Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Chen, Qin‐Sheng; Blair, Henry F.

doi:10.1118/1.1567737

Cited by 9 publications

(7 citation statements)

References 9 publications

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“…The overall migration rates observed of 14.0% of the cases, or 0.31% of the seeds, are within the range of previous publications (2)(3)(4)(5)(6). However, our results shows that because of fast movements associated with respiration or placement near the heart or the diaphragm, 18 sources that were visible with fluoroscopy were not by film radiography (Table 3).…”

Section: Discussionsupporting

confidence: 68%

“…It is defined as the process by which one or more of the implanted seeds migrate a distance from the planned volume, mostly to lungs. Publications on this subject have grown in number and report an incidence from 5.9% to 36.2% of patients (typically less than 0.5% of the total number of implanted seeds) (2)(3)(4)(5)(6). Some side effects attributed to the migration of a source to the lungs, the renal artery.…”

Section: Introductionmentioning

confidence: 94%

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A More Efficient, Radiation-Free Alternative to Systematic Chest X-Ray for the Detection of Embolized Seeds to the Lung

Morrier

Chrétien

Martin

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 94%

A More Efficient, Radiation-Free Alternative to Systematic Chest X-Ray for the Detection of Embolized Seeds to the Lung

Morrier

Chrétien

Martin

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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“…Organic starch has Maltese-cross morphology and stains positively with PAS [215]. A collimated gamma scintillation survey meter may be used to detect iodine-125 seeds after prostate brachytherapy, as their small size means the seeds are frequently neglected on a radiograph [239].…”

Section: Diagnosismentioning

confidence: 99%

Nonthrombotic pulmonary embolism

Jorens¹,

Marck²,

Snoeckx³

et al. 2009

Eur Respir J

162

127

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Nonthrombotic pulmonary embolism (NTPE) is defined as embolisation to the pulmonary circulation of different cell types (adipocytes, haematopoietic, amniotic, trophoblastic or tumour), bacteria, fungi, foreign material or gas. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different NTPE subtypes.The complex and diverse pathogenesis of different subtypes of emboli is subject to continuing speculation and is certainly far more complex than ''simple'' mechanical obstruction after embolisation of vascular thrombi. Nonthrombotic emboli may also lead to a severe inflammatory reaction both in the systemic and pulmonary circulation, as well as in the lung.NTPE presents a formidable diagnostic challenge, as the condition often presents with very unusual and peculiar clinical signs that are frequently overlooked. They range from very dramatic acute presentations such as acute respiratory distress syndrome to signs observed late in the disease course. Pathological observations play a key role in the exact diagnosis, and sometimes carefully aspirated blood from the pulmonary artery or specific staining of cells recovered from bronchoalveolar lavage fluid may be helpful. Frequently, lung biopsies revealing severe granulomatous reaction or unfortunate post-mortem pathological investigations of pulmonary tissue are necessary to confirm the diagnosis. Here, we also aim to familiarise the reader with the atypical radiological features of NTPE. Thin-section computed tomography of the lungs showing peculiar radiographic findings, such as a feeding vessel, the so-called tree-in-bud pattern or the appearance of micronodules distributed at the termination of bronchovascular bundles, may be observed in certain forms of NTPE.Increased awareness of NTPE as an underestimated cause of acute and chronic embolism, which may result in acute and chronic pulmonary hypertension, is needed. Despite the fact that detailed descriptions of several forms of NTPE have existed for nearly 100 years, well-designed trials have never been performed to evaluate therapy in the different subsets of these patients.

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“…In the care of prostate cancer patients, radioactive seed implantation continues to gain popularity over the past two decades. [1][2][3][4][5][6][7][8] To solve the seed migration problem, [9][10][11][12][13][14][15] a seedmigration detector, made from a gamma scintillation survey meter by adding a single-hole collimation cap to the probe, was developed and a comprehensive seed migration detection procedure was proposed 16 and implemented. As a quality control procedure, a seed-migration survey has been accomplished on 340 consecutive prostate patients implanted with iodine-125 ͑I-125͒ seeds since November 2001.…”

Section: Introductionmentioning

confidence: 99%

“…The detections of pulmonary seed embolization and intracardiac seed embolization have been reported. 16,17 In the 30-daypost-implant survey of a patient on February 13, 2003, the seed-migration detector sensed radioactivity in the patient's neck region. A gamma camera scan and a thyroid uptake survey of the patient confirmed a thyroid uptake due to the source leakage from one or more implanted I-125 seeds.…”

Section: Introductionmentioning

confidence: 99%

Dosimetry of a thyroid uptake detected in seed migration survey following a patient's iodine‐125 prostate implant and in vitro measurements of intentional seed leakages

et al. 2006

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As a quality control procedure, a post-implant seed migration survey has been accomplished on 340 prostate cancer patients since November 2001. Pulmonary seed embolization and intracardiac seed embolization have been detected. A case of thyroid uptake due to leaking iodine-125 (I-125) sources was also seized. In order to determine the dose to the thyroid, a dosimetry method was developed to link in vivo measurements and the cumulated dose to the thyroid. The calculated source leakage half-life in the case was approximately 15 days based on the measurements and the estimated cumulated dose to thyroid was 204 cGy. It is concluded that one seed was leaking. In order to verify the in vivo measurements, intentional in vitro seed leakage tests were performed. A seed was cut open and placed in a sealed glass container filled with a given volume of saline. The I-125 concentration in the saline was subsequently measured over a period of six months. Consistent in vivo and in vitro results were obtained. Recent incidents of seed leaks reported from other centers have drawn practitioners' attention to this problem. In order to make the measurements more useful, the seed leakage tests were expanded to include I-125 seeds from six other vendors. The results show that the leakage half-lives of those seeds varied from nine days to a half-year. Two seed models demonstrated least leakage. Since the measurements lasted for six months, the escape of iodine resulted from oxidation of iodide in the saline was a concern for the measurement accuracy. As a reference, another set of leakage tests were performed by adding sodium thiosulfate salt (Na2S2O3 x 5 H2O) to the saline. Sodium thiosulfate is a reducing agent that prevents the conversion of iodide to iodate so as to minimize I-125 evaporation. As a result, significantly shortened leakage half-lives were observed in this group. Seed agitation was also performed and no significant deviations of the leakage rates were observed. Considering the body fluid is more complex than saline, the in vivo leakage half-life, in case a source leak is encountered, may vary significantly from what is presented in this paper due to chemical reactions. In vivo measurements thus may produce a more accurate estimation of leakage half-life and thyroid uptake dose.

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Accurate and efficient detection of pulmonary seed embolization in prostate iodine-125 permanent brachytherapy with a collimated gamma scintillation survey meter

Cited by 9 publications

References 9 publications

A More Efficient, Radiation-Free Alternative to Systematic Chest X-Ray for the Detection of Embolized Seeds to the Lung

A More Efficient, Radiation-Free Alternative to Systematic Chest X-Ray for the Detection of Embolized Seeds to the Lung

Nonthrombotic pulmonary embolism

Dosimetry of a thyroid uptake detected in seed migration survey following a patient's iodine‐125 prostate implant and in vitro measurements of intentional seed leakages

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