1.Stereotactic Radiosurgery (SRS)
SRS is a precise and focused delivery of a single, high dose of irradiation to a small and critically located intracranial volume while sparing normal structure
2.Stereotactic Body Radiation Therapy (SBRT)
SBRT is a treatment procedure similar to SRS, except that it deals extra-cranial radiosurgery
3.Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
1.Stereotactic Radiosurgery (SRS)
SRS is a precise and focused delivery of a single, high dose of irradiation to a small and critically located intracranial volume while sparing normal structure
2.Stereotactic Body Radiation Therapy (SBRT)
SBRT is a treatment procedure similar to SRS, except that it deals extra-cranial radiosurgery
3.Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
Flattening Filter Free (FFF) mode
FFF beam is produced without the use of flattening Filter
In the 1990s, several groups studied about FFF high-energy photon beams. The main interest for that, is to increase the dose rate for radiosurgery or the "physics interest”.
Need of increase in dose rate from traditional 300-600 to 1400-2400MU/min to overcome time-inefficiency and to improve patients comfort specially in SRS/SBRT
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
A review of advances in Brachytherapy treatment planning and delivery in last decade or so, with main focus on brachytherapy for Prostate cancer, Breast cancer and Cervical cancer
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
ATOMIC ENERGY REGULATORY BOARD (AERB).pptxAALIA ABDULLAH
AERB, Functions of AERB , Regional Regulatory Centre , Purpose of safety code and ethics, Safety Specification for Medical Diagnostic X ray , Fluoroscopy and CT equipment and protective devices,
Guidelines on Radiation Safety in DentistryChow Peng Yue
Radiation is an integral part of many diagnostic and therapeutic procedures in healthcare, and dentistry is no exception. In the field of dentistry, X-rays play a crucial role in aiding dentists in the diagnosis and treatment of various oral health conditions. While these diagnostic tools offer valuable insights, it is essential to prioritize the safety of both patients and dental healthcare professionals when utilizing ionizing radiation.
Radiation safety in dentistry encompasses a set of practices, guidelines, and precautions designed to minimize the potential risks associated with exposure to ionizing radiation. Dental professionals must strike a delicate balance between obtaining necessary diagnostic information and ensuring the well-being of patients by minimizing radiation exposure.
The primary goal of radiation safety in dentistry is to achieve optimal diagnostic results while keeping radiation exposure as low as reasonably achievable (ALARA). This principle emphasizes the importance of utilizing the lowest possible radiation dose without compromising diagnostic efficacy. Dental practitioners must be well-versed in radiation safety protocols, equipment calibration, and proper shielding techniques to achieve this delicate balance.
airway management by comparative study beyween Airtraq and McGrath Videolaryngoscope and Classical Macintosh in neutral neck position (stimulated cervical injury scenarios)
Cholesterol Bio Sensors: getter better fastJeffrey Funk
These slides use concepts from my (Jeff Funk) course entitled analyzing hi-tech opportunities to analyze the increasing economic feasibility of bio-sensors for measuring cholesterol in humans. Bio-sensors detect the level of cholesterol (and other biological materials) using enzymes, matrices, and transducers. The enzymes, which are held in a matrix, react with the cholesterol and an electric signal is produced from an amperometric transducer. Improvements in sensitivity, response time, shelf life, detection limit, and reusability have been achieved through creating more appropriate biological materials for the enzymes, matrices, and transducers.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. 2 | VARIAN ONCOLOGY SYSTEMS
VARIAN
ONCOLOGY
SYSTEMS
CALYPSO® SYSTEM AND
PROSTATE BEACON® IMPLANT
OVERVIEW
November12, 2014
2
Brian Young
3. 6 | VARIAN ONCOLOGY SYSTEMS
• Locates and continuously tracks
target location
• The 4D Electromagnetic Array
excites the transponders and then
receives position information from
their response signals
GPS for the Body® Technology
TrackTarget
Locations
4. Platform Overview
9 9 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS: calypso
4D Console
4D Tracking Station
4D ElectromagneticArray
Optical System
with 3 Infrared Cameras
Implanted Beacon®
Electromagnetic Transponders
5. GPS for the Body® Technology
• Wireless Miniature Beacon®
Transponders
• Accurate, quantitative guidance for
prostate localization
• Continuous, real-time tracking
1 10 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS: calypso
0
6. GPS for the Body® Technology
• Unique frequencies identify location
• Implanted in a 15-minute outpatient
procedure*
* Data on File
