On the use of EBT3 film for relative dosimetry of kilovoltage X ray beams.

EBT3 films were evaluated for relative dosimetry in water, in the energy range of therapeutic kV X ray beams. A film batch was calibrated in air for all nine beam qualities of a clinical unit (XStrahl 200). Monte Carlo (MC) simulations using MCNP v.6 facilitated the calculation of the film absorbed dose (f), and beam quality (kbq) energy dependences in air. Results were found in agreement with corresponding data in the literature. Film samples from the same batch were irradiated in water along the central beam axis for each beam quality. Experimental percentage depth dose (PDD) results obtained using calibration data in air showed quality and depth dependent differences from corresponding MC simulations. These differences increased beyond film dosimetry uncertainty (<3.3%), reaching up to 8% at increased depth. The observed differences reduced only slightly when spectral variation as a function of measurement point was accounted for, using photon effective energy. PDD measurements and corresponding MC results facilitated the determination of f and kbq in water. Results showed that the origin of the observed differences between experimental and MC PDD results is the difference between film response in air and water, as a result of radiation field perturbation from the film oriented along the central beam axis. This implies a directional dependence of film response which necessitates that the angular distribution of photons impinging on the film is the same in the calibration and measurement geometries.

Dosimetric and radiobiological comparison of TG-43 and Monte Carlo calculations in 192Ir breast brachytherapy applications.

PURPOSE: To investigate the clinical significance of introducing model based dose calculation algorithms (MBDCAs) as an alternative to TG-43 in 192Ir interstitial breast brachytherapy. MATERIALS AND METHODS: A 57 patient cohort was used in a retrospective comparison between TG-43 based dosimetry data exported from a treatment planning system and Monte Carlo (MC) dosimetry performed using MCNP v. 6.1 with plan and anatomy information in DICOM-RT format. Comparison was performed for the target, ipsilateral lung, heart, skin, breast and ribs, using dose distributions, dose-volume histograms (DVH) and plan quality indices clinically used for plan evaluation, as well as radiobiological parameters. RESULTS: TG-43 overestimation of target DVH parameters is statistically significant but small (less than 2% for the target coverage indices and 4% for homogeneity indices, on average). Significant dose differences (>5%) were observed close to the skin and at relatively large distances from the implant leading to a TG-43 dose overestimation for the organs at risk. These differences correspond to low dose regions (<50% of the prescribed dose), being less than 2% of the prescribed dose. Detected dosimetric differences did not induce clinically significant differences in calculated tumor control probabilities (mean absolute difference <0.2%) and normal tissue complication probabilities. CONCLUSION: While TG-43 shows a statistically significant overestimation of most indices used for plan evaluation, differences are small and therefore not clinically significant. Improved MBDCA dosimetry could be important for re-irradiation, technique inter-comparison and/or the assessment of secondary cancer induction risk, where accurate dosimetry in the whole patient anatomy is of the essence.

A retrospective dosimetric comparison of TG43 and a commercially available MBDCA for an APBI brachytherapy patient cohort.

PURPOSE: To compare dosimetry using a contemporary model based dose calculation algorithm (MBDCA) following TG186 recommendations, and the conventional TG43 method in an (192)Ir high dose rate (HDR) accelerated partial breast irradiation (APBI) patient cohort. METHODS: Data of 38 APBI patients were studied. Dosimetry for the treatment plans was performed using both the TG43 and TG186 dose calculation methods of the Oncentra Brachy v4.4 treatment planning system (TPS). Analysis included indices of clinical interest for the planning target volume (PTV coverage, dose homogeneity, conformity) as well as dose volume histograms (DVH) for the breast, lung, heart, rib and skin. Significance testing of observed differences between TG43 and TG186 results was carried out and the effect of target location to these differences was studied. RESULTS: Statistically significant differences were observed in the values of clinically relevant DVH parameters for the PTV and the organs at risk (OAR), except for the heart. Differences for the PTV are relatively small (<1% for coverage, on the order of 2% for homogeneity and conformity) with a slight TG43 overestimation except for the dose homogeneity. Percentage differences are larger for the rib and lung (on the order of 4% for Dmax and 5% for V10Gy, respectively) and maximum for the skin (on the order of 6% for D10cc), with a correlation of the observed differences with target location. CONCLUSION: While the MBDCA option of the TPS appears to improve dosimetric accuracy, differences from TG43 do not appear to warrant dose prescription changes or treatment protocol amendment..

