Familiarize with commissioning aspects of a CBCT equipped simulator with emphasis on brachytherapy applications Learn about the current status and future developments in US-based prostate brachytherapy.

  13. Permanent-magnet multipole with adjustable strength

    DOEpatents

    Halbach, K.

    1982-09-20

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling there between. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  14. Permanent magnet multipole with adjustable strength

    DOEpatents

    Halbach, Klaus

    1985-01-01

    Two or more magnetically soft pole pieces are symmetrically positioned along a longitudinal axis to provide a magnetic field within a space defined by the pole pieces. Two or more permanent magnets are mounted to an external magnetically-soft cylindrical sleeve which rotates to bring the permanent magnets into closer coupling with the pole pieces and thereby adjustably control the field strength of the magnetic field produced in the space defined by the pole pieces. The permanent magnets are preferably formed of rare earth cobalt (REC) material which has a high remanent magnetic field and a strong coercive force. The pole pieces and the permanent magnets have corresponding cylindrical surfaces which are positionable with respect to each other to vary the coupling therebetween. Auxiliary permanent magnets are provided between the pole pieces to provide additional magnetic flux to the magnetic field without saturating the pole pieces.

  15. Gating of Permanent Molds for ALuminum Casting

    SciTech Connect

    David Schwam; John F. Wallace; Tom Engle; Qingming Chang

    2004-03-30

    This report summarizes a two-year project, DE-FC07-01ID13983 that concerns the gating of aluminum castings in permanent molds. The main goal of the project is to improve the quality of aluminum castings produced in permanent molds. The approach taken was determine how the vertical type gating systems used for permanent mold castings can be designed to fill the mold cavity with a minimum of damage to the quality of the resulting casting. It is evident that somewhat different systems are preferred for different shapes and sizes of aluminum castings. The main problems caused by improper gating are entrained aluminum oxide films and entrapped gas. The project highlights the characteristic features of gating systems used in permanent mold aluminum foundries and recommends gating procedures designed to avoid common defects. The study also provides direct evidence on the filling pattern and heat flow behavior in permanent mold castings.

  16. Dynamic modulated brachytherapy (DMBT) and intensity modulated brachytherapy (IMBT) for the treatment of rectal and breast carcinomas

    NASA Astrophysics Data System (ADS)

    Webster, Matthew Julian

    The ultimate goal of any treatment of cancer is to maximize the likelihood of killing the tumor while minimizing the chance of damaging healthy tissues. One of the most effective ways to accomplish this is through radiation therapy, which must be able to target the tumor volume with a high accuracy while minimizing the dose delivered to healthy tissues. A successful method of accomplishing this is brachytherapy which works by placing the radiation source in very close proximity to the tumor. However, most current applications of brachytherapy rely mostly on the geometric manipulation of isotropic sources, which limits the ability to specifically target the tumor. The purpose of this work is to introduce several types of shielded brachytherapy applicators which are capable of targeting tumors with much greater accuracy than existing technologies. These applicators rely on the modulation of the dose profile through a high-density tungsten alloy shields to create anisotropic dose distributions. Two classes of applicators have been developed in this work. The first relies on the active motion of the shield, to aim a highly directional radiation profile. This allows for very precise control of the dose distribution for treatment, achieving unparalleled dose coverage to the tumor while sparing healthy tissues. This technique has been given the moniker of Dynamic Modulated Brachytherapy (DMBT). The second class of applicators, designed to reduce treatment complexity uses static applicators. These applicators retain the use of the tungsten shield, but the shield is motionless during treatment. By intelligently designing the shield, significant improvements over current methods have been demonstrated. Although these static applicators fail to match the dosimetric quality of DMBT applicators the simplified setup and treatment procedure gives them significant appeal. The focus of this work has been to optimize these shield designs, specifically for the treatment of rectal and

  17. Permanency and the Foster Care System.

    PubMed

    Lockwood, Katie K; Friedman, Susan; Christian, Cindy W

    2015-10-01

    Each year over 20,000 youth age out of the child welfare system without reaching a permanent placement in a family. Certain children, such as those spending extended time in foster care, with a diagnosed disability, or adolescents, are at the highest risk for aging out. As young adults, this population is at and increased risk of incarceration; food, housing, and income insecurity; unemployment; educational deficits; receipt of public assistance; and mental health disorders. We reviewed the literature on foster care legislation, permanency, outcomes, and interventions. The outcomes of children who age out of the child welfare system are poor. Interventions to increase permanency include training programs for youth and foster parents, age extension for foster care and insurance coverage, an adoption tax credit, and specialized services and programs that support youth preparing for their transition to adulthood. Future ideas include expanding mentoring, educational support, mental health services, and post-permanency services to foster stability in foster care placements and encourage permanency planning. Children in the child welfare system are at a high risk for physical, mental, and emotional health problems that can lead to placement instability and create barriers to achieving permanency. Failure to reach the permanency of a family leads to poor outcomes, which have negative effects on the individual and society. Supporting youth in foster care throughout transitions may mediate the negative outcomes that have historically followed placement in out-of-home care. PMID:26403649

  18. Poor Predictive Value of Intraoperative Real-Time Dosimetry for Prostate Seed Brachytherapy

    SciTech Connect

    Igidbashian, Levon; Donath, David; Carrier, Jean-Francois; Lassalle, Stephanie; Hervieux, Yannick; David, Sandrine; Bahary, Jean-Paul; Taussky, Daniel

    2008-10-01

    Purpose: To identify dosimetric parameters predictive of a good prostate seed I{sup 125} quality implant. We analyzed preimplant and postimplant realtime dosimetry in patients treated with intraoperative (IO) inverse planning. Methods and Materials: We analyzed 127 consecutively treated patients with primarily low-risk prostate carcinoma who underwent prostate permanent seed I{sup 125} brachytherapy using an IO planning approach. The implant was done using the three-dimensional transrectal ultrasound (PRE-TRUS)-guided IO interactive inverse preplanning system. The TRUS was repeated in the operating room after the implant procedure was complete (POST-TRUS). The prostate was recontoured and postimplant dosimetry was calculated. Each patient underwent computed tomography scan on Day 28 (CT-D28) to evaluate implant quality. Area under the receiver operating characteristic curves (AUROC) was evaluated for models predictive of a V100 of {>=}90% and a D90 of {>=}140 Gy on the basis of CT-D28 values. Results: On CT-D28, 72.4% of patients had a V100 of {>=}90% and 74.8% had a D90 of {>=}140 Gy. AUROC for a V100 of {>=}90% was 0.665 (p = 0.004) on PRE-TRUS and 0.619 (p = 0.039) on POST-TRUS. AUROC for D90 of {>=}140 Gy was 0.602 (p = 0.086) on PRE-TRUS and 0.614 (p = 0.054) on POST-TRUS. Using PRE-TRUS V100 cutoff of >97% gives sensitivity of 88% and a false-positive rate of 63%. A POST-TRUS D90 cutoff of >170 Gy resulted in a sensitivity of 62% and a false-positive rate of 34%. Conclusions: Because of unacceptably high false-positive rates, IO preimplant and postimplant TRUS-based dosimetry are not accurate tools to predict for postimplant computed tomography-based dosimetry.

  19. Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results

    SciTech Connect

    Genebes, Caroline; Filleron, Thomas; Graff, Pierre; Jonca, Frédéric; Huyghe, Eric; Thoulouzan, Matthieu; Soulie, Michel; Malavaud, Bernard; Aziza, Richard; Brun, Thomas; Delannes, Martine; Bachaud, Jean-Marc

    2013-11-15

    Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

  20. Operator-free, film-based 3D seed reconstruction in brachytherapy.

    PubMed

    Todor, D A; Cohen, G N; Amols, H I; Zaider, M

    2002-06-21

    In brachytherapy implants, the accuracy of dose calculation depends on the ability to localize radioactive sources correctly. If performed manually using planar images, this is a time-consuming and often error-prone process-primarily because each seed must be identified on (at least) two films. In principle, three films should allow automatic seed identification and position reconstruction; however, practical implementation of the numerous algorithms proposed so far appears to have only limited reliability. The motivation behind this work is to create a fast and reliable system for real-time implant evaluation using digital planar images obtained from radiotherapy simulators, or mobile x-ray/fluoroscopy systems. We have developed algorithms and code for 3D seed coordinate reconstruction. The input consists of projections of seed positions in each of three isocentric images taken at arbitrary angles. The method proposed here consists of a set of heuristic rules (in a sense, a learning algorithm) that attempts to minimize seed misclassifications. In the clinic, this means that the system must be impervious to errors resulting from patient motion as well as from finite tolerances accepted in equipment settings. The software program was tested with simulated data, a pelvic phantom and patient data. One hundred and twenty permanent prostate implants were examined (105 125I and 15 103Pd) with the number of seeds ranging from 35 to 138 (average 79). The mean distance between actual and reconstructed seed positions is in the range 0.03-0.11 cm. On a Pentium III computer at 600 MHz the reconstruction process takes 10-30 s. The total number of seeds is independently validated. The process is robust and able to account for errors introduced in the clinic. PMID:12118599

  1. Prospective evaluation of quality of life after interstitial brachytherapy for localized prostate cancer

    SciTech Connect

    Caffo, Orazio . E-mail: orazio.caffo@apss.tn.it; Fellin, Gianni; Bolner, Andrea; Coccarelli, Franco; Divan, Claudio; Frisinghelli, Michela; Mussari, Salvatore; Ziglio, Franco; Malossini, Gianni; Tomio, Luigi; Galligioni, Enzo

    2006-09-01

    Purpose: Permanent interstitial brachytherapy (IB) has become an increasingly appealing therapeutic option for localized prostate cancer (LPC) among physicians and patients because it involves short hospitalization and treatment and its postulated low degree of toxicity may reduce its impact on the patients' quality of life (QoL). The aim of this prospective study was to assess the impact of IB on the QoL of patients with LPC. Methods and Materials: A validated self-completed questionnaire was administered to the patients before and after IB and then at yearly intervals. The items allowed the identification of seven subscales exploring physical well-being (PHY), physical autonomy (POW), psychological well-being (PSY), relational life (REL), urinary function (URI), rectal function (REC), and sexual function (SEX). Results: The assessment of the QoL of 147 patients treated between May 2000 and February 2005 revealed no relevant differences in the PHY scale scores 1 month after IB or later, and the same was true of the POW, PSY, and REL scales. Urinary function significantly worsened after IB and returned to pretreatment levels only after 3 years; the impact of the treatment on the URI scale was greater in the patients with good baseline urinary function than in those presenting more urinary symptoms before IB. Rectal and sexual functions were significantly worse only at the post-IB evaluation. Conclusions: The results of the present study confirm that the impact of IB on the patients' QoL is low despite its transient negative effects on some function, and extend existing knowledge concerning QoL after IB.

  2. Permanent Magnetic Bearing for Spacecraft Applications

    NASA Technical Reports Server (NTRS)

    Morales, Winfredo; Fusaro, Robert; Kascak, Albert

    2008-01-01

    A permanent, totally passive magnetic bearing rig was designed, constructed, and tested. The suspension of the rotor was provided by two sets of radial permanent magnetic bearings operating in the repulsive mode. The axial support was provided by jewel bearings on both ends of the rotor. The rig was successfully operated to speeds of 5500 rpm using an air impeller. Radial and axial stiffnesses of the permanent magnetic bearings were experimentally measured and then compared to finite element results. The natural damping of the rotor was measured and a damping coefficient was calculated.

  3. Macroscopic simulation of isotropic permanent magnets

    NASA Astrophysics Data System (ADS)

    Bruckner, Florian; Abert, Claas; Vogler, Christoph; Heinrichs, Frank; Satz, Armin; Ausserlechner, Udo; Binder, Gernot; Koeck, Helmut; Suess, Dieter

    2016-03-01

    Accurate simulations of isotropic permanent magnets require to take the magnetization process into account and consider the anisotropic, nonlinear, and hysteretic material behaviour near the saturation configuration. An efficient method for the solution of the magnetostatic Maxwell equations including the description of isotropic permanent magnets is presented. The algorithm can easily be implemented on top of existing finite element methods and does not require a full characterization of the hysteresis of the magnetic material. Strayfield measurements of an isotropic permanent magnet and simulation results are in good agreement and highlight the importance of a proper description of the isotropic material.

  4. Permanent multipole magnets with adjustable strength

    SciTech Connect

    Halbach, K.

    1983-03-01

    Preceded by a short discussion of the motives for using permanent magnets in accelerators, a new type of permanent magnet for use in accelerators is presented. The basic design and most important properties of a quadrupole will be described that uses both steel and permanent magnet material. The field gradient produced by this magnet can be adjusted without changing any other aspect of the field produced by this quadrupole. The generalization of this concept to produce other multipole fields, or combination of multipole fields, will also be presented.

  5. Brachytherapy in cancer cervix: Time to move ahead from point A?

    PubMed Central

    Srivastava, Anurita; Datta, Niloy Ranjan

    2014-01-01

    Brachytherapy forms an integral part of the radiation therapy in cancer cervix. The dose prescription for intracavitary brachytherapy (ICBT) in cancer cervix is based on Tod and Meredith’s point A and has been in practice since 1938. This was proposed at a time when accessibility to imaging technology and dose computation facilities was limited. The concept has been in practice worldwide for more than half a century and has been the fulcrum of all ICBT treatments, strategies and outcome measures. The method is simple and can be adapted by all centres practicing ICBT in cancer cervix. However, with the widespread availability of imaging techniques, clinical use of different dose-rates, availability of a host of applicators fabricated with image compatible materials, radiobiological implications of dose equivalence and its impact on tumour and organs at risk; more and more weight is being laid down on individualised image based brachytherapy. Thus, computed tomography, magnetic-resonance imaging and even positron emission computerized tomography along with brachytherapy treatment planning system are being increasingly adopted with promising outcomes. The present article reviews the evolution of dose prescription concepts in ICBT in cancer cervix and brings forward the need for image based brachytherapy to evaluate clinical outcomes. As is evident, a gradual transition from “point” based brachytherapy to “profile” based image guided brachytherapy is gaining widespread acceptance for dose prescription, reporting and outcome evaluation in the clinical practice of ICBT in cancer cervix. PMID:25302176

  6. High-dose-rate brachytherapy in uterine cervical carcinoma

    SciTech Connect

    Patel, Firuza D. . E-mail: patelfd@glide.net.in; Rai, Bhavana; Mallick, Indranil; Sharma, Suresh C.

    2005-05-01

    Purpose: High-dose-rate (HDR) brachytherapy is in wide use for curative treatment of cervical cancer. The American Brachytherapy Society has recommended that the individual fraction size be <7.5 Gy and the range of fractions should be four to eight; however, many fractionation schedules, varying from institution to institution, are in use. We use 9 Gy/fraction of HDR in two to five fractions in patients with carcinoma of the uterine cervix. We found that our results and toxicity were comparable to those reported in the literature and hereby present our experience with this fractionation schedule. Methods and Materials: A total of 121 patients with Stage I-III carcinoma of the uterine cervix were treated with HDR brachytherapy between 1996 and 2000. The total number of patients analyzed was 113. The median patient age was 53 years, and the histopathologic type was squamous cell carcinoma in 93% of patients. The patients were subdivided into Groups 1 and 2. In Group 1, 18 patients with Stage Ib-IIb disease, tumor size <4 cm, and preserved cervical anatomy underwent simultaneous external beam radiotherapy to the pelvis to a dose of 40 Gy in 20 fractions within 4 weeks with central shielding and HDR brachytherapy of 9 Gy/fraction, given weekly, and interdigitated with external beam radiotherapy. The 95 patients in Group 2, who had Stage IIb-IIIb disease underwent external beam radiotherapy to the pelvis to a dose of 46 Gy in 23 fractions within 4.5 weeks followed by two sessions of HDR intracavitary brachytherapy of 9 Gy each given 1 week apart. The follow-up range was 3-7 years (median, 36.4 months). Late toxicity was graded according to the Radiation Therapy Oncology Group criteria. Results: The 5-year actuarial local control and disease-free survival rate was 74.5% and 62.0%, respectively. The actuarial local control rate at 5 years was 100% for Stage I, 80% for Stage II, and 67.2% for Stage III patients. The 5-year actuarial disease-free survival rate was 88.8% for

  7. In vivo photoacoustic imaging of prostate brachytherapy seeds

    NASA Astrophysics Data System (ADS)

    Lediju Bell, Muyinatu A.; Kuo, Nathanael P.; Song, Danny Y.; Kang, Jin; Boctor, Emad M.

    2014-03-01

    We conducted an approved canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. Brachytherapy seeds coated with black ink were inserted into the canine prostate using methods similar to a human procedure. A transperineal, interstitial, fiber optic light delivery method, coupled to a 1064 nm laser, was utilized to irradiate the prostate and the resulting acoustic waves were detected with a transrectal ultrasound probe. The fiber was inserted into a high dose rate (HDR) brachytherapy needle that acted as a light-diffusing sheath, enabling radial light delivery from the tip of the fiber inside the sheath. The axis of the fiber was located at a distance of 4-9 mm from the long axis of the cylindrical seeds. Ultrasound images acquired with the transrectal probe and post-operative CT images of the implanted seeds were analyzed to confirm seed locations. In vivo limitations with insufficient light delivery within the ANSI laser safety limit (100 mJ/cm2) were overcome by utilizing a short-lag spatial coherence (SLSC) beamformer, which provided average seed contrasts of 20-30 dB for energy densities ranging 8-84 mJ/cm2. The average contrast was improved by up to 20 dB with SLSC beamforming compared to conventional delay-and-sum beamforming. There was excellent agreement between photoacoustic, ultrasound, and CT images. Challenges included visualization of photoacoustic artifacts that corresponded with locations of the optical fiber and hyperechoic tissue structures.

  8. Conformal Brachytherapy Planning for Cervical Cancer Using Transabdominal Ultrasound

    SciTech Connect

    Van Dyk, Sylvia Narayan, Kailash; Fisher, Richard; Bernshaw, David

    2009-09-01

    Purpose: To determine if transabdominal ultrasound (US) can be used for conformal brachytherapy in cervical cancer patients. Materials and Methods: Seventy-one patients with locoregionally advanced cervix cancer treated with chemoradiation and brachytherapy were included in this study. The protocol consisted of US-assisted tandem insertion and conformal US-based planning. Orthogonal films for applicator reconstruction were also taken. A standard plan was modified to suit the US-based volume and treatment was delivered. The patient then underwent a magnetic resonance imaging (MRI) scan with the applicators in situ. Retrospectively, individual standard (STD), US, and MRI plans were extrapolated for five fractions and superimposed onto the two-dimensional sagittal MRI images for comparison. Doses to Point A, target volume, International Commission on Radiation Units and Measurements (ICRU) 38 bladder and rectal points, and individualized bowel points were calculated on original implant geometry on Plato for each planning method. Results: STD (high-dose-rate) plans reported higher doses to Point A, target volume, ICRU 38 bladder and rectal points, and individualized bowel point compared with US and MRI plans. There was a statistically significant difference between standard plans and image-based plans-STD vs. US, STD vs. MRI, and STD vs. Final-having consistent (p {<=} 0.001) respectively for target volume, Point A, ICRU 38 bladder, and bowel point. US plan assessed on two-dimensional MRI image was comparable for target volume (p = 0.11), rectal point (p = 0.8), and vaginal mucosa (p = 0.19). Local control was 90%. Late bowel morbidity (G3, G4) was <2%. Conclusions: Transabdominal ultrasound offers an accurate, quick, accessible, and cost-effective method of conformal brachytherapy planning.

