Brachytherapy

RDTH 3120

URL : http://www.md.ucl.ac.be/rbnt/rpr

Prof. S.Vynckier

UCL, Brussels

This PowerPoint file is taken from the lecture :

« dosimetry : RDTH3120 » at the UCL

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S. Vynckier, UCL
 What is brachytherapy (Curiethérapie)

z The word brachytherapy is derived from the ancient

Greek words βραχυς, which means ‘short’ or ‘close,’
and θεραπεια, which has several meanings including
‘medical treatment’ or ‘therapy.’
z Brachytherapy is a form of radiotherapy in which
radioactive sources are placed inside or near the
tissue to be irradiated.
z With this form of treatment, a high dose can locally
be deliver to the tumor, with a rapid dose fall-off in
the surrounding healthy tissues due to the inverse-
square law.
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 History
From: RF Mould, JJ Batterman, AA Martinez, BL Speiser (eds), Brachytherapy: from Radium to Optimization, Nucletron, 1994

The first successful brachytherapy treatments were performed soon after Marie and
Pierre Curie’s discovery of radium in 1898. This picture shows how radium (226Ra)
surface applicators were used for the treatment of skin cancer.
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 Brachytherapy today
Courtesy of Nucletron

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 Applications
z Four types of brachytherapy applications are commonly
distinguished:
– Surface applications: source molds or flexible surface applicators
are used to position the sources at a fixed distance from the lesion
(e.g. skin cancer) to be irradiated.
– Intracavitary applications: the sources are inserted into a natural
body cavity, often using specially designed applicators for precise
source positioning.
– Interstitial applications: the sources are inserted into the tumor
itself by means of e.g. needles or catheters:
 in a temporary implant, the sources are removed when the treatment
has been completed;
 in a permanent implant, the sources are left in place.
– Intravascular brachytherapy: catheter-based delivery of radiation
to prevent restenosis after angioplasty.
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 Courtesy of Nucletron

Intracavitary examples

z The most common intracavitary

application of brachytherapy is
for gynecological tumors (e.g.
cervical cancer)
z Other intracavitary applications
include e.g. cancer of the
rectum and nasopharynx
z So-called intraluminal
applications include e.g.
bronchial or esophageal cancer

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 Interstitial examples
z Common interstitial applications include prostate cancer, breast
cancer (breast conserving therapy), and cancers in the head
and neck region.
z Interstitial treatment is also used for cancers of the brain,
pancreas, lung, soft tissues, etc.
z Generally, temporary implants allow better control of the dose
distribution (more accurate source
positioning and, in HDR brachytherapy,
control of dwell times)
z However, permanent implantation is a
one-time procedure and may therefore
be preferable for tumors that are
difficult to reach (e.g. in the abdomen)
Courtesy of Nucletron

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 Intravascular brachytherapy
Courtesy of Nucletron
Schematic overview of the
principle of intravascular
brachytherapy (IVB). The
left-hand column
represents the normal
chain of events, where the
initial success of an
angioplasty treatment may
be limited by the
occurrence of restenosis
and repeated intervention
may be necessary. The
right-hand column shows
how intravascular
irradiation may be used to
prevent restenosis. IVB is
performed in coronary as
well as peripheral arteries.

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Contact treatments: plaque treatments
• Choroidal melanoma
• Rethinoblastoma © b-ray plaques
• Choroidal hemangioma 90Sr + 90Y (Eave= 0.933 MeV b)
(Emax= 2.28 MeV b)
• ... (T1/2 = 29.21 years)
106Ru +106Rh (Eave= 1.43MeV b)
(Emax= 3.54 MeV b)
Treatment techniques (T1/2 = 368 days)
© gold plaques loaded with seeds :
• Enucleation 125I (27-35 keV photons)
(T1/2 = 59.4 days)
• Plaque therapy 103Pd (20-23 keV photons)
(T1/2 = 17.0 days)
• Proton therapy
• ...
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 Fundus photograph of the choroidal melanoma

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 Echography of the choroidal melanoma

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Normal eye Melanoma

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 125I ophthalmic plaques

Longitudinal view of a 125I seed

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 106Ru ophthalmic plaques

Silver window
Silver window
0.1mmthickness
0.1mm thickness

Radioactive part
Radioactivepart
0.2mmthickness
0.2 mm thickness
Silver shell
Silver shell
0.9mmthickness
0.3 mm thickness

