1
|
Kalinowski J, Enger SA. RapidBrachyTG43: A Geant4-based TG-43 parameter and dose calculation module for brachytherapy dosimetry. Med Phys 2024; 51:3746-3757. [PMID: 38252746 DOI: 10.1002/mp.16948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The AAPM TG-43U1 formalism remains the clinical standard for dosimetry of low- and high-energy γ $\gamma$ -emitting brachytherapy sources. TG-43U1 and related reports provide consensus datasets of TG-43 parameters derived from various published measured data and Monte Carlo simulations. These data are used to perform standardized and fast dose calculations for brachytherapy treatment planning. PURPOSE Monte Carlo TG-43 dosimetry parameters are commonly derived to characterize novel brachytherapy sources. RapidBrachyTG43 is a module of RapidBrachyMCTPS, a Monte Carlo-based treatment planning system, designed to automate this process, requiring minimal user input to prepare Geant4-based Monte Carlo simulations for a source. RapidBrachyTG43 may also perform a TG-43 dose to water-in-water calculation for a plan, substantially accelerating the same calculation performed using RapidBrachyMCTPS's Monte Carlo dose calculation engine. METHODS TG-43 parametersS K / A $S_K/A$ , Λ $\Lambda$ ,g L ( r ) $g_L(r)$ , andF ( r , θ ) $F(r,\theta)$ were calculated using three commercial source models, one each of125 $^{125}$ I,192 $^{192}$ Ir, and60 $^{60}$ Co, and were benchmarked to published data. TG-43 dose to water was calculated for a clinical breast brachytherapy plan and was compared to a Monte Carlo dose calculation with all patient tissues, air, and catheters set to water. RESULTS TG-43 parameters for the three simulated sources agreed with benchmark datasets within tolerances specified by the High Energy Brachytherapy Dosimetry working group. A gamma index comparison between the TG-43 and Monte Carlo dose-to-water calculations with a dose difference and difference to agreement criterion of 1%/1 mm yielded a 98.9% pass rate, with all relevant dose volume histogram metrics for the plan agreeing within 1%. Performing a TG-43-based dose calculation provided an acceleration of dose-to-water calculation by a factor of 165. CONCLUSIONS Determination of TG-43 parameter data for novel brachytherapy sources may now be facilitated by RapidBrachyMCTPS. These parameter datasets and existing consensus or published datasets may also be used to determine the TG-43 dose for a plan in RapidBrachyMCTPS.
Collapse
Affiliation(s)
- Jonathan Kalinowski
- Medical Physics Unit, Faculty of Medicine, Department of Oncology, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| | - Shirin A Enger
- Medical Physics Unit, Faculty of Medicine, Department of Oncology, McGill University, Montréal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada
| |
Collapse
|
2
|
Berumen F, Ouellet S, Enger S, Beaulieu L. Aleatoric and epistemic uncertainty extraction of patient-specific deep learning-based dose predictions in LDR prostate brachytherapy. Phys Med Biol 2024; 69:085026. [PMID: 38484398 DOI: 10.1088/1361-6560/ad3418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Objective.In brachytherapy, deep learning (DL) algorithms have shown the capability of predicting 3D dose volumes. The reliability and accuracy of such methodologies remain under scrutiny for prospective clinical applications. This study aims to establish fast DL-based predictive dose algorithms for low-dose rate (LDR) prostate brachytherapy and to evaluate their uncertainty and stability.Approach.Data from 200 prostate patients, treated with125I sources, was collected. The Monte Carlo (MC) ground truth dose volumes were calculated with TOPAS considering the interseed effects and an organ-based material assignment. Two 3D convolutional neural networks, UNet and ResUNet TSE, were trained using the patient geometry and the seed positions as the input data. The dataset was randomly split into training (150), validation (25) and test (25) sets. The aleatoric (associated with the input data) and epistemic (associated with the model) uncertainties of the DL models were assessed.Main results.For the full test set, with respect to the MC reference, the predicted prostateD90metric had mean differences of -0.64% and 0.08% for the UNet and ResUNet TSE models, respectively. In voxel-by-voxel comparisons, the average global dose difference ratio in the [-1%, 1%] range included 91.0% and 93.0% of voxels for the UNet and the ResUNet TSE, respectively. One forward pass or prediction took 4 ms for a 3D dose volume of 2.56 M voxels (128 × 160 × 128). The ResUNet TSE model closely encoded the well-known physics of the problem as seen in a set of uncertainty maps. The ResUNet TSE rectum D2cchad the largest uncertainty metric of 0.0042.Significance.The proposed DL models serve as rapid dose predictors that consider the patient anatomy and interseed attenuation effects. The derived uncertainty is interpretable, highlighting areas where DL models may struggle to provide accurate estimations. The uncertainty analysis offers a comprehensive evaluation tool for dose predictor model assessment.
Collapse
Affiliation(s)
- Francisco Berumen
- Service de Physique Médicale et de Radioprotection, Centre Intégré de Cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Quebec, Quebec, Canada
- Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Quebec, Quebec, Canada
| | - Samuel Ouellet
- Service de Physique Médicale et de Radioprotection, Centre Intégré de Cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Quebec, Quebec, Canada
- Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Quebec, Quebec, Canada
| | - Shirin Enger
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Luc Beaulieu
- Service de Physique Médicale et de Radioprotection, Centre Intégré de Cancérologie, CHU de Québec-Université Laval et Centre de recherche du CHU de Québec, Quebec, Quebec, Canada
- Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Quebec, Quebec, Canada
| |
Collapse
|
3
|
Antunes PCG, Siqueira PDTD, Shorto JMB, Yoriyaz H. Heterogeneous physical phantom for I-125 dose measurements and dose-to-medium determination. Brachytherapy 2024; 23:73-84. [PMID: 38016863 DOI: 10.1016/j.brachy.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE In this paper we present a further step in the implementation of a physical phantom designed to generate sets of "true" independent reference data as requested by TG-186, intending to address and mitigate the scarcity of experimental studies on brachytherapy (BT) validation in heterogeneous media. To achieve this, we incorporated well-known heterogeneous materials into the phantom in order to perform measurements of 125I dose distribution. The work aims to experimentally validate Monte Carlo (MC) calculations based on MBDCA and determine the conversion factors from LiF response to absorbed dose in different media, using cavity theory. METHODS AND MATERIALS The physical phantom was adjusted to incorporate tissue equivalent materials, such as: adipose tissue, bone, breast and lung with varying thickness. MC calculations were performed using MCNP6.2 code to calculate the absorbed dose in the LiF and the dose conversion factors (DCF). RESULTS The proposed heterogeneous phantom associated with the experimental procedure carried out in this work yielded accurate dose data that enabled the conversion of the LiF responses into absorbed dose to medium. The results showed a maximum uncertainty of 6.92 % (k = 1), which may be considered excellent for dosimetry with low-energy BT sources. CONCLUSIONS The presented heterogeneous phantom achieves the required precision in dose evaluations due to its easy reproducibility in the experimental setup. The obtained results support the dose conversion methodology for all evaluated media. The experimental validation of the DCF in different media holds great significance for clinical procedures, as it can be applied to other tissues, including water, which remains a widely utilized reference medium in clinical practice.
Collapse
Affiliation(s)
- Paula Cristina Guimarães Antunes
- Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP, Sao Paulo, Brazil; Institute of Physics, University of Sao Paulo, Sao Paulo, Brazil.
| | | | | | - Hélio Yoriyaz
- Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP, Sao Paulo, Brazil
| |
Collapse
|
4
|
Guo H, Huang T, Dai Y, Fan Q, Zhang Y, He Y, Huang S, He X, Hu P, Chen G, Zhu W, Zhong Z, Liu D, Lu L, Zhang F. A Functional Stent Encapsulating Radionuclide in Temperature-Memory Spiral Tubes for Malignant Stenosis of Esophageal Cancer. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2307141. [PMID: 37929924 DOI: 10.1002/adma.202307141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/22/2023] [Indexed: 11/07/2023]
Abstract
Stent implantation is a commonly used palliative treatment for alleviating stenosis in advanced esophageal cancer. However, tissue proliferation induced by stent implantation and continuous tumor growth can easily lead to restenosis. Therefore, functional stents are required to relieve stenosis while inhibiting tissue proliferation and tumor growth, thereby extending the patency. Currently, no ideal functional stents are available. Here, iodine-125 (125 I) nuclides are encapsulated into a nickel-titanium alloy (NiTi) tube to develop a novel temperature-memory spiral radionuclide stent (TSRS). It has the characteristics of temperature-memory, no cold regions at the end of the stent, and a uniform spatial dose distribution. Cell-viability experiments reveal that the TSRS can reduce the proliferation of fibroblasts and tumor cells. TSRS implantation is feasible and safe, has no significant systemic radiotoxicity, and can inhibit in-stent and edge stenosis caused by stent-induced tissue proliferation in healthy rabbits. Moreover, TSRS can improve malignant stenosis and luminal patency resulting from continuous tumor growth in a VX2 esophageal cancer model. As a functional stent, the TSRS combines the excellent properties of NiTi with brachytherapy of the 125 I nuclide and will make significant contributions to the treatment of malignant esophageal stenosis.
Collapse
Affiliation(s)
- Huanqing Guo
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Tao Huang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Yi Dai
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Qichao Fan
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Yanling Zhang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Yao He
- Institute of Nuclear Physics and Chemistry, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Shuke Huang
- Institute of Machinery Manufacturing Technology, China Academy of Engineering Physics, Mianyang, 621900, P. R. China
| | - Xiaofeng He
- Vascular and Interventional Therapy Department, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, P. R. China
| | - Pan Hu
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Guanyu Chen
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Wenliang Zhu
- Department of Minimally Invasive & Interventional Radiology, Guangxi Medical University Cancer Hospital, Nanning, 530021, P. R. China
| | - Zhihui Zhong
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| | - Dengyao Liu
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
- Department of Interventional Radiology, Cancer Hospital Affiliated to Xinjiang Medical University, Urumqi, 830011, P. R. China
| | - Ligong Lu
- Zhuhai Interventional Medical Center, Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai, 519000, P. R. China
| | - Fujun Zhang
- Department of Minimally Invasive Intervention, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou, 510060, P. R. China
| |
Collapse
|
5
|
Oliver S, Giménez-Alventosa V, Berumen F, Gimenez V, Beaulieu L, Ballester F, Vijande J. Benchmark of the PenRed Monte Carlo framework for HDR brachytherapy. Z Med Phys 2023; 33:511-528. [PMID: 36509574 PMCID: PMC10751717 DOI: 10.1016/j.zemedi.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The purpose of this study is to validate the PenRed Monte Carlo framework for clinical applications in brachytherapy. PenRed is a C++ version of Penelope Monte Carlo code with additional tallies and utilities. METHODS AND MATERIALS Six benchmarking scenarios are explored to validate the use of PenRed and its improved bachytherapy-oriented capabilities for HDR brachytherapy. A new tally allowing the evaluation of collisional kerma for any material using the track length kerma estimator and the possibility to obtain the seed positions, weights and directions processing directly the DICOM file are now implemented in the PenRed distribution. The four non-clinical test cases developed by the Joint AAPM-ESTRO-ABG-ABS WG-DCAB were evaluated by comparing local and global absorbed dose differences with respect to established reference datasets. A prostate and a palliative lung cases, were also studied. For them, absorbed dose ratios, global absorbed dose differences, and cumulative dose-volume histograms were obtained and discussed. RESULTS The air-kerma strength and the dose rate constant corresponding to the two sources agree with the reference datatests within 0.3% (Sk) and 0.1% (Λ). With respect to the first three WG-DCAB test cases, more than 99.8% of the voxels present local (global) differences within ±1%(±0.1%) of the reference datasets. For test Case 4 reference dataset, more than 94.9%(97.5%) of voxels show an agreement within ±1%(±0.1%), better than similar benchmarking calculations in the literature. The track length kerma estimator scorer implemented increases the numerical efficiency of brachytherapy calculations two orders of magnitude, while the specific brachytherapy source allows the user to avoid the use of error-prone intermediate steps to translate the DICOM information into the simulation. In both clinical cases, only minor absorbed dose differences arise in the low-dose isodoses. 99.8% and 100% of the voxels have a global absorbed dose difference ratio within ±0.2% for the prostate and lung cases, respectively. The role played by the different segmentation and composition material in the bone structures was discussed, obtaining negligible absorbed dose differences. Dose-volume histograms were in agreement with the reference data. CONCLUSIONS PenRed incorporates new tallies and utilities and has been validated for its use for detailed and precise high-dose-rate brachytherapy simulations.
