Air-kerma strength determination of a 169Yb high dose rate brachytherapy source

The increased demand for high dose rate (HDR) brachytherapy as an alternative to external beam radiotherapy has led to the introduction of a HDR brachytherapy isotope 169Yb. This source offers a dose rate similar to 192Ir HDR sources, at about one fourth the effective photon energy. This work presents the calibration of this source in terms of air-kerma strength, based on an adaptation of the current, National Institute of Standards and Technology traceable, in air measurement technique currently used for 192Ir HDR sources. Several additional measurement correction factors were required, including corrections for air scatter, air attenuation, and ion recombination. A new method 169Yb is introduced for determining the ion chamber calibration coefficient Nk(169Yb). An uncertainty analysis was also performed, indicating an overall measurement expanded uncertainty in the air-kerma strength (k=2) of 2.2%.

Primary calibration of coiled 103Pd brachytherapy sources

Coiled 103Pd brachytherapy sources have been developed by RadioMed Corporation for use as low-dose-rate (LDR) interstitial implants. The coiled sources are provided in integer lengths from 1 to 6 cm and address many common issues seen with traditional LDR brachytherapy sources. The current standard for determining the air-kerma strength (SK) of low-energy LDR brachytherapy sources is the National Institute of Standards and Technology's Wide-Angle Free-Air Chamber (NIST WAFAC). Due to geometric limitations, however, the NIST WAFAC is unable to determine the S(K) of sources longer than 1 cm. This project utilized the University of Wisconsin's Variable-Aperture Free-Air Chamber (UW VAFAC) to determine the S(K) of the longer coiled sources. The UW VAFAC has shown agreement in S(K) values of 1 cm length coils to within 1% of those determined with the NIST WAFAC, but the UW VAFAC does not share the same geometric limitations as the NIST WAFAC. A new source holder was constructed to hold the coiled sources in place during measurements with the UW VAFAC. Correction factors for the increased length of the sources have been determined and applied to the measurements. Using the new source holder and corrections, the S(K) of 3 and 6 cm coiled sources has been determined. Corrected UW VAFAC data and ionization current measurements from well chambers have been used to determine calibration coefficients for use in the measurement of 3 and 6 cm coiled sources in well chambers. Thus, the UW VAFAC has provided the first transferable, primary measurement of low-energy LDR brachytherapy sources with lengths greater than 1 cm.

Supplement to the 2004 update of the AAPM Task Group No. 43 Report

Since publication of the 2004 update to the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report (TG-43U1), several new low-energy photon-emitting brachytherapy sources have become available. Many of these sources have satisfied the AAPM prerequisites for routine clinical use as of January 10, 2005, and are posted on the Joint AAPM/RPC Brachytherapy Seed Registry. Consequently, the AAPM has prepared this supplement to the 2004 AAPM TG-43 update. This paper presents the AAPM-approved consensus datasets for these sources, and includes the following 125I sources: Amersham model 6733, Draximage model LS-1, Implant Sciences model 3500, IBt model 1251L, IsoAid model IAI-125A, Mentor model SL-125/ SH-125, and SourceTech Medical model STM1251. The Best Medical model 2335 103Pd source is also included. While the methodology used to determine these data sets is identical to that published in the AAPM TG-43U1 report, additional information and discussion are presented here on some questions that arose since the publication of the TG-43U1 report. Specifically, details of interpolation and extrapolation methods are described further, new methodologies are recommended, and example calculations are provided. Despite these changes, additions, and clarifications, the overall methodology, the procedures for developing consensus data sets, and the dose calculation formalism largely remain the same as in the TG-43U1 report. Thus, the AAPM recommends that the consensus data sets and resultant source-specific dose-rate distributions included in this supplement be adopted by all end users for clinical treatment planning of low-energy photon-emitting brachytherapy sources. Adoption of these recommendations may result in changes to patient dose calculations, and these changes should be carefully evaluated and reviewed with the radiation oncologist prior to implementation of the current protocol.

Monte Carlo aided design of an improved well-type ionization chamber for low energy brachytherapy sources

The determination of the air kerma strength of a brachytherapy seed is necessary for effective treatment planning. Well-type ionization chambers are used on site at therapy clinics to determine the air kerma strength of seeds. In this work, an improved well-type ionization chamber for low energy, low dose rate brachytherapy sources is designed using Monte Carlo transport calculations to aid in the design process. The design improvements are the elimination of the air density induced over-response effect seen in other air-communicating chambers for low energy photon sources, and a larger signal strength (response or current) for 103Pd and 125I based seeds. A prototype well chamber based on the Monte Carlo aided design but using graphite coated acrylic walls rather than the design basis air equivalent plastic (C-552) walls was constructed and experimentally evaluated. The prototype chamber produced an 85% stronger signal when measuring a commonly used 103Pd seed and a 26% stronger signal when measuring a commonly used 125I seed when compared to another commonly used well chamber. The normalized PTP corrected chamber response is, at most, 1.3% and 2.4% over unity for air densities/pressures corresponding to an elevation of 3048 m (10000 feet) above sea level for the commonly used 103Pd and 125I based seeds respectively. Comparing calculated and measured chamber responses for common 103Pd and 125I based brachytherapy seeds show agreement within 0.6% and 0.2%, respectively. We conclude that Monte Carlo transport calculations accurately model the response of this new well chamber and in general can be used to predict the response of well chambers. The prototype chamber built in this work responds as predicted by the Monte Carlo calculations.

