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Brachytherapy
1.
2. Two major categories for the application of
radiation for cancer treatment are externalbeam therapy and brachytherapy. For
external-beam treatment, the patient lies
underneath a machine that emits radiation or
generates a beam of x-rays. This tech-nique is
also called teletherapy, or long- distance
treatment. Most cancer patients are treated in
this fashion. However, some pa-tients may also
be treated with brachyther-apy.
4. • from the Greek word
βραχυς brachys, meaning "shortdistance“.
• Also known as internal
radiotherapy, sealed source
radiotherapy, curietherapy or
endocurietherapy.
5. •A type of radiation therapy
used to treat
cancer, involving the
placement of a radioactive
material, either
temporarily or
permanently, directly
inside the body.
6. • Unlike EBRT which delivers an
external radiation source through
healthy tissue (‘from the
outside, in’), brachytherapy delivers
the radioactive dose directly within or
adjacent to the tumor (‘from the
inside, out’).
8. • The theory behind brachytherapy is to
deliver low-intensity radiation over an
extended period to a relatively small
volume of tissue.
• The low intensity isotopes are placed
directly into a tissue or cavity depositing
radiation only a short distance, covering
the tumor area but sparing surrounding
normal tissue.
9. • This technique allows a higher total
dose of radiation to be delivered to
the tumor than is achievable with
external beam radiation alone.
11. 1896
Discovery of
radioactivity
Henri Becquerel, a French
physicist, accidentally discovered
radioactivity. He noticed that
Uranium caused a black spot to
appear on a photographic plate that
had not been exposed to sunlight.
This discovery raised interest into
the effects of radiation, which
would later lead to the first use of
Brachytherapy
Henri Becquerel
12. 1901
First use of
Brachytherapy
Pierre Curie (a French physicist who
studied the effects of radioactivity)
suggested to Henri-Alexander Danlos
(a French doctor) that radioactivity
could be use to treat cancer. Danlos
tested the idea and found that
radiation caused cancer tumors to
shrink. Early techniques of
brachytherapy were pioneered at the
Curie Institute in Paris by Danlos and
at St. Luke’s and Memorial Hospital in
New York by a surgeon called Robert
Abbe.
P i e r re Cu r i e
13. 1903-1950
Early
pioneers
In the years after the first use of
brachytherapy, a number of
doctors pioneered the
application of it to treat different
types of cancer. These included
Margaret Cleaves in the field of
cervical cancer, Hugh Hampton
Young and Benjamin Barringer in
the field of prostate cancer and
Geoffrey Keynes in the field of
breast cancer.
Margaret Cleaves
14. 1970
Enhanced
radiation safety
One of the early challenges of
brachytherapy is ensuring the
healthcare professionals delivering
treatment were not exposed to
radiation on a daily basis. By 1970’s,
special machine known as
‘afterloaders’ were made available.
Afterloaders contain the radiation
sources used for high dose rate
brachytherapy. Staff can remotely
control the ‘afterloader’ from a
separate observation room to deliver
the radiation from the machine into the
patient’s body.
A modern afterloader machine
15. 1990
Advanced
Imaging techniques
In the 1990s, various imaging
technologies, such as
ultrasound, magnetic resonance
imaging (MRI) and computed
tomography (CT) scans become more
widely available. These technologies
help doctors plan the brachytherapy
procedures. They can also be used
during the brachytherapy procedure to
ensure the radiation is precisely
delivered to exactly the right place.
Ultrasound image of the prostate
16. 2000
Virtual treatment
planning introduced
At the turn of the new century,
advanced computerized brachytherapy
planning systems were introduced.
These enable healthcare professionals
to accurately plan the delivery of the
radiation using a virtual 3D
representation of the patient. Doctors
can then precisely target the radiation
to the cancerous tumor and avoid
damage to the healthy surrounding
tissues.
Creation of a 3D ‘virtual’ patient
17. 2005
Robotic delivery of
Prostate seed therapy
The first robotic device to
accurately deliver
brachytherapy for prostate
cancer (seed therapy) was
introduced. Technological
innovations such as this
have helped to make
brachytherapy even more
effective and safe.
Robotic delivery of seed therapy
18. CLINICAL APPLICATIONS
• Brachytherapy can be used in combination with other
therapies such as surgery, EBRT or
chemotherapy, particularly when the tumor is too large or is
not easily accessible.
• Brachytherapy has been most widely applied in the treatment
of :
Cervical
Prostate
Breast and
skin cancers
Brachytherapy can also be used
to treat tumors in several other
body sites.
