Autoradiography for iodine-125 seeds

Determination of Ir-192 micrselectron-V2 HDR/PDR dwell position reproducibility using a slit camera

PURPOSE

To examine the limits of dwell position reproducibility of an ELEKTA microSelectron-V2 HDR/PDR remote afterloader.

METHODS AND MATERIALS

The variability in source dwell position of an ELEKTA Microselectron mHDR - V2 HDR/PDR Microselectron was assessed using a slit camera. 100 consecutive extensions each of the source were made to positions of 1200 mm and 1470 mm and the variations in dwell position were observed.

RESULTS

Maximum deviations of 0.4 mm from the median dwell position were observed. 72% of all deviations from median dwell position were 0.15 mm or less while 96% were no greater than 0.3 mm.

CONCLUSION

Guide wire flexibility makes buckling over the length of source extension an unavoidable reality which, in turn, produces variability in the dwell position achieved. Fortunately these deviations in source dwell position are small and may be compensated for using margins along the dose distribution length.

Microscintigraphy with high resolution collimators and radiographic detectors

The potential use of high resolution collimators with standard radiographic detectors in place of conventional gamma cameras for high resolution microscintigraphy is presented. Polycapillary multiple hole collimators are shown to provide 10-100 micron scale spatial resolution. A series of images from arrays of 125I brachytherapy seeds in Lucite phantoms display resolution better than 0.1 mm with good sensitivity and a 30 mm field of view. In addition to application to brachytherapy seed localization, such "cellular" level resolution is necessary for high-resolution in vivo imaging in mouse models. The system could also enable the use of a wider variety of isotopes, including much lower photon energy isotopes in nuclear medicine, as the high resolution collimator allows more flexibility in detector constraints.

Update of AAPM Task Group No. 43 Report: A revised AAPM protocol for brachytherapy dose calculations

Since publication of the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report in 1995 (TG-43), both the utilization of permanent source implantation and the number of low-energy interstitial brachytherapy source models commercially available have dramatically increased. In addition, the National Institute of Standards and Technology has introduced a new primary standard of air-kerma strength, and the brachytherapy dosimetry literature has grown substantially, documenting both improved dosimetry methodologies and dosimetric characterization of particular source models. In response to these advances, the AAPM Low-energy Interstitial Brachytherapy Dosimetry subcommittee (LIBD) herein presents an update of the TG-43 protocol for calculation of dose-rate distributions around photon-emitting brachytherapy sources. The updated protocol (TG-43U1) includes (a) a revised definition of air-kerma strength; (b) elimination of apparent activity for specification of source strength; (c) elimination of the anisotropy constant in favor of the distance-dependent one-dimensional anisotropy function; (d) guidance on extrapolating tabulated TG-43 parameters to longer and shorter distances; and (e) correction for minor inconsistencies and omissions in the original protocol and its implementation. Among the corrections are consistent guidelines for use of point- and line-source geometry functions. In addition, this report recommends a unified approach to comparing reference dose distributions derived from different investigators to develop a single critically evaluated consensus dataset as well as guidelines for performing and describing future theoretical and experimental single-source dosimetry studies. Finally, the report includes consensus datasets, in the form of dose-rate constants, radial dose functions, and one-dimensional (1D) and two-dimensional (2D) anisotropy functions, for all low-energy brachytherapy source models that met the AAPM dosimetric prerequisites [Med. Phys. 25, 2269 (1998)] as of July 15, 2001. These include the following 125I sources: Amersham Health models 6702 and 6711, Best Medical model 2301, North American Scientific Inc. (NASI) model MED3631-A/M, Bebig/Theragenics model I25.S06, and the Imagyn Medical Technologies Inc. isostar model IS-12501. The 103Pd sources included are the Theragenics Corporation model 200 and NASI model MED3633. The AAPM recommends that the revised dose-calculation protocol and revised source-specific dose-rate distributions be adopted by all end users for clinical treatment planning of low energy brachytherapy interstitial sources. Depending upon the dose-calculation protocol and parameters currently used by individual physicists, adoption of this protocol may result in changes to patient dose calculations. These changes should be carefully evaluated and reviewed with the radiation oncologist preceding implementation of the current protocol.

Real-time monitoring and verification of in vivo high dose rate brachytherapy using a pinhole camera

We investigated a pinhole imaging system for independent in vivo monitoring and verification of high dose rate (HDR) brachytherapy treatment. The system consists of a high-resolution pinhole collimator, an x-ray fluoroscope, and a standard radiographic screen-film combination. Autofluoroscopy provides real-time images of the in vivo Ir-192 HDR source for monitoring the source location and movement, whereas autoradiography generates a permanent record of source positions on film. Dual-pinhole autoradiographs render stereo-shifted source images that can be used to reconstruct the source dwell positions in three dimensions. The dynamic range and spatial resolution of the system were studied with a polystyrene phantom using a range of source strengths and dwell times. For the range of source activity used in HDR brachytherapy, a 0.5 mm diameter pinhole produced sharp fluoroscopic images of the source within the dynamic range of the fluoroscope. With a source-to-film distance of 35 cm and a 400 speed screen-film combination, the same pinhole yielded well recognizable images of a 281.2 GBq (7.60 Ci) Ir-192 source for dwell times in the typical clinical range of 2 to 400 s. This 0.5 mm diameter pinhole could clearly resolve source positions separated by lateral displacements as small as 1 mm. Using a simple reconstruction algorithm, dwell positions in a phantom were derived from stereo-shifted dual-pinhole images and compared to the known positions. The agreement was better than 1 mm. A preliminary study of a patient undergoing HDR treatment for cervical cancer suggests that the imaging method is clinically feasible. Based on these studies we believe that the pinhole imaging method is capable of providing independent and reliable real-time monitoring and verification for HDR brachytherapy.

TLD, diode and Monte Carlo dosimetry of an 192Ir source for high dose-rate brachytherapy

Very few dosimetry data are available for the current generation of high-dose-rate (HDR) 192Ir sources, which have broad application in remotely afterloaded brachytherapy. We have measured the two-dimensional dose rate distribution around a microSelectron-HDR source and used the results to validate Monte Carlo simulations. Thermoluminescent dosimeters (TLDs) in solid-water phantoms were used to measure the transverse-axis dose rates in the distance range 0.5-10 cm and the polar dose-rate profiles at 1.5, 3 and 5 cm distance from the source. At close distances, 2-40 mm from the HDR source, we performed transverse axis dose-rate measurements with a Si diode in water. We performed diode measurements at the same distances also for a pulsed dose-rate (PDR) source to compare the results for 192Ir sources with different encapsulation. Both the HDR and the PDR sources were decayed, separated from their cables and calibrated prior to the measurements. The measured dose rates were compared with Monte Carlo photon transport calculations, which realistically modelled the experimental and source geometry at each measurement point. Agreement between Monte Carlo photon transport absolute dose-rate calculations and measurements was, on average, within 5%. From the transverse-axis experimental data, we deduced a value for the dose-rate constant lambda 0 of 192Ir HDR sources of 1.14 cGy h-1 U-1 +/- 5%. This value agrees within the experimental error with the Monte Carlo estimate of 1.115 cGy h-1 U-1 +/- 0.5%. Excellent agreement with previously measured anisotropy functions was observed. Higher anisotropy is observed for the point at 0 degree along the source cable for which no previous data have been reported.