Collapse
Affiliation(s)
- Sandra Oliver
- Instituto de Seguridad Industrial, Radiofísica y Medioambiental (ISIRYM), Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain.
| | - Vicent Giménez-Alventosa
- Escuela de Ciencias, Ingeniería y Diseño, Universidad Europea de Valencia, Paseo de la Alameda 7, 46010 València, Spain; Instituto de Instrumentación para Imagen Molecular (I3M), Centro mixto CSIC - Universitat Politècnica de València, Camí de Vera s/n, 46022 València, Spain
| | - Francisco Berumen
- Département de Radio-Oncologie et Axe oncologie du Centre de recherche du CHU de Québec, CHU de Québec, Québec, QC, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, QC, Canada
| | - Vicente Gimenez
- Departament de Física Teórica and IFIC, Universitat de València-CSIC, Dr. Moliner, 50, 46100 Burjassot, València, Spain
| | - Luc Beaulieu
- Département de Radio-Oncologie et Axe oncologie du Centre de recherche du CHU de Québec, CHU de Québec, Québec, QC, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, QC, Canada
| | - Facundo Ballester
- Departamento de Física Atómica, Molecular y Nuclear. IRIMED, IIS-La Fe-Universitat de Valencia, 46100 Burjassot, Spain
| | - Javier Vijande
- Departamento de Física Atómica, Molecular y Nuclear. IRIMED, IIS-La Fe-Universitat de Valencia, 46100 Burjassot, Spain; Instituto de Física Corpuscular, IFIC (UV-CSIC), 46100 Burjassot, Spain
| |
Collapse
|
6
|
Akino Y, Shiomi H, Tsujimoto T, Hamatani N, Hirata T, Oda M, Takeshita A, Shimamoto H, Ogawa K, Murakami S. Inverse planning optimization with lead block effectively suppresses dose to the mandible in high-dose-rate brachytherapy for tongue cancer. Jpn J Radiol 2023; 41:1290-1297. [PMID: 37273111 PMCID: PMC10613594 DOI: 10.1007/s11604-023-01451-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE In this study, we developed in-house software to evaluate the effect of the lead block (LB)-inserted spacer on the mandibular dose in interstitial brachytherapy (ISBT) for tongue cancer. In addition, an inverse planning algorithm for LB attenuation was developed, and its performance in mandibular dose reduction was evaluated. METHODS Treatment plans of 30 patients with tongue cancer treated with ISBT were evaluated. The prescribed dose was 54 Gy/9 fractions. An in-house software was developed to calculate the dose distribution based on the American Association of Physicists in Medicine (AAPM) Task Group No.43 (TG-43) formalism. The mandibular dose was calculated with consideration of the LB attenuation. The attenuation coefficient of the lead was computed using the PHITS Monte Carlo simulation. The software further optimized the treatment plans using an attraction-repulsion model (ARM) to account for the LB attenuation. RESULTS Compared to the calculation in water, the D2 cc of the mandible changed by - 2.4 ± 2.3 Gy (range, - 8.6 to - 0.1 Gy) when the LB attenuation was considered. The ARM optimization with consideration of the LB resulted in a - 2.4 ± 2.4 Gy (range, - 8.2 to 0.0 Gy) change in mandibular D2 cc. CONCLUSIONS This study enabled the evaluation of the dose distribution with consideration of the LB attenuation. The ARM optimization with lead attenuation further reduced the mandibular dose.
Collapse
Affiliation(s)
- Yuichi Akino
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan.
| | - Hiroya Shiomi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Tomomi Tsujimoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Noriaki Hamatani
- Department of Medical Physics, Osaka Heavy-Ion Therapy Center, Osaka, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Michio Oda
- Department of Medical Technology, Osaka University Hospital, Suita, Osaka, Japan
| | - Ami Takeshita
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Hiroaki Shimamoto
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shumei Murakami
- Department of Oral and Maxillofacial Radiology, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| |
Collapse
|
7
|
Ogawa S, Yasui K, Hayashi N, Saito Y, Hayashi S. Impact of Dose Perturbations Around Brachytherapy Seeds in External-Beam Radiotherapy Planning: A Fundamental and Clinical Validation Using Treatment Planning System-Based Monte Carlo Simulations. Cureus 2023; 15:e48041. [PMID: 38046495 PMCID: PMC10689119 DOI: 10.7759/cureus.48041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Background This study evaluates dose perturbations caused by nonradioactive seeds in clinical cases by employing treatment planning system-based Monte Carlo (TPS-MC) simulation. Methodology We investigated dose perturbation using a water-equivalent phantom and 20 clinical cases of prostate cancer (10 cases with seeds and 10 cases without seeds) treated at Fujita Health University Hospital, Japan. First, dose calculations for a simple geometry were performed using the RayStation MC algorithm for a water-equivalent phantom with and without a seed. TPS-independent Monte Carlo (full-MC) simulations and film measurements were conducted to verify the accuracy of TPS-MC simulation. Subsequently, dose calculations using TPS-MC were performed on CT images of clinical cases of prostate cancer with and without seeds, and the dose distributions were compared. Results In clinical cases, dose calculations using MC simulations revealed hotspots around the seeds. However, the size of the hotspot was not correlated with the number of seeds. The maximum difference in dose perturbation between TPS-MC simulations and film measurements was 3.9%, whereas that between TPS-MC simulations and full-MC simulations was 3.7%. The dose error of TPS-MC was negligible for multiple beams or rotational irradiation. Conclusions Hotspots were observed in dose calculations using TPS-MC performed on CT images of clinical cases with seeds. The dose calculation accuracy around the seeds using TPS-MC simulations was comparable to that of film measurements and full-MC simulations, with differences within 3.9%. Although the clinical impact of hotspots occurring around the seeds is minimal, utilizing MC simulations on TPSs can be beneficial to verify their presence.
Collapse
Affiliation(s)
- Shuta Ogawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, JPN
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Keisuke Yasui
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Naoki Hayashi
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Yasunori Saito
- Division of Radiology, Fujita Health University Hospital, Toyoake, JPN
- School of Medical Sciences, Fujita Health University, Toyoake, JPN
| | - Shinya Hayashi
- Department of Radiation Oncology, Fujita Health University School of Medicine, Toyoake, JPN
| |
Collapse
|
8
|
Beaulieu L, Ballester F, Granero D, Tedgren ÅC, Haworth A, Lowenstein JR, Ma Y, Mourtada F, Papagiannis P, Rivard MJ, Siebert FA, Sloboda RS, Smith RL, Thomson RM, Verhaegen F, Fonseca G, Vijande J. AAPM WGDCAB Report 372: A joint AAPM, ESTRO, ABG, and ABS report on commissioning of model-based dose calculation algorithms in brachytherapy. Med Phys 2023; 50:e946-e960. [PMID: 37427750 DOI: 10.1002/mp.16571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/16/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023] Open
Abstract
The introduction of model-based dose calculation algorithms (MBDCAs) in brachytherapy provides an opportunity for a more accurate dose calculation and opens the possibility for novel, innovative treatment modalities. The joint AAPM, ESTRO, and ABG Task Group 186 (TG-186) report provided guidance to early adopters. However, the commissioning aspect of these algorithms was described only in general terms with no quantitative goals. This report, from the Working Group on Model-Based Dose Calculation Algorithms in Brachytherapy, introduced a field-tested approach to MBDCA commissioning. It is based on a set of well-characterized test cases for which reference Monte Carlo (MC) and vendor-specific MBDCA dose distributions are available in a Digital Imaging and Communications in Medicine-Radiotherapy (DICOM-RT) format to the clinical users. The key elements of the TG-186 commissioning workflow are now described in detail, and quantitative goals are provided. This approach leverages the well-known Brachytherapy Source Registry jointly managed by the AAPM and the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center (with associated links at ESTRO) to provide open access to test cases as well as step-by-step user guides. While the current report is limited to the two most widely commercially available MBDCAs and only for 192 Ir-based afterloading brachytherapy at this time, this report establishes a general framework that can easily be extended to other brachytherapy MBDCAs and brachytherapy sources. The AAPM, ESTRO, ABG, and ABS recommend that clinical medical physicists implement the workflow presented in this report to validate both the basic and the advanced dose calculation features of their commercial MBDCAs. Recommendations are also given to vendors to integrate advanced analysis tools into their brachytherapy treatment planning system to facilitate extensive dose comparisons. The use of the test cases for research and educational purposes is further encouraged.
