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Khan AU, Jollota S, DeWerd LA. A diffusion-leakage model coupled with dose point kernels (DPK) for dosimetry of diffusing alpha-emitters radiation therapy (DaRT). Med Phys 2024; 51:3725-3733. [PMID: 38284426 DOI: 10.1002/mp.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Diffusing alpha-emitters radiation therapy (DaRT) is a novel brachytherapy technique that leverages the diffusive flow of 224Ra progeny within the tumor volume over the course of the treatment. Cell killing is achieved by the emitted alpha particles that have a short range in tissue and high linear energy transfer. The current proposed absorbed dose calculation method for DaRT is based on a diffusion-leakage (DL) model that neglects absorbed dose from beta particles. PURPOSE This work aimed to couple the DL model with dose point kernels (DPKs) to account for dose from beta particles as well as to consider the non-local deposition of energy. METHODS The DaRT seed was modeled using COMSOL multiphysics and the DL model was implemented to extract the spatial information of the diffusing daughters. Using Monte-Carlo (MC) methods, DPKs were generated for 212Pb, 212Bi, and their progenies since they were considered to be the dominant beta emitters in the 224Ra radioactive decay chain. A convolution operation was performed between the integrated number densities of the diffusing daughters and DPKs to calculate the total absorbed dose over a 30-day treatment period. Both high-diffusion and low-diffusion cases were considered. RESULTS The calculated DPKs showed non-negligible energy deposition over several millimeters from the source location. An absorbed dose >10 Gy was deposited within a 1.8 mm radial distance for the low diffusion case and a 2.2 mm radial distance for the high diffusion case. When the DPK method was compared with the local energy deposition method that solely considered dose from alpha particles, differences above 1 Gy were found within 1.3 and 1.8 mm radial distances from the surface of the source for the low diffusion and high diffusion cases, respectively. CONCLUSIONS The proposed method enhances the accuracy of the dose calculation method used for the DaRT technique.
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Affiliation(s)
- Ahtesham Ullah Khan
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sean Jollota
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Larry A DeWerd
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Kojima T, Kawamura S, Otani Y, Hanada T, Wakitani Y, Naniwa K, Yorozu A, Ikushima H, Dokiya T. Current status and issues with the dosimetric assay of iodine-125 seed sources at medical facilities in Japan: a questionnaire-based survey†. JOURNAL OF RADIATION RESEARCH 2023; 64:962-966. [PMID: 37697653 PMCID: PMC10665308 DOI: 10.1093/jrr/rrad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/13/2023] [Indexed: 09/13/2023]
Abstract
In conducting dosimetric assays of seed sources containing iodine-125 (125I), several major guidelines require the medical physicist to verify the source strength before patient treatment. Japanese guidelines do not mandate dosimetric assays at medical facilities, but since 2017, three incidents have occurred in Japan wherein seeds with incorrect strengths were delivered to medical facilities. Therefore, this study aimed to survey the current situation and any barriers to conducting the dosimetric assay of iodine-125 seeds at medical facilities in Japan. We conducted a questionnaire-based survey from December 2020 to April 2021, to examine whether seed assay and verification of the number of seeds delivered were being performed. We found that only 9 facilities (16%) performed seed assay and 28 (52%) verified the number of seeds. None of the facilities used an assay method that ensured traceability. The reasons for not performing an assay were divided into two categories: lack of resources and legal issues. Lack of resources included lack of instruments, lack of knowledge of assay methods, shorthand, or all of the above, whereas legal issues included the inability to resterilize iodine-125 seeds distributed in Japan and/or purchase seeds dedicated to the assay. Dosimetric assays, including simple methods, are effective in detecting calibration date errors and non-radioactive seeds. The study findings suggest that familiarization of medical personnel with these assay methods and investigation of the associated costs of labor and equipment should be recommended, as these measures will lead to medical reimbursement for quality assurance.
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Affiliation(s)
- Toru Kojima
- Department of Radiation Oncology, Saitama Prefectural Cancer Center, 780 Komuro, Ina-machi, Saitama 362-0806, Japan
| | - Shinji Kawamura
- Department of Radiological Technology, Graduate School of Health Sciences, Teikyo-Univercity, 6-22 Misaki-machi, Omuta, Fukuoka 836-8505, Japan
| | - Yuki Otani
- Department of Radiology, Kaizuka City Hospital, 3-10-20 Hori, Kaizuka, Osaka 597-0015, Japan
| | - Takashi Hanada
- Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yuichiro Wakitani
- Japan Radioisotope Association, 2-28-45 Hon-komagome, Bunkyo-ku, Tokyo 113-8941, Japan
| | - Kenta Naniwa
- Chiyoda Technol Corporation, 1-7-12 Yushima, Bunkyo-ku, Tokyo 113-8681, Japan
| | - Atsunori Yorozu
- Department of Radiology, National Hospital Organization Tokyo Medical Center, 2-5-1, Higashigaoka, Meguro-ku, Tokyo 152-8902, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Takushi Dokiya
- The Japan Foundation for Prostate Research, 2-9-3 Higashi-Shimbashi, Minato-ku, Tokyo 105-0021, Japan
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Finger PT, Stewart R, Rivard MJ, Beers RJ, Kamen J, Lama S, Chin KJ, Mohney K, Welles TS, Sauerwein WAG, Rosenzweig K. First clinical implementation of Yttrium-90 Disc Brachytherapy after FDA clearance. Brachytherapy 2023; 22:416-427. [PMID: 36948988 DOI: 10.1016/j.brachy.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/04/2023] [Accepted: 02/15/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Herein, we study if high-dose-rate (HDR) yttrium-90 (90Y) brachytherapy could be utilized by medical physicists, radiation oncologists, and ophthalmic surgeons. METHODS AND MATERIALS Yttrium-90 (90Y) beta-emitting brachytherapy sources received United States Food and Drug Administration clearance for episcleral treatment of ocular tumors and benign growths. Dose calibration traceable to the National Institute of Standards and Technology as well as treatment planning and target delineation methods were established. Single-use systems included a 90Y-disc affixed within specialized, multifunction, handheld applicator. Low-dose-rate to high-dose-rate prescription conversions and depth-dose determinations were performed. Radiation safety was evaluated based on live exposure rates during assembly and surgeries. Clinical data for radiation safety, treatment tolerability, and local control was collected. RESULTS Practice parameters for the medical physicist, radiation oncologist, and ophthalmic surgeon were defined. Device sterilizations, calibrations, assemblies, surgical methods, and disposals were reproducible and effective. Treated tumors included iris melanoma, iridociliary melanoma, choroidal melanoma, and a locally invasive squamous carcinoma. Mean calculated 90Y disc activity was 14.33 mCi (range 8.8-16.6), prescription dose 27.8 Gy (range 22-30), delivered to depth of 2.3 mm (range 1.6-2.6), at treatment durations of 420 s (7.0 min, range 219 s-773 s). Both insertion and removal were performed during one surgical session. After surgery, each disc-applicator- system was contained for decay in storage. Treatments were well-tolerated. CONCLUSIONS HDR 90Y episcleral brachytherapy devices were created, implementation methods developed, and treatments performed on 6 patients. Treatments were single-surgery, rapid, and well-tolerated with short-term follow up.
