Radial dose functions for 103Pd, 125I, 169Yb and 192Ir brachytherapy sources: an EGS4 Monte Carlo study

Tissue composition and density impact on the clinical parameters for (125)I prostate implants dosimetry

The MCNPX code was used to calculate the TG-43U1 recommended parameters in water and prostate tissue in order to quantify the dosimetric impact in 30 patients treated with (125)I prostate implants when replacing the TG-43U1 formalism parameters calculated in water by a prostate-like medium in the planning system (PS) and to evaluate the uncertainties associated with Monte Carlo (MC) calculations. The prostate density was obtained from the CT of 100 patients with prostate cancer. The deviations between our results for water and the TG-43U1 consensus dataset values were -2.6% for prostate V100, -13.0% for V150, and -5.8% for D90; -2.0% for rectum V100, and -5.1% for D0.1; -5.0% for urethra D10, and -5.1% for D30. The same differences between our water and prostate results were all under 0.3%. Uncertainties estimations were up to 2.9% for the gL(r) function, 13.4% for the F(r,θ) function and 7.0% for Λ, mainly due to seed geometry uncertainties. Uncertainties in extracting the TG-43U1 parameters in the MC simulations as well as in the literature comparison are of the same order of magnitude as the differences between dose distributions computed for water and prostate-like medium. The selection of the parameters for the PS should be done carefully, as it may considerably affect the dose distributions. The seeds internal geometry uncertainties are a major limiting factor in the MC parameters deduction.

Local tumor control probability to evaluate an applicator-guided volumetric-modulated arc therapy solution as alternative of 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecological cancer

The purpose of this study was to evaluate the applicator‐guided volumetric‐modulated arc therapy (AGVMAT) solution as an alternative to high‐dose‐rate brachytherapy (HDR‐BRT) treatment of the vaginal vault in patients with gynecological cancer (GC). AGVMAT plans for 51 women were developed. The volumetric scans used for plans were obtained with an implanted CT‐compatible vaginal cylinder which provides spatial registration and immobilization of the gynecologic organs. Dosimetric and radiobiological comparisons for planning target volume (PTV) and organs at risk (OARs) were performed by means of a dose‐volume histogram (DVH), equivalent uniform dose (EUD), and local tumor control probability (LTCP). In addition, the integral dose and the overall delivery time, were evaluated. The HDR‐BRT averages of EUD and minimum LTCP were significantly higher than those of AGVMAT. Doses for the OARs were comparable for the bladder and sigmoid, while, although HDR‐BRT was able to better spare the bowel, AGVMAT provided a significant reduction of d2cc, d1cc, and dmax (p<0.01) for the rectum. AGVMAT integral doses were higher than HDR‐BRT with low values in both cases. Delivery times were about two or three times higher for HDR‐BRT with respect to the single arc technique (AGVMAT1) and dual arc technique (AGVMAT2), respectively. The applicator‐guided volumetric‐modulated arc therapy seems to have the potential of improving rectum avoidance. However, brachytherapy improves performance in terms of PTV coverage, as demonstrated by a greater EUD and better LTCP curves.

PACS number: 87

Comparative dosimetric and radiobiological assessment among a nonstandard RapidArc, standard RapidArc, classical intensity-modulated radiotherapy, and 3D brachytherapy for the treatment of the vaginal vault in patients affected by gynecologic cancer

To evaluate a nonstandard RapidArc (RA) modality as alternative to high-dose-rate brachytherapy (HDR-BRT) or IMRT treatments of the vaginal vault in patients with gynecological cancer (GC). Nonstandard (with vaginal applicator) and standard (without vaginal applicator) RapidArc plans for 27 women with GC were developed to compare with HDR-BRT and IMRT. Dosimetric and radiobiological comparison were performed by means of dose-volume histogram and equivalent uniform dose (EUD) for planning target volume (PTV) and organs at risk (OARs). In addition, the integral dose and the overall treatment times were evaluated. RA, as well as IMRT, results in a high uniform dose on PTV compared with HDR-BRT. However, the average of EUD for HDR-BRT was significantly higher than those with RA and IMRT. With respect to the OARs, standard RA was equivalent of IMRT but inferior to HDR-BRT. Furthermore, nonstandard RA was comparable with IMRT for bladder and sigmoid and better than HDR-BRT for the rectum because of a significant reduction of d(2cc), d(1cc), and d(max) (p < 0.01). Integral doses were always higher than HDR-BRT, although the values were very low. Delivery times were about the same and more than double for HDR-BRT compared with IMRT and RA, respectively. In conclusion, the boost of dose on vaginal vault in patients affected by GC delivered by a nonstandard RA technique was a reasonable alternative to the conventional HDR-BRT because of a reduction of delivery time and rectal dose at substantial comparable doses for the bladder and sigmoid. However HDR-BRT provides better performance in terms of PTV coverage as evidenced by a greater EUD.

