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New miniaturized cesium-137 for needle implants
168
Worli
I.---~ ~-9cm
in progress
4
Total length
Total content:6
68 mCI CS’~’ 2 66 mg Ra
I IOcm
Total
length
Inert
I I cm Tota~~length Encapsulated
I” 90%
Total
material
content.
I
8.35 mCf CS’~’ 3 33 mg Ra
-i
Pt -10% Ir tubing
FIG. 1. Miniaturized
afterloading
to 0.66 mg of radium equivalent activity in cesium-137 per cm. This activity corresponds to the activity of the radium needles we used in implants for decates. Platinum-iridium encapsulation filters out the undesirable beta particles from the disintegration of cesium- 137. The radioactive cesium itself is incorporated into canes of Vycor glass which are inserted into the lumen of the platinum-iridium tubes, and permanently sealed. The outer diameter of our sources is 0.7 mm, thin enough to fit in the lumen of an 18 gauge needle. This particular “thinness” has practical advantages, for these sources also fit in the lumen of Intracaths. Angiocaths, spinal puncture needles, No. 5 French ureteral catheters, polyethylene tubing of 1.5 mm o.d., Henschke afterloading tubes. and other similar tubing. a practical method is the use of Clinically. Henschke needles through which polyethylene tubes are drawn. These polyethylene tubes are placed in their final position before afterloading and are made secure in that positon by flanges, buttons, or a split lead shot (such as used by fishermen). In the operating room. these tubes are loaded with “dummy” wires of the same dimensions as the. Slender Cesium Sources. The patient can then be safely transported to the X-ray department and then to his room where the inactive wires are removed and replaced by the Slender Cesium Sources which were brought to the patient’s room directly from the Radiotherapy Department. Calculations for dosage are made according to the Paterson--Parker rules. as we did in former years for the comparable radium needle imp1ant.‘3’ Calculations can also be made by computer. The Slender Cesium Sources are stored in a lead cylinder 12.8 cm in diameter and 26 cm in height. Three holes in the central part of the cylinder are made of proper depth for each of the different
interstitial
source.
sources, 9, 10 and 11 cm with a small well so that one cm of the color-coded inactive end of each source projects above the surface. The total content is equivalent to 32 mg of radium in 13’Cs. With this amount of activity, the reading at the surface of the cylinder is less than 3 mR/hr. The lead cylinder is mounted on a sturdy cart for transportation to and from the patient’s room. When not in use. it is stored in the Radium Room of our Department of Radiotherapy. According to regulations. the patient is kept in a private room. Nurses are instructed in safety measures. Visitors are kept at an appropriate safe distance.
Summary
and Conclusion
1. Slender cesium-137 sources have been devised for afterloading implants which simulate the radium implants employed in the past. 2. These sources have active lengths of 3, 4 or 5 cm with 0.66mg Ra equivalent of ‘-“Cs/cm. The overall length of each source consists of an additional 6 cm of inactive platinum-iridium tubing which encapsulates these sources. 3. The active lengths were chosen on the basis of our previous experience with radium needles. but individual preference and future experience may suggest other active lengths. 4. When not in use, these sources can be kept safely in an appropriate lead shield in the Radiotherapy Department to be available on demand. 5. These sources are thin enough, 0.7mm in diameter, to fit in the lumen of an 18 gauge needle which includes Intracaths, Angiocaths, spinal puncture needles, No. 5 French ureteral catheters, Henschke’s tubes, polyethylene tubes and any tube that corresponds to 18 gauge.
Work in progress
6. The implant is done in the operating room with hollow tubes which are loaded with dummy wires simulating the Slender Cesium Sources so that appropriate X-ray studies can be made. 7. There is no radiation hazard during the entire operating room and X-ray procedures, or during transportation of the patient. 8. Afterloading is done in the patient’s room. Department of Radiotherapy, The Mount Sinai
NORMAN SIMON SIDNEY
M.
SILVERSTONE
School of
Medicine, New York, NY 10029, U.S.A.