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Affiliation(s)
- Paul T Finger
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH.
| | - Robert Stewart
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Mark J Rivard
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Raymond J Beers
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jacob Kamen
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shyam Lama
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kimberly J Chin
- The Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, NY; Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Kyle Mohney
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | - Toby S Welles
- Scientific Advisory Board and Employees of Liberty Vision Corporation, Portsmouth, NH
| | | | - Kenneth Rosenzweig
- The Departments of Ophthalmology, Radiation Oncology, and Radiation Safety, New York Eye and Ear Infirmary of Mount Sinai and Icahn School of Medicine at Mount Sinai, New York, NY
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Meltsner SG, Rodrigues A, Materin MA, Kirsch DG, Craciunescu O. Transitioning from a COMS-based plaque brachytherapy program to using eye physics plaques and plaque simulator treatment planning system: A single institutional experience. J Appl Clin Med Phys 2023; 24:e13902. [PMID: 36637797 PMCID: PMC10161060 DOI: 10.1002/acm2.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 01/14/2023] Open
Abstract
The aim of this work is to describe the implementation and commissioning of a plaque brachytherapy program using Eye Physics eye plaques and Plaque Simulator treatment planning system based on the experience of one institution with an established COMS-based plaque program. Although commissioning recommendations are available in official task groups publications such as TG-129 and TG-221, we found that there was a lack of published experiences with the specific details of such a transition and the practical application of the commissioning guidelines. The specific issues addressed in this paper include discussing the lack of FDA approval of the Eye Physics plaques and Plaque Simulator treatment planning system, the commissioning of the plaques and treatment planning system including considerations of the heterogeneity corrected calculations, and the implementation of a second check using an FDA-approved treatment planning system. We have also discussed the use of rental plaques, the analysis of plans using dose histograms, and the development of a quality management program. By sharing our experiences with the commissioning of this program this document will assist other institutions with the same task and act as a supplement to the recommendations in the recently published TG-221.
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Affiliation(s)
- Sheridan G Meltsner
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Anna Rodrigues
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Miguel A Materin
- Departments of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - David G Kirsch
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Oana Craciunescu
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
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GEC-ESTRO ACROP recommendations on calibration and traceability of HE HDR-PDR photon-emitting brachytherapy sources at the hospital level. Radiother Oncol 2022; 176:108-117. [PMID: 36167195 DOI: 10.1016/j.radonc.2022.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/14/2022] [Indexed: 12/14/2022]
Abstract
The vast majority of radiotherapy departments in Europe using brachytherapy (BT) perform temporary implants of high- or pulsed-dose rate (HDR-PDR) sources with photon energies higher than 50 keV. Such techniques are successfully applied to diverse pathologies and clinical scenarios. These recommendations are the result of Working Package 21 (WP-21) initiated within the BRAchytherapy PHYsics Quality Assurance System (BRAPHYQS) GEC-ESTRO working group with a focus on HDR-PDR source calibration. They provide guidance on the calibration of such sources, including practical aspects and issues not specifically accounted for in well-accepted societal recommendations, complementing the BRAPHYQS WP-18 Report dedicated to low energy BT photon emitting sources (seeds). The aim of this report is to provide a European-wide standard in HDR-PDR BT source calibration at the hospital level to maintain high quality patient treatments.
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Valdes‐Cortez C, Niatsetski Y, Perez‐Calatayud J, Ballester F, Vijande J. A Monte Carlo study of the relative biological effectiveness in surface brachytherapy. Med Phys 2022; 49:5576-5588. [DOI: 10.1002/mp.15774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
| | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1, 3905 TH Veenendaal The Netherlands
| | - Jose Perez‐Calatayud
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED) Instituto de Investigación Sanitaria La Fe (IIS‐La Fe)‐Universitat de Valencia (UV)
- Radiotherapy Department La Fe Hospital Valencia Spain
- Radiotherapy Department Hospital Clinica Benidorm Alicante Spain
| | - Facundo Ballester
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED) Instituto de Investigación Sanitaria La Fe (IIS‐La Fe)‐Universitat de Valencia (UV)
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot Spain
| | - Javier Vijande
- Unidad Mixta de Investigación en Radiofísica e Instrumentación Nuclear en Medicina (IRIMED) Instituto de Investigación Sanitaria La Fe (IIS‐La Fe)‐Universitat de Valencia (UV)
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot Spain
- Instituto de Física Corpuscular IFIC (UV‐CSIC) Burjassot Spain
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CT-MR Image Fusion for Post-Implant Dosimetry Analysis in Brain Tumor Seed Implantation- a Preliminary Study. DISEASE MARKERS 2022; 2022:6310262. [PMID: 35620270 PMCID: PMC9129983 DOI: 10.1155/2022/6310262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 12/17/2022]
Abstract
Purpose To calculate and evaluate postimplant dosimetry (PID) with CT-MR fusion technique after brain tumor brachytherapy and compare the result with CT-based PID. Methods and Materials 16 brain tumor patients received MR-guided intervention with Iodine-125 (125I) seed implantation entered this preliminary study for PID evaluation. Registration and fusion of CT and MR images of the same patients were performed one day after operation. Seeds identification and targets delineation were carried out on CT, MR, and CT-MR fusion images, each. The number and location of seeds on MR or CT- MR fusion images were compared with those of actually implanted seeds. Clinical target volume (CTV) and dosimetric parameters such as %D90, %V100 and external V100 were measured and calculated. In addition, the correlation of the fusion to CT CTV ratio and other factors were analyzed. Results The numbers of fusion seeds were not significantly different compared with reference seeds (t =1.76, p >0.05). The difference between reference seeds numbers and truly extracted MR seeds numbers was statistically significant (t =3.91, p <0.05). All dosimetric parameters showed significant differences between the two techniques (p <0.05). The mean CTV delineated on fusion images was 34.3 ± 33.6, smaller than that on CT images. The mean values of external V100, %V100 and %D90 on fusion images were larger than those on CT images. Correlation analysis showed that the fusion-CT V100 ratio was positively and significantly correlated with the fusion-CT volume ratio. Conclusions This preliminary study indicated that CT-MR fusion-based PID exhibited good accuracy for 125I brain tumor brachytherapy dosimetry when compared to CT-based PID and merits further research to establish best-outcome protocols.
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Ayala Alvarez DS, Watson PGF, Popovic M, Heng VJ, Evans MDC, Seuntjens J. Monte Carlo calculation of the TG-43 dosimetry parameters for the INTRABEAM source with spherical applicators. Phys Med Biol 2021; 66. [PMID: 34663769 DOI: 10.1088/1361-6560/ac309f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The relative TG-43 dosimetry parameters of the INTRABEAM (Carl Zeiss Meditec AG, Jena, Germany) bare probe were recently reported by Ayala Alvarezet al(2020Phys. Med. Biol.65245041). The current study focuses on the dosimetry characterization of the INTRABEAM source with the eight available spherical applicators according to the TG-43 formalism using Monte Carlo (MC) simulations. APPROACH This report includes the calculated dose-rate conversion coefficients that determine the absolute dose rate to water at a reference point of 10 mm from the applicator surface, based on calibration air-kerma rate measurements at 50 cm from the source on its transverse plane. Since the air-kerma rate measurements are not yet provided from a standards laboratory for the INTRABEAM, the values in the present study were calculated with MC. This approach is aligned with other works in the search for standardization of the dosimetry of electronic brachytherapy sources. As a validation of the MC model, depth dose calculations along the source axis were compared with calibration data from the source manufacturer. MAIN RESULTS The calculated dose-rate conversion coefficients were 434.0 for the bare probe, and 683.5, 548.3, 449.9, 376.5, 251.0, 225.6, 202.8, and 182.6 for the source with applicators of increasing diameter from 15 to 50 mm, respectively. The radial dose and the 2D anisotropy functions of the TG-43 formalism were also obtained and tabulated in this document. SIGNIFICANCE This work presents the data required by a treatment planning system for the characterization of the INTRABEAM system in the context of intraoperative radiotherapy applications.
