RADIATION THERAPY

R.S JANG, RRT

AIM OF RADTHERA

To deliver a precisely measured dose

of radiation to a defined tumor
volume with as minimal damage as
possible to surrounding healthy tissue,
resulting eradication of the tumor, a
high quality of life and prolongation
of survival at competitive cost
RADIATION THERAPY

▶ Often referred as RADIATION ONCOLOGY

▶ It is a medical specialty that involves

TREATMENT OF MALIGNANT AND BENIGN
TUMORS by the application of ionizing
radiation
RADIOTHERAPY STAFF

1. RADIATION ONCOLOGIST

Physician skilled in the act of applying

radiation in the treatment of malignant dses.
RADIOTHERAPY STAFF

2. MEDICAL PHYSICIST
▶ Dosimetry
▶ Radiation Safety
▶ Quality control
▶ Equipment selection
RADIOTHERAPY STAFF

MEDICAL PHYSICIST
DOSIMETRY

- Help minimize the probability of patient injury

- responsible for appropriate treatment regimen
and reviewing treatment plans
- Responsible for calibration of the output of the
treatment machine on routine basis
RADIOTHERAPY STAFF

MEDICAL PHYSICIST

RADIATION SAFETY

- Maintenance of radiation protection program

to ensure safety of staff and public
- Design and certify all radiation shielding for
treatment facilities
RADIOTHERAPY STAFF

MEDICAL PHYSICIST

QUALITY CONTROL

-Establish and run a quality control program

facility
RADIOTHERAPY STAFF

3. Medical Dosimetrist

- Assist physicist in the calibration of machine.

Dosimetry works and design treatment plan by
means of computer or manual computation
that will deliver a prescribe radiation dose.
RADIOTHERAPY STAFF

4. Radiation Therapist

- The one who execute or

implements the treatment plan
KEY STAFF FUNCTION
Key Staff Supportive role
1. Clinical Evaluation Rad. Oncologist
2. Therapeutic decision Rad. Oncologist
3. Target Volume localization
3.1 Tumor volume Rad. Oncologist & Physicist Simulator tech./
Dosimetrist
3.2 Sensitive critical organs Rad. Oncologist Dosimetrist
3.3 Patient Contour Dosimetrist Physicist
4. Treatment Planning
4.1 Beam Date computerization Physicist
4.2 Shielding blocks treatment Dosimetrist Rad.Oncologist/ Physicist
4.3 Analysis of alternate plans Rad. Oncologist/ Physicist Dosimetrist
4.4 Selection of treatment plan Rad. Oncologist/ Physicist/
Dosimetrist
4.5 Dose calculation Dosimetrist Physicist
KEY STAFF FUNCTION

Key Staff Supportive role

5. Simulation/ Verification of treatment Rad. Oncologist/ Rad.tech Dosimetrist/ Physicist
6. Treatment
6.1 1st day Set-up Rad. Oncologist / Dosimetrist Dosimetrist/ Physicist
6.2 Localization Films Rad. Oncologist / Rad.Tech Dosimetrist/ Physicist
6.3 Daily treatment RadTech
7. Evaluation during treatment Rad.Oncologist/ Nurse Radiotherapist/ Dietician
8. Follow-up exams Rad. Oncologist
THREE PATHWAYS OF MALIGNANT
NEOPLASM

▶ SEEDING - The spread of a malignancy into body cavities can occur via
penetrating the surface of the peritoneal, pleural, pericardial, or subarachnoid
spaces.
▶ LYMPHATIC SPREAD - Lymphatic spread allows the transport of tumor cells to
lymph nodes and ultimately, to other parts of the body. This is the most common
route of metastasis for carcinomas.
▶ HEMATOGENOUS SPREAD - This is typical route of metastasis for sarcomas, but it is
also the favored route for certain types of carcinoma, such as those originating
in the kidney (renal cell carcinoma). Because of their thinner walls, veins are
more frequently invaded than are arteries, and metastasis tends to follow the
pattern of venous flow.
REMISSION - Stage or period of absence of cancer

TYPES OF REMISSION

▶ COMPLETE REMISSION – all signs and symptoms of Ca are gone.