Air-kerma evaluation at the maze entrance of HDR brachytherapy facilities.

In the absence of procedures for evaluating the design of brachytherapy (BT) facilities for radiation protection purposes, the methodology used for external beam radiotherapy facilities is often adapted. The purpose of this study is to adapt the NCRP 151 methodology for estimating the air-kerma rate at the door in BT facilities. Such methodology was checked against Monte Carlo (MC) techniques using the code Geant4. Five different facility designs were studied for (192)Ir and (60)Co HDR applications to account for several different bunker layouts.For the estimation of the lead thickness needed at the door, the use of transmission data for the real spectra at the door instead of the ones emitted by (192)Ir and (60)Co will reduce the lead thickness by a factor of five for (192)Ir and ten for (60)Co. This will significantly lighten the door and hence simplify construction and operating requirements for all bunkers.The adaptation proposed in this study to estimate the air-kerma rate at the door depends on the complexity of the maze: it provides good results for bunkers with a maze (i.e. similar to those used for linacs for which the NCRP 151 methodology was developed) but fails for less conventional designs. For those facilities, a specific Monte Carlo study is in order for reasons of safety and cost-effectiveness.

Current state of the art brachytherapy treatment planning dosimetry algorithms.

Following literature contributions delineating the deficiencies introduced by the approximations of conventional brachytherapy dosimetry, different model-based dosimetry algorithms have been incorporated into commercial systems for (192)Ir brachytherapy treatment planning. The calculation settings of these algorithms are pre-configured according to criteria established by their developers for optimizing computation speed vs accuracy. Their clinical use is hence straightforward. A basic understanding of these algorithms and their limitations is essential, however, for commissioning; detecting differences from conventional algorithms; explaining their origin; assessing their impact; and maintaining global uniformity of clinical practice.

Brachytherapy structural shielding calculations using Monte Carlo generated, monoenergetic data.

PURPOSE: To provide a method for calculating the transmission of any broad photon beam with a known energy spectrum in the range of 20-1090 keV, through concrete and lead, based on the superposition of corresponding monoenergetic data obtained from Monte Carlo simulation. METHODS: MCNP5 was used to calculate broad photon beam transmission data through varying thickness of lead and concrete, for monoenergetic point sources of energy in the range pertinent to brachytherapy (20-1090 keV, in 10 keV intervals). The three parameter empirical model introduced by Archer et al. ["Diagnostic x-ray shielding design based on an empirical model of photon attenuation," Health Phys. 44, 507-517 (1983)] was used to describe the transmission curve for each of the 216 energy-material combinations. These three parameters, and hence the transmission curve, for any polyenergetic spectrum can then be obtained by superposition along the lines of Kharrati et al. ["Monte Carlo simulation of x-ray buildup factors of lead and its applications in shielding of diagnostic x-ray facilities," Med. Phys. 34, 1398-1404 (2007)]. A simple program, incorporating a graphical user interface, was developed to facilitate the superposition of monoenergetic data, the graphical and tabular display of broad photon beam transmission curves, and the calculation of material thickness required for a given transmission from these curves. RESULTS: Polyenergetic broad photon beam transmission curves of this work, calculated from the superposition of monoenergetic data, are compared to corresponding results in the literature. A good agreement is observed with results in the literature obtained from Monte Carlo simulations for the photon spectra emitted from bare point sources of various radionuclides. Differences are observed with corresponding results in the literature for x-ray spectra at various tube potentials, mainly due to the different broad beam conditions or x-ray spectra assumed. CONCLUSIONS: The data of this work allow for the accurate calculation of structural shielding thickness, taking into account the spectral variation with shield thickness, and broad beam conditions, in a realistic geometry. The simplicity of calculations also obviates the need for the use of crude transmission data estimates such as the half and tenth value layer indices. Although this study was primarily designed for brachytherapy, results might also be useful for radiology and nuclear medicine facility design, provided broad beam conditions apply.

