On the applicability of the AAPM TG-60/TG-43 dose calculation formalism to intravascular line sources: proposal for an adapted formalism

Variation in PPP3CC Genotype Is Associated with Long-Term Recovery after Severe Brain Injury

After experimental traumatic brain injury (TBI), calcineurin is upregulated; blocking calcineurin is associated with improved outcomes. In humans, variation in the calcineurin A-gamma gene (PPP3CC) has been associated with neuropsychiatric disorders, though any role in TBI recovery remains unknown. This study examines associations between PPP3CC genotype and mortality, as well as gross functional status assessed at admission using the Glasgow Coma Scale (GCS) and at 3, 6, and 12 months after severe TBI using the Glasgow Outcome Score (GOS). The following tagging single nucleotide polymorphisms (tSNPs) in PPP3CC were genotyped: rs2443504, rs2461491, rs2469749, and rs10108011. The rs2443504 AA genotype was univariately associated with GCS (p = 0.022), GOS at 3, 6, and 12 months (p = 0.002, p = 0.034, and p = 0.004, respectively), and mortality (p = 0.007). In multivariate analysis controlling for age, sex, and GCS, the AA genotype of rs2443504 was associated with GOS at 3 (p = 0.02), and 12 months (p = 0.01), with a trend toward significance at 6 months (p = 0.05); the AA genotype also was associated with mortality in the multivariate model (p = 0.04). Further work is warranted to better understand the role of calcineurin, as well as the genes encoding it and their relevance to outcomes after brain injury.

Cylindrical coordinate based TG-43U1 parameters for dose calculation around elongated brachytherapy sources

In 2001, the use of cylindrical coordinates was demonstrated to be more suitable than was the use of polar coordinates for accurate computer calculations during treatment planning for I192r intravascular brachytherapy sources. In the present work, we investigated the applicability of cylindrical coordinate–based TG‐43U1 parameters for dosimetric evaluation and dose calculations for RadioCoil 103Pd sources (RadioMed Corporation, Tyngsboro, MA) 1.0‐cm to 6.0‐cm long. For brevity, only the results for sources 1.0‐cm, 3.0‐cm, and 5.0‐cm long are presented here. Dosimetric characteristics of RadioCoil 103Pd sources were calculated in liquid water using the Monte Carlo simulation technique. To demonstrate the suitability of this methodology, the Monte Carlo–simulated dose profiles for a RadioCoil 103Pd source 5.0‐cm long at radial distances of 0.5 cm, 0.9 cm, and 1.25 cm were compared with calculated data using TG‐43U1 parameters in the polar and cylindrical coordinate systems. In addition, we also used a source 1.0‐cm long parameterized using cylindrical coordinates to investigate the application of a linear segmented source (LSS) model originally introduced by our group. The results indicate that, for dose calculation around elongated brachytherapy sources, cylindrical coordinate–based TG‐43U1 parameters more accurately represent the dose distribution around an elongated source than the polar coordinate–based parameters. In addition, the LSS model, in conjunction with the cylindrical coordinate–based parameters for a source 1.0‐cm long, can be used to replicate the dose distribution around any integral source length. This process eliminates the need to collect and enter data for multiple source lengths into treatment planning systems.

PACS number: 87.66.Jj

Treatment planning consideration for prostate implants with the new linear RadioCoil 103Pd brachytherapy source

Recently, various linear source models, for example, 103Pd RadioCoil, have been introduced to overcome the shortcomings of traditional "seed" type interstitial prostate brachytherapy implants, such as migration and clumping of the seeds. However, the existing prostate treatment-planning systems have not been updated to perform dose calculation for implants with linear sources greater than 1.0 cm in length. In these investigations, two new models are developed for 3D dose calculation for a prostate implant with linear brachytherapy sources using the commercially available treatment-planning systems. The proposed models are referred to as the linear-segmented source (LSS) model and the point-segmented source (PSS) model. The calculated dose distributions obtained by these models for a single linear source have been validated by their comparison with the Monte Carlo-simulated data. Moreover, these models were used to calculate the dose distributions for a multilinear source prostate implant, and the results were compared to "seed" type implants. The results of these investigations show that the LSS model better approximates the linear sources than the PSS model. Moreover, these models have shown a better approximation of the dose distribution from a linear source for 0.5 cm source segments as compared to 1.0 cm source segments. However, for the points close to the longitudinal axis of the source located outside the region bounded by the active length, both models show differences of approximately +/-15%. These deficiencies are attributed to the limitations of the TG43 formalism for elongated sources.

