On the biological basis for competing macroscopic dose descriptors for kilovoltage dosimetry: cellular dosimetry for brachytherapy and diagnostic radiology

Multiscale Monte Carlo simulations of gold nanoparticle dose-enhanced radiotherapy II. Cellular dose enhancement within macroscopic tumor models

BACKGROUND

Gold NanoParticle (GNP) dose-enhanced radiation therapy (GNPT) requires consideration of physics across macro- to microscopic length scales, however, this presents computational challenges that have limited previous investigations.

PURPOSE

To develop and apply multiscale Monte Carlo (MC) simulations to assess variations in nucleus and cytoplasm dose enhancement factors (n,cDEFs) over tumor-scale volumes.

METHODS

The intrinsic variation of n,cDEFs (due to fluctuations in local gold concentration and cell/nucleus size variation) are estimated via MC modeling of varied cellular GNP uptake and cell/nucleus sizes. Then, the Heterogeneous MultiScale (HetMS) model is implemented in MC simulations by combining detailed models of populations of cells containing GNPs within simplified macroscopic tissue models to evaluate n,cDEFs. Simulations of tumors with spatially uniform gold concentrations (5, 10, or 20 mgAu /gtissue ) and spatially varying gold concentrations eluted from a point are performed to determine n,cDEFs as a function of distance from the source for 10 to 370 keV photons. All simulations are performed for three different intracellular GNP configurations: GNPs distributed on the surface of the nucleus (perinuclear) and GNPs packed into one or four endosome(s).

RESULTS

Intrinsic variations in n,cDEFs can be substantial, for example, if GNP uptake and cell/nucleus radii are varied by 20%, variations of up to 52% in nDEF and 25% in cDEF are observed compared to the nominal values for uniform cell/nucleus size and GNP concentration. In HetMS models of macroscopic tumors, subunity n,cDEFs (i.e., dose decreases) can occur for low energies and high gold concentrations due to attenuation of primary photons through the gold-filled volumes, for example, n,cDEF<1 is observed 3 mm from a 20 keV source for the four endosome configuration. In HetMS simulations of tumors with spatially uniform gold concentrations, n,cDEFs decrease with depth into the tumor as photons are attenuated, with relative differences between GNP models remaining approximately constant with depth in the tumor. Similar initial n,cDEF decreases with radius are seen in the tumors with spatially varying gold concentrations, but the n,cDEFs for all of the GNP configurations converge to a single value for each energy as gold concentration reaches zero.

CONCLUSIONS

The HetMS framework has been implemented for multiscale MC simulations of GNPT to compute n,cDEFs over tumor-scale volumes, with results demonstrating that cellular doses are highly sensitive to cell/nucleus size, GNP intracellular distribution, gold concentration, and cell position in tumor. This work demonstrates the importance of proper choice of computational model when simulating GNPT scenarios and the need to account for intrinsic variations in n,cDEFs due to variations in cell/nucleus size and gold concentration.

Multiscale Monte Carlo simulations of gold nanoparticle dose-enhanced radiotherapy I: Cellular dose enhancement in microscopic models

BACKGROUND

The introduction of Gold NanoParticles (GNPs) in radiotherapy treatments necessitates considerations such as GNP size, location, and quantity, as well as patient geometry and beam quality. Physics considerations span length scales across many orders of magnitude (nanometer-to-centimeter), presenting challenges that often limit the scope of dosimetric studies to either micro- or macroscopic scales.

PURPOSE

To investigate GNP dose-enhanced radiation Therapy (GNPT) through Monte Carlo (MC) simulations that bridge micro-to-macroscopic scales. The work is presented in two parts, with Part I (this work) investigating accurate and efficient MC modeling at the single cell level to calculate nucleus and cytoplasm Dose Enhancement Factors (n,cDEFs), considering a broad parameter space including GNP concentration, GNP intracellular distribution, cell size, and incident photon energy. Part II then evaluates cell dose enhancement factors across macroscopic (tumor) length scales.