▶ PARTIAL REMISSION – the malignant tumor shrunk, but does not
disappear.
▶ CURED – FREE OF SIGNS AND SYMPTOMS FOR FIVE (5) YEARS.
▶ SECOND PRIMARY CANCER – PATIENT IS DIAGNOSED WITH NEW
CANCER THAT’S COMPLETELY UNRELATED WITH THE PREVIOUS
CANCER.
 RECURRENCE - return of cancer after treatment and after a period of
time during which the cancer cannot be detected.

TYPES OF RECURRENCE

▶ LOCAL – Ca returns at the original site.

▶ REGIONAL - Ca returns at a lymph node or tissue
located near the previous Ca.
▶ DISTANT – at a farther site.
3 MAJOR SUBTYPES OF CANCER

▶ CARCINOMA – originating from epithelial tissue.

▶ SARCOMA – originating from connective tissue.
▶ LYPHOMA – involves blood forming tissue.
CANCER RISK FACTORS
▶ EXTERNAL

▶ EXPOSURE TO CHEMICALS
▶ VIRUSES
▶ IONIZING RADIATION

▶ INTERNAL

▶ HORMONES
▶ GENETIC MUTATTION
▶ DISORDERS OF THE IMMUNE SYSTEM
GENERAL CANCER SYMPTOMS

▶ UNEXPECTED WEIGHT LOSS – about 10 lbs.

▶ FEVER
▶ FATIGUE
▶ PAIN
▶ SKIN CHANGES
▶ CHANGE IN BOWEL/BLADDER FUNCTION
▶ UNHEALING SORE
BIOPSY - MEDICAL REMOVAL OF TISSUE FROM LIVING
SUBJECT TO DETERMINE PRESENCE OR EXTENT OF
DISEASE.

TYPES OF BIOPSY

▶ SURGICAL – a surgical procedure done at the o.r.

▶ EXCISIONAL – entire lump removed
▶ INCISIONAL – small sample tissue
▶ FINE NEEDLE ASPIRATION – sample fluid
▶ CORE NEEDLE – small solid sample
 3 WAYS OF CANCER TREATMENT
1. SURGICAL METHOD - Removal of tumor by surgical operation

2. CHEMOTHERAPY- use of chemical substance to kill tumor cells and for

regional or system metastases
-Brachytherapy/ Plesiotherapy /curietherapy/endocurie therapy
(placement of radioactive substance or nuclides in or on neoplasm to deliver
cancercidal dose)

3. RADIATION THERAPY - uses of radiation such as x-ray, gamma ray, electron

to kill tumor cells
-EBCT/ Teletherapy
radiotheraphy technique in which source is at distance from the
patient
 GOAL OF RAD.THERAPY
CURATIVE - probability of long term survival
▶ Adjuvant – (Additive) given to destroy left-over microscopic cells that may be present
after the known tumor is removed by surgery.
▶ Is given to prevent a possible cancer reoccurrence.

▶ Neo Adjuvant – (primary) given prior to the surgical procedure.

▶ may be given to attempt to shrink the cancer so that the surgical procedure may not need to be as
extensive.

PALLIATIVE- No hope for total eradication, prolonging life

PROPHYLACTIC - treatment of some parts of the body that is

suspected of harbouring tumor cell but without any symptoms
 DETERMINATION OF TREATMENT PLAN

GROSS TUMOR VOLUME (GTV)

- All known dse. Including abnormal enlarge lymph nodes
- to determine GTV, appropriate CT window and level settings that give
maximum dimension of what is considered potential dse must be use

CLINICAL TARGET VOLUME (CTV)

-encompasses GTV plus region considered to harbour potential
microscopic dse

PLANNING TARGET VOLUME (PTV)

-Provide margin around CTV to allow for internal target motion
 STAGING

-Usually done after the diagnosis of malignancies has been

confirmed in biopsy
-Determining the EXTENT of the dse
-TNM system allows classification of disease extent.
T- primary tumor
N- Regional Lymph nodes
M- Distant Metastases
 STAGING
T- PRIMARY TUMOR