Differential dose contributions on total dose distribution of (125)I brachytherapy source

This work provides an improvement of the approach using Monte Carlo simulation for the Amersham Model 6711 (125)I brachytherapy seed source, which is well known by many theoretical and experimental studies. The source which has simple geometry was researched with respect to criteria of AAPM Tg-43 Report. The approach offered by this study involves determination of differential dose contributions that come from virtual partitions of a massive radioactive element of the studied source to a total dose at analytical calculation point. Some brachytherapy seeds contain multi-radioactive elements so the dose at any point is a total of separate doses from each element. It is momentous to know well the angular and radial dose distributions around the source that is located in cancerous tissue for clinical treatments. Interior geometry of a source is effective on dose characteristics of a distribution. Dose information of inner geometrical structure of a brachytherapy source cannot be acquired by experimental methods because of limits of physical material and geometry in the healthy tissue, so Monte Carlo simulation is a required approach of the study. EGSnrc Monte Carlo simulation software was used. In the design of a simulation, the radioactive source was divided into 10 rings, partitioned but not separate from each other. All differential sources were simulated for dose calculation, and the shape of dose distribution was determined comparatively distribution of a single-complete source. In this work anisotropy function was examined also mathematically.

Evaluation of interpolation methods for TG-43 dosimetric parameters based on comparison with Monte Carlo data for high-energy brachytherapy sources

Purpose

The aim of this work was to determine dose distributions for high-energy brachytherapy sources at spatial locations not included in the radial dose function g_L(r) and 2D anisotropy function F(r,θ) table entries for radial distance r and polar angle θ. The objectives of this study are as follows: 1) to evaluate interpolation methods in order to accurately derive g_L(r) and F(r,θ) from the reported data; 2) to determine the minimum number of entries in g_L(r) and F(r,θ) that allow reproduction of dose distributions with sufficient accuracy.

Material and methods

Four high-energy photon-emitting brachytherapy sources were studied: ⁶⁰Co model Co0.A86, ¹³⁷Cs model CSM-3, ¹⁹²Ir model Ir2.A85-2, and ¹⁶⁹Yb hypothetical model. The mesh used for r was: 0.25, 0.5, 0.75, 1, 1.5, 2–8 (integer steps) and 10 cm. Four different angular steps were evaluated for F(r,θ): 1°, 2°, 5° and 10°. Linear-linear and logarithmic-linear interpolation was evaluated for g_L(r). Linear-linear interpolation was used to obtain F(r,θ) with resolution of 0.05 cm and 1°. Results were compared with values obtained from the Monte Carlo (MC) calculations for the four sources with the same grid.

Results

Linear interpolation of g_L(r) provided differences ≤ 0.5% compared to MC for all four sources. Bilinear interpolation of F(r,θ) using 1° and 2° angular steps resulted in agreement ≤ 0.5% with MC for ⁶⁰Co, ¹⁹²Ir, and ¹⁶⁹Yb, while ¹³⁷Cs agreement was ≤ 1.5% for θ < 15°.

Conclusions

The radial mesh studied was adequate for interpolating g_L(r) for high-energy brachytherapy sources, and was similar to commonly found examples in the published literature. For F(r,θ) close to the source longitudinal-axis, polar angle step sizes of 1°-2° were sufficient to provide 2% accuracy for all sources.

