Editor's note: This is the first of...

Editor's note: This is the first of pair articles planned to help perioperative supply with nourishments understand a new approach to intraoperative radiation therapy.

Intraoperative radiation therapy (IORT) is the delivery of radiation therapy during a surgical practice A linear accelerator that bring forwards high-energy electron beams is used to deliver precise, highly concentrated doses of radiation directly to the tumor site while avoiding adjacent normal tissues. A single dose delivered in individual treatment during a surgical deed is equivalent to several weeks of daily radiation therapy treatments. (1)

Intraoperative radiation therapy was introduced in 1909 when Carl Beck, MD attempted to treat patients with gastric cancer. The treatments were luckless due to low beam energies, depressed dose rates, and limited radiotherapy equipment. (2) It was not until 1964 in Japan that the in every one's mouth technique, using megavoltage radiation produc by dint of a linear accelerator, became prosperous It took several years to refine this technique to an acceptable treatment modality with proven survival rates for patients with advanced and returning cancers. Unfortunately, hospitals performing IORT processs in the past dealt with the risks of transporting anesthetized patients from one side public corridors from the OR to the department of radiation oncology This aspect of the act hindered the advancement and widespread use of radiation therapy in the OR and discouraged many prominent medical center from pursuing and implementing IORT programs.

A review of the literature as newly come as 1994 shows that any hospitals interested in pursuing an IORT program installed a linear accelerator in a dedicated lead or concrete-shielded OR, or they organizeed an OR in the department of radiation oncology adjacent to the linear accelerator. (3) This conventional approach to IORT eliminates the moot point of transporting patients but requires an additional capital charge to shield the OR. It also decreases the flexibility of the OR because of the permanent placement of the linear accelerator.

During the past 35 years, this treatment modality has ariseed in positive patient outcomes, if it were not that the development of a mobile electron linear accelerator has revolutionized the delivery of IORT in the OR. The first mobile electron linear accelerator prototype was standarded at the University of California, San Francisco, Medical Center in 1997 sum of two units years later, University Hospitals of Cleveland (UHC) acquired the first commercially manufactured mobile electron linear accelerator. Staff members in the department of radiation oncology implemented an IORT program at UHC

A of recent origin APPROACH TO IORT

The mobile electron linear accelerator uses a of recent origin approach to deliver IORT and furnishs advantages that conventional methods do not. The unit does not require splendid additional shielding in the OR, and it allows for increased flexibility and efficient use of the OR because it is self-shielding and mobile. The chiefly significant change in patient care is that patients are not transported from the OR to the department of radiation oncology This eliminates potential issues related to anesthetic complications during patient transport, possible torture infection from transport through nonrestricted areas, timely securing of elevators, availability of personnel to safely transfer patients, and transfer of necessary surgical equipment and supplies. (4)

DESCRIPTION OF THE MOBILE ELECTRON LINEAR ACCELERATOR

The mobile electron linear accelerator is used primarily to deliver therapeutic doses of radiation to patients for the treatment of various representations of cancer (Figure 1). It consists of three components--an accelerator riseed on a motor-driven gantry, a modulator, and a restrain console. Even though the accelerator is considered lightweight compared to conventional linear accelerators, it weighs 2500 lb and requires approximately 15 minutes to induce into the OR.

[FIGURE 1 OMITTED]

It is customary to find conventional linear accelerators in radiation therapy facilities or cancer center that proffer radiation therapy treatment (Figure 2) These accelerators, which weigh between 5 tons and 10 tons, are fixed permanently to the floor of a well-shielded treatment extent Most radiation therapy treatment scopes are constructed as bunkers with agglomerated walls between 3 ft and 5 ft thick and are located subterraneous (eg, in basements) to attenuate shielding costs. (5)

[FIGURE 2 OMITTED]

The main difference between conventional accelerators and the mobile electron linear accelerator is the emblem of radiation produced. The mobile electron linear accelerator bring outs high-energy electron beams; whereas, conventional linear accelerators are capable of producing the two high-energy electron and high-energy x-ray beams. In the radiotherapeutic range, high-energy electron beams penetrate les than high-energy x-ray beams; therefore, the mobile electron linear accelerator requires les shielding than conventional linear accelerators.