1.WLJ Brachy 3 PDF

Brachytherapy and Radioactive Sources Lecture 3
Wendy Julian Christie Physics and Engineering

wendy.julian@christie.nhs.uk
Christie Hospital NHS
NHS Foundation Trust
Introduction
Lecture 3:
Clinical applications of brachytherapy Gynaecological treatments Interstitial implant systems Use of HDR micro-Selectron Prostate treatments

Gynaecological treatments

Manchester System for Cervix


Activity distribution rules 1955
Modified for Cs137 afterloading Modified again for HDR/PDR Prescription convention for Cervix treatments point A
Standard treatment times can be used for standard geometry


Point A
2cm along uterine canal (from os) 2cm lateral In paracervical triangle, area of broad ligament near to uterine vessels crossing the ureter


Non-Ideal Geometry
Point A 2cm along uterine canal & 2cm lateral Point B 5cm lateral to patient mid-line (Indicates dose at pelvic wall/obturator node)

Manchester System for Gynae

Intra-uterine tubes (various lengths) Ovoids (various sizes) Vaginal cylinders (if ovoids are not suitable)
Arrangements of (MDR) Selectron pellets were set to replicate preloaded sources (Ra226, Cs137)
HDR or PDR dwells have replaced the Selectron
Manchester System for Gynae
Dose rate at pt A Manual sources ~ 55 cGy/hr Selectron (MDR) ~ 160 cGy/hr HDR ~ 400 cGy/hr

Radiobiological Effects
Allowance must be made for the dose-rate
When moving to higher dose-rate, a dose reduction is usually required Eg. When Selectron replaced manual Cs sources, dose-rate ~ 3 x greater, leading to a reduction of 10% for prescribed doses in order to give same radiobiological effect E.g. Moving from Selectron LDR treatments to fractionated HDR treatments
Manchester System for Uterus

Longer intra-uterine tubes (up to 12cm) Heavier weighting of activity at distal end of the uterus Nominal body dose average of dose at 2cm lateral to the uterine tube

Manchester System for Vagina (post hysterectomy)

Transverse ovoids, or Single applicator, cigar shaped treatment isodose For disease extending further down the vagina Sources spread out to reduce dose rate at vaginal mucosa Prescribed at maximum vaginal mucosa dose point

Brachytherapy ICRU 38 (1985)

The data recommended for reporting of gynaecological brachytherapy are: - Description of technique (source, applicator) - Total reference air-kerma (TRAK) - Time-dose pattern - Description of reference volume - Dose at reference points (bladder, rectum, lymphatic trapezoid, pelvic wall)
Brachytherapy ICRU 38
Requirement to specify the dimensions (width, height, and thickness) of the pear shaped isodose reference volume

Brachytherapy ICRU 38
Bladder on posterior surface of balloon catheter Rectum from the centre of the vaginal sources, drop a vertical towards the rectum (use gauze packing to identify vaginal posterior wall)
Brachytherapy GEC ESTRO

Group Europen de Curiethrapie European Society for Therapeutic Radiology and Oncology
2005 - European guidelines recommend full image guided 3D dosimetry and prescriptions, using DVH analysis for target coverage and organs at risk 2009 - RCR published guidelines for implementation CT imaging is widely used, but MR is superior for tumour delineation
Brachytherapy CT or MRI?
Conventional CT
MR good soft tissue detail

Brachytherapy CT/MR fusion

*** QUESTION! ***

The dose at 1cm depth in tissue from surface of an ovoid, expressed as a percentage of the surface dose, is:
A) Greater for large ovoids B) Greater for small ovoids C) Independent of ovoid size

Interstitial implant systems

Interstitial implant systems

A set of rules to determine source arrangement and treatment time
Manchester system
Devised for Radium and Caesium needle implants Tabulated data
Paris system
Devised for Iridium wire implants (manual afterloading) Widely used in Europe System introduced in 1960s with early planning computers

An iridium wire implant

Requires manual afterloading

Paris system rules
Overall source length should exceed target volume by 20% (long wires) 30% (short wires)
Target length (l)
Needle Separation (s) Between 5 and 20mm, depending on target volume

Paris System rules
Uniform activity per unit length Same activity and length Straight and parallel Equal spacing

Paris System rules

Single plane implant - crosssection view
A thicker target needs a multiplane implant
Cross-section must be a series of equilateral triangles or squares

Paris system rules

Treatment volume Defined by minimum dimensions of reference isodose
Length, l
Thickness, t
Wires Paris System

Basal dose points = local dose minima in the implanted volume Average of basal dose point dose rates is the Basal Dose Rate Reference Dose Rate is 85% of BDR use this to calculate treatment time
Wires Paris System calculation

Calculate Dose rate at each basal dose point Mean dose rate for basal dose points (mean BDR) x 0.85 to give reference dose rate
treatment_time
prescribed_dose reference_ dose_rate

Wires Paris System example

A single plane iridium wire implant has 4 wires, each 40mm long, separation 12mm. From tables, dose rate at each basal dose point is 0.415, 0.438 and 0.415 Gyh-1. Calculate the time to give a treatment of 60Gy

Wires Paris System example

Mean basal dose rate = 0.423 Gyh-1 Reference dose rate = 0.423 x 0.85 = 0.359 Gyh-1 Treatment time = 60/0.359 = 167 hours

Brachytherapy ICRU 58(1997)

The dosimetry information recommended for reporting of interstitial implant treatments consists of:
Description of clinical target volumes. Sources, technique and implant time. Total reference air-kerma (TRAK) Description of dose: prescription point/surface, prescription dose, reference doses Greater detail is recommended only 3D computer calculation, including dose volume histograms, can fully comply

*** QUESTION! ***

Which of these are features of Paris system??
1) 2) 3) 4) 5) 6) Crossed ends? All wires parallel? Higher activity around periphery? Wires longer than treatment length? Dose prescribed to Basal Dose point? Dose prescribed to reference isodose?

