Dosimetric and radiobiological investigation of permanent implant prostate brachytherapy based on Monte Carlo calculations

PurposePermanent implant prostate brachytherapy plays an important role in prostate cancer treatment, but dose evaluations typically follow the water-based TG-43 formalism, ignoring patient anatomy and interseed attenuation. The purpose of this study is to investigate advanced TG-186 model-based dose calculations via retrospective dosimetric and radiobiological analysis for a new patient cohort.Methods and MaterialsA cohort of 155 patients treated with permanent implant prostate brachytherapy from The Ottawa Hospital Cancer Centre is considered. Monte Carlo (MC) dose calculations are performed using tissue-based virtual patient models. Dose–volume histogram (DVH) metrics (target, organs at risk) are extracted from 3D dose distributions and compared with those from calculations under TG-43 assumptions (TG43). Equivalent uniform biologically effective dose and tumor control probability are calculated.ResultsFor the target, D₉₀ (V₁₀₀) is 136.7 ± 20.6 Gy (85.8% ± 7.8%) for TG43 and 132.8 ± 20.1 Gy (84.1% ± 8.2%) for MC; D₉₀ is 3.0% ± 1.1% lower for MC than TG43. For organs at risk, MC D_1cc = 104.4 ± 27.4 Gy (TG43: 106.3 ± 28.3 Gy) for rectum and 80.8 ± 29.7 Gy (TG43: 78.4 ± 28.4 Gy) for bladder; D_1cc = 185.9 ± 30.2 Gy (TG43: 191.1 ± 32.0 Gy) for urethra. Equivalent uniform biologically effective dose and tumor control probability are generally lower when evaluated using MC doses. The largest dosimetric and radiobiological discrepancies between TG43 and MC are for patients with intraprostatic calcifications, for whom there are low doses (cold spots) in the vicinity of calcifications within the target, identified with MC but not TG43.ConclusionsDVH metrics and radiobiological indices evaluated with TG43 are systematically inaccurate by upward of several percent compared with MC patient-specific models. Mean cohort DVH metrics and their MC:TG43 variances are sensitive to patient cohort and clinical practice, underlining the importance of further retrospective MC studies toward widespread clinical adoption of advanced model-based dose calculations.     

Dosimetric investigation of 103Pd permanent breast seed implant brachytherapy based on Monte Carlo calculations

PurposePermanent breast seed implant using ¹⁰³Pd is emerging as an effective adjuvant radiation technique for early stage breast cancer. However, clinical dose evaluations follow the water-based TG-43 approach with its considerable approximations. Toward clinical adoption of advanced TG-186 model-based dose evaluations, this study presents a comprehensive investigation for permanent breast seed implant considering both target and normal tissue doses.Methods and MaterialsDose calculations are performed with the free open-source Monte Carlo (MC) code, egs_brachy, using two types of virtual patient models: TG43sim (simulated TG-43 conditions) and MCref (heterogeneous tissue modeling from patient CT, seeds at implant angle) for 35 patients. The sensitivity of dose metrics to seed orientation and tissue segmentation are assessed.ResultsIn the target volume, D₉₀ is 14.1 ± 5.8% lower with MCref than with TG43sim, on average. Conversely, normal tissue doses are generally higher with MCref than with TG43sim, for example, by 22 ± 13% for skin D_1cm2, 82 ± 7% for ribs D_max, and 71 ± 23% for heart D_1cm3. Discrepancies between MCref and TG43sim doses vary over the patient cohort, as well as with the tissue and metric considered. Skin doses are particularly sensitive to seed orientation, with average difference of 4% (maximum 28%) in D_1cm2 for seeds modeled vertically (egs_brachy default) compared with those aligned with implant angle.ConclusionsTG-43 dose evaluations generally underestimate doses to critical normal organs/tissues while overestimating target doses. There is considerable variation in MCref and TG43sim on a patient-by-patient basis, motivating clinical adoption of patient-specific MC dose calculations. The MCref framework presented herein provides a consistent modeling approach for clinical implementation of advanced TG-186 dose calculations.     

Dosimetric characteristics of 192Ir sources used in interstitial brachytherapy.

Dosimetric quantities of 192Ir seed (5 mm length) and wire (10 mm length) brachytherapy sources have been determined. The quantities were measured based on the protocol introduced by the Radiation Therapy Committee of the American Association of Physicists in Medicine (AAPM) Task Group 43. Quantities such as dose rate constant, (lambda), radial dose function, g(r), and anisotropy function, F(r, theta) were experimentally determined and the geometry function, G(r, theta), was calculated. TLD measurements were made in a polymethyl methacrylate (PMMA) phantom of dimensions 25 cm x 20 cm x 5 cm by means of LiF:Mg,Ti (TLD-100) dosimeters for distances of 1-10 cm for g(r), and the same distances at angles of 0-180 degrees for F(r, theta). Dose rate constant for 192Ir seed and wire were found to be 1.196+/-5 and 1.082+/-5% cGy h(-1) U(-1), respectively (1 U = unit of air Kerma strength = 1 microGy m2 h(-1) = 1 cGy cm2 h(-1)). The obtained results for g(r), G(r, theta) and F(r, theta) are also presented and discussed.     