Dosimetric accuracy of a deterministic radiation transport based (192)Ir brachytherapy treatment planning system. Part III. Comparison to Monte Carlo simulation in voxelized anatomical computational models.

PURPOSE: To compare TG43-based and Acuros deterministic radiation transport-based calculations of the BrachyVision treatment planning system (TPS) with corresponding Monte Carlo (MC) simulation results in heterogeneous patient geometries, in order to validate Acuros and quantify the accuracy improvement it marks relative to TG43. METHODS: Dosimetric comparisons in the form of isodose lines, percentage dose difference maps, and dose volume histogram results were performed for two voxelized mathematical models resembling an esophageal and a breast brachytherapy patient, as well as an actual breast brachytherapy patient model. The mathematical models were converted to digital imaging and communications in medicine (DICOM) image series for input to the TPS. The MCNP5 v.1.40 general-purpose simulation code input files for each model were prepared using information derived from the corresponding DICOM RT exports from the TPS. RESULTS: Comparisons of MC and TG43 results in all models showed significant differences, as reported previously in the literature and expected from the inability of the TG43 based algorithm to account for heterogeneities and model specific scatter conditions. A close agreement was observed between MC and Acuros results in all models except for a limited number of points that lay in the penumbra of perfectly shaped structures in the esophageal model, or at distances very close to the catheters in all models. CONCLUSIONS: Acuros marks a significant dosimetry improvement relative to TG43. The assessment of the clinical significance of this accuracy improvement requires further work. Mathematical patient equivalent models and models prepared from actual patient CT series are useful complementary tools in the methodology outlined in this series of works for the benchmarking of any advanced dose calculation algorithm beyond TG43.

On the output factor measurements of the CyberKnife iris collimator small fields: Experimental determination of the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for microchamber and diode detectors.

PURPOSE: To measure the output factors (OFs) of the small fields formed by the variable aperture collimator system (iris) of a CyberKnife (CK) robotic radiosurgery system, and determine the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for a microchamber and four diode detectors. METHODS: OF measurements were performed using a PTW PinPoint 31014 microchamber, four diode detectors (PTW-60017, -60012, -60008, and the SunNuclear EDGE detector), TLD-100 microcubes, alanine dosimeters, EBT films, and polymer gels for the 5 mm, 7.5 mm, 10 mm, 12.5 mm, and 15 mm iris collimators at 650 mm, 800 mm, and 1000 mm source to detector distance (SDD). The alanine OF measurements were corrected for volume averaging effects using the 3D dose distributions registered in polymer gel dosimeters. k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors for the PinPoint microchamber and the diode dosimeters were calculated through comparison against corresponding polymer gel, EBT, alanine, and TLD results. RESULTS: Experimental OF results are presented for the array of dosimetric systems used. The PinPoint microchamber was found to underestimate small field OFs, and a k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factor ranging from 1.127 ± 0.022 (for the 5 mm iris collimator) to 1.004 ± 0.010 (for the 15 mm iris collimator) was determined at the reference SDD of 800 mm. The PinPoint k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factor was also found to increase with decreasing SDD; k(Q(clin),Q(msr) ) (f(clin),f(msr) ) values equal to 1.220 ± 0.028 and 1.077 ± 0.016 were obtained for the 5 mm iris collimator at 650 mm and 1000 mm SDD, respectively. On the contrary, diode detectors were found to overestimate small field OFs and a correction factor equal to 0.973 ± 0.006, 0.954 ± 0.006, 0.937 ± 0.007, and 0.964 ± 0.006 was measured for the PTW-60017, -60012, -60008 and the EDGE diode detectors, respectively, for the 5 mm iris collimator at 800 mm SDD. The corresponding correction factors for the 15 mm iris collimator were found equal to 0.997 ± 0.010, 0.994 ± 0.009, 0.988 ± 0.010, and 0.986 ± 0.010, respectively. No correlation of the diode k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors with SDD was observed. CONCLUSIONS: This work demonstrates an experimental procedure for the determination of the k(Q(clin),Q(msr) ) (f(clin),f(msr) ) correction factors required to obtain small field OF results of increased accuracy.