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Affiliation(s)
| | - Peter G F Watson
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montreal, Canada
| | - Marija Popovic
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montreal, Canada
| | - Veng Jean Heng
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montreal, Canada
| | - Michael D C Evans
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montreal, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montreal, Canada
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Standardization and Validation of Brachytherapy Seeds' Modelling Using GATE and GGEMS Monte Carlo Toolkits. Cancers (Basel) 2021; 13:cancers13215315. [PMID: 34771479 PMCID: PMC8582469 DOI: 10.3390/cancers13215315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/01/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Simple Summary This study used GATE and GGEMS simulation toolkits, to estimate dose distribution on Brachytherapy procedures. Specific guidelines were followed as defined by the American Association of Physicists in Medicine (AAPM) as well as by the European SocieTy for Radiotherapy and Oncology (ESTRO). Several types of brachytherapy seeds were modelled and simulated, namely Low-Dose-Rate (LDR), High-Dose-Rate (HDR), and Pulsed-Dose-Rate (PDR). The basic difference between GATE and GGEMS is that GGEMS incorporates GPU capabilities, which makes the use of Monte Carlo (MC) simulations more accessible in clinical routine, by minimizing the computational time to obtain a dose map. During the validation procedure of both codes with protocol data, differences as well as uncertainties were measured within the margins defined by the guidelines. The study concluded that MC simulations may be utilized in clinical practice, to optimize dose distribution in real time, as well as to evaluate therapeutic plans. Abstract This study aims to validate GATE and GGEMS simulation toolkits for brachytherapy applications and to provide accurate models for six commercial brachytherapy seeds, which will be freely available for research purposes. The AAPM TG-43 guidelines were used for the validation of two Low Dose Rate (LDR), three High Dose Rate (HDR), and one Pulsed Dose Rate (PDR) brachytherapy seeds. Each seed was represented as a 3D model and then simulated in GATE to produce one single Phase-Space (PHSP) per seed. To test the validity of the simulations’ outcome, referenced data (provided by the TG-43) was compared with GATE results. Next, validation of the GGEMS toolkit was achieved by comparing its outcome with the GATE MC simulations, incorporating clinical data. The simulation outcomes on the radial dose function (RDF), anisotropy function (AF), and dose rate constant (DRC) for the six commercial seeds were compared with TG-43 values. The statistical uncertainty was limited to 1% for RDF, to 6% (maximum) for AF, and to 2.7% (maximum) for the DRC. GGEMS provided a good agreement with GATE when compared in different situations: (a) Homogeneous water sphere, (b) heterogeneous CT phantom, and (c) a realistic clinical case. In addition, GGEMS has the advantage of very fast simulations. For the clinical case, where TG-186 guidelines were considered, GATE required 1 h for the simulation while GGEMS needed 162 s to reach the same statistical uncertainty. This study produced accurate models and simulations of their emitted spectrum of commonly used commercial brachytherapy seeds which are freely available to the scientific community. Furthermore, GGEMS was validated as an MC GPU based tool for brachytherapy. More research is deemed necessary for the expansion of brachytherapy seed modeling.
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Wei S, Li C, Li M, Xiong Y, Jiang Y, Sun H, Qiu B, Lin CJ, Wang J. Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions. Front Oncol 2021; 11:717180. [PMID: 34660280 PMCID: PMC8514864 DOI: 10.3389/fonc.2021.717180] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
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Affiliation(s)
- Shuhua Wei
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Mengyuan Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yan Xiong
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | | | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
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Abtahi M, Gholami S, Nashi HHJ. High dose rate 192Ir versus high dose rate 60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020. Biomed Phys Eng Express 2021; 7:055022. [DOI: https:/doi.org/10.1088/2057-1976/ac1c52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
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12
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Feng W, Rivard MJ, Carey EM, Hearn RA, Pai S, Nath R, Kim Y, Thomason CL, Boyce DE, Zhang H. Recommendations for intraoperative mesh brachytherapy: Report of AAPM Task Group No. 222. Med Phys 2021; 48:e969-e990. [PMID: 34431524 DOI: 10.1002/mp.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 08/17/2021] [Accepted: 08/17/2021] [Indexed: 11/11/2022] Open
Abstract
Mesh brachytherapy is a special type of a permanent brachytherapy implant: it uses low-energy radioactive seeds in an absorbable mesh that is sutured onto the tumor bed immediately after a surgical resection. This treatment offers low additional risk to the patient as the implant procedure is carried out as part of the tumor resection surgery. Mesh brachytherapy utilizes identification of the tumor bed through direct visual evaluation during surgery or medical imaging following surgery through radiographic imaging of radio-opaque markers within the sources located on the tumor bed. Thus, mesh brachytherapy is customizable for individual patients. Mesh brachytherapy is an intraoperative procedure involving mesh implantation and potentially real-time treatment planning while the patient is under general anesthesia. The procedure is multidisciplinary and requires the complex coordination of multiple medical specialties. The preimplant dosimetry calculation can be performed days beforehand or expediently in the operating room with the use of lookup tables. In this report, the guidelines of American Association of Physicists in Medicine (AAPM) are presented on the physics aspects of mesh brachytherapy. It describes the selection of radioactive sources, design and preparation of the mesh, preimplant treatment planning using a Task Group (TG) 43-based lookup table, and postimplant dosimetric evaluation using the TG-43 formalism or advanced algorithms. It introduces quality metrics for the mesh implant and presents an example of a risk analysis based on the AAPM TG-100 report. Recommendations include that the preimplant treatment plan be based upon the TG-43 dose calculation formalism with the point source approximation, and the postimplant dosimetric evaluation be performed by using either the TG-43 approach, or preferably the newer model-based algorithms (viz., TG-186 report) if available to account for effects of material heterogeneities. To comply with the written directive and regulations governing the medical use of radionuclides, this report recommends that the prescription and written directive be based upon the implanted source strength, not target-volume dose coverage. The dose delivered by mesh implants can vary and depends upon multiple factors, such as postsurgery recovery and distortions in the implant shape over time. For the sake of consistency necessary for outcome analysis, prescriptions based on the lookup table (with selection of the intended dose, depth, and treatment area) are recommended, but the use of more advanced techniques that can account for real situations, such as material heterogeneities, implant geometric perturbations, and changes in source orientations, is encouraged in the dosimetric evaluation. The clinical workflow, logistics, and precautions are also presented.
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Affiliation(s)
- Wenzheng Feng
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Mark J Rivard
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Robert A Hearn
- Department of Radiation Physics at Theragenics, Theragenics Corp., Buford, Georgia, USA
| | - Sujatha Pai
- Department of Radiation Oncology, Memorial Hermann Texas Medical Center, Houston, Texas, USA
| | - Ravinder Nath
- Department of Therapeutic Radiology, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Yongbok Kim
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Cynthia L Thomason
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Hualin Zhang
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
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Abtahi M, Gholami S, Jassim HH. High dose rate 192Ir versus high dose rate 60Co brachytherapy: an overview of systematic reviews of clinical responses of gynecological cancers from 1984 to 2020. Biomed Phys Eng Express 2021; 7:055022. [PMID: 34375964 DOI: 10.1088/2057-1976/ac1c52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/10/2021] [Indexed: 12/24/2022]
Abstract
The Purpose. Radioisotope of192Iradium (192Ir) has a half-life (74 days) and is not easily accessible in developing countries. As a result, by the time source shipment clearance and the customs paperwork are completed, a large proportion of useful activity had already been decayed away. In fact,60Cobalt (60Co) remote afterloading systems are commercially available by many venders. As a result, it may well become an alternative source to192Ir and conform many of these challenges. The aim of this study is that to report clinical responses of different types of gynaecological cancers treated with high dose rate (HDR)192Ir and HDR60Co brachytherapy in order to check whether HDR60Co could be used as an alternative brachytherapy, source to HDR192Ir.Materials and Methods. A retrospective study of clinical responses of different types of gynaecological cancers, staged from I to IV according to recommendations of International Federation of Gynaecology and Obstetrics (FIGO), treated by brachytherapy alone, radiotherapy alone (combined brachytherapy and radiotherapy) and combined radiotherapy and chemotherapy (brachytherapy, radiotherapy and chemotherapy) between 1984 and December 2020 was conducted. The patients were treated with external beam radiotherapy 45-51 Gy boosted with HDR192Ir and HDR60Co afterloading brachytherapy of 18-30 Gy to point A.The results. The study scrutinized the data of 11086 patients with different types of gynaecological cancers. Most of the patients, 70 percent of them, were diagnosed with gynaecological cancers in stages II and III. For patients treated with192Ir brachytherapy source 5-years overall survival rate (OS), local control, 2-years, 5-years and 10-years disease free survival (DFS), complications of gastro-intestine (GI) and complications of genito-urinary (GU) were 63.5%, 92%, 72.6%, 64.07%, 43.75%, 3.9% and 5.92%, but for those treated with60Co they were 57.7%, 86.63%, 82.5%, 53.35%, 43.75%, 4.8% and 3.7%, respectively.Conclusions.The use of HDR60Co brachytherapy has the capacity to produce overall survival rate and disease control in patients with carcinoma of the gynaecology comparable to that reported for HDR192Ir brachytherapy. Currently, the toxicity and damage of the normal tissues and radiation-related second cancers are of a similar incidence to that of standard HDR192Ir brachytherapy. Source exchange frequency is not a serious concern because it requires less frequency of replacement, and commissioning can be accomplished within years; hence, replacing HDR192Ir with HDR60Co brachytherapy achieves significant cost saving. Therefore, we recommend that60Co source ought to be the first choice for low resource radiotherapy setting as it offers economic advantages over192Ir and have comparable clinical outcomes to that of192Ir source.
