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Dose Perturbation Caused by Stents: Experiments with a Model 90Sr/90Y Source

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Abstract

Purpose

Biological effects of intravascular brachytherapy are very sensitive to discrepancies between the prescription and the applied dose. If brachytherapy is aimed at in-stent restenosis, shielding and shadowing effects of metallic stents may change the dose distribution relative to that produced by the bare source. The development of new generations of stents inspired us to a new experimental study in this field. The effect was studied for 14 stents which we have recently encountered in clinical practice.

Methods

The model source was a continuous 20-mm column of 90Sr/90Y solution sealed in a 1-mm-I.D. Plexiglas capillary. The dose distribution in the Plexiglas phantom was mapped using GafChromic MD-55-2 film. The stent masses varied from 2.5 to 25 mg; the strut thicknesses, from 0.075 to 0.15 mm; and the atomic numbers of stent materials, from 24 (Cr) to 79 (Au).

Results

Dose perturbations depend on a variety of stent features. Local reduction of the mean dose rates near the reference distance (r0 = 2 mm) varied from 11% to 47%. No simple correlation was found between these data and stent characteristics, but it seems that the atomic number of the stent material is less important than the strut thickness and mesh density.

Conclusion

The results provide a warning that clinical indications for in-stent radiation therapy must always be confronted with another aspect of the patient’s history: the kind of implanted stent. Intravascular brachytherapy using pure beta sources may be recommended only for patients “wearing” light, thin-strut stents. The presence of thick-strut stents is a contraindication for this modality, due to excessive dose perturbation.

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Acknowledgments

Part of this work was done as MSc research by Miss Słonimska (now Mrs. Strzała). The thesis was defended at the University of Science and Technology AGH, Kraków, Poland. We thank Ms. Marta Ptaszkiewicz, MSc, and Ms. Urszula Sroka, MSc, for their assistance with the GAF film calibrations and Dr. Paweł Gaca for LSC measurement of the 90Sr solution. Free samples of stents used in this work were kindly donated by representatives of the following companies: Balton, PL; B. Braun, DE; Biocompatibles Ltd., AbbottVascular Devices, UK; Cordis Europa, Johnson-Johnson, NL; EuroCOR, DE; Guidant, USA/Europe; Medinol Ltd., IL, and& Boston Scientific SCIMED, IR; Medtronic AVE, USA and NL; and sorin biomedica Cardio, IT. Sheets of GafChromic MD55-2 film were kindly given to us by Mr. Hubert Sylwester of Medservice, PL, representative of ISP Technologies Inc., USA. Another part of this work was financially supported by the Foundation for Development of Cardiac Surgery (Fundacja Rozwoju Kardiochirurgii, Zabrze, PL). None of the authors is in any sense related to any of the companies which offered free samples of their products.

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Authors and Affiliations

  1. The Silesian Center for Heart Diseases, 3rd Chair and Clinical Hospital for Heart Diseases, Medical University of Silesia, 41-800 Zabrze, Szpitalna 2, Poland

    Krzysztof Wilczek & Lech Poloński

  2. Department of Nuclear Physical Chemistry, The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Kraków, Radzikowskiego 152, Poland

    Barbara Petelenz

  3. Physical Chemistry and Surface Engineering Laboratory, The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Kraków, Radzikowskiego 152, Poland

    Alicja Strzała

  4. Department of Health Physics, The Henryk Niewodniczański Institute of Nuclear Physics, Polish Academy of Sciences, 31-342 Kraków, Radzikowskiego 152, Poland

    Barbara Marczewska

  5. Department of Medical Physics, The Andrzej Sołtan Institute for Nuclear Studies, 05-400, Świerk, Poland

    Marek Traczyk

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  1. Krzysztof Wilczek
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  2. Barbara Petelenz
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  3. Alicja Strzała
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  4. Barbara Marczewska
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  6. Lech Poloński
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Correspondence to Barbara Petelenz.

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Wilczek, K., Petelenz, B., Strzała, A. et al. Dose Perturbation Caused by Stents: Experiments with a Model 90Sr/90Y Source. Cardiovasc Intervent Radiol 30, 981–991 (2007). https://doi.org/10.1007/s00270-007-9148-9

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  • DOI: https://doi.org/10.1007/s00270-007-9148-9

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