Verification of Ir-192 near source dosimetry using GAFCHROMIC film

Intravascular brachytherapy treatments of in-stent restenosis have been performed extensively using Ir-192 ribbon. Task Group 60 of the American Association of Physicists in Medicine (AAPM) recommends a dose reference point at 2 mm from the source center for these treatments. However, it is known that the source can be as close as 0.5 mm to the arterial wall if not centered in the lumen. Therefore, the source dosimetry needs to be characterized at these close distances to accurately determine the amount of dose delivered for noncentered cases. In this paper, we report the verification of the dose distributions around Ir-192 seed sources at radial distances from 0.5 mm to 6 mm using GAFCHROMIC film. We evaluated an Ir-192 single seed source and a train of 6 seeds spaced 1 mm apart enclosed in a nylon ribbon. Each source was placed in a homogeneous solid water phantom directly below a stack of GAFCHROMIC films (MD-55-2). The calibration curve of the lot of films used in the experiment was established for Ir-192 by exposing a set of calibration films, one at a time, to an Ir-192 high dose rate (HDR) source. All films were scanned 5 or more days after exposure with a Lumisys Model 150 microdensitometer. The data were acquired and evaluated using RIT113 (Radiological Imaging Technology) software and analyzed using Excel and IDL (Interactive Data Language) software. Isodose curve plots in the plane containing the source's longitudinal axis and dose rate plots in the radial direction were obtained. For both configurations, the dose rates along the transverse axes agree to within the margin of error with previous Monte Carlo results. The isodose curve plots display hot spots near the seed ends, which is consistent with the leakage of beta particles and electrons from the unsealed seed ends as predicted with Monte Carlo calculations.     

EPR dosimetry of radiotherapy photon beams in inhomogeneous media using alanine films

In the current work, EPR (electron paramagnetic resonance) dosimetry using alanine films (134 microm thick) was utilized for dose measurements in inhomogeneous phantoms irradiated with radiotherapy photon beams. The main phantom material was PMMA, while either Styrofoam or aluminium was introduced as an inhomogeneity. The phantoms were irradiated to a maximum dose of about 30 Gy with 6 or 15 MV photons. The performance of the alanine film dosimeters was investigated and compared to results from ion chamber dosimetry, Monte Carlo simulations and radiotherapy treatment planning calculations. It was found that the alanine film dosimeters had a linear dose response above approximately 5 Gy, while a background signal obscured the response at lower dose levels. For doses between 5 and 60 Gy, the standard deviation of single alanine film dose estimates was about 2%. The alanine film dose estimates yielded results comparable to those from the Monte Carlo simulations and the ion chamber measurements, with absolute differences between estimates in the order of 1-15%. The treatment planning calculations exhibited limited applicability. The current work shows that alanine film dosimetry is a method suitable for estimating radiotherapeutical doses and for dose measurements in inhomogeneous media.     

3D dose verification in 192Ir HDR prostate monotherapy using polymer gels and MRI

VIPAR polymer gels and 3D MRI techniques were evaluated for their ability to provide experimental verification of 3D dose distributions in a simulation of a 192Ir prostate monotherapy clinical application. A real clinical treatment plan was utilized, generated by post-irradiation, CT based calculations derived from Plato BPS and Swift treatment planning systems. The simulated treatment plan involved the use of 10 catheters and 39 source positions within a glass vessel of appropriate dimensions, homogeneously filled with the VIPAR gel. 3D high resolution MR scanning of the gel produced T2 relaxation time maps, from which 3D dose distributions were derived via an appropriate calibration procedure. Results were compared to corresponding dose distributions obtained from the Plato and Swift treatment planning systems. Quantitative comparison, on a point by point basis, was based on user adopted acceptance criteria of 5% dose-difference and 3 mm distance-to-agreement. Significant deviations between experimental and calculated dose distributions were found for doses lower than 50% due to the reduced dose resolution of the method in the low dose, low dose gradient region. Measurement errors were observed at 1.0-1.5 mm around each catheter due to MR imaging susceptibility artifacts. For most remaining points the acceptance criteria were fulfilled. Systematic offsets of the order of 1-2 mm, observed between measured and corresponding calculated isocontours at specific segments, are attributed to the 1 mm uncertainty in catheter reconstruction and 1 mm uncertainty in the alignment of the MR and CT imaging planes.     

Radiation dose measurements with alanine/agarose gel and thin alanine films around a 192Ir brachytherapy source,using ESR spectroscopy

Alanine/agarose gel and alanine films in stacks have been used for measurements of absorbed dose around an HDR 192Ir source in a vaginal cylinder-applicator, with and without a 180 degrees tungsten shield. The gel and the films were analysed by means of ESR spectroscopy and calibrated against an ion chamber in a 4 MV photon beam to obtain absolute dose values. The gel serves as both dosimeter and phantom material, and the thin (130 microm) films are used to achieve an improved spatial resolution in the dose estimations. Experimental values were compared with Monte Carlo simulations using two different codes. Results from the measurements generally agree with the simulations to within 5%, for both the alanine/agarose gel and the alanine films.     