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 Dose planning for 125I gold plaques

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Dose planning for b-plaques (106Ru+106Rh)

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 From manual to remote afterloading

Up until the 1950’s,

brachytherapy sources were
prepared and put in place
manually in most cases,
resulting in high doses to the
medical personnel involved.
The picture shows an example
of a surface mold used to treat
a skin lesion.
Courtesy of Nucletron

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 From manual to remote afterloading

z A first improvement was the development of manual

afterloading techniques. In this approach, unloaded needles,
catheters or applicators are carefully implanted. Hereafter, the
radioactive seeds, wires or tubes are inserted. Besides a
reduction of staff exposure, these techniques also improved the
accuracy of dose delivery. Manual afterloading of (relatively
weak) LDR brachytherapy sources is still being performed
today.
z In the 1960’s the first remotely controlled afterloaders were
developed. The use of these machines completely eliminated
staff exposure and made possible the use of much stronger
sources.

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 Manual afterloading

Example of manual
afterloading, using
192Ir wires for the

treatment of a
tumor in an eyelid.
Note the moveable
lead shields at both
sides of the patient.
From: European School of Medical Physics (ESMP), Archamps 2002
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 Remote afterloading
Example of a modern afterloader,
the microSelectron HDR V2 from
Nucletron B.V. It contains a small,
sealed, 10 Ci 192Ir stepping source,
mounted at the end of a stainless
steel drive wire. The afterloader is
connected to the implanted
applicator, catheter or needle using
flexible transfer tubes. The device
is able to position the source at a
preprogrammed series of source
positions with millimeter accuracy.
The dose distribution can be
optimized by adjusting the dwell
time at each source position. Courtesy of Nucletron

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 Remote afterloading
Hand cranks if
Emergency Safe, holding the active
everything else fails
button source and a dummy source
From: European School of Medical Physics (ESMP), Archamps 2002

Optopair to verify
source position

Indexer face
with 18
source
channels

Stepper motor
with shaft encoder (additional Transfer
Indexer
DC motor available for source tube
retraction in case of failure) Radiation monitor connector
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Battery pack available in case of power failure

S. Vynckier, UCL
 Remote afterloading
Courtesy of Nucletron

The indexer guides the source into one

of the 18 source channels. Before the
active source is inserted into any of the
channels, a dummy source is inserted
first to check for obstructions etc.
Courtesy of Nucletron
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 Remote afterloading

Courtesy of Nucletron

As illustrated by this autoradiograph, an important advantage of a stepping source is that

the dose distribution can be modified by altering the source positions and the dwell times
(i.e., the time spent at each source position). Each of the four dose distributions in this
example were produced by a single source in a single catheter.
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 No staff allowed in the treatment

Remote afterloading room during irradiation, but

treatment can be interrupted
when patient care is necessary.
Courtesy of Nucletron

Afterloader

Treatment
room has
shielded
walls Treatment control station

Treatment planning

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 HDR versus LDR
z In low dose rate (LDR) brachytherapy, irradiation times are of
the order of hours to days (surface, intracavitary and temporary
implants) or even days to weeks (permanent implants).
z In high dose rate (HDR) brachytherapy, doses are typically
delivered in a faction of an hour, using much stronger sources.
z Although HDR brachytherapy requires more expensive
equipment, necessities room shielding and increases personnel
demands, it has some practical advantages:
– possibility of treatment on an out-patient basis;
– possibility to treat more patients in the same amount of time;
– decreased patient discomfort.
z Radiobiologically, there are important differences between HDR
and LDR brachytherapy.
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 HDR versus LDR

From: S. Nag, High Dose rate Brachytherapy: a Textbook, Futura, 1994

¾In low dose rate (LDR)
brachytherapy, (almost) all
of the potential for repair is
being utilized. In contrast,
(almost) no repair takes
place in HDR treatments.

¾Lower doses are needed

with HDR than with LDR
to achieve the same cell
kill.

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 HDR versus LDR
One way in which HDR

From: S. Nag, High Dose rate Brachytherapy: a Textbook, Futura, 1994

treatment can be made
(more) equivalent to
LDR irradiation is by
means of fractionation.

