1.wendy Julian Brachytherapy 1

Thursday 16.5.
12
W Julian
2.00 pm
Brachytherapy and
Radioactive Sources
Lecture 1
Wendy Julian
Christie Physics and Engineering
wendy.julian@christie.nhs.uk
Christie Hospital NHS

NHS Foundation Trust
Introduction
• Lecture 1:
• What is brachytherapy?
• Types of brachytherapy
• Imaging in brachytherapy
• Doserates in brachytherapy
• Recap of radioactivity
• Sealed sources
• Sources used in brachytherapy
• Inverse square law

Introduction
• Lecture 2:
• Safety of sealed sources
• Afterloading
• Remote afterloaders
• Brachytherapy source specification
• Measurement of source strength
• Dose calculations

Introduction
• Lecture 3:
• Clinical applications of brachytherapy
• Gynaecological treatments
• Interstitial implant systems
• Use of HDR micro-Selectron
• Prostate treatments

What is brachytherapy?

Brachytherapy
• The implantation of sealed radioactive
sources near to the tissue being treated
• High dose to treatment volume with (relative)

sparing of surrounding tissue
• Three types of treatment-

• interstitial
• intra-cavitary (also intra-luminal/vascular)
• surface
Types of brachytherapy

Interstitial Brachytherapy
• Sources implanted directly in

the tissue being treated
• Small dimensions make this

less traumatic
• Wires or ”hairpins” used to

treat tongue, vulva & anus
• Seeds used to treat prostate

Intra-cavitary Brachytherapy
• Sources positioned in body cavity

• Common treatments include cervix/uterus, vagina,
bronchus & oesophagus
• Sources are often placed inside “applicators”, such
as tubes (linear) and ovoids (roughly spherical)

Examples of intra-cavitary
applicators

Surface/Mould Brachytherapy
• Sources held in surface applicator
• Useful for surface lesion overlying

sensitive normal tissues
• Demand has reduced due to

greater use of other modalities
(electrons, Photo-Dynamic
Therapy)
• Iridium wire/Gold seeds loaded into

cast placed on surface
• Strontium Sr90 eye applicator (beta

emitter)

Imaging in Brachytherapy

Imaging
• Traditionally planar x-rays were used for

imaging brachytherapy implants
• Modern implants are planned using 3D cross-

sectional imaging:
• CT
• MR
• Ultrasound

Dose rates in brachytherapy

Dose-rate & Treatment Duration
ICRU 38 (1985) and 58 (1997)
Doserate Treatment Duration
Low 0.4 – 2.0 Gy/hr
2-4 days
(LDR) around 10 Gy/day
Medium
2 – 12 Gy/hr
(MDR) 10-20 hours
around 10Gy/hr
High
60-300 Gy/hr
(HDR) Few minutes
around 10 Gy/min
Recap of radioactivity

Decay of an unstable atom
electrons
(Beta particles)
Gamma ray
(electromagnetic)
Alpha particles
(2 protons + 2 neutrons)
Alpha – stopped by a sheet of paper

– intense, very localised effect on tissue
Beta – stopped by a few mm Al

– very short range in tissue
Gamma – ‘infinite’ range - intensity reduced with distance

Radioisotopes
• Isotopes
• same number of protons
• different number of neutrons
• Unstable isotopes include

• carbon 14
• uranium 238
radium 226 caesium 137 iridium 192
iodine 125 strontium 90

Half-life

Activity
• Activity is measured in
• Becquerels (Bq) – disintegrations per second
• Curies – 1Ci = 3.7 x 1010 Bq
• Decay is exponential
Activity = A0e-λt
λ = decay constant = ln(2)/half-life

t = time since activity was A0

*** Question! ***
• I125 seeds of 0.400 mCi/seed will be

0.100mCi/seed after ____ days
(I125 half life ≈ 60 days)
• A) 15
• B) 60
• C) 120
• D) 240

Decay
series
for
U 235

Parent and
Daughter
Original = parent
Product = daughter
Shapes of curves
depend on relative
half lives of parent
and daughter
Transient equilibrium (of daughter)
• Rate of production = rate of decay
• Number of atoms is constant
Sealed sources

Sealed and unsealed sources
• Unsealed sources are commonly used in

Nuclear Medicine, typically in small quantities
as diagnostic tracers.
• Sealed Sources are used in Brachytherapy;

they are usually encapsulated in either
platinum or steel

‘Sealed’ Sources
• Radioactive material encapsulated to give:
• physical strength
• radioactive containment
• Attenuation of low energy gammas
• Absorbance of a and b emissions

Leak tests
• To confirm integrity of
source encapsulation
• Sources wiped using long

handled forceps
• Alcohol swab used to
collect any residue
Leak tests
• Swab analysed in
radio-isotope sample
counter set to
appropriate energy
range

Properties of Sealed Sources
Desirable Energy?
• Single photon energy simplifies calculations
• Low energy emissions are easier to shield

(radiation protection for staff)
• High energy minimises attenuation & scatter

(more penetrating for treatment)

Desirable Half Life?

• Long half-life prolongs working life (so
sources don’t have to be replaced so often)
• Long half-life requires less recalculation of

treatment times in source lifetime
• Short half-life useful for permanent implants

(less remaining activity)
Charged Particle emissions?

• Ideally absent or easily removed by thickness of
encapsulation
High specific activity?

• More photons per unit mass; can use small
source volumes (so more useful for implantation
etc)

Physical properties?
• No gaseous decay products
• Insoluble
• Non-toxic
• Easily fabricated
• Identifiable?

