Medical Physical Aspects of Intravascular Brachytherapy
1. Intravascular Brachytherapy (IVB): Intraluminal radiotherapy with the β or γ radiation of sealed or unsealed, but encapsuled, sources (no nuclear medical therapy). Team IVB: Intensive, interdis-ciplinary collaboration of cardiologists/angiologists, radiotherapists/physicians from nuclear medicine/radiologists and medical physicists, as well as nurses and assistants.
2. Need of personnel: One medical physicist at least, with special education and regular training;
responsibilities/tasks: selection, decision and introduction of intravascular brachytherapy; do-simetry, planning, quality assurance, documentation and radiation protection of IVB.
3. Need of premises: Brachytherapy is allowed only in controlled areas. Special rooms are required e.g. for the handling of sealed and non-sealed radioactive sources; for dosimetry, quality assur-ance and storage of documents, for storage of sources, for disposal of radioactive waste.
4. Need of equipment: Devices for intravascular (afterloading-)brachytherapy; dosimetry (phantoms, directly indicating dosemeter with high precision and resolution, linear over >4 orders of magni-tude of dose); quality assurance; (IVUS-)localization, planning; and radiation protection.
5. Requirements for IVB devices: Automatic afterloader only; built-in redundant dual timer; control of source position (using a dummy source and the same device) and completeness of sources be-fore and after irradiation; indication of status: resting position, transfer, irradiation, interruption, and fault. For Germany, the requirements should be met within a transition period of two years.
6. Sources: Bookkeeping and reporting (to the authorities) of new and the disposal of waste sources.
7. Radiation protection: Written instructions and regular training should include the procedures of purchase, storage, transport, disposal of radioactivity; handling/therapy with sealed/unsealed ra-dioactivity; behaviour in case of a fault, accident, alarm, rescue, contamination or incorporation.
8. Area dosimetry: Required prior to installation, in case of rescue, contamination, or incorporation.
9. Personnel dosimetry: Additionally to personnel dosimetry, finger/hand dosemeters are required.
10. Quality assurance: Regular checks of devices and procedures; the results must be recorded.
11. Verification: Prior to IVB, positioning and length or travel distance of sources must be checked.
12. Faults: In case of a fault or unusual behaviour, damage, leakage or loss of radioactive sources the radiation protection officer (medical physicist) has to be informed and actions must be initiated.
13. Source calibration: In terms of absorbed dose to water at a clinical relevant calibration reference point: PRef= 2mm radial distance from the source center for IVB of coronaries and PRef = 5mm for peripherals.
14. Acceptance of sources: The calibration of IVB-sources in terms of absorbed dose to water and units of Gy(/min), traceable to national standards (PTB, NIST), should be checked by the user at the specified calibration reference point PRef; the depth dose distributions and the radial and axial dose(rate) uniformity should be checked completely once (for ≥ 2 specified diameters of employ-ment of balloon/applicator/stent), and at a few specified points for replaced sources (for γ-radiation e.g. at 10 mm; for βradiation e.g. at 50%, 75%, and 125% of β range).
15. Relevant parameters: The absorbed dose to water prescribed to the system related calibration ref-erence point PRef should be recorded and reported. In addition, the dose delivered to a target-related specification point at 1 mm (2 mm) tissue depth for intracoronary (peripheral) IVB; the dose-volume-histogram (or the mean dose and dose variation); the (maximal) dose rate at the cali-bration reference point PRef., the (effective) irradiation time and the treatment timing schedule (e.g.
before, after or in-between PTCA and stenting) should be specified and reported.
16. Documentation: Patient-related: prescription, treatment plan and record; system-related: IVB log-book and patient list in chronological order. All documents have to be stored for 30 years.
11. Literature
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