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 HDR versus LDR
z Besides fractionation, there are several other ways to improve
the clinical efficacy of HDR brachytherapy, making use of the
dosimetric and treatment advantages that HDR has over LDR:
– possibility to optimize the dose distribution by adjusting
source positions and dwell times, resulting in a more
“conformal” dose distribution;
– more precise dose delivery due to immobilization;
– possibility to move (some) sensitive healthy tissues away
from the source during treatment.
z The clinical outcome of HDR has been shown to be comparable
to LDR for many indications. Given the practical advantages, this
makes HDR preferred modality in many cases.

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 Common radionuclides
Nuclide Main Half-life Energy Half-value Air kerma rate
emission (keV) thickness constant
(mm Pb) (µGy m2 h-1 MBq-1)
32
P β 14.26 d 1710 max
(696 avg)
60
Co γ 5.271 y 1173, 1332 11.0 0.3078
(1252 avg)
90
Sr/90Y β 28.79 y 2280 max*
(935 avg)*
103
Pd X-rays 16.99 d 20-23 0.008 0.1746
(21 avg)
106
Ru/106Rh β 373.6 d 3541 max
(1413 avg)
125
I X-rays 59.41 d 27-35 0.025 0.2519
(28 avg)
137
Cs γ 30.07 y 662 5.5 0.08807
192
Ir γ 73.83 d 61-612 2.5 0.1230
(354 avg)
198
Au γ 2.695 d 412 2.5 0.05759
* Maximum and average beta energies are given for the daughter nuclide.
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 Examples of Iodine sources
MED3631 from North American InterSource125 from IBt

Symmetra from Uromed/Bebig Models 6702 and 6711

from Amersham

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 Examples of Palladium sources
MED3633 from North American InterSource103 from IBt

Model 200 from Theragenics

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 Beta sources
90Sr/90Y intravascular source for the
treatment of in-stent restenosis in
coronary arteries. This source from
Novoste Corporation consists of a
train of tiny seeds that is advanced to
the lesion through a catheter by
means of hydraulic pressure. Gold
marker seeds at both ends of the
source train are used to localize the
source under fluoroscopy. Kindly provided by Wim Dries, Catharina Hospital, Eindhoven

106Ru/106Rh eye plaques

from Bebig GmbH. These
are temporarily (2-14 days)
stitched to the eye to treat
eye melanoma. Some
plaques have cut-outs for
the iris or optic nerve.

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 Source strength
z The first brachytherapy sources contained 226Ra, and the source
strength of such a sources was simply specified by the mass (in
mg) of radium contained within the source.
z A more general quantity is activity, i.e. the number of
disintegrations per unit time taking place within the source. The
SI unit for activity is Bq (Becquerel, the number of
disintegrations per second), but for historical reasons many
people still use the Ci (Curie, 1 Ci = 3.7⋅1010 Bq).
z The major problem with both of these quantities is that, for a
given radionuclide, the dose rate at a given point outside the
source depends not only on the amount of radioactivity inside
the source but also on the attenuation, scattering and filtration
of the emitted radiation in the source material and capsule
(often called self-absorption).
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 Source strength
Nowadays, the quantity used to specify the source strength of
brachytherapy gamma sources is the air kerma strength defined by
the American Association of Physicists in Medicine (AAPM) as “the
product of air kerma rate in free space and the square of the
distance of the calibration point from the source center along the
perpendicular bisector.”
– This definition is only valid if the distance between the source and the detector is
large enough that they can be treated as a point source and a point detector,
respectively.
– With "in free space" one means that the measurement must be corrected for air
attenuation and photon scattering (i.e. the interaction of the radiation with the air
between source and detector and with surrounding
media such as the walls of the measurement room),
so the result equals that of a hypothetical
measurement in an infinite vacuum.
– The unit recommended for air kerma perpendicular bisector
strength is µGy h-1 m2. or transverse axis
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 Source strength
z Similarly, the International Commission on Radiation Units and
measurements (ICRU) defines the reference air kerma rate of a
source as “the kerma rate to air, in air, at a reference distance
of one meter, corrected for air attenuation and scattering.”
– The corresponding unit is µGy h-1 at 1 m.
– Although defined somewhat differently, this quantity numerically equals the
air kerma strength defined by the AAPM.
z While the air kerma strength and reference air kerma rate are
proportional to the activity of the source, they are a much
better measure of the strength of a source because self-
absorption (which, due to production tolerances, may not even
be equal for different sources of the same type) is taken into
account.

