1. HDR Brachytherapy Nicolas G. Zouain, MD Department of Radiation Oncology Roger Maris Cancer Center

2. History 1905

3. 1920’s

4. Dose Rate Low dose rate (LDR) 0.4 to 2 Gy/hr Medium dose rate (MDR) 2 to 12 Gy/hr High dose rate (HDR) > 12 Gy/hr but usually in the region of 150 Gy/hr ~ 2.5 Gy/min

5. Why Brachytherapy Delivering the high dose of radiation to the tumor Sparing of the surrounding normal tissues Delivered in a short period of time Tumor repopulation Limited to localized tumors

6. High Dose Inside of the Tumor 100% 25% 150%

7. HDR Afterloading Machine Iridium-192

8. Prostate HDR Brachytherapy

9. Breast HDR Brachytherapy

10. Lungs HDR Brachytherapy

11. Esophagus HDR Brachytherapy

12. Cervix HDR Brachytherapy

13. Uterus HDR Brachytherapy

14. H&N HDR Brachytherapy

16. Rectal Brachytherapy

19. Templates

20. Trans Rectal Ultrasound

21. Ultrasound Stepper

22. Ultrasound Stepper Stabilizer

23. TRUS Guided Needles Insertion

24. MammoSite

25. Lumpectomy Cavity is Created Troacar Used to Create Pathway to Cavity Un-inflated MammoSite is Advanced into the Cavity Through the Troacar Path

26. MammoSite MammoSite is Inflated to Position the Tissue to Receive Radiation Therapy Design allows the 192 Ir Source to be Centrally Positioned within the Applicator The 192 Ir Source is Delivered Into the MammoSite and Radiation Therapy is Delivered Per the Treatment Plan

27. MammoSite