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Affiliation(s)
- M Abtahi
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - S Gholami
- Radiation Oncology department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - H H Jassim
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
- Najaf Health Directorate, Ministry of Health, Najaf, Iraq
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Sheikholeslami S, Khodaverdian S, Hashemzaei F, Ghobadi P, Ghorbani M, Farhood B. Evaluation of bone dose arising from skin cancer brachytherapy: A comparison between 192Ir and 60Co sources through Monte Carlo simulations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 205:106089. [PMID: 33862569 DOI: 10.1016/j.cmpb.2021.106089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/01/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE This study aimed to calculate and compare absorbed dose to bone following exposure to 192Ir and 60Co sources in high dose rate (HDR) skin brachytherapy. Moreover, effects of the bone thickness and soft tissue thickness before the bone on absorbed dose to the bone are evaluated . MATERIALS AND METHODS 192Ir and 60Co sources inserted in Leipzig applicators with internal diameters of 1, 2 and 3 cm with/without their optimal flattening filters were simulated by MCNPX Monte Carlo code. Then, heterogeneous phantoms (including skin, soft tissue before and after the bone, cortical bone and bone marrow) were defined. Finally, relative depth dose values for the bone and other tissues in the heterogeneous phantoms were obtained and compared. RESULTS The average relative depth dose values of the skin, soft tissue before and after bone and bone marrow were almost similar for both 192Ir and 60Co sources, with a maximum difference less than 2%. However, a 0.1-6.8% difference was observed between average relative depth dose values of these two sources for the cortical bone. The results showed that with increasing the bone thickness and bone distance from the skin surface, the average relative depth dose values of the bone marrow and cortical bone decreased for both 192Ir and 60Co sources inserted in the applicators without/with their optimal flattening filters. For most of evaluated the applicators without/with their flattening filters, the average relative depth dose values of the bone marrow arisen from the 60Co source were higher than those obtained from the 192Ir source, while an opposite trend was observed for the cortical bone . CONCLUSION The obtained findings showed that the average relative depth dose values of 192Ir and 60Co sources at the corresponding depths of the designed heterogeneous phantoms were almost similar (expect for the cortical bone). Hence, it is concluded that 60Co source can be used instead of 192Ir source in HDR skin brachytherapy, particularly in developing countries.
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Affiliation(s)
- Sahar Sheikholeslami
- Department of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Shaghayegh Khodaverdian
- Department of Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fatemeh Hashemzaei
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Parvin Ghobadi
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Mahdi Ghorbani
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
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15
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Badali DS, Vainer Y, Ellenor CW, Mitchell CR, Fishman K, Soro N, Price R, Funk T. Inverse treatment planning for an electronic brachytherapy system delivering anisotropic radiation therapy. Phys Med Biol 2021; 66:055004. [PMID: 33429370 DOI: 10.1088/1361-6560/abda9a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An inverse radiation treatment planning algorithm for Sensus Healthcare's SculpturaTM electronic brachytherapy system has been designed. The algorithm makes use of simulated annealing to optimize the conformation number (CN) of the treatment plan. The highly anisotropic dose distributions produced by the SculpturaTM x-ray source empower the inverse treatment planning algorithm to achieve highly conformal treatment plans for a wide range of prescribed planning target volumes. Over a set of 10 datasets the algorithm achieved an average CN of 0.79 ± 0.08 and an average gamma passing rate of 0.90 ± 0.10 at 5%/5 mm. A regularization term that encouraged short treatment plans was used, and it was found that the total treatment time could be reduced by 20% with only a nominal reduction in the CN and gamma passing rate. It was also found that downsampling the voxelized volume (from 3203 to 643 voxels) prior to optimization resulted in a 150× speedup in the optimization time (from 2 + minutes to < 1 s) without affecting the quality of the treatment plan.
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16
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Licciardello T, Feliciani G, Mazzotti G, Mostacci D, Sarnelli A, Menghi E. Radiation protection and dosimetry issues for patients with prostate cancer after I-125 low-dose-rate brachytherapy permanent implant. Brachytherapy 2021; 20:272-278. [PMID: 33041230 DOI: 10.1016/j.brachy.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/03/2020] [Accepted: 09/04/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this work was to analyze the exposure rates measured in the proximity of patients who underwent prostate low-dose-rate brachytherapy with I-125 implant. Effective doses to relatives and to population were computed to estimate the time to reach radioprotection dose constraints. METHODS AND MATERIALS Measurements were obtained from 180 patients, whereas the body mass index was calculated and reported for 77 patients. The day after the implant, K˙ measurements were conducted at various skin distances and positions and converted to effective doses. A theoretical model was developed to estimate effective doses from total implanted activity. The latter was approximated with a 10-mL vial inside the patient. RESULTS The K˙ measurements showed a low correlation with the total implanted activity, albeit an increasing trend of K˙ was observed on increasing the activity. A stronger correlation was found between body mass index and K˙ measurements. The effective dose to population is in general lower than dose constraints as well as the effective doses to relatives, with the exception of children and pregnant women, who command special precautions. We report differences between the experimental model- and theoretical model-based dose evaluation together with their comparison with previous studies found in literature. CONCLUSIONS Based on the K˙ measurements and the results of the present analysis, it is possible to provide the patient with radiation safety instructions specifically tailored to his relatives' habits and working environment.