Collapse
Affiliation(s)
- Luc Beaulieu
- Service de Physique Médicale et Radioprotection et Axe Oncologie du Centre de Recherche du CHU de Québec, CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, Québec, Canada
| | - Facundo Ballester
- Departamento de Física Atómica, Molecular y Nuclear, IRIMED, IIS-La Fe-Universitat de Valencia, Burjassot, Spain
| | - Domingo Granero
- Departamento de Física Atómica, Molecular y Nuclear, IRIMED, IIS-La Fe-Universitat de Valencia, Burjassot, Spain
| | - Åsa Carlsson Tedgren
- Department of Health, Medicine and Caring Sciences (HMV), Radiation Physics, Linköping University, Linköping, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | | | - Jessica R Lowenstein
- Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, Texas, USA
| | - Yunzhi Ma
- Service de Physique Médicale et Radioprotection et Axe Oncologie du Centre de Recherche du CHU de Québec, CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, Québec, Canada
| | - Firas Mourtada
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Panagiotis Papagiannis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Mark J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Frank-André Siebert
- Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ron S Sloboda
- Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta, Canada
- Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Ryan L Smith
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Gabriel Fonseca
- Department of Radiation Oncology (MAASTRO), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Javier Vijande
- Departamento de Física Atómica, Molecular y Nuclear, IRIMED, IIS-La Fe-Universitat de Valencia, Burjassot, Spain
- Instituto de Física Corpuscular, IFIC (UV-CSIC), Burjassot, Spain
| |
Collapse
|
9
|
Ng SK, Yue Y, Shiue K, Shah MV, Le Y. Dosimetric Impact of Source Displacement in GammaTile Surgically Targeted Radiation Therapy for Gliomas. Cureus 2023; 15:e38463. [PMID: 37273347 PMCID: PMC10234842 DOI: 10.7759/cureus.38463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Background This study aims to evaluate dosimetric changes that happened during the first month after GammaTile surgically targeted radiation therapy (STaRT) for gliomas due to Cesium-131 (Cs-131) seed displacement caused by cavity shrinkage in brain brachytherapy. Methodology In this study, 10 glioma patients had 4-11 GammaTiles placed along the resection bed after maximal safe resection during craniotomy. Each GammaTile is composed of four Cs-131 seeds embedded in a biodegradable collagen sponge to minimize seed movement and maintain seed-to-cavity surface distance. The Cs-131 seed positions were identified using VariSeed on day one. On day 30, post-implant computed tomography (CT) images and dosimetry parameters were calculated. An iterative closest point (ICP) algorithm was used to compute rigid transformation between the day one and day 30 seed clouds. The seed displacement was calculated after registration. The volume receiving 100% of the prescription dose (V100), the dose received by 90% of the planning target volume (D90_PTV), the planning target volume receiving 100% of the prescription dose (V100_PTV), and the dose to organs at risk (OARs) were calculated for both CT images to determine the dosimetric changes from any seed displacement. Results The mean seed displacement of 1.8 ± 1.0 mm for all patients was observed between day one and day 30. The maximum seed displacement for each patient ranged from 2.3 mm to 7.3 mm. The mean V100 difference between day one and day 30 was 2.5 cc (range = 0.5-6.5 cc). The mean D90_PTVs were 95.5% (range = 69.0%-131.0%) and 98.1% (range = 19.9%-149.0%) on day one and day 30, respectively. The mean V100_PTVs were 88.4% (range = 81.3%-99.1%) and 87.9% (range = 47.0%-99.7%) on day one and day 30, respectively. On day one, the brainstem dose was 63.5 Gy for one case and 28.1 Gy for another case; while on day 30, the brainstem dose was 55.8 Gy and 20.6 Gy for the same patients, contributing to 7.7 Gy (12.8%) and 7.5 Gy (12.5%) dose reductions to brainstem for these patients, respectively. Only two patients received a dose to the optic nerves (34.1 Gy and 5.2 Gy). There were small changes (1.8 Gy and 0.5 Gy, respectively) in the dose to optic nerves when comparing the dose calculated on day one and the dose calculated on day 30 CT images. The same two patients received 30.4 Gy and 6.8 Gy to the chiasm, respectively. Small changes in the dose to the chiasm (≤1.1 Gy) were noted between day one and day 30. Conclusions A maximum seed displacement of up to 7.3 mm and a mean seed displacement of 1.8 mm caused by cavity shrinkage were observed during the first month after GammaTile STaRT for gliomas. There were noticeable changes in dosimetry parameters. Changes in the doses to OARs, particularly the brainstem, were large (up to 12.8% of the prescription dose). These changes in dosimetry should be considered when evaluating treatment outcomes and planning future GammaTile treatments.
Collapse
Affiliation(s)
- Sook Kien Ng
- Radiation Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Yong Yue
- Radiation Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Kevin Shiue
- Radiation Oncology, Indiana University School of Medicine, Indianapolis, USA
| | - Mitesh V Shah
- Neurological Surgery, Indiana University Health, Indianapolis, USA
| | - Yi Le
- Radiation Oncology, Oklahoma Proton Center, Oklahoma City, USA
| |
Collapse
|
10
|
Manna F, Pugliese M, Buonanno F, Gherardi F, Iannacone E, La Verde G, Muto P, Arrichiello C. Use of Thermoluminescence Dosimetry for QA in High-Dose-Rate Skin Surface Brachytherapy with Custom-Flap Applicator. SENSORS (BASEL, SWITZERLAND) 2023; 23:3592. [PMID: 37050652 PMCID: PMC10098582 DOI: 10.3390/s23073592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 06/19/2023]
Abstract
Surface brachytherapy (BT) lacks standard quality assurance (QA) protocols. Commercially available treatment planning systems (TPSs) are based on a dose calculation formalism that assumes the patient is made of water, resulting in potential deviations between planned and delivered doses. Here, a method for treatment plan verification for skin surface BT is reported. Chips of thermoluminescent dosimeters (TLDs) were used for dose point measurements. High-dose-rate treatments were simulated and delivered through a custom-flap applicator provided with four fixed catheters to guide the Iridium-192 (Ir-192) source by way of a remote afterloading system. A flat water-equivalent phantom was used to simulate patient skin. Elekta TPS Oncentra Brachy was used for planning. TLDs were calibrated to Ir-192 through an indirect method of linear interpolation between calibration factors (CFs) measured for 250 kV X-rays, Cesium-137, and Cobalt-60. Subsequently, plans were designed and delivered to test the reproducibility of the irradiation set-up and to make comparisons between planned and delivered dose. The obtained CF for Ir-192 was (4.96 ± 0.25) μC/Gy. Deviations between measured and TPS calculated doses for multi-catheter treatment configuration ranged from -8.4% to 13.3% with an average of 0.6%. TLDs could be included in clinical practice for QA in skin BT with a customized flap applicator.
Collapse
Affiliation(s)
- Francesco Manna
- Department of Physics “E. Pancini”, Federico II University, 80126 Naples, Italy
- Centro Servizi Metrologici e Tecnologici Avanzati, Federico II University, 80146 Naples, Italy
| | - Mariagabriella Pugliese
- Department of Physics “E. Pancini”, Federico II University, 80126 Naples, Italy
- National Institute of Nuclear Physics, Section of Naples, 80126 Naples, Italy
| | - Francesca Buonanno
- Radiotherapy Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, 80131 Naples, Italy
| | - Federica Gherardi
- Radiotherapy Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, 80131 Naples, Italy
| | - Eva Iannacone
- Radiotherapy Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, 80131 Naples, Italy
| | - Giuseppe La Verde
- Department of Physics “E. Pancini”, Federico II University, 80126 Naples, Italy
- National Institute of Nuclear Physics, Section of Naples, 80126 Naples, Italy
| | - Paolo Muto
- Radiotherapy Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, 80131 Naples, Italy
| | - Cecilia Arrichiello
- Radiotherapy Unit, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione G. Pascale, 80131 Naples, Italy
| |
Collapse
|
11
|
Safigholi H, Chamberland MJP, Taylor REP, Martinov MP, Rogers DWO, Thomson RM. Update of the CLRP Monte Carlo TG-43 parameter database for high-energy brachytherapy sources. Med Phys 2023; 50:1928-1941. [PMID: 36542404 DOI: 10.1002/mp.16176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/11/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To update and extend version 2 of the Carleton Laboratory for Radiotherapy Physics (CLRP) TG-43 dosimetry database (CLRP_TG43v2) for high-energy (HE, ≥50 keV) brachytherapy sources (1 169 Yb, 23 192 Ir, 5 137 Cs, and 4 60 Co) using egs_brachy, an open-source EGSnrc application. A comprehensive dataset of TG-43 parameters is compiled, including detailed source descriptions, dose-rate constants, radial dose functions, 1D and 2D anisotropy functions, along-away dose-rate tables, Primary and Scatter Separated (PSS) dose tables, and mean photon energies escaping each source. The database also documents the source models which are freely distributed with egs_brachy. ACQUISITION AND VALIDATION METHODS Datasets are calculated after a recoding of the source geometries using the egs++ geometry package and its egs_brachy extensions. Air kerma per history is calculated in a 10 × 10 × $\,{\times}\, 10\,{\times}\,$ 0.05 cm3 voxel located 100 cm from the source along the transverse axis and then corrected for the lateral and thickness dimensions of the scoring voxel to give the air kerma on the central axis at a point 100 cm from the source's mid-point. Full-scatter water phantoms with varying voxel resolutions in cylindrical coordinates are used for dose calculations. Most data (except for 60 Co) are based on the assumption of charged particle equilibrium and ignore the potentially large effects of electron transport very close to the source and dose from initial beta particles. These effects are evaluated for four representative sources. For validation, data are compared to those from CLRP_TG43v1 and published data. DATA FORMAT AND ACCESS Data are available at https://physics.carleton.ca/clrp/egs_brachy/seed_database_v2 or http://doi.org/10.22215/clrp/tg43v2 including in Excel (.xlsx) spreadsheets, and are presented graphically in comparisons to previously published data for each source. POTENTIAL APPLICATIONS The CLRP_TG43v2 database has applications in research, dosimetry, and brachytherapy planning. This comprehensive update provides the medical physics community with more precise and in some cases more accurate Monte Carlo (MC) TG-43 dose calculation parameters, as well as fully benchmarked and described source models which are distributed with egs_brachy.
Collapse
Affiliation(s)
- Habib Safigholi
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Marc J P Chamberland
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Randle E P Taylor
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Martin P Martinov
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - D W O Rogers
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| | - Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics (CLRP), Department of Physics, Carleton University, Ottawa, Ontario, Canada
| |
Collapse
|
12
|
Poher A, Berumen F, Ma Y, Perl J, Beaulieu L. Validation of the TOPAS Monte Carlo toolkit for LDR brachytherapy simulations. Phys Med 2023; 107:102516. [PMID: 36804693 DOI: 10.1016/j.ejmp.2022.102516] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/07/2022] [Accepted: 12/27/2022] [Indexed: 02/18/2023] Open
Abstract
PURPOSE This work has the purpose of validating the Monte Carlo toolkit TOol for PArticle Simulation (TOPAS) for low-dose-rate (LDR) brachytherapy uses. METHODS AND MATERIALS Simulations of 12 LDR sources and 2 COMS eye plaques (10 mm and 20 mm in diameter) and comparisons with published reference data from the Carleton Laboratory for Radiotherapy Physics (CLRP), the TG-43 consensus data and the TG-129 consensus data were performed. Sources from the IROC Houston Source Registry were modeled. The OncoSeed 6711 and the SelectSeed 130.002 were also modeled for historical reasons. For each source, the dose rate constant, the radial dose function and the anisotropy functions at 0.5, 1 and 5 cm were extracted. For the eye plaques (loaded with 125I sources), dose distribution maps, dose profiles along the central axis and transverse axis were calculated. RESULTS Dose rate constants for 11 of the 12 sources are within 4% of the consensus data and within 2% of the CLRP data. The radial dose functions and anisotropy functions are mostly within 2% of the CLRP data. In average, 92% of all voxels are within 1% of the CLRP data for the eye plaques dose distributions. The dose profiles are within 0.5% (central axis) and 1% (transverse axis) of the reference data. CONCLUSION The TOPAS MC toolkit was validated for LDR brachytherapy applications. Single-seed and multi-seed results agree with the published reference data. TOPAS has several benefits such as a simplified approach to MC simulations and an accessible brachytherapy package including comprehensive learning resources.