112 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
7. GPS for the Body® Technology
113 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
8. GPS for the Body® Technology
Step 1
114 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
9. GPS for the Body® Technology
Step 1 Step 2
115 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
11. • 160+ Calypso® Systems sold in US
• 180+ Calypso® Systems sold
worldwide
1 17 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS: calypso
7
Calypso® Update
Growing
Customer
Base
13. • Patients were evaluated before and
after treatment
• Patients treated without Calypso®
reported significantly more side effects
compared to those treated with
Calypso® real-time tracking in three of
the four categories surveyed
220 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
AIM Study, Journal of Urology 2010
Reduced
Toxicities
14. Increase in average side effects at end of
radiation treatment
•* AIM Study, Journal of Urology 2010
Bowel/Rectal
Problems
Urinary
Irritation/Obstruct
ion
Urinary
Incontinenece
Sexual
Dysfuntion
Without Calypso®With Calypso®
2.1%
16.9%
4.7%
19.1%
7.2%
8.5%
0%
18.8%
221 T| EVACRIAHN ONNCOOLOLGOY SGYSTYEMSSOLUTIONS:
calypso
16. Prostate and Prostatic Bed Implant Training
26 | VARIAN ONCOLOGY SYSTEMS
• Contraindications, warnings, precautions
• Patient selection considerations
• Pre-implant patient preparation
• Pre-implant equipment preparation
• Implantation process
• Possible adverse reactions
• Frequently asked questions
17. Indications for Use
27 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• The Calypso® System is intended for use as an adjunct in treatment planning
and radiation therapy, to align and/or monitor the patient’s position relative to
the isocenter of a radiation therapy system. The Calypso® System provides
accurate, precise and continuous localization of a treatment isocenter by
using two or more Beacon® transponders.
• The Dynamic Edge Gating® component may signal a radiation therapy
system to impose a beam-hold when the treatment target position has moved
outside the defined tracking limits and to signal the radiation therapy system
to remove the beam-hold upon the target’s return to a position inside the
defined tracking limits. The Dynamic Edge Gating® feature has been shown
to be compatible with Varian and Siemens radiation therapy systems and
external gating interfaces.
18. Indications for Use
28 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• Implanted Beacon transponders are indicated for use to radiographically and
electromagnetically mark soft tissue for future therapeutic procedures.
• Permanent Beacon transponders are indicated for implantation in the
prostate and the peri-prostatic tissue, to align and monitor the treatment
isocenter in real time during radiation therapy.
• Surface Beacon transponders are indicated for temporary external placement
on the skin, to monitor respiratory motion and other patient motion in real
time during radiation therapy.
19. Implant Contraindications
29 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• Hip prosthesis
• Anti-coagulant or anti-platelet drug therapy
• Low dose aspirin is not contraindicated
20. Warnings, per FDA Guidelines
30 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• Effect of the electromagnetic fields generated by the Calypso® 4D
Localization System in the presence of other active medical device
implants, such as pacemakers and defibrillators or other medical
devices, is unknown and may impact operation
• Beacon® electromagnetic transponders and introducers are gamma
sterilized and pyrogen free
• Use standard operating proceduresto maintain the sterility of the devices
• Do not use packages which have been previously opened ordamaged
• Beacon Transponders and introducers are designed for single use
only
• Do not re-sterilize or reuse
• Each Beacon transponder is tuned to a specific frequency and is to be
implanted in a designated region of the prostate
• Labeling indicates the intendedregion
21. Warnings, per FDA Guidelines
31 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• Use transrectal ultrasound imaging for guidance in
implantation
• During procedure preparation, if a Beacon®
electromagnetic transponder drops onto sterile field and
sterility is uncompromised:
• Do not use metal tweezers to retrieve the Beacon transponder
• Retrieve the Beacon transponder with a gloved hand
• Place it directly into the hub end of the introducer
• Do not use non-sterile or damaged introducers or
Beacon transponders
22. Precautions, per FDA Guidelines
• Non-clinical testing has demonstrated that Beacon
transponders are MR conditional. Apatient implanted with
Beacon transponders can be safely scanned under the
following conditions:
• Static magnetic field of 1.5T or 3T;
• Static magnetic field gradient of 2.5 T/m; maximum
whole-body-averaged
• Specific absorption rate of 2.0 W/kg for 20 minutes, in
the normal operating mode of MR scanning.
