ABSTRACT
The real-time implantation of permanent sources into the prostate was introduced at Mount Sinai Medical Center in New York in 1990. The desire to develop a real-time implant technique came from the concern that the preplan method would not adequately address gland motion and changes in patient set-up. While the concept that the use of low energy radioactive sources could prove attractive in the treatment of localized prostate cancer, attaining uniform good results has been more elusive. The transition from the open, retropubic technique to the transperineal approach with ultrasound guidance was a necessary step in ensuring dosimetric consistency.1-4
The initial transrectal ultrasound probes used in prostate brachytherapy were crude compared to today’s equipment. Problems with image quality and proper planning led to many false starts and even caused the initiator of this approach, Holm, to abandon it altogether.2 Ragde had visited Holm and decided to take the ultrasound approach back to America.5 Working in Seattle with Blasko and Grimm, he developed the preplanned implant in the mid 1980s.