Evaluation of the dose distribution for prostate implants using various 125I and 103Pd sources

Recently, several different models of 125I and 103Pd brachytherapy sources have been introduced in order to meet the increasing demand for prostate seed implants. These sources have different internal structures; hence, their TG-43 dosimetric parameters are not the same. In this study, the effects of the dosimetric differences among the sources on their clinical applications were evaluated. The quantitative and qualitative evaluations were performed by comparisons of dose distributions and dose volume histograms of prostate implants calculated for various designs of 125I and 103Pd sources. These comparisons were made for an identical implant scheme with the same number of seeds for each source. The results were compared with the Amersham model 6711 seed for 125I and the Theragenics model 200 seed for 103Pd using the same implant scheme.

Benchmarking BrachyDose: Voxel based EGSnrc Monte Carlo calculations of TG-43 dosimetry parameters

In this study, BrachyDose, a recently developed EGSnrc Monte Carlo code for rapid brachytherapy dose calculations, has been benchmarked by reproducing previously published dosimetry parameters for three brachytherapy seeds with varied internal structure and encapsulation. Calculations are performed for two 125I seeds (Source Tech Medical Model STM1251 and Imagyn isoSTAR model 12501) and one l03Pd source (Theragenics Model 200). Voxel size effects were investigated with dose distribution calculations for three voxel sizes: 0.1 x 0.1 x 0.1 mm(3), 0.5 x 0.5 x 0.5 mm(3), and 1 X 1 X 1 mm(3). In order to minimize the impact of voxel size effects, tabulated dosimetry data for this study consist of a combination of the three calculations: 0.1 X 0.1 x 0.1 mm(3) voxels for distances in the range of 0<r< or = l cm, 0.5 x0.5 0.5 mm(3) voxels for 1 <r< or =5 cm and 1 x 1 X 1 mm(3) voxels for 5<r< or = 10 cm. Dosimetry parameters from this study are compared with values calculated by other authors using Williamson's PTRAN code and to measured values. Overall, calculations made with Brachydose show good agreement with calculations made with PTRAN although there are some exceptions.

Impact of interseed attenuation and tissue composition for permanent prostate implants

The purpose is to evaluate the impact of interseed attenuation and prostate composition for prostate treatment plans with 125I permanent seed implants using the Monte Carlo (MC) method. The effect of seed density (number of seeds per prostate unit volume) is specifically investigated. The study focuses on treatment plans that were generated for clinical cases. For each plan, four different dose calculation techniques are compared: TG-43 based calculation, superposition MC, full MC with water prostate, and full MC with realistic prostate tissue. The prostate tissue description is from the ICRP report 23 (W. S. Snyer, M. J. Cook, E. S. Nasset, L. R. Karkhausen, G. P. Howells, and I. H. Tipton, "Report of the task group on reference man," Technical Report 23, International Commission on Radiological Protection, 1974). According to the comparisons, the seed density has an influence on interseed attenuation. A plan with a typical low seed density (42 0.6 mCi seeds in a 26 cm3 prostate) suffers a 1.2% drop in the CTV D90 value due to interseed attenuation. A drop of 3.0% is calculated for a higher seed density (75 0.3 mCi seeds, same prostate). The influence of the prostate composition is similar for all seed densities and prostate sizes. The difference between MC simulations in water and MC simulations in prostate tissue is between 4.4% and 4.8% for the D90 parameter. Overall, the effect on D90 is ranging from 5.8% to 12.8% when comparing clinically approved TG-43 and MC simulations in prostate tissue. The impact varies from one patient to the other and depends on the prostate size and the number of seeds. This effect can reach a significant level when reporting correlations between clinical effect and deposited dose.

144Ce as a potential candidate for interstitial and intravascular brachytherapy

PURPOSE

To investigate the suitability of (144)Ce for both interstitial and intravascular brachytherapy applications.

METHODS AND MATERIALS

Monte Carlo calculations of radial dose rate distributions in water were performed for (144)Ce in a spring-shaped source and compared with two commonly used interstitial and intravascular sources, (192)Ir and (32)P. The numeric simulations were checked experimentally with a calibrated ionization chamber in a water phantom. Other source characteristics, such as half-life and specific activity, were also compared.

RESULTS

For interstitial brachytherapy, (144)Ce presents dosimetric advantages over (192)Ir in terms of higher dose rate at shorter distances and lower irradiation of organs outside the tumor. The source size and shape reduce the anisotropy and the number of dwell positions necessary. The longer half-life of (144)Ce might also be advantageous over (192)Ir. For intravascular brachytherapy, (144)Ce permits the treatment of larger arteries as compared with (32)P, compensates centering errors more effectively, and has a more suitable half-life. The experimental validation showed good agreement (within 10%) with the Monte Carlo simulated dose rate distributions.

