Intraoperative Electron Beam Irradiation: Physics and Techniques

Since IORT using electron beams first became popular in the late 1970s and early 1980s, enthusiasm for the technique using conventional accelerators waned. The reasons for this are manyfold. The main factor was that IORT required considerable effort on the part of physicians, physicists, and therapists, as well as the loss of time on the linear accelerator for treating external beam irradiation therapy (EBRT) patients. While a dedicated facility alleviates some of these problems, the cost of building a shielded room for a low use (∼3–5 cases per week) linear accelerator was hard to justify in the face of declining reimbursements. The problem with reimbursements was in part related to the fact that in the USA there is no specific CPT code for this procedure, so the utilization costs were harder to recover. Finally, in some institutions, the lack of definite improvements in survival in certain disease-sites of interest made it hard to justify the additional departmental resources to carry out the procedure.