19. Body sites in which brachytherapy
can be used to treat cancer
20. Brachytherapy can be characterized
according to three main factors:
• Source placement
• Treatment duration &
• Dose rate
21. ACCORDING TO SOURCE
PLACEMENT
• Interstitial - the sources are placed directly in the
target tissue of the affected site, such as the prostate or
breast.
• Contact - involves placement of the radiation
source in a space next to the target tissue.
•
•
•
•
Intracavitary – A body cavity such as cervix, uterus or vagina.
Intraluminal – A body lumen such as the trachea or esophagus.
Surface (Mould) – externally such as the skin.
Intravascular – Blood vessels.
22. ACCORDING TO TREATMENT DURATION
• Temporary- Dose is delivered over a short period of
time and the sources are removed after the prescribed dose
has been reached. The specific treatment duration will
depend on many different factors, including the required
rate of dose delivery and the type, size and location of the
cancer.
• Permanent-
also known as seed implantation,
involves placing small LDR radioactive seeds or
pellets (about the size of a grain of rice) in the
tumour or treatment site and leaving them there
permanently to gradually decay.
23. ACCORDING TO DOSE RATE
• Low-dose rate(LDR)- Emit radiation at a rate of 0.4–
2 Gy/hour. Commonly used for cancers of the oral
cavity, oropharynx, sarcomas and prostate cancer
• Medium-dose rate (MDR)- characterized by a medium
rate of dose delivery, ranging between 2-12 Gy/hour.
• High-dose rate (HDR)-when the rate of dose delivery
exceeds 12 Gy/h.
• Pulsed-dose rate (PDR) - involves short pulses of
radiation, typically once an hour, to simulate the overall
rate and effectiveness of LDR treatment.
24. Characteristic
Source Placement
Type
Description
Clinical
example(s)
Source placed next
to the tumor
Cervix, trachea,
skin
Permanent
Source implanted
permanently
Prostate “seed”
implants
Temporary
Dose Rate
Source place within Breast, Prostate
the tumor
Contact
Duration
Interstitial
Source implanted
for a specific
treatment duration
Most
brachytherapy
treatments are
temporary for a
wide variety of
cancers
High
12 Gy/hour
Breast, cervix,
prostate, skin
Medium
2–12 Gy/hour
Cervix
Low
0.4–2 Gy/hour
Prostate, oral
26. • In brachytherapy, the radiation dose is applied to
tumor by sealed sources. The sources are
implanted to the tumor tissue itself or in its close
vicinity.
• They are enclosed in a protective capsule or wire
which allows the ionizing radiation to escape
to treat and kill surrounding tissue, but
prevents the charge of radioisotope from
moving or dissolving in body fluids.
• Sources can be tubes, needles, wires, pellets or
seeds.
27. • Brachytherapy sources are usually
encapsulated; the capsule serves several
purposes:
• Containing the radioactivity;
• Providing source rigidity;
• Absorbing any alpha and, for photon emitting
sources, beta radiation produced through the
source decay.
28. • The choice of an appropriate photon emitting
radionuclide for a specific brachytherapy treatment
depends on several relevant physical and dosimetric
characteristics, the most important of which are the:
Photon energies and photon beam penetration
into tissue and the shielding materials;
Half-life;
Half-value layer (HVL) in shielding materials such
as lead;
Specific activity;
Source strength;
Inverse square fall-off of dose with distance from
the source (this is the dominant dosimetric
effect, because of the very short treatment
distances used in brachytherapy).
29. Radionuclide
Type
Half-Life
Energy
Cesium-137 (137Cs)
γ-ray
30.17 years
0.662 MeV
Cobalt-60 (60Co)
γ-rays
5.26 years
1.17, 1.33 MeV
Iridium192 (192Ir)
γ-rays
73.8 days
0.38 MeV (mean)
Iodine-125 (125I)
γ-rays
59.6 days
27.4, 31.4 and
35.5 keV
Palladium103 (103Pd)
γ-ray
17.0 days
21 keV (mean)
β--particles
1.02 years
3.54 MeV
Ruthenium106 (106Ru)
Commonly used radiation sources (radionuclides) for brachytherapy
30. CESIUM 137
• Symbol: (137Cs)
• Half-Life: 30.17 years
• Energy: 0.662 MeV
• most widely used source for the
treatment of gynecological
cancer
• distributed within an insoluble
glass or ceramic matrix
• encapsulated in stainless-steel
sheaths with wall thicknesses of
0.5 to 1.0 mm, active lengths of
13.5 to 15 mm, diameters of 2.6
to 3.1 mm, and total lengths of
about 20 mm.