CONCLUSIONS

There are certain potential advantages of using (144)Ce as a source for both interstitial and intravascular brachytherapy. The basis for this finding is provided by the Monte Carlo radial dose rate comparisons with (192)Ir and (32)P, as well as by such characteristics as half-life and specific activity.

Dosimetric parameters estimation using PENELOPE Monte-Carlo simulation code: Model 6711 a 125I brachytherapy seed

The dosimetric parameters for characterization of a low-energy interstitial brachytherapy source (125)I are examined. In this work, the radial dose function, g(r), anisotropy function F(r,theta), and the absolute dose rate, Lambda, around (125)I seed model 6711 have been estimated by means of the PENELOPE Monte-Carlo (MC) simulation code. The results obtained are in good agreement with the corresponding values recommended by TG-43 that are based in experimental and MC published results.

Monte Carlo dosimetric study of Best Industries and Alpha Omega Ir-192 brachytherapy seeds

Ir-192 seeds are widely used in the USA for low dose rate interstitial brachytherapy. There are two commercially available models: those manufactured by Best Industries filtered with stainless steel, and those manufactured by Alpha-Omega seeds filtered with Pt. Newly developed 3D correction algorithms for brachytherapy are based on dosimetry data obtained on unbounded phantom size, allowing corrections for heterogeneities and actual tissue boundaries. Published dosimetric datasets for both seeds have been obtained under bounded conditions. The aim of the present study is to obtain dosimetric datasets for these seeds under full scatter conditions. The Monte Carlo GEANT4 code has been used to estimate air-kerma strength and dose rate in water around the Ir-192 seeds. Functions and parameters following the TG43 formalism are obtained and presented in tabular forms: the dose rate constant, the radial dose function, and the anisotropy function. Tables for the anisotropy factor have been obtained in order to apply punctual approximation. Differences between dose rate distributions for both seeds show that specific dataset must be used for each type of seed in clinical dosimetry. The data in the present study improve on published data in the following aspects: (i) dosimetric data were obtained under full scatter conditions, which affect dose values at distances greater than 4-5 cm from the source; (ii) the dose rate tables are given at greater distances from the source; and (iii) the spatial resolution in high dose gradient areas, such as those near the longitudinal source axis, has been improved.

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.

On the development of consensus values of reference dosimetry parameters for interstitial brachytherapy sources

The American Association of Physicists in Medicine recommends that the reference dose-rate distribution, used for treatment planning for low-energy photon brachytherapy sources in routine clinical use, must be based on at least two independent determinations: one using experimentally measured dose rates and one using Monte Carlo simulation dosimetry techniques. In this work, we present an approach for developing consensus dosimetry parameters from various independent reference dosimetry studies for interstitial brachytherapy sources. This approach is applied to four recently published papers on the dosimetric properties of the BrachySeed Model LS-1 125I seed. Consensus values for the dose-rate constant, radial dose function, and anisotropy parameters are presented for the LS-1 Model 125I seed.

Brachytherapy dosimetry of 125I and 103Pd sources using an updated cross section library for the MCNP Monte Carlo transport code

Permanent implantation of low energy (20-40 keV) photon emitting radioactive seeds to treat prostate cancer is an important treatment option for patients. In order to produce accurate implant brachytherapy treatment plans, the dosimetry of a single source must be well characterized. Monte Carlo based transport calculations can be used for source characterization, but must have up to date cross section libraries to produce accurate dosimetry results. This work benchmarks the MCNP code and its photon cross section library for low energy photon brachytherapy applications. In particular, we calculate the emitted photon spectrum, air kerma, depth dose in water, and radial dose function for both 125I and 103Pd based seeds and compare to other published results. Our results show that MCNP's cross section library differs from recent data primarily in the photoelectric cross section for low energies and low atomic number materials. In water, differences as large as 10% in the photoelectric cross section and 6% in the total cross section occur at 125I and 103Pd photon energies. This leads to differences in the dose rate constant of 3% and 5%, and differences as large as 18% and 20% in the radial dose function for the 125I and 103Pd based seeds, respectively. Using a partially updated photon library, calculations of the dose rate constant and radial dose function agree with other published results. Further, the use of the updated photon library allows us to verify air kerma and depth dose in water calculations performed using MCNP's perturbation feature to simulate updated cross sections. We conclude that in order to most effectively use MCNP for low energy photon brachytherapy applications, we must update its cross section library. Following this update, the MCNP code system will be a very effective tool for low energy photon brachytherapy dosimetry applications.