METHODS

Different methods of modeling gold within cells are compared, from a contiguous volume of either pure gold or gold-tissue mixture to discrete GNPs in a hexagonal close-packed lattice. MC simulations with EGSnrc are performed to calculate n,cDEF for a cell with radiusr cell = 7.35 $r_{\rm cell}=7.35$  µm and nucleusr nuc = 5 $r_{\rm nuc} = 5$  µm considering 10 to 370 keV incident photons, gold concentrations from 4 to 24 mgAu /gtissue , and three different GNP configurations within the cell: GNPs distributed around the surface of the nucleus (perinuclear) or GNPs packed into one (or four) endosome(s). Select simulations are extended to cells with different cell (and nucleus) sizes: 5 µm (2, 3, and 4 µm), 7.35 µm (4 and 6 µm), and 10 µm (7, 8, and 9 µm).

RESULTS

n,cDEFs are sensitive to the method of modeling gold in the cell, with differences of up to 17% observed; the hexagonal lattice of GNPs is chosen (as the most realistic model) for all subsequent simulations. Across cell/nucleus radii, source energies, and gold concentrations, both nDEF and cDEF are highest for GNPs in the perinuclear configuration, compared with GNPs in one (or four) endosome(s). Across all simulations of the (rcell , rnuc ) = (7.35, 5) µm cell, nDEFs and cDEFs range from unity to 6.83 and 3.87, respectively. Including different cell sizes, nDEFs and cDEFs as high as 21.5 and 5.5, respectively, are observed. Both nDEF and cDEF are maximized at photon energies above the K- or L-edges of gold by 10 to 20 keV.

CONCLUSIONS

Considering 5000 unique simulation scenarios, this work comprehensively investigates many physics trends on DEFs at the cellular level, including demonstrating that cellular DEFs are sensitive to gold modeling approach, intracellular GNP configuration, cell/nucleus size, gold concentration, and incident source energy. These data should prove especially useful in research as well as treatment planning, allowing one to optimize or estimate DEF using not only GNP uptake, but also account for average tumor cell size, incident photon energy, and intracellular configuration of GNPs. Part II will expand the investigation, taking the Part I cell model and applying it in cm-scale phantoms.

Multiple Mesh-type Real Human Cell Models for Dosimetric Application Coupled with Monte Carlo Simulations

The mesh-type models are superior to voxel models in cellular dose assessment coupled with Monte Carlo codes. The aim of this study was to expand the micron-scale mesh-type models based on the fluorescence tomography of real human cells, and to investigate the feasibility of these models in the application of various irradiation scenarios and Monte Carlo codes. Six different human cell lines, including pulmonary epithelial BEAS-2B, embryonic kidney 293T, hepatocyte L-02, B-lymphoblastoid HMy2.CIR, Gastric mucosal GES-1, and intestine epithelial FHs74Int, were adopted for single mesh-type models reconstruction and optimization based on laser confocal tomography images. Mesh-type models were transformed into the format of polygon mesh and tetrahedral mesh for the GATE and PHITS Monte Carlo codes, respectively. The effect of model reduction was analyzed by dose assessment and geometry consideration. The cytoplasm and nucleus doses were obtained by designating monoenergetic electrons and protons as external irradiation, and S values with different "target-source" combinations were calculated by assigning radioisotopes as internal exposure. Four kinds of Monte Carlo codes were employed, i.e., GATE with "Livermore," "Standard" and "Standard and Geant4-DNA mixed" models for electrons and protons, as well as PHITS with "EGS" mode for electrons and radioisotopes. Multiple mesh-type real human cellular models can be applied to Monte Carlo codes directly without voxelization when combined with certain necessary surface reduction. Relative deviations between different cell types were observed among various irradiation scenarios. The relative deviation of nucleus S value reaches up to 85.65% between L-02 and GES-1 cells by 3H for the "nucleus-nucleus" combination, while that of 293T and FHs74Int nucleus dose for external beams at a 5.12 cm depth of water is 106.99%. Nucleus with smaller volume is far more affected by physical codes. There is a considerable deviation for dose within BEAS-2B at the nanoscale. The multiple mesh-type real cell models were more versatile than voxel models and mathematical models. The present study provided several models which can easily be extended to other cell types and irradiation scenarios for RBE estimations and biological effect predictions, including radiation biological experiments, radiotherapy and radiation protection.

