Brachytherapy Glossary

Absorbed dose: The amount of energy imparted by nuclear radiation to unit mass of absorbing material;
the unit is the rad.

Active length: length of the radioactive source contained within the encapsulated source

Air Kerma Strength: is the quantity used to specify the strength of a gamma-ray emitting radionuclide.
Kerma, kinetic energy released per unit mass, is a measure of the energy released in a volume of air at
some distance from a radioactive source. For photon emitting sources used in brachytherapy it has units
of Gy s-1 m2.

Afterloading Techniques: In these techniques, hollow applicators (designed to carry a radioactive

material) are implanted or inserted into the volume to be treated. These are checked by various
methods (x-ray films or image intensifier) before the radioactive material is inserted, a step that is
usually done when the patient has been transferred back to his room. Its main advantage is that it
allows the operation to be carried out with little exposure of personnel to radiation. It also limits the
radiation exposure to specified personnel who are closely monitored. The most commonly used
afterloading technique is that used in the treatment of carcinoma of the cervix.

Alpha particle: A particle emitted spontaneously from the nuclei of some radioactive elements. It is
identical with a helium nucleus, having a mass of four units and an electric charge of two positive units.
The alpha particle has a very short range in air and a very low ability to penetrate other materials, but it
has a strong ability to ionize materials.

Americium: An artificial radioactive element with atomic number 95 (symbol Am), produced in nuclear
explosions and reactors; emits alpha particles.

Anisotropy: having a different value when measured in different directions

Apparent Activity: the activity of a bare point source of the same nuclide that produces the same
exposure rate at 1 m as the source to be specified; determined by measuring exposure rate at 1 m with
the exposure rate constant of the unfiltered source at 1 m

Atomic number: The atomic number of an element, which indicates its place in the periodic table of
elements, is the number of protons (positively charged particles) in the nucleus of one of its atoms. If an
atom is electrically neutral, the same number of electrons are present. Atomic number is often
symbolized with the letter Z and is shown as a numerical subscript to the left of its chemical symbol.

Atomic weight: The relative mass of an atom of the given element. As a basis of reference, the atomic
weight of the common isotope of carbon (carbon-12) is taken to be exactly 12; the atomic weight of
hydrogen (the lightest element) is then 1.008. Hence, the atomic weight of any element is
approximately the mass of an atom of that element relative to the mass of a hydrogen atom.

Beta Decay: The radioactive decay process which occurs via the transmission of a beta particle (or high
speed electron).
Beta particle: A charged particle of very small mass emitted spontaneously from the nuclei of certain
radioactive elements. Most (if not all) of direct fission products emit (negative) beta particles. Physically,
the beta particle is identical with an electron moving at high velocity.

Beta Plaque: A flat plate or curved surface that is coated with a radioactive material and emits
electrons. It is placed on the surface of the area to be treated. The depth of penetration is very small, in
the order of millimeters. A common isotope used is strontium-90. An example of a beta plaque is an
ophthalmological applicator, curved to conform to the surface of the eye.

Becquerel: A modern unit of radioactivity replacing the curie; the activity of an amount of a radioactive
material in which one nucleus decays each second.

Brachytherapy: treatment of cancerous tissues, or tumors, using radioactive sources placed in close
proximity to the tumor being treated.

Brachy: word element from the Greek meaning short; “short distance”

Brachytherapy: The administration of radiation therapy by applying a radioactive material inside or in

close approximation to the patient. This material may be contained in various types of apparatus, may
be on the surface of plaques, or may be enclosed in tubes, needles, wire, seeds, or other small
containers. Common materials for the administration of brachytherapy are radium, cobalt-60, cesium-
137, iodine-125, and iridium-192.

Brachytherapy-Intracavitary Application: The radioactive material, usually in the form of sealed

sources, is placed into various types of applicators, which are then (or have been previously) inserted
directly into a cavity in the patient through natural or surgically produced apertures. See Internal
Sources of Radiation.