Basic treatment planning parameters for a 90Sr / 90Y source train used in endovascular brachytherapy

Working groups of the AAPM, DGMP, and ESTRO have published recommendations for endovascular brachytherapy, introducing concepts of relevant parameters for dose specification and treatment planning. However, the procedures for this treatment remain often mainly based on trial protocols and manufacturer instructions. Treatment planning requires the essential knowledge of the radial and longitudinal dose distribution, as well as information about geometrical uncertainties. The present study includes a whole data set for daily clinical practice using a commercially available device for endovascular brachytherapy (Novoste Betacath). The dose distribution around the 90Sr seed train was calculated with Monte-Carlo algorithms and verified by film dosimetry. The radial dose profile was determined starting from the surface of the delivery catheter Calculated dose profiles were in good agreement to measured values. The geometrical uncertainties were estimated with a retrospective analysis of 51 patient treatments. This shows the importance of using a safety margin of at least 10 mm between Intervention Length and Reference Isodose Length. Based on the longitudinal dose profile and the necessary safety margins, the maximum treatable intervention length is 25 mm and 45 mm for a 40 mm and 60 mm source train, respectively.

Dosimetric characteristics of the Novoste Beta-Cath 90Sr/Y source trains at submillimeter distances

Measurements were performed on the 30, 40, and 60 mm 90Sr/Y beta-emitter source trains used in the Novoste Beta-Cath system to determine their dosimetric characteristics at submillimeter distances and provide the necessary TG-60 parameters for mapping their dose distributions. These measurements were carried out in a Solid Water phantom where MD55-2 Gafchromic films were placed in direct contact with a 5 French (F) catheter used for the 30 and 60 mm source trains and a 3.5F catheter used for thinner 30 and 40 mm source trains. A data set consisted of three pieces of Gafchromic film irradiated for periods of 1.5, 5, and 10 minutes, respectively. This 3-film irradiation technique provided reliable dose data at short, intermediate and long distances from a source train. Three data sets per source train were collected in this study. For the 30 mm source train with a 5F catheter, data were collected with the source axis at proximal (0.41 mm) and distal (1.19 mm) positions to the film surface in order to investigate dosimetric effects due to the off centering of the source train lumen within the catheter. Absolute doses were determined by calibrating the Gafchromic film in a high-energy electron beam from a radiotherapy accelerator. The absolute dose rates at a distance of 2 mm along the source trains transverse axis were found to be within 13.7% of the values provided by Novoste. Radial dose functions were within 13% compared to 90Sr/Y source train data constructed from Soares' 90Sr/Y single seed data and within 17% and 25% compared to Monte Carlo data by Ye et al., and Wang et al., respectively. Discrepancies of 33% and 19% were observed at short radial distances (< or = 1 mm) between the Novoste Monte Carlo and the 3.5F and 5F catheter measured data, respectively. The source off centering data showed higher dose contribution from the source train at its distal rather than proximal position. Radial dose function comparisons between the Novoste Monte Carlo and the measured data, calculated as a function of radial distance from the catheter's center showed good agreement (< or = 10%).

A segmented 32P source Monte Carlo model to derive AAPM TG-60 dosimetric parameters used for intravascular brachytherapy

A new high dose rate 20 mm 32P intravascular brachytherapy (IVB) beta source used with automated stepping has recently been introduced. The AAPM Task Group 60 recommends that beta IVB sources should have well characterized dosimetric parameters in water. In this study, Monte Carlo simulations (MCNPX v 2.4) were used to derive these parameters for a 2 mm source segment rather than the entire 20 mm source to ensure the correct formulation using the traditional TG-60 and TG-43 polar coordinate system (r, theta) parameters. The dose rate at the reference depth of 2 mm, the radial dose function, and the anisotropy function were generated for the 2 mm 32P source segment at the mid-plane, distal edge and proximal edge of the original 20 mm source. Our results indicate that the anisotropy of the 2 mm distal and proximal segments are the same, but differ from that of the mid-plane segment due to the perturbation of the adjacent tungsten marker. Using the TG-60 formulation of the mid-plane and edge segments resulted in dose distributions similar to those obtained for a 20 mm linear beta source model. The segmented formulation provides a method consistent with the familiar TG-60 formulation and ability to calculate the dose-distribution inside curved vessels.

