A pilot study has been conducted in which coronary arteries subject to re-stenosis after angioplasty and stenting have been irradiated following further angioplasty. The method of irradiation has been to use radioactive 188Re in an angioplasty balloon. This paper considers all aspects of the procedure including elution of the rhenium from a tungsten/rhenium generator, its concentration, dispensing and safe delivery to the patient using specially designed equipment to reduce staff doses and radioactive spills. In the pilot study of 28 lesions in 26 patients only 1 was recorded as having angiographic re-stenosis in the treated region at 6 months although 4 other patients had edge re-stenosis. This represents less than 18% re-stenosis in a population that would have been expected to exhibit at least 50% re-stenosis at 6 months. A total of 72 patients have been treated either in the pilot study or a subsequent trial. In only one case has a minor spill of radioactivity occurred and in no case has the balloon burst. Radiation doses to staff are approximately 20 microSv per procedure and are therefore not of serious consequence. It is concluded that this procedure is safe, feasible and effective in reducing in-stent re-stenosis.

A method of using GAFchromic film to determine the absolute activity of beta emitters by immersing the film in a bath of activity is described. This includes calculations of the effect of part of the radioactive solution being displaced by the film that is performing the measurement. Calculations have been performed for 90Y, 32P and 188Re. It is shown that for the film used in this study, this effect will cause a correction of the order of 15-20% for the three radionuclides studied. The results of the GAFchromic film measurement are compared with results obtained from liquid scintillation counting and from a commercial dose calibrator. It is shown that for 32P all methods were in reasonable agreement, but for 188Re, although the GAFchromic film and the liquid scintillation counting methods give similar results, the dose calibrator measurement differed by more than 20%. The GAFchromic film was also used to perform a direct measurement of the radiation dose at a distance of 0.5 mm from the surface of a cylindrical source of 188Re activity. This gave good agreement with the value of the dose predicted from theoretical calculations.

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Early-stage squamous cell carcinoma of the larynx is usually treated with local field radiotherapy. Surgery is used for salvage following recurrence. Further recurrences present a more difficult therapeutic problem which requires individualized management. The aims of local control, survival, maintenance of function and minimizing side effects all need to be balanced according to the site and extent of disease. The present case study looks at the management of a 54-year-old man with multiple recurrences from a squamous cell carcinoma of the larynx. It describes a technique of endoluminal brachytherapy using an iridium-192 wire spiralled around the outer part of a tracheostomy tube that achieves good local control while enabling self-insertion and self-cleaning during the procedure. The dose given was 2500 cGy at 5 mm over 25.2 h and was achieved with minimal early or delayed side effects. The patient had no further symptoms relating to the stomal recurrence until his death from metastatic disease 6 months later.

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