This document discusses the clinical applications of low dose rate and high dose rate brachytherapy. It begins by defining brachytherapy as a type of radiation treatment involving placing radioactive sources close to or inside the target tissue. It then discusses the clinical advantages and limitations of brachytherapy. Several cancer types are described as suitable indications for brachytherapy as a sole treatment or boost after external beam radiation, including cancers of the skin, head and neck, breast, prostate, and soft tissue sarcomas. Technical aspects like dose rates, implantation techniques, and radiobiology are also covered.
LDR and HDR Brachytherapy: A Primer for non radiation oncologistsSantam Chakraborty
A small presentation I made for a 30 minutes class comparing and contrasting LDR and HDR brachytherapy. Good for a person with non radiation oncology background to grasp the basics.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
LDR and HDR Brachytherapy: A Primer for non radiation oncologistsSantam Chakraborty
A small presentation I made for a 30 minutes class comparing and contrasting LDR and HDR brachytherapy. Good for a person with non radiation oncology background to grasp the basics.
Management of cacrinoma cervix: Techniques of radiotherapy (2D conventional, 3D Conformal radiotherapy (3DCRT) and IMRT with a review of various contouring guidelines.
Particle beam – proton,neutron & heavy ion therapyAswathi c p
particle therapy is advanced external beam therapy used to treat cancer , which uses beams of protons or other charged particles such as helium, carbon or other ions instead of photons. charged particles have different depth-dose distributions compared to photons. They deposit most of their energy in the last final millimeters of their trajectory (when their speed slows). This results in a sharp and localized peak of dose, known as the Bragg peak.
IORT uses a high single-fraction radiation dose (10-30 Gy) is delivered during surgery to a surgically-exposed tumour bed, immediately after a chunk of the tumour has been surgically excised. This slide includes topics like APBI, IOERT, IOHDR.
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 combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
High-dynamic range (HDR) video is available to consumers today via both streaming services and optical discs. HDR video is a visually compelling experience that the average consumer can readily differentiate from existing HD content. As such, HDR video is expected to drive the next wave of consumer video. HDR TVs are available today, and HDR monitors will be available this year. The availability of these monitors will allow new user experiences on PCs, including true HDR gaming. This presentation describes what exactly HDR is and the challenges of properly displaying it on existing devices (PCs, laptops, phones, and such.) Some of the unique challenges of HDR include needing to convert content into linear light space for proper blending and scaling. This requires substantially more precision in hardware and software than we use for displaying today’s standard dynamic range content.
Particle beam – proton,neutron & heavy ion therapyAswathi c p
particle therapy is advanced external beam therapy used to treat cancer , which uses beams of protons or other charged particles such as helium, carbon or other ions instead of photons. charged particles have different depth-dose distributions compared to photons. They deposit most of their energy in the last final millimeters of their trajectory (when their speed slows). This results in a sharp and localized peak of dose, known as the Bragg peak.
IORT uses a high single-fraction radiation dose (10-30 Gy) is delivered during surgery to a surgically-exposed tumour bed, immediately after a chunk of the tumour has been surgically excised. This slide includes topics like APBI, IOERT, IOHDR.
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 combined use of radiation therapy and chemotherapy in cancer treatment is a logical and reasonable approach that has already proven beneficial for several malignancies.
High-dynamic range (HDR) video is available to consumers today via both streaming services and optical discs. HDR video is a visually compelling experience that the average consumer can readily differentiate from existing HD content. As such, HDR video is expected to drive the next wave of consumer video. HDR TVs are available today, and HDR monitors will be available this year. The availability of these monitors will allow new user experiences on PCs, including true HDR gaming. This presentation describes what exactly HDR is and the challenges of properly displaying it on existing devices (PCs, laptops, phones, and such.) Some of the unique challenges of HDR include needing to convert content into linear light space for proper blending and scaling. This requires substantially more precision in hardware and software than we use for displaying today’s standard dynamic range content.
Inspired by the 2010 Ethical Literacy Conference featured presentation, “Embedding Social Responsibility into School Culture,” this interactive session will illustrate how students can be empowered to contribute and take responsibility for the culture of their school. Chris Cooper and Jill Reilly will explore ways to promote student ownership and social responsibility by using a student-centered approach to positive behavior intervention, called GO HDR! (Giving back, Ownership, Honest, Dependable, Respectful). They will also discuss ways of increasing awareness of GO HDR across the schools, including building values rubrics for various school settings, using the Honor Council as a driving force, and advancing GO HDR using student led activities.