Dosimetry characterization of 32P intravascular brachytherapy source wires using Monte Carlo codesPENELOPEandGEANT4

Monte Carlo calculations using the codes PENELOPE and GEANT4 have been performed to characterize the dosimetric parameters of the new 20 mm long catheter-based 32P beta source manufactured by the Guidant Corporation. The dose distribution along the transverse axis and the two-dimensional dose rate table have been calculated. Also, the dose rate at the reference point, the radial dose function, and the anisotropy function were evaluated according to the adapted TG-60 formalism for cylindrical sources. PENELOPE and GEANT4 codes were first verified against previous results corresponding to the old 27 mm Guidant 32P beta source. The dose rate at the reference point for the unsheathed 27 mm source in water was calculated to be 0.215 +/- 0.001 cGy s(-1) mCi(-1), for PENELOPE, and 0.2312 +/- 0.0008 cGy s(-1) mCi(-1), for GEANT4. For the unsheathed 20 mm source, these values were 0.2908 +/- 0.0009 cGy s(-1) mCi(-1) and 0.311 0.001 cGy s(-1) mCi(-1), respectively. Also, a comparison with the limited data available on this new source is shown. We found non-negligible differences between the results obtained with PENELOPE and GEANT4.

Dosimetric characteristics of a linear array of gamma or beta-emitting seeds in intravascular irradiation: Monte Carlo studies for the AAPM TG-43/60 formalism

In principle, the AAPM TG-43/60 formalism for intravascular brachytherapy (IVBT) dosimetry of catheter-based sources is fully valid with a single seed of cylindrical symmetry and in the region comparable to or larger than the mean-free path of emitting radiation. However, for the geometry of a linear array of seeds within the few millimeter range of interest in IVBT, the suitability of the AAPM TG-43/60 formalism has not been fully addressed yet. We have meticulously investigated the dosimetric characteristics of catheter-based gamma (192Ir) and beta (90Sr/Y) sources using Monte Carlo methods before applying the AAPM TG-43/60 formalism. The dosimetric perturbation due to radiation interactions with neighboring seeds is at most 2% over the entire region of interest for the 192Ir source, while it increases to about 5% for the 90Sr/Y source. As the transaxial distance (y) increases beyond 3 mm, the sum of the dose contributions from neighboring seeds exceeds the dose contribution from the center seed for both sources. However, it continues to increase with the increasing y for 192Ir but is saturated beyond y = 5 mm for 9Sr/Y. Even within a few millimeters from the seeds, the dose from the low-energy betas of 192Ir is still less than 1% of the total dose. The radial dose and anisotropy functions are reformulated in reduced cylindrical coordinate with the reference point at y = 2 mm. The dose rate constant of 192Ir and the dose rate of 90Sr/Y at the reference point showed a fairly good agreement (within +/- 2%) with earlier studies and the NIST-traceable value, respectively. We conclude that the dosimetric perturbation caused by close proximity of neighboring seeds is nearly negligible so that the AAPM TG-43/60 formalism can be applied to a linear array of seeds.

The scaling method applied to beta particle line sources with a finite diameter

The well-known scaling method for planar and punctiform beta particle sources is extended to the case of a cylindrical source with a length larger than the beta particle range times two and with an infinitesimal or finite diameter. The equation for a spherical source with a finite diameter is also given. As a means of illustration, previously measured and simulated radial depth-dose distributions of a 40-mm-long prototype 188W/188Re intravascular beta source in polymethylmethacrylate are scaled to H2O and compared with simulations in the latter medium. The results suggest that the scaling method is accurate to within about 3%, provided that the finite diameter of the source is taken into account.

The radial depth-dose distribution of a 188W/188Re beta line source measured with novel, ultra-thin TLDs in a PMMA phantom: comparison with Monte Carlo simulations

The radial depth-dose distribution of a prototype 188W/188Re beta particle line source of known activity has been measured in a PMMA phantom, using a novel, ultra-thin type of LiF:Mg,Cu,P thermoluminescent detector (TLD). The measured radial dose function of this intravascular brachytherapy source agrees well with MCNP4C Monte Carlo simulations, which indicate that 188Re accounts for > or = 99% of the dose between 1 mm and 5 mm radial distance from the source axis. The TLDs were calibrated using a 90Sr/90Y beta secondary standard. Several correction factors are calculated using analytical and Monte Carlo methods. An analysis of the measurement uncertainty is made. Since it is partly determined by components of uncertainty arising from random effects, repeated measurements yield a lower uncertainty. The expanded uncertainty in the absolute dose at 2 mm radial distance equals 11%, 10%, 9% and 8% for 1, 2, 3 and 5 measurements, respectively. After a correction for source non-uniformity, the measured dose rate per unit source activity at 2 mm radial distance equals (1.53 +/- 0.16) Gy min(-1) GBq(-1) (2sigma), in agreement with the value of (1.45 +/- 0.01) Gy min(-1) GBq(-1) (2sigma) predicted by the MCNP4C simulations.

