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Radioactive seed implantation for treatment of early stage prostate cancer is often

performed with a permanent, low dose rate (LDR) brachytherapy implant used as the sole means
of treatment or along with EBRT.1 At the Minneapolis VA Radiation Oncology Clinic, this
procedure is performed with a Mick applicator and is done at least on a monthly basis. The
advantages of this procedure is that the patient is subjected to anesthesia only once and most
often the patient is released the same day of the procedure.2 This is in contrast to the high dose
rate (HDR) implants that can require as many as 7 fractions over several days. These LDR
insterstitial implants are done with either a I-125 isotope, that have a half-life of 60 days or a Pd-
103 isotope that has a half-life of 17 days. These isotopes emit photons with low enough energy
that the patient will pose no threat in regards to exposing anyone in the public to radiation.1,2
For the LDR implants with a mick applicator, the procedure is done in the OR with
the patient being given general or epidural anesthesia. The patient is then placed in the dorsal
lithotomy position where they are then catheterized for the duration of the procedure.1,2,3
In order to accurately place seeds for optimal dose distribution, a trans-rectal ultra sound
(TRUS) probe that is locked into a precise stepper is used to guide the procedure.4
For pre-planning purposes, the prostate is contoured from a CT scan to determine approximate
volume in order to account for the appropriate amount of seeds that will be needed.
When performing prostate implants at the Minneapolis VA, the procedure begins with a
volume study. In this volume study, transverse and sagittal images are obtain from the TRUS and
are used to determine the current size of the prostate so that planning can be done
intraoperatively within the OR.1 Once the planning is complete, all of the needles that are
planned for are placed into the prostate evenly. Placement for all of the seeds and needles are
determined with the computer based Variseed brachytherapy planning system that is run by the
dosimetrist. I-125 seeds are utilized from manufacturer Bard and sit within the mick cartridge
that is then loaded into the mick applicator. The physician then transfers the seeds through the
needle, with the mick applicator into the tumor. During this procedure one dosimetrist tracks the
number and placement of seeds on the computer while another dosimetrist and physicist double
checks the numbers on a planning sheet. Placement of the seeds as well as dose distribution is
calculated by the Variseed program to evaluate the DVH values of the prostate as well as
the critical structures. Placement of the seeds is also verified throughout the procedure with the
use of fluoroscopy.
References
1. Khan FM, Gibbons JP. The Physics of Radiation Therapy. 5th ed. Philadelphia, PA: Lippincott
Williams and Wilkins. 2014.
2. Washington C, Leaver D. Principles and Practice of Radiation Therapy. 4th ed. St. Louis,
Missouri: Mosby and Elsevier. 2016.
3. Lenards N, Berner P, Schmidt K. Prostate seed implants. [Softchalk]. La Crosse, WI: UW-L
Medical Dosimetry Program; 2016.
4. Lief E. Prostate seed implant delivery. AAPM Brachytherapy School.
https://www.aapm.org/meetings/05SS/program/ProstateDelivery.pdf. Accessed August 4,2017.
Figures

Figure 1: Mick applicator for use in Prostate LDR implants.4

Figure 2: Magazines that hold the seed implants and are placed on top of the Mick applicator.4

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