  9. Dose rate constant and energy spectrum of interstitial brachytherapy sources.

    PubMed

    Chen, Z; Nath, R

    2001-01-01

    In the past two years, several new manufacturers have begun to market low-energy interstitial brachytherapy seeds containing 125I and 103Pd. Parallel to this development, the National Institute of Standards and Technology (NIST) has implemented a modification to the air-kerma strength (S(K)) standard for 125I seeds and has also established an S(K) standard for 103Pd seeds. These events have generated a considerable number of investigations on the determination of the dose rate constants (inverted V) of interstitial brachytherapy seeds. The aim of this work is to study the general properties underlying the determination of dose rate constant and to develop a simple method for a quick and accurate estimation of dose rate constant. As the dose rate constant of clinical seeds is defined at a fixed reference point, we postulated that dose rate constant may be calculated by treating the seed as an effective point source when the seed's source strength is specified in S(K) and its source characteristics are specified by the photon energy spectrum measured in air at the reference point. Using a semi-analytic approach, an analytic expression for dose rate constant was derived for point sources with known photon energy spectra. This approach enabled a systematic study of dose rate constant as a function of energy. Using the measured energy spectra, the calculated dose rate constant for 125I model 6711 and 6702 seeds and for 192Ir seed agreed with the AAPM recommended values within +/-1%. For the 103Pd model 200 seed, the agreement was 5% with a recently measured value (within the +/-7% experimental uncertainty) and was within 1% with the Monte Carlo simulations. The analytic expression for dose rate constant proposed here can be evaluated using a programmable calculator or a simple spreadsheet and it provides an efficient method for checking the measured dose rate constant for any interstitial brachytherapy seed once the energy spectrum of the seed is known. PMID:11213926

  10. Study of dose calculation on breast brachytherapy using prism TPS

    SciTech Connect

    Fendriani, Yoza; Haryanto, Freddy

    2015-09-30

    PRISM is one of non-commercial Treatment Planning System (TPS) and is developed at the University of Washington. In Indonesia, many cancer hospitals use expensive commercial TPS. This study aims to investigate Prism TPS which been applied to the dose distribution of brachytherapy by taking into account the effect of source position and inhomogeneities. The results will be applicable for clinical Treatment Planning System. Dose calculation has been implemented for water phantom and CT scan images of breast cancer using point source and line source. This study used point source and line source and divided into two cases. On the first case, Ir-192 seed source is located at the center of treatment volume. On the second case, the source position is gradually changed. The dose calculation of every case performed on a homogeneous and inhomogeneous phantom with dimension 20 × 20 × 20 cm{sup 3}. The inhomogeneous phantom has inhomogeneities volume 2 × 2 × 2 cm{sup 3}. The results of dose calculations using PRISM TPS were compared to literature data. From the calculation of PRISM TPS, dose rates show good agreement with Plato TPS and other study as published by Ramdhani. No deviations greater than ±4% for all case. Dose calculation in inhomogeneous and homogenous cases show similar result. This results indicate that Prism TPS is good in dose calculation of brachytherapy but not sensitive for inhomogeneities. Thus, the dose calculation parameters developed in this study were found to be applicable for clinical treatment planning of brachytherapy.

  11. Optimized source selection for intracavitary low dose rate brachytherapy

    SciTech Connect

    Nurushev, T.; Kim, Jinkoo

    2005-05-01

    A procedure has been developed for automating optimal selection of sources from an available inventory for the low dose rate brachytherapy, as a replacement for the conventional trial-and-error approach. The method of optimized constrained ratios was applied for clinical source selection for intracavitary Cs-137 implants using Varian BRACHYVISION software as initial interface. However, this method can be easily extended to another system with isodose scaling and shaping capabilities. Our procedure provides optimal source selection results independent of the user experience and in a short amount of time. This method also generates statistics on frequently requested ideal source strengths aiding in ordering of clinically relevant sources.

  12. [Endobronchial brachytherapy: state of the art in 2013].

    PubMed

    Derhem, N; Sabila, H; Mornex, F

    2013-04-01

    Endobronchial brachytherapy is an invasive technique, which allows localizing radioactive sources at the tumour contact. Therefore, high doses are administered to tumour while healthy tissues can be spared. Initially dedicated to a palliative setting, improvements helped reaching 60 to 88% symptoms alleviation and 30 to 100% of endoscopic macroscopic response. New diagnostic techniques and early diagnosis extended the indications to a curative intent: endoluminal primitive tumour, post radiation endobronchial recurrence, inoperable patients. CT-based dosimetry is a keypoint to optimize treatment quality and to minimize potential side effects, making this treatment a safe and efficient technique for specific indications. PMID:23465785

  13. Nonuniform radiation damage in permanent magnet quadrupoles

    SciTech Connect

    Danly, C. R.; Merrill, F. E.; Barlow, D.; Mariam, F. G.

    2014-08-15

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL’s pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components.

  14. Nonuniform radiation damage in permanent magnet quadrupoles.

    PubMed

    Danly, C R; Merrill, F E; Barlow, D; Mariam, F G

    2014-08-01

    We present data that indicate nonuniform magnetization loss due to radiation damage in neodymium-iron-boron Halbach-style permanent magnet quadrupoles. The proton radiography (pRad) facility at Los Alamos uses permanent-magnet quadrupoles for magnifying lenses, and a system recently commissioned at GSI-Darmsdadt uses permanent magnets for its primary lenses. Large fluences of spallation neutrons can be produced in close proximity to these magnets when the proton beam is, intentionally or unintentionally, directed into the tungsten beam collimators; imaging experiments at LANL's pRad have shown image degradation with these magnetic lenses at proton beam doses lower than those expected to cause damage through radiation-induced reduction of the quadrupole strength alone. We have observed preferential degradation in portions of the permanent magnet quadrupole where the field intensity is highest, resulting in increased high-order multipole components. PMID:25173260

  15. Characterizing hydrologic permanence in headwater streams

    EPA Science Inventory

    The presentation will be an overview of research to inform jurisdictional determinations for the Clean Water Act, in particular research that hydrographic comparisons of the extent and hydrologic permanence of headwater streams, indicator development, and an evaluation of a rapid...

  16. In vivo TLD dose measurements in catheter-based high-dose-rate brachytherapy.

    PubMed

    Adlienė, Diana; Jakštas, Karolis; Urbonavičius, Benas Gabrielis

    2015-07-01

    Routine in vivo dosimetry is well established in external beam radiotherapy; however, it is restricted mainly to detection of gross errors in high-dose-rate (HDR) brachytherapy due to complicated measurements in the field of steep dose gradients in the vicinity of radioactive source and high uncertainties. The results of in vivo dose measurements using TLD 100 mini rods and TLD 'pin worms' in catheter-based HDR brachytherapy are provided in this paper alongside with their comparison with corresponding dose values obtained using calculation algorithm of the treatment planning system. Possibility to perform independent verification of treatment delivery in HDR brachytherapy using TLDs is discussed. PMID:25809111

  17. Novel application of high-dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis.

    PubMed

    Timerman, D; Devlin, P M; Nambudiri, V E; Wright, N A; Vleugels, R A; Clark, R A; Kupper, T S; Merola, J F; Patel, M

    2016-07-01

    Palmoplantar pustulosis (PPP) is a chronic pustular dermatitis of the palms and soles, which is frequently associated with significant pruritus and pain, often limiting daily activities. We present the case of a 36-year-old man with severe PPP who had treatment failure with multiple medical therapies but showed marked improvement with high-dose rate brachytherapy. Brachytherapy has the advantage of providing a conformal dose distribution over complex curved surfaces, such as the foot and ankle. Our observations suggest that brachytherapy may be a well-tolerated treatment option for patients with severe, refractory PPP. PMID:26848819

  18. Permanent Darkness at the Lunar North Pole

    NASA Astrophysics Data System (ADS)

    Bussey, B.; Robinson, M. S.; Spudis, P. D.; Lucey, P. G.

    2001-12-01

    The Clementine mission provided the first dynamic temporal look at the illumination conditions of both lunar poles. Data of the lunar north pole were collected during summer in the northern hemisphere and are therefore ideal for placing a constraint on the maximum amount of permanent shadowed regions that exist. An early estimate of permanent shadow using Clementine data by Nozette and coworkers, based on a conservative measurement of permanently shadowed small craters close to the pole, was 530 km2. A later estimate, produced using Earth based radar topography data (by Margot et al), extended the area analyzed to lower latitudes (85oN), and indicated an increased permanently shadowed area of 2650 km2. By producing movies using Clementine UVVIS data it is possible to study dynamically how the illumination conditions vary during the length of a lunar day (708 hours). These movies show that small areas of permanent shadow possibly exist at lower latitudes than included in the Margot study, including regions of the farside that are inaccessible to Earth based study. An initial analysis shows that portions of north facing crater walls, as far out as 80oN, appear to be permanently shadowed. A preliminary examination of such features has raised the value of the permanently shadowed terrain area to greater than 10,000km2. A recent control network for the north pole will permit a more precise determination of the amount of permanently shadowed terrain. Comparison of this value, together with the data returned by Lunar Prospectors neutron spectrometer will place constraints on the amount of ice present at the lunar north pole as presented by Feldman and coworkers.

  19. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, Roman O.

    1997-01-01

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis.

  20. Permanent magnet edge-field quadrupole

    DOEpatents

    Tatchyn, R.O.

    1997-01-21

    Planar permanent magnet edge-field quadrupoles for use in particle accelerating machines and in insertion devices designed to generate spontaneous or coherent radiation from moving charged particles are disclosed. The invention comprises four magnetized rectangular pieces of permanent magnet material with substantially similar dimensions arranged into two planar arrays situated to generate a field with a substantially dominant quadrupole component in regions close to the device axis. 10 figs.

  1. Permanent education in health: a review

    PubMed Central

    Miccas, Fernanda Luppino; Batista, Sylvia Helena Souza da Silva

    2014-01-01

    OBJECTIVE To undertake a meta-synthesis of the literature on the main concepts and practices related to permanent education in health. METHODS A bibliographical search was conducted for original articles in the PubMed, Web of Science, LILACS, IBECS and SciELO databases, using the following search terms: “public health professional education”, “permanent education”, “continuing education”, “permanent education health”. Of the 590 articles identified, after applying inclusion and exclusion criteria, 48 were selected for further analysis, grouped according to the criteria of key elements, and then underwent meta-synthesis. RESULTS The 48 original publications were classified according to four thematic units of key elements: 1) concepts, 2) strategies and difficulties, 3) public policies and 4) educational institutions. Three main conceptions of permanent education in health were found: problem-focused and team work, directly related to continuing education and education that takes place throughout life. The main strategies for executing permanent education in health are discussion, maintaining an open space for permanent education, and permanent education clusters. The most limiting factor is mainly related to directly or indirect management. Another highlight is the requirement for implementation and maintenance of public policies, and the availability of financial and human resources. The educational institutions need to combine education and service aiming to form critical-reflexive graduates. CONCLUSIONS The coordination between health and education is based as much on the actions of health services as on management and educational institutions. Thus, it becomes a challenge to implement the teaching-learning processes that are supported by critical-reflexive actions. It is necessary to carry out proposals for permanent education in health involving the participation of health professionals, teachers and educational institutions. PMID:24789649

  2. EDITORIAL: Permanent revolution - or evolution?

    NASA Astrophysics Data System (ADS)

    Dobson, Ken

    1998-03-01

    Honorary Editor It was that temporary Bolshevik Leon Trotsky who developed the principle of `permanent revolution', a principle that perhaps characterizes the recent history of education in (south) Britain more than does, say, principles traditionally associated with the Conservative or Labour parties. As this editorial is being written, changes are being made to primary school education, and the long-awaited details of the post-Dearing reorganizing of post-16 education are yet to hit the overful bookshelves and filing cabinets of school heads and examination board officials. But something unique has happened recently which might have surprised even Trotsky. The Secretary of State for Education has set up targets for primary school pupils' attainment and threatened (or promised) to resign if they are not met within the lifetime of our newly elected parliament. Of course, if Mr Blunkett is still in a position to resign at that stage he will have been the longest serving Secretary of State since time immemorial. But we should not carp: this is truly a revolutionary idea. Not the promise to resign - although this idea is not so fashionable now as it once was. The revolutionary idea is that a major change to an educational process is actually being made that carries with it a predicted and testable outcome. By contrast, when school physics was refreshed a generation ago by the introduction of Nuffield courses at both pre- and post-16 stages, no `targets' were set. I and many other physics teachers certainly preferred teaching these to teaching their predecessor syllabuses, and might even dare to assert that the pupils liked them too. But we still don't really know whether or not they learned more - or even better - physics. Very little happened as far as the outside world was concerned: the usual fraction of students gave up physics at the usual ages, and those who were examined didn't really get a better reward for their more up-to-date and more enjoyably learned

  3. REDMAPS: reduced-dimensionality matching for prostate brachytherapy seed reconstruction.

    PubMed

    Lee, Junghoon; Labat, Christian; Jain, Ameet K; Song, Danny Y; Burdette, Everette Clif; Fichtinger, Gabor; Prince, Jerry L

    2011-01-01

    The success of prostate brachytherapy critically depends on delivering adequate dose to the prostate gland. Intraoperative localization of the implanted seeds provides potential for dose evaluation and optimization during therapy. A reduced-dimensionality matching algorithm for prostate brachytherapy seed reconstruction (REDMAPS) that uses multiple X-ray fluoroscopy images obtained from different poses is proposed. The seed reconstruction problem is formulated as a combinatorial optimization problem, and REDMAPS finds a solution in a clinically acceptable amount of time using dimensionality reduction to create a smaller space of possible solutions. Dimensionality reduction is possible since the optimal solution has approximately zero cost when the poses of the acquired images are known to be within a small error. REDMAPS is also formulated to address the "hidden seed problem" in which seeds overlap on one or more observed images. REDMAPS uses a pruning algorithm to avoid unnecessary computation of cost metrics and the reduced problem is solved using linear programming. REDMAPS was first evaluated and its parameters tuned using simulations. It was then validated using five phantom and 21 patient datasets. REDMAPS was successful in reconstructing the seeds with an overall seed matching rate above 99% and a reconstruction error below 1 mm in less than 5 s. PMID:20643600

  4. In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging

    NASA Astrophysics Data System (ADS)

    Lediju Bell, Muyinatu A.; Kuo, Nathanael P.; Song, Danny Y.; Kang, Jin U.; Boctor, Emad M.

    2014-12-01

    We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10-20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ≤2 mm. Results provide insights into the potential for clinical translation to humans.

  5. Thermoluminescence dosimetry measurements of brachytherapy sources in liquid water

    SciTech Connect

    Tailor, Ramesh; Tolani, Naresh; Ibbott, Geoffrey S.

    2008-09-15

    Radiation therapy dose measurements are customarily performed in liquid water. The characterization of brachytherapy sources is, however, generally based on measurements made with thermoluminescence dosimeters (TLDs), for which contact with water may lead to erroneous readings. Consequently, most dosimetry parameters reported in the literature have been based on measurements in water-equivalent plastics, such as Solid Water. These previous reports employed a correction factor to transfer the dose measurements from a plastic phantom to liquid water. The correction factor most often was based on Monte Carlo calculations. The process of measuring in a water-equivalent plastic phantom whose exact composition may be different from published specifications, then correcting the results to a water medium leads to increased uncertainty in the results. A system has been designed to enable measurements with TLDs in liquid water. This system, which includes jigs to support water-tight capsules of lithium fluoride in configurations suitable for measuring several dosimetric parameters, was used to determine the correction factor from water-equivalent plastic to water. Measurements of several {sup 125}I and {sup 131}Cs prostate brachytherapy sources in liquid water and in a Solid Water phantom demonstrated a correction factor of 1.039{+-}0.005 at 1 cm distance. These measurements are in good agreement with a published value of this correction factor for an {sup 125}I source.

  6. Effects Of The Inhomogeneity of Brachytherapy Sources In Cancer Treatments

    NASA Astrophysics Data System (ADS)

    Onumah, Nnenna

    2006-03-01

    Uniformity of radioactive sources is vital in delivering accurate doses in Brachytherapy. The International Atomic Energy Agency (IAEA) defines source uniformity as no more than a 20 % deviation from the average value of the dose along a transverse region. Brachytherapy induced cell damages occur at the microdosimetric levels, and as such, small deviations in dose delivered from different geometrical positions on the source can lead to huge deviations in proper treatment. A Geant4 simulation of a uniform source and a non-uniform source was simulated to check the validity of IAEA's proposed definition. A realistic source of non-uniformity, air bubbles of differing diameters (from 20 to 80 microns) were simulated and their uniformity checked against the model suggested by IAEA in two ways: (1) using the average obtained from the non-uniform source (2) using that obtained from the uniform source. Significant deviations of up to 50% were observed. These results validate the need for the scintillating fiber based detector currently in development within our research group.

  7. Observations on rotating needle insertions using a brachytherapy robot

    NASA Astrophysics Data System (ADS)

    Meltsner, M. A.; Ferrier, N. J.; Thomadsen, B. R.

    2007-09-01

    A robot designed for prostate brachytherapy implantations has the potential to greatly improve treatment success. Much of the research in robotic surgery focuses on measuring accuracy. However, there exist many factors that must be optimized before an analysis of needle placement accuracy can be determined. Some of these parameters include choice of the needle type, insertion velocity, usefulness of the rotating needle and rotation speed. These parameters may affect the force at which the needle interacts with the tissue. A reduction in force has been shown to decrease the compression of the prostate and potentially increase the accuracy of seed position. Rotating the needle as it is inserted may reduce frictional forces while increasing accuracy. However, needle rotations are considered to increase tissue damage due to the drilling nature of the insertion. We explore many of the factors involved in optimizing a brachytherapy robot, and the potential effects each parameter may have on the procedure. We also investigate the interaction of rotating needles in gel and suggest the rotate-cannula-only method of conical needle insertion to minimize any tissue damage while still maintaining the benefits of reduced force and increased accuracy.

  8. Dosimetric Study of a Low-Dose-Rate Brachytherapy Source

    NASA Astrophysics Data System (ADS)

    Rodríguez-Villafuerte, M.; Arzamendi, S.; Díaz-Perches, R.

    Carcinoma of the cervix is the most common malignancy - in terms of both incidence and mortality - in Mexican women. Low dose rate (LDR) intracavitary brachytherapy is normally prescribed for the treatment of this disease to the vast majority of patients attending public hospitals in our country. However, most treatment planning systems being used in these hospitals still rely on Sievert integral dose calculations. Moreover, experimental verification of dose distributions are hardly ever done. In this work we present a dosimetric characterisation of the Amersham CDCS-J 137Cs source, an LDR brachytherapy source commonly used in Mexican hospitals. To this end a Monte Carlo simulation was developed, that includes a realistic description of the internal structure of the source embedded in a scattering medium. The Monte Carlo results were compared to experimental measurements of dose distributions. A lucite phantom with the same geometric characteristics as the one used in the simulation was built. Dose measurements were performed using thermoluminescent dosimeters together with commercial RadioChromic dye film. A comparison between our Monte Carlo simulation, the experimental data, and results reported in the literature is presented.

  9. 2D/3D registration algorithm for lung brachytherapy

    SciTech Connect

    Zvonarev, P. S.; Farrell, T. J.; Hunter, R.; Wierzbicki, M.; Hayward, J. E.; Sur, R. K.

    2013-02-15

    Purpose: A 2D/3D registration algorithm is proposed for registering orthogonal x-ray images with a diagnostic CT volume for high dose rate (HDR) lung brachytherapy. Methods: The algorithm utilizes a rigid registration model based on a pixel/voxel intensity matching approach. To achieve accurate registration, a robust similarity measure combining normalized mutual information, image gradient, and intensity difference was developed. The algorithm was validated using a simple body and anthropomorphic phantoms. Transfer catheters were placed inside the phantoms to simulate the unique image features observed during treatment. The algorithm sensitivity to various degrees of initial misregistration and to the presence of foreign objects, such as ECG leads, was evaluated. Results: The mean registration error was 2.2 and 1.9 mm for the simple body and anthropomorphic phantoms, respectively. The error was comparable to the interoperator catheter digitization error of 1.6 mm. Preliminary analysis of data acquired from four patients indicated a mean registration error of 4.2 mm. Conclusions: Results obtained using the proposed algorithm are clinically acceptable especially considering the complications normally encountered when imaging during lung HDR brachytherapy.

  10. Remote afterloading for intracavitary and interstitial brachytherapy with californium-252

    NASA Astrophysics Data System (ADS)

    Tačev, Tačo; Grigorov, Grigor; Papírek, Tomáš; Kolařík, Vladimír.

    2004-01-01

    The authors present their design concept of remote afterloading for 252Cf brachytherapy with respect to characteristic peculiarities of 252Cf and the current worldwide development of remote afterloading devices. The afterloading device has been designed as a stationary radiator comprising three mutually interconnected units: (1) a control and drive unit, consisting of a control computer and a motor-driven Bowden system carrying the 252Cf source; (2) a source housed in a watertight, concrete vessel, which is stored in a strong room situated well beneath the patient's bed and (3) an afterloading application module installed in the irradiation room. As 252Cf is a nuclide with low specific activity, it was necessary to produce two independent devices for high dose rate intracavitary treatment and for low dose rate intestinal treatment. The sources may be moved arbitrarily during the treatment with a position accuracy of 0.5-1.0 mm within a distance of 520 cm from the source storage position in the strong room to the application position. The technical concept of the present automatic afterloading device for neutron brachytherapy represents one possible option of a range of conceivable design variants, which, while minimizing the technical and economic requirements, provides operating personnel with optimum protection and work safety, thus extending the applicability of high-LET radiation-based treatment methods in clinical practice.