Brachytherapy-Surface Application: The radioactive material is usually contained on the surface of a

plaque or mold, which is applied directly or close to the surface of the patient.

Cesium-137: Tubes Used instead of radium for intracavitary insertions, especially in the treatment of
carcinoma of the cervix. They are cylinders two centimeters in length and approximately four
millimeters in diameter, usually calibrated as milligram equivalent of radium. Half-life is 30.2 years.

Cobalt-60: A strong gamma ray source, and is extensively used as a radiotherapeutic for treating cancer,
food and material irradiation, gamma radiography, and industrial measurement gauges. Half-life is 5.27
years.

Cumulative dose: total dose resulting from continued or repeated exposures of ionizing radiation to a
portion or the entire body over a period of time

Curie: Special (older) unit of radioactivity, equal to 3.7 x 1010 disintegrations per second. Historically, the
curie (Ci) was based on the disintegration rate of one gram of radium. The gamma curie is sometimes
defined correspondingly as the activity of material in which this number of gamma-ray photons are
emitted per second.

Daughter nucleus: The term used to describe a decay product of a radioactive substance; the nucleus
remaining after a radioactive decay.
Decay: The decrease in activity of any radioactive material with the passage of time due to spontaneous
emission from the atomic nuclei of either alpha or beta particles, sometimes accompanied by gamma
radiation.

Decay constant: is the percent reduction per unit of time

Distributed Internal Source: Intracavitary application of radiocolloids, such as Au-198, or P-32 (chromic
phosphate), allows uniform distribution of radioactivity over serosal surfaces.

Dose: A (total or accumulated) quantity of radiation. The absorbed dose in rads represents the amount
of energy absorbed from radiation per gram of specified absorbed material.

Exposure rate constant: is the exposure normally measured at 1 meter from the source. For
Brachytherapy, the constant is calculated in Roentgens per hour at 1cm from a 1 mCi source.

For 1 mg of radium Exposure Rate Constant = 8.25 R cm2 / h mg or 8.25 R/hr / mCi @ 1cm (This is for
a filtered source with a .5mm platinum filter. IMPORTANT!!! For every addition of .1mm above
.5mm platinum a 2% reduction in output occurs and must be taken into account)

Fletcher Suit applicators: used for the treatment of gynecological malignancies of the uterus, cervix, and
pelvic side walls; the set consists of 3 intrauterine tandems with curvature of varied degrees and a pair
of ovoids with shields to reduce bladder and rectal doses

Gamma-Ray: A photon emitted from the nucleus of a radioactive atom, different from an x-ray photon
only with respect to origin. A photon may be thought of as a moving electromagnetic disturbance which
behaves sometimes as a wave and sometimes as a particle. They can penetrate deeply into body tissue
and many materials. Shielding against gamma radiation requires thick layers of dense materials, such as
lead.

Gold-198: A radioactive isotope used in interstitial therapy in the form of seeds or wire, or in
intracavitary therapy in the form of a colloidal solution. The isotope has a half-life of 2.7 days and emits
photons at 0.41 MeV, as well as electrons.

Half-Life: The time during which half the atoms initially present in a sample of radioactive material will
have decayed; the time required for the activity of a given radioactive substance to decrease to half of
its initial value due to radioactive decay. The half-life is a characteristic property of each radioactive
element and is independent of its amount or condition.

Physical half-life: the time it takes for ½ the initial radioactive atoms to decay (half life is not
effected by temperature or pressure)

Biological half-life: the time it takes for the body to eliminate ½ the dose of the isotope by
whatever is the normal excretion process
 Effective half-life: is the combination of the physical half life and the biological half life (this is an
artificial half life)

Te – is the time required for the radioactivity in the body to be reduced by ½ as a result of
the combined actions of radioactive decay and biological elimination (Note: you can use a
long lived physical half life if they have a very short biological half life)

High Dose Rate (HDR): ICRU-38 defines a brachytherapy procedure delivering dose with a range of over
12 Gy per hour which must be delivered by automatic afterloading

