Monte Carlo dosimetric study of the BEBIG Co-60 HDR source

Although not as widespread as Ir-192, Co-60 is also available on afterloading equipment devoted to high dose rate brachytherapy, mainly addressed to the treatment of gynaecological lesions. The purpose of this study is to obtain the dosimetric parameters of the Co-60 source used by the BEBIG MultiSource remote afterloader (BEBIG GmbH, Germany) for which there are no dosimetric data available in the literature. The Monte Carlo code GEANT4 has been used to obtain the TG43 parameters and the 2D dose rate table in Cartesian coordinates of the BEBIG Co-60 HDR source. The dose rate constant, radial dose function and anisotropy function have been calculated and are presented in a tabular form as well as a detailed 2D dose rate table in Cartesian coordinates. These dosimetric datasets can be used as input data and to validate the treatment planning system calculations.     

Dose distribution for endovascular brachytherapy using Ir-192 sources: comparison of Monte Carlo calculations with radiochromic film measurements

An analysis of Ir-192 source distribution using the Monte Carlo method and radiochromic film experiments for endovascular brachytherapy is presented. Three different source possibilities, namely, mHDR Ir-192 sources with 5 mm and 2.5 mm step sizes and Ir-192 seed sources with 1 mm air gap are investigated to obtain uniform radial dose distribution throughout the treatment area. From this study, it is inferred that mHDR Ir-192 sources with 2.5 mm step size are effective for getting dose uniformity. Hence, different restenosis geometries, namely, linear, dumb bell and hairpin, are simulated with 2.5 mm step size, 15 mHDR Ir-192 sources using the Monte Carlo technique and the results are compared experimentally by using radiochromic films. The results from both methods agreed to within 7%. Further, it is also inferred that for the dosimetry of endovascular brachytherapy, the film dosimetry may be considered adequate, even if the film calibration is time consuming and requires adequate dosimetric procedures.     

Monte Carlo study of the dose rate distributions for the Ir2.A85-2 and Ir2.A85-1 Ir-192 afterloading sources

The two most commonly used modalities of cancer treatment in clinical brachytherapy practice today are high dose rate (HDR) and pulsed dose rate (PDR) brachytherapy. In a clinical treatment, quality dose rate distribution data sets of the brachytherapy sources are required for each source model. The purpose of this study is to obtain detailed dose rate distributions around the new BEBIG HDR and PDR Ir-192 brachytherapy sources. These distributions will then be used as input data in the treatment planning systems dedicated to brachytherapy and its calculations can be verified. The Monte Carlo method was used to obtain the dose rate distributions around the sources studied, taking into account the AAPM-ESTRO recent recommendations. A complete dosimetric data set for the BEBIG Ir-192 HDR and PDR sources, types Ir2.A85-2 and Ir2.A85-1, were obtained. This dosimetric data set is composed of the TG-43 dosimetric functions and parameters and along-away dose rate table to facilitate quality control of treatment planning systems.     

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.     

Conversion from Cs-137 to Ir-192 for high dose rate remote afterloading: practical considerations.

High dose rate (HDR) remote afterloading is increasingly being used to replace many conventional low dose rate (LDR) brachytherapy procedures. Implementation of the microSelectron-HDR with Ir-192 at our facility necessitated this study to obtain equivalent dosimetric distributions with those of our LDR Cs-137 techniques using our current treatment planning system. Three anatomical sites are presented: nasopharynx, esophagus, and uterine cervix. Attention must be given to the anisotropy of Cs-137 tubes when converting to Ir-192; for linear geometries, total equivalent activity may be preserved but the shapes of the resulting isodose curves for Ir-192 are longer than those of Cs-137. In the case of Fletcher-Suit intracavitary treatments of the uterine cervix, the longer contours for Ir-192 in the vaginal ovoids results in higher isodose levels reaching the bladder and rectum. Maintaining the traditional dose levels to these organs is accomplished by modifying the loading of the ovoids to approximately 85% of the corresponding Cs-137 activity. Computerized dosimetry is presented, along with a chart we have devised to easily convert a standard LDR treatment to HDR dwell times. Our results are especially suitable to those users who will continue to make use of their present computer treatment planning system.     