Validation of accordance of ArcCHECK diode detector output with Monte Carlo simulation in brachytherapy

There are several accepted methods to verify External Beam Radiation Therapy (EBRT) treatment plans, but there is no standard way to check the quality of a brachytherapy treatment plan.

PURPOSE

This feasibility study assesses whether the ArcCHECK EBRT radiation detector can also be used to verify Treatment Planning System software quality check procedures for brachytherapy.

METHODS AND MATERIALS

ArcCHECK is a three-dimensional matrix of 1386 semiconductor diodes, arranged spirally around an internal cylindrical space that is 32 cm long and 15 cm in diameter. The detector makes it possible to reproduce the distribution of sources in a planned EBRT procedure (energy range 6-22 MeV) using an appropriate phantom. Detector responses are displayed as a two-dimensional dose distribution map on the diode surface. In this pilot brachytherapy study, we determined values that characterized the output of the detectors to a simulated Ir-192 radiation source with an energy range of approximately 9-1378 keV, and compared this to the actual signal recorded by an ArcCHECK detector. Experimental treatment plan measurement was performed using a standard Elekta micro-Selectron-v2 unit equipped with an iridium-192 source. To avoid unit inconsistencies, the signal from each of the diodes and the simulation results were normalized to the maximum value, with similar statistical parameters.

RESULTS

The difference between diode indications in the simulation and the actual measurement was analyzed statistically to show the degree of general inconsistency between them. The average difference for diode pairs here is equal 1,07%, with standard deviation 3, 95%.

CONCLUSION

The results obtained represent the first quantitative evidence of potential usefulness of the ArcCHECK detector in brachytherapy Treatment Planning System software QC verification.

Impact assessment of breast glandularity on relative biological effectiveness of low energy IORT X-rays through Monte Carlo simulation

INTRODUCTION

Intraoperative radiotherapy (IORT) by low energy X-rays is a single fraction treatment modality for tumor bed irradiation after breast-conserving surgery. It has been shown that the variations of breast tissue composition can affect the absorbed dose in this method. Apart from physical quantities such as absorbed dose value, radiobiological quantities including relative biological effectiveness (RBE) may also change with the variations of breast tissue composition. Accordingly, the current study aims to quantify both single and double-strand break RBE values (RBE_SSB and RBE_DSB) of low energy X-rays at different breast glandular fractions using a hybrid Monte Carlo (MC) simulation approach.

MATERIALS AND METHODS

Produced low-energy X-rays by a validated MC model of INTRABEAM machine with 50 kV nominal voltage were considered as the radiation source. The secondary electron energy spectra at various depths inside the breast tissue with different glandular fractions were scored through GEANT4 MC Toolkit. Calculated spectra were then imported to MCDS MC code for DNA strand break calculation and RBE assessment. Both RBE_SSB and RBE_DSB were calculated for various breast glandular fractions.

RESULTS

Changing the breast glandularity can affect both the trend of secondary electron spectra and relevant RBE values at different depths inside the breast volume. In this regard, RBE_SSB increments by about 1% with increasing the breast glandular fraction from 0% to 100%. On the other hand, RBE_DSB decrements by about 3.3% with increasing the glandular fraction in the range of 0% to 100%. Variations of the depth within the breast tissue can also influence the RBE value so that RBE_SSB reduces by about 1% with increasing the depth from 2 mm to 10 mm one, while RBE_DSB increases about 3.4%. The relevant RBE_SSB and RBE_DSB values to the entire target volume (breast PTV) respectively increment and decrement by about 0.8% and 3.2% with increasing the breast glandularity from 0% to 100%.

