Practical considerations in setting up an intracoronary brachytherapy program: results of a multicenter survey

To identify logistic issues faced by radiation oncologists in initiating intracoronary radiation therapy (RT) and to delineate their role in these procedures.

Radiation oncologists from 12 sites (with combined experience of >500 cases) that participated in a randomized, double-blinded study of intracoronary RT completed a questionnaire that included demographics and experience, regulatory issues, scheduling and interaction with patients, time commitment, involvement of the radiation oncologist, and ideas for overcoming hurdles.

Licensing was perceived as a substantial hurdle; Nuclear Regulatory Commission approval took more than 5 months at five of 12 sites. At two higher-volume sites, 10-20 procedures were performed per week; 75% of these radiation oncologists did not see the patient prior to the procedure and were not involved in obtaining informed consent. The mean time spent per case was 30-90 minutes; however, there were major concerns about case scheduling (<50% had any input in case scheduling) and after-hours coverage. Radiation oncologists performed fluoroscopy and cineangiography at most centers (92% and 83%); they also performed intracoronary contrast material injections (67%), interpreted intravascular ultrasonographic images (42%), and repositioned the intracoronary RT catheter (33%).

The authors identify several issues that need to be addressed before intracoronary RT becomes a part of widespread clinical practice. Close collaboration between cardiologists and radiation oncologists at various levels is required to ensure that patients derive maximal benefit from this new technology.