Low dose rate versus high dose rate brachytherapy for carcinoma cervixRam Abhinav
Carcinoma cervix is the second most commonly occuring cancer in India.
Brachytherapy forms the most important part radiation therapy
Low dose rate Brachytherapy – Gold Standard
Experience more than a century
A quick walk-through some of the ways one can use HDR Imaging tools to enhance their photographic imagery. HDR is a tool, not an end-all solution, and requires fundamental photographic skills in order to leverage this technique to your advantage.
The real world scenes have a very wide range of luminance levels. But in the field of photography, the ordinary cameras are not capable of capturing the true dynamic range of a natural scene. To enhance the dynamic range of the captured image, a technique known as High Dynamic Range (HDR) imaging is generally used. HDR imaging is the process of capturing scenes with larger intensity range than what conventional sensors can capture. It can faithfully capture the details in dark and bright part of the scene. In this paper HDR generation method such as multiple exposure fusion in image domain and radiance domain are reviewed. The main issues in HDR imaging using multiple exposure combination technique are Misalignment of input images, Noise in data sets and Ghosting artefacts. The removal of these artefacts is a major step in HDR reconstruction. Methods for removing misalignment and noise are discussed and detailed survey of ghost detection and removal techniques are given in this paper. Single shot HDR imaging is a recent technique in the field of HDR reconstruction. Here instead of taking multiple exposure input images, a single image is used for generating HDR image. Various methods for Single shot HDR imaging are also reviewed.
New developments in image capture and delivery will affect entire entertainme...Technicolor
New developments in image capture and delivery will affect entire entertainment technology value chain - A conversation with Kirk Barker, Senior Vice President, Emerging Products, Technology Division, Technicolor
Technologies such as Ultra-High Definition (UHD), High Dynamic Range (HDR) and Wide Color Gamut (WCG) are disruptive agents of change in the film and television industry. At the heart of each is a better entertainment experience for the viewing public, but each has its challenges and benefits.
In this Q&A, Technicolor Senior Vice President Kirk Barker shares his insights on how UHD, HDR and other technologies will evolve. He also discusses what their impact will be on the various players who are leveraging the technologies, from consumer electronics manufacturers to film distributors, and how Technicolor is differentiating itself with its offerings.
2015 NAPIM Fall Tech Conference: Extended Gamut Guide PresentationBuzz Apostol
The National Association of Printing Ink Manufacturers New Technology Innovations Session Speaker on October 1, 2015 - Presented overview of Pantone's Expanded Gamut Guide that helps Brand Owners, Printers, and Designers achieve an acceptable visual match for approximately 90% of the solid colors in the PANTONE MATCHING SYSTEM® using a 7-color printing process, by adding Orange, Green and Violet (OGV) to the traditional Cyan, Magenta, Yellow and Black (CMYK) inks.
the role of brachytherapy in oral cavity carcinoma.
physics of brachytherapy
radiobiology of brachytherapy
clinical application in tongue, buccal mucosa cancer
Brachytherapy-A Brief Review with focus on Carcinoma Cervixiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Treatment of Advanced stage of Carcinoma Cervix & Ca cervix in Pregnancy.pptxMuthuRamanK3
1. Treatment of advanced stage of carcinoma cervix: Radiotherapy (including brachytherapy, teletherapy and adjuvant radiotherapy), Chemotherapy and Chemoradiotherapy;
2. Ca Cervix in Pregnancy: Includes flowchart for screening and management
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. BRACHYTHERAPY
Type of radiation treatment
Consists of placing sealed radioactive
sources very close to or in contact
with the target tissue.