Dose and dose averaged LET comparison of ¹H, 4He, 6Li, 8Be, ¹°B, ¹²C, ¹4N, and ¹6O ion beams forming a spread-out Bragg peak.

PURPOSE: Modern clinical accelerators are capable of producing ion beams from protons up to neon. This work compares the depth dose distribution and corresponding dose averaged linear energy transfer (LET) distribution, which is related to the biological effectiveness, for different ion beams (¹H, 4He, 6Li, 8Be, ¹°B, ¹²C, ¹4N, and ¹6O) using multi-energetic spectra in order to configure spread-out Bragg peaks (SOBP). METHODS: Monte Carlo simulations were performed in order to configure a 5 cm SOBP at 8 cm depth in water for all the different ion beams. Physical dose and dose averaged LET distributions as a function of depth were then calculated and compared. The superposition of dose distribution of all ions is also presented for a two opposing fields configuration. Additional simulations were performed for (12)C beams to investigate the dependence of dose and dose averaged LET distributions on target depth and size, as well as beam configuration. These included simulations for a 3 cm SOBP at 7, 10, and 13 cm depth in water, a 6 cm SOBP at 7 depth in water, and two opposing fields of 6 cm SOBP. RESULTS: Alpha particles and protons present superior physical depth dose distributions relative to the rest of the beams studied. Dose averaged LET distributions results suggest higher biological effectiveness in the target volume for carbon, nitrogen and oxygen ions. This is coupled, however, with relatively high LET values-especially for the last two ion species-outside the SOBP where healthy tissue would be located. Dose averaged LET distributions for 8Be and ¹°B beams show that they could be attractive alternatives to ¹²C for the treatment of small, not deeply seated lesions. The potential therapeutic effect of different ion beams studied in this work depends on target volume and position, as well as the number of beams used. CONCLUSIONS: The optimization of beam modality for specific tumor cites remains an open question that warrants further investigation and clinically relevant results.

Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part II: Monte Carlo and experimental verification of a multiple source dwell position plan employing a shielded applicator.

PURPOSE: The aim of this work is the dosimetric validation of a deterministic radiation transport based treatment planning system (BRACHYVISION v. 8.8, referred to as TPS in the following) for multiple 192Ir source dwell position brachytherapy applications employing a shielded applicator in homogeneous water geometries. METHODS: TPS calculations for an irradiation plan employing seven VS2000 192Ir high dose rate (HDR) source dwell positions and a partially shielded applicator (GM11004380) were compared to corresponding Monte Carlo (MC) simulation results, as well as experimental results obtained using the VIP polymer gel-magnetic resonance imaging three-dimensional dosimetry method with a custom made phantom. RESULTS: TPS and MC dose distributions were found in agreement which is mainly within +/- 2%. Considerable differences between TPS and MC results (greater than 2%) were observed at points in the penumbra of the shields (i.e., close to the edges of the "shielded" segment of the geometries). These differences were experimentally verified and therefore attributed to the TPS. Apart from these regions, experimental and TPS dose distributions were found in agreement within 2 mm distance to agreement and 5% dose difference criteria. As shown in this work, these results mark a significant improvement relative to dosimetry algorithms that disregard the presence of the shielded applicator since the use of the latter leads to dosimetry errors on the order of 20%-30% at the edge of the "unshielded" segment of the geometry and even 2%-6% at points corresponding to the potential location of the target volume in clinical applications using the applicator (points in the unshielded segment at short distances from the applicator). CONCLUSIONS: Results of this work attest the capability of the TPS to accurately account for the scatter conditions and the increased attenuation involved in HDR brachytherapy applications employing multiple source dwell positions and partially shielded applicators.

On the implementation of a recently proposed dosimetric formalism to a robotic radiosurgery system.