Measured TG-60 dosimetric parameters of the Novoste Beta-Cath 90Sr/Y source trains for intravascular brachytherapy

Measurements were performed on the 30, 40 and 60-mm 90Sr/Y beta-emitter source trains used in the Novoste Beta-Cath system to determine the dosimetric characteristics of the sources at millimeter distances and provide the necessary TG-60 dosimetry parameters for mapping the dose distributions. These measurements were carried out in a Solid Water phantom where MD-55-2 Gafchromic films were placed in direct contact with a 5 French (F) catheter used for the 30 and 60-mm source trains and a 3.5 F catheter used for a thinner 40-mm source train. The dosimetric analysis was performed according to the AAPM TG-60 formalism. For the 30-mm source train, data were collected with the source axis at distances of 0.41 and 1.19 mm from the film surface, respectively, in order to investigate possible dosimetric effects due to the intrinsic off centering of the source train lumen within the 5 F catheter. Absolute dose rates at 2 mm were determined by calibrating the radiochromic film in a high energy electron beam from a radiotherapy accelerator. The dose rates at a radial distance of 2 mm were found to be within 10% of the values provided by Novoste. Radial dose functions from this study were in good agreement (< or = 10%) with a 30-mm, 90Sr/Y source train dose data generated from C. G. Soares et al. 90Sr/Y single seed data. However, larger differences were observed at distances shorter than 1 mm when compared to radial dose functions from the Novoste Monte Carlo data.

A comparison of intravascular source designs based on the beta particle emitter 114mIn/114In. Line source versus stepping source

BACKGROUND

Catheter-based intravascular brachytherapy (IVB) sources of the next generation will have to meet high demands in terms of miniaturization, flexibility, safety, reliability, costs and versatility. The radionuclide pair 114mIn/114In (half-life 49.51 days, maximum beta energy 2.0 MeV, average beta energy 0.78 MeV) is an attractive beta emitter for application in such a source.

METHODS

Since metallic indium is unfit for the manufacture of a brachytherapy source, the feasibility, safety and dosimetric properties of a design concept comprising a linear array of ceramic In2O3 spheres within a thin-walled, superelastic Ni/Ti capsule are investigated.

RESULTS

Neutron activation of enriched In2O3 spheres yields a specific activity sufficiently high for the manufacture of a stepping source, keeping treatment times limited to a few minutes. Although 114mIn/114In also emits some gamma radiation, the effective doses received by members of the medical staff are an order of magnitude lower than those received from fluoroscopy. The dose distributions about a 40-mm line source and a 5-mm stepping source (outer diameter 0.36 mm) are calculated using MCNP4C. Dose-volume histograms (DVHs) are calculated for the line source (centered and noncentered) and the stepping source (centered) using the geometry of a human coronary artery.

CONCLUSION

The results show that a centered stepping source with optimized dwell times delivers the most homogenous dose within the target volume.

The use of cylindrical coordinates for treatment planning parameters of an elongated 192Ir source

PURPOSE

The doses given to the intima, media, and adventitia are very crucial quantities in intravascular brachytherapy. To facilitate accurate computerized treatment planning calculations, we have determined dose distributions in away-and-along table format around an 192Ir wire source and developed pertinent dosimetric parameters in cylindrical coordinates.

METHODS AND MATERIALS

The Monte Carlo method (MCNP4C code) was used to calculate the dose distributions for the AngioRad 192Ir wire source (model SL-77HS, Interventional Therapies). The calculations were carried out for photon, beta, and electron (conversion and Auger) contributions for radial distances from 0.03 to 2.0 cm with 0.01-cm increments, and up to 2.24 cm from the source center in the longitudinal direction with 0.04-cm resolution. Dose rate values are determined in away-and-along format (cylindrical coordinates) and then converted to spherical coordinate format. Dosimetric parameters, such as the geometry factor, G(r, theta), and anisotropy function, F(r, theta), are generated in both cylindrical (R, Z, phi) and spherical (r, theta, phi) coordinates. The use of a cylindrical coordinate system for treatment planning parameters is proposed as a more suitable approach for accurate calculations.