Question
Does this implant comply with Paris rules?

Use of HDR micro-Selectron

HDR micro-Selectron
Single 10 Ci Iridium-192 source welded to a steel transfer cable Machine has shielding built-in
Machine can be portable

Dose distributions HDR source

Dose distribution around the HDR source is approximately spherical
(almost a point source) e.g. For MammoSite breast treatments, a single dwell position is used to treat a spherical shell around a balloon inside a lumpectomy site
HDR micro-Selectron
For most treatments, a different shape of dose distribution is required

HDR micro-Selectron
The single is source driven along by a cable Dose distribution made up by adding contribution from several dwell positions

HDR micro-Selectron
A series of HDR dwell positions can be used to simulate a line source Used for intraluminal lung treatment

HDR micro-Selectron
Marker wire shows position of catheter for ILT treatment Radio-opaque markers at 1cm intervals Use markers to select dwell positions for HDR treatment

HDR micro-Selectron
HDR dwell positions can be combined to treat a skin lesion, using a superficial mould

HDR micro-Selectron Surface Mould
Catheters held in surface applicator Dwell positions chosen to provide desired dose distribution
HDR micro-Selectron Surface Mould
Catheters are connected to HDR unit Depth of treatment depends upon height of dwells above skin 1cm dwell height treats depth 2-3mm, depending on area
HDR & PDR QC

QC checks following quarterly source replacement Source calibration Positional checks with autoradiograph Timer checks Power failure checks Interlock checks Leak test
Brachytherapy - HDR Calibration Autoradiograph

To check accuracy of source dwell positions Catheter taped to film Marker wire inserted into catheter (as for lung treatments) Pin pricks/marks made on film Treat between the marks & check coincidence

Prostate Brachytherapy

Prostate Brachytherapy - HDR

Prostate brachytherapy - I125 seeds

Prostate brachytherapy
Trans-rectal ultrasound is used to image the prostate

Prostate brachytherapy
The planning process Outline prostate, bladder, rectum and urethra Locate possible needle positions Plan final source positions Calculate dose distribution

Outlines
Dose distribution
Sagittal views

Post-implant dosimetry for prostate seed implants

Take images 6 weeks after treatment Reconstruct actual source positions in 3D
Calculate actual dose delivered or generate actual dose distribution

The End!!!


1.WLJ Brachy 3 PDF

Hochgeladen von

Dokumentinformationen

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

1.WLJ Brachy 3 PDF

Hochgeladen von

Copyright:

Verfügbare Formate

Brachytherapy and Radioactive Sources Lecture 3

Wendy Julian Christie Physics and Engineering

Christie Hospital NHS

Christie Hospital NHS

Manchester System for Cervix

Christie Hospital NHS

Manchester System for Cervix

Standard treatment times can be used for standard geometry

Christie Hospital NHS

Manchester System for Cervix

Christie Hospital NHS

Manchester System for Cervix

Christie Hospital NHS

Manchester System for Gynae

Manchester System for Gynae

Christie Hospital NHS

Manchester System for Uterus

Christie Hospital NHS

Manchester System for Vagina (post hysterectomy)

Christie Hospital NHS

Brachytherapy ICRU 38 (1985)

Christie Hospital NHS

Brachytherapy GEC ESTRO

MR good soft tissue detail

Christie Hospital NHS

Brachytherapy CT/MR fusion

Christie Hospital NHS

*** QUESTION! ***

Christie Hospital NHS

Interstitial implant systems

Christie Hospital NHS

Interstitial implant systems

Christie Hospital NHS

An iridium wire implant

Christie Hospital NHS

Paris system rules

Target length (l)

Needle Separation (s) Between 5 and 20mm, depending on target volume

Paris System rules

Christie Hospital NHS

Paris System rules

A thicker target needs a multiplane implant

Cross-section must be a series of equilateral triangles or squares

Christie Hospital NHS

Paris system rules

Wires Paris System

Wires Paris System calculation

prescribed_dose reference_ dose_rate

Christie Hospital NHS

Wires Paris System example

Christie Hospital NHS

Wires Paris System example

Christie Hospital NHS

Brachytherapy ICRU 58(1997)

Christie Hospital NHS

*** QUESTION! ***

Christie Hospital NHS

Christie Hospital NHS

Use of HDR micro-Selectron

Christie Hospital NHS

Christie Hospital NHS

Dose distributions HDR source

Christie Hospital NHS

* QUESTION! *

* QUESTION! *