31. COBALT 60
• Symbol: (60Co)
• Half-Life: 5.26 years
• Energy: 1.17-1.33 MeV
• In the form of wire which is encapsulated in
a sheath of platinum, iridium or stainless
steel.
• available as pellets with a typical
activity of 18.5 GBq (0.5 Ci) per pellet.
32. IRIDIUM 192
• Symbol: (192Ir)
• Half-Life: 30.17 years
• Energy: 73.8 days
• available in the form of seeds, 0.5 mm in
diameter and 3 mm long, for LDR BT
• Also used in the form of a wire (0.3-mm
or 0.6-mm outer diameter) consisting
of an iridium-platinum radioactive core
encased in a 0.1-mm sheath of platinum.
33. IODINE 125
• Symbol: (125I)
• Half-Life: 59.6 days
• Energy: 35.5 keV
• Used for permanent implants
• Only available as seeds. They are usually
inserted into the tumour volume using
special delivery ‘guns’.
34. Source storage and handling
Radioactive sources must be under the control
of an appropriate person at all times…
Ordering
Receiving
Storage
Handling
Use
Disposal
35. SOURCE STORAGE
Source stores must:
provide protection against environmental conditions
be only for radioactive
materials
provide sufficient shielding
be resistant to fire
be secure
be labelled
36. ACCOUNTABILITY OF SOURCES
Source accountancy records should contain:
radionuclide and activity of sources
location and description of sources
disposal details
The records should
be updated regularly,
and the location of the
sources checked.
39. HANDLING OF SOURCES
General:
avoid contamination
use gloves
no eating/drinking in room
use long forceps
Let someone know if you work with
radioactivity
41. AFTERLOADER MACHINE
• A computerized medical device that
drives a small radioactive source
through catheters to predetermined
dwell positions for a specific time in a
patient's body during brachytherapy.
42.
43.
44.
45. APPLICATOR
• A device used to hold a radioactive
source in place during brachytherapy.
• Applicators are non-radioactive and
are typically needles or plastic
catheters. The specific type of
applicator used will depend on the
type of cancer being treated and the
characteristics of the target tumor.
53. INITIAL PLANNING
• In order to accurately plan the brachytherapy
procedure, a thorough clinical examination is
performed to understand the characteristics of
the tumor.
• A range of imaging modalities can be used to
visualize the shape and size of the tumor and its
relation to surrounding tissues and organs.
• Data from many of these sources can be used to
create a 3D visualization of the tumor and the
surrounding tissues.
54. • This initial planning helps to ensure
that ‘cold spots’ (too little
irradiation) and ‘hot spots’ (too
much irradiation) are avoided during
treatment, as these can respectively
result in treatment failure and sideeffects.
55. INSERTION AND IMAGING OF THE
APPLICATOR(S)
• Before radioactive sources can be delivered to the
tumor site, the applicators have to be inserted and
correctly positioned in line with the initial
planning.
• Imaging techniques, such as x-ray, fluoroscopy
and ultrasound are typically used to help guide
the placement of the applicators to their correct
positions and to further refine the treatment plan.
• CAT scans and MRI can also be used.
56. • Once the applicators are inserted, they
are held in place against the skin using
sutures or adhesive tape to prevent them
from moving. Once the applicators are
confirmed as being in the correct
position, further imaging can be
performed to guide detailed treatment
planning.
57. CREATION OF A VIRTUAL
PATIENT
• The treatment planning software enables
multiple 2D images of the treatment site to be
translated into a 3D ‘virtual patient’, within which
the position of the applicators can be defined.
• The spatial relationships between the
applicators, the treatment site and the
surrounding healthy tissues within this ‘virtual
patient’ are a copy of the relationships in the
actual patient.
58.
59.
60.
61.
62.
63. TREATMENT DELIVERY
• The sources used in Brachytherapy can be delivered
manually, but are more commonly delivered through a
technique known as ‘afterloading’.
• Manual delivery of brachytherapy is limited to a few LDR
applications, due to risk of radiation exposure to clinical
staff
• In contrast, afterloading involves the accurate positioning
of non-radioactive applicators in the treatment site,
which are subsequently loaded with the radiation sources.
In manual afterloading, the source is delivered into the
applicator by the operator
64. • Once the applicators are correctly positioned in the
patient, they are connected to an ‘afterloader’ machine
(containing the radioactive sources) through a series of
connecting guide tubes.
