Remote afterloaders for HDR brachytherapy
The machine that makes modern brachytherapy safe for staff: a shielded safe holding one tiny, intensely radioactive source on a cable, which it drives out through tubes into applicators inside the patient, dwells at programmed positions, and pulls back before anyone re-enters the room.
Overview
Remote afterloading was introduced in the 1960s so that radiographers no longer handled live sources by hand. A modern high-dose-rate afterloader holds a single iridium-192 or cobalt-60 source about the size of a grain of rice welded to a steel cable, with a dummy cable to check the path first. Under computer control it steps the source through up to several dozen channels connected to needles, intrauterine tubes, vaginal cylinders, oesophageal or bronchial catheters, or skin moulds, pausing at each dwell position for the time calculated by the planning system, and retracts it into the shielded safe if anything goes wrong. Iridium sources are replaced every few months because of their short half-life; cobalt-60 sources last years and suit centres with difficult logistics. Elekta (Flexitron, microSelectron), Varian (Bravos, GammaMedplus) and Eckert & Ziegler BEBIG (SagiNova) are the main vendors, and low-energy electronic X-ray sources (Xoft Axxent, Zeiss Intrabeam) offer a source-free alternative for skin, breast and gynaecological applicators.
Brachytherapy is essential for curing cervical cancer and valuable as a boost in prostate, oesophageal, skin and breast cancer, but the global shortage of afterloaders, applicators and trained teams is worse than the shortage of linacs.
- Prostate
- Needle template
- I-125 / Pd-103 seeds
- Rectum (spared)
How it works
A computer-controlled shielded unit drives a single high-activity sealed source along catheters to programmed dwell positions inside applicators in or beside the tumour, then withdraws it, so steep dose fall-off is delivered from within without staff exposure.
- Highest achievable conformal dose from inside the tumour
- No staff exposure during treatment
- One source serves many applicators and sites
- Source replacement and licensing
- Applicator placement often needs anaesthesia
- Global shortage of machines and trained teams
Latest papers
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