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Affiliation(s)
- Tiziana Licciardello
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | - Giacomo Feliciani
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy.
| | - Giorgio Mazzotti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | | | - Anna Sarnelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
| | - Enrico Menghi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola FC, Italy
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Niroomand‐Rad A, Chiu‐Tsao S, Grams MP, Lewis DF, Soares CG, Van Battum LJ, Das IJ, Trichter S, Kissick MW, Massillon‐JL G, Alvarez PE, Chan MF. Report of AAPM Task Group 235 Radiochromic Film Dosimetry: An Update to TG‐55. Med Phys 2020; 47:5986-6025. [DOI: 10.1002/mp.14497] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Indra J. Das
- Radiation Oncology Northwestern University Memorial Hospital Chicago IL USA
| | - Samuel Trichter
- New York‐Presbyterian HospitalWeill Cornell Medical Center New York NY USA
| | | | - Guerda Massillon‐JL
- Instituto de Fisica Universidad Nacional Autonoma de Mexico Mexico City Mexico
| | - Paola E. Alvarez
- Imaging and Radiation Oncology Core MD Anderson Cancer Center Houston TX USA
| | - Maria F. Chan
- Memorial Sloan Kettering Cancer Center Basking Ridge NJ USA
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18
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Fulkerson RK, Perez‐Calatayud J, Ballester F, Buzurovic I, Kim Y, Niatsetski Y, Ouhib Z, Pai S, Rivard MJ, Rong Y, Siebert F, Thomadsen BR, Weigand F. Surface brachytherapy: Joint report of the AAPM and the GEC‐ESTRO Task Group No. 253. Med Phys 2020; 47:e951-e987. [DOI: 10.1002/mp.14436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Regina K. Fulkerson
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Jose Perez‐Calatayud
- Radiotherapy Department La Fe Hospital Valencia46026 Spain
- Radiotherapy Department Clinica Benidorm Alicante03501 Spain
| | - Facundo Ballester
- Department of Atomic, Molecular and Nuclear Physics University of Valencia Burjassot46100 Spain
| | - Ivan Buzurovic
- Dana‐Farber/Brigham and Women’s Cancer Center Harvard Medical School Boston MA02115 USA
| | - Yongbok Kim
- Department of Radiation Oncology University of Arizona Tucson AZ85724 USA
| | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1 Veenendaal3903 DD Netherlands
| | - Zoubir Ouhib
- Radiation Oncology Department Lynn Regional Cancer CenterBoca Raton Community Hospital Boca Raton FL33486 USA
| | - Sujatha Pai
- Radion Inc. 20380 Town Center Lane, Suite 135 Cupertino CA95014 USA
| | - Mark J. Rivard
- Department of Radiation Oncology Alpert Medical School Brown University Providence RI02903 USA
| | - Yi Rong
- Department of Radiation Oncology University of California Davis Comprehensive Cancer Center Sacramento CA95817 USA
| | - Frank‐André Siebert
- UK S‐HCampus Kiel, Klinik fur Strahlentherapie (Radioonkologie) Arnold‐Heller‐Str. 3Haus 50 KielD‐24105 Germany
| | - Bruce R. Thomadsen
- Department of Medical Physics University of Wisconsin–Madison Madison WI53705 USA
| | - Frank Weigand
- Carl Zeiss Meditec AG Rudolf‐Eber‐Straße 11 Oberkochen73447 Germany
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19
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Low dose rate permanent seed brachytherapy: tracing its evolution and current status. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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20
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Ghobadi P, Farhood B, Ghorbani M, Mohseni M. Design and characterization of flattening filter for high dose rate 192Ir and 60Co Leipzig applicators used in skin cancer brachytherapy: A Monte Carlo study. Comput Biol Med 2020; 123:103878. [PMID: 32658791 DOI: 10.1016/j.compbiomed.2020.103878] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aimed to design optimal flattening filters for high dose rate (HDR) 192Ir and 60Co Leipzig applicators which are used to treat skin cancer. MATERIALS AND METHODS MCNPX Monte Carlo code was used to design flattening filters for Leipzig applicators with inner diameters of 1, 2 and 3 cm. Then, their dosimetric characterizations such as dose distribution, dose profile, percentage depth dose, flatness, symmetry and homogeneity were evaluated in a 20 × 20 × 20 cm3 water phantom and compared with those without the flattening filter. RESULTS The flattening filter thickness varied from 0 mm (at the edge) to the maximum values of 0.30, 1.18, and 2.41 mm for the 192Ir Leipzig applicators of H1, H2, and H3 type, respectively. This quantity has maximum values of 0.96, 6.27, and 12.31 mm for the 60Co double wall applicators of D1, D2, and D3 type, respectively. The dose profile flatness values for the H1, H2, and H3 192Ir Leipzig applicators with the optimal flattening filters were 0.76, 1.26, and 1.85%, respectively. Furthermore, the dose profile flatness values for the D1, D2, and D3 60Co double wall applicators with the optimal flattening filters were 1.11, 2.10 and 3.12%, respectively. The dose profile symmetry values obtained from various source-applicator combinations were less than 1.02. Compared to the applicators without flattening filter, the homogeneity values for the H1, H2, and H3 192Ir Leipzig applicators with the optimal flattening filters were improved 1.68, 6.51, and 13.17 times, respectively, and for the D1, D2, and D3 60Co double wall applicators were improved 1.23, 6.21 and 9.54 times, respectively. CONCLUSION The findings revealed that the inhomogeneous dose distribution resulted from the Leipzig applicators without the optimal flattening filter at the treatment surface could be improved by insertion of optimal lead flattening filters between the sources and treatment surface.
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Affiliation(s)
- Parvin Ghobadi
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Mahdi Ghorbani
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehran Mohseni
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
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21
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Abstract
The purpose of this study was to review the limitations of dose calculation formalisms for photon-emitting brachytherapy sources based on the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) report and to provide recommendations to transition to model-based dose calculation algorithms. Additionally, an overview of these algorithms and approaches is presented. The influence of tissue and seed/applicator heterogeneities on brachytherapy dose distributions for breast, gynecologic, head and neck, rectum, and prostate cancers as well as eye plaques and electronic brachytherapy treatments were investigated by comparing dose calculations based on the TG-43 formalism and model-based dose calculation algorithms.
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22
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Thomson RM, Furutani KM, Kaulich TW, Mourtada F, Rivard MJ, Soares CG, Vanneste FM, Melhus CS. AAPM recommendations on medical physics practices for ocular plaque brachytherapy: Report of task group 221. Med Phys 2020; 47:e92-e124. [PMID: 31883269 DOI: 10.1002/mp.13996] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/12/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
The American Association of Physicists in Medicine (AAPM) formed Task Group 221 (TG-221) to discuss a generalized commissioning process, quality management considerations, and clinical physics practice standards for ocular plaque brachytherapy. The purpose of this report is also, in part, to aid the clinician to implement recommendations of the AAPM TG-129 report, which placed emphasis on dosimetric considerations for ocular brachytherapy applicators used in the Collaborative Ocular Melanoma Study (COMS). This report is intended to assist medical physicists in establishing a new ocular brachytherapy program and, for existing programs, in reviewing and updating clinical practices. The report scope includes photon- and beta-emitting sources and source:applicator combinations. Dosimetric studies for photon and beta sources are reviewed to summarize the salient issues and provide references for additional study. The components of an ocular plaque brachytherapy quality management program are discussed, including radiation safety considerations, source calibration methodology, applicator commissioning, imaging quality assurance tests for treatment planning, treatment planning strategies, and treatment planning system commissioning. Finally, specific guidelines for commissioning an ocular plaque brachytherapy program, clinical physics practice standards in ocular plaque brachytherapy, and other areas reflecting the need for specialized treatment planning systems, measurement phantoms, and detectors (among other topics) to support the clinical practice of ocular brachytherapy are presented. Expected future advances and developments for ocular brachytherapy are discussed.