Comparison of measured and calculated dose rates in water near I-125 and Ir-192 seeds

Recent theoretical and experimental work indicates that currently accepted 125I dosimetry data may overestimate dose in water at 1 cm by 10%-24%. Among the most comprehensive measurements are those of the NCI-sponsored brachytherapy contract participants. Absolute dose rates in water calculated by the Monte Carlo method have been compared with the NCI dose measurements about 125I and 192Ir seeds embedded in solid-water phantoms. The photon transport code allows realistic geometric simulation of the complex internal seed structure, the National Institute of Standards and Technology air-kerma strength standardization geometry, and the dose measurement setup. When the appropriate measurement medium and geometry are assumed, agreement between theory and measurement is excellent, within 3% at 1 cm and averaging 3% at larger distances. However, the data do not support the water equivalence of solid water at 125I energies indicating that solid-water measurements underestimate 125I specific dose-rate constants in water by 4.3%. Because of its higher ratio of absorption to scatter, 125I dose distributions measured in solid water are less penetrating (by 35% at 10 cm) than those measured in liquid water. For model 6711, model 6702, and steel-clad 192Ir seeds, Monte Carlo calculations yielded specific dose-rate constants (assuming liquid water medium) of 0.877, 0.932, and 1.122 cGy cm2 h-1 per unit air-kerma strength, respectively. For 125I, currently accepted values are 18% and 11% larger for the two seed models.     

Experimental determination of the energy response of alanine pellets in the high dose rate 192Ir spectrum

An experimental determination of the energy correction factor for alanine/paraffin pellets in the 192Ir spectrum at varying distances from the source is presented. Alanine dosimeters were irradiated in water under full scatter conditions with a high dose rate (HDR) 192Ir source (Flexisource), using a dedicated holder. Up to six line sources (catheters) fit in a regular pattern at fixed radial distances from the holder axis, the alanine detector being placed at the centre of the holder. The HDR source was stepping every 0.5 cm within a trocar needle within ± 3.0 cm around the medial plane through the detector in order to achieve dose homogeneity within the detector volume. The energy correction factor of alanine/paraffin pellets in 192Ir relative to 60Co was experimentally determined as the inverse ratio of the dose to water measured in water around the 192Ir source to the dose to water calculated in water using the TG-43 formalism. The pellets were read out with a Bruker EMX(micro) spectrometer (X-band). The amplitude of the central line in the alanine absorption spectrum from pellets irradiated within the 192Ir spectrum was directly compared with the amplitude from 60Co-irradiated pellets. The energy correction factors of Harwell pellets irradiated in the 192Ir spectrum are 1.029 ± 0.02, 1.027 ± 0.02 and 1.045 ± 0.02 at a mean weighted source–detector distance of 2.0, 2.9 and 5.3 cm, respectively. The experimentally obtained values for the energy response are 1.3% lower compared to the theoretical values for radial distances smaller than 3 cm.     

Technical note: Monte-Carlo dosimetry of the HDR 12i and Plus 192Ir sources.

In this study a complete set of dosimetric data for the GammaMed high dose rate (HDR) 12i and Plus 192Ir sources are presented. These data have been calculated by means of the Monte Carlo simulation code GEANT3. Absolute dose rate distributions in water are presented as conventional two dimensional (2D) Cartesian look-up tables, and in the TG43 formalism.     

Preliminary evaluation of second harmonic direct detection scheme for low-dose range in alanine/EPR dosimetry

The usefulness of a direct detection scheme of the second harmonic (2h) overmodulated signal from irradiated alanine in EPR dosimetry was studied. For this purpose, a group of DL-alanine/paraffin cylindrical pellets was produced. The dosimeters were irradiated with a 60Co radiotherapy gamma source with doses of 0.05, 0.1, 0.5, 1 and 5 Gy. The EPR measurements were carried out in a VARIAN-E4 spectrometer operating in X-band with optimized parameters to obtain highest amplitude signals of both harmonics. The 2h signal was detected directly at twice the modulation frequency. In preliminary results, the 2h showed some advantages over the 1 h such as better resolution for doses below 1 Gy, better repeatability results and better linear behaviour in the dose range indicated.     

