Brachytherapy
Dr. Ung Ngie Min
Clinical Oncology Unit, PPUM
Pierre made a rubber capsule of 0.398g
of radium sulfate for Dr.Danlos of
St.Louis Hospital
Dr. Henri Danlos and
Paul Blotch in 1901
successfully treated
lupus skin lesion with
Radium
In 1903 Gynecological
Brachytherapy was first introduced
On 15 September 1903 she
treated an inoperable cancer
of the cervix uteri with 700
milligrams of radium bromide
sealed in a glass tube.
Two applications of 10 minutes
each were made with an
interval of 3 days between.
O'Brien, F. w. (1947): Amer. J.
Roentgenol., 57, 281.
Margaret Abigail Cleaves
Brachytherapy
treatment & QA
Dr. Ung Ngie Min
Clinical Oncology Unit, PPUM
Slides courtesy of Prof Tomas Kron,
Peter Mac
Sealed sources
• IAEA BSS glossary: “Radioactive
material that is a) permanently
sealed in a capsule or b) closely
bound and in a solid form.”
• In other words: the activity is fixed
to its carrier and contamination of
the environment is not possible as
long as the source is intact
Sealed sources
• Have an activity which can be
derived from a calibration
certificate and the half life of the
isotope
• MUST be checked for integrity
regularly - a good means of doing
this is by wipe tests
The ideal
source in
brachytherapy
What do you think one would
expect from and ideal
brachytherapy source?
…in terms of
?
• Type of decay
• Energy
• Activity
• Half life
Radium-226 (Ra-226)
• The first isotope used clinically was
radium around 1903
• However, radium and radon have
only historical importance - they
should not be used in a modern
radiotherapy department
Ra-226
• It was discovered in 1898. It is the sixth member of the
uranium series, which starts with and ends with
stable .
Ra-226 decay
• Radium disintegrates with a half-life of about 1,600 years to form radon.
• 226 Ra(88) ----------> 222Rn(86) + 4He(2)
• 49 rays - 0.05~ 2.5 MeV
• Average energy - 0.83 MeV (filter by 0.5 mm platinum)
Why Radium is not used now?
•Spectrum has wide photon energies ranging from
0.047- 2.45 MeV : gives heterogeneous beam & non
uniform dose distribution
• Low specific activity : 1 Ci/gm : requiring large
diameter needles
• High energy: High radiation shielding will be required
• Rn 222 being the gaseous daughter product - threat
of leaks from long bent needles
• Storage & disposal of leaked sources a big problem
Caesium-137 (Cs-137)
• “Caesium 137”
• Main substitute for radium
• Formed as one of the more common
fission products by the nuclear fission of
uranium-235.
• Mostly used in gynecological applications
• Long half life of 30 years ---> decay
correction necessary every 6 months
• Sources are expensive and must be
replaced every 10 to 15 years
Cs-137
• The decay of Cs-137 transforms to Ba-137 by the
process of β-decay and 95% of the disintegrations are
followed by γ rays from the Ba-137 metastable state.
• Cs-137 emits γ rays of 0.662 MeV.
Iridium-192 (Ir-192)
• “Iridium 192”
• Many different forms available
• Most important source for HDR applications
• Produced by bombarding Ir-191 with thermal
neutrons. High neutron capture of cross section of
Ir-191 produces Ir-192 of high specific activity
(7760 Ci/g)
• Medium half life (74 days) - decay correction
necessary for each treatment
• Needs to be replaced every 3 to 4 months
(disadvantage) to maintain effective activity and
therefore an acceptable treatment time
Ir most commonly
192
used in HDR
• Average energy 0.38 MeV
• High specific activity in small volume
therefore even high activity sources can
be miniaturized essential for HDR
applications
• A bit easier to shield than 137-Cs -
because the gamma energies of 192-Ir
range from 136 to 1062keV (effective
energy around 380keV)
HDR 192-Ir source
• 10 Ci (370GBq)
• diameter of the order of 1mm
• length of the order of 3 to 5 mm
• encapsulation
• attached to steel cable
Purpose of
encapsulation
• Containing the radioactive material
• Providing source rigidity
• Absorbing any and, for photon emitting
sources, radiation produced through the
source decay
Cobalt-60 (Co-60)
• Getting more popular for HDR source
• Produced by neutron activation of stable
isotope Co-59
• Half life of 5.26 years, mean gamma
energy of 1.25 MeV
• Main advantages:
• High specific activity
• Longer half life than Ir-192, more
economical, no need for frequent
replacement
Co-60
• The decay of Co-60 transforms to Ni-60 by the process
of β-decay and 99% of the disintegrations are followed
by γ rays from the Ni-60 metastable state.
