Beam quality correction factors for dose measurements around 192Ir brachytherapy sources

PURPOSE

To provide beam quality correction factors (k Q , Q o ${k}_{Q,Qo}$ ) for detectors used in 192Ir brachytherapy dosimetry measurements.

MATERIALS AND METHODS

Ten detectors were studied, including the PTW 30013 and Exrading12 Farmer large cavity chambers, seven medium (0.1-0.3 cm3) and small (< 0.1 cm3) cavity chambers, and a synthetic microdiamond detector. The kQ,Qo correction factors were calculated at distances from 1 to 10 cm away from an 192Ir source, using the EGSnrc Monte Carlo (MC) code. All detectors were calibrated in a 60Co 10 × 10 cm2 reference field provided by standard calibration laboratories. The impact of the central electrode, stem and wall on the detectors' responses in 192Ir photon energies was investigated. An experimental procedure was additionally applied for dose measurements around a microSelectron-v2 192Ir high dose rate (HDR) brachytherapy source using a motorized water phantom.

RESULTS

Farmer chambers underestimated the dose near the source due to signal volume averaging effects, resulting in kQ,Qo values ranging from 1.177 and 1.317 at 1 cm, decreasing with distance to between 0.980 and 1.005 at 10 cm. Small cavity volume detectors should be used close to the source. The kQ,Qo for the studied small and medium cavity volume detectors were found to be close to unity (within 1.3%), showing also a small dependence on source-to-detector distance, except for ion chambers containing high-Z materials in their construction. The presence of high-Z materials caused an overresponse in these detectors, resulting in kQ,Qo values ranging from 0.950 at 1 cm to 0.729 at 10 cm away from the source. A dose rate constant of (1.114 ± 0.023)cGyh-1U-1 was found in agreement with the literature (within 0.5%).

CONCLUSIONS

kQ,Qo values were calculated for dose measurements around 192Ir brachytherapy sources. Farmer chambers should be preferred for measurements at increased distances, whereas small or medium cavity volume detectors, not containing high-Z materials, should be used close to the source.

Investigations on the beam quality correction factor for ionization chambers in high-energy brachytherapy dosimetry

Objective. To enhance the investigations on MC calculated beam quality correction factors of thimble ionization chambers from high-energy brachytherapy sources and to develop reliable reference conditions in source and detector setups in water.Approach. The response of five different ionization chambers from PTW-Freiburg and Standard Imaging was investigated for irradiation by a high dose rate Ir-192 Flexisource in water. For a setup in a Beamscan water phantom, Monte Carlo simulations were performed to calculate correction factors for the chamber readings. After exact positioning of source and detector the absorbed dose rate at the TG-43 reference point at one centimeter nominal distance from the source was measured using these factors and compared to the specification of the calibration certificate. The Monte Carlo calculations were performed using the restricted cema formalism to gain further insight into the chamber response. Calculations were performed for the sensitive volume of the chambers, determined by the methods currently used in investigations of dosimetry in magnetic fields.Main results. Measured dose rates and values from the calibration certificate agreed within the combined uncertainty (k= 2) for all chambers except for one case in which the full air cavity was simulated. The chambers showed a distinct directional dependence. With the restricted cema formalism calculations it was possible to examine volume averaging and energy dependence of the perturbation factors contributing to the beam quality correction factor also differential in energy.Significance. This work determined beam quality correction factors to measure the absorbed dose rate from a brachytherapy source in terms of absorbed dose to water for a variety of ionization chambers. For the accurate dosimetry of brachytherapy sources with ionization chambers it is advisable to use correction factors based on the sensitive volume of the chambers and to take account for the directional dependence of chamber response.

Practical dosimetry procedure of air kerma for kilovoltage X-ray imaging in radiation oncology using a 0.6-cc cylindrical ionization chamber with a cobalt absorbed dose-to-water calibration coefficient

In this study, we implemented a practical dosimetry procedure of air kerma for kilovoltage X-ray beams using a 0.6-cc cylindrical ionization chamber, and validated the procedure with the accuracy of the measurements using the 0.6-cc chamber compared to the measurements using a 6-cc chamber and a semiconductor device. In addition, the kerma area products (KAPs) were compared with the dose reference levels of radiology. A modified air kerma formalism using a 0.6-cc cylindrical ionization chamber air kerma formalism with a cobalt absorbed dose-to-water calibration coefficient was implemented. Validation of the formalism showed good agreement between the 0.6-cc chamber and the 6-cc chamber (< 5%), and between the 0.6-cc chamber and the semiconductor device (< 2%) in the 60-120 kV range. The KAPs for four RO machines had difference factors of 0.04-15.4 and 0.01-4.1 from their median and maximum dose reference levels in radiology, respectively.