192Ir在经介入近距离放疗的临床应用

探经介入途径的近距离放射治疗是利用介入放射技术开展的高精度近距离放射治疗,¹⁹²Ir作为一种最常用的放射源,在胆管内的近距离放疗以治疗恶性阻塞性黄疸（MOJ）的作用已被应用于临床,临床研究也已经证实了血管内放射治疗能使血管成形术后再狭窄得到很好的抑制,并能保持血管内支架通畅。本文就¹⁹²Ir在血管和胆道的近距离腔内放疗机制、临床应用加以综述。     

高剂量率后装192Ir源剂量测试研究进展

现代后装治疗大多采用HDR(高剂量率)微型192Ir源,其近源区剂量特性常用针点电离室、热释光剂量计测量,但ESR(电子自旋共振)胶片法测量的空间分辨率更高,可达156μm,而蒙特卡罗光子输运模拟方法是衡量测量准确度的金标准.用热释光剂量计进行直肠内剂量测量是预测直肠并发症发生率的良好指针.慢感光胶片测量193Ir源二维剂量分布精度可达1%,用基于MR(核磁共振)的凝胶剂量计测量192Ir源三维剂量分布准确度可达2.5%、空间分辨率达1.56mm,光学体层成像凝胶剂量计测量三维剂量分布具有独特的优势.     

Evaluation of Dosimetric Parameters for Various Ir Brachytherapy Sources Under Unbounded Phantom Geometry by Monte Carlo Simulation

As per TG-43 dose calculation formalism, it is essential to obtain various dosimetric parameters such as the air-kerma strength, dose rate constant, radial dose function, and anisotropy function, as they account for accurate determination of dose rate distribution around brachytherapy sources. Most of the available reported Monte Carlo simulations were performed in liquid water phantoms with a bounded region of 30-cm diameter. In this context, an attempt was made to report the dosimetric parameters for various commercially available pulsed-dose rate (PDR) and high-dose rate (HDR) sources under unbounded phantom conditions, as the data may be used as input to treatment planning systems (TPSs) for quality control assistance. The air-kerma strength per unit activity, S_k/A, was computed for various Iridium-192 (¹⁹²Ir) sources in dry air medium. The air-kerma strength and dose rate constant for old PDR is (9.77 ± 0.03) 10⁻⁸ U/Bq and 1.124 ± 0.001 cGyh⁻¹U⁻¹; for new PDR, the values are (9.96 ± 0.03) 10⁻⁸ U/Bq and 1.124 ± 0.001 cGyh⁻¹U⁻¹; for old MHDR, the values are (9.80 ± 0.01) 10⁻⁸ U/Bq and 1.115 ± 0.001 cGyh⁻¹U⁻¹; for new MHDR, (9.80 ± 0.01) 10⁻⁸ U/Bq and 1.112 ± 0.001cGyh⁻¹U⁻¹; for old VHDR, the values are (10.32 ± 0.01) 10⁻⁸ U/Bq and 1.035 ± 0.002 cGyh⁻¹U⁻¹; for new VHDR, the values are (10.34 ± 0.02) 10⁻⁸ U/Bq and 1.096 ± 0.001 cGyh⁻¹U⁻¹. The computed radial dose function values and anisotropy function values are also in good agreement with available data.     

Evaluation of Dosimetric Parameters for Various Ir Brachytherapy Sources Under Unbounded Phantom Geometry by Monte Carlo Simulation

As per TG-43 dose calculation formalism, it is essential to obtain various dosimetric parameters such as the air-kerma strength, dose rate constant, radial dose function, and anisotropy function, as they account for accurate determination of dose rate distribution around brachytherapy sources. Most of the available reported Monte Carlo simulations were performed in liquid water phantoms with a bounded region of 30-cm diameter. In this context, an attempt was made to report the dosimetric parameters for various commercially available pulsed-dose rate (PDR) and high-dose rate (HDR) sources under unbounded phantom conditions, as the data may be used as input to treatment planning systems (TPSs) for quality control assistance. The air-kerma strength per unit activity, S_k/A, was computed for various Iridium-192 (¹⁹²Ir) sources in dry air medium. The air-kerma strength and dose rate constant for old PDR is (9.77 ± 0.03) 10⁻⁸ U/Bq and 1.124 ± 0.001 cGyh⁻¹U⁻¹; for new PDR, the values are (9.96 ± 0.03) 10⁻⁸ U/Bq and 1.124 ± 0.001 cGyh⁻¹U⁻¹; for old MHDR, the values are (9.80 ± 0.01) 10⁻⁸ U/Bq and 1.115 ± 0.001 cGyh⁻¹U⁻¹; for new MHDR, (9.80 ± 0.01) 10⁻⁸ U/Bq and 1.112 ± 0.001cGyh⁻¹U⁻¹; for old VHDR, the values are (10.32 ± 0.01) 10⁻⁸ U/Bq and 1.035 ± 0.002 cGyh⁻¹U⁻¹; for new VHDR, the values are (10.34 ± 0.02) 10⁻⁸ U/Bq and 1.096 ± 0.001 cGyh⁻¹U⁻¹. The computed radial dose function values and anisotropy function values are also in good agreement with available data.     