- It is categories by apparent anatomic extent of dse, which determine the ff. features:

Depth invasion – degree of extension into adjacent structure such as muscle,

hallo organs, bone cartilage etc

Surface Spread – determination of the degree of circumferential involvement

by dse for hallow organs

Size – tumor size can be related to cell number, tumor age and anatomic extent
 THE TNM SYSTEM
T0 No evidence of Primary tumor

T1 Confine to the organ of origin, usually

localized mobile
2cm its largest diameter,

Deeply invading to adjacent structure, including muscles and ligaments,

T2 2-5cm diameter its largest diameter ,localized mobile, partially mobile
Regionally confined, >5cm but <10cm, fixed. Critical criterion is
T3 fixation, most often to bone and cartilage, but invasion of the intrinsic
muscle wall, serosa and skin is also included

, >10cm
T4 A massive lesion diameter, destructive, not confined to the
region. Invasion into major nerves, arteries and veins included
 STAGING
N- Nodal involvement criteria:

Size – must be palpable and detectable

Roundness– Nodal thickness, Discoid or flat, Shotty node usually benign.

‘’the rounder the nodes the more likely firm and involves tumor’’

# of involve lymph nodes – invasion of nodal capsule, loss of

mobility (flexibility)

Mobility – loss of mobility result from invasion of capsule and

infiltration of adjacent tissue
 THE TNM SYSTEM
N0 No evidence of dse in lymph nodes

Palpable and movable nodes limited to the first station.

N1 Metastases are suggest on basis of firmness and roundness of the
nodes or its size alone

Firm to hard nodes, palpable and partially movable, 3-5cm

N2 Diameter

Complete fixation, invasion extend beyond the capsule,

N3 with complete fixation to the bone, large blood vessels, skin(Dermal
lymphatic invasion), or nerves

N4 Nodes involved beyond first station. They are in second or distant station
 THE TNM SYSTEM
M0 No evidence of metastases

Solitary, isolated metastasis confined to one organ or

M1 anatomical site
Multiple metastatic foci confined to one organ or system
M2 or one anatomic site, NO functional impairment
Multiple organ involve anatomically, no or minimal to
M3 moderate functional impairment of involve organs
Multiple organs involves, moderate to severe functional
M4 impairment of involve organs
 TELETHERAPY OR EBRT MACHINES
▶ Contact therapy/endocavitary therapy
- 40-45 kv
-SSD: 2cm

▶ DIFFRACTION RAY
- produce in <10 kVp
-Application: Research: Structural and Molecular analysis

▶ GRENZ RAY THERAPY

-Very soft (Low enegy) X-rays
- produce below 20kV
-energy: 10-20 kVp –(reference: Bushong)
-Application: Dermatology
TELETHERAPY OR EBRT MACHINES

▶ SUPERFICIAL THERAPY
- 50-150 kV
- 50-100 kVp (Bushong reference)
-Produce large amount of soft (Low energy) x-rays
- Can irradiate up-to 5mm depth of superficial tissue
- uses 1-6mm Al as filter to harden the beam to desired degree
SSD: 20cm
 TELETHERAPY OR EBRT MACHINES

▶ ORHTOVOLTAGE THERAPY / Deep therapy

-Energy: 150-500 kV
- 200- 300 (Bushong reference)
-Allows treatment of lesion located within a few centimetre
of the surface without delivering excessive dose to the skin.
- treatment on deep lying tissue
-SSD used: 50cm
 TELETHERAPY OR EBRT MACHINES

▶ SUPERVOLTAGE THERAPY/ High voltage therapy

- 500-1000 kV
- 300-1000 kVp (Bushong reference)
-use for therapy on deep lying tissue

▶ MEGAVOLTAGE THERAPY
-Energy: >1 MV
-use for therapy on deep lying tissue
TELETHERAPY OR EBRT MACHINES