CONCLUSION

From the results, it can be concluded that the breast tissue composition has a measurable effect on RBE values of employed low energy X-rays during breast IORT which can cause variations of prescribed dose for patients with distinct breast glandularity fractions.

Influence of gold nanoparticles embedded in water on nanodosimetry for keV photon irradiation

PURPOSE

For the past two decades, high-Z nanoparticles have been of high interest to improve the therapeutic outcomes of radiation therapy, especially for low-energy x-rays. Monte Carlo (MC) simulations have been used to evaluate the boost of dose deposition induced by Auger electrons near the nanoparticle surface, by calculating average energy deposition at the nanoscale. In this study, we propose to go beyond average quantities and quantify the stochastic nature of energy deposition at such a scale. We present results of probability density of the specific energy (restricted to ionization, excitation and electron attachment events) in cylindrical nanotargets of height and radius set at 10 nm. This quantity was evaluated for nanotargets located within 200 nm around 5-50 nm gold nanoparticles (GNPs), for 20-90 keV photon irradiation.

METHODS

This nanodosimetry study was based on the MC simulation MDM that allows tracking of electrons down to thermalization energy. We introduced a new quantity, namely the probability enhancement ratio (PER), by estimating the probability of imparting to nanotargets a restricted specific energy larger than a threshold z 0 (1, 10, and 20 kGy), normalized to the probability for pure water. The PER was calculated as a function of the distance between the nanotarget and the GNP surface. The threshold values were chosen in light of the biophysical model NanOx that predicts cell survival by calculating local lethal events based on the restricted specific energy and an effective local lethal function. z 0 then represents a threshold above which the nanotarget damages induce efficiently cell death.

RESULTS

Our calculations showed that the PER varied a lot with the GNP radius, the photon energy, z 0 and the distance of the GNP to the nanotarget. The highest PER was 95 when the nanotarget was located at 5 nm from the GNP surface, for a photon energy of 20 keV, a threshold of 20 kGy, and a GNP radius of 50 nm. This enhancement dramatically decreased with increasing GNP-nanotarget distances as it went below 1.5 for distances larger than 200 nm.

CONCLUSIONS

The PER seems better adapted than the mean dose deposition to describe the formation of biological damages. The significant increase of the PER within 200 nm around the GNP suggests that severe damages could occur for biological nanotargets located near the GNP. These calculations will be used as an input of the biophysical model NanOx to convert PER into estimation of radiation-induced cell death enhanced by GNPs.

Technical Note: Taking EGSnrc to new lows: Development of egs++ lattice geometry and testing with microscopic geometries

PURPOSE

This work introduces a new lattice geometry library, egs_lattice, into the EGSnrc Monte Carlo code, which can be used for both modeling very large (previously unfeasible) quantities of geometries (e.g., cells or gold nanoparticles (GNPs)) and establishing recursive boundary conditions. The reliability of egs_lattice, as well as EGSnrc in general, is cross-validated and tested at short length scales and low energies.

METHODS

New Bravais, cubic, and hexagonal lattice geometries are defined in egs_lattice and their transport algorithms are described. Simulations of cells and GNP-containing cavities are implemented to compare to independent, published Geant4-DNA and PENELOPE results. Recursive boundary conditions, implemented through a cubic lattice, are used to perform electron Fano cavity tests. The Fano test is performed on three different-sized cells containing GNPs in the region around the nucleus for three source energies.

RESULTS

Lattices are successfully implemented in EGSnrc, and are used for validation. EGSnrc calculated the dose to cell cytoplasm and nucleus when irradiated by an internal electron source with a median difference of 0.6% compared to published Geant4-DNA results. EGSnrc calculated the ratio of dose to a microscopic cavity containing GNPs over dose to a cavity containing a homogeneous mixture of gold, and results generally agree (within 1%) with published PENELOPE results. The electron Fano cavity test is passed for all energies and cells considered, with sub-0.1% discrepancies between EGSnrc-calculated and expected values. Additionally, the recursive boundary conditions used for the Fano test provided a factor of over a million increase in efficiency in some cases.