Dosimetric characteristics of the <Superscript>192</Superscript>Ir high-dose-rate afterloading brachytherapy source

Purpose  

For the treatment of some cancerous tumors using brachytherapy, an American Association of Physicists in Medicine (AAPM) Task Group No. 43U1 report recommends that the dosimetric parameters of a new brachytherapy source must be determined in two experimental and Monte Carlo theoretical methods before using each new source clinically. This study presents the results of Monte Carlo calculations of the dosimetric parameters for a Ir2.A85-2 brachytherapy source design.     

Consistency of vendor-specified activity values for 192Ir brachytherapy sources

A long-term comparison was done between the manufacturer-stated ¹⁹²Ir activity and the measured ¹⁹²Ir activities determined with a well-type ionization chamber. Sources for a Nucletron Micro Selectron high-dose-rate (HDR) unit were used for this purpose. The radioactive sources reference activities were determined using a PTW well-type ionization chamber traceable to the National Institute of Standards and Technology Primary Calibration Laboratory. The measurements were taken in a period of 56 months with 17 different radioactive sources. The manufacturer stated activities were taken from the source calibration certificate provided by the manufacturer. These values were compared with the measured activities. The results have shown that both the percentage deviation of the monthly control measurements with the well-type chamber and the ratio between the measured activities to the manufacturer-stated value lie within ± 2.5%. These results were compared with similar published data and with uncertainty level (3% of the mean and 5% maximum deviation from mean) for brachytherapy sources calibration recommended by the AAPM. It was concluded that a threshold level of ±2.5% can be used as a suitable quality assurance indicator to spot problems in our department. The typical ±5% uncertainty as provided by the manufacturers may be tightened to ±3% to be more in line with published AAPM reports.     

Dosimetric study of Varian Universal Multi-Channel Cylinder System for High-Dose-Rate 192Ir Brachytherapy

PurposeRecently, the Varian multichannel vaginal cylinder (MCVC) set for high-dose-rate ¹⁹²Ir brachytherapy was commercially released. This MCVC was distinct from our existing MCVC in its peripheral channel layout and tip design. This investigation sought to assess the dosimetric impact of these changes.Methods and MaterialsThe dimensions of the virtual model for each applicator were compared against both physical and radiographic measurements. Volumetric dose distributions were generated in silico using a model-based dose calculation algorithm (MBDCA). To characterize the effects of the new peripheral channel layout on dose to adjacent areas (“dose-spill”), point doses were compared using two sets of applicator-based reference points: at surface or 5 mm radially from surface. To evaluate the dose-shaping capabilities, a dose distribution was generated for the new applicator and assessed against a representative dose distribution for a patient previously treated with existing equipment.ResultsBased on both physical and radiographic measurements, virtual models were representative of each applicator within ±1 mm. Commissioning of the MBDCA was benchmarked based on AAPM Working Group on Dose Calculation Algorithms in Brachytherapy. The layout of the new applicator reduced dose-spill to other reference points significantly, as much as a factor of 16.3, compared with the existing equipment. The rounded tip shape and curve of the peripheral channels in the new applicator produced more conformity to its HR-CTV than existing equipment.ConclusionsCompared with our existing equipment, the design changes in the new Varian MCVC set offered improved control of dose spill and better conformality to HR-CTV.     

Monte Carlo calculations of electrons in aluminum

The interaction of keV electrons with solids was studied by considering electrons transmitted through thin films as well as electrons backscattering from semi-infinite solid targets. The elastic scattering cross-section was obtained from the Rutherford differential cross-section. The numerical coefficient in the atomic screening parameter and spin-relativistic correction factor were taken as variables. The inelastic scattering model was employed to simulate the energy loss using Gryzinski's semi-empirical expression and Gryzinski and Liljequist models to calculate the total inelastic scattering cross-section. The simulation results were found to be in good agreement with other simulations and experiments.     

