Basic Radiation Terminology

The terms used to describe radiation are confusing and complex. To make matters worse, two different sets of terms are commonly used to describe radiation related quantities. The United States has persisted in its use of older terms whereas much of the rest of the world has adopted newer terms call Standard International (SI) units. Despite this difficulty, mastery of a basic radiation vocabulary is necessary in order to understand some important fundamental concepts regarding radiation and in...

Initiating A Program

In most institutions, surgeons have been the driving force behind initiating these procedures, usually after being trained at one of the specialized courses. As discussed in another chapter in this handbook, many courses do not appear to adequately prepare attendees for the logistical hurdles they must negotiate upon their return to their home institutions. This begins with surgeon training and credentialing. The hospital, with input from interested physicians, should decide before any RGS is...

Pathologic Evaluation of Sentinel Lymph Nodes in Breast Cancer

106 111 113 Lymphatic mapping utilizing technetium labeled sulfur colloid and isosulfan blue dye injections has successfully identified the sentinel lymph nodes (SLNs) and allowed accurate staging.1,2 This minimally invasive technique may lead to more conservative lymph node dissection for stages I and II breast cancer patients with decreased morbidity and cost savings for the health care system. For most cancers, the nodal status is the single most important prognostic indicator and...

Radiation Safety And Regulations

Radiation is frightening to many people. The reality is much less sensational. The potential harm from radiation exposure is proportional to the dose. The harm of greatest concern from occupational exposure to radiation is that the radiation will cause cancer. Although it has been possible to measure small (8 ) increases in cancers in large populations instantaneously exposed to large doses of radiation (e.g., atomic bomb survivors), it has been difficult to measure any increase in cancers in...

Technique for Lymphatic Mapping in Breast Carcinoma

Introduction Economic Imperatives 72 Status of Axillary Node Dissection Historical 73 Histo rical Persp ective of the D evelop ment of Lymp hatic Mapping Technical Aspects ofLymphatic Mapping for Breast Carcinoma 74 Operative Techniquefor Lymphatic Mapping of Breast Carcinoma 76 80 The surgical treatment of breast cancer is rapidly evolving. Some factors influencing these changes include altered disease demographics, advances in technology, governmental and reimbursement controls, and...

Radioguided Surgery and Vulvar Carcinoma

Fiorica l42 Epidemiolo Surgical Management and Stagingof Vulvar Intraoperative Lymphatic Mapping for Vulvar l47 Technique of Vulvar Lymphoscint l47 Vulvar Overall, carcinoma of the vulva is a relatively rare malignancy representing approximately 5 of all female genital tract cancers1 and 1 of all malignancies in women. The incidence has risen slightly over the past 50 years, perhaps because of an overall rise in the average age of women in the U.S.,2 or an...

Billing And Reimbursement

This is simultaneously the most difficult, most challenging and most controversial and problematic section to write or edit in this handbook. It may also be perceived as the most valuable section by the general practitioner, who after all would like to reasonably and appropriately be compensated for the performance of a specialized operative procedure that requires special training and perhaps national credentialing. During talks that I give on RGS, discussions of billing and reimbursement are...

Bone Lesion Localization

Bone Radioisotope Bone Techniques of Bone Lesion Accurate staging plays a critical role in the evaluation of any malignancy because it has a pivotal role in determining therapy. Since stage and survival are strongly correlated, the prognosis is also determined by staging. Metastases to bone from any solid tumor are classified as distant, blood-born metastases and the tumor is considered Stage IV.1 Documented bone metastases eliminates surgery as a curative option, generally mandating a...