New era of electronic brachytherapy

Table 1 Comparison of radionuclide and electronic brachytherapy sources

Source	Strengths	Weaknesses
Radionuclide	Small source Fixed energy spectrum Easy to predict the output at any point in time using half-life Used in combination with EBRT/alone Rapid dose fall-off Lower dose to organs at risk Proven clinical application Well-established protocols and treatment procedures	Radiation leakage – Off condition Radioactive waste – A big concern Frequent source replacement (depends on half-life) Output correction due to source decay Source transportation related radiation accidents Fixed-dose rate and dosimetric properties Limited treatment sites compared to EBRT
Electronic brachytherapy	No radiation leakage in off condition User adjustable energy and current (dose rate) No radioactive waste Source transportation - not an issue Relatively stable output during the life of the X-ray tube Less exposure to staff	Relatively large source size Limited treatment sites compared to radionuclide brachytherapy Minimal experience compared to radionuclide-based brachytherapy

EBRT: External beam radiation therapy.