In radioimmunoassay, radioactively labeled antigen-antibody reaction has been found to be a sensitive and specific test for the detection of very small amount of antigen in the specimen.“’ It is usually done as an in uitro test. We have successfully labeled The present antibody with 99mTc-pertechnetate.“o’ study, employing the principles of specific antigenantibody reaction, used 99mTc-labeled antibacterial antibody to look in vioo for the site of infection in the rabbit with experimental aortic endocarditis and utilized the scintillation scan to detect the infected valve.
References 1.
HENSCHKE
2.
SIMON N.
Materials and Methods
U. K. et al. Am. J. Roentg.
90,
386
(1963).
3.
and SILVERSTONE S. M. Gynecoloyic Oncology 1, 13 (1972). SILVERSTONES. M. Am. J. Roentg. 55. 203 (1946).
Bacteria Staphylococcus aureus, obtained from a patient with endocarditis, was used for antibody production in the rabbit and animal model of bacterial endocarditis. Antibacferial
99”Tc-Labeled Antibacterial Antibody Scan for the Diagnosis of Infective Endocarditis (in Rabbit)
(Received
10 December
169
1977)
Introduction THE DIAGNOSIS of infective endocarditis is usually based on multiple positive blood cultures and clinical manifestations, such as cardiac murmur and peripheral emboli. However, the diagnosis made on such grounds may be unreliable. For example, bacteremia without endocarditis may have peripheral emboli.“-3’ Cardiac murmur and peripheral emboli may be absent in endocarditis,‘4,5’ and blood culture is negative at times, especially in fungal endocarditis.‘5*6’ Echocardiogram may detect vegetations in only one-third of the patients with endocarditis.“’ In addition, vegetations of the valve are not specific for infective endocarditis, they also occur in patients with rheumatic fever, carcinoid syndrome, and lupus erythematosus. Quantitative bacteria] culture of blood specimens taken from cardiac chambers by cardiac catheterization has been used for the diagnosis of infective endocarditis as well as localization of the infected valve. In this technique the blood around the infected valve had a higher bacterial cell count than that in the other areas of the body.“’ This method is difficult and not without risk.
antibody production
S. aureus, cultured on a blood agar plate, was suspended in normal saline and killed with O.]% of formaldehyde solution. The formalin killed bacterial suspension was centrifuged at 2OOOrev/min for 20 min. The sediment (bacteria) was then washed three times with normal saline. A final suspension of killed bacteria of 2 x 10’ cells/ml, determined by comparison to a McFarland standard, was mixed with complete Freud’s adjuvant in a 1 : 1 ratio. Two milliliters of the mixture, used as antigen, was injected subcutaneously twice a week for 4 weeks into both inguinal areas of New Zealand rabbits, weighing 5 lb. After an interval of 1 week, antiserum against S. aureus was obtained from the rabbits. Antibacterial antibody titer was determined by tube agglutination test.” ” Antibody purification
Antibody was complexed to antigen by mixing 3Om] of antiserum, with an agglutinating antibody titer between 1:2048 and 1:8192, and 3 ml of concentrated S. aureus, obtained from blood agar plate cu]ture. The mixture was stirred constantly for 4 hr at room temperature and then overnight at 4-C. The antigen-antibody complex was separated from serum by centrifugation at 20,OOOg and washed three times with 30ml of normal saline. Finally, the sediment (antigen-antibody complex) was suspended in 5 ml of 0.1 N acetic acid solution at pH 2.8 and constantly stirred for 1 hr at 4°C for 20 min to dissociate the antigen-antibody complex.“2~13’ Antigen was removed from the solution by centrifugation at 20,000 g, for 20 min at 4°C. The remaining antibody solution was dialyzed against 0.1 M phosphate buffer solution at pH 7.8. The dialysis was complete when the antibody solution reached a pH of 7.4. The antibody solution was further centrifuged at 20,000 g for 20 min to remove denatured protein particles.“3’ Method for labeling antibody with 99mTc-pertechnetate A slightly modified method for preparing 99mTc-yglobulin”O’ was used in this procedure. Five milliliters
Worli
I.---~ ~-9cm
in progress
4
Total length
Total content:6
68 mCI CS’~’ 2 66 mg Ra
I IOcm
Total
length
Inert
I I cm Tota~~length Encapsulated
I” 90%
Total
material
content.
