Comparison of high-dose-rate (192)Ir source strength measurements using equipment with traceability to different standards.

PURPOSE: According to the American Association of Physicists in Medicine Task Group No. 43 (TG-43) formalism used for dose calculation in brachytherapy treatment planning systems, the absolute level of absorbed dose is determined through coupling with the measurable quantity air-kerma strength or the numerically equal reference air-kerma rate (RAKR). Traceability to established standards is important for accurate dosimetry in laying the ground for reliable comparisons of results and safety in adoption of new treatment protocols. The purpose of this work was to compare the source strength for a high-dose rate (HDR) (192)Ir source as measured using equipment traceable to different standard laboratories in Europe and the United States. METHODS AND MATERIALS: Source strength was determined for one HDR (192)Ir source using four independent systems, all with traceability to different primary or interim standards in the United States and Europe. RESULTS: The measured HDR (192)Ir source strengths varied by 0.8% and differed on average from the vendor value by 0.3%. Measurements with the well chambers were 0.5% ± 0.1% higher than the vendor-provided source strength. Measurements with the Farmer chamber were 0.7% lower than the average well chamber results and 0.2% lower than the vendor-provided source strength. All of these results were less than the reported source calibration uncertainties (k=2) of each measurement system. CONCLUSIONS: In view of the uncertainties in ion chamber calibration factors, the maximum difference in source strength found in this study is small and confirms the consistency between calibration standards in use for HDR (192)Ir brachytherapy.

A technique for calibrating a high dose rate ¹9²Ir brachytherapy source.

The reference air kerma rate of an ¹9²Ir high dose rate brachytherapy source is determined based broadly on the International Atomic Energy Agency (IAEA) TECDOC 1274 code of practice. Since the primary standards dosimetry laboratory at the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) does not maintain a standard at ¹9²Ir quality, the air kerma calibration coefficient of an IBA FC65-G Farmer type ionisation chamber is calculated using coefficients determined at 300 kV and 6°Co qualities. The methodology proposed by Mainegra-Hing and Rogers [1] at 250 kV and ¹³7Cs qualities is used. The validity of this approach is tested by performing Monte Carlo simulations to determine the chamber's air kerma calibration coefficient at ¹9²Ir quality. Very good agreement is obtained between values using these two methods. The reference air kerma rate is measured using the Farmer chamber in an in air jig. In addition the necessary correction factors are applied to the measured value. The reference air kerma rate determined in this way is compared to the value stated by the vendor of the ¹9²Ir source on the source calibration certificate. Differences are with one exception less than 1%. It is concluded that because of the agreement between the values from the methodology used in this study and the source calibration certificate values this methodology can be used clinically.

[Quality control in pulsed dose rate brachytherapy]. / Contrôle de qualité en curiethérapie de débit de dose pulsé

A prospective multicenter study (PDR) was leaded on pulsed dose rate brachytherapy over 2 years (2005/2006) in 20 French centres, as part of a programme entitled Stic-PDR and supported by the French ministry of health. Eight hundred and fifty patients were treated for cervix carcinoma with 2D classic or 3D innovative brachytherapy (425 in each arm). The main objectives of this study were to assess the cost of PDR brachytherapy with dose optimization compared to traditional treatments, and to evaluate the complications and local control. A joint programme of quality control was established by the physicists of the different centres, concerning the software treatment planning, the source replacement, the projector and the technical parameters of the course of patient treatment. This technical note lists these controls, and their frequency.

Comparison of 192Ir air kerma calibration coefficients derived at ARPANSA using the interpolation method and at the National Physical Laboratory using a direct measurement.

The reference air kerma rate from 192Ir High Dose Rate (HDR) brachytherapy sources can be measured using a suitably calibrated Farmer chamber and an appropriate in-air calibration jig. When a primary standard for 192Ir gamma rays is available, a calibration coefficient for the chamber and jig combination can be determined directly. In Australia, due to the absence of such a standard, the chamber must be calibrated by interpolation of the response in 60Co and in a kilovoltage x-ray beam. Corrections for the effect of the jig, scatter and beam non-uniformity must then be measured or calculated before the reference air kerma rate can be determined. We compare the air-kerma calibration coefficient of a PTW 30010 PMMA/A1 Farmer chamber (referred to as Farmer chamber throughout this report) obtained from the 192Ir primary standard at the National Physical Laboratory in the UK with the corresponding coefficient obtained by interpolating Australian calibrations using 60Co and 250 kV x-rays and determining suitable correction factors. The resulting chamber/jig calibration coefficients differ by 0.2% which is well within the combined standard uncertainties of 1.2% and 0.6% reported by ARPANSA and NPL respectively.