PURPOSE: The aim of this work is to implement a recently proposed dosimetric formalism for nonstandard fields to the calibration and small field output factor measurement of a robotic stereotactic radiosurgery system. METHODS: Reference dosimetry measurements were performed in the nonstandard, 60 mm diameter machine specific reference (msr) field using a Farmer ion chamber, five other cylindrical chambers with cavity lengths ranging from 16.25 down to 2.7 mm, and alanine dosimeters. Output factor measurements were performed for the 5, 7.5, 10, and 15 mm field sizes using microchambers, diode detectors, alanine dosimeters, TLD microcubes, and EBT Gafchromic films. Measurement correction factors as described in the proposed formalism were calculated for the ion chamber and diode detector output factor measurements based on published Monte Carlo data. Corresponding volume averaging correction factors were calculated for the alanine output factor measurements using 3D dose distributions, measured with polymer gel dosimeters. RESULTS: Farmer chamber and alanine reference dosimetry results were found in close agreement, yielding a correction factor of k(Q(msr),Q)(f(msr),f(ref)) = 0.999 +/- 0.016 for the chamber readings. These results were also found to be in agreement within experimental uncertainties with corresponding results obtained using the shorter cavity length ionization chambers. The mean measured dose values of the latter, however, were found to be consistently greater than that of the Farmer chamber. This finding, combined with an observed inverse relationship between the mean measured dose and chamber cavity length that follows the trend predicted by theoretical volume averaging calculations in the msr field, implies that the Farmer k(Q(msr),Q)(f(msr),f(ref)) correction is greater than unity. Regarding the output factor results, deviations as large as 33% were observed between the different dosimeters used. These deviations were substantially decreased when appropriate correction factors were applied to the measured microchamber, diode, and alanine values. After correction, all diode and microchamber measured output factors agreed within 1.6% with the corresponding alanine measurements, and within 3.1% with the TLD measurements. The weighted mean output factors were 0.681 +/- 0.001, 0.824 +/- 0.001, 0.875 +/- 0.001, and 0.954 +/- 0.001 for the 5, 7.5, 10, and 15 mm beams, respectively. CONCLUSIONS: The comparison of Farmer chamber measurements versus alanine reference dosimetry validates the use of the former for dosimetry in the msr field of this treatment delivery system. The corresponding results of this work obtained using chambers with different cavity lengths, combined with previous literature findings, suggest that a k(Q(msr),Q)(f(msr),f(ref)) Farmer chamber dose response correction factor of 1.01 may improve calibration measurement accuracy when using the proposed dosimetric formalism. The k(Q(msr),Q)(f(msr),f(ref)) correction factor is within 0.5% from unity for ion chambers with cavity lengths less than 10 mm. Substantial improvements in small field output factor measurement accuracy can be obtained when using microchambers and diodes by applying appropriately calculated correction factors to the detector measurements according to the proposed dosimetric formalism, and their routine use is therefore recommended.

Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part I: single sources and bounded homogeneous geometries.

PURPOSE: The aim of this work is to validate a deterministic radiation transport based treatment planning system (TPS) for single 192Ir brachytherapy source dosimetry in homogeneous water geometries. METHODS: TPS results were obtained using the deterministic radiation transport option of a BRACHYVISION v. 8.8 system for three characteristic source designs (VS2000, GMPlus HDR, and GMPlus PDR) with each source either centered in a 15 cm radius spherical water phantom, or positioned at varying distance away from the phantom center. Corresponding MC simulations were performed using the MCNPX code v.2.5.0 and source geometry models prepared using information provided by the manufacturers. RESULTS: Comparison in terms of the AAPM TG-43 dosimetric formalism quantities, as well as dose rate distributions per unit air kerma strength with a spatial resolution of 0.1 cm, yielded close agreement between TPS and MC results for the sources centered in the phantom. Besides some regions close to the source longitudinal axes where discrepancies could be characterized as systematic, overall agreement for all three sources studied is comparable to the statistical (type A) uncertainty of MC simulations (1% at the majority of points in the geometry increasing to 2%-3% at points lying both away from the source center and close to the source longitudinal axis). A corresponding good agreement was also found between TPS and MC results for the sources positioned away from the phantom center. CONCLUSIONS: Results of this work attest the capability of the TPS to accurately account for the scatter conditions regardless of the size or shape of a given geometry of dosimetric interest, and the position of a source within it. This is important since, as shown in the literature and summarized also in this work, these factors could introduce a significant dosimetric effect that is currently ignored in clinical treatment planning. It is concluded that the implementation of the deterministic radiation transport option of the BRACHYVISION v. 8.8 system for 192Ir brachytherapy dosimetry in homogeneous water geometries yields results of comparable accuracy to the golden standard of Monte Carlo simulation, in clinically viable calculation times.