▶ VAN DE GRAAFF GENERATOR

- First particle accelerator
- can accelerates electrons up-to 2MV
- developed by: R.J van de graaff- 1931
- designed to accelerates charge particles
 TELETHERAPY OR EBRT MACHINES

▶ MICROTRON
-electron accelerator which combines the principles of both LINAC and the cyclotron
-Method of accelerating electron use in microtron was proposed by VEKSLER-1944
-10 MeV- 1st microtron radiotherapy- by: Reistad and Brahme-1972

▶ BETATRON
- Developed by KERTZ-1941
- is a machine w/c the electrons are accelerated in a circular orbit via a changing
magnetic field.
- first used in therapy during 1950s
 TELETHERAPY OR EBRT MACHINES

▶ LINAC
- Produce high electron beams using high
frequency electromagnetic waves to accelerate
charge particles
- Developed by WIRDOE 1928
LINAC 5 main structures:

1. TREATMENT COUCH
2. CONSOLE
- brain of the accelerator
-includes: controlling circuits, tuning and capacitor
3. MODULATOR
- Power source of linac
- Transforms AC-DC
4. STAND
- Contains KLYSTRON
- KLYSTRON – it amplifies radiofrequency waves
5. TREATMENT HEAD
-Located in the gantry
- Contains high density shielding such as: Pb, W or Pb tungsten alloy
 LINAC- TREATMENT HEAD subparts
1. MAGNETRON
– device produces microwaves
- Frequency of microwaves each pulse : 3,000 MHz

2. ELECTRON GUN
- electronic device produces electron to be accelerated and used for rad. Theraphy
and top produce x-rays

3. WAVE GUIDE
- vacuum tube that consist of copper tube where electrons are accelerated

4. BENDING MAGNET
- direct electron beam to target or scattering foil
 LINAC- TREATMENT HEAD subparts

5. TARGET
- transmission type target ‘’ as the kinetic energy of the electron increases, x-ray
emission also increases
6. Beam Flattening filter
- use to make the beam intensity uniform across the field
- made up of Pb
- other material that can be used: W, Uranium, steel, Al
7. IONIZATION CHAMBER
-Gas filled detector used to monitor dose rate
8. COLLIMATORS
- use to restrict the beam
- 2 types: PRIMARY (Fixed collimator)AND SECONDAR (Movable collimator)
 2 types of collimator used in LINAC

1. PRIMARY COLLIMATOR
- FIXED
- confine the photon or x-ray beam 30 deg. Cone
2. SECONDARY COLLIMATOR
- MOVABLE
- Square aperture to confine the size of the beam
-consist of 2 pairs tungsten block (X and Y jaw)
- minimum field size: 0 x 0 cm2
- maximum field size: 40 cm x 40 cm
Types of treatment for LinAc

▶ 2DXRT – Conventional External Beam RadioTherapy

▶ 3DCRT – 3 Dimensional Conformal RadioTherapy
-Multi-leaf collimator
-Cerrobend blocks – fixed heavy custom made wedge filter
dedicated for each patient.
▶ 4DXRT (IGRT) – Image-guided real time RadioTherapy
▶ IMRT – Intensity Modulation RadioTherapy
▶ STEREOTACTIC RADIOSURGERY – gamma knifes
▶ PARTICLE THERAPY –
TELETHERAPY OR EBRT MACHINES

▶ COBALT 60
-Is a megavoltage therapy equipment that uses
radioactive Co60 source.
- developed in 1951
-SSD: 80cm
- the source is consist of double encapsulated
cylinder filled with disks or pellets of isotopes
TELETHERAPY OR EBRT MACHINES

▶ COBALT 60
-the source cylindrical diameter: 1-1.5 cm
- cobalt 60 is produce by irradiating stable Co59
with neutrons in nuclear reactor
TELETHERAPY OR EBRT MACHINES

▶ ELECTRONIC PORTAL IMAGING

- video based imaging
-the beam is transmitted through the patient and excites
a metal fluorescent screen, which is viewed by video
camera using 45 deg. Mirror. The camera is interfaced with
microcomputer to produce an image
RADIATION
DOSIMETRY
 RADIATION DOSIMETRY

