Use text resources and internet resources to discuss the different systems used

for interstitial brachytherapy (Manchester, Paris, Memorial, etc.). Discuss the

applicators used for the specific system, the points to which the system is
prescribing dose, the actual calculation of dose and any other information you
feel pertinent to the discussion. Try not to select a system someone in the group
has already selected.

There are a number of historical interstitial implant systems that were covered in the
lecture material. I chose to do some additional research on the Paris System. This
interstitial implant system was developed in the 1960s and was published and used
frequently in the clinical setting by the 1970’s.1 The basis of this system is afterloading
flexible Ir-192 wires into the patient. This offered therapists and other treatment staff
more radiation protection over the other techniques. Another benefit of this system was
that it introduced more flexible dose schemes over systems such as the Manchester
system that relied on rigid sources with finite active lengths.1 The Paris system
technique is performed by lying out the active radioisotope sources parallel and straight.
Their centers should sit on the same plane, called the central plane.2 They should be
spaced out with equal distances between the sources and they should remain
perpendicular to one another.1 The spacing between the sources is determined by the
patient anatomy and tumor volume. The minimum spacing between the sources should
be 5 mm and the largest gaps should not exceed 20 mm.1 Below, I have included some
images that show how the sources should be spaced out and lined up.

This is true for linear/planar implants. These implants can also be performed for
volumetric implants and should have cross sections that resemble a triangle or square.
Unlike some other interstitial implant methods like the Manchester system, the Paris
system uses a uniform source activity. It used these uniform sources to achieve
homogeneous dose distribution. However, unlike other systems like the Manchester or
Quimby system, the sources are not allowed to cross in the Paris system. This means
that to achieve proper coverage of the tumor volume, the sources must be 20 to 30
percent longer than the target volume.1 Some of these applicators are called “hairpin”
applicators. They are two parallel sources connected by a single perpendicular source
on one end, so they do technically cross. This is accounted for by only making the
“open” end longer than the target.2

The dose calculations are determined based on a couple factors specific to the Paris
system. First is the “Basal Dose” (BD) which is the mean of the minimum dose rates
between the parallel sources.2 Below, there is an image that shows how the BD is
calculated based on the implant shape. The second dose factor is the reference isodose
which is equal to 85 percent of the BD.1,2 While the source remains at the reference
dose rate (measured on the first day of application), the prescribed dose is delivered to
the treatment volume. A table is used to account for decay during the implant and this
time is added.1 A dose regimen for the Paris system would be 60 to 70 Gy.1 One of the
more common areas of use for this treatment system is a breast boost after EBRT.
References

1. Pierquin, B., Dutreix, A., Paine, C. H., Chassagne, D., Marinello, G., & Ash, D.
(1978). The Paris system in interstitial radiation therapy. Acta Radiologica: Oncology,
Radiation, Physics, Biology, 17(1), 33–48. https://doi.org/10.3109/02841867809127689

2. Systeme de Paris - Aapm.org. aapm.org. Accessed June 25, 2023.

https://aapm.org/meetings/05SS/program/AAPM.ParisSystem_Gillin.pdf.