  11. In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging

    PubMed Central

    Lediju Bell, Muyinatu A.; Kuo, Nathanael P.; Song, Danny Y.; Kang, Jin U.; Boctor, Emad M.

    2014-01-01

    Abstract. We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10–20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ≤2 mm. Results provide insights into the potential for clinical translation to humans. PMID:25531797

  12. Current status and perspectives of brachytherapy for cervical cancer.

    PubMed

    Toita, Takafumi

    2009-02-01

    Standard definitive radiotherapy for cervical cancer consists of whole pelvic external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). In Japan, high-dose-rate ICBT (HDR-ICBT) has been utilized in clinical practice for more than 40 years. Several randomized clinical trials demonstrated that HDR-ICBT achieved comparative outcomes, both for pelvic control and incidences of late complications, to low-dose-rate (LDR) ICBT. In addition, HDR-ICBT has some potential advantages over LDR-ICBT, leading to further improvement in treatment results. Prior to the current computer planning systems, some excellent treatment planning concepts were established. At present, systems modified from these concepts, or novel approaches, such as image-guided brachytherapy (IGBT) are under investigation. One serious problem to be solved in HDR-ICBT for cervical cancer is that of the discrepancy in standard treatment schedules for combination HDR-ICBT and EBRT between the United States and Japan. Prospective studies are ongoing to assess the efficacy and toxicity of the Japanese schedule. PMID:19225920

  13. Comparison of dose calculation methods for brachytherapy of intraocular tumors

    SciTech Connect

    Rivard, Mark J.; Chiu-Tsao, Sou-Tung; Finger, Paul T.; Meigooni, Ali S.; Melhus, Christopher S.; Mourtada, Firas; Napolitano, Mary E.; Rogers, D. W. O.; Thomson, Rowan M.; Nath, Ravinder

    2011-01-15

    Purpose: To investigate dosimetric differences among several clinical treatment planning systems (TPS) and Monte Carlo (MC) codes for brachytherapy of intraocular tumors using {sup 125}I or {sup 103}Pd plaques, and to evaluate the impact on the prescription dose of the adoption of MC codes and certain versions of a TPS (Plaque Simulator with optional modules). Methods: Three clinical brachytherapy TPS capable of intraocular brachytherapy treatment planning and two MC codes were compared. The TPS investigated were Pinnacle v8.0dp1, BrachyVision v8.1, and Plaque Simulator v5.3.9, all of which use the AAPM TG-43 formalism in water. The Plaque Simulator software can also handle some correction factors from MC simulations. The MC codes used are MCNP5 v1.40 and BrachyDose/EGSnrc. Using these TPS and MC codes, three types of calculations were performed: homogeneous medium with point sources (for the TPS only, using the 1D TG-43 dose calculation formalism); homogeneous medium with line sources (TPS with 2D TG-43 dose calculation formalism and MC codes); and plaque heterogeneity-corrected line sources (Plaque Simulator with modified 2D TG-43 dose calculation formalism and MC codes). Comparisons were made of doses calculated at points-of-interest on the plaque central-axis and at off-axis points of clinical interest within a standardized model of the right eye. Results: For the homogeneous water medium case, agreement was within {approx}2% for the point- and line-source models when comparing between TPS and between TPS and MC codes, respectively. For the heterogeneous medium case, dose differences (as calculated using the MC codes and Plaque Simulator) differ by up to 37% on the central-axis in comparison to the homogeneous water calculations. A prescription dose of 85 Gy at 5 mm depth based on calculations in a homogeneous medium delivers 76 Gy and 67 Gy for specific {sup 125}I and {sup 103}Pd sources, respectively, when accounting for COMS-plaque heterogeneities. For off

  14. Comparison of dose calculation methods for brachytherapy of intraocular tumors

    PubMed Central

    Rivard, Mark J.; Chiu-Tsao, Sou-Tung; Finger, Paul T.; Meigooni, Ali S.; Melhus, Christopher S.; Mourtada, Firas; Napolitano, Mary E.; Rogers, D. W. O.; Thomson, Rowan M.; Nath, Ravinder

    2011-01-01

    Purpose: To investigate dosimetric differences among several clinical treatment planning systems (TPS) and Monte Carlo (MC) codes for brachytherapy of intraocular tumors using 125I or 103Pd plaques, and to evaluate the impact on the prescription dose of the adoption of MC codes and certain versions of a TPS (Plaque Simulator with optional modules). Methods: Three clinical brachytherapy TPS capable of intraocular brachytherapy treatment planning and two MC codes were compared. The TPS investigated were Pinnacle v8.0dp1, BrachyVision v8.1, and Plaque Simulator v5.3.9, all of which use the AAPM TG-43 formalism in water. The Plaque Simulator software can also handle some correction factors from MC simulations. The MC codes used are MCNP5 v1.40 and BrachyDose∕EGSnrc. Using these TPS and MC codes, three types of calculations were performed: homogeneous medium with point sources (for the TPS only, using the 1D TG-43 dose calculation formalism); homogeneous medium with line sources (TPS with 2D TG-43 dose calculation formalism and MC codes); and plaque heterogeneity-corrected line sources (Plaque Simulator with modified 2D TG-43 dose calculation formalism and MC codes). Comparisons were made of doses calculated at points-of-interest on the plaque central-axis and at off-axis points of clinical interest within a standardized model of the right eye. Results: For the homogeneous water medium case, agreement was within ∼2% for the point- and line-source models when comparing between TPS and between TPS and MC codes, respectively. For the heterogeneous medium case, dose differences (as calculated using the MC codes and Plaque Simulator) differ by up to 37% on the central-axis in comparison to the homogeneous water calculations. A prescription dose of 85 Gy at 5 mm depth based on calculations in a homogeneous medium delivers 76 Gy and 67 Gy for specific 125I and 103Pd sources, respectively, when accounting for COMS-plaque heterogeneities. For off-axis points

  15. Systematic Review of Focal Prostate Brachytherapy and the Future Implementation of Image-Guided Prostate HDR Brachytherapy Using MR-Ultrasound Fusion

    PubMed Central

    Peach, M. Sean; Trifiletti, Daniel M.; Libby, Bruce

    2016-01-01

    Prostate cancer is the most common malignancy found in North American and European men and the second most common cause of cancer related death. Since the practice of PSA screening has become common the disease is most often found early and can have a long indolent course. Current definitive therapy treats the whole gland but has considerable long-term side effects. Focal therapies may be able to target the cancer while decreasing dose to organs at risk. Our objective was to determine if focal prostate brachytherapy could meet target objectives while permitting a decrease in dose to organs at risk in a way that would allow future salvage treatments. Further, we wanted to determine if focal treatment results in less toxicity. Utilizing the Medline repository, dosimetric papers comparing whole gland to partial gland brachytherapy and clinical papers that reported toxicity of focal brachytherapy were selected. A total of 9 dosimetric and 6 clinical papers met these inclusion criteria. Together, these manuscripts suggest that focal brachytherapy may be employed to decrease dose to organs at risk with decreased toxicity. Of current technology, image-guided HDR brachytherapy using MRI registered to transrectal ultrasound offers the flexibility and efficiency to achieve such focal treatments. PMID:27293899

  16. Systematic Review of Focal Prostate Brachytherapy and the Future Implementation of Image-Guided Prostate HDR Brachytherapy Using MR-Ultrasound Fusion.

    PubMed

    Peach, M Sean; Trifiletti, Daniel M; Libby, Bruce

    2016-01-01

    Prostate cancer is the most common malignancy found in North American and European men and the second most common cause of cancer related death. Since the practice of PSA screening has become common the disease is most often found early and can have a long indolent course. Current definitive therapy treats the whole gland but has considerable long-term side effects. Focal therapies may be able to target the cancer while decreasing dose to organs at risk. Our objective was to determine if focal prostate brachytherapy could meet target objectives while permitting a decrease in dose to organs at risk in a way that would allow future salvage treatments. Further, we wanted to determine if focal treatment results in less toxicity. Utilizing the Medline repository, dosimetric papers comparing whole gland to partial gland brachytherapy and clinical papers that reported toxicity of focal brachytherapy were selected. A total of 9 dosimetric and 6 clinical papers met these inclusion criteria. Together, these manuscripts suggest that focal brachytherapy may be employed to decrease dose to organs at risk with decreased toxicity. Of current technology, image-guided HDR brachytherapy using MRI registered to transrectal ultrasound offers the flexibility and efficiency to achieve such focal treatments. PMID:27293899

  17. The role of brachytherapy in the treatment of squamous cell carcinoma of the head and neck.

    PubMed

    Wierzbicka, Małgorzata; Bartochowska, Anna; Strnad, Vratislav; Strojan, Primož; Mendenhall, William M; Harrison, Louis B; Rinaldo, Alessandra; Sahai, Puja; Wiegand, Susanne; Ferlito, Alfio

    2016-02-01

    Brachytherapy is a form of intensive local irradiation, allowing effective protection of surrounding structures with preservation of organ function and results in a favorable therapeutic ratio. It can be used alone, adjuvantly after surgery, and as a local boost in combination with external-beam radiation therapy. This paper is a literature review on the role of brachytherapy in the management of head and neck cancers with a special emphasis on papers published in the last 5 years. Technical details, effectiveness and potential toxicities of brachytherapy when used in different combinations with other therapeutic modalities and tumor sites are presented. Brachytherapy is an attractive treatment option in the management of primary malignancies and recurrent tumors in previously irradiated areas of the head and neck. It is effective and safe, and results in good functional and oncological outcomes. PMID:25338181

  18. Relative biological effectiveness enhancement of a 125I brachytherapy seed with characteristic x rays from its constitutive materials.

    PubMed

    Taschereau, Richard; Roy, René; Pouliot, Jean

    2002-07-01

    The isotopes used for permanent prostate implants, 125I and 103Pd, provide about equivalent tumor control. The purpose of this study is to investigate how characteristic x rays may be used to raise the relative biological effectiveness (RBE) of an iodine seed at short distances to increase the differential effect between tumor and healthy tissue. Within the theoretical framework of microdosimetry, the GEANT4 Monte Carlo simulation toolkit has been used to calculate the RBE of experimental seed designs in which shell and core dimensions and composition were varied independently. A new seed model was also simulated based on the best results obtained. The RBE could be enhanced by increasing the shell thickness and for the range considered, optimum results were obtained by using gradually lower atomic number elements. For a practical 50-60 microm shell, molybdenum is the material of choice. The core diameter has little influence on RBE, but maximum effectiveness is obtained with yttrium or zirconium. These results were put together to design a Mo-shell and Y-core seed for which the RBE enhancement was at least 5-7% (close to the source), which is higher than palladium. This enhanced RBE combined with the longer half-life of iodine could mean comparable tumor control and better protection to organs at risk than with current seeds. The RBE dependence on distance is an interesting feature that could benefit other applications such as ocular melanoma or coronary brachytherapy where a highly localized dose distribution is desired. PMID:12148718

  19. Dosimetric comparison of four new design {sup 103}Pd brachytherapy sources: Optimal design using silver and copper rod cores

    SciTech Connect

    Hosseini, S. Hamed; Sadeghi, Mahdi; Ataeinia, Vahideh

    2009-07-15

    Four new brachytherapy sources, IRA1-{sup 103}Pd, IRA2-{sup 103}Pd, IRA3-{sup 103}Pd, and IRA4-{sup 103}Pd, have been developed at Agricultural, Medical, and Industrial Research School and are designed for permanent implant application. With the goal of determining an optimal design for a {sup 103}Pd source, this article compares the dosimetric properties of these sources with reference to the authors' earlier IRA-{sup 103}Pd source. The four new sources differ in end cap configuration and thickness and in the core material, silver or copper, that carries the adsorbed {sup 103}Pd. Dosimetric data derived from the authors' Monte Carlo simulation results are reported in accordance with the updated AAPM Task Group No. 43 report (TG-43U1). For each source, the authors obtained detailed results for the dose rate constant {Lambda}, the radial dose function g(r), the anisotropy function F(r,{theta}), and the anisotropy factor {phi}{sub an}(r). In this study, the optimal source IRA3-{sup 103}Pd provides the most isotropic dose distribution in water with the dose rate constant of 0.678({+-}0.1%) cGy h{sup -1} U{sup -1}. The IRA3-{sup 103}Pd design has a silver rod core combined with thin-wall, concave end caps. Finally, the authors compared the results for their optimal source with published results for those of other source manufacturers.

  20. Monte Carlo calculations and experimental measurements of dosimetric parameters of the IRA-{sup 103}Pd brachytherapy source

    SciTech Connect

    Sadeghi, Mahdi; Raisali, Gholamreza; Hosseini, S. Hamed; Shavar, Arzhang

    2008-04-15

    This article presents a brachytherapy source having {sup 103}Pd adsorbed onto a cylindrical silver rod that has been developed by the Agricultural, Medical, and Industrial Research School for permanent implant applications. Dosimetric characteristics (radial dose function, anisotropy function, and anisotropy factor) of this source were experimentally and theoretically determined in terms of the updated AAPM Task group 43 (TG-43U1) recommendations. Monte Carlo simulations were used to calculate the dose rate constant. Measurements were performed using TLD-GR200A circular chip dosimeters using standard methods employing thermoluminescent dosimeters in a Perspex phantom. Precision machined bores in the phantom located the dosimeters and the source in a reproducible fixed geometry, providing for transverse-axis and angular dose profiles over a range of distances from 0.5 to 5 cm. The Monte Carlo N-particle (MCNP) code, version 4C simulation techniques have been used to evaluate the dose-rate distributions around this model {sup 103}Pd source in water and Perspex phantoms. The Monte Carlo calculated dose rate constant of the IRA-{sup 103}Pd source in water was found to be 0.678 cGy h{sup -1} U{sup -1} with an approximate uncertainty of {+-}0.1%. The anisotropy function, F(r,{theta}), and the radial dose function, g(r), of the IRA-{sup 103}Pd source were also measured in a Perspex phantom and calculated in both Perspex and liquid water phantoms.

  1. Experimental measurements and Monte Carlo calculations of dosimetric parameters of the IRA1-103Pd brachytherapy source.

    PubMed

    Sadeghi, Mahdi; Hosseini, S Hamed; Raisali, Gholamreza

    2008-10-01

    This work presents a brachytherapy source having (103)Pd adsorbed onto a cylindrical silver rod that has been developed by Agricultural, Medical and Industrial Research School for permanent implant applications. Dosimetric characteristics (dose-rate constant, radial dose function, anisotropy function and anisotropy factor) of this source were experimentally and theoretically determined in terms of the updated AAPM Task Group 43 (TG-43U1) recommendations. Measurements were performed using TLD-GR200A circular chip dosimeters using standard methods employing thermoluminescent dosimeters in a Perspex phantom. Precision machined bores in the phantom located dosimeters and source in a reproducible fixed geometry providing for transverse-axis and angular dose profiles over a range of distances from 0.5 to 5 cm. The Monte Carlo N-Particle (MCNP) code, version 4C was used to evaluate the dose-rate distributions around this model (103)Pd source in water and Perspex phantoms. The Monte Carlo calculated dose-rate constant of the IRA1-(103)Pd source in water was found equal to Lambda=0.669 cGy/h/U with approximate uncertainties of +/-0.1%. The anisotropy function, F(r, theta), and the radial dose function, g(L)(r), of the IRA1-(103)Pd source were also measured in Perspex phantom and calculated in both Perspex and liquid water phantom. PMID:18387806

  2. Iodine-125-labeled lipoprotein lipase as a tool to detect and study spontaneous lipolysis in bovine milk

    SciTech Connect

    Sundheim, G.; Bengtsson-Olivecrona, G.

    1986-07-01

    The distribution of lipoprotein lipase among cream, casein, and milk serum can be evaluated by addition of a trace amount of /sup 125/I-labeled lipoprotein lipase to milk. Radioactive lipase was distributed in parallel to endogenous lipase under several conditions. In some milk samples, binding of lipase to cream increased when the milk was cooled. Correlation was good between bound labeled lipase and degree of cold-induced lipolysis in corresponding milk samples. Binding of lipase to cream or to casein was not saturable by addition of two-to threefold more lipase than is normally present in milk. In milk with a relatively high fraction of lipase bound to cream, a correspondingly lower fraction was associated with casein, whereas the fraction of lipase in milk serum was similar in all milk samples. Cold-induced binding of lipoprotein lipase to cream was not fully reversed when the milk was warmed again. Heparin released lipase from casein and increased the amount of lipase bound to cream after cooling.

  3. Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes

    SciTech Connect

    Perez, Bradford A.; Mettu, Pradeep; Vajzovic, Lejla; Rivera, Douglas; Alkaissi, Ali; Steffey, Beverly A.; Cai, Jing; Stinnett, Sandra; Dutton, Jonathan J.; Buckley, Edward G.; Halperin, Edward; Marks, Lawrence B.; Mruthyunjaya, Prithvi; Kirsch, David G.

    2014-05-01

    Purpose: To investigate, in the treatment of uveal melanomas, how tumor control, radiation toxicity, and visual outcomes are affected by the radiation dose at the tumor apex. Methods and Materials: A retrospective review was performed to evaluate patients treated for uveal melanoma with {sup 125}I plaques between 1988 and 2010. Radiation dose is reported as dose to tumor apex and dose to 5 mm. Primary endpoints included time to local failure, distant failure, and death. Secondary endpoints included eye preservation, visual acuity, and radiation-related complications. Univariate and multivariate analyses were performed to determine associations between radiation dose and the endpoint variables. Results: One hundred ninety patients with sufficient data to evaluate the endpoints were included. The 5-year local control rate was 91%. The 5-year distant metastases rate was 10%. The 5-year overall survival rate was 84%. There were no differences in outcome (local control, distant metastases, overall survival) when dose was stratified by apex dose quartile (<69 Gy, 69-81 Gy, 81-89 Gy, >89 Gy). However, increasing apex dose and dose to 5-mm depth were correlated with greater visual acuity loss (P=.02, P=.0006), worse final visual acuity (P=.02, P<.0001), and radiation complications (P<.0001, P=.0009). In addition, enucleation rates were worse with increasing quartiles of dose to 5 mm (P=.0001). Conclusions: Doses at least as low as 69 Gy prescribed to the tumor apex achieve rates of local control, distant metastasis–free survival, and overall survival that are similar to radiation doses of 85 Gy to the tumor apex, but with improved visual outcomes.

  4. Induction of lethal bystander effects in human breast cancer cell cultures by DNA-incorporated Iodine-125 depends on phenotype

    PubMed Central

    Akudugu, John M.; Azzam, Edouard I.; Howell, Roger W.

    2013-01-01

    Purpose This study uses a three-dimensional cell culture model to investigate lethal bystander effects in human breast cancer cell cultures (MCF-7, MDA-MB-231) treated with 125I-labeled 5-iodo-2′-deoxyuridine (125IdU). These breast cancer cell lines respectively form metastatic xenografts in nude mice in an estrogen-dependent and independent manner. Materials and methods In the present study, these cells were cultured in loosely-packed three-dimensional architecture in a Cytomatrix™ carbon scaffold. Cultures were pulse-labeled for 3 h with 125IdU to selectively irradiate a minor fraction of cells, and simultaneously co-pulse-labeled with 0.04 mM 5-ethynyl-2′-deoxyuridine (EdU) to identify the radiolabeled cells using Click-iT® EdU and flow cytometry. The cultures were then washed and incubated for 48 h. The cells were then harvested, serially diluted, and seeded for colony formation. Aliquots of cells were subjected to flow cytometry to determine the percentage of cells labeled with 125IdU/EdU. Additional aliquots were used to determine the mean 125I activity per labeled cell. The percentage of labeled cells was about 15% and 10% for MCF-7 and MDA-MB-231 cells, respectively. This created irradiation conditions wherein the cross-dose to unlabeled cells was small relative to the self-dose to labeled cells. The surviving fraction relative to EdU-treated controls was measured. Results Survival curves indicated significant lethal bystander effect in MCF-7 cells, however, no significant lethal bystander effect was observed in MDA-MB-231 cells. Conclusions These studies demonstrate the capacity of 125IdU to induce lethal bystander effects in human breast cancer cells and suggest that the response depends on phenotype. PMID:22489958

  5. Complex cell geometry and sources distribution model for Monte Carlo single cell dosimetry with iodine 125 radioimmunotherapy

    NASA Astrophysics Data System (ADS)

    Arnaud, F. X.; Paillas, S.; Pouget, J. P.; Incerti, S.; Bardiès, M.; Bordage, M. C.