1. CALORIMETRY
- measurement of radiation based on change in thermal
energy per unit mass of the medium

2. FRICKE DOSIMETRY
- based on chemical changes caused by radiation
-chemical radiation dosimeter
- Ferric ION – absorption spectrometry: 224nm and 304nm

3. FILM DOSIMETER/ densitomer

 RADIATION DOSIMETRY

4. IONIZATION METHOD

- THIMBLE CHAMBER - used for PHOTON BEAM

- FARMER CHAMBER - used for PHOTON BEAM
- MARKUS CHAMBER - used for ELECTRON BEAM
 RADIATION DOSIMETRY

4. TLD

CRYSTAL USE:

LITHIUM FLUORIDE
LITHIUM BORATE
CALCIUM FLUORIDE
 RADIATION DOSIMETRY

4. TLD

CRYSTAL USE:

LITHIUM FLUORIDE
LITHIUM BORATE
CALCIUM FLUORIDE

ANNEALING – heating of TLD crystals to remove

unwanted residual signal (400 deg.C- 3hrs)
 TYPES OF
DETECTORS
 TYPES OF DETECTOR

1. GAS FILLED DETECTOR

PRINCIPLE: incident rad’n ionized gas particles. The ionization of gas
within the electrically charged enclosure alters the voltage potential bet. 2
electrode
-POCKET DOSIMETER
-GM COUNTER
- THIMBLE CHAMB ER

2. SCINTILLATION DETECTOR
PRINCIPLE: based on the property of certain crystals to emit light photons
after deposition of energy in the crustal by ionizing rad’n
 DOSIMETRY
PARAMETERS
 DOSIMETRY PARAMETERS

OUTPUT FACTOR
- Is the ratio of the dose rate at the depth of maximum dose for a given
field size
- Reference field size : 10x10 cm square

ISODOSE CURVE
- points of equal dose
 DOSIMETRY PARAMETERS

TISSUE-PHANTOM RATIO (TPR)

-Is the ratio of the dose at specific point in tissue or the ratio in phantom
to the dose at the same distance in the beam at a reference depth usually
5cms
TPR= dose in tissue/ dose in phantom (ref. depth)

TISSUE-AIR RATIO (TAR)

- it is the ratio of the dose at a given point in a medium to the dose at
the same point in free space
TAR= DOSE IN TISSUE/ DOSE IN AIR
 DOSIMETRY PARAMETERS

PERCENT DEPTH DOSE

-absorbed dose at a given depth expressed in a percentage of the
absorbed dose at a reference depth on the central axis of the field

SOURCE AXIS DISTANCE(SAD) TECHNIQUE (isocentric technique)

-Axis of the machine rotation (ISOCENTER) is place in the target volume
 DOSIMETRY PARAMETERS

DOSE
-General term used to refer to the effect on a material which is exposed
to radiation

DOSE RATE
- radiation dose delivered per unit time dosimeter
 DOSIMETRY PARAMETERS

DEPTH OF MAXIMUM DOSE

-is a depth along the beam axis at which maximum dose occurs

WEDGE TRANSMISSION FACTOR (WF)

- ratio of dose per monitor unit at the reference depth in a specified field
with a wedge present in the beam.
MODIFICATION
OF RADIATION
FIELDS
 MODIFICATION OF RADIATION FIELDS

BOLUS
- Is a tissue equivalent material that have electron density, physical density
and atomic number similar to the tissue or water
- place directly on the skin surface to even out the irregular patien countour

COMPENSATOR
-custom made device that mimic the shape of the bolus but are place
in radiation beam at some 15-20 cm from the skin surface
- usually fabricated from Pb or low melting point alloy such as LIPOWITZ’S
METAL
 MODIFICATION OF RADIATION FIELDS

WEDGE FILTER
- May be used even out of the isodose surface for photon beams striking
relatively flat patient surface under an oblique beam coincidence