Phantom size in brachytherapy source dosimetric studies

An important point to consider in a brachytherapy dosimetry study is the phantom size involved in calculations or experimental measurements. As pointed out by Williamson [Med. Phys. 18, 776-786 (1991)] this topic has a relevant influence on final dosimetric results. Presently, one-dimensional (1-D) algorithms and newly-developed 3-D correction algorithms are based on physics data that are obtained under full scatter conditions, i.e., assumed infinite phantom size. One can then assume that reference dose distributions in source dosimetry for photon brachytherapy should use an unbounded phantom size rather than phantom-like dimensions. Our aim in this paper is to study the effect of phantom size on brachytherapy for radionuclide 137Cs, 192Ir, 125I and 103Pd, mainly used for clinical purposes. Using the GEANT4 Monte Carlo code, we can ascertain effects on derived dosimetry parameters and functions to establish a distance dependent difference due to the absence of full scatter conditions. We have found that for 137Cs and 192Ir, a spherical phantom with a 40 cm radius is the equivalent of an unbounded phantom up to a distance of 20 cm from the source, as this size ensures full scatter conditions at this distance. For 125I and 103Pd, the required radius for the spherical phantom in order to ensure full scatter conditions at 10 cm from the source is R = 15 cm. A simple expression based on fits of the dose distributions for various phantom sizes has been developed for 137Cs and 192Ir in order to compare the dose rate distributions published for different phantom sizes. Using these relations it is possible to obtain radial dose functions for unbounded medium from bounded phantom ones.     

Dosimetric characteristics of a linear array of gamma or beta-emitting seeds in intravascular irradiation: Monte Carlo studies for the AAPM TG-43/60 formalism

In principle, the AAPM TG-43/60 formalism for intravascular brachytherapy (IVBT) dosimetry of catheter-based sources is fully valid with a single seed of cylindrical symmetry and in the region comparable to or larger than the mean-free path of emitting radiation. However, for the geometry of a linear array of seeds within the few millimeter range of interest in IVBT, the suitability of the AAPM TG-43/60 formalism has not been fully addressed yet. We have meticulously investigated the dosimetric characteristics of catheter-based gamma (192Ir) and beta (90Sr/Y) sources using Monte Carlo methods before applying the AAPM TG-43/60 formalism. The dosimetric perturbation due to radiation interactions with neighboring seeds is at most 2% over the entire region of interest for the 192Ir source, while it increases to about 5% for the 90Sr/Y source. As the transaxial distance (y) increases beyond 3 mm, the sum of the dose contributions from neighboring seeds exceeds the dose contribution from the center seed for both sources. However, it continues to increase with the increasing y for 192Ir but is saturated beyond y = 5 mm for 9Sr/Y. Even within a few millimeters from the seeds, the dose from the low-energy betas of 192Ir is still less than 1% of the total dose. The radial dose and anisotropy functions are reformulated in reduced cylindrical coordinate with the reference point at y = 2 mm. The dose rate constant of 192Ir and the dose rate of 90Sr/Y at the reference point showed a fairly good agreement (within +/- 2%) with earlier studies and the NIST-traceable value, respectively. We conclude that the dosimetric perturbation caused by close proximity of neighboring seeds is nearly negligible so that the AAPM TG-43/60 formalism can be applied to a linear array of seeds.     

Dose rate calculations around 192Ir brachytherapy sources using a Sievert integration model

The classical Sievert integral method is a valuable tool for dose rate calculations around brachytherapy sources, combining simplicity with reasonable computational times. However, its accuracy in predicting dose rate anisotropy around 192Ir brachytherapy sources has been repeatedly put into question. In this work, we used a primary and scatter separation technique to improve an existing modification of the Sievert integral (Williamson's isotropic scatter model) that determines dose rate anisotropy around commercially available 192Ir brachytherapy sources. The proposed Sievert formalism provides increased accuracy while maintaining the simplicity and computational time efficiency of the Sievert integral method. To describe transmission within the materials encountered, the formalism makes use of narrow beam attenuation coefficients which can be directly and easily calculated from the initially emitted 192Ir spectrum. The other numerical parameters required for its implementation, once calculated with the aid of our home-made Monte Carlo simulation code, can be used for any 192Ir source design. Calculations of dose rate and anisotropy functions with the proposed Sievert expression, around commonly used 192Ir high dose rate sources and other 192Ir elongated source designs, are in good agreement with corresponding accurate Monte Carlo results which have been reported by our group and other authors.     

