Insertion of loose seeds centrally

12. Central needle and seed insertion

• The central needles are then all inserted in the transverse view. Once complete switch to the longitudinal views and starting with the anterior needles, insert the loose seeds with the Mick applicator using ultrasound probe retraction planes, or create bespoke strands via the Isoloader as previously calculated.
• Before the centre (D column) seeds/strand is inserted reassess the urethral position by inserting the foley catheter to ensure the dosimetry is optimised, especially at the apex of the gland.

13. Post implant dosimetry check

• When all the seeds are inserted, switch to the transverse view, align both the ultrasound and the planning computer at the base and scroll through the prostate to assess the isodose curves. Determine whether any further seeds are required to complete the implant.

14. Assess for haematuria

• At the end of the procedure, insert the catheter and inflate