Dosimetric evaluation of the Fletcher–Williamson ovoid for pulsed-dose-rate brachytherapy: a Monte Carlo study

Dosimetry for 131Cs and 125I seeds in solid water phantom using radiochromic EBT film

PURPOSE

To measure the 2D dose distributions with submillimeter resolution for (131)Cs (model CS-1 Rev2) and (125)I (model 6711) seeds in a Solid Water phantom using radiochromic EBT film for radial distances from 0.06cm to 5cm. To determine the TG-43 dosimetry parameters in water by applying Solid Water to liquid water correction factors generated from Monte Carlo simulations.

METHODS

Each film piece was positioned horizontally above and in close contact with a (131)Cs or (125)I seed oriented horizontally in a machined groove at the center of a Solid Water phantom, one film at a time. A total of 74 and 50 films were exposed to the (131)Cs and (125)I seeds, respectively. Different film sizes were utilized to gather data in different distance ranges. The exposure time varied according to the seed air-kerma strength and film size in order to deliver doses in the range covered by the film calibration curve. Small films were exposed for shorter times to assess the near field, while larger films were exposed for longer times in order to assess the far field. For calibration, films were exposed to either 40kV (M40) or 50kV (M50) x-rays in air at 100.0cm SSD with doses ranging from 0.2Gy to 40Gy. All experimental, calibration and background films were scanned at a 0.02cmpixel resolution using a CCD camera-based microdensitometer with a green light source. Data acquisition and scanner uniformity correction were achieved with Microd3 software. Data analysis was performed using ImageJ, FV, IDL and Excel software packages. 2D dose distributions were based on the calibration curve established for 50kV x-rays. The Solid Water to liquid water medium correction was calculated using the MCNP5 Monte Carlo code. Subsequently, the TG-43 dosimetry parameters in liquid water medium were determined.

RESULTS

Values for the dose-rate constants using EBT film were 1.069±0.036 and 0.923±0.031cGyU(-1)h(-1) for (131)Cs and (125)I seed, respectively. The corresponding values determined using the Monte Carlo method were 1.053±0.014 and 0.924±0.016cGyU(-1)h(-1) for (131)Cs and (125)I seed, respectively. The radial dose functions obtained with EBT film measurements and Monte Carlo simulations were plotted for radial distances up to 5cm, and agreed within the uncertainty of the two methods. The 2D anisotropy functions obtained with both methods also agreed within their uncertainties.

CONCLUSION

EBT film dosimetry in a Solid Water phantom is a viable method for measuring (131)Cs (model CS-1 Rev2) and (125)I (model 6711) brachytherapy seed dose distributions with submillimeter resolution. With the Solid Water to liquid water correction factors generated from Monte Carlo simulations, the measured TG-43 dosimetry parameters in liquid water for these two seed models were found to be in good agreement with those in the literature.

Suitability of point kernel dose calculation techniques in brachytherapy treatment planning

Brachytherapy treatment planning system (TPS) is necessary to estimate the dose to target volume and organ at risk (OAR). TPS is always recommended to account for the effect of tissue, applicator and shielding material heterogeneities exist in applicators. However, most brachytherapy TPS software packages estimate the absorbed dose at a point, taking care of only the contributions of individual sources and the source distribution, neglecting the dose perturbations arising from the applicator design and construction. There are some degrees of uncertainties in dose rate estimations under realistic clinical conditions. In this regard, an attempt is made to explore the suitability of point kernels for brachytherapy dose rate calculations and develop new interactive brachytherapy package, named as BrachyTPS, to suit the clinical conditions. BrachyTPS is an interactive point kernel code package developed to perform independent dose rate calculations by taking into account the effect of these heterogeneities, using two regions build up factors, proposed by Kalos. The primary aim of this study is to validate the developed point kernel code package integrated with treatment planning computational systems against the Monte Carlo (MC) results. In the present work, three brachytherapy applicators commonly used in the treatment of uterine cervical carcinoma, namely (i) Board of Radiation Isotope and Technology (BRIT) low dose rate (LDR) applicator and (ii) Fletcher Green type LDR applicator (iii) Fletcher Williamson high dose rate (HDR) applicator, are studied to test the accuracy of the software. Dose rates computed using the developed code are compared with the relevant results of the MC simulations. Further, attempts are also made to study the dose rate distribution around the commercially available shielded vaginal applicator set (Nucletron). The percentage deviations of BrachyTPS computed dose rate values from the MC results are observed to be within plus/minus 5.5% for BRIT LDR applicator, found to vary from 2.6 to 5.1% for Fletcher green type LDR applicator and are up to -4.7% for Fletcher-Williamson HDR applicator. The isodose distribution plots also show good agreements with the results of previous literatures. The isodose distributions around the shielded vaginal cylinder computed using BrachyTPS code show better agreement (less than two per cent deviation) with MC results in the unshielded region compared to shielded region, where the deviations are observed up to five per cent. The present study implies that the accurate and fast validation of complicated treatment planning calculations is possible with the point kernel code package.

Dose perturbation due to the polysulfone cap surrounding a Fletcher-Williamson colpostat

We conducted a Monte Carlo evaluation of the dosimetric impact of the polysulfone cap used with the Fletcher‐Williamson (FW) colpostat for I192r high‐dose rate and pulsed‐dose rate intracavitary brachytherapy. Polysulfone caps with diameters of 30 mm, 25 mm, 20 mm, and 16 mm (mini‐ovoid) were simulated, and the absorbed dose rate in surrounding water was calculated and compared to the dose rate calculated for a bare I192r source in water. The dose perturbation depended on the cap diameter, distance away from the cap surface, and angular position around the cap. The largest dose rate reductions were found to be where the cap is thickest, in the general direction of the tumor bed. The range of perturbation mainly from the polysulfone cap over all depths and cap diameters was +2.8% (dose enhancement) to −6.8% (dose reduction); this perturbation is separate from the well‐documented attenuation of the rectal and bladder tungsten shields of the colpostat. Based on the impact of the polysulfone cape, the FW colpostat cap's material composition should be modified to reduce this dosimetric effect, or brachytherapy treatment planning dose algorithms should be improved to account for this perturbation.