• The treatment plan is sent to the afterloader, which then
controls the delivery of the sources along the guide tubes into
the pre-specified positions within the applicator.
• This process is only engaged once staff are removed from the
treatment room.
• The sources remain in place for a pre-specified length of
time, again following the treatment plan, following which they
are returned along the tubes to the afterloader.
65.
66. PROSTATE
• literally "one who stands
before", "protector",
"guardian“
• Tubuloalveolar exocrine gland
of the male reproductive system
in most mammals.
• A walnut-sized gland located
between the bladder and the
penis
67. • A healthy human prostate
is classically said to be
slightly larger than a
walnut.
• The mean weight of the
normal prostate in adult
males is about 11 grams,
usually ranging between 7
and 16 grams.
• It surrounds the urethra
just below the urinary
bladder and can be felt
during a rectal exam.
FUNCTION
The function of the prostate is
to secrete a slightly alkaline
fluid, milky or white in
appearance,
that
usually
constitutes 50–75% of the
volume of the semen along
with spermatozoa and seminal
vesicle fluid.
68. DESCRIPTION
• Brachytherapy takes 30 minutes or more, depending on
the type of therapy you have. Before the procedure, you
will be given medicine so that you do not feel pain. You
may receive:
• A sedative to make you drowsy and numbing medicine
on your perineum. This is the area between the anus
and rectum.
• Anesthesia. With spinal anesthesia, you will be drowsy
but awake, and numb below the waist. With general
anesthesia, you will be asleep and pain-free.
69. After you receive anesthesia:
• The doctor places an ultrasound probe into your
rectum to view the area. The probe is like a camera
connected to a video monitor in the
room. A catheter (tube) may be placed in your
bladder to drain urine.
• The doctor uses ultrasound or a CT scan to plan
and then place the seeds that deliver radiation into
your prostate. The seeds are placed with needles or
special applicators through your perineum.
• Placing the seeds may hurt a little (if you are
awake).
70. Types of brachytherapy
• Low-dose radiation brachytherapy is the most
common type of treatment. The seeds stay inside
your prostate and put out a small amount of
radiation for several months. You go about your
normal routine with the seeds in place.
• High-dose radiation brachytherapy lasts about
30 minutes. Your doctor inserts the radioactive
material into the prostate. The doctor may use a
computerized robot to do this. The radioactive
material is removed right away after treatment.
71. WHY THE PROCEDURE IS PERFORMED?
• Brachytherapy is often used for men
with a small prostate cancer that is
found early and is slow-growing.
Brachytherapy has fewer
complications and side effects than
standard radiation therapy. You will
also need fewer visits with the doctor.
72. BEFORE THE PROCEDURE
Tell your doctor or nurse what medicines you are taking. These
include medicines, supplements, or herbs you bought without a
prescription.
Before this procedure:
• You may need to have ultrasounds, x-rays, or CT scans to prepare
for the procedure.
• Several days before the procedure, you may be told to stop
taking medicines that make it hard for your blood to clot. These
medicines include aspirin, ibuprofen (Advil), clopidogrel
(Plavix), and warfarin (Coumadin).
• Ask your doctor which medicines you should still take on the day
of the surgery.
• If you smoke, try to stop. Your doctor or nurse can help.
73. ON THE DAY OF THE
PROCEDURE:
• You will likely be asked not to drink or eat
anything for several hours before the
procedure.
• Take the medicines your doctor told you to
take with a small sip of water.
• Your doctor or nurse will tell you when to
arrive at the hospital. Be sure to arrive on
time.
74. AFTER THE PROCEDURE
• You may be sleepy and have mild pain and tenderness after
the procedure.
• After an outpatient procedure, you can go home as soon as
the anesthesia wears off. In rare cases, you will need to
spend 1 - 2 days in the hospital. If you stay in the hospital,
your visitors will need to follow special radiation safety
precautions.
• If you have a permanent implant, your doctor may tell you
to limit the amount of time you spend around children and
women who are pregnant. After a few weeks to months,
the radiation is gone and will not cause any harm. Because
of this, there is no need to take out the seeds.