    2016-01-01

    In cellular dosimetry, common assumptions consider concentric spheres for nucleus and cell and uniform radionuclides distribution. These approximations do not reflect reality, specially in the situation of radioimmunotherapy with Auger emitters, where very short-ranged electrons induce hyper localised energy deposition. A realistic cellular dosimetric model was generated to give account of the real geometry and activity distribution, for non-internalizing and internalizing antibodies (mAbs) labelled with Auger emitter I-125. The impact of geometry was studied by comparing the real geometry obtained from confocal microscopy for both cell and nucleus with volume equivalent concentric spheres. Non-uniform and uniform source distributions were considered for each mAbs distribution. Comparisons in terms of mean deposited energy per decay, energy deposition spectra and energy-volume histograms were calculated using Geant4. We conclude that realistic models are needed, especially when energy deposition is highly non-homogeneous due to source distribution.

  6. Iodine 125-lysergic acid diethylamide binds to a novel serotonergic site on rat choroid plexus epithelial cells

    SciTech Connect

    Yagaloff, K.A.; Hartig, P.R.

    1985-12-01

    /sup 125/I-Lysergic acid diethylamide (/sup 125/I-LSD) binds with high affinity to serotonergic sites on rat choroid plexus. These sites were localized to choroid plexus epithelial cells by use of a novel high resolution stripping film technique for light microscopic autoradiography. In membrane preparations from rat choroid plexus, the serotonergic site density was 3100 fmol/mg of protein, which is 10-fold higher than the density of any other serotonergic site in brain homogenates. The choroid plexus site exhibits a novel pharmacology that does not match the properties of 5-hydroxytryptamine-1a (5-HT1a), 5-HT1b, or 5-HT2 serotonergic sites. /sup 125/I-LSD binding to the choroid plexus site is potently inhibited by mianserin, serotonin, and (+)-LSD. Other serotonergic, dopaminergic, and adrenergic agonists and antagonists exhibit moderate to weak affinities for this site. The rat choroid plexus /sup 125/I-LSD binding site appears to represent a new type of serotonergic site which is located on non-neuronal cells in this tissue.

  7. Method for the simultaneous preparation of radon-211, xenon-125, xenon-123, astatine-211, iodine-125 and iodine-123

    SciTech Connect

    Mirzadeh, S.; Lambrecht, R.M.

    1987-05-12

    A method is described for simultaneously preparing a mixture of about equal amounts of /sup 211/Rn and /sup 125/Xe, and a second mixture of about equal amounts of /sup 211/At and /sup 123/I with a proton-irradiation procedure followed by a one-step chemical procedure. The method comprises: irradiating a body of material selected from the group consisting of /sup 232/Th and /sup 238/U for about 15 hours with protons that have been accelerated to at least 2 GeV; promptly dissolving the irradiated body of material in a vessel containing a mixture of hydrochloric acid, nitric acid and hydrofluoric acid; and forcing a stream of helium (He) carrier gas into the vessel at a predetermined flow rate to entrain radionuclides of gaseous /sup 210/Rn, /sup 211/Rn, /sup 123/Xe and /sup 125/Xe and trace amounts of radiohalogens and remove them from the vessel.

  8. Method for the simultaneous preparation of radon-211, xenon-125, xenon-123, astatine-211, iodine-125 and iodine-123

    DOEpatents

    Mirzadeh, S.; Lambrecht, R.M.

    1985-07-01

    The invention relates to a practical method for commercially producing radiopharmaceutical activities and, more particularly, relates to a method for the preparation of about equal amount of Radon-211 (/sup 211/Rn) and Xenon-125 (/sup 125/Xe) including a one-step chemical procedure following an irradiation procedure in which a selected target of Thorium (/sup 232/Th) or Uranium (/sup 238/U) is irradiated. The disclosed method is also effective for the preparation in a one-step chemical procedure of substantially equal amounts of high purity /sup 123/I and /sup 211/At. In one preferred arrangement of the invention almost equal quantities of /sup 211/Rn and /sup 125/Xe are prepared using a onestep chemical procedure in which a suitably irradiated fertile target material, such as thorium-232 or uranium-238, is treated to extract those radionuclides from it. In the same one-step chemical procedure about equal quantities of /sup 211/At and /sup 123/I are prepared and stored for subsequent use. In a modified arrangement of the method of the invention, it is practiced to separate and store about equal amounts of only /sup 211/Rn and /sup 125/Xe, while preventing the extraction or storage of the radionuclides /sup 211/At and /sup 123/I.

  9. Film dosimetry analyses on the effect of gold shielding for Iodine-125 eye plaque therapy for choroidal melanoma

    SciTech Connect

    Wu, A. ); Krasin, F. )

    1990-09-01

    One of the methods currently being used to treat choroidal melanoma employs an episcleral plaque containing I-125 radioactive seeds. However, comprehensive dosimetry studies on the plaque are scarce and controversial. For this work, we use film to study the dosimetry outside the lip of the gold shield of the eye plaque. This lip around the gold shield was made to protect the critical structures behind and adjacent to the lesion. Since the changes of energy spectrum of I-125 in tissue are negligible, film dosimetry seems to be a logical choice because of high spatial resolution required around the lip of the gold plaque. For this study, we first established an H and D curve with dose expressed in a unit of specific dose rate constant. This avoids absolute dose measurements. All film density measurements are made with a 1-mm aperture scan, normalized to the density at the prescription point for tumor of 3--5-mm apical height, i.e., 5 mm from the interior surface of sclera, and converted to percentage isodose curves. With a gold shield, it is found that when the plaque is placed against the optical nerve, the optical disk and macula, located at 2 mm outside the lip, on the exterior surface of sclera, may receive 85% of the prescription dose for a 12-mm plaque and 58% for a 16-mm plaque. For tumors of 8-mm apical height, the optical nerve would receive more than the prescription dose.

  10. Temporal relationship between prostate brachytherapy and the diagnosis of colorectal cancer

    SciTech Connect

    Gutman, Sarah A.; Merrick, Gregory S. . E-mail: gmerrick@urologicresearchinstitute.org; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah A.; Galbreath, Robert W.; Adamovich, Edward

    2006-09-01

    Purpose: To identify the location of pretreatment and posttreatment colorectal malignancies and posttreatment colorectal polyps in patients with clinically localized prostate cancer managed with brachytherapy. Methods and Materials: From April 1995 through July 2004, 1,351 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (American Joint Committee on Cancer, 2002) prostate cancer. Supplemental external beam radiotherapy (XRT) was administered to 699 patients. The median follow-up was 4.6 years. Operative and pathology reports were reviewed for all patients with pretreatment and posttreatment colorectal cancer and posttreatment colorectal polyps. Multiple parameters were evaluated for the development of colorectal cancer or colorectal polyps. Results: Colorectal cancer was diagnosed in 23 and 25 patients before and after prostate brachytherapy, respectively. No differences were identified in the distribution of colorectal cancers either before or after treatment (3 and 4 rectal cancers in the pre- and postbrachytherapy cohorts). Thirty-five of the 48 colorectal cancers (73%) were diagnosed within 5 years of brachytherapy with a peak incidence 1 year after brachytherapy. One hundred ninety-two colorectal polyps were diagnosed after brachytherapy, 160 (83%) occurred within 4 years of brachytherapy, and only 27 (14%) were located in the rectum. In multivariate Cox regression analysis, prostate D{sub 9} (minimum percentage of the dose covering 90% of the target volume) predicted for posttreatment colorectal cancer. Rectal polyps were most closely related to patient age and percent positive biopsies, whereas sigmoid/colon polyps were best predicted by patient age, planning volume, and supplemental XRT. Conclusions: Colorectal cancer was diagnosed with equal frequency before and after brachytherapy with comparable geographic distributions. In addition, the vast majority of postbrachytherapy colorectal polyps were located beyond the confines of the

  11. Effect of brachytherapy technique and patient characteristics on cervical cancer implant dosimetry

    SciTech Connect

    Anker, Christopher J.; O'Donnell, Kristen; Boucher, Kenneth M.; Gaffney, David K.

    2013-01-01

    Our purpose was to evaluate the relationship between brachytherapy technique and patient characteristics on dose to organs-at-risk (OARs) in patients undergoing high dose rate (HDR) brachytherapy for cervical cancer. From 1998 to 2008, 31 patients with cervical cancer with full dosimetric data were identified who received definitive external-beam radiation and HDR brachytherapy with tandem and ovoid applicators. Doses were recorded at point A, the International Commission on Radiation Units and Measurements (ICRU)-38 rectal point, the ICRU-38 bladder point, the vaginal surface, and the pelvic sidewall. Generalized estimating equations were used to determine the significance of changes in OAR to point A dose ratios with differences in brachytherapy technique or patient characteristics. Patients underwent a median of 5 brachytherapy procedures (range, 3 to 5), with a total of 179 procedures for 31 patients. For all brachytherapy treatments, the average ratios between the doses for the rectal, bladder, vaginal surface, and pelvic sidewall reference points to those at point A were 0.49, 0.59, 1.15, and 0.17, respectively. In general, decreased OAR dose was associated with a lower stage, younger age, increased ovoid size, increased tandem length, and earlier implant number. Increased tandem curvature significantly increased bladder dose and decreased rectal dose. Intravenous anesthesia usage was not correlated with improved dosimetry. This study allowed identification of patient and procedure characteristics influencing OAR dosing. Although the advent of 3-dimensional (3D) image-guided brachytherapy will bring new advances in treatment optimization, the actual technique involved at the time of the brachytherapy implant procedure will remain important.

  12. High Dose-Rate Versus Low Dose-Rate Brachytherapy for Lip Cancer

    SciTech Connect

    Ghadjar, Pirus; Bojaxhiu, Beat; Simcock, Mathew; Terribilini, Dario; Isaak, Bernhard; Gut, Philipp; Wolfensberger, Patrick; Broemme, Jens O.; Geretschlaeger, Andreas; Behrensmeier, Frank; Pica, Alessia; Aebersold, Daniel M.

    2012-07-15

    Purpose: To analyze the outcome after low-dose-rate (LDR) or high-dose-rate (HDR) brachytherapy for lip cancer. Methods and Materials: One hundred and three patients with newly diagnosed squamous cell carcinoma of the lip were treated between March 1985 and June 2009 either by HDR (n = 33) or LDR brachytherapy (n = 70). Sixty-eight patients received brachytherapy alone, and 35 received tumor excision followed by brachytherapy because of positive resection margins. Acute and late toxicity was assessed according to the Common Terminology Criteria for Adverse Events 3.0. Results: Median follow-up was 3.1 years (range, 0.3-23 years). Clinical and pathological variables did not differ significantly between groups. At 5 years, local recurrence-free survival, regional recurrence-free survival, and overall survival rates were 93%, 90%, and 77%. There was no significant difference for these endpoints when HDR was compared with LDR brachytherapy. Forty-two of 103 patients (41%) experienced acute Grade 2 and 57 of 103 patients (55%) experienced acute Grade 3 toxicity. Late Grade 1 toxicity was experienced by 34 of 103 patients (33%), and 5 of 103 patients (5%) experienced late Grade 2 toxicity; no Grade 3 late toxicity was observed. Acute and late toxicity rates were not significantly different between HDR and LDR brachytherapy. Conclusions: As treatment for lip cancer, HDR and LDR brachytherapy have comparable locoregional control and acute and late toxicity rates. HDR brachytherapy for lip cancer seems to be an effective treatment with acceptable toxicity.

  13. Preparation of (103)Pd brachytherapy seeds by electroless plating of (103)Pd onto carbon bars.

    PubMed

    Li, Zhong-Yong; Gao, Hui-Bo; Deng, Xue-Song; Zhou, Leng; Zhang, Wen-Hui; Han, Lian-Ge; Jin, Xiao-Hai; Cui, Hai-Ping

    2015-09-01

    A method for preparing (103)Pd brachytherapy seeds is reported. The key of the method was to deposit (103)Pd onto carbon bars by electroless plating so as to prepare source cores. After each carbon bar with (103)Pd was sealed in a titanium capsule, the (103)Pd seeds were fabricated. This paper provides valuable experiences and data for the preparation of (103)Pd brachytherapy seeds. PMID:26092353

  14. Prostate Brachytherapy seed migration to the Bladder presenting with Gross Hematuria

    PubMed Central

    Haroun, Reham R; Nance, John W; Fishman, Elliot K

    2016-01-01

    We present the radiologic findings in a case of prostate brachytherapy seed migration to the bladder presenting as gross hematuria. While prostate brachytherapy seed implantation is considered a relatively safe procedure, migration is not uncommon; however, it is usually clinically silent and the seeds most commonly migrate to the lungs through the venous circulation via the periprostatic venous plexus. Our case illustrates that local erosion is possible, can be symptomatic, and therefore must be considered when evaluating select patients. PMID:27200152

  15. Cylindrical Hall Thrusters with Permanent Magnets

    SciTech Connect

    Raitses, Yevgeny; Merino, Enrique; Fisch, Nathaniel J.

    2010-10-18

    The use of permanent magnets instead of electromagnet coils for low power Hall thrusters can offer a significant reduction of both the total electric power consumption and the thruster mass. Two permanent magnet versions of the miniaturized cylindrical Hall thruster (CHT) of different overall dimensions were operated in the power range of 50W-300 W. The discharge and plasma plume measurements revealed that the CHT thrusters with permanent magnets and electromagnet coils operate rather differently. In particular, the angular ion current density distribution from the permanent magnet thrusters has an unusual halo shape, with a majority of high energy ions flowing at large angles with respect to the thruster centerline. Differences in the magnetic field topology outside the thruster channel and in the vicinity of the channel exit are likely responsible for the differences in the plume characteristics measured for the CHTs with electromagnets and permanent magnets. It is shown that the presence of the reversing-direction or cusp-type magnetic field configuration inside the thruster channel without a strong axial magnetic field outside the thruster channel does not lead to the halo plasma plume from the CHT. __________________________________________________

  16. Seeing is saving: the benefit of 3D imaging in gynecologic brachytherapy.

    PubMed

    Viswanathan, Akila N; Erickson, Beth A

    2015-07-01

    Despite a concerning decline in the use of brachytherapy over the past decade, no other therapy is able to deliver a very high dose of radiation into or near a tumor, with a rapid fall-off of dose to adjacent structures. Compared to traditional X-ray-based brachytherapy that relies on points, the use of CT and MR for 3D planning of gynecologic brachytherapy provides a much more accurate volume-based calculation of dose to an image-defined tumor and to the bladder, rectum, sigmoid, and other pelvic organs at risk (OAR) for radiation complications. The publication of standardized guidelines and an online contouring teaching atlas for performing 3D image-based brachytherapy has created a universal platform for communication and training. This has resulted in a uniform approach to using image-guided brachytherapy for treatment and an internationally accepted format for reporting clinical outcomes. Significant improvements in survival and reductions in toxicity have been reported with the addition of image guidance to increase dose to tumor and decrease dose to the critical OAR. Future improvements in individualizing patient treatments should include a more precise definition of the target. This will allow dose modulation based on the amount of residual disease visualized on images obtained at the time of brachytherapy. PMID:25748646

  17. WE-E-BRD-01: HDR Brachytherapy I: Overview of Clinical Application and QA

    SciTech Connect

    Libby, B; Showalter, T

    2014-06-15

    With the increased usage of high dose rate (HDR) brachytherapy and the introduction of dedicated image guided brachytherapy suites, it is necessary to review the processes and procedures associated with safely delivering these treatments in the expedited time scales that dedicated treatment suites afford. The speakers will present the clinical aspects of switching from LDR to HDR treatments, including guidelines for patient selection, and the clinical outcomes comparing LDR to HDR. The speakers will also discuss the HDR treatment process itself, because the shortened clinical timeline involved with a streamlined scan/plan/treat workflow can introduce other issues. Safety and QA aspects involved with the streamlined process, including increased personnel required for parallel tasks, and possible interfering tasks causing delays in patient treatments will also be discussed. Learning Objectives: To understand the clinical aspects of HDR Brachytherapy, including common clinical indications, patient selection, and the evolving evidence in support of this therapeutic modality To review the current prominent clinical trials for HDR brachytherapy To interpret the established guidelines for HDR brachytherapy quality assurance for implementation into practical clinical settings. To introduce the basic requirements for image guided brachytherapy.

  18. Adherence to Vaginal Dilation Following High Dose Rate Brachytherapy for Endometrial Cancer

    SciTech Connect

    Friedman, Lois C.; Abdallah, Rita; Schluchter, Mark; Panneerselvam, Ashok; Kunos, Charles A.

    2011-07-01

    Purpose: We report demographic, clinical, and psychosocial factors associated with adherence to vaginal dilation and describe the sexual and marital or nonmarital dyadic functioning of women following high dose rate (HDR) brachytherapy for endometrial cancer. Methods and Materials: We retrospectively evaluated women aged 18 years or older in whom early-stage endometrial (IAgr3-IIB) cancers were treated by HDR intravaginal brachytherapy within the past 3.5 years. Women with or without a sexual partner were eligible. Patients completed questionnaires by mail or by telephone assessing demographic and clinical variables, adherence to vaginal dilation, dyadic satisfaction, sexual functioning, and health beliefs. Results: Seventy-eight of 89 (88%) eligible women with early-stage endometrial cancer treated with HDR brachytherapy completed questionnaires. Only 33% of patients were adherers, based on reporting having used a dilator more than two times per week in the first month following radiation. Nonadherers who reported a perceived change in vaginal dimension following radiation reported that their vaginas were subjectively smaller after brachytherapy (p = 0.013). Adherers reported more worry about their sex lives or lack thereof than nonadherers (p = 0.047). Patients reported considerable sexual dysfunction following completion of HDR brachytherapy. Conclusions: Adherence to recommendations for vaginal dilator use following HDR brachytherapy for endometrial cancer is poor. Interventions designed to educate women about dilator use benefit may increase adherence. Although sexual functioning was compromised, it is likely that this existed before having cancer for many women in our study.

  19. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  20. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  1. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  2. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  3. 31 CFR 515.335 - Permanent resident alien.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Permanent resident alien. 515.335... Definitions § 515.335 Permanent resident alien. As used in § 515.208, the term permanent resident alien means an alien lawfully admitted for permanent residence into the United States....

  4. Laced permanent magnet quadrupole drift tube magnets

    SciTech Connect

    Feinberg, B.; Behrsing, G.U.; Halbach, K.; Marks, J.S.; Morrison, M.E.; Nelson, D.H.

    1989-03-01

    Twenty-three laced permanent magnet quadrupole drift tube magnets have been constructed, tested, and installed in the SuperHILAC heavy ion linear accelerator at LBL, marking the first accelerator use of this new type of quadrupole. The magnets consist of conventional tape-wound quadrupole electromagnets, using iron pole-pieces, with permanent magnet material (samarium cobalt) inserted between the poles to reduce the effects of saturation. The iron is preloaded with magnetic flux generated by the permanent magnet material, resulting in an asymmetrical saturation curve. Since the polarity of the individual quadrupole magnets in a drift tube linac is never reversed, we can take advantage of this asymmetrical saturation to provide about 20% greater focusing strength than is available with conventional quadrupoles, while replacing the vanadium permendur poletips with iron poletips. Comparisons between these magnets and conventional tape-wound quadrupoles will be presented. 3 refs., 5 figs.

  5. Permanent magnet array for the magnetic refrigerator

    NASA Astrophysics Data System (ADS)

    Lee, S. J.; Kenkel, J. M.; Pecharsky, V. K.; Jiles, D. C.

    2002-05-01

    Recent research into the development of magnetic refrigeration (MR) operating at room temperature has shown that it can provide a reliable, energy-efficient cooling system. To enhance the cooling power of the magnetic refrigerator, it is required to use a magnetic refrigerant material with large magnetocaloric effect (MCE) at the appropriate temperature. Most advanced magnetic refrigerant materials show largest MCE at high applied magnetic fields generated by a superconducting magnet. For application of MCE to air conditioners or household refrigerators, it is essential to develop a permanent magnet array to form a compact, strong, and energy-efficient magnetic field generator. Generating a magnetic field well above the remanence of a permanent magnet material is hard to achieve through conventional designs. A permanent magnet array based on a hollow cylindrical flux source is found to provide an appropriate geometry and magnetic field strength for MR applications.