ICRU System: Brachytherapy implant procedure for treatment of cervix; recommends system of dose
specification that relates the dose distribution to the target volume instead of the dose to a specific
point; the dose is prescribed as the value of an isodose surface that just surrounds the target volume;
Recommended dose specification to be reported in terms of: 1) total reference air kerma; 2) description
of a reference volume; 3) calculated values of dose to specific normal tissue reference points within the
treatment volume

ICRU Bladder point: localized by using Foley catheter with a contrast filled balloon; on frontal
radiograph, bladder point is in center of balloon; on lateral radiograph, bladder point is obtained on
a line drawn anteroposteriorly through the center of the balloon at the posterior surface

ICRU Rectal point: identified on the frontal radiograph at midpoint of the ovoid sources; on lateral
radiograph, located at line drawn from middle of ovoid sources 5 mm behind posterior vaginal wall

ICRU Lymphatic Trapezoid of Fletcher: points that correspond to the paraaortic and iliac nodes

ICRU Pelvic Wall points: on AP radiograph, located at intersection of a horizontal tangent to the
superior aspect of the acetabulum and a vertical line touching the medial aspect of the acetabulum;
on a lateral view, these points are marked as the highest mid-distance points of the right and left
acetabulums

Inverse Square Law: The law which states that when radiation (thermal or nuclear) from a point source
is emitted uniformly in all directions, the amount received per unit area at any given distance from the
source, assuming no absorption, is inversely proportional to the square of that distance.

Intraluminal catheter: catheters of various lengths to treat intraluminal disease such as endobronchial
carcinoma

Iodine: A naturally-occurring element required in small amounts for the normal working of the thyroid.
A radioactive isotope is created in nuclear explosions and in nuclear reactors.

Ionize: To split off one or more electrons from an atom, thus leaving it with a positive electric charge.
The electrons usually attach to one of the atoms or molecules, giving them a negative charge.
Ionizing radiation: Electromagnetic radiation (gamma or X-ray) or particulate radiation (alpha particles,
beta particles, neutrons, etc.) capable of producing ions, i.e., electrically charged particles, directly or
indirectly, in its passage through matter.

Iridium-192: A gamma-ray emitting radioisotope used for gamma- radiography. The half-life is 73.83
days.

Isobar: atoms with the same number of nucleons but different number of protons

Isomer: atoms that contain the same number of protons as well as neutrons; they differ in their nuclear
energy states.

Isotope: atoms that have the same number of protons but a different number of neutrons; that is, they
are atoms of the same element that have different masses. Their atomic number (proton number) is the
same, but their mass numbers (the total number of protons and neutrons in the nucleus) vary; forms of
the same element having identical chemical properties but differing in their atomic masses and in their
nuclear properties.

Isotone: atoms with the same number of neutrons but different number of protons

Isotropy: having the same value when measured in different directions.

Low Dose Rate (LDR): ICRU-38 defines a brachytherapy procedure delivering dose with a range of 0.4 to
2 Gy per hour; clinical practice may range from 0.3 to 1 Gy per hour or a bit higher

Manchester System: Brachytherapy intracavitary implant procedure to treat cancer of the cervix;
characterized by 4 points: A, B, bladder, rectum; relies on dose rate to point A as the prescription point;
defines point A as 2 cm superior from mucous membrane of the lateral fornix in the plane of the uterus
and 2 cm lateral to the center of the uterine canal; Point B is 3 cm lateral to Point A

Mean life: average life; the average lifetime for the decay of radioactive atoms; = 1.44 (T1/2)

Medium Dose Rate (MDR): ICRU-38 defines a brachytherapy procedure delivering dose with a range of
2 to 12 Gy per hour

Memorial System: an extension of the Quimby system and characterized by complete dose distribution
around lattices of point sources of uniform strength spaced 1 cm apart

Metabolically Located Sources: Administered radionuclide is transported and concentrated by normal

metabolic activity, e.g. I-131 in thyroid.