Sources used in brachytherapy

Isotopes used in brachytherapy
Iridium-192
• Half-life : 74 days
• Energy: 397 keV (average)
• For interstitial implant

• Wires (0.3mm)
• hair-pins (0.6mm)
• for HDR and PDR after-loading
• cylindrical source

Iridium-192
192 192
77 Ir 78 Pt + β + γ

Iodine-125
• Half-life : 59.4 days
• Energy: 27-35 keV
• ‘Electron capture’ decay process leads to gamma emissions and some

beta decay
• Beta decay (Electrons) absorbed by casing (and some very low energy
gammas)
• Low energy & half-life make it suitable for permanent implant to prostate,
brain
• Low energy means that radiation protection is simpler:
• lead apron is effective shielding
• prostate patients can be discharged after 24 hours Christie Hospital NHS
Iodine-125
125 0
53 I + -1 e 125
52 Te + γ
• Decays by electron capture
• Tellurium-125 undergoes 93% internal conversion and 7% gamma
emission of a 35.5 keV photon
• The electron capture and internal conversion also produce
characteristic x-rays: 27.4 and 31.4 keV

Caesium-137
• Half-life : 30.17 years
• Energy: 662 keV gamma
• Needles used for surface implants

• “J-tubes” – old style manual sources for
gynaecological work
• pellets (after-loading) for gynaecological work
• Common Radium substitute – similar energy

Caesuim-137
137 137
Cs
55 Ba + β
56 + γ

Cobalt-60
• Energy: 1.25 MeV (average)
• Wires
• Beads in HDR after-loading
• Radiation protection an issue (high energy and long
half-life)

Cobalt-60
60 60
Co
27 28 Ni + β + γ

Gold-198
• Half-life : 2.7 days
• Energy: 412 keV (& others)
• Grains supplied in a magazine of 14 and implanted

using a “gun”
• Half-life suitable for permanent implant, in superficial
lesions
• Used to be used on superficial skin moulds
Gold-198
198 198
Au
79 Hg + β
80 + γ

Strontium-90
• Energy: 546 keV b particle
• Sr90 opthalmic applicator:

• Concave applicator about the size of a teaspoon used
for treatments on the surface of the eye, mounted on a
rod with shield, (radiation protection for operator)
• Beta particles used for treatment; treats a shallow
depth of tissue effectively
• Window on active surface to shield (unwanted) low
energy emissions
Strontium-90
90 90
38 Sr 39 Y + β
90 90
39 Y 40 Zr + β
• The beta energy from the first decay is too low to
be useful (546 keV), but the daughter element
decays with beta energy 2.27 MeV

*** QUESTION! ***
• Match the isotope with its properties!
1) I125 B A) betas used for treatment

2) Cs137 D B) has 59.4 day half life
3) Ir192 C C) Used as HDR source
4) Sr90 A D) Has 662 keV gamma

Inverse square law

The effect of distance –
Inverse square law
• Spherical dispersion of
radiation
• Dose ‘falls off’ depending
on area of ‘sphere’
• If Dose at A = 100,
dose at B = (A/B)2 x 100
where A and B are
distances away from the
point source
• At twice the distance, the
dose falls to ¼

*** QUESTION! ***
• The fall-off around a Cs137 Source in tissue is

mainly due to:
• A) tissue attenuation
• B) inverse square law
• C) short range of betas
• D) attenuation in source encapsulation

*** QUESTION! ***
• The dose at 10cm from a source is 160 units.

What is the dose at 40cm from the source?
• A) 10 units
• B) 20 units
• C) 40 units
• D) 80 units

Break time!


1.wendy Julian Brachytherapy 1

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Thursday 16.5.

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

• High dose to treatment volume with (relative)

• Three types of treatment-

Christie Hospital NHS

• Sources implanted directly in

• Small dimensions make this

• Wires or ”hairpins” used to

• Seeds used to treat prostate

• Sources positioned in body cavity

Christie Hospital NHS

Christie Hospital NHS

• Useful for surface lesion overlying

• Demand has reduced due to

• Iridium wire/Gold seeds loaded into

• Strontium Sr90 eye applicator (beta

Christie Hospital NHS

Christie Hospital NHS

• Traditionally planar x-rays were used for

• Modern implants are planned using 3D cross-

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

Alpha – stopped by a sheet of paper

Beta – stopped by a few mm Al

Gamma – ‘infinite’ range - intensity reduced with distance

• Unstable isotopes include

radium 226 caesium 137 iridium 192

iodine 125 strontium 90

Christie Hospital NHS

Christie Hospital NHS

λ = decay constant = ln(2)/half-life

Christie Hospital NHS

• I125 seeds of 0.400 mCi/seed will be

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

• Unsealed sources are commonly used in

• Sealed Sources are used in Brachytherapy;

Christie Hospital NHS

Christie Hospital NHS

• Sources wiped using long

Christie Hospital NHS

• Low energy emissions are easier to shield

• High energy minimises attenuation & scatter

Christie Hospital NHS

Desirable Half Life?

• Long half-life requires less recalculation of

• Short half-life useful for permanent implants

Charged Particle emissions?

High specific activity?

Christie Hospital NHS

Christie Hospital NHS

Christie Hospital NHS

• For interstitial implant

Christie Hospital NHS

Christie Hospital NHS

• ‘Electron capture’ decay process leads to gamma emissions and some

Christie Hospital NHS