Non-invasive determination of the irradiation dose in fingers using low-frequency EPR

Several reports in the literature have described the effects of radiation in workers who exposed their fingers to intense radioactive sources. The radiation injuries occurring after local exposure to a high dose (20 to 100 Gy) could lead to the need for amputation. Follow-up of victims needs to be more rational with a precise knowledge of the irradiated area that risks tissue degradation and necrosis. It has been described previously that X-band electron paramagnetic resonance (EPR) spectroscopy could be used to assess the dose in irradiated amputated fingers. Here, we propose the use of low-frequency EPR spectroscopy to evaluate non-invasively the absorbed dose. Low-frequency microwaves are indeed less absorbed by water and penetrate more deeply into living material (approximately 10 mm in tissues using 1 GHz spectrometers). This work presents preliminary results obtained with baboon and human fingers compared with human dry phalanxes placed inside a surface-coil resonator. The EPR signal increased linearly with the dose. The ratio of the slopes of the dry bone to whole finger linear regression lines was around 5. The detection limit achievable with the present spectrometer and resonator is around 60 Gy, which is well within the range of accidentally exposed fingers. It is likely that the detection limit could be improved in the future, thanks to further technical spectrometer and resonator developments as well as to appropriate spectrum deconvolution into native and dosimetric signals.     

Experimental determination of the radial dose function of 90Sr/90Y IVBT sources

A series of measurements were undertaken using both high sensitivity radiochromic film and new lithium fluoride thermoluminescent dosimeters in a liquid water medium to define the radial dose function of 90Sr/90Y beta emitting intravascular brachytherapy sources more accurately. These measurements of a single 5 French source pellet served to verify current Monte Carlo transport models and extrapolation chamber measurements of the radial dose function, thus providing the recommended independent published measurements for g(r) of these sources. A slight deviation in the published radial dose function at depth leads the authors to recommend that treatment planning be performed using updated g(r) values from current Monte Carlo transport models verified by measurements such as those shown in this investigation.     

The effect of patient inhomogeneities in oesophageal 192Ir HDR brachytherapy: a Monte Carlo and analytical dosimetry study

The effect of patient inhomogeneities surrounding the oesophagus on the dosimetry planning of an upper thoracic oesophageal 192Ir HDR brachytherapy treatment is studied. The MCNPX Monte Carlo code is used for dosimetry in a patient-equivalent phantom geometry and results are compared in terms of isodose contours as well as dose volume histograms with corresponding calculations by a contemporary treatment planning system software featuring a full TG-43 dose calculation algorithm (PLATO BPS version 14.2.4). It is found that the presence of patient inhomogeneities does not alter the delivery of the planned dose distribution to the planning treatment volume. Regarding the organs at risk, the common practice of current treatment planning systems (TPSs) to consider the patient geometry as a homogeneous water medium leads to a dose overestimation of up to 13% to the spinal cord and an underestimation of up to 15% to the sternum bone. These findings which correspond to the dose region of about 5-10% of the prescribed dose could only be of significance when brachytherapy is used as a boost to external beam therapy. Additionally, an analytical dosimetry model, which is efficient in calculating dose in mathematical phantoms containing inhomogeneity shells of materials of radiobiological interest, is utilized for dosimetry in the patient-equivalent inhomogeneous phantom geometry. Analytical calculations in this work are in good agreement with corresponding Monte Carlo results within the bone inhomogeneities of spinal cord and sternum bone but, like treatment planning system calculations, the model fails to predict the dose distribution in the proximal lung surface as well as within the lungs just as the TPS does, due to its inherent limitation in treating lateral scatter and backscatter radiation.     

Computation of relative dose distribution and effective transmission around a shielded vaginal cylinder with 192Ir HDR source using MCNP4B

The present work is primarily focused on the estimation of relative dose distribution and effective transmission around a shielded vaginal cylinder with an 192Ir source using the Monte Carlo technique. The MCNP4B code was used to evaluate the dose distribution around a tungsten shielded vaginal cylinder as a function of thickness and angular shielding. The dose distribution and effective transmission of 192Ir by 0.8 cm thickness tungsten were also compared with that for gold and lead. Dose distributions were evaluated for different distances starting from 1.35 cm to 10.15 cm from the center of the cylinder. Dose distributions were also evaluated sequentially from 0 degrees to 180 degrees for every 5 degrees interval. Studies show that all the shielding material at 0.8 cm thickness contribute tolerable doses to normal tissues and also protect the critical organs such as the rectum and bladder. However, the computed dose values are in good agreement with the reported experimental values. It was also inferred that the higher the shielding angles, the more the protection of the surrounding tissues. Among the three shielding materials, gold has been observed to have the highest attenuation and hence contribute lowest transmission in the shielded region. Depending upon the shielding angle and thickness, it is possible to predict the dose distribution using the MCNP4B code. In order to deliver the higher dose to the unshielded region, lead may be considered as the shielding material and further it is highly economic over other materials.     