Treatment planning dosimetric parameters for 192Ir seed at short distances: effects of air channels and neighboring seeds based on Monte Carlo study

The dose distributions around two different arrangements of a single radioactive 192Ir seed in water, (1) with air channels at the ends, and (2) surrounded by two nonactive ("dummy") seeds on both longitudinal ends, were calculated using MCNP4C Monte Carlo simulations at distances up to 1 cm. The contributions from beta particles and electrons emitted by 192Ir were included in the calculations. The effects of (a) the air channels at the seed ends and (b) the interference effect of the dummy seeds on the dose distribution were quantified and compared. It was found that the dummy seeds do not cause significant dose reduction for radial distances beyond 0.05 cm from the seed center. It is decided to report the dose rate values and the dosimetric parameters in TG43 format for a single seed with air channels for use in treatment planning computer systems. The dose rate constant (at 1 cm) of 192Ir seed, lambda, is 1.108 cGyU(-1) h(-1). The values of radial dose function, g(r), are within 1% from the TG43 recommended polynomial fit, except for distances within 0.08 cm. The anisotropy function, F(r, theta), attains large values near the seed ends and shallow angles (up to 8), as well as many values greater than 2 at the 20 degrees polar angle. Treatment planning systems involving intravascular brachytherapy do not compromise the accuracy for dosimetry of multiple seed trains by summing single seed values in water.     

A standard dosimetry procedure for 192Ir sources used for endovascular brachytherapy

The experimental dosimetry of a high dose rate (HDR) 192Ir source used for the brachytherapy of peripheral vessels is reported. The direct determination of the reference air kerma rate Kr agrees, within the experimental uncertainty, with the results obtained by a well ionization chamber calibrated at the NIST and the manufacturer's certification. A highly sensitive (HS) radiochromic film (RCF), that presents only one active layer, was used for the source dosimetry in a water phantom. The adopted experimental set-up, with the source in its catheter positioned on the RCF plane, seems to have given better accuracy of the RCF optical density measurements. The agreement between the measurement of the dose rate constant DKr (10 mm, pi/2) and the literature data confirmed the coherence of the HS RCF calibration obtained by the kerma in air measurements. The RCF measurements supplied dosimetric information about the dose to water per reference air kerma rate D(r, theta)/Kr along the source transverse bisector axis, the radial dose function g(r) and the anisotropy function F(r, theta). The value D(2 mm, pi/2)/Kr = 22.4 +/- 1.2 cGy h(-1)/(microGy h(-1)) is supplied with a dose uncertainty that is essentially due to the indeterminacy of the source position in the catheter. The data of the radial and anisotropy functions have been compared with Monte Carlo determinations reported in the literature.     

Monte Carlo calculated TG-43 dosimetry parameters for the SeedLink 125Iodine brachytherapy system

The SeedLink brachytherapy system is comprised from an assembly of I-Plant 3500 interstitial brachytherapy seeds and bioresorbable spacers joined together by a 6-mm-long titanium sleeve centered over each seed. This device is designed to maintain specified spacing between seeds during treatment thereby decreasing implant preparation time and reducing radionuclide migration within the prostate and periprostatic region. Reliable clinical treatment and planning applications necessitate accurate dosimetric data for source evaluation, therefore the authors report the results of a Monte Carlo study designed to calculate the AAPM Task Group Report No. 43 dosimetric parameters for the SeedLink brachytherapy source and compare these values against previously published Monte Carlo study results of the I-Plant 3500 brachytherapy seed. For this investigation, a total of 1 x 10(9) source photon histories were processed for each set of in-water and in-air calculations using the MCNP4C2 Monte Carlo radiation transport code (RSICC). Statistically, the radial dose function, g(r), and the dose-rate constant, lambda, were identical to the values calculated previously for the Model 3500 with the dose-rate constant evaluated to be lambda = 1.000+/-0.026 cGyh(-1) U(-1). The titanium sleeve used in SeedLink to bind together Model 3500 seeds and spacers resulted in slightly greater dosimetric anisotropy as exhibited in the anisotropy function, F(r, theta), the anisotropy factor, phi(an) (r), and the anisotropy constant, phi(an), which was calculated to be phi(an) = 0.91 +/- 0.01, or roughly 2% lower than the value calculated previously for the Model 3500. These results indicate that the radiological characteristics of the SeedLink dosimetry system are comparable to those obtained for previously characterized single seeds such as the Implant Sciences Model 3500 I-Plant seed.     

