1

Heather Maurer
April 2014
Brachytherapy surface application: COMS eye plaques
Currently at The University of Michigan Ann Arbor Radiation Oncology the only type of
brachytherapy surface application we preform are eye plaques. Most of my career has been here
and eye plaques seem to be a fairly common occurrence. I was quickly when talking with our
physics department. Eye plaques do happen quiet frequently here, typically a couple a week, but
Ive learned it is quite a specialized procedure. We happen to have a specialist whose main
interest is in ocular melanomas. Due to having this specialist our patient load for eye plaques has
increased considerably.
The eye plaques we currently use are the COMS (Collaborative Ocular Melanoma Study) eye
plaque (Figure 1). These eye plaques come in several different standard sizes. The correct size
is determined by the physician and then the physician puts a request in to our physics department
to build the appropriate plaque. Plaques can be created using Co
60
, Ru
106
, Ir
192
, or I
125
.
1
We use
I
125
for our plaques and to get the correct strength for each seed we will divide the prescribed
dose, 85Gy, by the number of seeds, 24 seeds, to get the strength needed for each source. Its not
quite that simple, you will also need to know the length of time the seeds will be applied in order
to deliver accurate dose to the patient. Cases here leave the eye plaque in either 99.5 hours or
101 hours. Once the correct seeds arrive and they have been assayed for strength they will each
be placed into a grove on the silastic insert, and then glued into the gold plaque. It is very
important to order the correct number of seeds and keep in mind that as the plaque gets bigger
the number of seeds it is designed to hold increases as well (Figure 2).
In the figures 1 and 2 you may notice a clear replica of the gold plaque; this is what we refer to
as the dummy plaque. The tumor is visualized by illuminating the eye from the opposing side of
the tumor.
1
We then use the dummy plaque to align to an illuminated tumor in the operating
room since we are unable to see through the gold hot plaque. The dummy plaque is then traced
with a specialized marker in the pace where they would like to suture the hot plaque. After the
suturing of the hot plaque the patient is given a leaded eye patch, is surveyed to make sure he is
within acceptable dose limits to others, and given a time to return for removal.

2


References
1. Bentel G. Radiation Therapy Planning. 2nd ed. New York, NY: McGraw-Hill; 1996.
2. Chiu-Tsao S. Episcleral eye plaques for treatment of intra-ocular malignancies and
benign diseases.
http://www.aapm.org/meetings/05SS/program/eyeplaque072005_chiu.pdf July 2005.
Accessed April 2014.





















3


Figure 1: COMS standard eye plaque.
2


Figure 2: COMS standard eye plaques in different sizes.
2
One of the links that helped me understand and visualize these procedures was
http://www.aapm.org/meetings/05SS/program/eyeplaque072005_chiu.pdf

Seeds
Silastic insert Gold plaque