CONCLUSIONS

The egs_lattice geometry library, currently available as a pull request on the EGSnrc GitHub "develop" branch, is now freely accessible as open-source code. Lattice geometry implementations cross-validated with independent simulations in other MC codes and verified with the electron Fano cavity test demonstrate not only the reliability of egs_lattice, but also, by extension, EGSnrc's ability to simulate transport in nanometer geometries and score in microscopic cavities.

Dose to water versus dose to medium from cavity theory applied to small animal irradiation with kilovolt x-rays

Dose reporting is a matter of concern in the preclinical field as the different dose descriptors dose-to-water-in-medium [Formula: see text] and dose-to-medium-in-medium [Formula: see text] coexist. For kV photons differences between both quantities are expected to be amplified due to photon energy absorption coefficients differences for different media, and could represent a limiting factor for accurate translation of pre-clinical research into clinical trials. The main goal of this study was to analyse the relationship between [Formula: see text] and [Formula: see text] for kV irradiation of small animals, using different flavours of the intermediate cavity theory (ICT). Irradiations of mathematical phantoms and a mouse CT scan, both with different voxel sizes and materials, were investigated. A modified version of the Monte Carlo code DOSXYZnrc was used to derive [Formula: see text] and convert to [Formula: see text] using ICT. Local photon spectra were generated in different regions of the mouse. Depending on energy and cavity size, which we equate to the voxel size, [Formula: see text] ranged from 0.68 to 4.37 times [Formula: see text]. Higher kV energy combined with very small cavity sizes yielded decreased [Formula: see text] in comparison to [Formula: see text]; this behaviour was reversed for larger cavities combined with lower kV energies. Hence, the impact of the cavity dimensions on estimated [Formula: see text] is significant on pre-clinical kV beams. [Formula: see text] and [Formula: see text] in the ex vivo male mouse were found to differ by  -29% to 286%. Caution is advised when using the ICT due to a lack of consensus on weighting factor (d-parameter) deriving methods; for the same irradiation conditions, different d-values affected [Formula: see text] up to 20%. Pre-clinically, such divergence between dose descriptors could enable biological damage. The abiding debate over which quantity to favour is foreseen to linger while it is unclear which quantity correlates better with the biological effects of ionizing irradiation: preclinical radiotherapy might represent an ideal platform for measurement-based studies to settle this fundamental question. Finally, dose distribution comparisons require caution and should use the same reporting quantity.

Investigating energy deposition in glandular tissues for mammography using multiscale Monte Carlo simulations

PURPOSE

To investigate energy deposition in glandular tissues of the breast on macro- and microscopic length scales in the context of mammography.

METHODS

Multiscale mammography models of breasts are developed, which include segmented, voxelized macroscopic tissue structure as well as nine regions of interest (ROIs) embedded throughout the breast tissue containing explicitly-modelled cells. Using a 30 kVp Mo/Mo spectrum, Monte Carlo (MC) techniques are used to calculate dose to ∼mm voxels containing glandular and/or adipose tissues, as well as energy deposition on cellular length scales. ROIs consist of at least 1000 mammary epithelial cells and ∼200 adipocytes; specific energy (energy imparted per unit mass; stochastic analogue of the absorbed dose) is calculated within mammary epithelial cell nuclei.

RESULTS

Macroscopic dose distributions within segmented breast tissue demonstrate considerable variation in energy deposition depending on depth and tissue structure. Doses to voxels containing glandular tissue vary between ∼0.1 and ∼4 times the mean glandular dose (MGD, averaged over the entire breast). Considering microscopic length scales, mean specific energies for mammary epithelial cell nuclei are ∼30% higher than the corresponding glandular voxel dose. Additionally, due to the stochastic nature of radiation, there is considerable variation in energy deposition throughout a cell population within a ROI: for a typical glandular voxel dose of 4 mGy, the standard deviation of the specific energy for mammary epithelial cell nuclei is 85% relative to the mean. Thus, for a glandular voxel dose of 4 mGy at the centre of the breast, corresponding mammary epithelial cell nuclei will receive specific energies up to ∼9 mGy (considering the upper end of the 1σ standard deviation of the specific energy), while a ROI located 2 cm closer to the radiation source will receive specific energies up to ∼40 mGy. Energy deposition within mammary epithelial cell nuclei is sensitive to cell model details including cellular elemental compositions and nucleus size, underlining the importance of realistic cellular models.