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Affiliation(s)
- Rowan M Thomson
- Carleton Laboratory for Radiotherapy Physics, Physics Department, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Keith M Furutani
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Theodor W Kaulich
- Department of Medical Physics, University of Tübingen, 72074, Tübingen, Germany
| | - Firas Mourtada
- Department of Radiation Oncology, Christiana Care Hospital, Newark, DE, 19713, USA
| | - Mark J Rivard
- Department of Radiation Oncology, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | | | | | - Christopher S Melhus
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA, 02111, USA
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Shaikh MY, Joiner MC, Nalichowski A, Kumaraswamy LK, Burmeister J. Evaluation of the dosimetric impact of manufacturing variations for the INTRABEAM x‐ray source. J Appl Clin Med Phys 2020; 21:20-31. [PMID: 31976605 PMCID: PMC7075384 DOI: 10.1002/acm2.12809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/02/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022] Open
Abstract
Introduction INTRABEAM x‐ray sources (XRSs) have distinct output characteristics due to subtle variations between the ideal and manufactured products. The objective of this study is to intercompare 15 XRSs and to dosimetrically quantify the impact of manufacturing variations on the delivered dose. Methods and Materials The normality of the XRS datasets was evaluated with the Shapiro–Wilk test, the accuracy of the calibrated depth–dose curves (DDCs) was validated with ionization chamber measurements, and the shape of each DDC was evaluated using depth–dose ratios (DDRs). For 20 Gy prescribed to the spherical applicator surface, the dose was computed at 5‐mm and 10‐mm depths from the spherical applicator surface for all XRSs. Results At 5‐, 10‐, 20‐, and 30‐mm depths from the source, the coefficient of variation (CV) of the XRS output for 40 kVp was 4.4%, 2.8%, 2.0%, and 3.1% and for 50 kVp was 4.2%, 3.8%, 3.8%, and 3.4%, respectively. At a 20‐mm depth from the source, the 40‐kVp energy had a mean output in Gy/Minute = 0.36, standard deviation (SD) = 0.0072, minimum output = 0.34, and maximum output = 0.37 and a 50‐kVp energy had a mean output = 0.56, SD = 0.021, minimum output = 0.52, and maximum output = 0.60. We noted the maximum DRR values of 2.8% and 2.5% for 40 kVp and 50 kVp, respectively. For all XRSs, the maximum dosimetric effect of these variations within a 10‐mm depth of the applicator surface is ≤ 2.5%. The CV increased as depth increased and as applicator size decreased. Conclusion The American Association of Physicist in Medicine Task Group‐167 requires that the impurities in radionuclides used for brachytherapy produce ≤ 5.0% dosimetric variations. Because of differences in an XRS output and DDC, we have demonstrated the dosimetric variations within a 10‐mm depth of the applicator surface to be ≤ 2.5%.
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Affiliation(s)
- Mubin Y. Shaikh
- Department of Radiation Oncology Rochester Regional Rochester NY USA
| | - Michael C. Joiner
- Department of Oncology Wayne State University Gershenson Radiation Oncology Center Detroit MI USA
| | - Adrian Nalichowski
- Wayne State University School of Medicine Gershenson Radiation Oncology Center Barbara Ann Karmanos Cancer Institute Detroit MI USA
| | - Lalith K. Kumaraswamy
- Department of Radiation Medicine Roswell Park Cancer Institute State University of New York at Buffalo Buffalo NY USA
| | - Jay Burmeister
- Wayne State University School of Medicine Gershenson Radiation Oncology Center Barbara Ann Karmanos Cancer Institute Detroit MI USA
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Shaikh MY, Tanny S. Dosimetric comparison of the INTRABEAM and Axxent for intraoperative breast radiotherapy. Brachytherapy 2020; 19:234-240. [DOI: 10.1016/j.brachy.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 01/28/2023]
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25
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Shaikh MY, Burmeister J, Scott R, Kumaraswamy LK, Nalichowski A, Joiner MC. Dosimetric evaluation of incorporating the revised V4.0 calibration protocol for breast intraoperative radiotherapy with the INTRABEAM system. J Appl Clin Med Phys 2020; 21:50-59. [PMID: 32039545 PMCID: PMC7020998 DOI: 10.1002/acm2.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/20/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022] Open
Abstract
In breast‐targeted intraoperative radiotherapy (TARGIT) clinical trials (TARGIT‐B, TARGIT‐E, TARGIT‐US), a single fraction of radiation is delivered to the tumor bed during surgery with 1.5‐ to 5.0‐cm diameter spherical applicators and an INTRABEAM x‐ray source (XRS). This factory‐calibrated XRS is characterized by two depth‐dose curves (DDCs) named "TARGIT" and "V4.0.” Presently, the TARGIT DDC is used to treat patients enrolled in clinical trials; however, the V4.0 DDC is shown to better represent the delivered dose. Therefore, we reevaluate the delivered prescriptions under the TARGIT protocols using the V4.0 DDC. A 20‐Gy dose was prescribed to the surface of the spherical applicator, and the TARGIT DDC was used to calculate the treatment time. For a constant treatment time, the V4.0 DDC was used to recalculate the dosimetry to evaluate differences in dose rate, dose, and equivalent dose in 2‐Gy fractions (EQD2) for an α/β = 3.5 Gy (endpoint of locoregional relapse). At the surface of the tumor bed (i.e., spherical applicator surface), the calculations using the V4.0 DDC predicted increased values for dose rate (43–16%), dose (28.6–23.2 Gy), and EQD2 (95–31%) for the 1.5‐ to 5.0‐cm diameter spherical applicator sizes, respectively. In general, dosimetric differences are greatest for the 1.5‐cm diameter spherical applicator. The results from this study can be interpreted as a reevaluation of dosimetry or the dangers of underdosage, which can occur if the V4.0 DDC is inadvertently used for TARGIT clinical trial patients. Because the INTRABEAM system is used in TARGIT clinical trials, accurate knowledge about absorbed dose is essential for making meaningful comparisons between radiation treatment modalities, and reproducible treatment delivery is imperative. The results of this study shed light on these concerns.
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Affiliation(s)
- Mubin Y Shaikh
- Department of Radiation Oncology, Rochester Regional, Rochester, NY, USA
| | - Jay Burmeister
- Wayne State University School of Medicine, Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | | | - Lalith K Kumaraswamy
- Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Adrian Nalichowski
- Wayne State University School of Medicine, Gershenson Radiation Oncology Center, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Michael C Joiner
- Department of Oncology, Gershenson Radiation Oncology Center, Wayne State University, Detroit, USA
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26
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Badali DS, Plateau GR, Ellenor CW, Ku CY, Vatahov P, Esterline J, Wilfley BP, Mitchell CR, Fishman K, Funk T. Characterization of an x-ray source with a partitioned diamond-tungsten target for electronic brachytherapy with 3D beam directionality. ACTA ACUST UNITED AC 2019; 64:245007. [DOI: 10.1088/1361-6560/ab5130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Thomadsen BR, Biggs PJ, Cardarelli GA, Chu JCH, Cormack RA, Feng W, Heaton HT, Hiatt JR, Law JN, Limmer JP, Ouhib Z, Pai S, Pillai S, Ringor MR, Rivard MJ, Waldron TJ, Caldwell BS, Holt RW, Pike TL, Safigholi H, Stacey C, Weigand F. Electronic intracavitary brachytherapy quality management based on risk analysis: The report of AAPM TG 182. Med Phys 2019; 47:e65-e91. [PMID: 31702063 DOI: 10.1002/mp.13910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/28/2019] [Accepted: 09/10/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this study was to provide guidance on quality management for electronic brachytherapy. MATERIALS AND METHODS The task group used the risk-assessment approach of Task Group 100 of the American Association of Physicists in Medicine. Because the quality management program for a device is intimately tied to the procedure in which it is used, the task group first designed quality interventions for intracavitary brachytherapy for both commercial electronic brachytherapy units in the setting of accelerated partial-breast irradiation. To demonstrate the methodology to extend an existing risk analysis for a different application, the task group modified the analysis for the case of post-hysterectomy, vaginal cuff irradiation for one of the devices. RESULTS The analysis illustrated how the TG-100 methodology can lead to interventions to reduce risks and improve quality for each unit and procedure addressed. CONCLUSION This report provides a model to guide facilities establishing a quality management program for electronic brachytherapy.