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 Source strength
z Once a source has been calibrated in terms of air kerma
strength or reference air kerma rate, its strength can also be
specified as apparent activity, defined as the activity of a bare
point source of the same radionuclide that produces the same
air kerma rate at 1 m. This may for example be convenient
within the context of radiation protection regulations (e.g.
transport), where an estimate of the source activity may be
required.
z The equivalent mass of radium (mg-Ra eq) is derived by
dividing the air kerma strength or reference air kerma rate by
the air kerma rate constant (in µGy h-1 mg-1 m2) of a 226Ra point
source filtered by 0.5 mm Pt. This is mainly of interest for
historical reasons, e.g. for comparison with past treatments.

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 Source specification (cont’d)
z User calibration : well type ionization chamber with
a calibration traceable to the national standard for
each type of brachytherapy sources

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 3D dose distribution
The 3D dose distribution about a source is
determined by the following factors:
– The inverse square law. The particle fluence about a point
source in vacuum falls off with the square of the distance to
the source. For a source of finite extend one can calculate it
as the integral of the contributions of infinitesimal volume
elements over the radioactive volume.
– The interaction of the emitted particles with the materials
within the source itself and around it. The parameters that
include the influence of interactions on the dose distribution
are the type(s) of particle emitted by the radionuclide, the
energy spectrum of the emitted radiation and the
composition and density of the materials involved.
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 3D dose distribution
Some common terminology:
– the radial depth-dose distribution or radial depth-dose curve
describes the variation of the dose rate along the transverse
axis or perpendicular bisector as a function of distance from
the source center in a given medium;
– the anisotropy describes the variation of the dose rate as a
function of the angle with the source axis.
– the dose distribution about
a source or implant is
commonly depicted
using isodose curves source axis
(lines connecting perpendicular bisector
points of equal dose) or transverse axis

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 3D dose distribution

Med Phys 22(2), 209-234, 1995

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 TG-43 protocol

Nowadays, the dose calculation formalism recommended by Task Group 43

(TG-43) of the AAPM is the generally accepted method to express the dose
distribution about (most) brachytherapy sources.
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 y

TG-43 protocol P(r, )

P(r0, 0) r

1 2

z
L

z The dose distribution in water is described in a polar coordinate

system with its origin at the source centre, as the product of a
number of parameters:
D(r , θ ) = D(r0 , θ 0 ) [G (r , θ ) / G (r0 , θ 0 )] g (r ) F (r , θ )
z Here, D(r0,θ0) equals the dose rate in water at the reference
point that is located at a distance of r0 = 1 cm on the
transverse bisector of the source, i.e., at θ0 = π/2.
z For gamma sources, D(r0,θ0) = SkΛ, where Sk is the air kerma
strength and Λ is the dose rate constant, defined as the dose
rate in water at the reference point per unit air kerma strength.
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 y

TG-43 protocol P(r, )

P(r0, 0) r

The geometry factor is defined as: 1 2

z
v v v 2 L

v ∫ [ ρ A (r ) / (r ′ − r ) ] dV ′
′ D(r, )=D(r0, 0) [G(r, )/G(r0, 0)] g(r) F(r, )
G (r ) = v
∫ ρ A (r ′) dV ′
where the activity distribution equals the activity per unit volume at
and is an infinitesimal volume element located at the same position.
This function reduces to:
1 θ 2 − θ1
G (r ) = for a point source; G ( r ,θ ) = for a line source.
r 2
L r sin(θ )
Here, L is the active length of the source and the angles θ1 and θ2 are
indicated in the figure.
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 y

TG-43 protocol P(r, )

P(r0, 0) r

1 2

z
L

D(r, )=D(r0, 0) [G(r, )/G(r0, 0)] g(r) F(r, )

The radial dose function is defined as:

G (r0 ,θ 0 ) D(r ,θ 0 )
g (r ) =
G (r ,θ 0 ) D(r0 ,θ 0 )

As the influence of the inverse square law is accounted for by the

geometry factor, it can be said that the radial dose function accounts
for the influence of the interaction of the emitted radiation in the
medium and source materials on the depth-dose distribution along
the transverse axis.
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 y

TG-43 protocol P(r, )

P(r0, 0) r

1 2

z
L

D(r, )=D(r0, 0) [G(r, )/G(r0, 0)] g(r) F(r, )