Collapse
Affiliation(s)
- Audran Poher
- Service de physique médicale et de radioprotection, Centre Intégré de Cancérologie, CHU de Québec - Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec Québec G1V 0A6, Canada.
| | - Francisco Berumen
- Service de physique médicale et de radioprotection, Centre Intégré de Cancérologie, CHU de Québec - Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec Québec G1V 0A6, Canada
| | - Yunzhi Ma
- Service de physique médicale et de radioprotection, Centre Intégré de Cancérologie, CHU de Québec - Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec Québec G1V 0A6, Canada
| | - Joseph Perl
- SLAC National Accelerator Laboratory, Menlo Park, CA, United States of America
| | - Luc Beaulieu
- Service de physique médicale et de radioprotection, Centre Intégré de Cancérologie, CHU de Québec - Université Laval et Centre de recherche du CHU de Québec, Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec Québec G1V 0A6, Canada
| |
Collapse
|
13
|
Karius A, Schweizer C, Strnad V, Lotter M, Kreppner S, Lamrani A, Fietkau R, Bert C. Seed-displacements in the immediate post-implant phase in permanent prostate brachytherapy. Radiother Oncol 2023; 183:109590. [PMID: 36858202 DOI: 10.1016/j.radonc.2023.109590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To investigate differences in seed-displacements between the immediate post-implant phase (day 0-1) and the time to post-plan computed tomography (CT) (day 1-30) in seed prostate brachytherapy. MATERIALS AND METHODS Seed positions were identified on the intra-operatively created ultrasound-based treatment plan (day 0) and CT scans of day 1 and 30 for 33 patients. The day 1 (30) seed arrangement was registered onto the day 0 (1) arrangement using a seed-only approach. Based on a 1:1 assignment of seeds via the Kuhn-Munkres algorithm, seed-displacements were analyzed. Displacements were evaluated depending on strand-length and anatomical implant location. Resulting dosimetric effects were calculated. RESULTS Seed-displacements in the immediate post-implant phase (median displacements: 3.8 ± 3.6 mm) were stronger than in the time to post-plan CT (2.1 ± 2.6 mm) and enhanced along the superior-inferior direction. From day 0 to 1, strands containing one (7.3 ± 5.4 mm) or two (8.1 ± 5.8 mm) seeds showed larger displacements than strands of higher lengths (up to 4.2 ± 7.0 mm), whereas no length-dependency was found to day 30. Seeds implanted in base and apex tended to move towards the prostate midzone during both time periods. D90 (dose that 90% of prostate receives) was with variations of 2 ± 15 Gy more stable from day 1 to 30 than in the immediate post-implant phase (-18 ± 11 Gy). CONCLUSION Seed-displacements in the immediate post-implant phase was enhanced compared to day 1-30. This may result from uncertainties in the gold-standard ultrasound-based treatment planning and implantation. Adaptive implantation workflows appear useful for ensuring high implant stability from the beginning.
Collapse
Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Claudia Schweizer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Allison Lamrani
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054 Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| |
Collapse
|
14
|
Poder J, Rivard MJ, Howie A, Carlsson Tedgren Å, Haworth A. Risk and Quality in Brachytherapy From a Technical Perspective. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00002-X. [PMID: 36682968 DOI: 10.1016/j.clon.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
AIMS To provide an overview of the history of incidents in brachytherapy and to describe the pillars in place to ensure that medical physicists deliver high-quality brachytherapy. MATERIALS AND METHODS A review of the literature was carried out to identify reported incidents in brachytherapy, together with an evaluation of the structures and processes in place to ensure that medical physicists deliver high-quality brachytherapy. In particular, the role of education and training, the use of process and technical quality assurance and the role of international guidelines are discussed. RESULTS There are many human factors in brachytherapy procedures that introduce additional risks into the process. Most of the reported incidents in the literature are related to human factors. Brachytherapy-related education and training initiatives are in place at the societal and departmental level for medical physicists. Additionally, medical physicists have developed process and technical quality assurance procedures, together with international guidelines and protocols. Education and training initiatives, together with quality assurance procedures and international guidelines may reduce the risk of human factors in brachytherapy. CONCLUSION Through application of the three pillars (education and training; process control and technical quality assurance; international guidelines), medical physicists will continue to minimise risk and deliver high-quality brachytherapy treatments.
Collapse
Affiliation(s)
- J Poder
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia; School of Physics, University of Sydney, Camperdown, New South Wales, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.
| | - M J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, RI, USA
| | - A Howie
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Å Carlsson Tedgren
- Department of Health, Medicine and Caring Sciences (HMV), Radiation Physics, Linköping University, Linköping, Sweden; Medical Radiation Physics and Nuclear Medicine, The Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, The Karolinska Institute, Stockholm, Sweden
| | - A Haworth
- School of Physics, University of Sydney, Camperdown, New South Wales, Australia
| |
Collapse
|
15
|
Antunes PCG, Siqueira PDTD, Shorto JBM, Yoriyaz H. A versatile physical phantom design and construction for I-125 dose measurements and dose-to-medium determination. Brachytherapy 2023; 22:80-92. [PMID: 36396567 DOI: 10.1016/j.brachy.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/15/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE In this paper we present a phantom designed to provide conditions to generate set of "true" independent reference data as requested by TG-186, and mitigating the scarcity of experimental studies on brachytherapy validation. It was used to perform accurate experimental measurements of dose of 125I brachytherapy seeds using LiF dosimeters, with the objective of experimentally validating Monte Carlo (MC) calculations with model-based dose calculation algorithm (MBDCA). In addition, this work intends to evaluate a methodology to convert the experimental values from LiF into dose in the medium. METHODS AND MATERIALS The proposed PMMA physical phantom features cavities to insert a LiF dosimeter and a 125I seed, adjusted in different configurations with variable thickness. Monte Carlo calculations performed with MCNP6.2 code were used to score the absorbed dose in the LiF and the dose conversion parameters. A sensitivity analysis was done to verify the source of possible uncertainties and quantify their impact on the results. RESULTS The proposed phantom and experimental procedure developed in this work provided precise dose data within 5.68% uncertainty (k = 1). The achieved precision made it possible to convert the LiF responses into absorbed dose to medium and to validate the dose conversion factor methodology. CONCLUSIONS The proposed phantom is simple both in design and as in its composition, thus achieving the demanded precision in dose evaluations due to its easy reproducibility of experimental setup. The results derived from the phantom measurements support the dose conversion methodology. The phantom and the experimental procedure developed here can be applied for other materials and radiation sources.
Collapse
Affiliation(s)
| | | | | | - Hélio Yoriyaz
- Instituto de Pesquisas Energéticas e Nucleares - IPEN-CNEN/SP, São Paulo, Brazil
| |
Collapse
|
16
|
GEC-ESTRO ACROP recommendations on calibration and traceability of HE HDR-PDR photon-emitting brachytherapy sources at the hospital level. Radiother Oncol 2022; 176:108-117. [PMID: 36167195 DOI: 10.1016/j.radonc.2022.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
The vast majority of radiotherapy departments in Europe using brachytherapy (BT) perform temporary implants of high- or pulsed-dose rate (HDR-PDR) sources with photon energies higher than 50 keV. Such techniques are successfully applied to diverse pathologies and clinical scenarios. These recommendations are the result of Working Package 21 (WP-21) initiated within the BRAchytherapy PHYsics Quality Assurance System (BRAPHYQS) GEC-ESTRO working group with a focus on HDR-PDR source calibration. They provide guidance on the calibration of such sources, including practical aspects and issues not specifically accounted for in well-accepted societal recommendations, complementing the BRAPHYQS WP-18 Report dedicated to low energy BT photon emitting sources (seeds). The aim of this report is to provide a European-wide standard in HDR-PDR BT source calibration at the hospital level to maintain high quality patient treatments.
Collapse
|
17
|
Foo CY, Munir N, Kumaria A, Akhtar Q, Bullock CJ, Narayanan A, Fu RZ. Medical Device Advances in the Treatment of Glioblastoma. Cancers (Basel) 2022; 14:5341. [PMID: 36358762 PMCID: PMC9656148 DOI: 10.3390/cancers14215341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 07/30/2023] Open
Abstract
Despite decades of research and the growing emergence of new treatment modalities, Glioblastoma (GBM) frustratingly remains an incurable brain cancer with largely stagnant 5-year survival outcomes of around 5%. Historically, a significant challenge has been the effective delivery of anti-cancer treatment. This review aims to summarize key innovations in the field of medical devices, developed either to improve the delivery of existing treatments, for example that of chemo-radiotherapy, or provide novel treatments using devices, such as sonodynamic therapy, thermotherapy and electric field therapy. It will highlight current as well as emerging device technologies, non-invasive versus invasive approaches, and by doing so provide a detailed summary of evidence from clinical studies and trials undertaken to date. Potential limitations and current challenges are discussed whilst also highlighting the exciting potential of this developing field. It is hoped that this review will serve as a useful primer for clinicians, scientists, and engineers in the field, united by a shared goal to translate medical device innovations to help improve treatment outcomes for patients with this devastating disease.
Collapse
Affiliation(s)
- Cher Ying Foo
- Imperial College School of Medicine, Imperial College London, Fulham Palace Rd., London W6 8RF, UK
| | - Nimrah Munir
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Ashwin Kumaria
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Qasim Akhtar
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Christopher J. Bullock
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Ashwin Narayanan
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
| | - Richard Z. Fu
- QV Bioelectronics Ltd., 1F70 Mereside, Alderley Park, Nether Alderley, Cheshire SK10 4TG, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Michael, Smith Building, Dover St., Manchester M13 9PT, UK
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Care Organisation, Northern Care Alliance NHS Foundation Trust, Salford Royal, Stott Lane, Salford M6 8HD, UK
| |
Collapse
|
18
|
Oare C, Sun S, Dusenbery K, Reynolds M, Koozekanani D, Gerbi B, Ferreira C. Analysis of dose to the macula, optic disc, and lens in relation to vision toxicities - A retrospective study using COMS eye plaques. Phys Med 2022; 101:71-78. [PMID: 35981450 DOI: 10.1016/j.ejmp.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/08/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The aim of this study was to relate common toxicity endpoints with dose to the macula, optic disc, and lens for uveal melanoma patients treated with Iodine-125 Collaborative Ocular Melanoma Study (COMS) eye plaque brachytherapy. METHODS A cohort of 52 patients treated at a single institution between 2005 and 2019 were retrospectively reviewed. Demographics, dosimetry, and clinical outcomes were recorded. Univariate, relative risk, and Kaplan-Meier analyses were performed to relate dose to toxicity endpoints including retinopathy, vision decline, and cataracts. RESULTS By the end of follow up (Median = 3.6 years, Range = 0.4 - 13.5 years), 65 % of eyes sustained radiation retinopathy, 40 % demonstrated moderate vision decline (>5 Snellen lines lost), and 56 % developed cataracts. Significant (p < 0.05) risk estimates exist for retinopathy and VA decline for doses >52 Gy to the macula and >42 Gy to the optic disc. Moreover, dose to the lens > 16 Gy showed a significant risk for cataract formation. Kaplan-Meier analysis demonstrated significantly different incidence of radiation retinopathy for > 52 Gy to the macula and > 42 Gy to the optic disc. In addition, the Kaplan-Meier analysis showed significantly different incidence of cataract formation for patients with lens dose > 16 Gy. CONCLUSIONS Dose-effect relationships exist for the macula and optic disc with respect to the loss of visual acuity and the development of retinopathy. To better preserve vision after treatment, further research is needed to reduce macula, optic disc, and lens doses while maintaining tumor control.
