A rotating shield brachytherapy (RSBT) apparatus includes a radiation source, at least one applicator, a catheter, a catheter drive assembly, a robotic positioning system, and a connection system. The applicator(s) is configured to be inserted or implanted into a patient. A distal end portion of the catheter has at least one radiation shield and is configured to receive a wire-mounted radiation source. The catheter drive assembly causes helical motion of the catheter and engages the proximal end portion of the catheter to selectively rotate the catheter about a longitudinal axis. The robotic positioning system aligns the catheter drive assembly, in both position and angular orientation at a modifiable rate, with the applicator(s), or to any programmed point in space. The connection system couples the catheter drive assembly to the applicator(s), and further decouple the catheter drive from the applicator(s).

A brachytherapy device including a primary guide, a telescoping primary applicator, a locator assembly for fixing the primary guide and the telescoping applicator, and a control system for managing the different components of the device is described. The primary applicator can be adjusted based on patient anatomy. The locator assembly includes a secondary applicator and a secondary guide connected to an expandable structure that can be inflated after insertion into the patient.