  6. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    SciTech Connect

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J.

    2009-01-15

    Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V{sub 100}{sup Prostate}>90%) and organ-at-risk dose sparing (V{sub 75}{sup Bladder}<1 cc, V{sub 75}{sup Rectum}<1 cc, V{sub 125}{sup Urethra}<<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of

  7. Critical Organ Preservation in Reirradiation Brachytherapy by Injectable Spacer

    SciTech Connect

    Kishi, Kazushi Sonomura, Tetsuo; Shirai, Shintaro; Sato, Morio; Tanaka, Kayo

    2009-10-01

    Purpose: This case series study evaluated the feasibility and effectiveness of an interstitial high-dose rate brachytherapy (HDR-BT) procedure combined with an at-risk organ-sparing procedure. Methods and Materials: Thirty patients who were scheduled for reirradiation treatment for recurrent cancer after receiving a median dose of 60 Gy (range, 44-70 Gy) in 2-Gy fractions of previous external beam treatment were enrolled. Thirteen patients had lesions in the head and neck, and other lesions were located in the axilla, skeleton, breast, pelvis, and abdominal wall. Chief complaints included local masses (for 25) and refractory pain (for 21). After high-dose rate brachytherapy applicator needle implantation, an optimal CT-based three-dimensional brachytherapy plan was created with a virtual at-risk organ shift from the target. According to the plan, hyaluronic acid gel was injected to maintain the shift during irradiation. The prescribed dose was the result of an individualized tradeoff between target dose and at-risk organ dose, to avoid serious complications. A single-fraction dose of 18.0 Gy (median, equivalent to 75.6 Gy at an {alpha}/{beta} value of 3; range, 16-20 Gy) was applied to the tumor. Results: The at-risk organ dose decreased from 9.1 {+-} 0.9 Gy to 4.4 {+-} 0.4 Gy (mean {+-} standard deviation, p < 0.01), and the normal tissue complication probability decreased from 60.8% {+-} 12.6% to 16.1% {+-} 19.8% (p < 0.01). The shift effect lasted at least 4 hours and disappeared gradually. Distinct tumor shrinkage in 20 of 21 eligible patients, including tumor disappearance in 6 patients, pain reduction in 18 of 21 eligible patients, and no unexpected late toxicity greater than grade 2 were observed during the 19.5-month observation period. Conclusions: This at-risk organ-sparing preservation procedure may provide a safe and efficient reirradiation treatment.

  8. Permanent isolation surface barrier: Functional performance

    SciTech Connect

    Wing, N.R.

    1993-10-01

    This document presents the functional performance parameters for permanent isolation surface barriers. Permanent isolation surface barriers have been proposed for use at the Hanford Site (and elsewhere) to isolate and dispose of certain types of waste in place. Much of the waste that would be disposed of using in-place isolation techniques is located in subsurface structures, such as solid waste burial grounds, tanks, vaults, and cribs. Unless protected in some way, the wastes could be transported to the accessible environment via transport pathways, such as water infiltration, biointrusion, wind and water erosion, human interference, and/or gaseous release.

  9. Studies on the development of ¹⁶⁹Yb-brachytherapy seeds: New generation brachytherapy sources for the management of cancer.

    PubMed

    Saxena, Sanjay Kumar; Kumar, Yogendra; Jagadeesan, K C; Nuwad, Jitendra; Bamankar, Y R; Dash, Ashutosh

    2015-07-01

    This paper describes development of (169)Yb-seeds by encapsulating 0.6-0.65 mm (ϕ) sized (169)Yb2O3 microspheres in titanium capsules. Microspheres synthesized by a sol-gel route were characterized by XRD, SEM/EDS and ICP-AES. Optimization of neutron irradiation was accomplished and (169)Yb-seeds up to 74 MBq of (169)Yb could be produced from natural Yb2O3 microspheres, which have the potential for use in prostate brachytherapy. A protocol to prepare (169)Yb-brachytherapy sources (2.96-3.7 TBq of (169)Yb) with the use of enriched targets was also formulated. PMID:25846454

  10. AUTOMATIC SEGMENTATION OF PELVIS FOR BRACHYTHERAPY OF PROSTATE.

    PubMed

    Kardell, M; Magnusson, M; Sandborg, M; Alm Carlsson, G; Jeuthe, J; Malusek, A

    2016-06-01

    Advanced model-based iterative reconstruction algorithms in quantitative computed tomography (CT) perform automatic segmentation of tissues to estimate material properties of the imaged object. Compared with conventional methods, these algorithms may improve quality of reconstructed images and accuracy of radiation treatment planning. Automatic segmentation of tissues is, however, a difficult task. The aim of this work was to develop and evaluate an algorithm that automatically segments tissues in CT images of the male pelvis. The newly developed algorithm (MK2014) combines histogram matching, thresholding, region growing, deformable model and atlas-based registration techniques for the segmentation of bones, adipose tissue, prostate and muscles in CT images. Visual inspection of segmented images showed that the algorithm performed well for the five analysed images. The tissues were identified and outlined with accuracy sufficient for the dual-energy iterative reconstruction algorithm whose aim is to improve the accuracy of radiation treatment planning in brachytherapy of the prostate. PMID:26567322

  11. Apparatus and method for high dose rate brachytherapy radiation treatment

    DOEpatents

    Macey, Daniel J.; Majewski, Stanislaw; Weisenberger, Andrew G.; Smith, Mark Frederick; Kross, Brian James

    2005-01-25

    A method and apparatus for the in vivo location and tracking of a radioactive seed source during and after brachytherapy treatment. The method comprises obtaining multiple views of the seed source in a living organism using: 1) a single PSPMT detector that is exposed through a multiplicity of pinholes thereby obtaining a plurality of images from a single angle; 2) a single PSPMT detector that may obtain an image through a single pinhole or a plurality of pinholes from a plurality of angles through movement of the detector; or 3) a plurality of PSPMT detectors that obtain a plurality of views from different angles simultaneously or virtually simultaneously. The plurality of images obtained from these various techniques, through angular displacement of the various acquired images, provide the information required to generate the three dimensional images needed to define the location of the radioactive seed source within the body of the living organism.

  12. Evaluating the cost of therapy for restenosis: considerations for brachytherapy.

    PubMed

    Weintraub, W S

    1996-11-01

    Costs have become increasingly important in medicine in recent years as demand for services has outstripped readily available resources. Clinical microeconomics offers an approach to understanding cost and outcomes in an environment of economic scarcity. In this article the types of costs and methods for determining cost are presented. In addition, methods for assessing outcome and outcome in relation to cost are developed. Restenosis after coronary angioplasty is a prime example of a clinical problem requiring economic evaluation. This is because it results in little serious morbidity except for recurrent chest pain, but it has serious economic consequences which occur some time after the original angioplasty. This makes the economic assessment of restenosis complicated. The application of health care microeconomic principles to brachytherapy for restenosis in the coronary arteries is presented. PMID:8960526

  13. Registration of structurally dissimilar images in MRI-based brachytherapy

    NASA Astrophysics Data System (ADS)

    Berendsen, F. F.; Kotte, A. N. T. J.; de Leeuw, A. A. C.; Jürgenliemk-Schulz, I. M.; Viergever, M. A.; Pluim, J. P. W.

    2014-08-01

    A serious challenge in image registration is the accurate alignment of two images in which a certain structure is present in only one of the two. Such topological changes are problematic for conventional non-rigid registration algorithms. We propose to incorporate in a conventional free-form registration framework a geometrical penalty term that minimizes the volume of the missing structure in one image. We demonstrate our method on cervical MR images for brachytherapy. The intrapatient registration problem involves one image in which a therapy applicator is present and one in which it is not. By including the penalty term, a substantial improvement in the surface distance to the gold standard anatomical position and the residual volume of the applicator void are obtained. Registration of neighboring structures, i.e. the rectum and the bladder is generally improved as well, albeit to a lesser degree.

  14. Angiosarcoma of the Prostate Gland following Brachytherapy for Prostatic Adenocarcinoma

    PubMed Central

    Gupta, Arjun; Patnaik, Mrinal M.; Naina, Harris V.

    2015-01-01

    Prostatic adenocarcinoma is the most common cancer in men, but only a handful of cases of prostatic angiosarcoma have been reported in the literature. Prior radiation therapy for prostatic adenocarcinoma has been hypothesized to be a risk factor for angiosarcoma. The increasing practice of prostate cancer screening and the use of radiation therapy for management of prostatic adenocarcinoma will likely lead to more cases of prostatic angiosarcoma. Diagnosis is made by tissue sampling. Optimal management of these aggressive tumors remains to be defined and outcomes are poor with a high 1-year mortality. Primary care physicians and urologists should be aware of this rare entity and refer these patients to specialist centers where they can be managed by a multidisciplinary team. We report a case of angiosarcoma of the prostate gland diagnosed in a male presenting with lower urinary tract symptoms 5 years after brachytherapy for prostate adenocarcinoma. PMID:26889128

  15. Radiobiological evaluation of low dose-rate prostate brachytherapy implants

    NASA Astrophysics Data System (ADS)

    Knaup, Courtney James

    Low dose-rate brachytherapy is a radiation therapy treatment for men with prostate cancer. While this treatment is common, the use of isotopes with varying dosimetric characteristics means that the prescription level and normal organ tolerances vary. Additionally, factors such as prostate edema, seed loss and seed migration may alter the dose distribution within the prostate. The goal of this work is to develop a radiobiological response tool based on spatial dose information which may be used to aid in treatment planning, post-implant evaluation and determination of the effects of prostate edema and seed migration. Aim 1: Evaluation of post-implant prostate edema and its dosimetric and biological effects. Aim 2: Incorporation of biological response to simplify post-implant evaluation. Aim 3: Incorporation of biological response to simplify treatment plan comparison. Aim 4: Radiobiologically based comparison of single and dual-isotope implants. Aim 5: Determine the dosimetric and radiobiological effects of seed disappearance and migration.

  16. Electronic brachytherapy--current status and future directions.

    PubMed

    Eaton, D J

    2015-05-01

    In the past decade, electronic brachytherapy (EB) has emerged as an attractive modality for the treatment of skin lesions and intraoperative partial breast irradiation, as well as finding wider applications in intracavitary and interstitial sites. These miniature X-ray sources, which operate at low kilovoltage energies (<100 kV), have reduced shielding requirements and inherent portability, therefore can be used outside the traditional realms of the radiotherapy department. However, steep dose gradients and increased sensitivity to inhomogeneities challenge accurate dosimetry. Secondly, ease of use does not mitigate the need for close involvement by medical physics experts and consultant oncologists. Finally, further studies are needed to relate the more heterogeneous dose distributions to clinical outcomes. With these provisos, the practical convenience of EB strongly suggests that it will become an established option for selected patients, not only in radiotherapy departments but also in a range of operating theatres and clinics around the world. PMID:25748070

  17. Regeneration in cervix cancer after sup 252 Cf neutron brachytherapy

    SciTech Connect

    Maruyama, Y.; Wierzbicki, J.; Feola, J.; Urano, M. )

    1990-07-01

    Regeneration of clonogens in human cervical cancer was assessed by the pathological evaluation of the hysterectomy specimen after intracavitary {sup 252}Cf neutron brachytherapy implants separated by varying time intervals followed by extrafascial hysterectomy. In this study, patients with bulky/barrel shaped Stage IB cervical cancers received {sup 252}Cf implants plus approximately 45 Gy of whole pelvis linear accelerator radiotherapy in approximately 25 fractions in 5 weeks followed by hysterectomy 4-6 weeks after radiotherapy. The specimens were studied grossly and microscopically for residual tumor. It was found that the fraction of positive specimens increased with elapsed time interval between implants. These findings support the hypothesis that there is repopulation of surviving clonogens with increased time interval between the implants. The observation also supports current concerns that rapid depopulation of tumor can lead to rapid repopulation, that is, rapid shrinkage of tumor can alter the physiological environment such that clonogens can rapidly regenerate.

  18. Experimental and Monte Carlo measurements of dose perturbation around a non-radioactive brachytherapy seed in external beam radiotherapy

    NASA Astrophysics Data System (ADS)

    Steinman, James P.

    I-125 seeds used in permanent prostate brachytherapy are composed of high-Z metals and may number from 40 to over 100 in a typical implant. If any supplemental external beam treatment is administered afterward (as for salvaging failed brachytherapy treatment), it is possible that the seeds may cause substantial dose perturbation which will depend on numerous factors (photon energy, depth, field size, number of seeds, etc.) and this effect needs to be thoroughly investigated. Film measurements were primarily done using Kodak XV2 layered above and below a non-radioactive I-125 seed placed in a groove on a Lucite plate with 5 cm buildup and 10 cm backscatter added at 95 cm SSD. The phantom was irradiated with and without seed with 6 MV photons for a 1 x 1 cm2 field size. Monte Carlo simulations were carried out using DOSXYZnrc using the same parameters and compared with Gafchromic EBT2 film. Other comparisons looked at changing energy, depth, and field size in both with and without seeds configuration. This study was further extended to include metals of various Z of the seed's dimensions and also looked into effect of 3 seeds spaced 0.5 cm vertically. Another measurement was done using two opposing fields using single as well as 3 seed configuration to see whether the dose enhancement and attenuation cancel out in multi-field treatments which is the norm clinically in a prostate treatment. For a single I-125 seed, on XV film a localized dose enhancement of 6.3% upstream and -10.9% downstream was noticed. With three seeds, this effect did not change. With two opposing fields, a cold spot around the seed of ~3% was noticed from film measurements. Increasing energy and field size decreased the effect while increase in Z of material greatly increased the effect. Increasing depth appeared to have no effect. DOSXYZnrc and EBT2 film verified maximum dose enhancement of +15% upstream and -20% downstream of the I-125 seed surface. In general, the range of the effect was

  19. Dose estimation for different skin models in interstitial breast brachytherapy

    PubMed Central

    Kabacińska, Renata; Makarewicz, Roman

    2014-01-01

    Purpose Skin is a major organ at risk in breast-conserving therapy (BCT). The American Brachytherapy Society (ABS) recommendations require monitoring of maximum dose received, however, there is no unambiguous way of skin contouring provided. The purpose of this study was to compare the doses received by the skin in different models. Material and methods Standard treatment plans of 20 patients who underwent interstitial breast brachytherapy were analyzed. Every patient had a new treatment plan prepared according to Paris system and had skin contoured in three different ways. The first model, Skin 2 mm, corresponds to the dermatological breast skin thickness and is reaching 2 mm into an external patient contour. It was rejected in a further analysis, because of distinct discontinuities in contouring. The second model, Skin 4 mm, replaced Skin 2 mm, and is reaching 2 mm inside and 2 mm outside of the External contour. The third model, Skin EXT, is created on the External contour and it expands 4 mm outside. Doses received by the most exposed 0.1 cc, 1 cc, 2 cc, and the maximum doses for Skin 4 mm and Skin EXT were compared. Results Mean, median, maximum, and standard deviation of percentage dose difference between Skin EXT and Skin 4 mm for the most exposed 0.1 cc (D0.1cc) of skin were 18.01%, 17.20%, 27.84%, and 4.01%, respectively. All differences were statistically significant (p < 0.05). Conclusions Monitoring of doses received by skin is necessary to avoid complications and obtain a satisfactory cosmetic effect. It is difficult to assess the compatibility of treatment plans with recommendations, while there is no unambiguous way of skin contouring. Especially, if a mean difference of doses between two models of skin contouring is 18% for the most exposed 0.1 cc and can reach almost 28% in some cases. Differences of this magnitude can result in skin complications during BCT. PMID:25097562

  20. Dosimetry of the 198Au Source used in Interstitial Brachytherapy

    SciTech Connect

    Dauffy, L; Braby, L; Berner, B

    2004-05-18

    The American Association of Physicists in Medicine Task Group 43 report, AAPM TG-43, provides an analytical model and a dosimetry protocol for brachytherapy dose calculations, as well as documentation and results for some sealed sources. The radionuclide {sup 198}Au (T{sub 1/2} = 2.70 days, E{gamma} = 412 keV) has been used in the form of seeds for brachytherapy treatments including brain, eye, and prostate tumors. However, the TG-43 report has no data for {sup 198}Au seeds, and none have previously been obtained. For that reason, and because of the conversion of most treatment planning systems to TG-43 based methods, both Monte Carlo calculations (MCNP 4C) and thermoluminescent dosimeters (TLDs) are used in this work to determine these data. The geometric variation in dose is measured using an array of TLDs in a solid water phantom, and the seed activity is determined using both a well ion chamber and a High Purity Germanium detector (HPGe). The results for air kerma strength, S{sub k}, per unit apparent activity, are 2.06 (MCNP) and 2.09 (measured) U mCi{sup -1}. The former is identical to what was published in 1991 in the AAPM Task Group 32 report. The dose rate constant results, {Lambda}, are 1.12 (MCNP) and 1.10 (measured), cGy h{sup -1} U{sup -1}. The radial dose function, g(r), anisotropy function, F(r,{theta}), and anisotropy factor, {psi}{sub an}(r), are given. The anisotropy constant values are 0.973 (MCNP) and 0.994 (measured) and are consistent with both source geometry and the emitted photon energy.

  1. Monte Carlo dosimetry of a new 90Y brachytherapy source

    PubMed Central

    Junxiang, Wu; Shihu, You; Jing, Huang; Fengxiang, Long; Chengkai, Wang; Zhangwen, Wu; Qing, Hou

    2015-01-01

    Purpose In this study, we attempted to obtain full dosimetric data for a new 90Y brachytherapy source developed by the College of Chemistry (Sichuan University) for use in high-dose-rate after-loading systems. Material and methods The dosimetric data for this new source were used as required by the dose calculation formalisms proposed by the AAPM Task Group 60 and Task Group 149. The active core length of the new 90Y source was increased to 4.7 mm compared to the value of 2.5 mm for the old 90Sr/90Y source. The Monte Carlo simulation toolkit Geant4 was used to calculate these parameters. The source was located in a 30-cm-radius theoretical sphere water phantom. Results The dosimetric data included the reference absorbed dose rate, the radial dose function in the range of 1.0 to 8.0 mm in the longitudinal axis, and the anisotropy function with a θ in the range of 0° to 90° at 5° intervals and an r in the range of 1.0 to 8.0 mm in 0.2-mm intervals. The reference absorbed dose rate for the new 90Y source was determined to be equal to 1.6608 ± 0.0008 cGy s–1 mCi–1, compared to the values of 0.9063 ± 0.0005 cGy s–1 mCi–1 that were calculated for the old 90Sr/90Y source. A polynomial function was also obtained for the radial dose function by curve fitting. Conclusions Dosimetric data are provided for the new 90Y brachytherapy source. These data are meant to be used commercially in after-loading system. PMID:26622247

  2. Dosimetry of the 198Au source used in interstitial brachytherapy.

    PubMed

    Dauffy, Lucile S; Braby, Leslie A; Berner, Barry M

    2005-06-01

    The American Association of Physicists in Medicine Task Group 43 reports, AAPM TG-43 and its update TG-43U1, provide an analytical model and a dosimetry protocol for brachytherapy dose calculations, as well as documentation and results for some sealed sources. The radionuclide 198Au (T(1/2)=2.70 days, Egamma=412 keV) has been used in the form of seeds for brachytherapy treatments including brain, eye, and prostate tumors. However, TG-43 reports have no data for 198Au seeds, and none have previously been obtained. For that reason, and because of the conversion of most treatment planning systems to TG-43 based methods, both Monte Carlo calculations (MCNP 4C2) and thermoluminescent dosimeters (TLDs) are used in this work to determine these data. The geometric variation in dose is measured using an array of TLDs in a solid water phantom, and the seed activity is determined using a high purity germanium detector (HPGe) and a well ionization chamber. The results for air kerma strength, Sk, per unit apparent activity, are 2.063 (MCNP) and 2.089 (measured) U mCi(-1), values close to those published in 1991 in the AAPM Task Group 32 report. The dose rate constant, lambda, is found equal to 1.115 (MCNP) and 1.095 (measured) cGy h(-1) U(-1). The radial dose function, g(r), anisotropy function, F(r, theta), and anisotropy factor, phi(an)(r), are also given. PMID:16013717

  3. Dovetail spoke internal permanent magnet machine

    DOEpatents

    Alexander, James Pellegrino; EL-Refaie, Ayman Mohamed Fawzi; Lokhandwalla, Murtuza; Shah, Manoj Ramprasad; VanDam, Jeremy Daniel

    2011-08-23

    An internal permanent magnet (IPM) machine is provided. The IPM machine includes a stator assembly and a stator core. The stator core also includes multiple stator teeth. The stator assembly is further configured with stator windings to generate a stator magnetic field when excited with alternating currents and extends along a longitudinal axis with an inner surface defining a cavity. The IPM machine also includes a rotor assembly and a rotor core. The rotor core is disposed inside the cavity and configured to rotate about the longitudinal axis. The rotor assembly further includes a shaft. The shaft further includes multiple protrusions alternately arranged relative to multiple bottom structures provided on the shaft. The rotor assembly also includes multiple stacks of laminations disposed on the protrusions and dovetailed circumferentially around the shaft. The rotor assembly further includes multiple pair of permanent magnets for generating a magnetic field, which magnetic field interacts with the stator magnetic field to produce a torque. The multiple pair of permanent magnets are disposed between the stacks. The rotor assembly also includes multiple middle wedges mounted between each pair of the multiple permanent magnets.