I
8.35 mCf CS’~’ 3 33 mg Ra
-i
Pt -10% Ir tubing
FIG. 1. Miniaturized
afterloading
to 0.66 mg of radium equivalent activity in cesium-137 per cm. This activity corresponds to the activity of the radium needles we used in implants for decates. Platinum-iridium encapsulation filters out the undesirable beta particles from the disintegration of cesium- 137. The radioactive cesium itself is incorporated into canes of Vycor glass which are inserted into the lumen of the platinum-iridium tubes, and permanently sealed. The outer diameter of our sources is 0.7 mm, thin enough to fit in the lumen of an 18 gauge needle. This particular “thinness” has practical advantages, for these sources also fit in the lumen of Intracaths. Angiocaths, spinal puncture needles, No. 5 French ureteral catheters, polyethylene tubing of 1.5 mm o.d., Henschke afterloading tubes. and other similar tubing. a practical method is the use of Clinically. Henschke needles through which polyethylene tubes are drawn. These polyethylene tubes are placed in their final position before afterloading and are made secure in that positon by flanges, buttons, or a split lead shot (such as used by fishermen). In the operating room. these tubes are loaded with “dummy” wires of the same dimensions as the. Slender Cesium Sources. The patient can then be safely transported to the X-ray department and then to his room where the inactive wires are removed and replaced by the Slender Cesium Sources which were brought to the patient’s room directly from the Radiotherapy Department. Calculations for dosage are made according to the Paterson--Parker rules. as we did in former years for the comparable radium needle imp1ant.‘3’ Calculations can also be made by computer. The Slender Cesium Sources are stored in a lead cylinder 12.8 cm in diameter and 26 cm in height. Three holes in the central part of the cylinder are made of proper depth for each of the different
interstitial
source.
sources, 9, 10 and 11 cm with a small well so that one cm of the color-coded inactive end of each source projects above the surface. The total content is equivalent to 32 mg of radium in 13’Cs. With this amount of activity, the reading at the surface of the cylinder is less than 3 mR/hr. The lead cylinder is mounted on a sturdy cart for transportation to and from the patient’s room. When not in use. it is stored in the Radium Room of our Department of Radiotherapy. According to regulations. the patient is kept in a private room. Nurses are instructed in safety measures. Visitors are kept at an appropriate safe distance.
Summary
and Conclusion
1. Slender cesium-137 sources have been devised for afterloading implants which simulate the radium implants employed in the past. 2. These sources have active lengths of 3, 4 or 5 cm with 0.66mg Ra equivalent of ‘-“Cs/cm. The overall length of each source consists of an additional 6 cm of inactive platinum-iridium tubing which encapsulates these sources. 3. The active lengths were chosen on the basis of our previous experience with radium needles. but individual preference and future experience may suggest other active lengths. 4. When not in use, these sources can be kept safely in an appropriate lead shield in the Radiotherapy Department to be available on demand. 5. These sources are thin enough, 0.7mm in diameter, to fit in the lumen of an 18 gauge needle which includes Intracaths, Angiocaths, spinal puncture needles, No. 5 French ureteral catheters, Henschke’s tubes, polyethylene tubes and any tube that corresponds to 18 gauge.
Work in progress
6. The implant is done in the operating room with hollow tubes which are loaded with dummy wires simulating the Slender Cesium Sources so that appropriate X-ray studies can be made. 7. There is no radiation hazard during the entire operating room and X-ray procedures, or during transportation of the patient. 8. Afterloading is done in the patient’s room. Department of Radiotherapy, The Mount Sinai
NORMAN SIMON SIDNEY
M.
SILVERSTONE
School of
Medicine, New York, NY 10029, U.S.A.