CONCLUSIONS

There is considerable variation in energy deposition on both macro- and microscopic length scales for mammography, with glandular voxel doses and corresponding cell nuclei specific energies many times higher than the MGD in parts of the breast. These results should be considered for radiation-induced cancer risk evaluation in mammography which has traditionally focused on a single metric such as the MGD.

Cavity theory applications for kilovoltage cellular dosimetry

Relationships between macroscopic (bulk tissue) and microscopic (cellular) dose descriptors are investigated using cavity theory and Monte Carlo (MC) simulations. Small, large, and multiple intermediate cavity theory (SCT, LCT, and ICT, respectively) approaches are considered for 20 to 370 keV incident photons; ICT is a sum of SCT and LCT contributions weighted by parameter d. Considering μm-sized cavities of water in bulk tissue phantoms, different cavity theory approaches are evaluated via comparison of [Formula: see text] (where D _w,m is dose-to-water-in-medium and D _m,m is dose-to-medium-in-medium) with MC results. The best overall agreement is achieved with an ICT approach in which [Formula: see text], where L is the mean chord length of the cavity and β is given by [Formula: see text] (R _CSDA is the continuous slowing down approximation range of an electron of energy equal to that of incident photons). Cell nucleus doses, D _nuc, computed with this ICT approach are compared with those from MC simulations involving multicellular soft tissue models considering a representative range of cell/nucleus sizes and elemental compositions. In [Formula: see text] of cases, ICT and MC predictions agree within [Formula: see text]; disagreement is at most 8.8%. These results suggest that cavity theory may be useful for linking doses from model-based dose calculation algorithms (MBDCAs) with energy deposition in cellular targets. Finally, based on the suggestion that clusters of water molecules associated with DNA are important radiobiological targets, two approaches for estimating dose-to-water by application of SCT to MC results for D _m,m or D _nuc are compared. Results for these two estimates differ by up to [Formula: see text], demonstrating the sensitivity of energy deposition within a small volume of water in nucleus to the geometry and composition of its surroundings. In terms of the debate over the dose specification medium for MBDCAs, these results do not support conversion of D _m,m to D _w,m using SCT.

A Monte Carlo study of macroscopic and microscopic dose descriptors for kilovoltage cellular dosimetry

This work investigates how doses to cellular targets depend on cell morphology, as well as relations between cellular doses and doses to bulk tissues and water. Multicellular models of five healthy and cancerous soft tissues are developed based on typical values of cell compartment sizes, elemental compositions and number densities found in the literature. Cells are modelled as two concentric spheres with nucleus and cytoplasm compartments. Monte Carlo simulations are used to calculate the absorbed dose to the nucleus and cytoplasm for incident photon energies of 20-370 keV, relevant for brachytherapy, diagnostic radiology, and out-of-field radiation in higher-energy external beam radiotherapy. Simulations involving cell clusters, single cells and single nuclear cavities are carried out for cell radii between 5 and [Formula: see text]m, and nuclear radii between 2 and [Formula: see text]m. Seven nucleus and cytoplasm elemental compositions representative of animal cells are considered. The presence of a cytoplasm, extracellular matrix and surrounding cells can affect the nuclear dose by up to [Formula: see text]. Differences in cell and nucleus size can affect dose to the nucleus (cytoplasm) of the central cell in a cluster of 13 cells by up to [Formula: see text] ([Formula: see text]). Furthermore, the results of this study demonstrate that neither water nor bulk tissue are reliable substitutes for subcellular targets for incident photon energies  <50 keV: nuclear (cytoplasm) doses differ from dose-to-medium by up to [Formula: see text] ([Formula: see text]), and from dose-to-water by up to [Formula: see text] ([Formula: see text]). The largest differences between dose descriptors are seen for the lowest incident photon energies; differences are less than [Formula: see text] for energies [Formula: see text]90 keV. The sensitivity of results with regard to the parameters of the microscopic tissue structure model and cell model geometry, and the importance of the nucleus and cytoplasm as targets for radiation-induced cell death emphasize the importance of accurate models for cellular dosimetry studies.