  4. PROCEDURE FOR ESTIMATING PERMANENT TOTAL ENCLOSURE COSTS

    EPA Science Inventory

    The paper discusses a procedure for estimating permanent total enclosure (PTE) costs. (NOTE: Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use PTEs, enclosures that mee...

  5. Considerations on the Development of Permanent Education.

    ERIC Educational Resources Information Center

    Ogunsbiye, Ayo

    This document presents possible ways in which Permanent Education in France could develop, based on experiments and research carried out at the Centre Universitaire de Cooperation Economique et Sociale (CUCES) and at the Institut National pour la Formation des Adults (INFA). Part one includes the following: the good to be had from continuing…

  6. Permanent embryo arrest: molecular and cellular concepts.

    PubMed

    Betts, D H; Madan, P

    2008-08-01

    Developmental arrest is one of the mechanisms responsible for the elevated levels of embryo demise during the first week of in vitro development. Approximately 10-15% of IVF embryos permanently arrest in mitosis at the 2- to 4-cell cleavage stage showing no indication of apoptosis. Reactive oxygen species (ROS) are implicated in this process and must be controlled in order to optimize embryo production. A stress sensor that can provide a key understanding of permanent cell cycle arrest and link ROS with cellular signaling pathway(s) is p66Shc, an adaptor protein for apoptotic-response to oxidative stress. Deletion of the p66Shc gene in mice results in extended lifespan, which is linked to their enhanced resistance to oxidative stress and reduced levels of apoptosis. p66Shc has been shown to generate mitochondrial H(2)O(2) to trigger apoptosis, but may also serve as an integration point for many signaling pathways that affect mitochondrial function. We have detected elevated levels of p66Shc and ROS within arrested embryos and believe that p66Shc plays a central role in regulating permanent embryo arrest. In this paper, we review the cellular and molecular aspects of permanent embryo arrest and speculate on the mechanism(s) and etiology of this method of embryo demise. PMID:18511487

  7. Atom optics with permanent magnetic components

    NASA Astrophysics Data System (ADS)

    Meschede, Dieter; Bloch, Immanuel; Goepfert, A.; Haubrich, D.; Kreis, M.; Lison, F.; Schuetze, R.; Wynands, Robert

    1997-05-01

    We have fabricated and investigated efficient magnetic lenses, waveguides, and mirrors from rare earth permanent materials. They are affordable and maintenance free. In contrast to corresponding light force components they do not need any supplies, they have large apertures, high reflectivity, and there is no spontaneous emission. The cylindrical shape of magnetic components is furthermore well suited to steer atomic beams.

  8. Sexism and Permanent Exclusion from School

    ERIC Educational Resources Information Center

    Carlile, Anna

    2009-01-01

    Focussing on narratives collected during a two year participant observation research project in the children's services department of an urban local authority, this article addresses the intersection between incidents of permanent exclusion from school and assumptions made on the basis of a young person's gender. The article considers gendered…

  9. War Crimes Tribunals: A Permanent Criminal Court?

    ERIC Educational Resources Information Center

    Dorsey, James E.; Rudelius-Palmer, Kristi

    1997-01-01

    Reports on the establishment and jurisdiction of war crimes tribunals in recent years. The tribunals, established and supported by the United Nations, investigate atrocities and other crimes committed during wartime. Discusses the tribunals in Rwanda and Yugoslavia, and the political opposition to the establishment of a permanent court. (MJP)

  10. Pupil Dilation and Object Permanence in Infants

    ERIC Educational Resources Information Center

    Sirois, Sylvain; Jackson, Iain R.

    2012-01-01

    This paper examines the relative merits of looking time and pupil diameter measures in the study of early cognitive abilities of infants. Ten-month-old infants took part in a modified version of the classic drawbridge experiment used to study object permanence (Baillargeon, Spelke, & Wasserman, 1985). The study involved a factorial design where…

  11. Lowering the Permanent Rate of Unemployment.

    ERIC Educational Resources Information Center

    Feldstein, Martin S.

    The first section of the study on lowering the permanent rate of unemployment discusses the effects and limitations of increasing aggregate demand through fiscal and monetary policy and indicates the inability to achieve the desired level of unemployment simply by stimulating demand. Section 2 analyzes the characteristics and structure of our…

  12. Laced permanent magnet quadrupole drift tube magnets

    SciTech Connect

    Feinberg, B.; Behrsing, G.U.; Halbach, K.; Marks, J.S.; Morrison, M.E.; Nelson, D.H.

    1988-10-01

    A laced permanent magnet quadrupole drift tube magnet has been constructed for a proof-of-principle test. The magnet is a conventional tape-wound quadrupole electromagnet, using iron pole- pieces, with the addition of permanent magnet material (neodymium iron) between the poles to reduce the effects of saturation. The iron is preloaded with magnetic flux generated by the permanent magnet material, resulting in an asymmetrical saturation curve. Since the polarity of the quadrupole magnets in a drift tube linac is not reversed we can take advantage of this asymmetrical saturation to provide greater focusing strength. The magnet configuration has been optimized and the vanadium permendur poles needed in a conventional quadrupole have been replaced with iron poles. The use of permanent magnet material has allowed us to increase the focusing strength of the magnet by about 20% over that of a conventional tape-wound quadrupole. Comparisons will be made between this magnet and the conventional tape-wound quadrupole. 3 refs., 5 figs.

  13. Permanent isolation surface barrier development plan

    SciTech Connect

    Wing, N.R.

    1994-01-01

    The exhumation and treatment of wastes may not always be the preferred alternative in the remediation of a waste site. In-place disposal alternatives, under certain circumstances, may be the most desirable alternatives to use in the protection of human health and the environment. The implementation of an in-place disposal alternative will likely require some type of protective covering that will provide long-term isolation of the wastes from the accessible environment. Even if the wastes are exhumed and treated, a long-term barrier may still be needed to adequately dispose of the treated wastes or any remaining waste residuals. Currently, no {open_quotes}proven{close_quotes} long-term barrier is available. The Hanford Site Permanent Isolation Surface Barrier Development Program (BDP) was organized to develop the technology needed to provide a long-term surface barrier capability for the Hanford Site. The permanent isolation barrier technology also could be used at other sites. Permanent isolation barriers use engineered layers of natural materials to create an integrated structure with redundant protective features. Drawings of conceptual permanent isolation surface barriers are shown. The natural construction materials (e.g., fine soil, sand, gravel, riprap, asphalt) have been selected to optimize barrier performance and longevity. The objective of current designs is to use natural materials to develop a maintenance-free permanent isolation surface barrier that isolates wastes for a minimum of 1,000 years by limiting water drainage to near-zero amounts; reducing the likelihood of plant, animal, and human intrusion; controlling the exhalation of noxious gases; and minimizing erosion-related problems.

  14. GGEMS-Brachy: GPU GEant4-based Monte Carlo simulation for brachytherapy applications

    NASA Astrophysics Data System (ADS)

    Lemaréchal, Yannick; Bert, Julien; Falconnet, Claire; Després, Philippe; Valeri, Antoine; Schick, Ulrike; Pradier, Olivier; Garcia, Marie-Paule; Boussion, Nicolas; Visvikis, Dimitris

    2015-07-01

    In brachytherapy, plans are routinely calculated using the AAPM TG43 formalism which considers the patient as a simple water object. An accurate modeling of the physical processes considering patient heterogeneity using Monte Carlo simulation (MCS) methods is currently too time-consuming and computationally demanding to be routinely used. In this work we implemented and evaluated an accurate and fast MCS on Graphics Processing Units (GPU) for brachytherapy low dose rate (LDR) applications. A previously proposed Geant4 based MCS framework implemented on GPU (GGEMS) was extended to include a hybrid GPU navigator, allowing navigation within voxelized patient specific images and analytically modeled 125I seeds used in LDR brachytherapy. In addition, dose scoring based on track length estimator including uncertainty calculations was incorporated. The implemented GGEMS-brachy platform was validated using a comparison with Geant4 simulations and reference datasets. Finally, a comparative dosimetry study based on the current clinical standard (TG43) and the proposed platform was performed on twelve prostate cancer patients undergoing LDR brachytherapy. Considering patient 3D CT volumes of 400  × 250  × 65 voxels and an average of 58 implanted seeds, the mean patient dosimetry study run time for a 2% dose uncertainty was 9.35 s (≈500 ms 10-6 simulated particles) and 2.5 s when using one and four GPUs, respectively. The performance of the proposed GGEMS-brachy platform allows envisaging the use of Monte Carlo simulation based dosimetry studies in brachytherapy compatible with clinical practice. Although the proposed platform was evaluated for prostate cancer, it is equally applicable to other LDR brachytherapy clinical applications. Future extensions will allow its application in high dose rate brachytherapy applications.

  15. Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus

    PubMed Central

    Wallace, Charlie; Gondi, Vinai; Das, Rupak; Straub, Margaret; Al-Niaimi, Ahmed; Applegate, Glenn; Bradley, Kristin A.

    2014-01-01

    Purpose To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma. Material and methods The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy. Results The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV. Conclusions Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances. PMID:24790625

  16. A comparison study on various low energy sources in interstitial prostate brachytherapy

    PubMed Central

    Bakhshabadi, Mahdi; Ghorbani, Mahdi; Knaup, Courtney; Meigooni, Ali S.

    2016-01-01

    Purpose Low energy sources are routinely used in prostate brachytherapy. 125I is one of the most commonly used sources. Low energy 131Cs source was introduced recently as a brachytherapy source. The aim of this study is to compare dose distributions of 125I, 103Pd, and 131Cs sources in interstitial brachytherapy of prostate. Material and methods ProstaSeed 125I brachytherapy source was simulated using MCNPX Monte Carlo code. Additionally, two hypothetical sources of 103Pd and 131Cs were simulated with the same geometry as the ProstaSeed 125I source, while having their specific emitted gamma spectra. These brachytherapy sources were simulated with distribution of forty-eight seeds in a phantom including prostate. The prostate was considered as a sphere with radius of 1.5 cm. Absolute and relative dose rates were obtained in various distances from the source along the transverse and longitudinal axes inside and outside the tumor. Furthermore, isodose curves were plotted around the sources. Results Analyzing the initial dose profiles for various sources indicated that with the same time duration and air kerma strength, 131Cs delivers higher dose to tumor. However, relative dose rate inside the tumor is higher and outside the tumor is lower for the 103Pd source. Conclusions The higher initial absolute dose in cGy/(h.U) of 131Cs brachytherapy source is an advantage of this source over the others. The higher relative dose inside the tumor and lower relative dose outside the tumor for the 103Pd source are advantages of this later brachytherapy source. Based on the total dose the 125I source has advantage over the others due to its longer half-life. PMID:26985200

  17. GGEMS-Brachy: GPU GEant4-based Monte Carlo simulation for brachytherapy applications.

    PubMed

    Lemaréchal, Yannick; Bert, Julien; Falconnet, Claire; Després, Philippe; Valeri, Antoine; Schick, Ulrike; Pradier, Olivier; Garcia, Marie-Paule; Boussion, Nicolas; Visvikis, Dimitris

    2015-07-01

    In brachytherapy, plans are routinely calculated using the AAPM TG43 formalism which considers the patient as a simple water object. An accurate modeling of the physical processes considering patient heterogeneity using Monte Carlo simulation (MCS) methods is currently too time-consuming and computationally demanding to be routinely used. In this work we implemented and evaluated an accurate and fast MCS on Graphics Processing Units (GPU) for brachytherapy low dose rate (LDR) applications. A previously proposed Geant4 based MCS framework implemented on GPU (GGEMS) was extended to include a hybrid GPU navigator, allowing navigation within voxelized patient specific images and analytically modeled (125)I seeds used in LDR brachytherapy. In addition, dose scoring based on track length estimator including uncertainty calculations was incorporated. The implemented GGEMS-brachy platform was validated using a comparison with Geant4 simulations and reference datasets. Finally, a comparative dosimetry study based on the current clinical standard (TG43) and the proposed platform was performed on twelve prostate cancer patients undergoing LDR brachytherapy. Considering patient 3D CT volumes of 400  × 250  × 65 voxels and an average of 58 implanted seeds, the mean patient dosimetry study run time for a 2% dose uncertainty was 9.35 s (≈500 ms 10(-6) simulated particles) and 2.5 s when using one and four GPUs, respectively. The performance of the proposed GGEMS-brachy platform allows envisaging the use of Monte Carlo simulation based dosimetry studies in brachytherapy compatible with clinical practice. Although the proposed platform was evaluated for prostate cancer, it is equally applicable to other LDR brachytherapy clinical applications. Future extensions will allow its application in high dose rate brachytherapy applications. PMID:26061230

  18. Brachytherapy Application with in situ Dose-painting Administered via Gold-nanoparticle Eluters

    PubMed Central

    Sinha, Neeharika; Cifter, Gizem; Sajo, Erno; Kumar, Rajiv; Sridhar, Srinivas; Nguyen, Paul; Cormack, Robert A; Makrigiorgos, G. Mike; Ngwa, Wilfred

    2014-01-01

    Purpose Recent studies show promise that administering gold nanoparticles (GNP) to tumor cells during brachytherapy could significantly enhance radiation damage to the tumor. A proposed new strategy for sustained administration of the GNP in prostate tumors is to load them into routinely used brachytherapy spacers for customizable in-situ release after implantation. This in silico study investigates the intra-tumor biodistribution and corresponding dose enhancement over time due to GNP released from such GNP-loaded brachytherapy spacers (GBS). Method and Materials An experimentally determined intra-tumoral diffusion coefficient (D) for 10 nm nanoparticles was employed to estimate D for other sizes using the Stoke-Einstein equation. GNP concentration profiles, obtained using D, were then employed to calculate the corresponding dose enhancement factor (DEF) for each tumor voxel using dose-painting by numbers approach, for times relevant to the considered brachytherapy sources' lifetimes. The investigation is carried out as a function of GNP size for clinically applicable low dose rate brachytherapy sources: I-125, Pd-103, Cs-131. Results Results showed that dose enhancement to tumor voxels/sub-volumes during brachytherapy can be customized by varying the sizes of GNP released or eluted from the GBS. For example, using 7 mg/g GNP concentration, significant DEF (> 20%) could be achieved 5 mm from a GBS after 5, 12, 25, 46, 72, 120, and 195 days, respectively, for GNPs sizes of 2 nm, 5 nm, 10 nm, 20 nm, 30 nm 50 nm, and 80 nm when treating with I-125. Conclusions Analyses show that using Cs-131 provides the highest dose enhancement to tumor voxels. However, given its relatively longer half-life, I-125 presents the most flexibility for customizing the dose enhancement as a function of GNP size. The findings provide a useful reference for further work towards potential development of a new brachytherapy application with in-situ dose-painting administered via gold

  19. Comparison of external beam radiation and brachytherapy to external beam radiation alone for unresectable extrahepatic cholangiocarcinoma

    PubMed Central

    Boothe, Dustin; Hopkins, Zachary; Frandsen, Jonathan

    2016-01-01

    Background Extrahepatic cholangiocarcinoma (EHC) is a rare malignancy with a relatively poor prognosis. There are no randomized, prospective data to help define the optimal method of radiation delivery for unresectable EHC. The purpose of this study was to evaluate the benefit of adding brachytherapy to external beam radiation therapy (EBRT) for unresectable EHC. Methods A retrospective review of 1,326 patients with unresectable EHC using the Surveillance, Epidemiology, and End Results (SEER) database was completed. Kaplan-Meier methods were used to analyze the primary endpoint, overall survival. Univariate and multivariate analysis was performed to identify and control for potential confounding variables, including age at diagnosis, sex, stage, grade, histology, race, year of diagnosis, and reason for no surgery. Results Of the 1,326 patients with unresectable EHC, 1,188 (92.9%) received EBRT only, while 91 (7.1%) received both EBRT and brachytherapy. Patients receiving combined modality radiation therapy were more likely to be treated prior to the year 2000. Median overall survival for patients receiving EBRT and EBRT plus brachytherapy was 9 and 11 months, respectively (P=0.04). Cause specific survival was 12 months for those receiving EBRT only, and 15 months for those who received EBRT + brachytherapy (P=0.10). Survival analysis performed on patients with locoregional disease only revealed a trend towards prolonged overall survival with those receiving EBRT + brachytherapy (P=0.08). Multivariate analysis revealed grade and stage of disease were correlated with both overall survival and cause specific survival (P≤0.05). Conclusions Among patients with unresectable EHC, the addition of brachytherapy to EBRT is associated with a prolonged median overall survival. However, the use of brachytherapy boost decreased in the last decade of the study. PMID:27563448

  20. In Vivo Dosimetry Using a Linear Mosfet-Array Dosimeter to Determine the Urethra Dose In {sup 125}I Permanent Prostate Implants

    SciTech Connect

    Bloemen-van Gurp, Esther J. Murrer, Lars H.P.; Haanstra, Bjoerk K.C.; Gils, Francis C.J.M. van; Dekker, Andre L.A.J.; Mijnheer, Ben J.; Lambin, Philippe

    2009-01-01

    Purpose: In vivo dosimetry during brachytherapy of the prostate with {sup 125}I seeds is challenging because of the high dose gradients and low photon energies involved. We present the results of a study using metal-oxide-semiconductor field-effect transistor (MOSFET) dosimeters to evaluate the dose in the urethra after a permanent prostate implantation procedure. Methods and Materials: Phantom measurements were made to validate the measurement technique, determine the measurement accuracy, and define action levels for clinical measurements. Patient measurements were performed with a MOSFET array in the urinary catheter immediately after the implantation procedure. A CT scan was performed, and dose values, calculated by the treatment planning system, were compared to in vivo dose values measured with MOSFET dosimeters. Results: Corrections for temperature dependence of the MOSFET array response and photon attenuation in the catheter on the in vivo dose values are necessary. The overall uncertainty in the measurement procedure, determined in a simulation experiment, is 8.0% (1 SD). In vivo dose values were obtained for 17 patients. In the high-dose region (> 100 Gy), calculated and measured dose values agreed within 1.7% {+-} 10.7% (1 SD). In the low-dose region outside the prostate (< 100 Gy), larger deviations occurred. Conclusions: MOSFET detectors are suitable for in vivo dosimetry during {sup 125}I brachytherapy of prostate cancer. An action level of {+-} 16% (2 SD) for detection of errors in the implantation procedure is achievable after validation of the detector system and measurement conditions.

  1. Evaluation of Dosimetric Parameters and Disease Response After {sup 125}Iodine Transperineal Brachytherapy for Low- and Intermediate-Risk Prostate Cancer

    SciTech Connect

    Morris, W. James Keyes, Mira M.D.; Palma, David M.D.; McKenzie, Michael; Spadinger, Ingrid; Agranovich, Alex; Pickles, Tom; Liu, Mitchell; Kwan, Winkle; Wu, Jonn; Lapointe, Vince; Berthelet, Eric; Pai, Howard; Harrison, Robert; Kwa, William; Bucci, Joe; Racz, Violet; Woods, Ryan

    2009-04-01

    Purpose: To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and 'low-tier' intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. Methods and Materials: A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi {sup 125}I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. Results: With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% {+-} 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p < 0.001), but this did not translate into improved bNED. Conclusions: In contrast to some previous studies, dosimetric outcomes did not correlate with biochemical recurrence in the first 1,006 patients treated with {sup 125}I prostate brachytherapy at the British Columbia Cancer Agency. Despite a median D90 of only 105% of MPD, our bNED rates are indistinguishable from series that reported higher D90 values.

