IORT-Electronic Brachytherapy [revised]
Scenario: 2022
Procedure: Intraoperative Radiation Therapy (IORT) Preoperative diagnosis: Stage I left breast cancer
Indications: The patient underwent radiation oncology consultation preoperatively and selected intraoperative radiation therapy (IORT) following lumpectomy. We were called to the operating room following the surgical resection and performed IORT as below.
Narrative: Physics staff performed XOFT machine/source quality assurance procedures. The surgical cavity was prepared by the breast surgery team. A cavity evaluation device was placed in the lumpectomy cavity, filled with saline and evaluated with ultrasound. Based on this evaluation a 4-5 cm XOFT Balloon applicator was selected. The balloon was tested and then paced in the cavity and filled with 50 cc of saline. Ultrasound was performed and demonstrated excellent tissue conformance of the balloon to the cavity, without air or fluid gaps, and a minimum skin-to-surface distance of 1.2 cm. The treatment plan was loaded into the system from the thumb drive.
The applicator was attached to the XOFT Electronic Brachytherapy controller, and the source was attached to the source positioning mechanism. The Flexi-Shield was placed over the area of the balloon, on top of the patient. Then a simple simulation was performed by deploying the inactive radiation source into the balloon catheter, and through all of the dwell positions. The test was passed. Then the OR was cleared of non-shielded staff and the treatment was delivered. High dose rate intraoperative radiation treatment of 20 Gy, prescribed at the balloon surface, was delivered via the 50 kV x-ray electronic brachytherapy source, with appropriate shielding of personnel in the operating room during the treatment. Following treatment, the saline was removed from the balloon applicator with a syringe and measured at 50 cc. The balloon catheter was removed from the patient and the surgery was completed by the surgical team. The patient will be seen at the time of the postoperative visit to evaluate final pathologic stage and need for external radiation
Question: How would you code Radiation Modality & Planning Technique?
- Modality: 02 External Beam, photon
Technique: 02 Low energy x-ray photon therapy
- Modality: 12 Brachytherapy, electronic
- Planning Technique: 88 Not Applicable Treatment not by external beam
Answer: Modality: 02 External Beam, photon Technique: 02 Low energy x-ray photon therapy
CTR Guide to Coding Radiation Therapy Treatment in the STORE 4.0
Appendix B – Coding Modality for the Heavy Equipment of Modern Radiation Therapy
Zeiss, Xoft, Esteya Modality 02 Applicable Planning Technique(s) 02
10-6-2022 NAACCR webinar Breast Cancer Part 1 by Wilson Apollo, CTR
- Volume: 41 Partial breast [IORT targets partial breast]
- Modality: 02 External beam, Photons
- Planning Technique: 02 Low energy x-ray photon therapy [Small-scale Linacs. They do not use radioactive isotopes (seeds).]