3. CLINICAL ADVANTAGES
High biological efficacy
Rapid dose fall-off
High tolerance
Tolerable acute intense reaction
Decreased risk of tumor population
High control rate
Minimal radiation morbidity
Day care procedure
4. LIMITATIONS & DISADVANTAGES
Difficult for inaccessible regions
Limited for small tumors (T1_T2)
Invasive procedures, require GA
Higher dose inhomogeneity
Greater conformation –small errors in
placement of sources lead to extreme
changes from the intended dose distribution
Radioactive hazards (not now)
Costly
5. SELECTION CRITERIA
Easily accessible lesions
Early stage diseases (Ideal implant ≤ 5 cm)
Well localized tumor to organ of origin
No nodal or distant metastases (radical
intent)
No local infections or inflammation
Favorable histology- mod. diff. i.e. SCC
Well controlled DM / HTN
Proliferative/exophtic lesions preferred
(better outcome)
6. INDICATIONS
SOLE MODALITY
Skin malignanciesBCC, SCC
Head & neck cancers
Ca cx
Ca prostate
BOOST( AFTER
EXT.RT±CCT)
Head & neck cancers
Ca Breast
Esophagus
Anal canal
7. INDICATIONS...
PERIOPERTIVE
STS
Ca Breast
POSTOP
Ca Endometrium
Ca cx
Ca Breast
PALLIATIVE
Bronchogenic Ca
Biliary duct
malignancy
Ca Esophagus
Recurrent tumors
BENIGN
Keloids / Pterygium
OTHERS
Endovascular/Rad.
stent
9. DOSE RATE(ICRU 38)
LOW DOSE RATE (LDR)
0.4-2 Gy/hr (clinical practice range 0.4 to 1 Gy per
hour)
MEDIUM DOSE RATE (MDR)
2-12 Gy/hr
HIGH DOSE RATE (HDR)
> 12 Gy/hr
ULTRA LOW DOSE RATE
0.01-0.3 Gy/hr
10. ADVANTAGES
LDR
HDR
Predictable clinical effects
Superior radiobiological
SHORT TREATMENT TIME
role
Less morbidity, control is
best
Well practised since long
Minimum intersession
variability in dose
distribution
Geometry well maintained
Better patient compliance /
comfort
Day care procedure
DOSE OPTIMIZATION
NO RADIATION HAZARDS
SMALL APPLICATOR
Less tissue trauma
Better packing
11. AFTER LOADING TECHNIQUE
MANUAL
Avoids radiation
protection issue of
preloading
Better applicator
placement
Verification prior to
source placement
More radiation hazard
Advantages of
preloading
REMOTE
CONTROLLED
No radiation hazard
Accurate placement
Geometry maintained
Better dose distribution
Highly precise
Short Treatment time
Day care procedure
Mainly used for HDR
14. INTERSTITIAL BRACHYTHERAPY
Sealed Radioactive sources directly
implanted into the tumor in a geometric
fashion
ADVANTAGES
Higher local dose in shorter time
Rapid dose fall
Better tumor control
Lesser radiation morbidities
Superior cosmetics
Functional preservation of organs
15. INTERSTITIAL BRACHYTHERAPY…
DISADVANTAGES
Invasive procedure
Costly
INTENTION OF TREATMENT
RADICAL INTENTION
As radical brachytherapy alone (smaller lesions)
Local boost in combination with EBRT (larger lesion)
16. SELECTION CRITERIA
Easily accessible lesions, at least from one
side
Early stage disease
T 1-T2 and sometimes early T3
Ideally total size of implant ≤ 5 cm
Well controlled DM /HTN
No local infection
17. CLINICAL APPLICATIONS
Head & neck tumors
Early stage oropharyngeal cancers
Ca breast- Boost /PBI
Ca prostate
Soft tissue sarcoma
Gynecologic malignancies
Ca anal canal and rectum
Ca lung and pancreas
18. TYPES OF INTERSTITIAL
IMPLANTS
TEMPORARY
PERMANENT
ACCORDING TO SIZE/LOCATION/PROXIMITY OF TUMOR TO NORMAL STRUCTURES
Radioactive sources
removed after desirable
dose has been delivered
Rigid stainless steel
needles/flexible Teflon /
nylon guides/plastic
tubes
Preloaded/After loaded
Preloaded – rigid needle
eg. Ra226 ,Cs137
After loaded – Manual/
Remote
Advantages
Flexibility of implant
design
Reduction of radiation
exposure levels resulting in