A brief look at model-based dose calculation principles, practicalities, and promise

Model-based dose calculation algorithms (MBDCAs) have recently emerged as potential successors to the highly practical, but sometimes inaccurate TG-43 formalism for brachytherapy treatment planning. So named for their capacity to more accurately calculate dose deposition in a patient using information from medical images, these approaches to solve the linear Boltzmann radiation transport equation include point kernel superposition, the discrete ordinates method, and Monte Carlo simulation. In this overview, we describe three MBDCAs that are commercially available at the present time, and identify guidance from professional societies and the broader peer-reviewed literature intended to facilitate their safe and appropriate use. We also highlight several important considerations to keep in mind when introducing an MBDCA into clinical practice, and look briefly at early applications reported in the literature and selected from our own ongoing work. The enhanced dose calculation accuracy offered by a MBDCA comes at the additional cost of modelling the geometry and material composition of the patient in treatment position (as determined from imaging), and the treatment applicator (as characterized by the vendor). The adequacy of these inputs and of the radiation source model, which needs to be assessed for each treatment site, treatment technique, and radiation source type, determines the accuracy of the resultant dose calculations. Although new challenges associated with their familiarization, commissioning, clinical implementation, and quality assurance exist, MBDCAs clearly afford an opportunity to improve brachytherapy practice, particularly for low-energy sources.

On the impact of improved dosimetric accuracy on head and neck high dose rate brachytherapy

PURPOSE

To study the effect of finite patient dimensions and tissue heterogeneities in head and neck high dose rate brachytherapy.

METHODS AND MATERIALS

The current practice of TG-43 dosimetry was compared to patient specific dosimetry obtained using Monte Carlo simulation for a sample of 22 patient plans. The dose distributions were compared in terms of percentage dose differences as well as differences in dose volume histogram and radiobiological indices for the target and organs at risk (mandible, parotids, skin, and spinal cord).

RESULTS

Noticeable percentage differences exist between TG-43 and patient specific dosimetry, mainly at low dose points. Expressed as fractions of the planning aim dose, percentage differences are within 2% with a general TG-43 overestimation except for the spine. These differences are consistent resulting in statistically significant differences of dose volume histogram and radiobiology indices. Absolute differences of these indices are however small to warrant clinical importance in terms of tumor control or complication probabilities.

CONCLUSIONS

The introduction of dosimetry methods characterized by improved accuracy is a valuable advancement. It does not appear however to influence dose prescription or call for amendment of clinical recommendations for the mobile tongue, base of tongue, and floor of mouth patient cohort of this study.

103Pd strings: Monte Carlo assessment of a new approach to brachytherapy source design

PURPOSE

A new type of (103)Pd source (CivaString and CivaThin by CivaTech Oncology, Inc.) is examined. The source contains (103)Pd and Au radio-opaque marker(s), all contained within low-Zeff organic polymers that permit source flexibility. The CivaString source is available in lengths L of 10, 20, 30, 40, 50, and 60 mm, and referred to in the current study as CS10-CS60, respectively. A thinner design, CivaThin, has sources designated as CT10-CT60, respectively. The CivaString and CivaThin sources are 0.85 and 0.60 mm in diameter, respectively. The source design is novel and offers an opportunity to examine its interesting dosimetric properties in comparison to conventional (103)Pd seeds.

METHODS

The MCNP5 radiation transport code was used to estimate air-kerma rate and dose rate distributions with polar and cylindrical coordinate systems. Doses in water and prostate tissue phantoms were compared to determine differences between the TG-43 formalism and realistic clinical circumstances. The influence of Ti encapsulation and 2.7 keV photons was examined. The accuracy of superposition of dose distributions from shorter sources to create longer source dose distributions was also assessed.