Monte Carlo characterization of the M-19 high dose rate Iridium-192 brachytherapy source.

The MCNP5 Monte Carlo code was used to simulate the dosimetry of an M-19 iridium-192 high dose rate brachytherapy source in both air/vacuum and water environments with the in-air photon spectrum filtered to remove low-energy photons below delta=10 keV. Dosimetric data was organized into an away-along table and was used to derive the updated AAPM Task Group Report No. 43 (TG-43U1) parameters including S(K), D(r, theta), lamda, gL(r), F(r, theta), phi an(r), and phi an, and their respective statistical uncertainties.

Quality assurance of HDR 192Ir sources using a Fricke dosimeter.

A prototype of a Fricke dosimetry system consisting of a 15 x 15 x 15 cm3 water phantom made of Plexiglas and a 11.3-ml Pyrex balloon fitted with a 0.2 cm thick Pyrex sleeve in its center was created to assess source strength and treatment planning algorithms for use in high dose rate (HDR) 192Ir afterloading units. In routine operation, the radioactive source is positioned at the end of a sleeve, which coincides with the center of the spherical balloon that is filled with Fricke solution, so that the solution is nearly isotropically irradiated. The Fricke system was calibrated in terms of source strength against a reference well-type ionization chamber, and in terms of radial dose by means of an existing algorithm from the HDR's treatment planning system. Because the system is based on the Fricke dosimeter itself, for a given type and model of 192Ir source, the system needs initial calibration but no recalibration. The results from measurements made over a 10 month period, including source decay and source substitutions, have shown the feasibility of using such a system for quality control (QC) of HDR afterloading equipment, including both the source activity and treatment planning parameters. The benefit of a large scale production and the use of this device for clinical HDR QC audits via mail are also discussed.

Design of a phantom for the quality control of high dose rate 192Ir source used in brachytherapy.

BACKGROUND AND PURPOSE: A new phantom is proposed for measuring the strength of 192Ir high dose rate sources and for verification of the dose calculated by the treatment planning system. The complete formalism and measurement procedure for this phantom is described, as well as the preliminary results obtained in a number of centers around Brazil. MATERIALS AND METHODS: The measurements are performed using powder thermoluminescent dosimeter capsules; the source strength is measured in air and the verification of the dose calculation algorithm in water phantom. The correction factors required to take into account the specificities related to the geometry and the phantom materials have been assessed using the PENELOPE Monte Carlo code and experimental methods. The dedicated phantom, constructed to use as part of a QA program, in this case specifically for high dose rate 192Ir brachytherapy sources, allows simultaneous irradiation of three thermoluminescent dosimeter capsules, requiring only one source stop (dwell positions). RESULTS: The phantom was mailed to seven radiotherapy institutions in Brazil, and the results show its usefulness in verifying the source air kerma and correctness of treatment planning dose calculation in water phantom. CONCLUSIONS: The comparison made between the phantom measurements, the well-type ionization chamber, and source specifications stated by the hospital (most of the times provided by the source manufacturer) agreed within 3% showing the quality in the HDR dose delivery in Brazilian radiotherapy centers.

On the accuracy of techniques for obtaining the calibration coefficient N(K) of 192Ir HDR brachytherapy sources.

The accuracy of interpolation or averaging procedures for obtaining the calibration coefficient N(K) for 192Ir high-dose-rate brachytherapy sources has been investigated using the EGSnrc Monte Carlo simulation system. It is shown that the widely used two-point averaging procedure of Goetsch et al. [Med. Phys. 18, 462 (1991)] has some conceptual problems. Most importantly, they recommended, as did the IAEA, averaging A(wall)N(K) values whereas one should average 1/N(K) values. In practice this and other issues are shown to have little effect except for Goetsch et al.'s methods for determining A(wall) values. Their method of generalizing the A(wall) values measured in one geometry to other geometries is incorrect by up to 2%. However, these errors in A(wall) values cause systematic errors of only 0.3% in 192Ir calibration coefficients. It is shown that A(wall) values need not be included in the averaging technique at all, thereby simplifying the technique considerably. It is demonstrated that as long as ion chambers with a flat response are used and/or very heavily filtered 250 kV (or higher) beams of x rays are used in the averaging, then almost all techniques can provide adequate accuracy.

Dosimetric characterization of radioactive sources employed in prostate cancer therapy.