Gamma knife output factor measurements using VIP polymer gel dosimetry.

PURPOSE: Water equivalent polymer gel dosimeters and magnetic resonance imaging were employed to measure the output factors of the two smallest treatment fields available in a Gamma Knife model C radiosurgery unit, those formed employing the 4 and 8 mm final collimator helmets. METHODS: Three samples of the VIP normoxic gel formulation were prepared and irradiated so that a single shot of the field whose output factor is to be measured and a single shot of the reference 18 mm field were delivered in each one. Emphasis is given to the development and benchmarking of a refined data processing methodology of reduced uncertainty that fully exploits the 3D dose distributions registered in the dosimeters. RESULTS: Polymer gel results for the output factor of the 8 mm collimator helmet are found to be in close agreement with the corresponding value recommended by the vendor (0.955 +/- 0.007 versus 0.956, respectively). For the 4 mm collimator helmet, however, polymer gel results suggest an output factor 3% lower than the value recommended by the vendor (0.841 +/- 0.009 versus 0.870, respectively). CONCLUSIONS: A comparison with corresponding measurements published in the literature indicates that output factor results of this work are in agreement with those obtained using dosimetric systems which, besides fine spatial resolution and lack of angular and dose rate dependence of the dosimeter's response, share with polymer gels the favorable characteristic of minimal radiation field perturbation.

Radiation transmission data for radionuclides and materials relevant to brachytherapy facility shielding.

To address the limited availability of radiation shielding data for brachytherapy as well as some disparity in existing data, Monte Carlo simulation was used to generate radiation transmission data for 60Co, 137CS, 198Au, 192Ir 169Yb, 170Tm, 131Cs, 125I, and 103pd photons through concrete, stainless steel, lead, as well as lead glass and baryte concrete. Results accounting for the oblique incidence of radiation to the barrier, spectral variation with barrier thickness, and broad beam conditions in a realistic geometry are compared to corresponding data in the literature in terms of the half value layer (HVL) and tenth value layer (TVL) indices. It is also shown that radiation shielding calculations using HVL or TVL values could overestimate or underestimate the barrier thickness required to achieve a certain reduction in radiation transmission. This questions the use of HVL or TVL indices instead of the actual transmission data. Therefore, a three-parameter model is fitted to results of this work to facilitate accurate and simple radiation shielding calculations.

Dosimetric characterization of CyberKnife radiosurgical photon beams using polymer gels.

Dose distributions registered in water equivalent, polymer gel dosimeters were used to measure the output factors and off-axis profiles of the radiosurgical photon beams employed for CyberKnife radiosurgery. Corresponding measurements were also performed using a shielded silicon diode commonly employed for CyberKnife commissioning, the PinPoint ion chamber, and Gafchromic EBT films, for reasons of comparison. Polymer gel results of this work for the output factors of the 5, 7.5, and 10 mm diameter beams are (0.702 +/- 0.029), (0.872 +/- 0.039), and (0.929 +/- 0.041), respectively. Comparison of polymer gel and diode measurements shows that the latter overestimate output factors of the two small beams (5% for the 5 mm beam and 3% for the 7.5 mm beams). This is attributed to the nonwater equivalence of the high atomic number silicon material of the diode detector. On the other hand, the PinPoint chamber is found to underestimate output factors up to 10% for the 5 mm beam due to volume averaging effects. Polymer gel and EBT film output factor results are found in close agreement for all beam sizes, emphasizing the importance of water equivalence and fine detector sensitive volume for small field dosimetry. Relative off-axis profile results are in good agreement for all dosimeters used in this work, with noticeable differences observed only in the PinPoint estimate of the 80%-20% penumbra width, which is relatively overestimated.

