BRACHYTHERAPY
Brachy means short
Discrete sources
Close proximity
Rapid dose fall off
Classification (main categories):
Surface mould therapy
Interstitial therapy
Intracavitary therapy
Intralumenal therapy
The history of brachytherapy is eq. to the history of radium therapy.
On the basis of treatment time
Temporary
Permanent
On the basis of Dose Rate
LDR
MDR
HDR/PDR
PROPERTY OF RADIONUCLIDES
Gamma ray emission : 0.2 - 0.4 MeV (monoenergetic)
Half-life should be such that correction for decay during treatment is
minimal. Permanent stock → long half-life is desirable. Short half-life
sources →permanent implants.
Charge particle emission (absent or of very low energy, which can be
easily filtered).
No gaseous disintegration product
High specific activity
Non-toxic and insoluble form and should not powder or disperse, if
damaged.
Different sizes and shapes
Cost
Availability
ADVANTAGES:
Localized high dose to the tumour volume
Rapid dose falls off
Results are excellent
Combination of external and brachytherapy.
LIMITATIONS
Accessibility of tumour volume and its size.
If lesion is too big, too many radioactive foci are required.
high risk of exposure during preparation and application of sources.
Source reconstruction and dosimetry are laborious.
SOURCES
Cs-137
Ir-192
Co-60
I-125
Pd-103
Ra-226 (discontinued)
FORMS
Pellets
Seeds
Miniature cylinders, tubes and wires
RADIUM-226
Spectrum of gamma energies.
Maximum Energy - 2.45 MeV , heavy shielding.
The maximum beta energy : 3.2 MeV, heavy filtration results in bulky
sources.
Main disadvantage
Daughter product radon.
Rupture.
Reencapsulation.
It is a bone seeker and highly toxic.
COBALT-60
Production 59Co (n γ) 60Co.
Half-life = 5.26 years.
Dominant beta energy = 0.32 MeV ,filtration required is 0.3
mm platinum.
Encapsulated (platinum iridium or stainless steel).
Disadvantage:
high gamma energy (1.17 MeV and 1.33 MeV), thicker
shielding.
CESIUM-137
Production – fission product of natural Uranium
Half-life - 30years.
Gamma energy - 0.66MeV.
Small contamination of 134Cs are always present (<1%).
Form: insoluble powder or ceramic microspheres.
Encapsulation: 10-20 % iridium-platinum alloy.
Beta energy: 0.51 MeV, Filteration: 0.5 mm platinum or stainless steel.
Presently many manual afterloading systems and some remote afterloading
units use 137Cs sources.
IRIDIUM-192
Production 191Ir(n γ) 192Ir.
Decays to Platinum-192 and Osmium-192, Mode: IC & EC, spectrum of
Gamma Rays & characteristic X-rays.
Avg. energy : 0.38 MeV.
Low energy gamma and High specific activity
Disadvantage:
Short half life - 73.8 days.
CONSTRUCTION
192Ir(alloy of 25% Ir and 75% Pt) sources, fabricated in the form of
seeds and wires are increasingly used for interstitial after loading
techniques.
192Ir wire has a core Φ: 0.3/0.1 mm, sheathed in pure Pt of 0.1mm
thick to form an outside Φ of 0.5 mm or 0.3 mm.
Encapsulation: Platinum(10% Ir & 90% Pt), core of 0.3 mm Φ Or
Stainless steel ( 30% Ir & 70% Pt encased in 0.2 mm) core of 0.1
mm Φ
Dimension: 0.5 mm Φ X 3 mm L
GOLD-198
Production 197Au(n γ) 198Au.
Half-life = 2.7 days.
Monoenergetic gamma of 0.412 MeV.
Dimensions - 2.5 mm L x 0.8 mm Φ.
Applications - permanent implants.
Discontinued: Due to 125I and 103Pd seeds.
IODINE-125
Neutron activation
Decay: EC
Energy: 35.5 keV gamma photons & Characteristic x-rays (27-35 keV)
Half life: 59.4 days.
Form: Seed.
External dimensions: 0.8 mm Φ X 4.5 mm L .
Advantage: Low energy photon, Less shielding.
Disadvantage: Complex dosimetry than other conventional sources.
PALLADIUM-103
External dimensions = 0.8mm Φ x 4.5mm L
Sheathing → Titanium.
Shorter half-life -17days
Decay: EC
Energy: Characteristic X-rays (20-23 keV, Mean energy 20.9 keV).
CALIFORNIUM-252
Man made neutron source.
Production: Neutrons activation in high flux reactors.
Core: Ceramic mixture of palladium and californium oxide
Encapsulation: Pd – Ir alloy.
Decay: α - emission and emits neutrons by spontaneous fission.
Avg energy: Neutron- 2.35 MeV Gamma- 140 keV.
Half-life: 2.65 yrs.
High specific activity.
Form: Tubes, Needles and Seeds.
Advantage: Low OER and High RBE.
Disadvantage: Shielding of neutrons restraining its use for manual
loading.
Source Half - Energy of Radiation Exp.Rate Air Kerma HVL in HVL in
s Life (MeV) const., Rate Water Lead
x const., k (cm) (mm)
(R.cm2.h- (Gy.m2.h
-1. MBq-1)
1.mCi-1)
Gamma
(Avg) Beta
Ra-226 1622 yr 0.83 0.02 - 3.26 8.25 0.195 10.6 12.0
( 0.05 - 2.45 )
Co-60 5.26 yr 1.25 (1.17,1.333) 0.31 13.07 0.308 10.8 11.0
Cs-137 30 yr 0.662 0.51-1.17 3.26 0.077 8.2 5.5
Ir-192 73.84 days 0.38 0.67 4.69 0.111 6.3 2.5
( 0.14 -1.06)
Au-198 2.7 days 0.412 0.96 2.38 0.056 7.0 2.5
I-125 59.4 days 0.028 1.46 0.034 2.0 0.025
Pd-103 17 days 0.021 1.48 0.035 1.0 0.008
