CLERAD

Gamma sup was created in order to achieve two main goals :
 Detection of the SLNB or small tumours.
 Make the surgical act easier to the surgeon.

Intraoperative Gamma Sup probes can be used successfully in :
 The SLNB detection in Breast & Skin cancer.
 The endocrine tumours detection
 The genitals tumours detection

Gamma Sup presents a very high sensitivity whatever the gamma rays isotope used:
 Tech-99
 Indium-111
 Iode-131l

Vidéo

Intraoperative Gamma probe has been customised for the Sentinel Lymph Node detection, the surgeon uses it during the surgery, its adjustable threshold with original sound and the four number digit allows an interactive use. The probes dimensions and technical proficiencies can be customised upon request.

Proficiencies :
 Energy range between 0-400 keV it can be adapted till 511keV thanks to an additional collimator.
 Great efficiency in beats/kbq studied with a 57co source : (d = distance between the source and the probe) :
 High sensitivity collimator: 10.2 on d = 1cm and 1.6 on d = 3 cm
 High resolution collimator: 3.0 on d = 1cm and 1.0 on d = 3 cm
 Lateral resolution in cm (LHM) studied with a 57co source : (d = distance between the source and the probe) :
 High sensitivity collimator: 1.5 on d = 1cm and 3.0 on d = 3 cm
 High resolution collimator: 0.5 on d = 1 cm and 1.2 on d = 3cm

Remarks The technical proficiencies of the 12-mm probe and the 14mm probe are equal. The only difference stands in the shield wide: the 12-mm probe is mainly used for 99tc detection.

Full set including :
 class II a device
 12 or 14 mm probe, 20 cm long, with an integrated gold collimator
 connecting cable made of PVC
 stainless steel cylinder
 control unit with one channel
 box for transport and storage

Control unit features

 ABS unit
 front part made of lexan
 power supply : 220 V
 counting rate visualised in real time on a 4 digit display
 pre-set time for counting
 audio-signal with adjustable threshold
 dimensions : 30,2 * 25,3 * 10,1 cm
 weight : 3,5 kg

Probe features :

12 mm probe collimator answers

High resolution collimator	Usual collimator

The high resolution collimator obtains a narrow field around the detection area which allows great discrimination for the detection ( inferior to 1 cm ). It is particularly well adapted in cases where the Sentinel Lymph Node is really close to the injection points ( producing gamma-rays that can parasite the detection ).

The high sensitivity collimator with its wide detector range is characterised by a very high sensitive detection. This is really useful for the pre-operative detection especially when the Sentinel Lymph Node is in depth.

Hight resolution probe and standart probe sensitivity in the air

Thanks to a large study on the collimating device it appears that the high resolution probe answer is the equivalent of the standard probe answer beyond 3 cm, which is the standard depth of the Sentinel Lymph Node.

Gamma-Sup was developed afterwards the numerous studies on the Sentinel Lymph Node

This is an historical summary of the beginnings of the Sentinel Lymph Node preoperative detection.

 In 1977 : R.M Cabanas defines the Sentinel Lymph Node term which is the first functional node in the lymphatic irrigation of a tumour in the case of penis cancer.
 In 1992 : D.L Morton and his team (oncology surgery 1992) describe the Sentinel Lymph Node detection by peri-tumoral injection of blue dye in case of melanoma. The node appears to be the best representative of the tumour progression in the lymphatic system ( in 99% of the cases ).

 In 1993 : J.C Alex and D.N Krag apply the Sentinel Lymph Node pre-operative detection at the melanoma (oncology surgery 1993; 2; 303-308). They report a very high sensitivity in the breast cancer method (oncology surgery 1993; 2; 335-340).

The remarkable results of these teams in pre-operative detection have been confirmed by many others teams

 Pijpers R. et al. (Amsterdam). World J. Surg. 1997 ; 21 :788-792. " Biopsy of the first tumor-draining lymph node (sentinel node) is bound to become the procedure of choice in regional staging of melanoma patients. A tumor-negative sentinel node virtually excludes lymphatic metastases and obviates the need for lymph node dissection ".

 Albertini J.J. et al. (Tampa). Ann. Surg. ; 1996 ; 223 :217-224. " The use of intraoperative radiolymphoscintigraphy can improve the identification of all sentinel lymph nodes during selective lymphadenectomy.

 Alex J.C. & Krag D.N. (Burlington). Surg. Oncol. Clin. Am. 1996 ; 5 :33-41. " Our experience with squamous cell carcinoma of the head and neck and Merkel cell carcinoma suggests that the assessment of the regional lymphatics using the gamma-probe technology for identification of the primary node may also be applicable to many other solid tumors ".

 EORTC breast cancer cooperative group, Sept. 2000. " The sentinel node concept in breast cancer has proven to be valid. Inbexperienced hands, the sentinel node procedure in invasive breast cancer can be considered as an equal staging procedure as axillary lymph node dissection ".