On the use of high dose rate 192Ir and 169Yb sources with the MammoSite radiation therapy system.

Ample literature exists on the dose overestimation by commercially available treatment planning systems in MammoSite applications using high dose rate 192Ir sources for partial breast brachytherapy as monotherapy, due to their inability to predict the dose reduction caused by the radiographic contrast solution in the balloon catheter. In this work Monte Carlo simulation is used to verify the dose rate reduction in a balloon breast applicator which does not vary significantly with distance and it is 1.2% at the prescription distance for the reference simulated geometry of 10% diluted radiographic contrast media and 2.5 cm balloon radius. Based on these findings and the minimal hardening of the initially emitted photon spectrum for 192Ir, a simple analytical method is proposed and shown capable for correcting dosimetry planning in clinical applications. Simulations are also performed to assess the corresponding dose reduction in applications of balloon breast applicators using high dose rate 169Yb sources that have recently become available. Results yield a far more significant and distance dependent dose reduction for 169Yb (on the order of 20% at the prescription distance for the abovementioned reference simulation geometry). This dose reduction cannot be accounted for using simple analytical methods as for 192Ir due to the significant hardening of the initially emitted 169Yb photons within the diluted radiographic contrast media. Combined with results of previous works regarding the effect of altered scatter conditions (relative to treatment planning system assumptions) on breast treatment planning accuracy, which is more pronounced for 169Yb relative to 192Ir, these findings call for the amendment of dose treatment planning systems before using 169Yb high dose rate sources in balloon breast applicators.

On the use of high dose rate Ir192 and Yb169 sources with the MammoSite® radiation therapy system.

Ample literature exists on the dose overestimation by commercially available treatment planning systems in MammoSite® applications using high dose rate Ir192 sources for partial breast brachytherapy as monotherapy, due to their inability to predict the dose reduction caused by the radiographic contrast solution in the balloon catheter. In this work Monte Carlo simulation is used to verify the dose rate reduction in a balloon breast applicator which does not vary significantly with distance and it is 1.2% at the prescription distance for the reference simulated geometry of 10% diluted radiographic contrast media and 2.5cm balloon radius. Based on these findings and the minimal hardening of the initially emitted photon spectrum for Ir192, a simple analytical method is proposed and shown capable for correcting dosimetry planning in clinical applications. Simulations are also performed to assess the corresponding dose reduction in applications of balloon breast applicators using high dose rate Yb169 sources that have recently become available. Results yield a far more significant and distance dependent dose reduction for Yb169 (on the order of 20% at the prescription distance for the abovementioned reference simulation geometry). This dose reduction cannot be accounted for using simple analytical methods as for Ir192 due to the significant hardening of the initially emitted Yb169 photons within the diluted radiographic contrast media. Combined with results of previous works regarding the effect of altered scatter conditions (relative to treatment planning system assumptions) on breast treatment planning accuracy, which is more pronounced for Yb169 relative to Ir192, these findings call for the amendment of dose treatment planning systems before using Yb169 high dose rate sources in balloon breast applicators.

Comparison of radiation shielding requirements for HDR brachytherapy using 169Yb and 192Ir sources.

169Yb has received a renewed focus lately as an alternative to 192Ir sources for high dose rate (HDR) brachytherapy. Following the results of a recent work by our group which proved 169Yb to be a good candidate for HDR prostate brachytherapy, this work seeks to quantify the radiation shielding requirements for 169Yb HDR brachytherapy applications in comparison to the corresponding requirements for the current 192Ir HDR brachytherapy standard. Monte Carlo simulation (MC) is used to obtain 169Yb and 192Ir broad beam transmission data through lead and concrete. Results are fitted to an analytical equation which can be used to readily calculate the barrier thickness required to achieve a given dose rate reduction. Shielding requirements for a HDR brachytherapy treatment room facility are presented as a function of distance, occupancy, dose limit, and facility workload, using analytical calculations for both 169Yb and 192Ir HDR sources. The barrier thickness required for 169Yb is lower than that for 192Ir by a factor of 4-5 for lead and 1.5-2 for concrete. Regarding 169Yb HDR brachytherapy applications, the lead shielding requirements do not exceed 15 mm, even in highly conservative case scenarios. This allows for the construction of a lead door in most cases, thus avoiding the construction of a space consuming, specially designed maze. The effects of source structure, attenuation by the patient, and scatter conditions within an actual treatment room on the above-noted findings are also discussed using corresponding MC simulation results.