Types:
Physical wedge - can be made of Pb, Brass or steel
- they cause progressive decrease in the intensity
accours the beam and tilt the idosecurve under
normal beam incidence

Dynamic wedges filter – provide wedge effect on isodose curve through a

closing motion of a collimator block during irradiation
 MODIFICATION OF RADIATION FIELDS

BLOCKS
-Used to shield organ at risk
-made up of LIPOWITZ’S metal (Cerrobend)
- 13.3% tin
- 50% bismuth
- 26.7% PB
-10% cadmium
-Lipowtiz’s metal physical density at 200 deg.C is
9.4g/cm3
OPTHALMIC APPLICATORS
▶ Indications:
Conjuctiva
Primarily Pteygia
Radioisotopes used:
Strontium90 –Sr90
half life – 20 years

- A source is encapsulated in a small, semi circular applicator

place in conjunctiva
- Dose rates very high 100cGy/sec
- Poor Penetration
- The dose at 1mm depth is 50% of the dose of the surface
- At 4mm depth it is only 15%. Therefore dose to the lens is very low
BRACHYTHERAPY

▶ Use to describe the short distance treatment of cancer with

radiation from small, encapsulated radionuclide sources

▶ This type of treatment is given by placing sources directly into or

near the volume to be treated.

▶ The dose is the delivered continuously over short period of time

(TEMPORARY IMPLANTS) or over a long period of time
(PERMANENT IMPLANT)
BRACHYTHERAPY
TREATMENT DURATION

▶ TEMPORARY IMPLANT
- Dose delivered over a short period of time and the sources are
removed after the prescribed dose has been reached

▶ PERMANENT IMPLANT
- dose delivered over lifetime of the source until complete
decay
BRACHYTHERAPY

▶ Types of BrachyTherapy

▶ Mould Technique – placement of Radioactive source on or in

close proximity to the lesion
▶ Intracavitary – Placement of Radioactive source in a body
cavity
▶ Interstitial – Placement of Radioactive directly into the tumor site
and adjacent tissue.
BRACHYTHERAPY
SOURCE LOADING

▶ HOT LOADING
- the applicator is pre-loaded and contains radioactive source at
the time of placement into the patient

▶ AFTERLOADING
- the applicator is placed first into the target position and
the radioactive sources are loaded later, either by hand (Manual
Afterloading) or by machine (Automatic remote afterloading)
BRACHYTHERAPY
DOSE RATE

Dose rate VALUE

0.4 – 2 Gy/hr
LOW DOSE RATE (LDR) 40-500 cGy/hr.
3-4 days

MEDIUM DOSE RATE (MDR) 2-12 Gy/hr

>12 Gy/hr
HIGH DOSE RATE (HDR) Greater than 1200 cGy/hr.
10-20 mins.
IMPLANTATION
TECHNIQUE
IMPLANTATION TECHNIQUE

1. INTRACAVITARY TECHNIQUE
▶ Consist of positioning applicators containing
radioactive sources into a body cavity
in close proximity to the target tissue

INTRACAVITARY APPARATUS
FLETCHER-SUIT SYSTEM – is the most common frequently used
afterloading apparatus in the treatment of gynaecological
malignancies. It consist of TANDEM and pair of OVOID
IMPLANTATION TECHNIQUE

▶ TANDEM
- is a hallow, stainless steel, curve tube with an internal diameter
slightly larger than the source.
- radioactive sources are inserted into a plastic tubing w/c fits
inside the tandem
- it is being inserted in uterine canal
KEEL- positioning stabilizer that place against the OS of the cervix
 IMPLANTATION TECHNIQUE
▶ OVOIDS
- is placed on each side of the tandem or
on the side of uterine cervix
- diameter: 20mm
- length: 30mm
-Pb is build into the ovoid medially to each
end to reduce dose to the bladder
and rectum
-the distal ovoid are assembled to avoid
any movement
IMPLANTATION TECHNIQUE

▶ CYLINDERS
are use for vaginal lesion.
BURNETT CYLINDERS are set of applicators with different
length and diameters.
IMPLANTATION TECHNIQUE

