Background Information:

What are the other Names for the Procedure?

• Internal Radiation Therapy
• Interstitial Brachytherapy
• Intracavity Brachytherapy

What is Brachytherapy radiology procedure? (General Explanation)

• Brachytherapy is a type of radiation therapy used to treat cancer. Doses of radioactive material are placed directly on target areas to kill cancer cells and shrink tumors
• The radioactive material is placed inside a catheter for a certain amount of time and removed in Temporary Brachytherapy. Temporary Brachytherapy can be applied at a high-dose rate (HDR) or low-dose rate (LDR)
• In Permanent Brachytherapy, radioactive material is left in or near the tumor permanently. Radioactivity of this material eventually diminishes to very small levels, ultimately not producing any radioactivity at all
• Brachytherapy can be used to treat various types of cancers such as those affecting the eye, rectum, breast, lung, vagina, uterus, prostate, cervix, head and neck, skin, and gallbladder

What part of the Body does the Procedure involve?

A Brachytherapy procedure may involve any of the following body parts, and this depends on the location of the cancer.

• Prostate
• Head and neck
• Breast
• Gallbladder
• Uterus
• Vagina
• Lung
• Rectum
• Eye

Why is the Brachytherapy radiology procedure Performed?

Brachytherapy is used to treat cervical, prostate, breast, and skin cancer. Tumors located at other body sites can be treated as well.

What is the Equipment used? (Description of Equipment)

The equipment for Brachytherapy procedure includes:

• Radioactive material encapsulated in a metal capsule is placed near the site of the tumor using a delivery device in permanent implants
• In temporary implants, plastic catheter or needles are placed on the treatment site
• Different types of radioactive materials such as palladium, cesium, iridium, or iodine, can be used in Brachytherapy
• An MRI scan, CT scan, ultrasound, or X-ray scan may be used to position the radioactive material near the tumor
• A computer calculates the exact position for the placement of the radioactive material and desired dose of radiation
• In all of these procedures, the source of radiation is encapsulated in a metal capsule, so that the radioactive material does not enter the patient’s body

What are the Recent Advances in the Procedure?

There have been no recent advances with respect to the Brachytherapy procedure.

What is the Cost of performing the Brachytherapy radiology procedure?

The cost of the Brachytherapy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Brachytherapy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.mayoclinic.org/tests-procedures/brachytherapy/basics/definition/prc-20021316 (accessed on May 10, 2015)

http://www.radiologyinfo.org/en/info.cfm?pg=brachy (accessed on May 10, 2015)

Prior to Brachytherapy radiology procedure:

How does the Brachytherapy radiology procedure work?

• Brachytherapy can be used alone or in conjunction with other therapies, such as surgery, external beam radiotherapy (EBRT), and chemotherapy
• EBRT involves high-energy X-ray beams produced by a machine that are directed at the tumor or cancer cells from outside the body

How is the Brachytherapy radiology procedure Performed?

Permanent Brachytherapy is performed as follows:

• Needles or specific delivery devices filled with radioactive materials are inserted into the tumor
• The needle or delivery device is removed and radioactive material is left in the tumor permanently
• Imaging techniques, such as an X-ray, MRI scan, ultrasound, or CT scan, are used for the placement of the material

Temporary Brachytherapy is performed as follows:

• By using imaging techniques, such as a CT scan, MRI, ultrasound, or fluoroscopy, the delivery device filled with radioactive material is placed into the tumor
• In Intracavity Brachytherapy, the delivery device is placed in body cavities such as the vagina or uterus
• In Interstitial Brachytherapy, the delivery device is inserted into body tissues
• High-dose rate (HDR):
  • In HDR, the radiation is delivered in short bursts to the tumor
  • The treatment is delivered at the rate of 10-20 minutes per session
  • Treatment is repeated several times, if necessary, and the delivery device is removed from the body
  • It is possible that the patient may receive up to 10 HDR Brachytherapy sessions over one or more weeks
• Low-dose rate (LDR):
  • The treatment is delivered at the rate of 20-50 hours
  • In LDR, the radiation is delivered at a continuous rate over one or two days. The patient is required to stay overnight in the hospital
• Pulse dose rate (PDR):
  • The treatment is delivered in periodic pulses, rather than continuously

Where is the Procedure Performed?

Brachytherapy is usually an outpatient procedure. Sometimes, the patient is admitted to the hospital for one or two days for additional treatment. 

Who Performs the Procedure?

The equipment for Brachytherapy treatment is operated by a medical physicist, a licensed dosimetrist (supervised by a physicist), or a radiation oncologist. The general treatment plan is created by a radiation oncologist.

