1. Radioactive seed localisation
Mr Paul Samson
Breast and General Surgeon
NZIMRT National Training Day, Invercargill
August 2014

2. Problems with Wires
Scheduling conflicts between radiology and surgery due to need for multiple procedures on day of surgery
Inability to use wire localization for first theatre case in the morning
Wire displacement or transection
Wire entry site and wire tip often well removed from target lesion -> non-uniform specimen results
Surgeon often unable to confirm exact site of lesion

3. Radioactive seed-localized lumpectomy
Titanium seed containing 3.7 to 10.7 MBq 125I which has half life of 60 days and emits 27 keV of gamma radiation
Technicium-99 has shorter half-life (6 hours) but stronger gamma emission of 140 keV.
Tip of 18G needle occluded with bone wax, seed is loaded, and a stilette loosely placed into the needle
USA protocols have seed placed within 5 days of surgery
Seed is introduced under USS or MMG guidance. Angle of radiologists approach not limited.

6. Radioactive seed-localized lumpectomy
Standard intra-op handheld gamma probe to localize the seed (settings 125I for seed or 99Tc for sentinel node)
Incise directly over the lesion
Gamma probe to guide resection with margin and confirm excision of lesion plus seed
Specimen radiograph taken (optional)
Seed removed by pathology and returned to nuclear medicine

8. Radioactive seed localisation
Mayo Clinic technique
Better cosmesis, no wire dislodgement worries, more comfortable for patient, easier scheduling of surgery
Rapid learning curve, improved cosmesis
No large multicentre trial, billing issues, radioactive substance regulations

9. Radioactive seed localisation. The end of Hookwires?

11. MSKCC Breast Seed Localization
The items you touch, people you encounter, and clothes that you wear will not become radioactive.
People who are in close physical contact with you may be exposed to very small amounts of radiation. While there is no evidence that this exposure causes harm, there are things you can do to minimize radiation exposure to others:
Distance. The amount of radiation emitted from your body is very small. It decreases significantly at a distance of 1 foot from the implant site. There is almost no radiation reaching a distance of 3 feet away.
Time. Radiation exposure to others depends on how long you remain in close contact with them. You will not harm anyone by hugging, kissing, or shaking hands. You should avoid placing an infant, child, or young animal on your chest for any longer than 30 minutes per day for the next month (30 days) or until the seed is removed during surgery.