[Evaluation of Stability and Reliability of the Measurement of Absorbed Dose-to-water for an HDR 192Ir Sandwich Setup Phantom]

PURPOSE

In this study, we evaluated the stability and reliability of absorbed dose-to-water for an HDR ¹⁹²Ir sandwich setup phantom method by comparing measurements with absorbed dose-to-water determination based on the AAPM TG-43 protocol.

METHODS

The sandwich setup phantom was designed with a dedicated device for two ion chamber measurements of absorbed dose-to-water for a mHDR-v2r ¹⁹²Ir brachytherapy source is presented. To test the reliability of sandwich setup phantom of measurements with absorbed dose-to-water, we were compared with values based on AAPM TG-43 protocol and evaluated temporal variations of the measurement, intra-rater reliability.

RESULTS

The measured doses at sandwich setup phantom agreed within 1.0% with AAPM TG-43 protocol. In all measurement fractions, the temporal variations of measurement value were less than 1.0%, and the intra-rater reliability were 0.94% or more.

CONCLUSIONS

The measurement value obtained by the absorbed dose-towater had good reliability, and sandwich setup phantom is potentially useful and convenient for daily dose management of ¹⁹²Ir sources in clinics.

Energy dependence of a radiophotoluminescent glass dosimeter for HDR 192 Ir brachytherapy source

PURPOSE

We determined correction factors for absorbed dose energy dependence and intrinsic energy dependence for measurements of absorbed dose to water around an ¹⁹² Ir source using a radiophotoluminescent glass dosimeter (RPLD) calibrated with a 4-MV photon beam.

METHODS

The ratio of the absorbed dose to the water and the average absorbed dose to RPLD for the ¹⁹² Ir beam relative to the same ratio in a 4 MV photon beam defines the absorbed dose energy dependence and was determined at distances of 2-10 cm (at intervals of 1 cm) from the ¹⁹² Ir source in a water phantom using the egs_chamber user code. The RPLD was calibrated to measure absorbed dose to water, D_w , in a 4 MV photon beam using an ionization chamber, which was also used to measure absorbed dose to water, D_w , in a water phantom using the ¹⁹² Ir source. The detector response radiophotoluminescence (RPL signal per average absorbed dose in the detector) in the ¹⁹² Ir beam relative to that in the 4 MV photon beam (the relative intrinsic efficiency) was determined experimentally. Finally, the beam quality correction factor was obtained as the quotient between the absorbed dose energy dependence and the relative intrinsic efficiency and corrects for the difference between the beam quality Q₀ used at calibration and the beam quality Q used in the measurements.

RESULTS

The relative dose ratio of the average absorbed dose to water relative to RPLD ranged from 0.930 to 0.746, and the beam quality correction factor ranged from 0.999 to 0.794 for distances of 2-10 cm from the ¹⁹² Ir source. The relative detector response to an ¹⁹² Ir source and a 4-MV photon beam was 0.930, and it did not vary significantly with distance.

CONCLUSIONS

These results demonstrate that corrections for absorbed dose energy dependence and intrinsic energy dependence are required when using an RPLD to measure with sources different from the reference source providing the primary calibration.

A multicentre audit of HDR/PDR brachytherapy absolute dosimetry in association with the INTERLACE trial (NCT015662405)

A UK multicentre audit to evaluate HDR and PDR brachytherapy has been performed using alanine absolute dosimetry. This is the first national UK audit performing an absolute dose measurement at a clinically relevant distance (20 mm) from the source. It was performed in both INTERLACE (a phase III multicentre trial in cervical cancer) and non-INTERLACE brachytherapy centres treating gynaecological tumours. Forty-seven UK centres (including the National Physical Laboratory) were visited. A simulated line source was generated within each centre's treatment planning system and dwell times calculated to deliver 10 Gy at 20 mm from the midpoint of the central dwell (representative of Point A of the Manchester system). The line source was delivered in a water-equivalent plastic phantom (Barts Solid Water) encased in blocks of PMMA (polymethyl methacrylate) and charge measured with an ion chamber at 3 positions (120° apart, 20 mm from the source). Absorbed dose was then measured with alanine at the same positions and averaged to reduce source positional uncertainties. Charge was also measured at 50 mm from the source (representative of Point B of the Manchester system). Source types included 46 HDR and PDR ¹⁹²Ir sources, (7 Flexisource, 24 mHDR-v2, 12 GammaMed HDR Plus, 2 GammaMed PDR Plus, 1 VS2000) and 1 HDR ⁶⁰Co source, (Co0.A86). Alanine measurements when compared to the centres' calculated dose showed a mean difference (±SD) of  +1.1% (±1.4%) at 20 mm. Differences were also observed between source types and dose calculation algorithm. Ion chamber measurements demonstrated significant discrepancies between the three holes mainly due to positional variation of the source within the catheter (0.4%-4.9% maximum difference between two holes). This comprehensive audit of absolute dose to water from a simulated line source showed all centres could deliver the prescribed dose to within 5% maximum difference between measurement and calculation.

