Reference Poon and Verhaegen 10 – Reference Lee, Chuang and Quivey 18 Despite the clinical importance of skin dose, the literature contains scanty detail concerning the expected accuracy of radiation treatment planning and skin dose calculations. The chosen planning optimisation strategy can also affect the skin dose. Skin dose can be the limiting factor in radiation therapy treatments, and it is a fairly common cause of toxicity in radiation therapy treatment. Ir-192 is the most common source for remote after loader in HDR with advantages of high specific activity (450 Ci/g) that allow the construction of high activity source (10 Ci) of small diameter (0♶–1♱ mm). Reference Major, Polgár, Lövey and Fröhlich 8, Reference Pantelis, Papagiannis and Karaiskos 9ĪPBI treatment with HDR brachytherapy delivered dose is accurate and reliable using Ir-92. Reference Petrokokkinos, Zourari and Pantelis 7 MammoSite® and multiple catheters of SAVI™ with struts adjusted volume combine the advantages of APBI treatment. The recent development in APBI is strut-adjusted volume implant (SAVI™) device (Cianna Medical Inc., Aliso Viejo, CA, USA) which has 6, 8 or 10 peripheral source channels with one centre channel. Reference Sakhalkar, Adamovics, Ibbott and Oldham 6 But one matter of concern in MammoSite ® is inadequate balloon to skin distance even using multiple dwell positions which can change the shape of the dose distribution up to some extent. Reference Guo, Adamovics and Oldham 2 – Reference Palmer, Di Pietro and Alobaidli 5 The MammoSite ® brachytherapy system (Hologic, Marlborough, MA, USA) with a single dwell position has been widely accepted due to technically much easier to perform and axially symmetric dose distribution.
Reference Manoharan, Rodriguez, Bobba and Mukka 1 APBI has been used by multiple methods which includes three-dimension conformal external radiotherapy, MammoSite ® balloon internal radiation therapy and multiple catheter brachytherapy. Accelerated partial breast irradiation (APBI) provided by high dose-rate (HDR) brachytherapy offers an excellent compact course of radiation due to a small number of fractions for early stage breast carcinoma.
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