Collapse
Affiliation(s)
- Courtney Oare
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States.
| | - Susan Sun
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Kathryn Dusenbery
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Margaret Reynolds
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Dara Koozekanani
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Bruce Gerbi
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| | - Clara Ferreira
- University of Minnesota Medical School, 420 Delaware St SE, MMC 494, Minneapolis, MN 55455, United States
| |
Collapse
|
19
|
Assam I, Vijande J, Ballester F, Pérez-Calatayud J, Poppe B, Siebert FA. Evaluation of dosimetric effects of metallic artifact reduction and tissue assignment on Monte Carlo dose calculations for 125 I prostate implants. Med Phys 2022; 49:6195-6208. [PMID: 35925023 DOI: 10.1002/mp.15865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/24/2022] [Accepted: 06/25/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Monte Carlo (MC) simulation studies, aimed at evaluating the magnitude of tissue heterogeneity in 125 I prostate permanent seed implant brachytherapy (BT), customarily use clinical post-implant CT images to generate a virtual representation of a realistic patient model (virtual patient model). Metallic artifact reduction (MAR) techniques and tissue assignment schemes (TAS) are implemented on the post-implant CT images to mollify metallic artifacts due to BT seeds and to assign tissue types to the voxels corresponding to the bright seed spots and streaking artifacts, respectively. The objective of this study is to assess the combined influence of MAR and TAS on MC absorbed dose calculations in post-implant CT-based phantoms. The virtual patient models used for 125 I prostate implant MC absorbed dose calculations in this study are derived from the CT images of an external radiotherapy prostate patient without BT seeds and prostatic calcifications, thus averting the need to implement MAR and TAS. METHODS The geometry of the IsoSeed I25.S17plus source is validated by comparing the MC calculated results of the TG-43 parameters for the line source approximation with the TG-43U1S2 consensus data. Four MC absorbed dose calculations are performed in two virtual patient models using the egs_brachy MC code: (1) TG-43-based Dw,w-TG 43 , (2) Dw,w-MBDC that accounts for interseed scattering and attenuation (ISA), (3) Dm,m that examines ISA and tissue heterogeneity by scoring absorbed dose in tissue, and (4) Dw,m that unlike Dm,m scores absorbed dose in water. The MC absorbed doses (1) and (2) are simulated in a TG-43 patient phantom derived by assigning the densities of every voxel to 1.00 g cm-3 (water), whereas MC absorbed doses (3) and (4) are scored in the TG-186 patient phantom generated by mapping the mass density of each voxel to tissue according to a CT calibration curve. The MC absorbed doses calculated in this study are compared with VariSeed v8.0 calculated absorbed doses. To evaluate the dosimetric effect of MAR and TAS, the MC absorbed doses of this work (independent of MAR and TAS) are compared to the MC absorbed doses of different 125 I source models from previous studies that were calculated with different MC codes using post-implant CT-based phantoms generated by implementing MAR and TAS on post-implant CT images. RESULTS The very good agreement of TG-43 parameters of this study and the published consensus data within 3% validates the geometry of the IsoSeed I25.S17plus source. For the clinical studies, the TG-43-based calculations show a D90 overestimation of more than 4% compared to the more realistic MC methods due to ISA and tissue composition. The results of this work generally show few discrepancies with the post-implant CT-based dosimetry studies with respect to the D90 absorbed dose metric parameter. These discrepancies are mainly Type B uncertainties due to the different 125 I source models and MC codes. CONCLUSIONS The implementation of MAR and TAS on post-implant CT images have no dosimetric effect on the 125 I prostate MC absorbed dose calculation in post-implant CT-based phantoms.
Collapse
Affiliation(s)
- Isong Assam
- UKSH, Campus Kiel, Clinic of Radiotherapy (Radiooncology), Kiel, Germany
| | - Javier Vijande
- Departamento de Física Atómica, Molecular y Nuclear, Universitat de Valencia (UV), Burjassot, Spain.,Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), Valencia, Spain.,Instituto de Física Corpuscular, IFIC (UV-CSIC), Burjassot, Spain
| | - Facundo Ballester
- Departamento de Física Atómica, Molecular y Nuclear, Universitat de Valencia (UV), Burjassot, Spain.,Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED), Instituto de Investigación Sanitaria La Fe (IIS-La Fe), Universitat de Valencia (UV), Valencia, Spain
| | - José Pérez-Calatayud
- Radiotherapy Department, La Fe Hospital, Valencia, Spain.,Radiotherapy Department, Clinica Benidorm, Alicante, Spain
| | - Björn Poppe
- Center for Radiotherapy and Radiation Oncology - University Center for Medical Radiation Physics, Pius-Hospital, Medical Campus of Carl-von-Ossietzky University of Oldenburg, Oldenburg, Germany
| | | |
Collapse
|
20
|
Permanent LDR prostate brachytherapy: Comprehensive characterization of seed-dynamics within the prostate on a seed-only level. Brachytherapy 2022; 21:635-646. [DOI: 10.1016/j.brachy.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/28/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022]
|
21
|
Penoncello GP, Gagneur JD, Vora SA, Yu NY, Fatyga M, Mrugala MM, Bendok BR, Rong Y. Comprehensive commissioning and clinical implementation of GammaTiles STaRT for intracranial brain tumors. Adv Radiat Oncol 2022; 7:100910. [PMID: 35434425 PMCID: PMC9010698 DOI: 10.1016/j.adro.2022.100910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To validate the dose calculation accuracy and dose distribution of GammaTiles for brain tumors, and to suggest a surgically targeted radiation therapy (STaRT) workflow for planning, delivery, radiation safety documentation, and posttreatment validation. Methods and Materials Novel surgically targeted radiation therapy, GammaTiles, uses Cs-131 radiation isotopes embedded in collagen-based tiles that can be resorbed after surgery. GammaTile target delineation and dose calculation were performed on MIM Symphony software. Point-based and complex seed distribution calculations in MIM Symphony were verified with hand calculations and BrachyVision calculations. Vendor-provided 2-dimensional dose distribution calculation accuracy was validated using gafchromic EBT3 film measurements at various depths. A workflow was established for safe and effective GammaTile implants. Results Good agreement was observed between different calculations. Calculation accuracy of less than 0.5% was achieved for all points except one, which had rounding issues for very low doses and resulted in just below 5% difference. Differences in anisotropy and geometry positioning were noticed in the delineation of Cs-131 IsoRay seeds in the compared systems, resulting in minor discrepancies in the calculated dosimetry distributions. Film measurements showed profiles with relatively good agreement of 0% to 5% in nongradient regions with higher differences between 5% to 10% in the sharp dose fall-off regions. Conclusions A comprehensive evaluation of GammaTile geometry, dose distribution, and clinical workflow was conducted. Safe intro-operative implantation of GammaTiles requires extensive preplanning and interdisciplinary collaboration. A STaRT workflow was outlined to provide a guideline for an accurate treatment planning and safe implant process at other institutions.
Collapse
|
22
|
Feng W, Rivard MJ, Carey EM, Hearn RA, Pai S, Nath R, Kim Y, Thomason CL, Boyce DE, Zhang H. Recommendations for intraoperative mesh brachytherapy: Report of AAPM Task Group No. 222. Med Phys 2021; 48:e969-e990. [PMID: 34431524 DOI: 10.1002/mp.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Abstract
Mesh brachytherapy is a special type of a permanent brachytherapy implant: it uses low-energy radioactive seeds in an absorbable mesh that is sutured onto the tumor bed immediately after a surgical resection. This treatment offers low additional risk to the patient as the implant procedure is carried out as part of the tumor resection surgery. Mesh brachytherapy utilizes identification of the tumor bed through direct visual evaluation during surgery or medical imaging following surgery through radiographic imaging of radio-opaque markers within the sources located on the tumor bed. Thus, mesh brachytherapy is customizable for individual patients. Mesh brachytherapy is an intraoperative procedure involving mesh implantation and potentially real-time treatment planning while the patient is under general anesthesia. The procedure is multidisciplinary and requires the complex coordination of multiple medical specialties. The preimplant dosimetry calculation can be performed days beforehand or expediently in the operating room with the use of lookup tables. In this report, the guidelines of American Association of Physicists in Medicine (AAPM) are presented on the physics aspects of mesh brachytherapy. It describes the selection of radioactive sources, design and preparation of the mesh, preimplant treatment planning using a Task Group (TG) 43-based lookup table, and postimplant dosimetric evaluation using the TG-43 formalism or advanced algorithms. It introduces quality metrics for the mesh implant and presents an example of a risk analysis based on the AAPM TG-100 report. Recommendations include that the preimplant treatment plan be based upon the TG-43 dose calculation formalism with the point source approximation, and the postimplant dosimetric evaluation be performed by using either the TG-43 approach, or preferably the newer model-based algorithms (viz., TG-186 report) if available to account for effects of material heterogeneities. To comply with the written directive and regulations governing the medical use of radionuclides, this report recommends that the prescription and written directive be based upon the implanted source strength, not target-volume dose coverage. The dose delivered by mesh implants can vary and depends upon multiple factors, such as postsurgery recovery and distortions in the implant shape over time. For the sake of consistency necessary for outcome analysis, prescriptions based on the lookup table (with selection of the intended dose, depth, and treatment area) are recommended, but the use of more advanced techniques that can account for real situations, such as material heterogeneities, implant geometric perturbations, and changes in source orientations, is encouraged in the dosimetric evaluation. The clinical workflow, logistics, and precautions are also presented.
Collapse
Affiliation(s)
- Wenzheng Feng
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Mark J Rivard
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Robert A Hearn
- Department of Radiation Physics at Theragenics, Theragenics Corp., Buford, Georgia, USA
| | - Sujatha Pai
- Department of Radiation Oncology, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - Ravinder Nath
- Department of Therapeutic Radiology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Yongbok Kim
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Cynthia L Thomason
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Hualin Zhang
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| |
Collapse
|
23
|
Dickhoff LR, Vrancken Peeters MJ, Bosman PA, Alderliesten T. Therapeutic applications of radioactive sources: from image-guided brachytherapy to radio-guided surgical resection. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:190-201. [PMID: 34105339 DOI: 10.23736/s1824-4785.21.03370-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate, cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound, computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSL include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemplify the implementation of RSL in a clinic through experiences at the Netherlands Cancer Institute.