In radioimmunoassay, radioactively labeled antigen-antibody reaction has been found to be a sensitive and specific test for the detection of very small amount of antigen in the specimen.“’ It is usually done as an in uitro test. We have successfully labeled The present antibody with 99mTc-pertechnetate.“o’ study, employing the principles of specific antigenantibody reaction, used 99mTc-labeled antibacterial antibody to look in vioo for the site of infection in the rabbit with experimental aortic endocarditis and utilized the scintillation scan to detect the infected valve.
References 1.
HENSCHKE
2.
SIMON N.
Materials and Methods
U. K. et al. Am. J. Roentg.
90,
386
(1963).
3.
and SILVERSTONE S. M. Gynecoloyic Oncology 1, 13 (1972). SILVERSTONES. M. Am. J. Roentg. 55. 203 (1946).
Bacteria Staphylococcus aureus, obtained from a patient with endocarditis, was used for antibody production in the rabbit and animal model of bacterial endocarditis. Antibacferial
99”Tc-Labeled Antibacterial Antibody Scan for the Diagnosis of Infective Endocarditis (in Rabbit)
(Received
10 December
169
1977)
Introduction THE DIAGNOSIS of infective endocarditis is usually based on multiple positive blood cultures and clinical manifestations, such as cardiac murmur and peripheral emboli. However, the diagnosis made on such grounds may be unreliable. For example, bacteremia without endocarditis may have peripheral emboli.“-3’ Cardiac murmur and peripheral emboli may be absent in endocarditis,‘4,5’ and blood culture is negative at times, especially in fungal endocarditis.‘5*6’ Echocardiogram may detect vegetations in only one-third of the patients with endocarditis.“’ In addition, vegetations of the valve are not specific for infective endocarditis, they also occur in patients with rheumatic fever, carcinoid syndrome, and lupus erythematosus. Quantitative bacteria] culture of blood specimens taken from cardiac chambers by cardiac catheterization has been used for the diagnosis of infective endocarditis as well as localization of the infected valve. In this technique the blood around the infected valve had a higher bacterial cell count than that in the other areas of the body.“’ This method is difficult and not without risk.
antibody production
S. aureus, cultured on a blood agar plate, was suspended in normal saline and killed with O.]% of formaldehyde solution. The formalin killed bacterial suspension was centrifuged at 2OOOrev/min for 20 min. The sediment (bacteria) was then washed three times with normal saline. A final suspension of killed bacteria of 2 x 10’ cells/ml, determined by comparison to a McFarland standard, was mixed with complete Freud’s adjuvant in a 1 : 1 ratio. Two milliliters of the mixture, used as antigen, was injected subcutaneously twice a week for 4 weeks into both inguinal areas of New Zealand rabbits, weighing 5 lb. After an interval of 1 week, antiserum against S. aureus was obtained from the rabbits. Antibacterial antibody titer was determined by tube agglutination test.” ” Antibody purification
Antibody was complexed to antigen by mixing 3Om] of antiserum, with an agglutinating antibody titer between 1:2048 and 1:8192, and 3 ml of concentrated S. aureus, obtained from blood agar plate cu]ture. The mixture was stirred constantly for 4 hr at room temperature and then overnight at 4-C. The antigen-antibody complex was separated from serum by centrifugation at 20,OOOg and washed three times with 30ml of normal saline. Finally, the sediment (antigen-antibody complex) was suspended in 5 ml of 0.1 N acetic acid solution at pH 2.8 and constantly stirred for 1 hr at 4°C for 20 min to dissociate the antigen-antibody complex.“2~13’ Antigen was removed from the solution by centrifugation at 20,000 g, for 20 min at 4°C. The remaining antibody solution was dialyzed against 0.1 M phosphate buffer solution at pH 7.8. The dialysis was complete when the antibody solution reached a pH of 7.4. The antibody solution was further centrifuged at 20,000 g for 20 min to remove denatured protein particles.“3’ Method for labeling antibody with 99mTc-pertechnetate A slightly modified method for preparing 99mTc-yglobulin”O’ was used in this procedure. Five milliliters