RESULTS

The photon contribution to dose varies nearly inversely with radial distance (from the source center) along the perpendicular bisector with 0.199 x 10(-3) cGy U(-1) s(-1) (0.802 cGy Ci(-1) s(-1)) at 1 cm. The beta and electron contributions start at very high values of about 35.5 x 10(-3) cGy U(-1) s(-1) and 11.0 x 10(-3) cGy U(-1) s(-1), respectively, at 0.03 cm and fall off exponentially to negligible amount near 0.2 cm. The total dose rate at 0.2 cm is 1.428 x 10(-3) cGy U(-1) s(-1) (5.754 cGy Ci(-1) s(-1)). The radial dose function, g(R), is nearly unity between 0.2 cm and 2 cm. Due to the beta and electron dose contributions, g(R) increases steeply to 5.5 as radial distance decreases from 0.2 cm down to 0.03 cm. The F(R, Z) values are close to unity for the majority of the region of interest. In contrast, F(r, theta) experiences a steep rise as shallow angles are approached (closer to the source), related to the beta dose contributions. Accurate treatment planning calculations would be possible with linear interpolation of F(R, Z), but difficult with F(r, theta) in the spherical coordinate system and the original normalization point as recommended in the American Association of Physicists in Medicine Task Group 60 (AAPM TG-60) formalism.

CONCLUSION

The AngioRad 192Ir wire source, model SL-77HS, was completely characterized dosimetrically using Monte Carlo methods. The use of cylindrical coordinates and a modified anisotropy function normalization point for dosimetric parameters of an elongated 192Ir source is more suitable for accurate computerized treatment planning calculations in intravascular brachytherapy.

A new treatment planning formalism for catheter-based beta sources used in intravascular brachytherapy

Intravascular brachytherapy (IVBT) is an emerging modality for the treatment of atherosclerotic lesions in the artery. As part of the refinement in this rapidly evolving modality of treatment, the current simplistic dosimetry approach based on a fixed-point prescription must be challenged by future rigorous dosimetry method employing image-based three-dimensional (3D) treatment planning. The goals of 3D IVBT treatment planning calculations include (1) achieving high accuracy in a slim cylindrical region of interest, (2) accounting for the edge effect around the source ends, and (3) supporting multiple dwell positions. The formalism recommended by Task Group 60 (TG-60) of the American Association of Physicists in Medicine (AAPM) is applicable for gamma sources, as well as short beta sources with lengths less than twice the beta particle range. However, for the elongated beta sources and/or seed trains with lengths greater than twice the beta range, a new formalism is required to handle their distinctly different dose characteristics. Specifically, these characteristics consist of (a) flat isodose curves in the central region, (b) steep dose gradient at the source ends, and (c) exponential dose fall-off in the radial direction. In this paper, we present a novel formalism that evolved from TG-60 in maintaining the dose rate as a product of four key quantities. We propose to employ cylindrical coordinates (R, Z, phi), which are more natural and suitable to the slim cylindrical shape of the volume of interest, as opposed to the spherical coordinate system (r, theta, phi) used in the TG-60 formalism. The four quantities used in this formalism include (1) the distribution factor, H(R, Z), (2) the modulation function, M(R, Z), (3) the transverse dose function, h(R), and (4) the reference dose rate at 2 mm along the perpendicular bisector, D(R0=2 mm, Z0=0). The first three are counterparts of the geometry factor, the anisotropy function and the radial dose function in the TG-60 formalism, respectively. The reference dose rate is identical to that recommended by TG-60. The distribution factor is intended to resemble the dose profile due to the spatial distribution of activity in the elongated beta source, and it is a modified Fermi-Dirac function in mathematical form. The utility of this formalism also includes the slow-varying nature of the modulation function, allowing for more accurate treatment planning calculations based on interpolation. The transverse dose function describes the exponential fall-off of the dose in the radial direction, and an exponential or a polynomial can fit it. Simultaneously, the decoupling nature of these dose-related quantities facilitates image-based 3D treatment planning calculations for long beta sources used in IVBT. The new formalism also supports the dosimetry involving multiple dwell positions required for lesions longer than the source length. An example of the utilization of this formalism is illustrated for a 90Y coil source in a carbon dioxide-filled balloon. The pertinent dosimetric parameters were generated and tabulated for future use.