Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed
CPT4 code
Name of the Procedure:
Interstitial Radiation Source Application, Complex (Brachytherapy)
Summary
Interstitial radiation source application, also known as brachytherapy, is a type of radiation treatment where a radioactive source is placed directly into or near a tumor. This method allows for high doses of radiation to target the tumor while minimizing exposure to surrounding healthy tissue.
Purpose
This procedure is primarily used to treat various types of cancer, including prostate, breast, and gynecological cancers. The goal is to destroy cancer cells and reduce the risk of the cancer returning while preserving as much healthy tissue as possible.
Indications
- Localized tumors (e.g., prostate cancer, breast cancer, cervical cancer)
- Recurrent cancer that has returned after previous treatments
- Non-responsive to external beam radiation therapy Criteria include tumor size and location, patient’s overall health, and prior treatments.
Preparation
- Detailed medical history and physical exam
- Imaging tests like MRI, CT, or ultrasound to map the tumor location
- Fasting may be required if anesthesia is involved
- Discussing any current medications that may need adjustment
Procedure Description
- The patient is positioned and potentially sedated or given anesthesia to reduce discomfort.
- Imaging guidance (e.g., ultrasound, CT scan) is used to accurately place the radiation sources within or near the tumor.
- Special applicators or needles are inserted into the target area.
- Radioactive material is loaded into the applicators and left in place for a specific duration.
- The applicators are carefully removed, and the patient is monitored for any immediate reactions.
- Tools: Applicators, radioactive seeds or wires, imaging equipment
- Anesthesia: Local, regional, or general anesthesia may be used depending on the tumor's location and procedure complexity.
Duration
Typically ranges from 1 to 2 hours, but can vary based on the tumor size and location.
Setting
Performed in a hospital, outpatient clinic, or surgical center with specialized facilities for radiation oncology.
Personnel
- Radiation oncologist
- Medical physicist
- Radiation therapist
- Nursing staff
- Anesthesiologist (if anesthesia is used)
Risks and Complications
- Common: Localized pain, swelling, bruising, fatigue
- Rare: Infection, bleeding, radiation burns, damage to nearby organs Complications are managed with medication, additional interventions, or close follow-up care.
Benefits
- High precision targeting of the tumor
- Preservation of surrounding healthy tissues
- Potential for shorter treatment times compared to external radiation
- Expected benefits may be realized several weeks to months after treatment
Recovery
- Post-procedure: Monitoring for a few hours (or overnight if necessary)
- Instructions: Wound care, activity restrictions, medication regimen
- Recovery time: Ranges from a few days to a week, with gradual return to normal activities
- Follow-up: Regular exams and imaging to monitor the treatment's effectiveness
Alternatives
- External beam radiation therapy
- Surgery to remove the tumor
- Chemotherapy or targeted drug therapy
- Pros and cons: Brachytherapy offers direct targeting with less exposure to healthy tissue, while other methods may be less invasive but less precise.
Patient Experience
- During: Some discomfort or pain from applicator insertion, managed with anesthesia or sedation
- After: Temporary soreness or swelling, fatigue
- Pain management: Prescribed pain medications, rest, and comfort measures like ice packs