more accurate placement
of needles and guides
19. PERMANENT IMPLANTS
ADVANTAGES
Less accessible sites
ultra low dose rate/Max
biological effectiveness
Better tissue heal
Better effect in slow and
radio resistant tumors
Improved mobility
DISADVANTAGES
Environmental issue
Dosimetric uncertainties/
Later part of Treatment
becomes less effective
Source displacement
Large tumor /Difficult
procedure and geometry
Radio biologically less
effective for rapidly
proliferating tumors
20. CLINICAL APPLICATIONS
Oral Cavity:
LIP:
Indications: T1-2N0 Lesions (monotherapy- 0.5to5 cm or
boost therapy->5 cm)
T.V.: All visible & palpable tumour with 5-10 mm margin
Dose: 50-70Gy in 5-7 days LDR
Technique:
Rigid after loading needles maintained in place by
Template
Classical plastic tubes
Spacers to decrease dose to gingiva, teeth & other lip
21. CLINICAL APPLICATIONS…
Buccal Mucosa:
Indications:
Brachytherapy alone indicated for small (<4cm), welldefined lesions in anterior 2/3rd
As boost after EBRT for larger lesions
T.V.: GTV +0.5 to 1 cm margins
Dose: Alone 65-70 Gy
Boost 25-30 Gy
Technique: Guide Gutter Technique: Lesion < 2cm
Plastic tube technique: For other lesions
23. CLINICAL APPLICATIONS…
Floor of Mouth:
Indications: T1-2N0 lesions, ≥ 5 mm away from
mandible
Dose: monotherapy-65Gy;boost-20 to 30 Gy
Complication: bone necrosis is most common, up
to 30%
Oropharynx:
Indications: Ca BOT, soft palate, tonsillar fossa &
vallecula usually as boost after EBRT
Lesions < 5 cm (after EBRT)
T.V.: GTV + 10 mm margin
Dose: Tonsillar fossa-25-30 Gy; BOT 30-35 Gy
Technique: Classical Plastic Loop technique
24. CLINICAL APPLICATIONS…
Nasopharynx:
Ind- T1 AND T2 lesions
Dose: LDR -as a sole treatment 60Gy; as a boost 12 to 20 Gy.
HDR- 18 Gy in 6 fr
Opthalmic brachytherapy(I-125,Ru-106,Sr90)
Ind- malignant tumors of the conjuctiva, pterygium,wet macular
degeneration,neovascularization
Sr 90 dose rate-100Gy/hr,, I-125 dose rate 0.5 to 1 Gy/hr
Pterygium – Sr 90 dose varying from 20 to 60 Gy in 1 to 6 fr.
25. CLINICAL APPLICATIONS…
Breast
Indications: Boost after BCS & EBRT
Postoperative interstitial irradiation alone of
the primary tumor site after BCS in selected
low risk T1 and small T2N0 (PBI)
As sole modality
As Boost to EBRT
Patient choice: cannot come for
5-6 wks treatment :
Close, positive or unknown
margins
Distance
Lack of time
Elderly, frail, poor health patient EIC
Large breasts, unacceptable
toxicity with EBRT
Younger patients
Deep tumour in large breast
Irregularly thick target vol.
Chest wall recurrences
26. CLINICAL APPLICATIONS…
T.V.: Primary Tumor site + 2-3 cm margin
Dose: As Boost: 10-20 Gy LDR
AS PBI: 45-50 Gy in 4-5 days LDR (30-70
cGy/hour)
34 Gy/10fr, 2fr per day HDR
Technique:
Localization of PTV: Surgical clips (at least 6)
USG, CT or MRI localization, Intra op USG
During primary surgery
Guide needle technique or
Plastic tube technique using Template
Double plane implant
Skin to source distance: Minimum 5 mm
27. MAMMOSITE
Used for Accelerated Partial Breast Irradiation(APBI)
Fluid filled balloon placed during surgery
Prescription
Reference Point at 1 cm
340cGy per fraction
2 fractions per day
6 hour separation
10 fractions total
Weekend break is allowed
28. Ideal patients for APBI(ASTRO)
Tumor Size < 2 cm
Absence of nodal involvement(N0)
Absence of Metastatic Status(M0)
Age > 60 yr
Negative margins
Invasive ductal histology in the absence of
DCIS
Estrogen receptor positive
29. HDR Brachytherapy with Savi
The Savi applicator is a new single insertion
multicatheter device used for partial breast
radiation.