2. INTERSTITIAL TECHNIQUE

▶ Consist of surgically placing small radioactive

source directly into the target tissue with the
use of needles.
▶ Hollow stainless steel neddles are inserted
through the lesion with both end visible,
plastic tubing with button affixed to the
sealed end and is threaded through each
needle. The tubing can accommodate
radioactive source
IMPLANTATION TECHNIQUE

3. MOULD THERAPY/ PLESIOTHERAPY

▶ Consists of an applicator containing array of

radioactive source usually designed to deliver
a uniform dose distribution to the skin or
mucosal surface
IMPLANTATION TECHNIQUE

4. TRANSLUMINAL BRACHYTHERAPY
▶ Consits of inserting a line source into a body
lumen to treat surface and adjacent tissues
 PHYSICAL STATE
OF
BRACHYTHERAPY
SOURCE
 1. TUBES
-standard capsule for radioactive source
- use for treatment of gynaecological malignancies
- Radium226, Co60, Cs137
- encapsulated in 0.5mm platinum that serve as dual function:
1. prevent tissue and body fluid contact
2. filter beta radiation emiited by Cs137 and Alpha emitted by
Radium226

- the amount of radioactivity in each tube is expressed as: milligram

radium eq. (mg Ra eq)
1. TUBES

1 mg of Radium = 8.25 R/hr at 1cm

distance when enclose within 0.5 mm
platinum wall
2. NEEDLES

▶ Radioctive
substance use in interstitial treatment
and encapsulated in shield shaped as needle

▶ Needles
are longer than tubes but smaller
diameter to allow it to penetrate the body or
tissue
2. NEEDLES
▶ INDIAN CLUB NEEDLES
▶ Needles with non uniform distribution of activity
▶ Greater activity at one end

▶ DUMBELL
▶ Needles have greater activity at both ends and
may used w/o crossing needle in either end
‘’Needles are reusable many times before the activity decreases
below acceptable level’’
3. SEEDS

▶ Seeds are left in place permanently

since the half life is short
▶ I125 and Gold 198 seed are routinely left permanently
▶ Iridium192 are remove after few days when desired
dose has been delivered
▶ The activity of the seed is usually <1 mg Ra Eq
4. FLUIDS

▶ Fluid radionuclides are I131 and Phosphorus 32]

▶ Unsealed source
▶ Usually use in NUCLEAR MEDICINE DEPT.
RADIOACTIVE SOURCE IN RADIOTHERAPY
ISOTOPE ENERGY (MeV) T½ SOURCE FORM

Ra-226 0.83 1,626 yrs Tube/needle

Cs-137 0.662 30 years Tube/ needle

Ir-192 0.397 73.8 days Seed

Co-60 1.25 5.27 yrs Spheers

I-125 0.028 59.6 days Seed

Pd103 0.24 28.9 yrs Plauque

I-131 0.60 8.06 days NaI orasl solution

Chromic Phosphate
P-32 1.71 14.3 days
fluid
CLINICAL APPLICATIONS
anatomy Dose Weeks Treatment

BREAST 5000 cGy 5 weeks

CERVICAL 4500-5000 cGy 5 weeks

EPIGLOTTIS 120-125 cGy BID

Post op: 4000-4500 cGy

HODGKIN’S DISEASE 3000-4000 cGy megavoltage

Megavoltage
LARYNGEAL CANCER 6300 t0 6500 cGy 6-week period radiation

4MV Cobalt 60

LUNG CANCER 5000-6000 cGy

4500 cGy (brain)

MEDULLOBLASTOMA
3500-4500 cGy (spinal cord)
CLINICAL APPLICATIONS

anatomy Dose Weeks Treatment

ORAL CAVITY 6000 cGy 4 weeks orthovoltage

PROSTATE 7600 cGy Megavoltage

4000-5000 cGy in Superficial radiation

SKIN CANCER 3-4 weeks
2-3 cm. in size

SUBGLOTTIS 4500 cGy