Notes de l'éditeur
Picture and text with reflection(Basic)To reproduce the picture effects on this slide, do the following:On the Home tab, in the Slides group, click Layout and then click Blank. On the Insert tab, in the Illustrations group, click Picture. In the Insert Picture dialog box, select a picture, and then click Insert. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 3.17” and the Width box is set to 10”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes. Select the picture. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide. Click Align Top.Under Picture Tools, on the Format tab, in the Picture Styles group, click Picture Effects, point to Reflections, and then under Reflection Variations click Half Reflection, touching (first row, second option from the left). On the Insert tab, in the Text group, click Text Box, and then on the slide, drag to draw the text box.Enter text in the text box, select the text, and then on the Home tab, in the Font group, select Impact from the Font list and then enter 42 in the Font Size box.On the Home tab, in the Paragraph group, click Align Text Right to align the text right in the text box.Select the text box. Under Drawing Tools, on the Format tab, in the WordArt Styles group, click Text Effects, point to Reflection, and then under Reflection Variations click Half Reflection, touching (first row, second option from the left). Under Drawing Tools, on the Format tab, in the bottom right corner of the WordArt Styles group, click the Format Text Effects dialog box launcher. In the Format Text Effects dialog box, click Text Fill in the left pane, select Solid fill in the Text Fill pane, and then do the following:Click the button next to Color, and then under Theme Colors, click White, Background 1 (first row, first option from the left). In the Transparency box, enter 12%.On the slide, drag the text box onto the picture to position as needed. To reproduce the background on this slide, do the following: Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).In the Angle box, enter 0⁰.Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 10%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 5% (second row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 99%.Click the button next to Color, and then under Theme Colors click White, Background 1, Darker 35% (fifth row, first option from the left).
Custom animation effects: shrink picture circle with text(Intermediate)To reproduce the picture effects on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, click Picture. In the InsertPicture dialog box, select a picture, and then click Insert.On the slide, select the picture. Under PictureTools, on the Format tab, in the PictureStyles group, click PictureShape, and then under BasicShapes click Oval (first row, first option from the left).Select the picture-filled oval. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, resize or crop the picture as needed so that under Size and rotate, the Height box is set to 6” and the Width box is set to 6”. Resize the picture under Size and rotate by entering values into the Height and Width boxes. Crop the picture under Crop from by entering values into the Left, Right, Top, and Bottom boxes. Under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, and then under GlowVariations click Accent color 1, 18 pt glow (fourth row, first option from the left).Under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, point to More Glow Colors, and then under ThemeColors click White, Background 1 (first row, first option from the left).On the Home tab, in the Drawing group, click the Format Shape dialog box launcher. In the Format Picture dialog box, click Shadow in the left pane. In the Shadow pane, click the button next to Presets, under Inner click InsideDiagonalBottomLeft (third row, first option from the left), and then do the following:In the Transparency box, enter 50%.In the Blur box, enter 8 pt.In the Angle box, enter 135°.In the Distance box, enter 8 pt.On the Insert tab, in the Text group, click TextBox. On the slide, drag to draw a text box.Enter text, and then select the text. On the Home tab, in the Font group, do the following:In the Font list, select Candara.In the FontSize box, enter 30.Click the arrow next to FontColor, and then click Black, Text 1, Lighter 25% (fourth row, second option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.On the slide, select the text box. Under DrawingTools, on the Format tab, in the WordArt Styles group, click TextEffects, point to Reflection, and then under ReflectionVariations click TightReflection, touching (first row, first option from the left).Drag the text box onto the right half of the slide.With the text box still selected, on the Home tab, in the Drawing group, click Arrange, and then do the following:Point to Align, and then click Align to Slide.Point to Align, and then click Align Right.Point to Align, and then click Align Middle.Click Send to Back. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Basic, click Wheel.Select the animation effect (wheel effect for the picture). Under Modify: Wheel,do the following:In the Start list, select WithPrevious.In the Spokes list, select 1 Spoke.