RESULTS

The normalized air-kerma rate was not highly dependent on L or the polar angle θ, with results being nearly identical between the CivaString and CivaThin sources for common L. The air-kerma strength was also weakly dependent on L. The uncertainty analysis established a standard uncertainty of 1.3% for the dose-rate constant Λ, where the largest contributors were μen/ρ and μ/ρ. The Λ values decreased with increasing L, which was largely explained by differences in solid angle. The radial dose function did not substantially vary among the CivaString and CivaThin sources for r ≥ 1 cm. However, behavior for r < 1 cm indicated that the Au marker(s) shielded radiation for the sources having L = 10, 30, and 50 mm. The 2D anisotropy function exhibited peaks and valleys that corresponded to positions adjacent to (103)Pd wells and Au markers, respectively. Dose distributions of both source types had minimal anisotropy in comparison to conventional (103)Pd seeds. Contributions by 2.7 keV photons comprised ≤ 0.1% of the dose from all photons at positions farther than 0.13 mm from the polymer source surface. Differences between absorbed dose to water and prostate became more substantial as distance from the sources increased, with prostate dose being about 13% lower for r = 5 cm. Using a cylindrical coordinate system, dose superposition of small length sources to replicate the dose distribution for a long length source proved to be a robust technique; a 2.0% tolerance compared with the reference dose distribution did not exceed 0.1 cm(3) for any of the examined source combinations.

CONCLUSIONS

By design, the CivaString and CivaThin sources have novel dosimetric characteristics in comparison to Ti-encapsulated (103)Pd seeds. The dosimetric characterization has determined the reasons for these differences through analysis using Monte Carlo-based radiation transport simulations.

Current state of the art brachytherapy treatment planning dosimetry algorithms

Following literature contributions delineating the deficiencies introduced by the approximations of conventional brachytherapy dosimetry, different model-based dosimetry algorithms have been incorporated into commercial systems for (192)Ir brachytherapy treatment planning. The calculation settings of these algorithms are pre-configured according to criteria established by their developers for optimizing computation speed vs accuracy. Their clinical use is hence straightforward. A basic understanding of these algorithms and their limitations is essential, however, for commissioning; detecting differences from conventional algorithms; explaining their origin; assessing their impact; and maintaining global uniformity of clinical practice.

Specification of absorbed dose to water using model-based dose calculation algorithms for treatment planning in brachytherapy

Model-based dose calculation algorithms (MBDCAs), recently introduced in treatment planning systems (TPS) for brachytherapy, calculate tissue absorbed doses. In the TPS framework, doses have hereto been reported as dose to water and water may still be preferred as a dose specification medium. Dose to tissue medium Dmed then needs to be converted into dose to water in tissue Dw,med. Methods to calculate absorbed dose to differently sized water compartments/cavities inside tissue, infinitesimal (used for definition of absorbed dose), small, large or intermediate, are reviewed. Burlin theory is applied to estimate photon energies at which cavity sizes in the range 1 nm-10 mm can be considered small or large. Photon and electron energy spectra are calculated at 1 cm distance from the central axis in cylindrical phantoms of bone, muscle and adipose tissue for 20, 50, 300 keV photons and photons from (125)I, (169)Yb and (192)Ir sources; ratios of mass-collision-stopping powers and mass energy absorption coefficients are calculated as applicable to convert Dmed into Dw,med for small and large cavities. Results show that 1-10 nm sized cavities are small at all investigated photon energies; 100 µm cavities are large only at photon energies <20 keV. A choice of an appropriate conversion coefficient Dw, med/Dmed is discussed in terms of the cavity size in relation to the size of important cellular targets. Free radicals from DNA bound water of nanometre dimensions contribute to DNA damage and cell killing and may be the most important water compartment in cells implying use of ratios of mass-collision-stopping powers for converting Dmed into Dw,med.