PURPOSE: Three types of radiation sources are employed currently in the radiation treatment of prostate cancer, namely, external, implant, and high-dose-rate (HDR) sources using an afterloader method. The present article provides a detailed dosimetric characterization of several commercially available implant sources and an HDR source employing the same stochastic code and dataset. METHODS AND MATERIALS: The radioactive implants considered are (125)I seeds: models 6701, 6702 and 6711, (103)Pd seed: model 200, and a high-dose-rate (192)Ir source: microSelectron-HDR model V7.0x. Detailed modeling of the sources and their associated X-rays and gamma rays has been carried out using the stochastic code MCNP4C. A sensitivity study has been conducted to quantify effects of varying the composition and density of the tissue equivalent material, and a dosimetric comparison is made for different media (tissue equivalent, solid-water, water, and air). Furthermore, a set of measurements using thermoluminescent dosimeters has been done to provide experimental validation of some of the calculational results obtained. RESULTS: Effectively, high-precision dosimetric values (Monte-Carlo statistical 1-sigma error <1%) are provided in tabulated form over a wide range to enable therapy planning as well as to check numerical values calculated by other methods. A subset of calculated dosimetric values has been experimentally validated by using thermoluminescent dosimeters. CONCLUSIONS: A detailed comparison of results obtained for the radial dose distribution function, anisotropy factor, and dose rate constant as defined in the TG-43 protocol has indicated reasonable agreement with the values reported in the literature.

The design of a new insert for calibration of LDR and HDR 192Ir sources in a well-type ionization chamber.

Some well-type ionization chambers, present a very small sweet spot that are sufficient for small HDR sources. However, if a longer HDR source or LDR wires are calibrated, the positional uncertainty increases and an approximated correction factor must be applied, resulting in an increased uncertainty. One of the ways to avoid this problem would be to flatten the well chamber response by increasing its sweet spot region. This work uses the Monte Carlo code PENELOPE to simulate the response of a well-type chamber HDR-1000, with its original insert, by using an HDR 192Ir source and proposes a new insert design that increases its flatness region from 1.0 cm to approximately 4.0 cm (+/- 2.0 cm about the peak response).

Influence of the non-homogeneity of Ir-192 wires in calibration of well chambers.

All international recommendations point out as necessary the calibration or verification of the reference air kerma rate (RAKR) for brachytherapy sources (independent of manufacturer established value) prior to their clinical use. The most common procedure for RAKR measurement in iridium wires is based on the use of well chambers with specific inserts that set the wire in a fixed position; previously, the electrometer plus well chamber with insert (EWI) was calibrated by using a source obtained from an accredited laboratory for which the RKAR was established precisely, called the 'reference' source. The distribution of Ir-192 material in the wire could be not perfectly homogeneous all along its length, and in this case the influence of these inhomogeneities in the calibration process should be studied. This paper focuses on the evaluation of this topic and an analytical and experimental study is presented taking into account the non-homogeneity of Ir-192 material along the wire for both the reference source (of length 14 cm) and a wire of unknown RAKR. This study is based on measurements with a 1 cm iridium wire on a rectilinear insert considering either of the two available reference sources (1 or 14 cm length), and has been experimentally evaluated using two typical well chambers. The main conclusion of the study is that if the non-homogeneity of the wires is lower than 5% the effect of non-homogeneity on RAKR measurements is negligible for rectilinear inserts even for short well chambers.

A semi-analytic approach to determine dose rate constant of brachytherapy sources in compliance with AAPM TG 60 formalism.

Values of dose rate constant (DRC) in compliance with AAPM TG 60 formalism recommended for intravascular brachytherapy (IVBT) were calculated for different point isotropic mono-energetic photon sources in the energy range E = 20-1000 keV using a semi-analytic model. Based on these DRC values, DRC of some existing models of 192Ir and 125I brachytherapy sources were then calculated using (1) bare energy spectra and (2) a single energy parameter which represents mean energy (photon number weighted or air-kerma weighted) for bare and actual sources or the most probable energy of the spectra (energy line with the highest probability of emission) of the investigated sources (192Ir and 125I). Applicability of the semi-analytic approach was examined by also computing the values of DRC of the investigated sources using MCNP Monte Carlo simulation code (Version 3.1) that involved modeling of the sources accurately. A comparison of values of DRC resulting from MCNP calculations with those resulting from the semi-analytic approach showed that for 192Ir sources the agreement was within 0.40% and for 125I sources it was within 2.3%.

Assaying 192Ir line sources using a standard length well chamber.