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, click FadedZoom.Select the second animation effect (faded zoom effect for the picture). Under Modify: FadedZoom,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Grow/Shrink.Select the third animation effect (grow/shrink effect for the picture). Click the arrow to the right of the selected effect, and then click EffectOptions. In the Grow/Shrink dialog box, do the following:On the Effect tab, under Settings, do the following:In the Size list, in the Custom box, enter 95%, and then press ENTER.Select SmoothStart.Select SmoothEnd.Select Auto-reverse.On the Timing tab, do the following: In the Start list, select AfterPrevious. In the Speed box, enter 0.3 seconds. On the slide, select the picture. In CustomAnimation task pane, do the following:Click Add Effect, point to Emphasis, and then click More Effects. In the Add Emphasis Effect dialog box, under Basic, click Grow/Shrink.Select the fourth animation effect (grow/shrink effect for the picture). Under Grow/Shrink, do the following:In the Start list, select AfterPrevious.In the Size list, select Smaller.In the Speed list, select Medium. On the slide, select the picture. In CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the fifth animation effect (left motion path for the picture). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium.On the slide, select the text box. In the CustomAnimation task pane, do the following:Click Add Effect, point to Entrance, and then click More Effects. In the Add Entrance Effect dialog box, under Subtle, select Fade.Select the sixth animation effect (fade effect for the text box). Click the arrow to the right of the selected effect, and then click Timing. In the Fade dialog box, on the Timing tab, do the following:In the Start list, select WithPrevious.In the Delay box, enter 1.5.In the Speed list, select 1 seconds (Fast).On the slide, select the text box. In CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the seventh animation effect (left motion path for the text box). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Fast.On the slide, right–click the selected motion path for the text box, and then clickReversePathDirection. To reproduce the rectangle on this slide, do the following: On the Home tab, in theDrawing group, clickShapes, and then under Rectangles click Rectangle (first option from the left). On the slide, drag to draw a rectangle.Select the rectangle.Under DrawingTools, on the Format tab, in the Size group, do the following:In the ShapeHeight box, enter 1.54”.In theShapeWidth box, enter 10”.Under DrawingTools, on theFormat tab, in the ShapeStyles group, click the arrow next to ShapeOutline, and then click NoOutline.Under DrawingTools, on the Format tab, in the bottom right corner of the ShapeStyles group, click the FormatShape dialog box launcher. In the Format Shape dialog box, clickFill in the left pane, selectGradientfill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).In the Transparency box, enter 88%.Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).In the Transparency box, enter 43%.On the Home tab, in the Drawinggroup, click Arrange, and then do the following:Point to Align, and then click Align to Slide. Point to Align, and then clickAlignMiddle.Point to Align, and then clickAlignCenter.Click Send to Back. To reproduce the background effects on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Black, Text 1, Lighter 50% (second row, second option from the left).
Custom animation effects: title fade-in on path and text fade by letter(Intermediate)Tip: For the effects on this slide, use a picture that measures 7.5” high (the height of the slide) and 2.61” wide.To reproduce the shape effects on this slide, do the following:On the Home tab, in theDrawing group, clickShapes, and then under Rectangles click Rectangle (first option from the left). On the slide, drag to draw a rectangle.Select the rectangle. Under DrawingTools, on the Format tab, in the Size group, do the following: In the ShapeHeight box, enter 3.17”.In the ShapeWidth box, enter 9.5”.Drag the rectangle slightly above the middle of the slide. Select the rectangle. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Left.Under DrawingTools, on theFormat tab, in the ShapeStyles group, click the next to ShapeOutline, and then click NoOutline.Under DrawingTools, on the Format tab, in the bottom right corner of the ShapeStyles group, click the FormatShape dialog box launcher. In the FormatShape dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.Click the button next to Direction, and then click Linear Right (first row, fourth option from the left). Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 50% (fifth row, 10th option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors click Orange, Accent 6, Darker 25% (fourth row, 10th option from the left).To reproduce the “heading” text box on this slide, do the following:On the Insert tab, in the Text group, select TextBox. On the slide, drag to draw a text box.Enter the heading text, and then select text. On the Home tab, in the Font group, do the following:In the Font list, select Calibri.In the FontSize box, enter 38.Click Bold.Click the arrow next to FontColor, and then under ThemeColors click Orange, Accent 6, Darker 25% (fourth row, 10th option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.Drag the text box just above the rectangle, in the right half of the slide. To reproduce the second text box on this slide, do the following:On the Insert tab, in the Text group, click TextBox. On the slide, drag to draw a text box.Enter three lines of text with paragraph breaks, and then select the text. On the Home tab, in the Font group, do the following:In the Font list, select Calibri.In the FontSize list, select 