Brachytherapi

Riyani Sabariani
Departemen Radioterapi
RSCM
 Pendahuluan
 Brachytherapy (Juga dikenal dengan
istilah Curieterapi) adalah teknik
penyinaran jarak dekat untuk kasus
keganasan, dengan menggunakan
sumber radioaktip yang tertutup.
 Sumber diletakan langsung didalam
volume target tumor, atau dekat
dengan volume tumor
 Perbedaan External radiasi dan brachyterapi

External beam radiotherapy Brachytherapy

(external source of radiation) (internal source of radiation)
Source
Co-60
Sealed Cs-137
X-ray tube Ir-192
sources
Cobalt-60 teletherapy I-125
Linear accelerator (linac) Pd-103
 Keuntungan Brachyterapi

• Dosis pada target tinggi

• Dosis pada daerah sekitar target sangat minimal
• Mendapatkan dosis yang lebih confirm

 Kerugian Brachyterapi

• Hanya bagus untuk tumor yang masih terlokalir

• Hanya bagus unutuk tumor kecil
• Memerlukan perlakukan yang khusus
 Jenis Aplikasi
 Interstitial Implants
 Intracavitary
Insertions
 Intravascular
Treatments
 Surface Applications
 Klasifikasi Brachyterapi sesuai
doserate sumber radioaktif

 Low dose rate (LDR) (0.4 - 2 Gy/h)

 Medium dose rate (MDR) (2 - 12 Gy/h)

 High dose rate (HDR) ( > 12 Gy/h)

Klasifikasi Brachyterapi sesuai cara
pemasangannya

 Manual Afterloading
 Remote After Loading
Manual afterloading

Generally, the radiation sources are

manually afterloaded into applicators
or catheters that have been placed
within the target volume. At the end
of treatment the sources are
removed, again manually.

The manual loading and removal of

sources from the applicators or
catheters result in some radiation
exposure to the medical and support
staff.
Remote afterloading

To minimize radiation exposure to medical and

support staff several computer driven remote
afterloading systems have been developed.

The use of remote afterloading machines offers

several practical advantages over manual
procedures, such as:

Increased patient treatment capacity.

Consistent and reproducible treatment delivery.
Reduced radiation exposure to staff.
 Remote After Loading
Beberapa Pesawat Remote After Loading

1970- 1990- 2000-

Cobalt RALSTON Ir-192 RALS Cobalt RALS
Diameter 3 mm Diameter 1.1 mm Diameter 1.1 mm
Jenis Aplikasi Implan
Interstitial

 Permanent
 Temporary

• Low Dose Rate (LDR)

• High Dose Rate (HDR)
 Karakteristik Sumber
Radioaktif
Implants:Permanent
 Photon emitter, minimal electron
contamination
 Low photon energy and/or short
half life
 Small size (High specific activity)

 biologically inert jacket

 Sources for Permanent
Interstitial Implants

Material Avg. Photon Half life HVL Pb

Energy [keV] [days] [mm]
(Radon) 830 3.83 12
Au-198 412 2.70 3
I-125 27 60 0.025
Pd-103 21 17 0.008
Sumber Permanen
 Jenis Aplikasi
Intracaviter

 Temporary LDR
 Temporary HDR
 Sources for Temporary LDR
Intracavitary Insertions
Material Avg. Photon Half life HVL
Pb
Energy [keV] [mm]
(Radium) 830 1622 y 12
(Co-60) 1250 5.27y 12
Cs-137 662 30y 6
Ir-192 380 74d 3
Am-241 60 432y 0.13
HDR and PDR Sources
Cable diameter
Source diameter
5 mm 1.1 mm
0.6 mm
3.5 mm

Iridium
MicroSelectron High Dose-rate Source Source

2.85 mm Cable diameter

Source diameter 1.1 mm
0.6 mm
0.6 mm

Inactive Iridium
Pellet Source
MicroSelectron Pulsed Dose-rate Source
 Two HDR Sources
Cable d iameter
Source d iameter
5 mm 1.1 m m
0.6 mm
3.5 m m

Iridium
MicroSelectron High Dose-rate Source Source

Iridu m Cable d iameter

Source d iameter
Source 0.59 m m
0.34 mm

10 mm

VariSource H igh Dose-rate Source

 192Ir LDR Sources
0.5 mm 0.5 mm

Alpha-Omega Best Medical

Services Industries, Inc.
3 mm

0.3 mm Ir (10%) 0.1 mm Ir (30%)

Pt (90%) Pt (70%)

0.1 mm Pt 0.2 mm Stainless Steel

Autoradiograph
of 137Cs sources
137Cs
Needle
(Amersham)
Radium Sources
 Radium Needles

Type Active length

Short 1.5 cm
Medium-short 2.0
Medium 3.0
Medium-long 4.0
Long 4.5
Strength Linear Ra density
Full 0.66 mg/cm
Half 0.33