  2. Long-Term Efficacy and Toxicity of Low-Dose-Rate {sup 125}I Prostate Brachytherapy as Monotherapy in Low-, Intermediate-, and High-Risk Prostate Cancer

    SciTech Connect

    Kittel, Jeffrey A.; Reddy, Chandana A.; Smith, Kristin L.; Stephans, Kevin L.; Tendulkar, Rahul D.; Ulchaker, James; Angermeier, Kenneth; Campbell, Steven; Stephenson, Andrew; Klein, Eric A.; Wilkinson, D. Allan; Ciezki, Jay P.

    2015-07-15

    Purpose/Objectives: To report long-term efficacy and toxicity for a single-institution cohort of patients treated with low-dose-rate prostate brachytherapy permanent implant (PI) monotherapy. Methods and Materials: From 1996 to 2007, 1989 patients with low-risk (61.3%), intermediate-risk (29.8%), high-intermediate-risk (4.5%), and high-risk prostate cancer (4.4%) were treated with PI and followed up prospectively in a registry. All patients were treated with {sup 125}I monotherapy to 144 Gy. Late toxicity was coded retrospectively according to a modified Common Terminology Criteria for Adverse Events 4.0 scale. The rates of biochemical relapse-free survival (bRFS), distant metastasis-free survival (DMFS), overall survival (OS), and prostate cancer–specific mortality (PCSM) were calculated. We identified factors associated with late grade ≥3 genitourinary (GU) and gastrointestinal (GI) toxicity, bRFS, DMFS, OS, PCSM, and incontinence. Results: The median age of the patients was 67 years, and the median overall and prostate-specific antigen follow-up times were 6.8 years and 5.8 years, respectively. The overall 5-year rates for bRFS, DMFS, OS, and PCSM were 91.9%, 97.8%, 93.7%, and 0.71%, respectively. The 10-year rates were 81.5%, 91.5%, 76.1%, and 2.5%, respectively. The overall rates of late grade ≥3 GU and GI toxicity were 7.6% and 0.8%, respectively. On multivariable analysis, age and prostate length were significantly associated with increased risk of late grade ≥3 GU toxicity. The risk of incontinence was highly correlated with both pre-PI and post-PI transurethral resection of the prostate. Conclusions: Prostate brachytherapy as monotherapy is an effective treatment for low-risk and low-intermediate-risk prostate cancer and appears promising as a treatment for high-intermediate-risk and high-risk prostate cancer. Significant long-term toxicities are rare when brachytherapy is performed as monotherapy.

  3. Comparison of 60Co and 192Ir sources in HDR brachytherapy

    PubMed Central

    Zwierzchowski, Grzegorz

    2011-01-01

    This paper compares the isotopes 60Co and 192Ir as radiation sources for high-dose-rate (HDR) afterloading brachytherapy. The smaller size of 192Ir sources made it the preferred radionuclide for temporary brachytherapy treatments. Recently also 60Co sources have been made available with identical geometrical dimensions. This paper compares the characteristics of both nuclides in different fields of brachytherapy based on scientific literature. In an additional part of this paper reports from medical physicists of several radiation therapy institutes are discussed. The purpose of this work is to investigate the advantages or disadvantages of both radionuclides for HDR brachytherapy due to their physical differences. The motivation is to provide useful information to support decision-making procedures in the selection of equipment for brachytherapy treatment rooms. The results of this work show that no advantages or disadvantages exist for 60Co sources compared to 192Ir sources with regard to clinical aspects. Nevertheless, there are potential logistical advantages of 60Co sources due to its longer half-life (5.3 years vs. 74 days), making it an interesting alternative especially in developing countries. PMID:23346129

  4. Tolerance of the carotid-sheath contents to brachytherapy: an experimental study

    SciTech Connect

    Werber, J.L.; Sood, B.; Alfieri, A.; McCormick, S.A.; Vikram, B. )

    1991-06-01

    Tumor invasion of the carotid artery is a potential indication for brachytherapy, which delivers a high dose of irradiation to residual tumor while limiting the dose to adjacent healthy tissues. The tolerance of carotid-sheath contents to varying doses of brachytherapy, however, has not been clearly established. In order to evaluate brachytherapy effects on carotid-sheath contents, after-loading catheters were implanted bilaterally in 3 groups of 6 rabbits each (18 rabbits). Iridium 192 brachytherapy doses of either 5000 cGy (rad), 9000 cGy, or 13,000 cGy were delivered unilaterally, with the contralateral neck serving as a nonirradiated control in each animal. There were no carotid ruptures and wound healing was normal. Two animals from each group were killed at 6, 20, and 48 weeks. Even at the highest dose (13,000 cGy), nerve conduction studies performed on the vagus nerve prior to sacrifice revealed no increased latency, histologic changes were minimal, and carotid arteries were patent. These observations suggest that the carotid-sheath contents in healthy rabbits could tolerate high doses (up to 13,000 cGy) of low-dose-rate interstitial brachytherapy without complications.

  5. Emerging permanent filler technologies: focus on Aquamid.

    PubMed

    Yamauchi, Paul S

    2014-01-01

    A plethora of soft tissue fillers have been developed within the past decade to correct the cutaneous changes that occur with photoaging. Such fillers, whether nonpermanent, semipermanent, or permanent, are widely used to fill undesired facial rhytides. In addition, fillers are employed to correct atrophy of the face as well as other parts of the body such as the dorsum of the hands through volumization and contouring. The extensive long-term safety outcomes reported with fillers and the ease with which they are administered make them an ideal choice to correct rhytides and to contour the face. However, as with any cosmetic procedure, in order to ensure high patient satisfaction and a safe outcome, proper training in injection techniques, the choice of the proper candidate, and awareness of potential adverse events are essential. This review article focuses on the permanent filler, Aquamid, which is composed of polyacrylamide hydrogel. PMID:25336982

  6. Emerging permanent filler technologies: focus on Aquamid

    PubMed Central

    Yamauchi, Paul S

    2014-01-01

    A plethora of soft tissue fillers have been developed within the past decade to correct the cutaneous changes that occur with photoaging. Such fillers, whether nonpermanent, semipermanent, or permanent, are widely used to fill undesired facial rhytides. In addition, fillers are employed to correct atrophy of the face as well as other parts of the body such as the dorsum of the hands through volumization and contouring. The extensive long-term safety outcomes reported with fillers and the ease with which they are administered make them an ideal choice to correct rhytides and to contour the face. However, as with any cosmetic procedure, in order to ensure high patient satisfaction and a safe outcome, proper training in injection techniques, the choice of the proper candidate, and awareness of potential adverse events are essential. This review article focuses on the permanent filler, Aquamid, which is composed of polyacrylamide hydrogel. PMID:25336982

  7. Towards Reliable Velocities of Permanent GNSS Stations

    NASA Astrophysics Data System (ADS)

    Bogusz, Janusz; Klos, Anna; Gruszczynska, Marta; Gruszczynski, Maciej

    2016-06-01

    In the modern geodesy the role of the permanent station is growing constantly. The proper treatment of the time series from such station lead to the determination of the reliable velocities. In this paper we focused on some pre-analysis as well as analysis issues, which have to be performed upon the time series of the North, East and Up components and showed the best, in our opinion, methods of determination of periodicities (by means of Singular Spectrum Analysis) and spatio-temporal correlations (Principal Component Analysis), that still exist in the time series despite modelling. Finally, the velocities of the selected European permanent stations with the associated errors determined following power-law assumption in the stochastic part is presented.

  8. Permanent genetic memory with >1-byte capacity.

    PubMed

    Yang, Lei; Nielsen, Alec A K; Fernandez-Rodriguez, Jesus; McClune, Conor J; Laub, Michael T; Lu, Timothy K; Voigt, Christopher A

    2014-12-01

    Genetic memory enables the recording of information in the DNA of living cells. Memory can record a transient environmental signal or cell state that is then recalled at a later time. Permanent memory is implemented using irreversible recombinases that invert the orientation of a unit of DNA, corresponding to the [0,1] state of a bit. To expand the memory capacity, we have applied bioinformatics to identify 34 phage integrases (and their cognate attB and attP recognition sites), from which we build 11 memory switches that are perfectly orthogonal to each other and the FimE and HbiF bacterial invertases. Using these switches, a memory array is constructed in Escherichia coli that can record 1.375 bytes of information. It is demonstrated that the recombinases can be layered and used to permanently record the transient state of a transcriptional logic gate. PMID:25344638

  9. Permanent genetic memory with >1 byte capacity

    PubMed Central

    Yang, Lei; Nielsen, Alec A.K.; Fernandez-Rodriguez, Jesus; McClune, Conor J.; Laub, Michael T.; Lu, Timothy K.; Voigt, Christopher A.

    2014-01-01

    Genetic memory enables the recording of information in the DNA of living cells. Memory can record a transient environmental signal or cell state that is then recalled at a later time. Permanent memory is implemented using irreversible recombinases that invert the orientation of a unit of DNA, corresponding to the [0,1] state of a bit. To expand the memory capacity, we have applied bioinformatics to identify 34 phage integrases (and their cognate attB and attP recognition sites), from which we build 11 memory switches that are perfectly orthogonal to each other and the FimE and HbiF bacterial invertases. Using these switches, a memory array is constructed in Escherichia coli that can record 1.375 bytes of information. It is demonstrated that the recombinases can be layered and used to permanently record the transient state of a transcriptional logic gate. PMID:25344638

  10. Permanent-magnet switched-flux machine

    DOEpatents

    Trzynadlowski, Andrzej M.; Qin, Ling

    2010-01-12

    A permanent-magnet switched-flux (PMSF) device has a ferromagnetic outer stator mounted to a shaft about a central axis extending axially through the PMSF device. Pluralities of top and bottom stator poles are respectively mounted in first and second circles, radially outwardly in first and second transverse planes extending from first and second sections of the central axis adjacent to an inner surface of the ferromagnetic outer stator. A ferromagnetic inner rotor is coupled to the shaft and has i) a rotor core having a core axis co-axial with the central axis; and ii) first and second discs having respective outer edges with first and second pluralities of permanent magnets (PMs) mounted in first and second circles, radially outwardly from the rotor core axis in the first and second transverse planes. The first and second pluralities of PMs each include PMs of alternating polarity.

  11. Permanent-magnet switched-flux machine

    DOEpatents

    Trzynadlowski, Andrzej M.; Qin, Ling

    2011-06-14

    A permanent-magnet switched-flux (PMSF) device has an outer rotor mounted to a shaft about a central axis extending axially through the PMSF device. First and second pluralities of permanent-magnets (PMs) are respectively mounted in first and second circles, radially outwardly in first and second transverse planes extending from first and second sections of the central axis adjacent to an inner surface of the outer rotor. An inner stator is coupled to the shaft and has i) a stator core having a core axis co-axial with the central axis; and ii) first and second pluralities of stator poles mounted in first and second circles, radially outwardly from the stator core axis in the first and second transverse planes. The first and second pluralities of PMs each include PMs of alternating polarity.

  12. Permanent-magnet switched-flux machine

    DOEpatents

    Trzynadlowski, Andrzej M.; Qin, Ling

    2012-02-21

    A permanent-magnet switched-flux (PMSF) device has an outer rotor mounted to a shaft about a central axis extending axially through the PMSF device. First and second pluralities of permanent-magnets (PMs) are respectively mounted in first and second circles, radially outwardly in first and second transverse planes extending from first and second sections of the central axis adjacent to an inner surface of the outer rotor. An inner stator is coupled to the shaft and has i) a stator core having a core axis co-axial with the central axis; and ii) first and second pluralities of stator poles mounted in first and second circles, radially outwardly from the stator core axis in the first and second transverse planes. The first and second pluralities of PMs each include PMs of alternating polarity.

  13. Rootless eruption of a mandibular permanent canine.

    PubMed

    Shapira, Yehoshua; Kuftinec, Mladen M

    2011-04-01

    The purpose of this article was to describe the rootless eruption of a mandibular permanent canine in a 10-year-old boy; his mandible had been fractured in a car accident. The fracture was at the region of the developing canine, resulting in arrested root formation and causing abnormal, rootless eruption. Current theories on tooth eruption and the important role of the dental follicle in the process of eruption are discussed. PMID:21457868

  14. "Permanence" - An Adaptationist Solution to Fermi's Paradox?

    NASA Astrophysics Data System (ADS)

    Cirkovic, Milan M.

    A new solution of Fermi's paradox sketched by SF writer Karl Schroeder in his 2002. novel Permanence is investigated. It is argued that this solution is tightly connected with adaptationism - a widely discussed working hypothesis in evolutionary biology. Schroeder's hypothesis has important ramifications for astrobiology, SETI projects, and future studies. Its weaknesses should be explored without succumbing to the emotional reactions often accompanying adaptationist explanations.

  15. Care of patients with permanent tracheostomy.

    PubMed

    Everitt, Erica

    The third article in our series on tracheostomy care discusses the care of patients with a permanent tracheostomy. While these patients make up a small proportion of all patients who have a tracheostomy inserted, they have complex needs. This means they require practitioners in both acute and community settings, who have time, support and competent tracheostomy-care skills, to achieve a successful discharge and ongoing management of their tracheostomy. PMID:27396099

  16. Magnetorheological torque transmission devices with permanent magnets

    NASA Astrophysics Data System (ADS)

    Böse, H.; Gerlach, T.; Ehrlich, J.

    2013-02-01

    A novel type of magnetorheological (MR) clutch whose magnetic circuit contains a combination of a permanent magnet and an electromagnet is described. Without the support of the electromagnet, the permanent magnet generates a magnetic field in the MR fluid shear gap which enables the MR clutch to transmit a torque without the supply of any electric energy. Hence, the operational states of this clutch are reversed with respect to the common MR clutches equipped with an electromagnet only. Three different MR clutches with hybrid magnetic circuits containing permanent magnet and electromagnet were designed, manufactured and tested. The three clutches differ in their number of mechanical parts which can rotate with respect to each other as well as in their size and weight and in their maximum transmittable torque. The largest MR clutch is capable to transmit torques up to nearly 800 Nm. The designs of the three novel MR clutches and the results of the mechanical tests upon variation of the coil current are presented in this paper.

  17. Retrosplenial Cortex Codes for Permanent Landmarks

    PubMed Central

    Auger, Stephen D.; Mullally, Sinéad L.; Maguire, Eleanor A.

    2012-01-01

    Landmarks are critical components of our internal representation of the environment, yet their specific properties are rarely studied, and little is known about how they are processed in the brain. Here we characterised a large set of landmarks along a range of features that included size, visual salience, navigational utility, and permanence. When human participants viewed images of these single landmarks during functional magnetic resonance imaging (fMRI), parahippocampal cortex (PHC) and retrosplenial cortex (RSC) were both engaged by landmark features, but in different ways. PHC responded to a range of landmark attributes, while RSC was engaged by only the most permanent landmarks. Furthermore, when participants were divided into good and poor navigators, the latter were significantly less reliable at identifying the most permanent landmarks, and had reduced responses in RSC and anterodorsal thalamus when viewing such landmarks. The RSC has been widely implicated in navigation but its precise role remains uncertain. Our findings suggest that a primary function of the RSC may be to process the most stable features in an environment, and this could be a prerequisite for successful navigation. PMID:22912894

  18. Modeling Of Permanent Magnet Motor Drives

    NASA Astrophysics Data System (ADS)

    Pillay, P.; Krishnan, R.

    1987-10-01

    Recent research has indicated that the permanent magnet motor drives which include the permanent magnet synchronous motor (PMSM) and the brushless DC motor (BDCM) could become serious competitors to the induction motor for servo applications. The PMSM has a sinusoidal back emf and requires sinusoidal stator currents to produce constant torque while the BDCM has a trapezoidal back emf and requires rectangular stator currents to produce constant torque. The PMSM is very similar to the wound rotor synchronous machine except that the PMSM that is used for servo applications tend not to have any damper windings and excitation is provided by a permanent magnet instead of a field winding. Hence the d,q model of the PMSM can be derived from the well known model of the synchronous machine with the equations of the damper windings and field current dynamics removed. Because of the nonsinusoidal variation of the mutual inductances between the stator and rotor in the BDCM, it is also shown in this paper that no particular advantage exists in transforming the abc equations of the BCDM to the d,q frame. Hence the solution of the original abc equations is proposed for the BDCM.

  19. [Permanent percutaneous electric connection. General principles].

    PubMed

    Sabin, P; Labbé, D; Levillain, D; Cazin, L; Caston, J

    1997-01-01

    The Swedes for more than twenty years, and the Germans for over five years have been able to maintain inert or active prostheses with permanent percutaneous connections, thanks to the dependable and proven material and techniques of extraoral implants. The significant improvement extra-oral implants have brought about is not only in a new therapeutic approach to the treatment of important facial defects or transmission deafness; it is also because for some twenty old years now, the few millimeter wide cylinders of Titanium, the affixed on the implants, have crossed the cutaneous barrier for extended periods without complications. The percutaneous abutment thus creates a permanent communication between the interior and the exterior of the organism. If the abutment, instead of simply carrying a Maxillo-Facial Prosthesis or an auditive prosthesis, is modified by placing an electric conductor inside it, the simple "percutaneous peg" will turn out to be, in a way, a "percutaneous electric plug". By adapting classic "mechanical" abutments and implants, authors have created a Permanent Percutaneous Electric Connection (PPEC) which has been successfully experimented on rabbits to record EEG. Clinical applications on humans would make it possible either to receive "bio-electrical information" coming from within the organism, or to send electrical energy into the organism. This last application opens vast perspectives of improvement both in diagnosis and therapy in many fields. PMID:9687654

  20. Patient perception of local anesthesia for prostate brachytherapy.

    PubMed

    Smathers, S; Wallner, K; Simpson, C; Roof, J

    2000-05-01

    Prostate brachytherapy is an increasingly popular treatment for early-stage prostate cancer. Until now, spinal or general anesthesia for the procedure has been the standard of care. For patient safety, patient convenience, and to limit use of operating facilities, the authors started performing implants routinely with local anesthesia. We present here an evaluation of patients' acceptance of prostate brachytherapy under local anesthesia. On arrival at our department on the morning of the procedure, the patient is brought into the simulator suite, an intravenous line is started, and a urinary catheter is inserted. With the patient in the lithotomy position, a 5-by-5-cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 mL of 1% lidocaine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 mL lidocaine solution with approximately 8 passes of a 20-gauge 1-inch needle. Following subcutaneous and periapical lidocaine injections, the transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 mL of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn. The lidocaine infiltration procedure takes approximately 10 to 15 minutes. Seed implantation is then performed as previously described. At the time of this report preparation, 58 of the 71 patients (81%) were interviewed, with a median follow-up of 6 months since the implant procedure. On a scale of 1 to 10, the median biopsy pain score was 4.5 compared with a median pain score with the implant procedure of 3.0. There was no clear correlation between the two scores (r = .26). There was no correlation

  1. Error Analysis of non-TLD HDR Brachytherapy Dosimetric Techniques

    NASA Astrophysics Data System (ADS)

    Amoush, Ahmad

    The American Association of Physicists in Medicine Task Group Report43 (AAPM-TG43) and its updated version TG-43U1 rely on the LiF TLD detector to determine the experimental absolute dose rate for brachytherapy. The recommended uncertainty estimates associated with TLD experimental dosimetry include 5% for statistical errors (Type A) and 7% for systematic errors (Type B). TG-43U1 protocol does not include recommendation for other experimental dosimetric techniques to calculate the absolute dose for brachytherapy. This research used two independent experimental methods and Monte Carlo simulations to investigate and analyze uncertainties and errors associated with absolute dosimetry of HDR brachytherapy for a Tandem applicator. An A16 MicroChamber* and one dose MOSFET detectors† were selected to meet the TG-43U1 recommendations for experimental dosimetry. Statistical and systematic uncertainty analyses associated with each experimental technique were analyzed quantitatively using MCNPX 2.6‡ to evaluate source positional error, Tandem positional error, the source spectrum, phantom size effect, reproducibility, temperature and pressure effects, volume averaging, stem and wall effects, and Tandem effect. Absolute dose calculations for clinical use are based on Treatment Planning System (TPS) with no corrections for the above uncertainties. Absolute dose and uncertainties along the transverse plane were predicted for the A16 microchamber. The generated overall uncertainties are 22%, 17%, 15%, 15%, 16%, 17%, and 19% at 1cm, 2cm, 3cm, 4cm, and 5cm, respectively. Predicting the dose beyond 5cm is complicated due to low signal-to-noise ratio, cable effect, and stem effect for the A16 microchamber. Since dose beyond 5cm adds no clinical information, it has been ignored in this study. The absolute dose was predicted for the MOSFET detector from 1cm to 7cm along the transverse plane. The generated overall uncertainties are 23%, 11%, 8%, 7%, 7%, 9%, and 8% at 1cm, 2cm, 3cm

  2. Thermodynamics of continuous media with permanent electric polarisation and magnetisation

    NASA Astrophysics Data System (ADS)

    Brechet, Sylvain; Ansermet, Jean-Philippe

    2012-11-01

    The thermodynamics of an electrically charged, multicomponent fluid with permanent electric polarisation, permanent magnetisation and intrinsic vorticity is analysed in the presence of electromagnetic fields with magnetoelectric coupling in the classical limit. Three equations characterising the fluid are derived: a thermostatic equilibrium equation, a reversible and an irreversible thermodynamic evolution equation. These equations are obtained by taking into account the first and second laws of thermodynamics, the chemical reactions, the second law of Newton in translation and in rotation, the local time evolution of the permanent polarisation and the permanent magnetisation, and Maxwell's equations. Explicit expressions for the temperature and the chemical potentials are derived in terms of the electromagnetic fields, the permanent electric polarisation, the permanent magnetisation, the intrinsic vorticity and the magnetoelectric coupling. The analysis of the irreversible thermodynamics yields novel dissipative equations accounting in particular for dielectrophoresis, magnetophoresis, the relaxation of the permanent electric polarisation and the permanent magnetisation, and other properties of electrorheological and magnetorheological fluids.