How long will the Procedure take?

The actual treatment lasts about 10-20 minutes, though the entire Brachytherapy procedure may last for a few hours.

Who interprets the Result?

• The radiation oncologist determines proper therapy for the patient, what area of the body is to be treated, and how much radiation is to be delivered
• The medical physicist and dosimetrist makes treatment calculations and determines the method of radiation dose delivery
• The radiation therapist assists in the delivery of the treatment; help from surgeons may be necessary, in case catheters or needles are necessary for the treatment
• Brachytherapy needs a medical team consisting of a medical physicist, dosimetrist, radiation therapist, nurse, surgeon, and a radiation oncologist

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Brachytherapy procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the X-ray
• Women should notify the physician if they are pregnant or breastfeeding their child, as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the test
• The physician may ask the patient to go through bowel preparation, blood tests, ultrasound, MRI or CT scan, EKG, or chest X-ray before the procedure, if necessary
• Specific instructions are given to the patient on how to prepare for the Brachytherapy procedure a few days before the actual procedure

What is the Consent Process before the Procedure?

A physician will request your consent for a Brachytherapy procedure using an Informed Consent Form

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent

You must sign the forms only after you are totally satisfied with the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Brachytherapy procedure:

• Brachytherapy is very effective in treating cancer with a high level of accuracy
• There are minimal side effects when undergoing the therapy
• It is a minimally-invasive method
• The treatment sessions and recovery time are relatively short

Following are the risks of the Brachytherapy procedure:

• There may be side effects to Brachytherapy, which are specific to the area being treated
• Tenderness or swelling may be found in the treatment area

What are the Limitations of the Brachytherapy radiology procedure?

• Brachytherapy requires one or two anesthetics, depending on the method used. The anesthetic may have side effects
• It is difficult to assess if the treatment was successful or not; for this assessment may take some time

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is the Brachytherapy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Brachytherapy radiology procedure:

What is to be expected during the Brachytherapy radiology procedure?

• If heavy sedation is used during the Brachytherapy procedure, then the patient will be moved to the hospital inpatient room after the procedure
• The patient may hear a clicking sound when the radioactive material is being pushed through the catheter
• The patient may feel a little uncomfortable due to having catheters and a needle in their body for a prolonged period of time
• The patient can have visitors between treatment pulses, during pulsed dose-rate Brachytherapy
• Children and pregnant women are not allowed to visit the patient during the procedure. However, they may be allowed to visit the patient after the procedure

What kind of Anesthesia is given, during the Procedure?

• A general anesthesia is given during the Brachytherapy procedure
• If the patient experiences an allergic reaction to the anesthesia, then he or she should notify the physician immediately

How much Blood will you lose, during the Procedure?

There is no blood drawn during the Brachytherapy procedure.

What are the possible Risks and Complications during the Brachytherapy radiology procedure?

The risks of the Brachytherapy procedure include:

• Side effects of Brachytherapy that may be specific to the area being treated
• Tenderness or swelling may be found in the treatment areas
• Allergic reaction to the anesthetic

What Post-Operative Care is needed at the Healthcare Facility after the Brachytherapy radiology procedure?

The patient may be required to stay overnight at the healthcare facility after the Brachytherapy procedure.

After the Brachytherapy radiology procedure:

What is to be expected after the Brachytherapy radiology procedure?

• Follow-up exams, such as a physical check-up, blood or other lab tests, may be recommended by the physician after the Brachytherapy procedure
• The patient is also required to visit the physician after the procedure, so that the physician can determine if the condition is stable or has changed
• Radioactive seeds placed in the patient’s body in Permanent Brachytherapy may set-off airport security checkpoint alarms, and the patient may need a physician’s note to explain their medical condition
• The radiation activity decays quickly in the case of Permanent Brachytherapy. Nevertheless, the patient should still discuss with their healthcare providers about having any contact with pregnant women or children

When do you need to call your Physician?

• If the patient experiences an allergic reaction to the anesthesia used, then they should notify the physician immediately
• Also, if there is redness or swelling a week after the Brachytherapy procedure, the patient should contact their healthcare provider

What Post-Operative Care is needed at Home after the Brachytherapy radiology procedure?

Patients may resume their normal activities a few days after the Brachytherapy procedure.

How long does it normally take to fully recover, from the Procedure?

The patient should be able to fully recover from the procedure a few days after Brachytherapy is administered.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

No tissue is extracted from the patient during a Brachytherapy procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Brachytherapy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• A radiologist performing the procedure
• Healthcare providers, physicians, who is involved in the process

The patient is advised to inquire and confirm the type of billing, before the Brachytherapy procedure is performed.