A dosimetric comparison of 169Yb versus 192Ir for HDR prostate brachytherapy

For the purpose of evaluating the use of 169Yb for prostate High Dose Rate brachytherapy (HDR), a hypothetical 169Yb source is assumed with the exact same design of the new microSelectron source replacing the 192Ir active core by pure 169Yb metal. Monte Carlo simulation is employed for the full dosimetric characterization of both sources and results are compared following the AAPM TG-43 dosimetric formalism. Monte Carlo calculated dosimetry results are incorporated in a commercially available treatment planning system (SWIFT), which features an inverse treatment planning option based on a multiobjective dose optimization engine. The quality of prostate HDR brachytherapy using the real 192Ir and hypothetical 169Yb source is compared in a comprehensive analysis of different prostate implants in terms of the multiobjective dose optimization solutions as well as treatment quality indices such as Dose Volume Histograms (DVH) and the Conformal Index (COIN). Given that scattering overcompensates for absorption in intermediate photon energies and distances in the range of interest to prostate HDR brachytherapy, 169Yb proves at least equivalent to 192Ir irrespective of prostate volume. This has to be evaluated in view of the shielding requirements for the 169Yb energies that are minimal relative to that for 192Ir.     

Two-dimensional dosimetry in the near field of the model 200 103Pd source for interstitial brachytherapy implants using a thermoluminescent sheet

A large area and highly sensitive thermoluminescent (TL) sheet film was used for two-dimensional dose distribution measurements at millimetre distances from a 103Pd interstitial brachytherapy source. The TL film is made of Teflon homogeneously mixed with small particles of thermoluminescent material (BaSO4: Eu doped). This TL sheet (5 cm x 5 cm) was used to determine the relative dosimetric characteristics (i.e., radial dose function, 2D and 1D anisotropy functions, as defined by the updated AAPM Task Group No 43 report) of the model 200 103Pd source that emits low energy photons (21 keV). The two-dimensional dosimetry data were obtained for distances from the source surface to 15 mm. The radial dose function measured with the TL sheet is in reasonable agreement within 11% with the values recommended in the updated AAPM TG-43 report. All the measured 2D dose distributions showed limited symmetry about the source axes. The differences between the 1D anisotropy function values measured with the TL sheet and the data recommended in the updated AAPM TG-43 report were 10% at 5 mm and 7.5% at 10 mm, respectively, for the model 200 103Pd seed. Our experiments have demonstrated that it is feasible to use the TL sheet as a dosimeter in the determination of the dosimetric characteristics in the immediate vicinity of interstitial brachytherapy sources emitting low energy photons.     

In vivo dosimeters for HDR brachytherapy: a comparison of a diamond detector, MOSFET, TLD, and scintillation detector

The large dose gradients in brachytherapy necessitate a detector with a small active volume for accurate dosimetry. The dosimetric performance of a novel scintillation detector (BrachyFOD) is evaluated and compared to three commercially available detectors, a diamond detector, a MOSFET, and LiF TLDs. An 192Ir HDR brachytherapy source is used to measure the depth dependence, angular dependence, and temperature dependence of the detectors. Of the commercially available detectors, the diamond detector was found to be the most accurate, but has a large physical size. The TLDs cannot provide real time readings and have depth dependent sensitivity. The MOSFET used in this study was accurate to within 5% for distances of 20 to 50 mm from the 192Ir source in water but gave errors of 30%-40% for distances greater than 50 mm from the source. The BrachyFOD was found to be accurate to within 3% for distances of 10 to 100 mm from an HDR 192Ir brachytherapy source in water. It has an angular dependence of less than 2% and the background signal created by Cerenkov radiation and fluorescence of the plastic optical fiber is insignificant compared to the signal generated in the scintillator. Of the four detectors compared in this study the BrachyFOD has the most favorable combination of characteristics for dosimetry in HDR brachytherapy.     

A Monte Carlo investigation of the dosimetric characteristics of the VariSource 192Ir high dose rate brachytherapy source.

An analytical Monte Carlo simulation code, incorporating in detail source construction and dimensions, was used to investigate the dosimetric characteristics of the VariSource 192Ir high dose rate brachytherapy source. Dose-rate constant, radial dose functions, and anisotropy functions, utilized in the AAPM Task Group 43 dose estimation formalism, were calculated with the source centered in a spherical water phantom of 30 cm in diameter. The results, which are in agreement with the corresponding data available in the literature, are compared to those obtained in our previous study for the widely used microSelectron 192Ir high dose-rate brachytherapy source. The dose-rate constant was found to be equal to 1.043 +/- 0.005 cGy h(-1) U(-1) for the VariSource, compared to a value of 1.116 +/- 0.006 cGy h(-1) U(-1) calculated for the microSelectron. Significant differences in the anisotropy of the two sources are observed only for polar angles close to their long axis and are due to their different dimensions.     

