Because of disadvantages, such as the need to perform the localization and operation the same day and difficulty maintaining orientation of the center of the localization in relation to the margins of excision, alternatives to wire localization for surgery of nonpalpable breast lesions have been widely pursued. Radioactive seed localization (RSL) is one technique that has gained acceptance in many practices throughout the world and has been shown to be a safe, effective alternative to wire localization. RSL allows the localization procedure to be scheduled on a different day from the operative procedure, the operative incision to be planned with no regard for the entry point used for localization, and ongoing feedback as to the location of and distance from the lesion throughout the operation. Although RSL is an attractive technique that is intuitive to learn, beginning a new RSL program entails a multidisciplinary effort that includes several challenges. We describe recommendations for how to start a RSL program.
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