Hence, the use of fluoroscopy aided in achieving parallel placement of the needles in all implants as seen on anterior-posterior radiographs. In all cases, some of the needles had to be repositioned to improve the alignment. The patients were followed for 6 to 63 months. The brachytherapy dose (prescribed to the periphery of the implant) was 40 to 55 Gy when used alone (15 patients) and 22-40 Gy when used as a boost to 34.2 to 59.4 Gy of pelvic external-beam radiotherapy (56 patients). Thirty patients were treated for primary cervical or vaginal carcinoma 41 patients were treated for recurrent disease from endometrial or cervical cancers. 137Cesium was added in a central tandem in cases with a cervical os. Seventy-one patients were implanted transperineally with 192iridium using a Syed template under fluoroscopic guidance, from September 1989 to May 1995, for bulky parametrial disease, narrow vagina, extensive vaginal involvement, recurrent disease after previous course of pelvic radiation therapy, or in cases in which the patient had previously undergone hysterectomy. This report focuses on the technique the outcome of patients implanted with this technique will be reported separately. Because the resultant needles are parallel, dosimetry can be performed based on the template hole positions used, rather than identifying individual sources. We have used fluoroscopy to guide the needles for interstitial brachytherapy to treat various gynecological malignancies.
Fluoroscopic guidance portable#
Often, the implanted needles are not parallel, and the multiple sources can be difficult to identify on localization radiographs, especially if obtained with a portable X-ray unit. Interstitial brachytherapy is generally performed for gynecological malignancies with extensive parametrial involvement, by inserting the needles through a transperineal template.
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