Echogenic medical devices, methods of fabrication and methods of use are disclosed. The device can be adapted to be inserted into a patient. The echogenic construction can be incorporated into the device at the time of fabrication providing acoustic impedance different from that of the surrounding biological tissue or fluid. The medical device is designed for use with an ultrasound imaging system to provide real-time location of the insertion and guidance at the time the device is implanted in a patient, such as in brachytherapy. Following placement of the device the position can be evaluated over time to insure the device remains in proper alignment and functional. Furthermore, the device is designed to incorporate a spacer element at one or both ends to provide separation between radioactive elements.