Seed fixity in the prostate/periprostatic region following brachytherapy

Merrick, Gregory S.; Butler, Wayne M.; Dorsey, Anthony T.; Lief, Jonathan H.; Benson, Mark L.

doi:10.1016/s0360-3016(99)00405-8

Cited by 153 publications

(71 citation statements)

References 19 publications

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“…The compromise between replacing a strand of sources with loose sources lies in the sensitivity of the treatment plan to an out-of-calibration source versus the approximately 1% probability of loosesource loss to treatment, primarily in the periprostatic region. [21][22][23] The consequences of source outliers or source loss due to migration may be modeled by the medical physicist, but the tolerance for such loss should be understood and agreed upon by the implant team.…”

Section: Iic Calibration Of Sources In Sterile Needles Cartridgesmentioning

confidence: 99%

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

et al. 2008

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The AAPM Low Energy Brachytherapy Source Calibration Working Group was formed to investigate and recommend quality control and quality assurance procedures for brachytherapy sources prior to clinical use. Compiling and clarifying recommendations established by previous AAPM Task Groups 40, 56, and 64 were among the working group's charges, which also included the role of third-party handlers to perform loading and assay of sources. This document presents the findings of the working group on the responsibilities of the institutional medical physicist and a clarification of the existing AAPM recommendations in the assay of brachytherapy sources. Responsibility for the performance and attestation of source assays rests with the institutional medical physicist, who must use calibration equipment appropriate for each source type used at the institution. Such equipment and calibration procedures shall ensure secondary traceability to a national standard. For each multi-source implant, 10% of the sources or ten sources, whichever is greater, are to be assayed. Procedures for presterilized source packaging are outlined. The mean source strength of the assayed sources must agree with the manufacturer's stated strength to within 3%, or action must be taken to resolve the difference. Third party assays do not absolve the institutional physicist from the responsibility to perform the institutional measurement and attest to the strength of the implanted sources. The AAPM leaves it to the discretion of the institutional medical physicist whether the manufacturer's or institutional physicist's measured value should be used in performing dosimetry calculations.

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Section: Iic Calibration Of Sources In Sterile Needles Cartridgesmentioning

confidence: 99%

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

et al. 2008

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“…Assuming that a proper history is taken during the consultation, patients with known septal defects are unlikely to undergo brachytherapy. Most local seed loss occurs within 28 d of implantation, and additional seed loss beyond 60 d is extremely rare (11). However, the seed embolization rate may be higher than that reported in previous studies based on radiographic findings.…”

Section: Discussionmentioning

confidence: 77%

Scintigraphic Detection of ¹²⁵I Seeds After Permanent Brachytherapy for Prostate Cancer

Kono

Kubota²,

Mitsumoto³

et al. 2008

J Nucl Med

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The purpose of this investigation was to monitor the localization and migration of 125 I seeds after permanent brachytherapy for prostate cancer using a new scintigraphic technique that may overcome the drawbacks of conventional x-ray methods. Methods: 125 I seeds emit g-rays with an average energy peak of 28 keV. We used a g-camera equipped with low-energy high-resolution collimators that were tuned to an energy level of 35 keV with a 70% window width. Sixteen patients with prostate cancer were examined after 125 I seed insertion. The number of seeds remaining in the prostate was confirmed using pelvic CT for postoperative dose planning; however, seeds that had migrated outside the prostate could not be detected. Furthermore, the migrated seeds were not completely traceable using chest or abdominal radiography. Thus, we adopted a scintigraphic technique to perform this task. The evaluation of radiography and scintigraphy findings was masked, and the rates of migrated seed detection were statistically examined using the McNemar test. To localize the migrated seeds, we fused the scintigraphic images of the migrated seeds and the patients' contours. Results: Scintigraphy was successfully used to detect 20 migrated seeds of a total of 1,182 implanted seeds, whereas radiography was successfully used to detect 7. The sensitivity of the scintigraphy results was 20 of 20 (100%), whereas that of the radiography results was 7 of 20 (35%). Seed migration was detected in 11 of 16 patients (69%) using scintigraphy, whereas seed migration was detected in only 4 patients (25%) using radiography; this difference was statistically significant (P 5 0.016). Conclusion: Scintigraphy is more effective for detecting seed migration and monitoring the localization of 125 I seeds than radiography. The precise anatomic location of migrated seeds can be pinpointed using fusion images. Scintigraphy may become a standard procedure for monitoring seed migration during 125 I brachytherapy in patients with prostate cancer.