  3. Physical indicators of hydrologic permanence in forested headwater streams

    EPA Science Inventory

    Recent court cases have brought headwater streams and their hydrologic permanence into the forefront for regulatory agencies, so rapid field-based indicators of hydrologic permanence in streams are critically needed. Our study objectives were to 1) identify environmental charact...

  4. ARE SALAMANDERS USEFUL INDICATORS OF HYDROLOGIC PERMANENCE IN HEADWATER STREAMS?

    EPA Science Inventory

    Regulatory agencies need appropriate indicators of stream permanence to aid in jurisdictional determinations for headwater streams. We evaluated salamanders as permanence indicators because they are often abundant in fishless headwaters. Salamander and habitat data were collect...

  5. Brachytherapy structural shielding calculations using Monte Carlo generated, monoenergetic data

    SciTech Connect

    Zourari, K.; Peppa, V.; Papagiannis, P.; Ballester, Facundo; Siebert, Frank-André

    2014-04-15

    Purpose: To provide a method for calculating the transmission of any broad photon beam with a known energy spectrum in the range of 20–1090 keV, through concrete and lead, based on the superposition of corresponding monoenergetic data obtained from Monte Carlo simulation. Methods: MCNP5 was used to calculate broad photon beam transmission data through varying thickness of lead and concrete, for monoenergetic point sources of energy in the range pertinent to brachytherapy (20–1090 keV, in 10 keV intervals). The three parameter empirical model introduced byArcher et al. [“Diagnostic x-ray shielding design based on an empirical model of photon attenuation,” Health Phys. 44, 507–517 (1983)] was used to describe the transmission curve for each of the 216 energy-material combinations. These three parameters, and hence the transmission curve, for any polyenergetic spectrum can then be obtained by superposition along the lines of Kharrati et al. [“Monte Carlo simulation of x-ray buildup factors of lead and its applications in shielding of diagnostic x-ray facilities,” Med. Phys. 34, 1398–1404 (2007)]. A simple program, incorporating a graphical user interface, was developed to facilitate the superposition of monoenergetic data, the graphical and tabular display of broad photon beam transmission curves, and the calculation of material thickness required for a given transmission from these curves. Results: Polyenergetic broad photon beam transmission curves of this work, calculated from the superposition of monoenergetic data, are compared to corresponding results in the literature. A good agreement is observed with results in the literature obtained from Monte Carlo simulations for the photon spectra emitted from bare point sources of various radionuclides. Differences are observed with corresponding results in the literature for x-ray spectra at various tube potentials, mainly due to the different broad beam conditions or x-ray spectra assumed. Conclusions

  6. Quantifying IOHDR brachytherapy underdosage resulting from an incomplete scatter environment

    SciTech Connect

    Raina, Sanjay; Avadhani, Jaiteerth S.; Oh, Moonseong; Malhotra, Harish K.; Jaggernauth, Wainwright; Kuettel, Michael R.; Podgorsak, Matthew B. . E-mail: matthew.podgorsak@roswellpark.org

    2005-04-01

    Purpose: Most brachytherapy planning systems are based on a dose calculation algorithm that assumes an infinite scatter environment surrounding the target volume and applicator. Dosimetric errors from this assumption are negligible. However, in intraoperative high-dose-rate brachytherapy (IOHDR) where treatment catheters are typically laid either directly on a tumor bed or within applicators that may have little or no scatter material above them, the lack of scatter from one side of the applicator can result in underdosage during treatment. This study was carried out to investigate the magnitude of this underdosage. Methods: IOHDR treatment geometries were simulated using a solid water phantom beneath an applicator with varying amounts of bolus material on the top and sides of the applicator to account for missing tissue. Treatment plans were developed for 3 different treatment surface areas (4 x 4, 7 x 7, 12 x 12 cm{sup 2}), each with prescription points located at 3 distances (0.5 cm, 1.0 cm, and 1.5 cm) from the source dwell positions. Ionization measurements were made with a liquid-filled ionization chamber linear array with a dedicated electrometer and data acquisition system. Results: Measurements showed that the magnitude of the underdosage varies from about 8% to 13% of the prescription dose as the prescription depth is increased from 0.5 cm to 1.5 cm. This treatment error was found to be independent of the irradiated area and strongly dependent on the prescription distance. Furthermore, for a given prescription depth, measurements in planes parallel to an applicator at distances up to 4.0 cm from the applicator plane showed that the dose delivery error is equal in magnitude throughout the target volume. Conclusion: This study demonstrates the magnitude of underdosage in IOHDR treatments delivered in a geometry that may not result in a full scatter environment around the applicator. This implies that the target volume and, specifically, the prescription

  7. Water equivalent phantom materials for (192)Ir brachytherapy.

    PubMed

    Schoenfeld, Andreas A; Harder, Dietrich; Poppe, Björn; Chofor, Ndimofor

    2015-12-21

    Several solid phantom materials have been tested regarding their suitability as water substitutes for dosimetric measurements in brachytherapy with (192)Ir as a typical high energy photon emitter. The radial variations of the spectral photon fluence, of the total, primary and scattered photon fluence and of the absorbed dose to water in the transversal plane of the tested cylindrical phantoms surrounding a centric and coaxially arranged Varian GammaMed afterloading (192)Ir brachytherapy source were Monte-Carlo simulated in EGSnrc. The degree of water equivalence of a phantom material was evaluated by comparing the radial dose-to-water profile in the phantom material with that in water. The phantom size was varied over a large range since it influences the dose contribution by scattered photons with energies diminished by single and multiple Compton scattering. Phantom axis distances up to 10 cm were considered as clinically relevant. Scattered photons with energies reaching down into the 25 keV region dominate the photon fluence at source distances exceeding 3.5 cm.The tested phantom materials showed significant differences in the degree of water equivalence. In phantoms with radii up to 10 cm, RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR phantoms show excellent water equivalence with dose deviations from a water phantom not exceeding 0.8%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene show deviations up to 2.6%. For larger phantom radii up to 30 cm, the deviations for RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR remain below 1.4%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene produce deviations up to 8.1%. PMMA plays a separate role, with deviations up to 4.3% for radii not exceeding 10 cm, but below 1% for radii up to 30 cm.As suggested

  8. Water equivalent phantom materials for 192Ir brachytherapy

    NASA Astrophysics Data System (ADS)

    Schoenfeld, Andreas A.; Harder, Dietrich; Poppe, Björn; Chofor, Ndimofor

    2015-12-01

    Several solid phantom materials have been tested regarding their suitability as water substitutes for dosimetric measurements in brachytherapy with 192Ir as a typical high energy photon emitter. The radial variations of the spectral photon fluence, of the total, primary and scattered photon fluence and of the absorbed dose to water in the transversal plane of the tested cylindrical phantoms surrounding a centric and coaxially arranged Varian GammaMed afterloading 192Ir brachytherapy source were Monte-Carlo simulated in EGSnrc. The degree of water equivalence of a phantom material was evaluated by comparing the radial dose-to-water profile in the phantom material with that in water. The phantom size was varied over a large range since it influences the dose contribution by scattered photons with energies diminished by single and multiple Compton scattering. Phantom axis distances up to 10 cm were considered as clinically relevant. Scattered photons with energies reaching down into the 25 keV region dominate the photon fluence at source distances exceeding 3.5 cm. The tested phantom materials showed significant differences in the degree of water equivalence. In phantoms with radii up to 10 cm, RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR phantoms show excellent water equivalence with dose deviations from a water phantom not exceeding 0.8%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene show deviations up to 2.6%. For larger phantom radii up to 30 cm, the deviations for RW1, RW3, Solid Water, HE Solid Water, Virtual Water, Plastic Water DT, and Plastic Water LR remain below 1.4%, while Original Plastic Water (as of 2015), Plastic Water (1995), Blue Water, polyethylene, and polystyrene produce deviations up to 8.1%. PMMA plays a separate role, with deviations up to 4.3% for radii not exceeding 10 cm, but below 1% for radii up to 30 cm. As suggested by

  9. Rapid emission angle selection for rotating-shield brachytherapy

    SciTech Connect

    Liu, Yunlong; Flynn, Ryan T.; Kim, Yusung; Bhatia, Sudershan K.; Sun, Wenqing; Yang Wenjun; Wu Xiaodong

    2013-05-15

    Purpose: The authors present a rapid emission angle selection (REAS) method that enables the efficient selection of the azimuthal shield angle for rotating shield brachytherapy (RSBT). The REAS method produces a Pareto curve from which a potential RSBT user can select a treatment plan that balances the tradeoff between delivery time and tumor dose conformity. Methods: Two cervical cancer patients were considered as test cases for the REAS method. The RSBT source considered was a Xoft Axxent{sup TM} electronic brachytherapy source, partially shielded with 0.5 mm of tungsten, which traveled inside a tandem intrauterine applicator. Three anchor RSBT plans were generated for each case using dose-volume optimization, with azimuthal shield emission angles of 90 Degree-Sign , 180 Degree-Sign , and 270 Degree-Sign . The REAS method converts the anchor plans to treatment plans for all possible emission angles by combining neighboring beamlets to form beamlets for larger emission angles. Treatment plans based on exhaustive dose-volume optimization (ERVO) and exhaustive surface optimization (ERSO) were also generated for both cases. Uniform dwell-time scaling was applied to all plans such that that high-risk clinical target volume D{sub 90} was maximized without violating the D{sub 2cc} tolerances of the rectum, bladder, and sigmoid colon. Results: By choosing three azimuthal emission angles out of 32 potential angles, the REAS method performs about 10 times faster than the ERVO method. By setting D{sub 90} to 85-100 Gy{sub 10}, the delivery times used by REAS generated plans are 21.0% and 19.5% less than exhaustive surface optimized plans used by the two clinical cases. By setting the delivery time budget to 5-25 and 10-30 min/fx, respectively, for two the cases, the D{sub 90} contributions for REAS are improved by 5.8% and 5.1% compared to the ERSO plans. The ranges used in this comparison were selected in order to keep both D{sub 90} and the delivery time within acceptable

  10. Evaluation of 101Rh as a brachytherapy source

    PubMed Central

    Ghorbani, Mahdi; Meigooni, Ali Soleimani

    2015-01-01

    Purpose Recently a number of hypothetical sources have been proposed and evaluated for use in brachytherapy. In the present study, a hypothetical 101Rh source with mean photon energy of 121.5 keV and half-life of 3.3 years, has been evaluated as an alternative to the existing high-dose-rate (HDR) sources. Dosimetric characteristics of this source model have been determined following the recommendation of the Task Group 43 (TG-43) of the American Association of the Physicist in Medicine (AAPM), and the results are compared with the published data for 57Co source and Flexisource 192Ir sources with similar geometries. Material and methods MCNPX Monte Carlo code was used for simulation of the 101Rh hypothetical HDR source design. Geometric design of this hypothetical source was considered to be similar to that of Flexisource 192Ir source. Task group No. 43 dosimetric parameters, including air kerma strength per mCi, dose rate constant, radial dose function, and two dimensional (2D) anisotropy functions were calculated for the 101Rh source through simulations. Results Air kerma strength per activity and dose rate constant for the hypothetical 101Rh source were 1.09 ± 0.01 U/mCi and 1.18 ± 0.08 cGy/(h.U), respectively. At distances beyond 1.0 cm in phantom, radial dose function for the hypothetical 101Rh source is higher than that of 192Ir. It has also similar 2D anisotropy functions to the Flexisource 192Ir source. Conclusions 101Rh is proposed as an alternative to the existing HDR sources for use in brachytherapy. This source provides medium energy photons, relatively long half-life, higher dose rate constant and radial dose function, and similar 2D anisotropy function to the Flexisource 192Ir HDR source design. The longer half-life of the source reduces the frequency of the source exchange for the clinical environment. PMID:26034499

  11. Simulation of dose distribution for iridium-192 brachytherapy source type-H01 using MCNPX

    SciTech Connect

    Purwaningsih, Anik

    2014-09-30

    Dosimetric data for a brachytherapy source should be known before it used for clinical treatment. Iridium-192 source type H01 was manufactured by PRR-BATAN aimed to brachytherapy is not yet known its dosimetric data. Radial dose function and anisotropic dose distribution are some primary keys in brachytherapy source. Dose distribution for Iridium-192 source type H01 was obtained from the dose calculation formalism recommended in the AAPM TG-43U1 report using MCNPX 2.6.0 Monte Carlo simulation code. To know the effect of cavity on Iridium-192 type H01 caused by manufacturing process, also calculated on Iridium-192 type H01 if without cavity. The result of calculation of radial dose function and anisotropic dose distribution for Iridium-192 source type H01 were compared with another model of Iridium-192 source.

  12. Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program

    PubMed Central

    Prisciandaro, Joann I.; Soliman, Abraam; Ravi, Ananth; Song, William Y.

    2015-01-01

    Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized. A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times. PMID:26622249

  13. High dose rate sources in remote afterloading brachytherapy: Implications for intracavitary and interstitial treatment of carcinoma

    SciTech Connect

    Syzek, E.J.; Bogardus, C.R. Jr. )

    1990-11-01

    Remote afterloading brachytherapy provides effective cancer treatment with zero personnel radiation exposure compared to conventional low dose rate systems requiring inpatient use of iridium, radium, or cesium sources. Clinical use of high dose rate brachytherapy is broadened to encompass curative treatment of cervical, endometrial, endobronchial, head and neck, esophageal, rectal, and prostatic carcinomas as well as palliation of intra-abdominal metastasis intraoperatively. Complications encountered with high dose rate sources will be compared to those of low dose rate systems commonly used in conjunction with external beam irradiation. Radiobiological effectiveness and economic benefits will be addressed to provide support for use of remote afterloading using high dose rate brachytherapy in palliative and curative treatment of selected carcinoma. 36 refs.

  14. Methodology for characterizing seeds under development for brachytherapy by means of radiochromic and photographic films.

    PubMed

    Meira-Belo, L C; Rodrigues, E J T; Grynberg, S E

    2013-04-01

    The development of new medical devices possess a number of challenges, including designing, constructing, and assaying prototypes. In the case of new brachytherapy seeds, this is also true. In this paper, a methodology for rapid dosimetric characterization of (125)I brachytherapy seeds during the early stages of their development is introduced. The characterization methodology is based on the joint use of radiochromic and personal monitoring photographic films in order to determine the planar anisotropy due to the radiation field produced by the seed under development, by means of isodose curves. To evaluate and validate the process, isodose curves were obtained with both types of films after irradiation with a commercial (125)I brachytherapy seed. PMID:23353089

  15. AAPM Task Group 128: Quality assurance tests for prostate brachytherapy ultrasound systems

    SciTech Connect

    Pfeiffer, Douglas; Sutlief, Steven; Feng Wenzheng; Pierce, Heather M.; Kofler, Jim

    2008-12-15

    While ultrasound guided prostate brachytherapy has gained wide acceptance as a primary treatment tool for prostate cancer, quality assurance of the ultrasound guidance system has received very little attention. Task Group 128 of the American Association of Physicists in Medicine was created to address quality assurance requirements specific to transrectal ultrasound used for guidance of prostate brachytherapy. Accurate imaging guidance and dosimetry calculation depend upon the quality and accuracy of the ultrasound image. Therefore, a robust quality assurance program for the ultrasound system is essential. A brief review of prostate brachytherapy and ultrasound physics is provided, followed by a recommendation for elements to be included in a comprehensive test phantom. Specific test recommendations are presented, covering grayscale visibility, depth of penetration, axial and lateral resolution, distance measurement, area measurement, volume measurement, needle template/electronic grid alignment, and geometric consistency with the treatment planning computer.

  16. Potential role of ultrasound imaging in interstitial image based cervical cancer brachytherapy

    PubMed Central

    2014-01-01

    In 2012, more than 500,000 cases of cervical cancer were diagnosed worldwide. Over three quarters of these cases occur in less developed countries [1]. Advancements in image-guided brachytherapy are resulting in improved outcomes and reduced morbidity for women with this disease, but its worldwide adoption is hampered by lack of accessibility to advanced imaging techniques. Ultrasound is emerging as a potential option for tumor visualization, brachytherapy catheter placement, and treatment planning. While additional work is needed, ultrasound can potentially serve as the sole imaging modality for catheter insertion and planning. This paper will review our current knowledge on the use of ultrasound in interstitial brachytherapy treatment for cervical cancer. PMID:25097565

  17. Simulation of dose distribution for iridium-192 brachytherapy source type-H01 using MCNPX

    NASA Astrophysics Data System (ADS)

    Purwaningsih, Anik

    2014-09-01

    Dosimetric data for a brachytherapy source should be known before it used for clinical treatment. Iridium-192 source type H01 was manufactured by PRR-BATAN aimed to brachytherapy is not yet known its dosimetric data. Radial dose function and anisotropic dose distribution are some primary keys in brachytherapy source. Dose distribution for Iridium-192 source type H01 was obtained from the dose calculation formalism recommended in the AAPM TG-43U1 report using MCNPX 2.6.0 Monte Carlo simulation code. To know the effect of cavity on Iridium-192 type H01 caused by manufacturing process, also calculated on Iridium-192 type H01 if without cavity. The result of calculation of radial dose function and anisotropic dose distribution for Iridium-192 source type H01 were compared with another model of Iridium-192 source.

  18. Magnetic resonance imaging-guided brachytherapy for cervical cancer: initiating a program.

    PubMed

    Owrangi, Amir M; Prisciandaro, Joann I; Soliman, Abraam; Ravi, Ananth; Song, William Y

    2015-10-01

    Over the past decade, the application of magnetic resonance imaging (MRI) has increased, and there is growing evidence to suggest that improvements in accuracy of target delineation in MRI-guided brachytherapy may improve clinical outcomes in cervical cancer. To implement a high quality image guided brachytherapy program, a multidisciplinary team is required with appropriate expertise as well as an adequate patient load to ensure a sustainable program. It is imperative to know that the most important source of uncertainty in the treatment process is related to target delineation and therefore, the necessity of training and expertise as well as quality assurance should be emphasized. A short review of concepts and techniques that have been developed for implementation and/or improvement of workflow of a MRI-guided brachytherapy program are provided in this document, so that institutions can use and optimize some of them based on their resources to minimize their procedure times. PMID:26622249

  19. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... source accountability required by § 35.406 for 3 years. (b) For temporary implants, the record must... storage, and the name of the individual who returned them to storage. (c) For permanent implants, the... activity of sources not implanted, the date they were returned to storage, and the name of the...

  20. 10 CFR 35.2406 - Records of brachytherapy source accountability.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... source accountability required by § 35.406 for 3 years. (b) For temporary implants, the record must... storage, and the name of the individual who returned them to storage. (c) For permanent implants, the... activity of sources not implanted, the date they were returned to storage, and the name of the...