The anisotropy function is defined as:

G (r ,θ 0 ) D(r ,θ )
F (r ,θ ) =
G (r ,θ ) D(r ,θ 0 )
the anisotropy function accounts for the anisotropy of the dose rate
distribution relative to the transverse axis, due to self-absorption,
oblique filtration of primary photons through the encapsulation
materials, and scattering of photons in the medium. Note that, in
principle, the geometry factor accounts for the anisotropy resulting
from the spatial distribution of the radioactivity in the source.
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 Measurements
„ Phantoms:
Phantoms different geometries for the
measurements of the dose distribution in
solid water WT1 and RW1

„ Detectors : LiF TLD-100 microcubes from

Harshaw 1x1x1 mm3
Calibration at 6MV with an
energy factor of 1.4
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 Phantoms geometry
Radial function Anisotropy function

10°

2 cm
5cm
3cm

TLD position

Source

Two types of solid water of slightly different composition

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 Radial function
1.4
10
calculations in WT1
1.2 5

0 measurements in WT1
0 2 4 6 8
1 -5
distances (cm) calculations in WT1

0.8 measurements in
WT1
125I calculation of
0.6 Meigooni and al.
measurements of
Meigooni and al.
0.4
calculations of
103Pd Meigooni and al.
0.2 measurement of
Meigooni and al.

0
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0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00
distance from the source (cm

S. Vynckier, UCL
 Comparison with literature
1.4 10
5
calculations in WT1
0
1.2
-5 0 2 4 6 8
measurements in WT1
-10
1
-15
calculations in WT1
-20

0.8 distance measurements in

WT1
125I
0.6 calculation of
Meigooni and al.
measurements of
0.4 Meigooni and al.
103Pd calculations of
0.2 Meigooni and al.
measurement of
Meigooni and al.
0
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0 1 2 3 4 5 6 7 8
distance from the source (cm)

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 10

5
difference

0
01.2 50 100

-10
-5
Anisotropy function

1.0 angle q 125I

anisotropy function f(r,q)

0.8 103Pd
calculations at 3cm in
WT1 for iodine
0.6
measurements at 3cm
for iodine
0.4
calculations at 2cm in
RW1 for palladium
0.2
measurement at 2cm for
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0.0
0 20 40 angle q 60 80 100
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 Dose calculation algorithm
for β-particles : point
kernels
from : Vynckier and Wambersie, PMB 1982

B ⎧⎨ ⎡ − ρν x ρν x ]
ρν ρν ρν 1− ρν x − f }
J(x) = c1 exp(1 − ) + xexp(1 − x) − xexp( )
( ρν x) 2⎩ ⎣ c c 2 2

with [ ] ≡ 0 for c < ρνx and J(x) ≡ 0 for ρνx > f.

α is expressed by :

α-1= 3c2- (c2-1)e +(3 + f)exp(1 - f) -4 exp(1 - (f/2))

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 Imaging and reconstruction
The 3D positions of
Brachytherapy Using Afterloading Systems, Edward Arnold, 2001
From: CA Joslin, A Flynn, EJ Hall (eds), Principles and Practice of

implanted needles,
catheters, applicators or, in
case of evaluating
permanent implants, the
sources themselves, may for
example be determined by
means of an orthogonal set
of X-ray images. Needles
and catheters for temporary
implants are filled with X-
ray markers (e.g. a steel
wire with tungsten markers
at every cm) before the
images are taken.

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 Imaging and reconstruction

From: European School of Medical Physics (ESMP), Archamps 2002

Orthogonal reconstruction of a gynecological applicator

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 Imaging and reconstruction

Courtesy of Nucletron

Reconstruction may also be done by means of a treatment simulator...