Experimental determination of the TG-43 dosimetric characteristics of EchoSeed model 6733 I25I brachytherapy source

Recently an improved design of a 125I brachytherapy source has been introduced for interstitial seed implants, particularly for prostate seed implants. This design improves the in situ ultrasound visualization of the source compared to the conventional seed. In this project, the TG-43 recommended dosimetric characteristics of the new brachytherapy source have been experimentally determined in Solid Water phantom material. The measured dosimetric characteristics of the new source have been compared with data reported in the literature for other source designs. The measured dose rate constant, A, in Solid Water was multiplied by 1.05 to extract the dose rate constant in water. The dose rate constant of the new source in water was found to be 0.99 +/- 8% cGy h(-1) U(-1). The radial dose function was measured at distances between 0.5 and 10 cm using LiF TLDs in Solid Water phantom. The anisotropy function, F(r, theta), was measured at distances of 2, 3, 5, and 7 cm.     

Dose calculation formalisms and consensus dosimetry parameters for intravascular brachytherapy dosimetry: recommendations of the AAPM Therapy Physics Committee Task Group No. 149

Since the publication of AAPM Task Group 60 report in 1999, a considerable amount of dosimetry data for the three coronary brachytherapy systems in use in the United States has been reported. A subgroup, Task Group 149, of the AAPM working group on Special Brachytherapy Modalities (Bruce Thomadsen, Chair) was charged to develop recommendations for dose calculation formalisms and the related consensus dosimetry parameters. The recommendations of this group are presented here. For the Cordis 192Ir and Novoste 90Sr/90Y systems, the original TG-43 formalism in spherical coordinates should be used along with the consensus values of the dose rate constant, geometry function, radial dose function, and anisotropy function for the single seeds. Contributions from the single seeds should be added linearly for the calculation of dose distributions from a source train. For the Guidant 32P wire system, the modified TG-43 formalism in cylindrical coordinates along with the recommended data for the 20 and 27 mm wires should be used. Data tables for the 6, 10, 14, 18, and 22 seed trains of the Cordis system, 30, 40, and 60 mm seed trains of the Novoste system, and the 20 and 27 mm wires of the Guidant system are presented along with our rationale and methodology for selecting the consensus data. Briefly, all available datasets were compared with each other and the consensus dataset was either an average of available data or the one obtained from the most densely populated study; in most cases this was a Monte Carlo calculation.     

Experimental determination of dosimetric characterization of a newly designed encapsulated interstitial brachytherapy source of 103Pd-model Pd-1

A newly designed encapsulated 103Pd source has been introduced (BrachySeed-Pd-103, also named Model Pd-1, manufactured by DRAXIMAGE Inc. and distributed by Cytogen Corp.) for interstitial brachytherapy to provide more isotropic dose distributions. In this work, the dosimetric characteristics of the 103Pd source were measured with micro LiF TLD chips and dosimetry parameters were characterized based upon the American Association of Physicists in Medicine (AAPM) Task Group No. 43 formalism. The dose rate constant of the sources was determined to be 0.66 +/-0.05 cGy h(-1) U(-1). The radial dose function was measured and was found to be similar to that of the Theragenics Model 200 103Pd source. The anisotropy constant for the Model Pd-1 source was determined to be 1.03.     

Experimental and theoretical determination of dosimetric characteristics of IsoAid ADVANTAGE 125I brachytherapy source

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, the ADVANTAGE 125I, Model IAI-125, source became commercially available for interstitial brachytherapy treatment. Dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined, following the AAPM Task Group 43 recommendations. Derivation of the dose rate constant was based on recent NIST WAFAC calibration performed in accordance with their 1999 standard. Measurements were performed in Solid Water phantom using LiF thermoluminescent dosimeters. The theoretical calculations were performed in both Solid Water and water using the PTRAN Monte Carlo code. The results indicated that a dose rate constant of the new source in water was 0.98 +/- 0.03 cGy h(-1) U(-1). The radial dose function of the new source was measured in Solid Water and calculated both in water and Solid Water at distances up to 10.0 cm. The anisotropy function, F(r, theta), of the new source was measured and calculated in Solid Water at distances of 2 cm, 3 cm, 5 cm, and 7 cm and also was calculated in water at distances ranging from 1 cm to 7 cm from the source. From the anisotropy function, the anisotropy factors and anisotropy constant were derived. The anisotropy constant of the ADVANTAGE 125I source in water was found to be 0.97 +/- 0.03. The dosimetric characteristics of this new source compared favorably with those from the Amersham Health Model 6711 source. Complete dosimetric parameters of the new source are presented in this paper.