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“…While this complicated the dosimetric analysis, it served the unique advantage of demonstrating that the polymer coating reduces seed slippage independent of other extrinsic factors such as the shape of the seed. The results of this study agree with those of Merrick et al., in that use of a polymer coating on 125 I seeds is more effective at bringing about seed fixity than any such advantage the cupped ends of the Model 200 source provide 5. It was for this reason that an additional comparison was made between coated AgX100 seeds and uncoated Model 200 seeds in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Slippage or initial seed movement from the intended point of implant, however, is a well‐known phenomenon with PPB 5. Placement of seeds into unintended positions may negatively affect real‐time and postimplant dosimetry, and suboptimal seed fixity may increase the incidence of seeds dislodging into adjacent blood vessels,6 where they may be transported by blood flow to distant anatomical sites, such as the lungs, heart, and other organs.…”

Section: Introductionmentioning

confidence: 99%

Reduction of seed motion using a bio‐absorbable polymer coating during permanent prostate brachytherapy using a mick applicator technique

Warrell

Xing

Podder

et al. 2018

J Applied Clin Med Phys

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PurposeThe addition of a braided bio‐absorbable vicryl coating to the surface of radioactive seeds used for low dose rate (LDR) prostate brachytherapy is intended to reduce the incidence of seed movement and migration. Here, we present a single‐institution study of the frequency and severity of seed slippage (initial seed movement) of coated seeds in comparison with uncoated seeds.MethodsForty‐seven patients received permanent prostate brachytherapy, with either coated (n = 26) or uncoated (n = 21) seeds. AgX100 125I seeds, coated or uncoated, and uncoated Model 200 103Pd seeds were used. During the ultrasound‐guided implantation procedure, each implanted seed was categorized as having remained in the implanted position after being placed, having moved slightly, or having left the ultrasound field of view.Results3.1% of the coated seeds (AgX100 seeds, n = 70) and 6.9% of the uncoated seeds (AgX100 and Model 200 seeds, n = 128) were observed to have moved at least 2 mm from their initial implant positions, respectively. The difference in incidence of this movement was 54.4% (P = 0.0026). Coated AgX100 seeds demonstrated a 66.7% lower rate of movement of at least 2 mm than that for uncoated AgX100 seeds (P = 0.038), and a 49.0% lower rate than that for Model 200 seeds (P = 0.021). While no significant differences were noted in prescription dose coverage of the prostate or the studied dosimetric parameters for the organs at risk between the coated and uncoated seeds (P > 0.05) in the CT‐based Day‐0 postoperative plans, the limited sample size and differences in energies between the 125I and 103Pd seeds make further analysis of postoperative dosimetric coverage difficult without additional data directly comparing the coated and uncoated 125I seeds.ConclusionWhen the vicryl coating is used, seeds have a significantly lower propensity to slip from their initial implant locations. This may help maintain dosimetric integrity, warranting further study of postoperative dosimetry.

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Seed fixity in the prostate/periprostatic region following brachytherapy

Cited by 153 publications

References 19 publications

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

Scintigraphic Detection of ¹²⁵I Seeds After Permanent Brachytherapy for Prostate Cancer

Reduction of seed motion using a bio‐absorbable polymer coating during permanent prostate brachytherapy using a mick applicator technique

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Seed fixity in the prostate/periprostatic region following brachytherapy

Cited by 153 publications

References 19 publications

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

Third‐party brachytherapy source calibrations and physicist responsibilities: Report of the AAPM Low Energy Brachytherapy Source Calibration Working Group

Scintigraphic Detection of 125I Seeds After Permanent Brachytherapy for Prostate Cancer

Reduction of seed motion using a bio‐absorbable polymer coating during permanent prostate brachytherapy using a mick applicator technique

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Scintigraphic Detection of ¹²⁵I Seeds After Permanent Brachytherapy for Prostate Cancer