• Co-60 emits γ rays of 1.17 & 1.33 MeV (average energy
of 1.25 MeV).
Brachytherapy
source types
(ICRU report
58)
Au-198
• For permanent interstitial use
• A half-life of 2.7 days
• Emits 0.412 MeV γ ray
• 2.5 mm long, 0.8 mm diameter with 0.1 mm thick
platinum wall
I-125
• The decay of I-125 transforms toTe-125 by the
process of electron capture and are followed by γ rays
from the Te-125 metastable state.
• Low γ ray energy, 35.5 keV
• half-life 59.4 days
I-125
• Very low energy - therefore
shielding is easy and radiation from
an implant is easily absorbed in the
patient: permanent implants are
possible
• Mostly used in the
form of seeds
125-I seeds
• Many different designs
X-ray visibility of I-125
seeds
Pd-103
• Shorter half-life 17 days
• Pd-103 decays by electron capture with emission of 20 ~ 23 keV
characteristic x rays
• Due to self absorption, it is highly anisotropic in photon fluence
Pd-103
• Recently become available for prostate permanent
implants
• 4.5 mm long and 0.8 mm in diameter
• Shorter half-life 17 days
Dose variation along
transverse axis when
1/r2 is removed
Angular dependence
Anisotropy function
• Radiation
propagation
is anisotropic
due to:
• Source self
absorption
• Absorbance
by the
capsule
Types of brachytherapy
• Types of brachytherapy implant:
• Interstitial
• Intracavitary
• Intraluminal
• Intraoperative
• Intravascular
Interstitial - Temporary
• Interstitial brachytherapy involves
the implantation of radioactive
sources directly into the tumour
volume as
• needles or wires which are inserted
surgically and then removed when the
prescribed dose has been delivered.
These temporary implants are
typically used for the tongue, breast,
vulva and anus.
Brachytherapy – Interstitial
Placement of Needles
Replacement of
needles with
plastic catheters
Interstitial - Permanent
• Seeds which are needle
containing
surgically inserted radioactive
seeds
and then left in the prostate
tissue for ever.
These are called
permanent seed ultrasound
implants and are probe
Diagram of a
typically used for permanent seed
the tongue and prostate implant
prostate.
Permanent seed
implants
• Permanent seed implants have gained
wide acceptance for treating early
stage prostate cancer
• They involve the permanent placement
of short-lived radioactive sources,
emitting low energy (~30 keV)
photons, into the prostate
• The most commonly used seeds are I-
125 and Pd-103
Prostate implants
• Transrectal
ultrasound
• 8 to 20 needles
Intracavitary
• Intracavitary implants are inserted
into body cavities which are close
to the tumour volume. Typical sites
are the cervix and uterus.
Intracavitary treatments are always
temporary.
Brachytherapy –
Intraluminal (NPC)
IORT
• Radiotherapy after excision of
tumour.
• Known as electronic brachytherapy
(using man-made X-rays)
• E.g. Treatment of early-stage
breast cancer.
• Deliver low energy (50 kV) x-rays
to the lumpectomy cavity at the
time of operation.
• Intrabeam by Carl Zeiss
IORT of breast
Carl Zeiss
Brachytherapy – Surface
(Mould)
