A buccal mucosa carcinoma treated with high dose rate brachytherapy.

This manuscript presents a case of early stage squamous cell carcinoma of the left buccal mucosa treated with intensity-modulated radiation therapy (IMRT) followed by a high-dose rate (HDR) brachytherapy boost. With limited literature available on HDR mold (stent) radiotherapy for oral cancer, a discussion on the issues encountered during treatment planning and delivery may prove to be insightful for facilities faced with a similar challenge.

Selective identification of different brachytherapy sources, ferromagnetic seeds, and fiducials in the prostate using an automated seed sorting algorithm.

PURPOSE: Routine permanent prostate brachytherapy (PPB) includes CT-based postimplant dosimetry (PID). A method of identifying different source types from CT data in the same implant volume is described. METHODS AND MATERIALS: A previously described automatic method for seed localization using CT data is used in this study. Two cases were analyzed: a PPB case with (103)Pd followed by salvage (125)I implantation, both performed at another institution, and a cadaver case where 4 different seed types, including ferromagnetic seeds, and fiducials were implanted. RESULTS: Automatic segregation of different seed types with minimal manual correction is demonstrated using the described localization algorithm. The process is confirmed accurate by comparison of plain film radiographs to CT data and digitally reconstructed radiographs. CONCLUSION: Unique identification of different source types, including PPB seeds, fiducial markers, and ferromagnetic seeds in permanent implants is possible and permits dosimetric analyses that are spatially coincident.

Radioactive seed migration to the chest after transperineal interstitial prostate brachytherapy: extraprostatic seed placement correlates with migration.

PURPOSE: To examine the incidence of seed migration detected on chest X-ray and to identify the predictors associated with its occurrence. METHODS AND MATERIALS: Between May 1998 and April 2000, 102 patients underwent permanent prostate brachytherapy at our institution and 100 were eligible for the study. Chest X-rays obtained at follow-up were examined for the number and location of seeds. The patient and treatment variables potentially associated with the occurrence and number of seed migrations were analyzed. RESULTS: One or more seeds were identified on the chest X-rays of 55 (55%) of 100 patients. The mean number of intrathoracic seeds in patients with migration was 2.2 (range, 1-10), and the proportion of seeds that migrated to the thorax was 0.98%. The rate of extraprostatic seeds planned was 43.9%, and postimplant CT identified 37.9% in such a location. The number of seeds planned for extraprostatic placement and below the apex were statistically significant (alpha = 0.05) predictors in univariate logistic analysis. Multivariate analysis revealed the planned number of extraprostatic seeds as the only statistically significant predictor (p = 0.04). CONCLUSION: Extraprostatic placement of loose seeds is associated with an increased likelihood for, and frequency of, seed migration to the thorax. Nonetheless, the small proportion of implanted seeds that migrated (

Radiation exposure to operating room personnel during transperineal interstitial permanent prostate brachytherapy.

PURPOSE: To identify factors associated with radiation exposure (RE) to operating room personnel during transperineal interstitial permanent prostate brachytherapy (TIPPB). METHODS AND MATERIALS: Between May 1998 and December 2000, 155 patients underwent TIPPB with fluoroscopic and ultrasound guidance. Data for each case included: operating room time (OT), anesthesia time (AT), fluoroscopy time (FT), number and type of seed implanted, total seed activity, and resident participation. RESULTS: Personnel RE per case, FT, OT, and AT decreased as case number increased. Whole body badge dose per case decreased from a mean of 0.15+/-0.01 mSv (15+/-1 mrem) in 1998 to 0.074+/-0.011 mSv (7+/-1 mrem) in 2000. Average FT per case decreased from a mean of 17:27 min (range, 10:40-28:23) in 1998 to 12:08 min (range, 6:40-31:00) in 2000. Resident participation was associated with increased FT. Mean whole body and ring badge doses for the treating radiation oncologist were 0.0076 mSv/min (0.76 mrem/min) and 0.05 mSv/min (5.26 mrem/min) of FT, respectively. CONCLUSIONS: FT was the predominant factor that related to RE during TIPPB. Treating radiation oncologists were exposed to less than 20 mSv per 100 cases, significantly less than other fluoroscopically guided procedures. Nonetheless, appropriate radiation exposure precautions during TIPPB should continue.