A quantitative three-dimensional dose attenuation analysis around Fletcher-Suit-Delclos due to stainless steel tube for high-dose-rate brachytherapy by Monte Carlo calculations

PurposeThe commercially available brachytherapy treatment-planning systems today, usually neglects the attenuation effect from stainless steel (SS) tube when Fletcher-Suit-Delclos (FSD) is used in treatment of cervical and endometrial cancers. This could lead to potential inaccuracies in computing dwell times and dose distribution. A more accurate analysis quantifying the level of attenuation for high-dose-rate (HDR) iridium 192 radionuclide (¹⁹²Ir) source is presented through Monte Carlo simulation verified by measurement.Methods and MaterialsIn this investigation a general Monte Carlo N-Particles (MCNP) transport code was used to construct a typical geometry of FSD through simulation and compare the doses delivered to point A in Manchester System with and without the SS tubing. A quantitative assessment of inaccuracies in delivered dose vs. the computed dose is presented. In addition, this investigation expanded to examine the attenuation-corrected radial and anisotropy dose functions in a form parallel to the updated AAPM Task Group No. 43 Report (AAPM TG-43) formalism. This will delineate quantitatively the inaccuracies in dose distributions in three-dimensional space. The changes in dose deposition and distribution caused by increased attenuation coefficient resulted from presence of SS are quantified using MCNP Monte Carlo simulations in coupled photon/electron transport. The source geometry was that of the Vari Source wire model VS2000. The FSD was that of the Varian medical system. In this model, the bending angles of tandem and colpostats are 15° and 120°, respectively. We assigned 10 dwell positions to the tandem and 4 dwell positions to right and left colpostats or ovoids to represent a typical treatment case. Typical dose delivered to point A was determined according to Manchester dosimetry system.Results and ConclusionsBased on our computations, the reduction of dose to point A was shown to be at least 3%. So this effect presented by SS–FSD systems on patient dose is of concern.     

High dose rate (192)Ir afterloading brachytherapy for cancer of the vagina

We report results of brachytherapy for carcinoma of the vagina, utilizing a Nucletron high dose rate system for Delclos Vaginal Applicators (cylinder) and Syed Template Applicators (interstitial). The linear quadratic (LQ) model was used to determine the optimum time-dose-fractionation schedules. Interstitial doses were determined at the isodose line that included gross tumour. Cylinder doses were determined either at the vaginal surface (5 cases), at 0.5 cm depth (5 cases), or at 1.0 cm depth (1 case). For the first treatment (n=19), interstitial templates were utilized in 8 patients and vaginal cylinders in 11. 11 patients received second treatments: 6 templates and 5 cylinders. The median dose of external beam radiation (n=15) was 40.0 Gy followed, after a median 23 day interval, by high dose rate brachytherapy (HDRB) of 4 fractions in 30-42 h; then a median interval gap of 25 days, followed by repeat HDRB. The median total fractionated HDRB dose per patient was 23.0 Gy (range: 6.9 Gy to 40.4 Gy; calculated low dose rate equivalent of 29.8 Gy). Tumour histologies included 14 squamous cell carcinomas, 2 adenocarcinomas, 2 melanomas, and 1 small cell tumour. Three patients experienced early brachytherapy-related complications (diarrhoea, dysuria and labial dermatitis). Three patients (15.8%) developed serious/late complications including ureteral stenosis, painful vaginal necrosis and small bowel obstruction. The first of these patients received 2 templates, the second a cylinder followed by a template and a cylinder, and the third a single cylinder. The 2 year progression-free survival was 39.3% (median 15.7 months), while the 2 year overall survival was 66.1% (median 29.9 months). (192)Ir afterloading HDRB is a feasible approach to women with vaginal cancer with acceptable toxicity and tumour response. Potential advantages include patient preference, outpatient cost-effectiveness in the case of cylinder technique, and no radiation exposure to hospital personnel. Long-term follow-up is needed to further assess late complications, and larger studies are needed to confirm our results.     

Experimental study and nuclear model calculations on the 192Os(p,n)192Ir reaction: Comparison of reactor and cyclotron production of the therapeutic radionuclide 192Ir.

In a search for an alternative route of production of the important therapeutic radionuclide (192)Ir (T(1/2)=78.83 d), the excitation function of the reaction (192)Os(p,n)(192)Ir was investigated from its threshold up to 20 MeV. Thin samples of enriched (192)Os were obtained by electrodeposition on Ni, and the conventional stacked-foil technique was used for cross section measurements. The experimental data were compared with the results of theoretical calculations using the codes EMPIRE-II and ALICE-IPPE. Good agreement was found with EMPIRE-II, but slightly less with the ALICE-IPPE calculations. The theoretical thick target yield of (192)Ir over the energy range E(p)=16-->8 MeV amounts to only 0.16MBq/muA.h. A comparison of the reactor and cyclotron production methods is given. In terms of yield and radionuclidic purity of (192)Ir the reactor method appears to be superior; the only advantage of the cyclotron method could be the higher specific activity of the product.