Collapse
Affiliation(s)
- Leah R Dickhoff
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands -
| | - Marie-Jeanne Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Peter A Bosman
- Life Sciences and Health group, Centrum Wiskunde & Informatica, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
24
|
Wu J, Xie Y, Ding Z, Li F, Wang L. Monte Carlo study of TG-43 dosimetry parameters of GammaMed Plus high dose rate 192 Ir brachytherapy source using TOPAS. J Appl Clin Med Phys 2021; 22:146-153. [PMID: 33955134 PMCID: PMC8200518 DOI: 10.1002/acm2.13252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/06/2021] [Accepted: 03/28/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To develop a simulation model for GammaMed Plus high dose rate 192 Ir brachytherapy source in TOPAS Monte Carlo software and validate it by calculating the TG-43 dosimetry parameters and comparing them with published data. METHODS We built a model for GammaMed Plus high dose rate brachytherapy source in TOPAS. The TG-43 dosimetry parameters including air-kerma strength SK , dose-rate constant Λ, radial dose function gL (r), and 2D anisotropy function F(r,θ) were calculated using Monte Carlo simulation with Geant4 physics models and NNDC 192 Ir spectrum. Calculations using an old 192 Ir spectrum were also carried out to evaluate the impact of incident spectrum and cross sections. The results were compared with published data. RESULTS For calculations using the NNDC spectrum, the air-kerma strength per unit source activity SK /A and Λ were 1.0139 × 10-7 U/Bq and 1.1101 cGy.h-1 .U-1 , which were 3.56% higher and 0.62% lower than the reference values, respectively. The gL (r) agreed with reference values within 1% for radial distances from 2 mm to 20 cm. For radial distances of 1, 3, 5, and 10 cm, the agreements between F(r,θ) from this work and the reference data were within 1.5% for 15° < θ < 165°, and within 4% for all θ values. The discrepancies were attributed to the updated source spectrum and cross sections. They caused deviations of the SK /A of 2.90% and 0.64%, respectively. As for gL (r), they caused average deviations of -0.22% and 0.48%, respectively. Their impact on F(r,θ) was not quantified for the relatively high statistical uncertainties, but basically they did not result in significant discrepancies. CONCLUSION A model for GammaMed Plus high dose rate 192 Ir brachytherapy source was developed in TOPAS and validated following TG-43 protocols, which can be used for future studies. The impact of updated incident spectrum and cross sections on the dosimetry parameters was quantified.
Collapse
Affiliation(s)
- Jianan Wu
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yaoqin Xie
- Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Zhen Ding
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Feipeng Li
- Shenzhen Key Laboratory of Advanced Machine Learning and Application, College of Mathematics and Statistics, Shenzhen University, Shenzhen, 518060, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.,Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| |
Collapse
|
25
|
Safigholi H, Parsons Z, Deering SG, Thomson RM. Update of the CLRP eye plaque brachytherapy database for photon-emitting sources. Med Phys 2021; 48:3373-3283. [PMID: 33735471 DOI: 10.1002/mp.14844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To update and extend the Carleton Laboratory for Radiotherapy Physics (CLRP) Eye Plaque (EP) dosimetry database for low-energy photon-emitting brachytherapy sources using egs_brachy, an open-source EGSnrc application. The previous database, CLRP_EPv1, contained datasets for the Collaborative Ocular Melanoma Study (COMS) plaques (10-22 mm diameter) with 103 Pd or 125 I seeds (BrachyDose-computed, 2008). The new database, CLRP_EPv2, consists of newly calculated three-dimensional (3D) dose distributions for 17 plaques [eight COMS, five Eckert & Ziegler BEBIG, and four others representative of models used worldwide] for 103 Pd, 125 I, and 131 Cs seeds. ACQUISITION AND VALIDATION METHODS Plaque models are developed with egs_brachy, based on published/manufacturer dimensions and material data. The BEBIG plaques (modeled for the first time) are identical in dimensions to COMS plaques but differ in elemental composition and/or density. Previously benchmarked seed models are used. Eye plaques and seeds are simulated at the center of full-scatter water phantoms, scoring in (0.05 cm)3 voxels spanning the eye for scenarios: (a) "HOMO": simulated TG43 conditions; (b) "HETERO": eye plaques and seeds fully modeled; (c) "HETsi" (BEBIG only): one seed is active at a time with other seed geometries present but not emitting photons (inactive); summation over all i seeds in a plaque then yields "HETsum" (includes interseed effects). For validation, doses are compared to those from CLRP_EPv1 and published data. DATA FORMAT AND ACCESS Data are available at https://physics.carleton.ca/clrp/eye_plaque_v2, http://doi.org/10.22215/clrp/EPv2. The data consist of 3D dose distributions (text-based EGSnrc "3ddose" file format) and graphical presentations of the comparisons to previously published data. POTENTIAL APPLICATIONS The CLRP_EPv2 database provides accurate reference 3D dose distributions to advance ocular brachytherapy dose evaluations. The fully-benchmarked eye plaque models will be freely distributed with egs_brachy, supporting adoption of model-based dose evaluations as recommended by TG-129, TG-186, and TG-221.
Collapse
Affiliation(s)
- Habib Safigholi
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Zack Parsons
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Stephen G Deering
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics, Department of Physics, Carleton University, Ottawa, ON, K1S 5B6, Canada
| |
Collapse
|
26
|
Seniwal B, Freitas LF, Mendes BM, Lugão AB, Katti KV, Fonseca TCF. In silico dosimetry of low-dose rate brachytherapy using radioactive nanoparticles. Phys Med Biol 2021; 66:045016. [PMID: 33561008 DOI: 10.1088/1361-6560/abd671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE Nanoparticles (NPs) with radioactive atoms incorporated within the structure of the NP or bound to its surface, functionalized with biomolecules are reported as an alternative to low-dose-rate seed-based brachytherapy. In this study, authors report a mathematical dosimetric study on low-dose rate brachytherapy using radioactive NPs. METHOD Single-cell dosimetry was performed by calculating cellular S-values for spherical cell model using Au-198, Pd-103 and Sm-153 NPs. The cell survival and tumor volume versus time curves were calculated and compared to the experimental studies on radiotherapeutic efficiency of radioactive NPs published in the literature. Finally, the radiotherapeutic efficiency of Au-198, Pd-103 and Sm-153 NPs was tested for variable: administered radioactivity, tumor volume and tumor cell type. RESULT At the cellular level Sm-153 presented the highest S-value, followed by Pd-103 and Au-198. The calculated cell survival and tumor volume curves match very well with the published experimental results. It was found that Au-198 and Sm-153 can effectively treat highly aggressive, large tumor volumes with low radioactivity. CONCLUSION The accurate knowledge of uptake rate, washout rate of NPs, radio-sensitivity and tumor repopulation rate is important for the calculation of cell survival curves. Self-absorption of emitted radiation and dose enhancement due to AuNPs must be considered in the calculations. Selection of radionuclide for radioactive NP must consider size of tumor, repopulation rate and radiosensitivity of tumor cells. Au-198 NPs functionalized with Mangiferin are a suitable choice for treating large, radioresistant and rapidly growing tumors.
Collapse
Affiliation(s)
- Baljeet Seniwal
- Departamento de Engenharia Nuclear-Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brasil
| | | | | | | | | | | |
Collapse
|
27
|
Ferreira C, Sterling D, Reynolds M, Dusenbery K, Chen C, Alaei P. First clinical implementation of GammaTile permanent brain implants after FDA clearance. Brachytherapy 2021; 20:673-685. [PMID: 33487560 DOI: 10.1016/j.brachy.2020.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE GammaTile cesium-131 (131Cs) permanent brain implant has received Food and Drug Administration (FDA) clearance as a promising treatment for certain brain tumors. Our center was the first institution in the United States after FDA clearance to offer the clinical use of GammaTile brachytherapy outside of a clinical trial. The purpose of this work is to aid the medical physicist and radiation oncologist in implementing this collagen carrier tile brachytherapy (CTBT) program in their practice. METHODS A total of 23 patients have been treated with GammaTile to date at our center. Treatment planning system (TPS) commissioning was performed by configuring the parameters for the 131Cs (IsoRay Model CS-1, Rev2) source, and doses were validated with the consensus data from the American Association of Physicists in Medicine TG-43U1S2. Implant procedures, dosimetry, postimplant planning, and target delineations were established based on our clinical experience. Radiation safety aspects were evaluated based on exposure rate measurements of implanted patients, as well as body and ring badge measurements. RESULTS An estimated timeframe of the GammaTile clinical responsibilities for the medical physicist, radiation oncologist, and neurosurgeon is presented. TPS doses were validated with published dose to water for 131Cs. Clinical aspects, including estimation of the number of tiles, treatment planning, dosimetry, and radiation safety considerations, are presented. CONCLUSION The implementation of the GammaTile program requires collaboration from multiple specialties, including medical physics, radiation oncology, and neurosurgery. This manuscript provides a roadmap for the implementation of this therapy.
Collapse
Affiliation(s)
- Clara Ferreira
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN.
| | - David Sterling
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN
| | - Margaret Reynolds
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN
| | - Kathryn Dusenbery
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN
| | - Clark Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN
| |
Collapse
|
28
|
First brachytherapy treatment of prostate cancer in Nigeria using low dose rate radioactive iodine 125. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-00098-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We report the first prostate brachytherapy in Nigeria, using low dose radioactive iodine 125 (I-125) permanent seeds implant.
Case Presentation
The low dose rate brachytherapy using I-125 implants was performed in a private clinic in the city of Benin, Edo state of Nigeria. This pilot study reports the case of the first two patients with prostate cancer. The patients were treated under spinal anesthesia using 2 ml of heavy bupibacaine which is equivalent to 10 mg of bupibacaine. Biopsy, total blood count, electrolytes, urea, creatinine, urinalysis, electrocardiogram, chest X-ray, prostate-specific antigen and bone scan were checked prior to the procedure. The first two prostate cancer patients who were in low risk category successfully received the treatment in the first day of the clinic’s operations. This paper describes the settings in which these clinical operations occurred, detailing the type of technology used, the clinical procedure and the obtained dose distribution.
Conclusions
The paper ends with discussing the overall cost of the investment and the challenges encountered as well as the perspectives of extending the brachytherapy practice to treat other cancer diseases, such as breast and genealogical cancers.
