CPT® Code 77786

Deleted

1. Indications

The procedure of remote afterloading high dose rate radionuclide brachytherapy is indicated for the treatment of various malignancies where localized radiation therapy is beneficial. The following conditions may warrant the use of this procedure:

• Cancer Treatment This procedure is primarily performed for patients diagnosed with specific types of cancer, where targeted radiation can effectively shrink or eliminate tumors.
• Localized Tumors It is particularly indicated for tumors that are localized and can be accessed through the placement of applicators, allowing for precise delivery of radiation.
• Recurrent Tumors Patients with recurrent tumors may also be candidates for this treatment, especially if previous therapies have not yielded successful results.

2. Procedure

The procedure for remote afterloading high dose rate radionuclide brachytherapy involves several critical steps to ensure effective treatment delivery. Each step is designed to maximize safety and precision in the administration of radiation.

• Step 1: Brachytherapy Isodose Planning Initially, a separate brachytherapy isodose planning procedure is performed. This involves detailed imaging and calculations to determine the optimal placement of the radioactive sources and the appropriate dosage required for effective treatment.
• Step 2: Placement of Applicators Following the planning phase, the physician implants empty cylinders or other applicators into and around the tumor site. This step is crucial as it sets the stage for the subsequent delivery of the radioactive source.
• Step 3: Inspection of Applicators Once the applicators are in place, they are inspected for size, placement, and stability. Any necessary adjustments are made to ensure that the applicators are correctly positioned to deliver the radiation effectively.
• Step 4: Connection to Remote Afterloading Machine A transfer tube is selected and connected to the channel applicator in the remote afterloading machine. This connection is vital for the safe and accurate loading of the radioactive source.
• Step 5: Monitoring the Patient The physician then leaves the room, but the patient is continuously monitored both visually and verbally throughout the procedure to ensure their safety and comfort during the radiation delivery.
• Step 6: Loading the Radioactive Source The remote afterloading machine then loads the radioactive source into the previously placed applicators. Timers within the machine control the duration of exposure to the radioactive source, ensuring that the prescribed dose is delivered accurately.
• Step 7: Retracting the Radioactive Source Upon completion of the procedure, the radioactive source is retracted and placed in a safe position within the afterloading machine. This step is verified using a room radiation detector, followed by a patient radiation survey to confirm that no residual radiation remains.
• Step 8: Removal of Applicators Finally, the empty applicators are removed from the patient, concluding the procedure.

3. Post-Procedure

After the completion of remote afterloading high dose rate radionuclide brachytherapy, patients may experience some side effects, which should be monitored. It is essential to provide post-procedure care instructions, including any necessary follow-up appointments for evaluation and management of potential side effects. Patients are typically advised to avoid close contact with others for a specified period, as a precaution against radiation exposure. Additionally, healthcare providers may conduct follow-up imaging or assessments to evaluate the effectiveness of the treatment and monitor for any recurrence of the tumor.