Afterloading: The Technique That Rescued Brachytherapy.

Although brachytherapy had been established as a highly effective modality for the treatment of cancer, its application was threatened by mid-20th century due to appreciation of the radiation hazard to health care workers. This review examines how the introduction of afterloading eliminated exposure and ushered in a brachytherapy renaissance.

A simple technique for the generation of institution-specific nomograms for permanent prostate cancer brachytherapy.

Purpose: Nomograms once had a vital role in prostate brachytherapy practice. Although some of their functions have been assumed by computerized dosimetry, many programs still find them useful to determine the number and strength of seeds to be ordered in advance of the implant. As it has been demonstrated that brachytherapists differ in their implant practices and preferences (in regard to seed distribution and total implanted activity), we propose a simple technique for generating institution-specific nomograms.

The evolution of computerized treatment planning for brachytherapy: American contributions.

Purpose: To outline the evolution of computerized brachytherapy treatment planning in the United States through a review of technological developments and clinical practice refinements.

Material And Methods: A literature review was performed and interviews were conducted with six participants in the development of computerized treatment planning for brachytherapy.

Results: Computerized brachytherapy treatment planning software was initially developed in the Physics Departments of New York's Memorial Hospital (by Nelson, Meurk and Balter), and Houston's M.

Introduction of transperineal image-guided prostate brachytherapy.

The modern prostate brachytherapy procedure is characterized by ultrasound guidance, template assistance, and a return to a "closed" transperineal approach. This review traces the introduction and evolution of these elements and charts the development of the procedure from the ashes of previous, failed efforts.

The phylogeny of permanent prostate brachytherapy.

Permanent prostate brachytherapy has been practiced for more than a century. This review examines the influence of earlier procedures on the modern transperineal ultrasound-directed technique. A literature review was conducted to examine the origin of current clinical practice.

Robert Abbe: early American brachytherapist.

Purpose: To assess Robert Abbe's career and contributions to brachytherapy, in the context of the work of contemporary European and American investigators.

Methods And Materials: Examination of his lectures and journal articles, as well as contemporaneous newspaper accounts, textbooks, and archival material.

Results: Although not the first American to apply radium therapeutically, Robert Abbe was among the earliest to acquire and systematically use a clinically significant quantity.

From the lost radium files: misadventures in the absence of training, regulation, and accountability.

Purpose: Radium was the foundation of brachytherapy in the early decades of the 20th century. Despite being a most precious and perilous substance, it was mislaid with surprising frequency. This essay explores how it was lost, the efforts taken to recover it, and measures instituted to prevent mishandling.

Whitmore, Henschke, and Hilaris: The reorientation of prostate brachytherapy (1970-1987).

Purpose: Urologists had performed prostate brachytherapy for decades before New York's Memorial Hospital retropubic program. This paper explores the contribution of Willet Whitmore, Ulrich Henschke, Basil Hilaris, and Memorial's physicists to the evolution of the procedure.

Methods And Materials: Literature review and interviews with program participants.

Partial breast irradiation by brachytherapy, 1927.

Purpose: Examination of Geoffrey Keynes's contributions to brachytherapy and the management of breast cancer.

Methods And Materials: Review of publications and texts of the era.

Results: In an era when radical mastectomy was accepted as standard treatment for breast cancer, Keynes demonstrated that brachytherapy (with or without local excision) was equally effective, while sparing body form and function.

Don Lawrence and the "k-capture" revolution.

Purpose: The practice of brachytherapy was in steep decline in the mid-20th century, largely because of safety issues. This article explores the innovations that revitalized brachytherapy with special attention to the introduction of low-energy seeds for permanent implantation.

Methods And Materials: Literature review; interviews; and the memos, records, and correspondence of Donald C.

Precedence for prostate brachytherapy.

Purpose: To identify the earliest practitioners of prostate brachytherapy.

Methods And Materials: Review of contemporary literature.

Results: Radiotherapy has been used for benign prostatic ailments as early as 1902.

Howard Kelly establishes gynecologic brachytherapy in the United States.

Purpose: Exploration of Howard Atwood Kelly's contributions to gynecologic brachytherapy.

Methods And Materials: Review of contemporary journals, texts, newspaper accounts, and the memoirs of Kelly's associates. Information from unpublished material, including Kelly's handwritten notes and diaries, was culled from the Alan Mason Chesney Archives of the Johns Hopkins Medical Institutions.

Optimal equations for describing the relationship between prostate volume, number of sources, and total activity in permanent prostate brachytherapy.

Objectives: To determine whether there is an optimal type of mathematical equation for predicting seed and activity requirements for permanent prostate brachytherapy.

Methods: Four institutions with extensive brachytherapy experience each submitted details of more than 40 implants. The data was used to generate power and linear equations to reflect the relationship between preimplant volume and the number of seeds implanted, and preimplant volume and the total implant activity.

Identification and management of persistently active brachytherapy seed implants.

Objective: The purpose of this article is to review the history of permanently implanted brachytherapy sources and to establish methods of identifying radon sources and discussing appropriate management.

Conclusion: There are likely thousands of people bearing radon seeds that continue to emit radiation decades after implantation. They can be identified by clinical history and emission of characteristic x-rays.

Inter-institutional variation of implant activity for permanent prostate brachytherapy.

Purpose: Despite the existence of guidelines for permanent prostate brachytherapy, it is unclear whether there is interinstitutional consensus concerning the parameters of an ideal implant.

Methods And Material: Three institutions with extensive prostate brachytherapy expertise submitted information regarding their implant philosophy and dosimetric constraints, as well as data on up to 50 radioiodine implants. Regression analyses were performed to reflect each institution's utilization of seeds and implanted activity.