Dosimetric impact of an air passage on intraluminal brachytherapy for bronchus cancer

The brachytherapy dose calculations used in treatment planning systems (TPSs) have conventionally been performed assuming homogeneous water. Using measurements and a Monte Carlo simulation, we evaluated the dosimetric impact of an air passage on brachytherapy for bronchus cancer. To obtain the geometrical characteristics of an air passage, we analyzed the anatomical information from CT images of patients who underwent intraluminal brachytherapy using a high-dose-rate ¹⁹²Ir source (MicroSelectron V2r®, Nucletron). Using an ionization chamber, we developed a measurement system capable of measuring the peripheral dose with or without an air cavity surrounding the catheter. Air cavities of five different radii (0.3, 0.5, 0.75, 1.25 and 1.5 cm) were modeled by cylindrical tubes surrounding the catheter. A Monte Carlo code (GEANT4) was also used to evaluate the dosimetric impact of the air cavity. Compared with dose calculations in homogeneous water, the measurements and GEANT4 indicated a maximum overdose of 5-8% near the surface of the air cavity (with the maximum radius of 1.5 cm). Conversely, they indicated a minimum overdose of ~1% in the region 3-5 cm from the cavity surface for the smallest radius of 0.3 cm. The dosimetric impact depended on the size and the distance of the air passage, as well as the length of the treatment region. Based on dose calculations in water, the TPS for intraluminal brachytherapy for bronchus cancer had an unexpected overdose of 3-5% for a mean radius of 0.75 cm. This study indicates the need for improvement in dose calculation accuracy with respect to intraluminal brachytherapy for bronchus cancer.

New absorbed dose measurement with cylindrical water phantoms for multidetector CT

The aim of this study was to develop new dosimetry with cylindrical water phantoms for multidetector computed tomography (MDCT). The ionization measurement was performed with a Farmer ionization chamber at the center and four peripheral points in the body-type and head-type cylindrical water phantoms. The ionization was converted to the absorbed dose using a (60)Co absorbed-dose-to-water calibration factor and Monte Carlo (MC) -calculated correction factors. The correction factors were calculated from MDCT (Brilliance iCT, 64-slice, Philips Electronics) modeled with GMctdospp (IMPS, Germany) software based on the EGSnrc MC code. The spectrum of incident x-ray beams and the configuration of a bowtie filter for MDCT were determined so that calculated photon intensity attenuation curves for aluminum (Al) and calculated off-center ratio (OCR) profiles in air coincided with those measured. The MC-calculated doses were calibrated by the absorbed dose measured at the center in both cylindrical water phantoms. Calculated doses were compared with measured doses at four peripheral points and the center in the phantom for various beam pitches and beam collimations. The calibration factors and the uncertainty of the absorbed dose determined using this method were also compared with those obtained by CTDIair (CT dose index in air). Calculated Al half-value layers and OCRs in air were within 0.3% and 3% agreement with the measured values, respectively. Calculated doses at four peripheral points and the centers for various beam pitches and beam collimations were within 5% and 2% agreement with measured values, respectively. The MC-calibration factors by our method were 44-50% lower than values by CTDIair due to the overbeaming effect. However, the calibration factors for CTDIair agreed within 5% with those of our method after correction for the overbeaming effect. Our method makes it possible to directly measure the absorbed dose for MDCT and is more robust and accurate than the CTDIair measurement.

Radiation dose to rectum in high-dose-rate brachytherapy with a single implant and two fractions for prostate cancer, and its prediction by prostate volume

We aimed to clarify the differences between the estimated rectal dose (ERD) and the first measured dose (FMD) and second measured dose (SMD) to the rectum during high-dose-rate (HDR) brachytherapy, and to predict FMD from the prostate volume (PV) or the rectal dose-volume parameters (RDVPs). ERD, FMD, and SMD were assessed with a rectal dosimeter during HDR brachytherapy of 18 Gy given in two fractions to 110 patients (48 hormone recipients, 62 hormone-naïve patients) with prostate cancer. The correlations between FMD and PV, and between FMD and RDVP (D 2ml-D 5ml) were investigated. ERD (mean ± SD) was 219 ± 44 cGy, FMD was 255 ± 52 cGy, and SMD was 298 ± 63 cGy, which differed significantly (p < 0.001). The correlation coefficients between ERD and FMD, and between FMD and SMD, were 0.82 and 0.78, respectively. SMD was equivalent to 118 ± 16 % FMD. The measured doses were significantly greater in the hormone recipients than in the hormone-naïve patients (p < 0.001). The increase in FMD correlated with the increases in PV and in RDVPs. The correlation coefficients between PV and FMD in all of the patients, in the hormone recipients, and in the hormone-naïve patients were 0.61, 0.64, and 0.64, respectively, whereas that between RDVPs and FMD was <0.53. In conclusion, the dose to the rectum increased with time and was correlated with the increases in PV and RDVPs. The correlation coefficient between FMD and PV was greater than that between FMD and RDVPs.