It has a single central catheter and multiple
peripheral catheters.
This allows the radiation dose to be tailored to
the shape of the lumpectomy cavity.
30. Contura- multi lumen baloon
Consists of a central lumen and 4 outer lumen
offering a total of 40 dwell positions
Encased in a polyurethane balloon which
maintains symmetry and reduces potential
for balloon ruputre.
31. NEW ELLIPTICAL BALOON(2004)
Provides excellent conformance
Ellipsoidal implant parellel to the chest wall
provides appropriate symmentry
32. AXXENT:NEWER DEVICE
Uses a miniaturized x-ray source to deliver low energy x-rays within
a needle or catheter.
Use of this device for APBI
No need for heavy room shielding
Stay in room with patient during treatment
No radioactive materials license needed
No handling, storing, security concerns
One source per patient
Must calibrate source before each treatment
33. CLINICAL APPLICATIONS…
Prostate:
Indications
Brachytherapy as monotherapy:
Stage T1-2a /Gleason score 2-6 / PSA ≤ 10 ng/ml
As boost after EBRT
Stage T2b, T2c /Gleason score 7-10 /PSA > 10 ng/ml
Patient factors :
Life expectancy > 5 yrs
IPSS<15
Prostate volume<60cm2
No defect if previous TURP
Minimal pubic arch interfence
T.V.: Whole prostate within capsule + 2-3 mm
margin
Methods: Permanent Implant (I125 or Pd103) or
Temporary Implant (Ir192)
34. CLINICAL APPLICATIONS…
Technique for Permanent implant
Retropubic approach with I125 seeds- Disappointing results
Modern technique: Transperineal Approach
TRUS guided
Two step approach
Volume study of prostate
pubic arch interfence assessment
Computer planning
Coverage check -USG & Flouroscopy
Bladder irrigation /Cystoscopy can be performed
Post-implant image based dosimetry
35. CLINICAL APPLICATIONS
Dose:
I125: 145 Gy as sole RT;100-110 Gy as boost to 40-50 Gy
EBRT
Pd103: 125 Gy as sole RT;90-100 Gy as boost to 40-50 Gy
EBRT
Cs 131 :115 GY as sole rt;85-95 Gy as boost to 40-50 Gy
EBRT
Temporary Implants with Ir192 (LDR or
HDR):
Procedure same as above; lesser no. of plastic
catheters required (8-15)
Dose:
LDR 30-35 Gy seeds left for 3 days(Boost to 45 Gy
EBRT)
HDR 20-25 Gy, 4-6 Gy/#(Boost to 45 Gy EBRT)
36. CLINICAL APPLICATIONS
Soft tissue Sarcomas (using Ir192 or I125)
Indications:
As sole postop RT:
completely resected intermediate or high grade tumours
of extremity or superficial trunk with -ve margins
As boost to postop EBRT:
Intermediate or high grade sarcoma with +/- margins
Postop pts with small lesions & +ve/uncertain margins
Deep lesions
Low grade sarcomas
T.V.: GTV + 2-5 cm margin
GTV based on preop MRI & clinical findings
Dose: LDR (Ir seeds or wires) as sole treatment
45-50 Gy in 4-6 days
As boost to 45-50 Gy EBRT: 15-25 Gy in 2-3 days
HDR: as sole treatment 40 t0 50 Gy in 12 to 15 fr/ as boost
to 45-50 Gy EBRT:18-25 Gy in 4-8 fr
37. CLINICAL APPLICATIONS…
Technique:
Usually performed at time of surgery
Basic or sealed end temporary implant technique
To delay the start of brachytherapy for about 4 to 7
days after surgery
limit the allowable skin dose the 40 Gy isodoseline
to <25cm2 and the 25 Gy isodose line <100 cm2
38. CLINICAL APPLICATIONS…
Brain: Permanent or temporary (using I125 or Ir192
seeds/wires )
Indications:
As boost to EBRT or recurrence
Anaplastic astrocytoma or GBM, unifocal, well
cicumscribed, peripheral lesions & < 5 cm in diameter
T.V.: Contrast enhancing area on MRI +/- 5mm