• A local MR image artifact may extend up to approximately2
cm from the transponder.
32 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
23. Precautions, per FDA Guidelines
33 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
• No specific evaluations have been made with transponders in the
presence of the following procedures
• LDR or HDR brachytherapy
• Electrosurgical procedures
• Harmonic scalpel, transurethral needle ablation, radiofrequency
ablation, cryoablation or lithotripsy
• The Calypso Beacon® transponder implantation training program
must be completed prior to implanting transponders in the prostate
24. Patient Selection Criteria
1 Place patient supine lying on a flat, hard
surface in the treatment position.
2 Measure from the table top to the maximum
anterior skin surface distance (A).
3 Record this distance in centimeters.
4 Estimate center position of patient’s prostate
by palpating the greater trochanter notch on
the lateral side of the femur.
5 Measure the distance from the table top to the
approximate prostate center (B).
6 Record this distance in centimeters.
7 Subtract A – B and use result to determineif
the patient is a candidate.
An optional CT image confirms implant
feasibility
Formula
A: Maximum anterior/posterior distance
B: Anticipated prostate isocenter
34 | VARIAN ONCOLOGY SYSTEMS
LBL0212-000 Rev A 2012-3-30
A – B < 19 cm = Localize and Track
A – B = 17 cm to 25 cm = Localize Only
A – B > 25 cm = Ineligible for implant
25. Beacon® Transponder ImplantationInstructions
35 | VARIAN ONCOLOGY SYSTEMS
Prior to Implantation Procedure
• Prepare patient according to institutional guidelines
• Administer antibiotic prophylaxis
• Bowel preparation for transrectal ultrasound
Day of Implantation
• Pre-load Beacon transponders into introducers and place on a sterile drape
• Prepare the patient for transrectal ultrasound examination
• Attach a sterile 14 gauge needle guide to the transrectal ultrasound
transducer
26. The Implant Procedure
Three Beacon® transponders are implanted in the prostate
Implant uses the same technique and equipment as a prostate biopsy
procedure
Implantation of Beacon transponders uses the same
technique as the implantation of other radiopaque markers
Standard UltrasoundProbe
Introducer Needle
Commercially available transrectal ultrasound probe guides
implantation of Beacon transponders
36 | VARIAN ONCOLOGY SYSTEMS
27. Beacon® Electromagnetic Transponders
• Beacon transponders consist of
• A miniature passive electrical circuit hermetically sealedin
biocompatible glass
• The Beacon transponders are visible on kV xray, CT,
• ultrasound
• Each Beacon transponder is packaged in a transfer
capsule
• Transfer capsules facilitate loading the Beacon
transponder into the introducer
• Capsules are color-coded indicating implant location
A = Apex (white)
L = Left mid-gland or base (blue)
R = Right mid-gland or base (green)
Implant Components
Transfer Capsule
37 | VARIAN ONCOLOGY SYSTEMS
Beacon Transponder
length = 8.5mm
diameter = 1.8mm
28. Implant Components
• Introducers
• Introducer hubs and stylets are color-coded to indicate the frequency
of the loaded Beacon transponder
• Each Beacon® electromagnetic transponders has a unique frequency
Right Base
Left Base
39 | VARIAN ONCOLOGY SYSTEMS
Apex
29. Implant Recommendations
• To ensure optimal localization accuracy:
• Implant Beacon® electromagnetic transponders
equidistant to prostate midpoint
• Avoid implanting the Beacon transponders adjacent to
urethra
• Attempt to place >1 centimeter apart from each other
• If 1 cm separation is not feasible, position Beacon
transponders as far apart from each other as possible
45 | VARIAN ONCOLOGY SYSTEMS
30. Implant Recommendations
• In the event order of implant is altered
• The Calypso System software may be modified to correct the
incorrect positions
• If a correction is required, inform radiation oncology departmentprior
to treatment planning
• For highest localization accuracy
• Implant the three Beacon® electromagnetic transponders in a
triangular pattern
• Spread Beacon transponders apart from each other, ideally>1cm
• Avoid placement near the urethra
• In the event a Beacon transponder is voided post-implant,the
Calypso System can recognize two Beacon transponders
• Accuracy with < three Beacon transponders is reduced
• Implant Beacon transponders within the prostate
capsule
• Avoid seminal vesicles or any areas outside theprostate
46 | VARIAN ONCOLOGY SYSTEMS
31. Most Common Implant “Issues”
48 | VARIAN ONCOLOGY SYSTEMS
• Beacons placed too close to one another.