Dosimetric properties of the new 125I BrachySeed model LS-1 source

The BrachySeed model LS-1 is one of the latest in a series of new brachytherapy 125I seeds that have recently become available commercially for interstitial implants. The dosimetric properties of the seed were investigated analytically, experimentally, and by Monte Carlo simulation. Following the AAPM Task Group 43 formalism, the radial dose function, dose rate constant, and anisotropy parameters were determined. Experimental measurements were made in solid water-equivalent phantoms using GafChromic MD-55-2 films, with correction for the low energy film response. Analyses were carried out from absolute measurements, as well as relative measurements against the Nycomed Amersham OncoSeed Model 6711, which also served to validate our experimental methodology. A small, but systematic difference in the absolute measurements was observed depending on the duration of the irradiation. Monte Carlo simulation was performed using the Integrated Tiger Series CYLTRAN code. We benchmarked the code by comparing the dose parameters of Model 6702 with published values. The radial dose function, g(r), of the Model LS-1 seed was computed at distances from 0.25 to 10 cm by analytical and Monte Carlo calculations with reasonably good agreement. The suggested dose rate constant, A, based on the Monte Carlo simulation is 0.90+/-0.03 cGy h(-1) U(-1). This value is smaller than, but overlaps the experimental determination of 0.98+/-0.06 cGy h(-1) U(-1). The anisotropy function, F(r, theta), and anisotropy factor, phi(an)(r), compared favorably with those of the Model 6711.

Anisotropy function for 192Ir low-dose-rate brachytherapy sources: an EGS4 Monte Carlo study

The anisotropy function of low-dose-rate 192Ir interstitial brachytherapy sources was studied. Absolute dose rates around 192Ir seeds with stainless steel or platinum cladding and a platinum covered wire have been estimated using the EGS4 Monte Carlo simulation system with a very well tested user code. Our results were compared with available experimental data. Excellent agreement between calculated and measured anisotropy function was found for stainless steel clad 192Ir sources, except along the longitudinal axis of the sources. Dosimetry data for the platinum covered seed and 3 mm long wire with platinum cladding as well as for the stainless steel clad 192Ir source are presented in TG43 format. The influence of phantom dimensions on the anisotropy function was found to be non-negligible over 7 cm, enhancing the anisotropy function by 1-2%. Our results have estimated statistical uncertainties below 1% at 1 sigma level up to 10 cm excluding the longitudinal axis where statistical uncertainties below 3% up to 10 cm are observed.

Anisotropy functions for 169Yb brachytherapy seed models 5, 8 and X1267. An EGS4 Monte Carlo study

Anisotropy functions for 169Yb sources used in interstitial brachytherapy are investigated. A comprehensive study of several factors affecting the angular dose distribution around four 169Yb seed models (Amersham International) has been undertaken. Absolute dose rates around 169Yb seed models 5, 8a, 8b and X1267 have been estimated by means of the EGS4 Monte Carlo Simulation System. An updated cross section library (DLC-136/PHOTX), binding corrections for Compton scattering and water molecular form factors were included in the calculations. Following the formalism developed by the Interstitial Brachytherapy Collaborative Working Group, anisotropy functions, F(r, theta), have been calculated and compared with other Monte Carlo results and whenever possible with experimental data. Excellent agreement is found with other Monte Carlo calculations. Considering the large experimental errors reported, a fairly good coincidence has been achieved between experimental and Monte Carlo data for models 8a and 8b. For model X1267 large discrepancies with experiment are obtained. Monte Carlo calculations for all seed models showed model 5 to be the least anisotropic and models 8b and X1267 to be almost identical. Statistical fluctuations can be drastically reduced computationally, offering an efficient alternative to measured data. Our results have estimated uncertainties of 0.5%-1.0% within one standard deviation everywhere excluding the longitudinal source axis, where uncertainties are below 3% up to 5 cm, this accuracy being excellent for clinical calculations.