The strength of intravascular 192Ir sources is typically measured by the manufacturer before shipment, and treatment planning is based on that assay. However, in-house verification of source strength is required at some institutions by state law or internal policy, is recommended by the AAPM TG 60 report on intravascular brachytherapy, and is considered a necessity by many medical physicists. To accommodate the long sources used in intravascular therapy, special well chambers with extended regions of constant response have been designed. To allow assays using a widely available standard well chamber, we have measured its position dependent sensitivity and derived from it a table of correction factors that account for the extended length of intravascular sources. An experimental verification shows that application of these correction factors yields assays with sufficient accuracy for routine quality assurance tests.

Direct calibration of a reference standard against the air kerma strength primary standard, at 192Ir HDR energy.

The primary standard of low air kerma rate sources or beams, maintained at the Radiological Standards Laboratory (RSL) of the Bhabha Atomic Research Centre (BARC), is a 60 cm3 spherical graphite ionization chamber. A 192Ir HDR source was standardized at the hospital site in units of air kerma strength (AKS) using this primary standard. A 400 cm3 bakelite chamber, functioning as a reference standard at the RSL for a long period, at low air kerma rates (compared to external beam dose rates), was calibrated against the primary standard. It was seen that the primary standard and the reference standard, both being of low Z, showed roughly the same scatter response and yielded the same calibration factor for the 400 cm3 reference chamber, with or without room scatter. However, any likelihood of change in the reference chamber calibration factor would necessitate the re-transport of the primary standard to the hospital site for re-calibration. Frequent transport of the primary standard can affect the long-term stability of the primary standard, due to its movement or other extraneous causes. The calibration of the reference standard against the primary standard at the RSL, for an industrial type 192Ir source maintained at the laboratory, showed excellent agreement with the hospital calibration, making it possible to check the reference chamber calibration at RSL itself. Further calibration procedures have been developed to offer traceable calibration of the hospital well ionization chambers.

Dosimetric measurements in isolated human coronary arteries: comparison of commercially available iridium(192) with strontium/yttrium(90) emitters.

BACKGROUND: Intravascular brachytherapy is being applied more and more in patients with coronary artery disease for the prevention of restenosis subsequent to balloon angioplasty, in particular after stent implantation. Several radiation sources (beta- and gamma-emitters) are available in clinical routine. It was the purpose of this study to compare the radiation doses at the level of the adventitia in diseased and stented human coronary arteries for (192)Ir and (90)Sr/Y emitters in routine use. In contrast to previously published work, we performed dosimetry instead of calculating depth-dose distribution by use of the Monte Carlo system. METHODS AND RESULTS: Postmortem calcified human coronary artery segments were stented and placed in an organ bath. Commercially available gamma-emitters ((192)Ir; Cordis Checkmate) and beta-emitters ((90)Sr/Y; Novoste Beta-Cath) were used. Relative dose distributions along the adventitia were measured by a specially designed scintillation detector system. Whereas dose perturbations caused by stents and calcified plaque were negligible for the (192)Ir source, radiation from the beta source was significantly impaired (as much as 40%) at the level of the adventitia (3.0-mm vessel diameter). Dose perturbation was clearly dependent on the extent and severity of calcification, less affected by stent material. CONCLUSIONS: Dose perturbation caused by calcified plaque and metallic stents is significant for beta-sources. This dosimetric difference between beta- and gamma-emitters in diseased coronary arteries should be considered when calculating doses in intravascular brachytherapy.

Monte Carlo calculation of dose rate distributions around 192Ir wires.

Monte Carlo calculations of absolute dose rate in liquid water are presented in the form of away-along tables for 1 and 5 cm 192Ir wires of 0.3 mm diameter. Simulated absolute dose rate values can be used as benchmark data to verify the calculation results of treatment planning systems or directly as input data for treatment planning. Best fit value of attenuation coefficient suitable for use in Sievert-integrals-type calculations has been derived based on Monte Carlo calculation results. For the treatment planning systems that are based on TG43 formalism we have also calculated the required dosimetry parameters.

Calibration of the NPL secondary standard radionuclide calibrator for 192Ir brachytherapy sources.

Safe and effective treatment with brachytherapy sources requires an accurate knowledge of the local tissue absorbed dose rate derived from the source reference air kerma rate. It is desirable that these air kerma rate measurements be traceable to national standards. The NPL has embarked on a programme that will enable the user to assay brachytherapy sources in a convenient manner prior to treatment. Calibration figures have been derived for the NPL secondary standard radionuclide calibrator for 192Ir brachytherapy sources manufactured by Amersham International plc. The calibration figures enable the user to accurately estimate the reference air kerma rate and activity of such sources by measuring the ionization chamber response. Calibration figures for other brachytherapy sources are also being derived.