An experimental and Monte Carlo investigation of the energy dependence of alanine/EPR dosimetry: II. Clinical electron beams

The energy dependence of alanine/EPR dosimetry for 8, 12, 18 and 22 MeV clinical electron beams was investigated by experiment and by Monte Carlo simulations. Alanine pellets in a waterproof holder were irradiated in a water phantom using an Elekta Precise linear accelerator. The dose rates at the reference point were determined following the TG-51 protocol using an NACP-02 parallel-plate chamber calibrated in a (60)Co beam. The EPR spectra of irradiated pellets were measured using a Bruker EMX 081 EPR spectrometer. Experimentally, we found no significant change in alanine/EPR response to absorbed dose-to-water over the energy range 8-22 MeV at an uncertainty level of 0.6%. However, the response for high-energy electrons is about 1.3 (+/-1.1)% lower than for (60)Co. The EGSnrc Monte Carlo system was used to calculate the ratio of absorbed dose-to-alanine to absorbed dose-to-water and it was shown that there is 1.3 (+/-0.2)% reduction in this ratio from the (60)Co beam to the electron beams, which confirms the experimental results. Alanine/EPR response per unit absorbed dose-to-alanine was also investigated and it is the same for high-energy electrons and (60)Co gamma-rays.     

Measurement of the absorbed dose distribution near an 192Ir intravascular brachytherapy seed using a high-spatial-resolution gel dosimetry system

The absorbed dose distribution at sub-millimeter distances from the Best single (192)Ir intravascular brachytherapy seed was measured using a high-spatial-resolution gel dosimetry system. Two gel phantoms from the same batch were used; one for the seed irradiation and one for calibration. Since the response of this gel is energy independent for photons between 20 and 1250 keV, the gel was calibrated using a narrowly collimated (60)Co gamma-ray beam (cross-sectional area ~1 cm(2)). A small format laser computed tomography scanner was used to acquire the data. The measurements were carried out with a spatial resolution of 100 μm in all dimensions. The seed was calibrated at NIST in terms of air-kerma strength. The absorbed dose rate as well as the radial dose function, g(L)(r), was measured for radial distances between 0.6 and 12.6 mm from the seed center. The dose rate constant was measured, yielding a value of Λ = (1.122 ± 0.032) cGy h(-1) U(-1), which agrees with published data within the measurement uncertainty. For distances between 0.6 and 1.5 mm, g(L)(r) decreases from a maximum value of 1.06 down to 1.00; between 1.5 and 6.7 mm, an enhancement is clearly observed with a maximum value around 1.24 and beyond 6.7 mm, g(L)(r) has an approximately constant value around 1.0, which suggests that this seed can be considered as a point source only at distances larger than 6.7 mm. This latter observation agrees with data for the same seed reported previously using Gafchromic film MD-55-2. Additionally, published Monte Carlo (MC) calculations have predicted the observed behavior of the radial dose function resulting from the absorbed dose contributions of beta particles and electrons emitted by the (192)Ir seed. Nonetheless, in the enhancement region, MC underestimates the dose by approximately 20%. This work suggests that beta particles and electrons emitted from the seed make a significant contribution to the total absorbed dose delivered at distances near the seed center (less than 6 mm) and therefore cannot be neglected, given the dimensions of blood vessel walls.     

An experimental and Monte Carlo investigation of the energy dependence of alanine/EPR dosimetry: I. Clinical x-ray beams

The energy dependence of alanine/EPR dosimetry, in terms of absorbed dose-to-water for clinical 6, 10, 25 MV x-rays and 60Co gamma-rays was investigated by measurements and Monte Carlo (MC) calculations. The dose rates were traceable to the NRC primary standard for absorbed dose, a sealed water calorimetry. The electron paramagnetic resonance (EPR) spectra of irradiated pellets were measured using a Bruker EMX 081 EPR spectrometer. The DOSRZnrc Monte Carlo code of the EGSnrc system was used to simulate the experimental conditions with BEAM code calculated input spectra of x-rays and gamma-rays. Within the experimental uncertainty of 0.5%, the alanine EPR response to absorbed dose-to-water for x-rays was not dependent on beam quality from 6 MV to 25 MV, but on average, it was about 0.6% lower than its response to 60Co gamma-rays. Combining experimental data with Monte Carlo calculations, it is found that the alanine/EPR response per unit absorbed dose-to-alanine is the same for clinical x-rays and 60Co gamma-rays within the uncertainty of 0.6%. Monte Carlo simulations showed that neither the presence of PMMA holder nor varying the dosimeter thickness between 1 mm and 5 mm has significant effect of the energy dependence of alanine/EPR dosimetry within the calculation uncertainty of 0.3%.