PACS numbers: 87.10.Rt 87.53.‐j 87.53.Bn 87.53.Jw

Retrospective Dosimetric Comparison of Low-Dose-Rate and Pulsed-Dose-Rate Intracavitary Brachytherapy Using a Tandem and Mini-Ovoids

The purpose of this study was to compare the dose distribution of Iridium-192 ((192)Ir) pulsed-dose-rate (PDR) brachytherapy to that of Cesium-137 ((137)Cs) low-dose-rate (LDR) brachytherapy around mini-ovoids and an intrauterine tandem. Ten patient treatment plans were selected from our clinical database, all of which used mini-ovoids and an intrauterine tandem. A commercial treatment planning system using AAPM TG43 formalism was used to calculate the dose in water for both the (137)Cs and (192)Ir sources. For equivalent system loadings, we compared the dose distributions in relevant clinical planes, points A and B, and to the ICRU bladder and rectal reference points. The mean PDR doses to points A and B were 3% +/- 1% and 6% +/- 1% higher than the LDR doses, respectively. For the rectum point, the PDR dose was 4% +/- 3% lower than the LDR dose, mainly because of the (192)Ir PDR source anisotropy. For the bladder point, the PDR dose was 1% +/- 4% higher than the LDR dose. We conclude that the PDR and LDR dose distributions are equivalent for intracavitary brachytherapy with a tandem and mini-ovoids. These findings will aid in the transfer from the current practice of LDR intracavitary brachytherapy to PDR for the treatment of gynecologic cancers.

Comparison of dose distributions around the pulsed-dose-rate Fletcher–Williamson and the low-dose-rate Fletcher–Suit–Delclos ovoids: a Monte Carlo study

We performed a Monte Carlo study to compare dose distributions for a Fletcher-Suit-Delclos (FSD) ovoid used with (137)Cs low-dose-rate (LDR) sources with those for a Fletcher-Williamson (FW) ovoid used with an (192)Ir pulsed-dose-rate (PDR) source for intracavitary brachytherapy of cervical cancer. We recently reported on extensive validation of Monte Carlo MCNPX models of these ovoids using radiochromic film measurements. Here, we compared these models assuming identical loading of 10, 15 and 20 mgRaEq (72, 108 and 145 cGy cm(2) h(-1), respectively) in three dose mesh planes: one perpendicular to the ovoid long axis bisecting the ovoid, one parallel to and displaced 2 cm medially from the long axis of the ovoid, and a 'rectal' plane perpendicular to the long axis located 1 cm distal to the distal face of the ovoid cap. The FW ovoid delivered slightly higher doses (within 10%) over all loadings to regions away from the bladder and rectal shields when compared to the FSD ovoid. However, the FW ovoid delivered much higher doses (>50%) in regions near these shields. In the rectal plane, the FW ovoid delivered a slightly higher dose, but within the region directly behind the rectal shield, the FW ovoid delivered a dose ranging from +35% to -35% of the FSD dose distribution. We attribute these differences to intrinsic differences in source characteristics (radial dose function and anisotropy factors) and extrinsic factors such as the solid-angle effect between sources and shields and applicator design.

Approaches to calculating AAPM TG-43 brachytherapy dosimetry parameters for Cs137, I125, Ir192, Pd103, and Yb169 sources

Underlying characteristics in brachytherapy dosimetry parameters for medical radionuclides 137Cs, 125I, 192Ir, 103Pd, and 169Yb were examined using Monte Carlo methods. Sources were modeled as unencapsulated point or line sources in liquid water to negate variations due to materials and construction. Importance of phantom size, mode of radiation transport physics--i.e., photon transport only or coupled photon:electron transport, phantom material, volume averaging, and Monte Carlo tally type were studied. For noninfinite media, g(r) was found to degrade as r approached R, the phantom radius. MCNP5 results were in agreement with those published using GEANT4. Brachytherapy dosimetry parameters calculated using coupled photon:electron radiation transport simulations did not differ significantly from those using photon transport only. Dose distributions from low-energy photon-emitting radionuclides 125I and 103Pd were sensitive to phantom material by upto a factor of 1.4 and 2.0, respectively, between tissue-equivalent materials and water at r =9 cm. In comparison, high-energy photons from 137Cs, 192Ir, and 169Yb demonstrated +/- 5% differences in dose distributions between water and tissue substitutes at r=20 cm. Similarly, volume-averaging effects were found to be more significant for low-energy radionuclides. When modeling line sources with L < or = 0.5 cm, the two-dimensional anisotropy function was largely within +/- 0.5% of unity for 137Cs, 125I, and 192Ir. However, an energy and geometry effect was noted for 103Pd and 169Yb, with Pd-103F(0.5,0 degrees)=l.05 and yb-169F(0.5,0 degrees)=0.98 for L=0.5 cm. Simulations of monoenergetic photons for L=0.5 cm produced energy-dependent variations in F(r, theta) having a maximum value at 10 keV, minimum at 50 keV, and approximately 1.0 for higher-energy photons up to 750 keV. Both the F6 cell heating and *F4 track-length estimators were employed to determine brachytherapy dosimetry parameters. F6 was found to be necessary for g(r), while both tallies provided equivalent results for F(r, theta).