Milligram-Hours System: Brachytherapy implant procedure for treatment of cervix; dose specification is
in milligram-hours which is the product of total source strength and the implant duration; most notable
example of this system is the Fletcher guidelines based on M.D. Anderson experiences.
Milligram Radium Equivalent: mass in mg of Radium filtered by 0.5 mm of Platinum that leads to the
same exposure rate as that resulting from the source under consideration at the same distance of 1 m in
air; 1 mg-Ra eq gives 8.25 x 10-4 R/h at 1 m

Nuclide: A species of atom having specified numbers of neutrons and protons in its nucleus.

Orthogonal source localization: radiographs taken at right angles with central axes of the x-ray beams
meeting approximately in the middle of the implant; typically AP and LAT films taken isocentrically

Parent nucleus: the original nucleus during a radioactive decay.

Paris System: Brachytherapy interstitial implant procedure intended for removable implants of
long line sources such as Ir-192 wires; prescribes wider spacing for longer sources or larger
treatment volumes; uniform linear activity and implanted in parallel lines; dose specification based
on isodose surface called the reference isodose which is fixed at 85% of the “basal dose”

Paterson-Parker System: Brachytherapy interstitial implant procedure to deliver uniform dose

(within +/- 10%) to a plane or volume; uses specified rules of source distribution to achieve the
dose uniformity and provides dosage tables for the implants

Permanent Interstitial: Implant Seeds containing the radionuclide are inserted directly into tissue, either
individually or in ribbons of absorbable suture material, and left indefinitely. The technique is used to
treat intrathoracic and intra-abdominal tumors (lung, pancreas, bladder, prostate) and in the palliative
treatment of accessible tumors. Radionuclides used include iodine-125 (60 day half-life) and radon-222
(3.8 day half-life). The seeds are inert after total decay and do not cause any foreign body reaction.

Phosphorus-32: A radioactive isotope that emits beta rays and has a half-life of 14.3 days. It is
administered internally, in solution, and tends to concentrate in the bone marrow, spleen, liver, and
lymph nodes. Useful in treatment of polycythemia vera. Phosphorus-32 is also used in colloidal form by
injection into the serous cavities (pleural and peritoneal) in order to control the malignant accumulation
of fluid.

Physical length: actual length of the source including the encapsulation

Point A: An imaginary point described by Todd and Meredith as being two centimeters lateral to the
cervical canal and two centimeters above the cervical os. The point is supposed to lie in the paracervical
tissues.

Point B: A reference point that lies three centimeters lateral to Point A and is used as a means of
evaluating pelvic wall dosage.

Pulsed Dose Rate (PDR): primarily used in Europe; requires an afterloading device with a single stepping
source of Ir-192; ten minute pulses every hour gives a dose equivalent of 60 cGy per hour; biological
effect mimics LDR and dose optimization mimics HDR
Quimby System: Brachytherapy interstitial implant procedure characterized by a uniform distribution of
sources of equal linear activity thus resulting in a non-uniform dose distribution and higher central
region treatment; stated dose is the maximum dose in the plane of treatment (planar) or volume of
treatment (volume)

Rad: Unit of the radiation quantity "absorbed dose". One rad is equal to an energy absorption of 0.01
joule per kilogram of any material.

Radioactive: Certain elements (radium, uranium, thorium, and their products), emit radiant energy by
spontaneously emitting alpha, beta, or gamma particles.

Radioactivity: The property of certain nuclides of spontaneously emitting particles or gamma radiation
or of emitting x-radiation following orbital electron capture or of undergoing spontaneous fission; the
spontaneous emission of radiation, generally alpha or beta particles, often accompanied by gamma rays,
from the nuclei of an unstable isotope. As a result of this emission the radioactive isotope is converted
(or decays) into the isotope of a different (daughter) element which may or may not be unstable.
Ultimately, as a result of one or more stages of radioactive decay, a stable (nonradioactive) end product
is formed.