• Beacons placed in/near rectal wall.
• Beacons are too coplanar.
• Beacons placed outside of prostate.
32. After Implantation Procedure
58 | VARIAN ONCOLOGY SYSTEMS
• Review post-operative care orders
• Review potential complications
• Refer patient to radiation therapy for
treatment planning
• A waiting period of 4 - 14 days recovery is recommended prior to
treatment planning CT to stabilize the Beacon® electromagnetic
transponder and reduce prostate swelling
33. Adverse Reactions
60 | VARIAN ONCOLOGY SYSTEMS
• Potential adverse events may include
• Bleeding (e.g., hematuria, hematospermia, hematochezia)
• Pain (e.g., procedural, perineal, bowel movements, unspecified)
• Infection (e.g., urinary tract infection)
• Fever
• Less common adverse events may include
• Urinary retention
• Urinary obstructive symptoms (e.g., urinary frequency, weak stream,etc.)
• Dysuria
• Migration of Beacon® electromagnetic transponder from implant site or
out of the body
34. Overview: Prostatic Bed
61 | VARIAN ONCOLOGY SYSTEMS
The overall implant training is similar to implanting transponders in
the intact prostate procedure.
Requirements common to both procedures:
• Patient size requirements
• Patient needs to meet implant criteria and contraindications
• Patient preparation prior to day of implantation
• Handling the product
• Preparing the product with the needle guide
• Minimum distance between transponders of 1cm apart in triangular pattern
• Color coded introducer stylets & hubs for specific region of prostatic bed
• After implantation procedure
Additional prostatic bed implant requirements:
• Implant site selection
• Post Operative Transrectal
35. 64 | VA RIAN ONCOLOGY SYSTEMS
Prostatic Bed: Post-Prostatectomy
Transrectal Implantation
• Implant at least 2-3 weeks post-prostatectomy in order to avoid
movement of the transponders
• Allows for reduction of edema and initiation of fibrosis in the
prostatic bed
• The recommended distance between the transponders is 2 cm
• Recommended minimum distance: 1cm
• Recommended maximum distance: 6cm
Color Implantation Position in Post Operative Transrectal
White
(Apex)
On right side of anastomosis site
Blue
(Left)
Between bladder and rectal wall, left side (behind trigone)
Green
(Right)
Between the bladder and rectal wall, right side (behind trigone)
36. Implantation Sites –
Postoperative Transrectal
•Optimal implantation locations
•Recommended distance between transponders is 2.0 cm
NOTE:
66 | VARIAN ONCOLOGY SYSTEMS
Recommended min distance is 1.0cm
Recommended max distance is 6.0cm
SAG
Transverse
AP
37. Summary
73 | VARIAN ONCOLOGY SYSTEMS
• Patient size is acceptable for localization and/or tracking
• Patient needs to meet implant criteria and contraindications
• Pre and post patient instructions per clinical guide lines
• Handling the product
• Sterile product
• Handling if dropped
• Keeping it out of urethra or other conduits
• Preparing the product with the needle guide
• Spacing of the Beacon® electromagnetic transponders is critical for
accuracy of localization and tracking (>1cm apart in triangular pattern)
• Identify target implant sites for optimal accuracy
• Color coded for specific region of prostate
• Implant Technique and manage tenting
• Patient Implant Card
38. Calypso® Online Implant Training Course
81 | VARIAN ONCOLOGY SYSTEMS
www.calypsoeinstitute.com
30-minute course reviews contraindications, patient
selection criteria and recommended technique.