margin
Dose: LDR 50-60 Gy, 0.4-0.5 Gy/hr
39. Gliasite
Used to treat brain tumors
Balloon filled with I-125
containing solution
Example: used to treat
glioblastoma multiformae to
50 Gy followed by EBRT
boost
40. CLINICAL APPLICATIONS…
Ca Anorectum
Indications: As boost to EBRT/ChemoRT
If T.V. does not exceeds 1/2 circumference, 5 mm thick, 5
cm long i.e. T1-2 & small T3 lesions
T1N0 adenocarcinoma of rectum 3-10 cm above anus
T.V.: Visible palpable tumor+5 mm
Dose: LDR 15-20 Gy at 0.3-0.6 Gy/hr
Technique: Guide needle technique with
plastic perineal template
41. CLINICAL APPLICATIONS…
Gynecological Tumors (Ir192 LDR or HDR)
Indications:
Ca Cervix
Ca Endometrium
Postop local recurrence
Ca Vagina & Vulva
Radical BT in early lesions (T1-2N0)
Boost after EBRT in large lesions (T2-3N1)
Technique:
Guide-gutter technique
Blind plastic tube implant
(transperineal technique)
Plastic or guide needles
42. CLINICAL APPLICATION – CA
ABS Recommendations
CX
Bulky primary disease
Prior hysterectomy-inability to place tandem
Post hysterectomy
vault rec/cervical stump presentation
Extesive parametrial involvement
Distorted anatomy
Narrow vagina & fornices
Extensive / Distal vaginal wall involvement
Re-irradiation after recurrences
45. CLINICAL APPLICATIONS…
Ca Lung: Permanent perioperative BT, I125 seeds
Persistent or recurrent ds after EBRT or residual ds after
surgery
Ca Pancreas: Permanent perioperative BT, I125 seeds
Locally advanced unresectable ds
Ca Penis: scc predominant histology,
Indications – T1,T2 and T3(<4cm)that do not involve the
shaft of penis.
Based on paris system using templates(12 &18mm)
Dose ;60 Gy at a dose rate of 0.5 to0.65Gy/hr
Ca urethra: as sole treatment is 60 to 70 Gy in 3 to 5 days;
as a boost 20 to 25 Gy.
46. INTRACAVITARY APPLICATION
Radioactive sources are placed in a existing
cavity usually inside a predefined applicator
with special geometry
Uses:
Cervix
Endometrium
Vagina
Maxilla
Nasopharynx
47. DOSE SCHEDULE
LDR (<200cgy/hr)
35-40 Gy at point A
MDR (200-1200cgy/hr)
35 Gy LDR EQUIVALENT at point A
HDR(>1200cgy/hr)
9 Gy in 2 fr
6.8Gy in 3 fr at point A
48. EXTERNAL RT WITH
BRACHYTHERAPYfollow external irradiation
Brachytherapy can
SIMULTANEOUS
Stage I - II with very minimal parametriun
involvement
HDR -5 sessions (9gy /fr, 1week apart)
40 Gy by EBRT simultaneously
SANDWICH
Stage I-II
40 Gy LDR eq.—› EBRT 40 Gy
In both above cases a MIDLINE SHIELD is
used
49. POST OP/ VAULT
Vault RT
BRACHYTHERAPY
No residual disease
8500 cGy at 5mm from the surface of the
vault
2 sessions 1 week apart
Residual disease
CTV of 2 cm given to gross tumor and the
prescription of 8500cgy encompassing the
whole CTV is made
2 sessions 1 week apart
Mostly after EBRT
50. POST OP BRACHYTHERAPY
CONTRAINDICATIONS
Vaginal wall involvement ( middle- lower 13)
Heavy parametrium infiltration
VVF or VRF
Inadequate space
Medical contraindications
Metastatic disease
Supplementary radiation 2000 cGy 10fr
51. SURFACE MOULDS
Radiation is delivered by arranging RA
sources over the surface of tumor
Types
Planar
Circular
Square
Rectangular
Line source
Cylinder
52. INDICATIONS
Superficial /Accessible tumors
keloid : Sr90 , 20 gy in 4 fr after surgery.
Skin ca – HAM applicator, Freiburg flab are
surface template applicators, dose – 35 to 50
Gy in 5 to 10 fr.
Post mastectomy recurrence – LDR- 65 Gy in
2 to 3 fr,monthly intervals.