Polymer gel dosimetry for the TG-43 dosimetric characterization of a new 125I interstitial brachytherapy seed.

In this work, a polymer gel-magnetic resonance (MR) imaging method is employed for the dosimetric characterization of a new 125I low dose rate seed (IsoSeed model I25.S17). Two vials filled with PABIG gel were prepared in-house and one new seed as well as one commercially available 125I seed of similar dose rate and well-known dosimetric parameters (IsoSeed model I25.S06) were positioned in each vial. Both seeds in each vial were MR scanned simultaneously on days 11 and 26 after implantation. The data obtained from the known seed in each vial are used to calibrate the gel dose response which, for the prolonged irradiation duration necessitated by the investigated dose rates, depends on the overall irradiation time. Data for this study are presented according to the AAPM TG-43 dosimetric formalism. Polymer gel results concerning the new seed are compared to corresponding, published dosimetric results obtained, for the purpose of the new seed clinical implementation, by our group using the established methods of Monte Carlo (MC) simulation and thermo-luminescence dosimetry (TLD). Polymer gel dosimetry yields an average dose rate constant value of lambda = (0.921 +/- 0.031) cGy h(-1) U(-1) relative to (MC)lambda = (0.929 +/- 0.014) cGy h(-1) U(-1), (TLD)lambda = (0.951 +/- 0.044) cGy h(-1) U(-1) and the average value of Lambda = (0.940 +/- 0.051) cGy h(-1) U(-1) proposed for the clinical implementation of the new seed. Results for radial dose function, g(L)(r), and anisotropy function, F(r, theta), also agree with corresponding MC calculations within experimental uncertainties which are smaller for the polymer gel method compared to TLD. It is concluded that the proposed polymer gel-magnetic resonance imaging methodology could be used at least as a supplement to the established techniques for the dosimetric characterization of new low energy and low dose rate interstitial brachytherapy seeds.

A dosimetric comparison of 169Yb and 192Ir for HDR brachytherapy of the breast, accounting for the effect of finite patient dimensions and tissue inhomogeneities.

Monte Carlo simulation dosimetry is used to compare 169Yb to 192Ir for breast high dose rate (HDR) brachytherapy applications using multiple catheter implants. Results for bare point sources show that while 169Yb delivers a greater dose rate per unit air kerma strength at the radial distance range of interest to brachytherapy in homogeneous water phantoms, it suffers a greater dose rate deficit in missing scatter conditions relative to 192Ir. As a result of these two opposing factors, in the scatter conditions defined by the presence of the lung and the finite patient dimensions in breast brachytherapy the dose distributions calculated in a patient equivalent mathematical phantom by Monte Carlo simulations for the same implant of either 169Yb or 1921r commercially available sources are found comparable. Dose volume histogram results support that 169Yb could be at least as effective as 192Ir delivering the same dose to the lung and slightly reduced dose to the breast skin. The current treatment planning systems' approach of employing dosimetry data precalculated in a homogeneous water phantom of given shape and dimensions, however, is shown to notably overestimate the delivered dose distribution for 169Yb. Especially at the skin and the lung, the treatment planning system dose overestimation is on the order of 15%-30%. These findings do not undermine the potential of 169Yb HDR sources for breast brachytherapy relative to the most commonly used 192Ir HDR sources. They imply, however, that there could be a need for the amendment of dose calculation algorithms employed in clinical treatment planning of particular brachytherapy applications, especially for intermediate photon energy sources such as 169Yb.