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..

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.

Conformal radiotherapy of prostate cancer: what is the proper technique for sparing organs-at-risk?

The aim of the current study was to evaluate the optimal coplanar technique for conformal radiotherapy of prostate cancer. Twelve inoperable patients with prostatic carcinoma were examined. Five different techniques with three-, four- and six-fields were applied for treatment of prostate and seminal vesicles with or without lymph nodes. Treatment techniques were compared by using rectum, bladder and femoral heads dose-volume histogram data. A three-field arrangement consisting of an anterior and two lateral portals resulted in the maximum rectal sparing irrespectively of the irradiated area. The maximum femoral head sparing was achieved by the technique consisting of six oblique and lateral fields. The maximum bladder protection was observed with the box technique for treatment with large pelvic fields and with the arrangement consisting of two oblique and two lateral portals for conedown irradiation. In conclusion, the presented data allow the radiotherapists to select the proper irradiation technique associated with the maximum sparing of each organ-at-risk.

Effect of acetone feeding on alcohol dehydrogenase activity in the olive fruit fly, Bactrocera oleae.

The purpose of this study is to demonstrate a clear connection between the presence of acetone in larval diet and alcohol dehydrogenase (ADH) activity in laboratory raised populations of Bactrocera oleae. ADH activity of B. oleae is depressed in acetone-impregnated diets. At the same time the change of activity is accompanied by a change in the relative proportions of the multiple forms of ADH. The bulk of activity in the most cathodally migrating form is lost, and all the activity becomes localized in the less cathodally migrating forms of the enzyme. Moreover, ADH activity, expressed in vivo, appears to drop after exposure to acetone, as shown by the fact that larvae become less sensitive to pentenol poisoning. Our results show clear selective differences imposed by acetone on three homozygous genotypes involving the ADH alleles F, S and I in B. oleae. The directions of these differences were found to vary with the fitness component under test. Acetone treatment seems to affect developmental time and larva's viability as well as allele frequencies of ADH under artificial rearing. The effect of acetone on the maintenance of ADH polymorphism in artificially reared populations of B. oleae is further discussed.