Oral tumor
hard palate ,alveolus,oral cavity,lip
as a sole modality 60 GY,as boost to 45 to 50 GY-
15 TO 30 Gy.
Penile carcinoma
53. INTRALUMINAL BRACHYTHERAPY
Radioactive source is passed through a tube and
passed into a hollow lumen
Sites
Esophagus : TV-tumor+distal and proximal margin of
2 to 3 cm
Dose: palliative-16 GY IN 2 FR or 18 GY IN 3 FR.
as boost EBRT 50 Gy-HDR 10 Gy in 2 fr at 1 cm
from surface.
54. ILBT..
Bronchus : Bronchogenic carcinoma
Definitive : T1-T2tumors
HDR- sole treatment-5Gy in 5 fr or 7.5 Gy in 2 fr
prescribed to 1cm.
as boost to EBRT treatment(45 TO 60 Gy)- three 5
Gy fr or two 7.5 GY fr
Palliative :
Dyspnea,hemoptysis,post obstructive pneumonitis
Poor lung function
Previous EBRT
Dose : 7.5Gy/fr in3 weekly fr, 10Gy/fr in 2 fr, 6Gy/fr in 4
fr prescribed at 1 cm.
Boost treatment- 30 Gy in 10 to 12 fr
55. Biliary tract
Ind – unresectable tumors
Technique – endoscopic retrograde technique
BT delivered throug a transhepatic
cholangiogram
TV- tumor +1 to 2 cm proximal and distal
margin
Monotherapy- palliative dose 30 gy in 6 fr
As boost(45 Gy EBRT) – 15 TO 20 Gy in 3 to 4
fr.
56. Intra vascular
brachytherapy
Coronary artery disease caused
by occlusion of cardiac vessels
IVB used to prevent restenosis
after angioplasty
Radiation delivered either with
temporary implant or radioactive
stent
57. Intra operative Radiation
brachytherapy
Attractive for deep tumors
because the skin dose was
limiting prior to the invention
of megavoltage accelerators.
Applications include:
retroperitoneal
sarcoma, pancreatic cancer,
rectal cancer, pediatric
tumors,malignant thoracic
tumors.
dose of 10 to 20 Gy in single
fr over 10 to 30 minutes.
58. Image guided brachytherapy
Image-guided brachytherapy may provide
better dose distribution to the target tumor
and reduced dose volumes to surrounding
healthy tissues when compared with imageguided IMRT and IMPT.
The use of imaging techniques, such as
ultrasound,CT and MRI for treatment
planning, has led to improved visualization of
the tumor and surrounding organs.
59. IGBT…
Applicators used for IGBRT should be such
that the applicator does not produce an
artifact on the cross sectional imaging
technique being used. For this purpose
special CT/MRI Compatible applicators
should be used. The applicators are usually
made up of a titanium alloy Now a days
carbon fibre based brachytherapy
applicators are also available.
MR is an ideal image guidance modality
for image guided brachytherapy.
Outstanding visualization of pelvic
60. Adaptive Brachytherapy
Adaptive Brachytherapy can be defined as
temporally changing the treatment plan
delivered to a patient based on observed
anatomic changes caused by tumor shrinkage,
weight loss, or internal motion.
Plans are altered throughout the treatment
course for every course of treatment depending
on tumor volume.
Patient setup and organ motion obtained from
imaging during treatment to alter the treatment
plan.
61. ROBOTIC BRACHYTHERAPY
Improve accuracy of needle placement
and seed delivery
Improve consistency of seed implant
Improve avoidance of critical structures
Reduce radiation exposure
MAINLY USED FOR CA PROSTATE
Seed placement error is at sub millimeter
level.
62. Intensity modulated
brachytherapy
This modulation is specific for the patient and allows for high
intensity radiation treatment of tumor tissue with limited
destructive effects on surrounding normal tissue.
Intensity modulated sources based on Monte Carlo
simulations
a “modified TG43” (mTG43) dose calculation algorithm
developed specifically for IMBT dosimetry. the anisotropic
function of a IMBT source, is a function of both the position
of measurement and the intensity distribution of the source
an inverse IMBT treatment planning method based on Dose
Volume Histogram (DVH) or Dose Surface Histogram (DSH)
constraints and simulated annealing optimization algorithm.