Dosimetric prerequisites for routine clinical use of photon emitting brachytherapy sources with average energy higher than 50 keva)

This paper presents the recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Therapeutic Radiology and Oncology (ESTRO) on the dosimetric parameters to be characterized, and dosimetric studies to be performed to obtain them, for brachytherapy sources with average energy higher than 50 keV that are intended for routine clinical use. In addition, this document makes recommendations on procedures to be used to maintain vendor source strength calibration accuracy. These recommendations reflect the guidance of the AAPM and the ESTRO for its members, and may also be used as guidance to vendors and regulatory agencies in developing good manufacturing practices for sources used in routine clinical treatments.

Calculated and measured brachytherapy dosimetry parameters in water for the Xoft Axxent X-Ray Source: An electronic brachytherapy sourcea)

A new x-ray source, the model S700 Axxent X-Ray Source (Source), has been developed by Xoft Inc. for electronic brachytherapy. Unlike brachytherapy sources containing radionuclides, this Source may be turned on and off at will and may be operated at variable currents and voltages to change the dose rate and penetration properties. The in-water dosimetry parameters for this electronic brachytherapy source have been determined from measurements and calculations at 40, 45, and 50 kV settings. Monte Carlo simulations of radiation transport utilized the MCNP5 code and the EPDL97-based mcplib04 cross-section library. Inter-tube consistency was assessed for 20 different Sources, measured with a PTW 34013 ionization chamber. As the Source is intended to be used for a maximum of ten treatment fractions, tube stability was also assessed. Photon spectra were measured using a high-purity germanium (HPGe) detector, and calculated using MCNP. Parameters used in the two-dimensional (2D) brachytherapy dosimetry formalism were determined. While the Source was characterized as a point due to the small anode size, < 1 mm, use of the one-dimensional (1D) brachytherapy dosimetry formalism is not recommended due to polar anisotropy. Consequently, 1D brachytherapy dosimetry parameters were not sought. Calculated point-source model radial dose functions at gP(5) were 0.20, 0.24, and 0.29 for the 40, 45, and 50 kV voltage settings, respectively. For 1<r<7 cm, measured point-source model radial dose functions were typically within 4% of calculated results. Calculated values for F(r, theta) for all operating voltages were within 15% of unity along the distal end (theta=0 degree), and ranged from F(1 cm, 160 degrees) = 0.2 to F(15 cm, 175 degrees) = 0.4 towards the catheter proximal end. For all three operating voltages using the PTW chamber, measured dependence of output as a function of azimuthal angle, psi, was typically on average +/-3% for 0 degree < or = psi < or = 360 degrees. Excluding an energy response function, measurements of normalized photon energy spectra were made for three operating voltages, and were typically within 2% agreement with the normalized Monte Carlo calculated spectra. In general, the model S700 Source exhibited depth dose behavior similar to low-energy photon-emitting low dose rate sources 125I and l03Pd, yet with capability for variable and much higher dose rates and subsequently adjustable penetration capabilities. This paper presents the calculated and measured in-water brachytherapy dosimetry parameters for the model S700 Source at the aforementioned three operating voltages.

Calibration of multiple LDR brachytherapy sources

A trend is underway toward the use of prepackaged low dose rate brachytherapy sources, which come in the form of strands, coiled line sources, preloaded needles, and sterile cartridge packs. Since the medical physicist is responsible for verification of source strength prior to patient treatment, development of prepackaged source strength verification methods is needed. Existing guidelines are reviewed to establish the situation that medical physicists find with respect to prepackaged sources. This investigation presents an experimental evaluation of the effect of some of these multiseed geometries on source strength measurements. Multiseed strands and coils, whether 125I, 103Pd, or 192Ir can be measured in a chamber with a long, sensitive axial length with a uniform response. Sterile seed cartridge packs can also be measured but require a correction factor to be applied. Sources in needles, however, cannot be measured in the needle since there is too great a variation in needle composition and needle tolerance thickness. Removing these seeds from the needle into a sterile measurement insert, which maintains sterility is a practical source strength verification method, similar to those done for multiple seed configurations in a well chamber with adequate axial uniformity. Values are compared with individual air kerma strength calibrations, and correction factors, are presented' where needed. In each case, care must be taken to maintain sterility as multiple seeds are measured in well chamber inserts.

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.