Radiation: The propagation of energy through space or matter. In radiology, it can be divided into two
main groups: charged particles (e.g. electrons, protons, alpha particles) and electromagnetic (x-rays,
gamma-rays).

Radium-226: A radioactive isotope commonly used for radiotherapy. It has historical importance in that
it was the first isotope to be used medically and is used as a radiation standard. The half-life is about
1,620 years and photons of many discrete energies are emitted up to a maximum of 2.2 MeV. It is used
in the form of needles and tubes for interstitial and intracavitary insertions.

Radon: It is available in the form of sealed gold seeds and is widely used for permanent implants.

Rectal applicator: acrylic cylinder of different diameters to treat superficial rectal tumors

REM (Roentgen-Equivalent-Man): A unit of biological dose of radiation; the name is derived from the
initial letters of the term "roentgen equivalent man." The number of rems of radiation is equal to the
number of rads absorbed multiplied by the RBE of the given radiation (for a specified effect). Dose
equivalent is obtained by multiplying absorbed dose by a "quality factor", which has higher values for
higher LET radiations. When dose is expressed in rads, dose equivalent is in rems; the rem is also the
unit of dose equivalent, which is equal to the product of the number of rads absorbed and the "quality
factor" of the radiation.

Removable Implant: The radioactive material is enclosed in needles, seeds, or tubes, which can be
removed after the desired dose is given. Examples are radium-226 or cesium-137 needles and iridium-
192 seeds or wire. The sources may be inserted directly into tissue or inside an applicator of some kind.
Roentgen (R): A unit of exposure to gamma (or X) radiation quantity "exposure", equal to an electrical
charge (produced by ionization) of 2.58 x 10-4 coulomb per kilogram of air. It is defined precisely as the
quantity of gamma (or X) rays that will produce electrons (in ion pairs) with a total charge of 2.58 x 10-4
coulomb in 1 kilogram of dry air. An exposure of 1 roentgen results in the deposition of about 94 ergs of
energy in 1 gram of soft body tissue. Hence, an exposure of 1 roentgen is approximately equivalent to an
absorbed dose of 1 rad in soft tissue.

Secular equilibrium: the half life of the parent is much greater than the half life of the daughter and at
equilibrium the rate at which the daughter is produced equals the rate at which the parent is decaying.

Sievert: The modern unit of radiation does, incorporating quality factors for the biological effectiveness
of different types of ionizing radiation (implying that alpha particles are 20 times more dangerous than
X-rays depositing the same amount of energy in tissues).

Specific Activity: the activity per unit mass of a radionuclide

Stereo-shift source localization: radiographs taken of the same view but the patient or the x-ray tube is
shifted a certain distance (e.g. 20 cm) between the 2 exposures; less accurate than orthogonal method
but more suitable for cases where source identification is difficult

Strontium-90 Applicator: A beta-ray source used for contact therapy, usually for eye lesions. Most of
the dose is delivered by beta-rays (maximum energy of 2.3 MeV) from the equilibrium activity of the
yttrium-90 daughter product.

Temporary interstitial implant – A procedure in which radioactive material sealed in needles, seeds,
wires, or catheters is temporarily placed directly into or near a tumor.

Transient equilibrium: parent half life is not much greater than the daughter; after the time required to
attain equilibrium has elapsed, the activity of the daughter decreases with the apparent “half life” equal
to half of the parent

Vaginal cylinder: acrylic cylinder applicator used to treat tumors of the vaginal wall; variety of diameters
and allows tandems to be placed in the center

Volume study – This is a procedure used in prostate brachytherapy to map out the prostate gland. An
ultrasound probe is placed in the rectum to get images of the prostate. Once the map is made, a
computer plan is generated to show the best place to put radioactive seeds in and around the prostate.
This is often done before or during a prostate implant procedure.

Written directive: an authorized physician prescription that must include the patient name, patient
hospital number, source material, dose per fraction, total dose, and site of administration