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Affiliation(s)
- Bruce R Thomadsen
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Peter J Biggs
- Massachusetts General Hospital, Boston, MA, 02114, USA.,2425 Gulf of Mexico Drive, Longboat Key, FL, 34228, USA
| | - Gene A Cardarelli
- Department of Radiation Oncology, Brown University, Providence, RI, 02903, USA
| | - James C H Chu
- Rush University Medical Center, Chicago, IL, 60612, USA
| | | | - Wenzheng Feng
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, NJ, 07039, USA
| | | | - Jessica R Hiatt
- University of Massachussetts Memorial Medical Center, Worcester, MA, 01655, USA
| | | | - Jeffery P Limmer
- Cancer Center Services, Texas Oncology, The Woodlands, TX, 77380, USA
| | - Zoubir Ouhib
- Lynn Regional Cancer Center, Delray Beach, FL, 33484, USA
| | | | | | | | - Mark J Rivard
- Department of Radiation Oncology, Brown University, Providence, RI, 02903, USA
| | | | | | | | - Tina L Pike
- Affinity Health System, Appleton, WI, 54915, USA
| | - Habib Safigholi
- Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada
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Applying radiation protection and safety in radiotherapy. Radiol Med 2019; 124:777-782. [PMID: 31104276 DOI: 10.1007/s11547-019-01043-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/08/2019] [Indexed: 01/06/2023]
Abstract
Radiotherapy is one of the primary treatment options in cancer management. Modern radiotherapy includes complex processes requiring many different kinds of expertise. Among them, knowledge and skills are needed in clinical oncology, radiobiology, radiotherapy planning and simulation, dose measurement and calculation, radiation safety and medical physics. Radiation oncologists should assume the full and final responsibility for treatment, follow-up and supportive care of the patient. For all these activities, radiation oncologist should coordinate and collaborate with a team including different professionals: nurses, radiographers (RTT), clinical engineers, information system experts, taking advantage in particular of the dosimetry expertise of the medical physicist. Radiation therapy is widely recognized to be one of the safest areas of modern medicine, and errors are very rare. However, radiation protection recommendations developed at national level should comply with the EURATOM Directive 2013/59. This paper describes several contemporary and emerging concerns related to radioprotection in radiation therapy including quality and safety in external beam radiotherapy and brachytherapy, foetal dose, secondary malignancies, and the safety issues related to the new techniques and treatment strategies.
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Tien CJ, Carlson DJ, Nath R, Chen ZJ. High-dose-rate brachytherapy as monotherapy for prostate cancer: The impact of cellular repair and source decay. Brachytherapy 2019; 18:701-710. [PMID: 31109870 DOI: 10.1016/j.brachy.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 04/02/2019] [Accepted: 04/12/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE This work quantifies the influence of intrafraction DNA damage repair and cellular repopulation on biologically effective dose (BED) in Ir-192 high-dose-rate brachytherapy for prostate cancer. In addition, it examines the effect of source-decay-induced BED variation for patients treated at different time points in a source exchange cycle. MATERIALS AND METHODS Current fractionation schemes are based on simplified-form BED = nd(1 + d/(α/β)), which assumes that intrafraction repair, interfraction repair, and repopulation are negligible. We took accepted radiobiological parameters of Tk, Tp, and α from the recommendations of the AAPM TG-137, and recalculated the full-form BED. Fraction times were normalized to require 15 min for 20 Gy at 10 Ci. Calculations were carried out for both α/β = 1.5 and 3 Gy. RESULTS After accounting for intrafraction repair, interfraction repair, and/or repopulation, full-form BED calculations showed significant values, as compared with simplified-form BED. For 1-fraction 20 Gy fractionation, the full-form BED was only 64-82% of the simplified-form BED. Dose protraction effects were milder for smaller prescriptions (6 Gy/Fx), where full form was 87-94%. With regard to source decay, BED varied >20% for patients treated at the beginning and the end of a source exchange cycle for 20 Gy single-fraction prescription. CONCLUSIONS Repair and repopulation can be significant in monotherapy high-dose-rate for prostate cancer. As fractionation schemes are established, the simplified BED calculation may not be appropriate. Investigators should consider evaluating BED as a range rather than a discrete value when presenting results unless source activity is explicitly incorporated as well.
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Affiliation(s)
- Christopher J Tien
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT.
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT; Department of Radiation Oncology, University of Pennsylvania Perelman Center for Advanced Medicine, Philadelphia, PA
| | - Ravinder Nath
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
| | - Zhe Jay Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT
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Perez-Calatayud J, Ballester F, Carlsson Tedgren Å, Rijnders A, Rivard MJ, Andrássy M, Niatsetski Y, Schneider T, Siebert FA. GEC-ESTRO ACROP recommendations on calibration and traceability of LE-LDR photon-emitting brachytherapy sources at the hospital level. Radiother Oncol 2019; 135:120-129. [PMID: 31015157 DOI: 10.1016/j.radonc.2019.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/09/2019] [Indexed: 11/25/2022]
Abstract
Prostate brachytherapy treatment using permanent implantation of low-energy (LE) low-dose rate (LDR) sources is successfully and widely applied in Europe. In addition, seeds are used in other tumour sites, such as ophthalmic tumours, implanted temporarily. The calibration issues for LE-LDR photon emitting sources are specific and different from other sources used in brachytherapy. In this report, the BRAPHYQS (BRAchytherapy PHYsics Quality assurance System) working group of GEC-ESTRO, has developed the present recommendations to assure harmonized and high-quality seed calibration in European clinics. There are practical aspects for which a clarification/procedure is needed, including aspects not specifically accounted for in currently existing AAPM and ESTRO societal recommendations. The aim of this report has been to provide a European wide standard in LE-LDR source calibration at end-user level, in order to keep brachytherapy treatments with high safety and quality levels. The recommendations herein reflect the guidance to the ESTRO brachytherapy users and describe the procedures in a clinic or hospital to ensure the correct calibration of LE-LDR seeds.
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Affiliation(s)
- Jose Perez-Calatayud
- Radiotherapy Department, University and Polytechnic La Fe Hospital, Valencia, Spain; IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain.
| | - Facundo Ballester
- IRIMED Joint Research Unit (IIS La Fe - UV), Valencia, Spain; Departmento of Atomic, Molecular and Nuclear Physics, University of Valencia, Valencia, Spain
| | - Åsa Carlsson Tedgren
- Radiation Physics, Department of Medicine and Health (IMH), Linköping University, Linköping, Sweden; Section of Radiotherapy Physics and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
| | - Alex Rijnders
- Department of Radiotherapy, Europe Hospitals, Brussels, Belgium
| | - Mark J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, USA
| | | | - Yury Niatsetski
- R&D Elekta Brachytherapy Waardgelder 1, Veenendaal, Netherlands
| | - Thorsten Schneider
- Physikalisch-Technische Bundesanstalt (PTB), Department of Radiation Protection Dosimetry, Braunschweig, Germany
| | - Frank-André Siebert
- UK S-H, Campus Kiel, Klinik für Strahlentherapie (Radioonkologie), Kiel, Germany
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Park SY, Kang S, Park JM, An HJ, Oh DH, Kim JI. Development and dosimetric assessment of a patient-specific elastic skin applicator for high-dose-rate brachytherapy. Brachytherapy 2018; 18:224-232. [PMID: 30528742 DOI: 10.1016/j.brachy.2018.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/01/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The purpose of this study was to develop a patient-specific elastic skin applicator and to evaluate its dosimetric characteristics for high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS We simulated the treatment of a nonmelanoma skin cancer on the nose. An elastic skin applicator was manufactured by pouring the Dragon Skin (Smooth-On Inc., Easton, PA) with a shore hardness of 10A into an applicator mold. The rigid skin applicator was printed using high-impact polystyrene with a shore hardness of 73D. HDR plans were generated using a Freiburg Flap (FF) applicator and patient-specific rigid and elastic applicators. For dosimetric assessment, dose-volumetric parameters for target volume and normal organs were evaluated. Global gamma evaluations were performed, comparing film measurements and treatment planning system calculations with various gamma criteria. The 10% low-dose threshold was applied. RESULTS The V120% values of the target volume were 56.9%, 70.3%, and 70.2% for HDR plans using FF, rigid, and elastic applicators, respectively. The maximum doses of the right eyeball were 21.7 Gy, 20.5 Gy, and 20.5 Gy for the HDR plans using FF, rigid, and elastic applicators, respectively. The average gamma passing rates were 82.5% ± 1.5%, 91.6% ± 0.8%, and 94.8% ± 0.2% for FF, rigid, and elastic applicators, respectively, with 3%/3 mm criterion. CONCLUSIONS Patient-specific elastic skin applicator showed better adhesion to irregular or curved body surfaces, resulting in better agreement between planned and delivered dose distributions. The applicator suggested in this study can be effectively implemented clinically.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Seonghee Kang
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advance Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Myongji Hospital, Goyang, Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Experimental study of pelvic perioperative brachytherapy with iodine 125 seeds (I-125) in an animal model. J Contemp Brachytherapy 2018; 10:463-469. [PMID: 30479624 PMCID: PMC6251451 DOI: 10.5114/jcb.2018.79470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/02/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-rate brachytherapy mesh implantation in pelvic locations in an animal model, before applying it clinically. Material and methods The animal model was the Romanov adult ewe. Non-radioactive dummy I-125 seeds were implanted by laparotomy in the pelvic area. Forty-five dummy seeds were placed on a 10 cm² polyglactin mesh to obtain a dose of 160 Gy at 5 mm from the center of each seed. Three CT scans were performed at day 15, day 70, and day 180 after surgery to check the positioning of the mesh for eventual seed migration according to bony landmarks and to perform a 3D theoretical dosimetric study. The experimental study design was based on Simon’s minimax plan with a preliminary analysis of 10 ewes to validate the protocol and a second series of 7 ewes. Results After the first step, 9 of 10 ewes were investigated. For 8 of 9 animals, the 160 Gy isodose line volume was within 10%, showing feasibility of the procedure and allowing 7 more to be added. At the end of the study, 16 of 17 animals were examined. No seeds loss was observed. The volume difference of the 160 Gy isodose line was within 10% in 13 of 16 ewes between the three CT scans. Twelve out of 16 had a coordinate deviation less than or equal to 10 mm on the three axes between the first and the third scans. Conclusions These results show the technical feasibility of the pelvic mesh implantation in ewes. A phase I study for patients with locally advanced or recurrent pelvic tumors amenable to surgery, in combination with surgical resection should be possible.