Collapse
|
29
|
Fulkerson RK, Perez‐Calatayud J, Ballester F, Buzurovic I, Kim Y, Niatsetski Y, Ouhib Z, Pai S, Rivard MJ, Rong Y, Siebert F, Thomadsen BR, Weigand F. Surface brachytherapy: Joint report of the AAPM and the GEC‐ESTRO Task Group No. 253. Med Phys 2020; 47:e951-e987. [DOI: 10.1002/mp.14436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Regina K. Fulkerson
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Jose Perez‐Calatayud
- Radiotherapy Department La Fe Hospital Valencia46026 Spain
- Radiotherapy Department Clinica Benidorm Alicante03501 Spain
| | - Facundo Ballester
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot46100 Spain
| | - Ivan Buzurovic
- Dana‐Farber/Brigham and Women’s Cancer Center Harvard Medical School Boston MA02115 USA
| | - Yongbok Kim
- Department of Radiation Oncology University of Arizona Tucson AZ85724 USA
| | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1 Veenendaal3903 DD Netherlands
| | - Zoubir Ouhib
- Radiation Oncology Department Lynn Regional Cancer CenterBoca Raton Community Hospital Boca Raton FL33486 USA
| | - Sujatha Pai
- Radion Inc. 20380 Town Center Lane, Suite 135 Cupertino CA95014 USA
| | - Mark J. Rivard
- Department of Radiation Oncology Alpert Medical School Brown University Providence RI02903 USA
| | - Yi Rong
- Department of Radiation Oncology University of California Davis Comprehensive Cancer Center Sacramento CA95817 USA
| | - Frank‐André Siebert
- UK S‐HCampus Kiel, Klinik fur Strahlentherapie (Radioonkologie) Arnold‐Heller‐Str. 3Haus 50 KielD‐24105 Germany
| | - Bruce R. Thomadsen
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Frank Weigand
- Carl Zeiss Meditec AG Rudolf‐Eber‐Straße 11 Oberkochen73447 Germany
| |
Collapse
|
30
|
Low-cost 3D print-based phantom fabrication to facilitate interstitial prostate brachytherapy training program. Brachytherapy 2020; 19:800-811. [PMID: 32690386 DOI: 10.1016/j.brachy.2020.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/29/2020] [Accepted: 06/16/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to manufacture a realistic and inexpensive prostate phantom to support training programs for ultrasound-based interstitial prostate brachytherapy. METHODS AND MATERIALS Five phantom material combinations were tested and evaluated for material characteristics; Ecoflex 00-30 silicone, emulsion silicone with 20% or 50% mineral oil, and regular or supersoft polyvinyl chloride (PVC). A prostate phantom which includes an anatomic simulated prostate, urethra, seminal vesicles, rectum, and normal surrounding tissue was created with 3D-printed molds using 20% emulsion silicone and regular and supersoft PVC materials based on speed of sound testing. Needle artifact retention was evaluated at weekly intervals. RESULTS Speed of sound testing demonstrated PVC to have the closest ultrasound characteristics of the materials tested to that of soft tissue. Several molds were created with 3D-printed PLA directly or cast on 3D-printed PLA with high heat resistant silicone. The prostate phantom fabrication workflow was developed, including a method to produce dummy seeds for low-dose-rate brachytherapy practice. A complete phantom may be fabricated in 1.5-2 h, and the material cost for each phantom was approximated at $23.98. CONCLUSIONS A low-cost and reusable phantom was developed based on 3D-printed molds for casting. The proposed educational prostate phantom is an ideal cost-effective platform to develop and build confidence in fundamental brachytherapy procedural skills in addition to actual patient caseloads.
Collapse
|
31
|
Safigholi H, Chamberland MJP, Taylor REP, Allen CH, Martinov MP, Rogers DWO, Thomson RM. Update of the CLRP TG‐43 parameter database for low‐energy brachytherapy sources. Med Phys 2020; 47:4656-4669. [DOI: 10.1002/mp.14249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022] Open
Affiliation(s)
- Habib Safigholi
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - Marc J. P. Chamberland
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - Randle E. P. Taylor
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - Christian H. Allen
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - Martin P. Martinov
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - D. W. O. Rogers
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| | - Rowan M. Thomson
- Carleton Laboratory for Radiotherapy Physics (CLRP) Department of Physics Carleton University Ottawa ON K1S 5B6 Canada
| |
Collapse
|
32
|
Kaveckyte V, Persson L, Malusek A, Benmakhlouf H, Alm Carlsson G, Carlsson Tedgren Å. Investigation of a synthetic diamond detector response in kilovoltage photon beams. Med Phys 2019; 47:1268-1279. [PMID: 31880809 DOI: 10.1002/mp.13988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE An important characteristic of radiation dosimetry detectors is their energy response which consists of absorbed-dose and intrinsic energy responses. The former can be characterized using Monte Carlo (MC) simulations, whereas the latter (i.e., detector signal per absorbed dose to detector) is extracted from experimental data. Such a characterization is especially relevant when detectors are used in nonrelative measurements at a beam quality that differs from the calibration beam quality. Having in mind the possible application of synthetic diamond detectors (microDiamond PTW 60019, Freiburg, Germany) for nonrelative dosimetry of low-energy brachytherapy (BT) beams, we determined their intrinsic and absorbed-dose energy responses in 25-250 kV beams relative to a 60 Co beam, which is usually the reference beam quality for detector calibration in radiotherapy. MATERIAL AND METHODS Three microDiamond detectors and, for comparison, two silicon diodes (PTW 60017) were calibrated in terms of air-kerma free in air in six x-ray beam qualities (from 25 to 250 kV) and in terms of absorbed dose to water in a 60 Co beam at the national metrology laboratory in Sweden. The PENELOPE/penEasy MC radiation transport code was used to calculate the absorbed-dose energy response of the detectors (modeled based on blueprints) relative to air and water depending on calibration conditions. The MC results were used to extract the relative intrinsic energy response of the detectors from the overall energy response. Measurements using an independent setup with a single ophthalmic BEBIG I25.S16 125 I BT seed (effective photon energy of 28 keV) were used as a qualitative check of the extracted intrinsic energy response correction factors. Additionally, the impact of the thickness of the active volume as well as the presence of extra-cameral components on the absorbed-dose energy response of a microDiamond detector was studied using MC simulations. RESULTS The relative intrinsic energy response of the microDiamond detectors was higher by a factor of 2 in 25 and 50 kV beams compared to the 60 Co beam. The variation in the relative intrinsic energy response of silicon diodes was within 10% over the investigated photon energy range. The use of relative intrinsic energy response correction factors improved the agreement among the absorbed dose to water values determined using microDiamond detectors and silicon diodes, as well as with the TG-43 formalism-based calculations for the 125 I seed. MC study of microDiamond detector design features provided a possible explanation for inter-detector response variation at low-energy photon beams by differences in the effective thickness of the active volume. CONCLUSIONS MicroDiamond detectors had a non-negligible variation in the relative intrinsic energy response (factor of 2) which was comparable to that in the absorbed-dose energy response relative to water at low-energy photon beams. Silicon diodes, in contrast, had an absorbed-dose energy dependence on photon energy that varied by a factor of 6, whereas the intrinsic energy dependence on beam quality was within 10%. It is important to decouple these two responses for a full characterization of detector energy response especially when the user and reference beam qualities differ significantly, and MC alone is not enough.
Collapse
Affiliation(s)
- Vaiva Kaveckyte
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Linda Persson
- Swedish Radiation Safety Authority, SE-171 16, Stockholm, Sweden
| | - Alexandr Malusek
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Hamza Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| | - Gudrun Alm Carlsson
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, SE-171 76, Stockholm, Sweden
| |
Collapse
|
33
|
Kry SF, Alvarez P, Cygler JE, DeWerd LA, Howell RM, Meeks S, O'Daniel J, Reft C, Sawakuchi G, Yukihara EG, Mihailidis D. AAPM TG 191: Clinical use of luminescent dosimeters: TLDs and OSLDs. Med Phys 2019; 47:e19-e51. [DOI: 10.1002/mp.13839] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Stephen F. Kry
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Paola Alvarez
- The University of Texas MD Anderson Cancer Center Houston TX USA
| | | | | | | | - Sanford Meeks
- University of Florida Health Cancer Center Orlando FL USA
| | | | | | | | | | | |
Collapse
|
34
|
Rogers D. Inverse square corrections for FACs and WAFACs. Appl Radiat Isot 2019; 153:108638. [DOI: 10.1016/j.apradiso.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 02/06/2019] [Accepted: 03/04/2019] [Indexed: 12/24/2022]
|
35
|
Pagulayan C, Heng SM, Corde S. Dosimetric validation of the Theragenics AgX-100® I-125 seed for ROPES eye plaque brachytherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 42:599-609. [PMID: 31087233 DOI: 10.1007/s13246-019-00761-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
With the discontinued distribution of the I-125 Oncura Onco seed (model 6711), the Theragenics AgX100® I-125 seeds were considered as a suitable alternative for eye plaque brachytherapy as their physical properties matched the requirements for use with the ROPES eye plaques. The purpose of this study aims at validating the dosimetry of the AgX-100 loaded ROPES plaques (11 mm diameter, 15 mm diameter with flange, 15 mm diameter with notch, 18 mm diameter) and assess the differences with the discontinued I-125 6711 model. To independently verify the plaque dosimetry, the brachytherapy module of RADCALC® version 6.2.3.6 was commissioned for the new AgX-100 I-125 seed using the published AAPM TG43 data from the literature. Experimental dosimetry verification was performed using EBT3 Gafchromic™ film and TLD-100 micro-cubes in a specially designed Solid Water® phantom. Both RADCALC® and film confirmed the dosimetry calculated by Plaque Simulator (PS) version 6.4.6 The dose calculated by PS agrees with RADCALC® to within 2% for depths of 1-15 mm for the 4 available ROPES plaques. The dosimetric measurements agreed with the calculations of PS for clinically relevant depths (4 mm to 6 mm) within the evaluated uncertainties of 4.7% and 7.2% for EBT3 film and TLDs respectively. The AgX-100 I-125 seed was a suitable replacement for the 6711 I-125 seed. Due to the introduction of the stainless-steel backscatter factor in PS v6.4.6, the department has decided to report both the homogenous dose and heterogeneity corrected dose for each eye plaque patient.
Collapse
Affiliation(s)
- Claire Pagulayan
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia.
| | - Soo Min Heng
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - Stephanie Corde
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| |
Collapse
|
36
|
Perez-Calatayud J, Ballester F, Carlsson Tedgren Å, Rijnders A, Rivard MJ, Andrássy M, Niatsetski Y, Schneider T, Siebert FA. GEC-ESTRO ACROP recommendations on calibration and traceability of LE-LDR photon-emitting brachytherapy sources at the hospital level. Radiother Oncol 2019; 135:120-129. [PMID: 31015157 DOI: 10.1016/j.radonc.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/25/2022]
Abstract
Prostate brachytherapy treatment using permanent implantation of low-energy (LE) low-dose rate (LDR) sources is successfully and widely applied in Europe. In addition, seeds are used in other tumour sites, such as ophthalmic tumours, implanted temporarily. The calibration issues for LE-LDR photon emitting sources are specific and different from other sources used in brachytherapy. In this report, the BRAPHYQS (BRAchytherapy PHYsics Quality assurance System) working group of GEC-ESTRO, has developed the present recommendations to assure harmonized and high-quality seed calibration in European clinics. There are practical aspects for which a clarification/procedure is needed, including aspects not specifically accounted for in currently existing AAPM and ESTRO societal recommendations. The aim of this report has been to provide a European wide standard in LE-LDR source calibration at end-user level, in order to keep brachytherapy treatments with high safety and quality levels. The recommendations herein reflect the guidance to the ESTRO brachytherapy users and describe the procedures in a clinic or hospital to ensure the correct calibration of LE-LDR seeds.
