title: Recommendations for implementation of high dose rate 192Ir brachytherapy in developing countries by the Advisory Group of International Atomic Energy Agency.
abstract: OBJECTIVE
  To provide recommendations for the implementation of high dose rate (HDR) 192Ir brachytherapy technology in developing countries.
  
  
  METHODS
  An Advisory Group Meeting of the International Atomic Energy Agency (IAEA) met to address the implementation of HDR 192Ir brachytherapy technology in developing countries. These recommendations reflect only the personal opinions of the authors and do not necessarily represent the opinion of the IAEA.
  
  
  RESULTS
  An HDR treatment system should be purchased as a complete unit that includes the 192Ir radioactive source, source loading unit, applicators, treatment planning system, and control console. Infrastructure support may require additional or improved buildings and procurement of or access to new imaging facilities. A supportive budget is needed for quarterly source replacement and the annual maintenance necessary to keep the system operational. The radiation oncologist, medical physicist, and technologist should be specially trained before HDR can be introduced. Training for the oncologist and medical physicist is an ongoing process as new techniques or sites of treatment are introduced. Procedures for quality assurance (QA) of patient treatment, and the planning system must be introduced. Emergency procedures with adequate training of all associated personnel must be in place.
  
  
  CONCLUSIONS
  The decision to select HDR in preference to alternate methods of brachytherapy is influenced by the ability of the machine to treat a wide variety of clinical sites. In departments with personnel and budgetary resources to support this equipment appropriately, economic advantage becomes evident only if large numbers of patients are treated. Intangible benefits of source safety, personnel safety, and easy adaptation to fluctuating demand for treatments also require consideration when evaluating the need to introduce this treatment system.
authors.affiliation: Ohio State University, 300 W. Tenth Avenue, Columbus 43210, USA.
authors.forename: Subir
authors.initials: S
authors.lastname: Nag
authors.forename: Michael
authors.initials: M
authors.lastname: Dally
authors.forename: Marcela
authors.initials: M
authors.lastname: de la Torre
authors.forename: Hideo
authors.initials: H
authors.lastname: Tatsuzaki
authors.forename: Nori
authors.initials: N
authors.lastname: Kizilbash
authors.forename: Srichai
authors.initials: S
authors.lastname: Kurusun
authors.forename: Luis
authors.initials: L
authors.lastname: Pinillos
authors.forename: Boris
authors.initials: B
authors.lastname: Pokrajac
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sur
authors.forename: Victor
authors.initials: V
authors.lastname: Levin
mesh_terms: D001918:Brachytherapy / Q000191:economics / Q000295:instrumentation / Q000379:methods; D003037:Cobalt Radioisotopes / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D003906:Developing Countries; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D004938:Esophageal Neoplasms / Q000532:radiotherapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006284:Health Plan Implementation; D006801:Humans; D007390:International Agencies; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D009678:Nuclear Energy; D011879:Radiotherapy Dosage; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy
chemical_list: D003037:Cobalt Radioisotopes; D007496:Iridium Radioisotopes