28.Click Bold.Click the arrow next to FontColor, and then under ThemeColors click White, Background 1 (first row, first option from the left).On the Home tab, in the Paragraph group, click AlignTextLeft.Drag the second text box onto the rectangle, below the “heading” text box. To reproduce the full-color picture on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, clickPicture. In the InsertPicture dialog box, select the 7.5” x 2.61” picture, and then click Insert.On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, under Crop from,in the Bottom box, enter 2.43”. (Note: Under Size and rotate, the Height should now be 5.08”.)On the slide, select the picture. UnderPicture Tools, on the Format tab, in the Picture Styles group, click Picture Effects, point to Glow, and then under Glow Variations click Accent color 1, 5 pt glow (first row, first option from the left).Also under PictureTools, on the Format tab, in the PictureStyles group, click PictureEffects, point to Glow, point to MoreGlowColors, and then under ThemeColors click White, Background 1 (first row, first option from the left).Drag the full-color picture on top of the rectangle, to the left of the text boxes. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Top. To reproduce the second picture on this slide, do the following:On the Insert tab, in the Illustrations group, click Picture. In the InsertPicture dialog box, select the same 7.5” x 2.61” picture, and then click Insert. On the slide, select the picture. Under Picture Tools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher. In the Size and Position dialog box, on the Size tab, under Crop from,in the Top box, enter 5.08”. (Note: Under Size and rotate, the Height should now be 2.43”.)On the slide, select the second, smaller picture. Under PictureTools, on the Format tab, in the PictureStyles group, click the FormatShape dialog box launcher. In the FormatPicture dialog box, click Picture in the left pane, and in the Picture pane do the following:In the Brightness box, enter 70%.In the Contrast box, enter -70%.On the slide, drag the smaller picture until it is directly underneath the larger full-color picture.Select the smaller picture. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align to Slide.Click Align Bottom. Press and hold CTRL, and then select both pictures. On the Home tab, in the Drawing group, click Arrange, point to Align, and then do the following:Click Align Selected Objects.Click Align Center. To reproduce the animation effects on this slide, do the following:On the Animations tab, in the Animations group, click CustomAnimation. On the slide, select the “heading” text box. In the CustomAnimation task pane, do the following:Click AddEffect, point to Entrance, and then click MoreEffects. In the AddEntranceEffect dialog box, under Subtle, click Fade.Select the animation effect (fade effect for the “heading” text box). Click the arrow to the right of the selected text box, and then click Timing. In the Fade dialog box, on the Timing tab, do the following:In the Start list, select WithPrevious.In the Delay box, enter 1.5.In the Speed list, select 2 seconds (Medium).On the slide, select the “heading” text box. In the CustomAnimation task pane, do the following:ClickAddEffect, point to MotionPaths, and then click Left.Select the second animation effect (left motion path for the “heading” text box). Under Modify: Left,do the following:In the Start list, select WithPrevious.In the Speed list, select Medium. On the slide, right-click the left motion path and click ReversePathDirection. With the motion path still selected,point to the starting point (green arrow) of the motion path until the cursor becomes a two-headed arrow. Press and hold SHIFT, and then drag the starting pointabout 1.5” off the left edge of the slide. (Note: It may help to display the ruler. On the View tab, in the Show/Hide group, select Ruler. If your lines of text are longer than in the example above, you may need to further increase the length of the motion path. )On the slide, select the second text box. In the CustomAnimation task pane, do the following:Click AddEffect, point to Entrance, and then click MoreEffects. In the AddEntranceEffect dialog box, under Subtle, click Fade.Select the third animation effect (fade effect for the second text box). Click the arrow to the right of the selected effect, and then click Effect Options. In the Fade dialog box, do the following:On the Effect tab, do the following:In the Animate text list, select By Letter.In the % delay between letters box, enter 5.On the Timing tab, do the following:In the Start list, select AfterPrevious.In the Speed list, select 0.5 seconds (VeryFast).On the TextAnimation tab, in the Grouptext list, select By 1st Level Paragraphs.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Radial.Click the button next to Direction, and then click From Center (third option from the left).Under Gradient stops, click Add or Remove until three stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops that you added as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 2 from the list, and then do the following: In the Stop position box, enter 40%.Click the button next to Color, and then under Theme Colors click White, Background 1 (first row, first option from the left).Select Stop 3 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, click More Colors, and then in the Colors dialog box, on the Custom tab, enter values for Red: 232, Green: 227, and Blue: 216.