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 Imaging and reconstruction
... when a simulator is

Brachytherapy Using Afterloading Systems, Edward Arnold, 2001

From: CA Joslin, A Flynn, EJ Hall (eds), Principles and Practice of
used for reconstruction,
the use of the variable
angle technique allows
one to select the
imaging angles that
provide the best image
quality and/or the best
visual separation
between sources or
catheters in a complex
implant

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 Imaging and reconstruction

From: European School of Medical Physics (ESMP), Archamps 2002

Compared to a bronchial implant with only a few catheters (see right-hand picture, where the
catheters contain X-ray markers), a permanent prostate implant (left-hand picture) is much
more difficult to reconstruct. The large number of sources makes manual reconstruction very
tedious, and sources may be overlapping from any viewing angle. This creates a need for
better imaging modalities and computerized reconstruction.
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 Imaging and reconstruction

From: European School of Medical Physics (ESMP), Archamps 2002

Example of automated reconstruction of an HDR gynecological applicator using

computed tomography (CT) images. The images also show the source dwell
positions within the 3 source channels, and the calculated isodose curves.
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 Imaging and reconstruction
uterus

cervix
bladder rectum

From: European School of Medical Physics (ESMP), Archamps 2002

An important advantage of magnetic resonance imaging (MRI) is that soft tissues are much
better visible than with CT. This makes it easier to localize not only the applicator, but also
the cancerous tissue to be irradiated as well as the radiosensitive tissues (such as the bladder
and rectum) to which the dose should be kept to a minimum.
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 Imaging and reconstruction

Courtesy of Nucletron

CT and MRI reconstruction require the use of applicators that contain no metal parts. The
right-hand picture shows a recent MRI and CT compatible gynecological applicator made of
carbon tubes and plastic parts, while the left-hand picture shows an older applicator
containing metal parts.
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 Imaging and reconstruction

bladder

prostate

rectum
urethra

From: European School of Medical Physics (ESMP), Archamps 2002

Ultrasound (US) imaging is also being used, especially for prostate implants. The left-hand
figure shows how the sources are implanted via needles that are inserted through a guiding
template (blue) into the prostate (yellow). The needle position is constantly monitored using a
trans-rectal US (TRUS) probe (pink), in order to avoid damage to the urethra or bladder. In
addition, a camera is often inserted into the bladder via a catheter to monitor the bladder wall.
25-05-2005 60

S. Vynckier, UCL
 Treatment planning

Courtesy of Nucletron

Screenshots of a modern treatment planning program. The left hand picture shows a
reconstructed breast implant with isodose curves, the right-hand picture shows a CT image
of a prostate implant together with the isodose curves predicted for a HDR brachytherapy
boost plus subsequent external beam fractions.
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S. Vynckier, UCL
 Système de Paris: exemple

A. Définition :

Système dosimétrique prévisionnel de curiethérapie basé sur une

répartition régulière de sources d ’Ir192

B. Règles d ’implantations :

1. Sources parallèles, rectilignes ;

2. 2. Plan central : plan perpendiculaire aux sources en leur centre;
3. Débit de Kerma uniforme le long de chaque ligne et identique
pour toutes les sources ;
4. Lignes équidistantes .
Exemples :
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Disposition en ligne Disposition en triangle

Disposition en carré
S. Vynckier, UCL
 Système de Paris
C. Distribution de dose :

Symétrie des isodoses circulaire ;

Source = axe de symétrie ;
La surface des isodoses entourant chaque ligne a la forme
d ’un cigare allongé.

X Y
Y

X Y
Z Coupe dans le plan central
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S. Vynckier, UCL
 Système de Paris
D. Points de base :

La distribution de dose est caractérisée par le débit de dose

des points de base.
La disposition des points de base assure une distribution
homogène.

Exemples :

DB placés au milieu de
2 sources
DB placés à l’intersection des
DB placé au centre du médiatrices des triangles
carré

25-05-2005 64
isodose 100 %
isodose 85 %

S. Vynckier, UCL
 Système de Paris

E. Paramètres et volumes :

Volume irradié : Volume délimité par l ’isodose 50 %

Volume traité : Volume délimité par l ’isodose 85 %

Lt
- Longueur traitée : fonction de la géométrie de l ’implant,
Axe de mesure
- Lt est la moyenne des longueurs élémentaires
de la longueur
traitée : ligne Isodose 85 %
des DB

- Epaisseur traitée : et est la moyenne des épaisseurs

e1 e2 élémentaires.

d1 m1
- Marge de sécurité et débord latéral : pour des implants
25-05-2005 - complexes tels qu ’un implant en triangle 65

m2
S. Vynckier, UCL
 2. Materials

z Implant of 7 needles in triangle

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S. Vynckier, UCL
 2. Materials

z Implant of 7 needles in triangle

z Plato V14.2 (Nucletron)

25-05-2005 67

S. Vynckier, UCL