Collapse
Affiliation(s)
- Jose Perez-Calatayud
- Radiotherapy Department, University and Polytechnic La Fe Hospital, Valencia, Spain; IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain.
| | - Facundo Ballester
- IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain; Departmento of Atomic, Molecular and Nuclear Physics, University of Valencia, Valencia, Spain
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Medicine and Health (IMH), Linköping University, Linköping, Sweden; Section of Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | - Alex Rijnders
- Department of Radiotherapy, Europe Hospitals, Brussels, Belgium
| | - Mark J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, USA
| | | | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1, Veenendaal, Netherlands
| | - Thorsten Schneider
- Physikalisch-Technische Bundesanstalt (PTB), Department of Radiation Protection Dosimetry, Braunschweig, Germany
| | - Frank-André Siebert
- UK S-H, Campus Kiel, Klinik für Strahlentherapie (Radioonkologie), Kiel, Germany
| |
Collapse
|
37
|
Yang YM, Chow PE, McCannel TA, Lamb JM. A comparison of the shielding effectiveness of silicone oil vitreous substitutes when used with Palladium-103 and Iodine-125 eye plaques. Med Phys 2018; 46:1006-1011. [PMID: 30554429 DOI: 10.1002/mp.13341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 11/11/2018] [Accepted: 12/06/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Episcleral eye plaques provide excellent local control of ocular melanoma, but vision sparing remains a significant problem with 30% or more of patients experiencing significant visual acuity degradation. The use of silicone oil shielding with Iodine-125 plaques has previously been reported to improve critical structure sparing. We hypothesized that the use of Palladium-103 would improve the shielding effectiveness of silicone oil due to the strong energy dependence of the photoelectric effect. This Monte Carlo simulation study reports a comparison of the shielding effects of silicone oil when used in conjunction with Pd-103 and with I-125 plaques. MATERIALS AND METHODS GEANT4 was used to simulate eye plaque treatments to an eye with either water-equivalent vitreous humor, or silicone oil in place of the vitreous humor. Two solid gold plaques, 15 and 23 mm, were simulated loaded with I-125 and with Pd-103 source seeds. Seed activity was normalized such that 85 Gy was delivered to the tumor apex in the water-equivalent cases. Tumor apex dose, central axis dose, and inner sclera dose reductions with silicone oil were evaluated. RESULTS Silicone oil resulted in an underdosing to the tumor apex of 6.1% and 7.5% in the 15 mm plaque for I-125 and Pd-103, respectively, and 3.4% and 4.3% in the 23 mm plaque for I-125 and Pd-103, respectively. When renormalized to 85 Gy to the tumor apex in all scenarios, silicone oil reduced the dose to the inner sclera 90° from the plaque by 19-32% for the 15 and 23 mm plaques using I-125, and by 33-65% for the 15 and 23 mm plaques using Pd-103. CONCLUSIONS The combination of silicone oil and Pd-103 eye plaques offers the potential for greatly improved sparing to normal structures compared to Pd-103 plaques alone or I-125 plaques with or without silicone oil.
Collapse
Affiliation(s)
- You M Yang
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
| | - Phillip E Chow
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
| | - Tara A McCannel
- Department of Ophthalmology, Stein Eye and Doheny Eye Institutes, University of California, 100 Stein PLZ, Los Angeles, CA, 90095, USA
| | - James M Lamb
- University of California, Los Angeles, 200 Medical Plaza Ste B265, Los Angeles, CA, 90095, USA
| |
Collapse
|
38
|
Kim Y, Cabel K, Sun W. Does the apex optimization line matter for single-channel vaginal cylinder brachytherapy planning? J Appl Clin Med Phys 2018; 19:307-312. [PMID: 29766643 PMCID: PMC6036350 DOI: 10.1002/acm2.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 04/02/2018] [Accepted: 04/05/2018] [Indexed: 01/01/2023] Open
Abstract
The objective of this study is to test the impact of the use of the apex optimization line for new vaginal cylinder (VC) applicators. New single channel VC applicators (Varian) that have different top thicknesses but the same diameters as the old VC applicators (2.0 cm diameter, 2.3, 2.6, 3.0, and 3.5 cm) were compared using phantom studies. Old VC applicator plans without the apex optimization line were also compared to the plans with an apex optimization line. The apex doses were monitored at 5 mm depth doses (eight points) where a prescription dose (Rx) of 6 Gy was prescribed. VC surface doses (eight points) were also analyzed. The new VC applicator plans without apex optimization line presented significantly lower 5‐mm depth doses over the Rx (on average −31 ± 7%, P < 0.00001) due to thicker VC tops (3.4 ± 1.1 mm thicker with the range of 1.2–4.4 mm) than the old VC applicators. Old VC applicator plans also showed a statistically significant reduction (P < 0.00001) due to the Ir‐192 source anisotropic effect at the apex region, but the percent reduction over the Rx was only −7 ± 9%. However, by adding the apex optimization line to the new VC applicator plans, the plans improved 5‐mm depth doses (−7 ± 9% over Rx) that were not statistically different from old VC applicator plans (P = 0.923), along with apex VC surface doses (−22 ± 10% over old VC vs −46 ± 7% without using apex optimization line). The use of the apex optimization line is important in order to avoid significant additional cold doses (−24 ± 2%) at the prescription depth (5 mm) of the apex, specifically for the new VC applicators that have thicker tops. A template‐based vaginal cylinder planning reduced the intra‐ and inter‐planner variations of manual generation of apex optimization line, along with treatment time.
Collapse
Affiliation(s)
- Yusung Kim
- Department of Radiation Oncology; Carver College of Medicine; Iowa, City IA USA
| | - Katherine Cabel
- Department of Biomedical Engineering; College of Engineering; The University of Iowa; Iowa, City IA USA
| | - Wenqing Sun
- Department of Radiation Oncology; Carver College of Medicine; Iowa, City IA USA
| |
Collapse
|
39
|
Sandwall PA, Feng Y, Platt M, Lamba M, Mahalingam S. Evolution of brachytherapy treatment planning to deterministic radiation transport for calculation of cardiac dose. Med Dosim 2018; 43:150-158. [PMID: 29609845 DOI: 10.1016/j.meddos.2018.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 02/21/2018] [Indexed: 12/25/2022]
Abstract
Brachytherapy was among the first methods of radiotherapy and has steadily continued to evolve. Here we present a brief review of the progression of dose calculation methods in brachytherapy to the current state-of-the art computerized methods for heterogeneity correction. We further review the origin and development of the BrachyVision (Varian Medical Systems, Inc., Palo Alto, CA) treatment planning system and evaluate dosimetric results from 12 patients implanted with the strut-assisted volumetric implant (SAVI) applicator (Cianna Medical, Aliso Viejo, CA) for accelerated partial breast irradiation (APBI). Dosimetric results from plans calculated using homogenous and heterogeneous algorithms have been compared to investigate the impact of heterogeneity corrections. Our study showed large percent difference between mean cardiac doses 11.8 ± 6.2% (p = 0.0007) calculated with and without heterogeneity corrections. Our findings are consistent with those of others, indicating an overestimation of the distal dose to organs-at-risk by traditional methods, especially at interfaces between air and tissue.
Collapse
Affiliation(s)
| | - Yuntao Feng
- OhioHealth-Radiation Oncology, Columbus, Ohio 43214
| | - Michael Platt
- College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267
| | - Michael Lamba
- College of Medicine, University of Cincinnati, Cincinnati, Ohio 45267
| | - Sudha Mahalingam
- American Brachytherapy Society and American Society for Radiation Oncology
| |
Collapse
|
40
|
Gelover E, Katherine C, Mart C, Sun W, Kim Y. Patient's specific integration of OAR doses (D2 cc) from EBRT and 3D image-guided brachytherapy for cervical cancer. J Appl Clin Med Phys 2018; 19:83-92. [PMID: 29349933 PMCID: PMC5849844 DOI: 10.1002/acm2.12247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/17/2017] [Accepted: 11/28/2017] [Indexed: 01/03/2023] Open
Abstract
The objective of this study was to assess the recommended DVH parameter (e.g., D2 cc) addition method used for combining EBRT and HDR plans, against a reference dataset generated from an EQD2‐based DVH addition method. A revised DVH parameter addition method using EBRT DVH parameters derived from each patient's plan was proposed and also compared with the reference dataset. Thirty‐one biopsy‐proven cervical cancer patients who received EBRT and HDR brachytherapy were retrospectively analyzed. A parametrial and/or paraaortic EBRT boost were clinically performed on 13 patients. Ten IMRT and 21 3DCRT plans were determined. Two different HDR techniques for each HDR plan were analyzed. Overall D2 cc and D0.1 cc OAR doses in EQD2 were statistically analyzed for three different DVH parameter addition methods: a currently recommended method, a proposed revised method, and a reference DVH addition method. The overall D2 ccEQD2 values for all rectum, bladder, and sigmoid for a conformal, volume optimization HDR plan generated using the current DVH parameter addition method were significantly underestimated on average −5 to −8% when compared to the values obtained from the reference DVH addition technique (P < 0.01). The revised DVH parameter addition method did not present statistical differences with the reference technique (P > 0.099). When PM boosts were considered, there was an even greater average underestimation of −8~−10% for overall OAR doses of conformal HDR plans when using the current DVH parameter addition technique as compared to the revised DVH parameter addition. No statistically significant differences were found between the 3DCRT and IMRT techniques (P > 0.3148). It is recommended that the overall D2 cc EBRT doses are obtained from each patient's EBRT plan.
Collapse
Affiliation(s)
- Edgar Gelover
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cabel Katherine
- College of Engineering, Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Christopher Mart
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA
| | - Wenqing Sun
- College of Engineering, Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| | - Yusung Kim
- College of Engineering, Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA
| |
Collapse
|
41
|
Rivard MJ, Ballester F, Butler WM, DeWerd LA, Ibbott GS, Meigooni AS, Melhus CS, Mitch MG, Nath R, Papagiannis P. Erratum: “Supplement 2 for the 2004 update of the AAPM Task Group No. 43 Report: Joint recommendations by the AAPM and GEC-ESTRO” [Med. Phys. Vol 44 (9), e297-e338 (2017)]. Med Phys 2018; 45:971-974. [DOI: 10.1002/mp.12728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mark J. Rivard
- Department of Radiation Oncology; Tufts University School of Medicine; Boston MA 02111 USA
| | - Facundo Ballester
- Department of Atomic, Molecular and Nuclear Physics; University of Valencia; Burjassot 46100 Spain
| | - Wayne M. Butler
- Schiffler Cancer Center; Wheeling Hospital; Wheeling WV 26003 USA
| | - Larry A. DeWerd
- Accredited Dosimetry and Calibration Laboratory; University of Wisconsin; Madison WI 53706 USA
| | - Geoffrey S. Ibbott
- Department of Radiation Physics; M.D. Anderson Cancer Center; Houston TX 77030 USA
| | - Ali S. Meigooni
- Comprehensive Cancer Centers of Nevada; Las Vegas NV 89169 USA
| | - Christopher S. Melhus
- Department of Radiation Oncology; Tufts University School of Medicine; Boston MA 02111 USA
| | - Michael G. Mitch
- Radiation Physics Division; National Institute of Standards and Technology; Gaithersburg MD 20899 USA
| | - Ravinder Nath
- Department of Therapeutic Radiology; Yale University School of Medicine; New Haven CT 06510 USA
| | | |
Collapse
|