Custom animation effects: spinning clip art with text(Intermediate)To reproduce the clip art on this slide, do the following:On the Home tab, in theSlides group, click Layout, and then click Blank.On the Insert tab, in the Illustrations group, click Clip Art.In the Clip Art pane, in the Search for box, enter j0435540. In the Search in list, select Everywhere, and then click Go. Select the clip art file in the pane to insert it into the slide. (Note: If you choose another clip art file, the clip art must be in the Windows Metafile format [.wmf].)On the slide, select the clip art. Under Drawing Tools, on the Format tab, in the Size group, do the following:In the Shape Height box, enter 5.83”.In the Shape Width box, enter 8.12”.On the Home tab, in the Drawing group, click Arrange, and then click Ungroup.In the Microsoft Office PowerPoint dialog box, click Yes. On the slide, select the converted clip art. On the Home tab, in the Editing group, click Select, and then click Selection Pane. In the Selection and Visibility pane, select the top-level group. On the Home tab, in the Drawing group, click Arrange, and then click Ungroup. Also in the Selection and Visibility pane, select the Autoshape object, and then press DELETE. Press CTRL+A to select all of the objects on the slide. On the Home tab, in the Drawing group, click Arrange, and then click Group.Select the group. On the Home tab, in the Drawing group, click Shape Effects, point to Preset, and then under Presets click Preset 8 (second row, fourth option from the left). With the group still selected, under DrawingTools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher, and do the following:On the Size tab, in the Height box, enter 6.27”.On the Size tab, in the Width box, enter 6.27”.On the Position tab, in the Horizontal box, enter 3.89”. On the Position tab, in the Vertical box, enter 1.55”To reproduce the text on this slide, do the following:On the Insert tab, in the Text group, click TextBox.Drag to draw a text box on the slide.In the text box, enter text and select it. On the Home tab, in the Font group do the following:In the Font list, select Candara.In the FontSize box, enter 32 pt.In the FontColor list, under StandardColors select Orange (third option from the left). Click Italic. Select the text box on the slide, and then under DrawingTools, on the Format tab, in the Size group, do the following:In the ShapeHeight box, enter 7.29”.In the ShapeWidth box, enter 7.29”.Under DrawingTools, on the Format tab, in the WordArtStyles group, click TextEffects, point to Transform, and under FollowPath select ArchUp (first option from the left).To wrap the text upside down, at the bottom of the text box, drag the pink adjustment diamond from the center left position in the text box to the lower right corner of the text box. With the text box still selected, under DrawingTools, on the Format tab, in the bottom right corner of the Size group, click the Size and Position dialog box launcher, and then on the Position tab do the following:In the Horizontal box, enter 3.38”. In the Vertical box, enter 1.04”.To reproduce the animation effects on this slide, do the following:On the Animation tab, in the Animations group, click CustomAnimation.Select the circle clip art on the slide, and then in the CustomAnimation task pane, do the following:Click AddEffect, point to Emphasis effect and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Click the arrow to the right of the spin emphasis effect, select Effect Options,and do the following:On the Effect tab, under Settings, in the Amount list, select QuarterSpin.On the Effect tab, under Settings, in the Amount list, select Counterclockwise.On the Timing tab, in the Start list, select WithPrevious.On the Timing tab, in the Speed box enter4.0 seconds.Click OK.On the slide, select the text box, and then in the CustomAnimation task pane, do the following:Click the AddEffect, point to Entrance and select MoreEffects. In the AddEntranceEffect dialog box, under Subtle select Fade, and then click OK.Select the fade entrance effect (second effect), and under Modify: Fade do the following:In the Start list, select WithPrevious.In the Speed list, select Slow. With the text box still selected, click AddEffect, point to Emphasis and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Select the spin emphasis effect (third effect), and under Modify: Spin do the following:In the Start list, select WithPrevious.In the Amount list, select HalfSpin.In the Speed list select Slow. With the text box still selected, click AddEffect, point to Emphasis and select MoreEffects. In the AddEmphasisEffect dialog box, under Basic select Spin, and then click OK.Click the arrow to the right of the spin emphasis effect (fourth effect), select Effect Options,and do the following:On the Effect tab, under Settings, in the Amount list, in the Custom box enter 30°, and then press ENTER.On the Effect tab, under Settings, in the Amount list, select Counterclockwise.On the Timing tab, in the Start list, select WithPrevious.On the Timing tab, in the Delay box enter 3.0 seconds.On the Timing tab, in the Speed box enter1 seconds (Fast).Click OK.To reproduce the background on this slide, do the following:Right-click the slide background area, and then click Format Background. In the Format Background dialog box, click Fill in the left pane, select Gradient fill in the Fill pane, and then do the following:In the Type list, select Linear.In the Direction, list click Linear Down (first row, second option from the left)Under Gradient stops, click Add or Remove until two stops appear in the drop-down list.Also under Gradient stops, customize the gradient stops as follows:Select Stop 1 from the list, and then do the following:In the Stop position box, enter 0%.Click the button next to Color, and then under Theme Colors click Black, Text 1 (first row, second option from the left). Select Stop 2 from the list, and then do the following: In the Stop position box, enter 100%.Click the button next to Color, and then under Theme Colors clickBlack, Text 1, Lighter 50% (second row, second option from the left).