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Cui S, Després P, Beaulieu L. A multi-criteria optimization approach for HDR prostate brachytherapy: I. Pareto surface approximation. ACTA ACUST UNITED AC 2018; 63:205004. [DOI: 10.1088/1361-6560/aae24c] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Cui S, Després P, Beaulieu L. A multi-criteria optimization approach for HDR prostate brachytherapy: II. Benchmark against clinical plans. ACTA ACUST UNITED AC 2018; 63:205005. [DOI: 10.1088/1361-6560/aae24f] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pittet P, Jalade P, Gindraux L, Guiral P, Wang R, Galvan JM, Lu GN. DoRGaN: Development of Quality Assurance and Quality Control Systems for High Dose Rate Brachytherapy Based on GaN Dosimetry Probes. Ing Rech Biomed 2018. [DOI: 10.1016/j.irbm.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bacorro WR, Agas RAF, Cabrera SMR, Bojador MR, Sogono PG, Mejia MBA, Sy Ortin TT. A novel applicator design for intracavitary brachytherapy of the nasopharynx: Simulated reconstruction, image-guided adaptive brachytherapy planning, and dosimetry. Brachytherapy 2018; 17:709-717. [DOI: 10.1016/j.brachy.2018.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/20/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022]
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Trichter S, Soares CG, Zaider M, DeWyngaert JK, DeWerd LA, Kleiman NJ. 15 years of
106
Ru eye plaque dosimetry at Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical Center using radiochromic film in a Solid Water phantom. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aab674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Redler G, Templeton A, Zhen H, Turian J, Bernard D, Chu JC, Griem KL, Liao Y. Dosimetric effects of saline- versus water-filled balloon applicators for IORT using the model S700 electronic brachytherapy source. Brachytherapy 2018; 17:500-505. [DOI: 10.1016/j.brachy.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 12/19/2022]
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Impact of missing attenuation and scatter corrections on 99m
Tc-MAA SPECT 3D dosimetry for liver radioembolization using the patient relative calibration methodology: A retrospective investigation on clinical images. Med Phys 2018; 45:1684-1698. [DOI: 10.1002/mp.12774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/14/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023] Open
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Hermida-López M, Brualla L. Absorbed dose distributions from ophthalmic 106 Ru/ 106 Rh plaques measured in water with radiochromic film. Med Phys 2018; 45:1699-1707. [PMID: 29399810 DOI: 10.1002/mp.12777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 12/19/2017] [Accepted: 01/06/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Brachytherapy with 106 Ru/106 Rh plaques offers good outcomes for small-to-medium choroidal melanomas and retinoblastomas. The dose measurement of the plaques is challenging, due to the small range of the emitted beta particles and steep dose gradients involved. The scarce publications on film dosimetry of 106 Ru/106 Rh plaques used solid phantoms. This work aims to develop a practical method for measuring the absorbed dose distribution in water produced by 106 Ru/106 Rh plaques using EBT3 radiochromic film. METHODS Experimental setups were developed to determine the dose distribution at a plane perpendicular to the symmetry axis of the plaque and at a plane containing the symmetry axis. One CCA and two CCX plaques were studied. The dose maps were obtained with the FilmQA Pro 2015 software, using the triple-channel dosimetry method. The measured dose distributions were compared to published Monte Carlo simulation and experimental data. RESULTS A good agreement was found between measurements and simulations, improving upon published data. Measured reference dose rates agreed within the experimental uncertainty with data obtained by the manufacturer using a scintillation detector, with typical differences below 5%. The attained experimental uncertainty was 4.1% (k = 1) for the perpendicular setup, and 7.9% (k = 1) for the parallel setup. These values are similar or smaller than those obtained by the manufacturer and other authors, without the need of solid phantoms that are not available to most users. CONCLUSIONS The proposed method may be useful to the users to perform quality assurance preclinical tests of 106 Ru/106 Rh plaques.
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Affiliation(s)
- Marcelino Hermida-López
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany.,Servei de Física i Protecció Radiològica, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lorenzo Brualla
- NCTeam, Strahlenklinik, Universitätsklinikum Essen, Essen, Germany
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Famulari G, Pater P, Enger SA. Microdosimetric Evaluation of Current and Alternative Brachytherapy Sources—A Geant4-DNA Simulation Study. Int J Radiat Oncol Biol Phys 2018; 100:270-277. [DOI: 10.1016/j.ijrobp.2017.09.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 09/09/2017] [Accepted: 09/18/2017] [Indexed: 12/12/2022]
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Failure modes and effects analysis for ocular brachytherapy. Brachytherapy 2017; 16:1265-1279. [DOI: 10.1016/j.brachy.2017.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/29/2017] [Accepted: 07/11/2017] [Indexed: 11/18/2022]
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Famulari G, Urlich T, Armstrong A, Enger SA. Practical aspects of 153Gd as a radioactive source for use in brachytherapy. Appl Radiat Isot 2017; 130:131-139. [PMID: 28963960 DOI: 10.1016/j.apradiso.2017.09.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/25/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
The goal of this study was to investigate the production, purification and immobilization techniques for a 153Gd brachytherapy source. We have investigated the maximum attainable specific activity of 153Gd through the irradiation of Gd2O3 enriched to 30.6% 152Gd at McMaster Nuclear Reactor. The advantage of producing 153Gd through this production pathway is the possibility to irradiate pre-sealed pellets of 152Gd enriched Gd2O3, thereby removing the need to perform chemical separation with large quantities of radio-impurities. However, small amounts of long-lived impurities are produced from the irradiation of enriched 152Gd targets due to traces of Eu in the sample. If the amount of impurities produced is deemed unacceptable, 153Gd can be isolated as an aqueous solution, chemically separated from impurities and loaded onto a sorbent with a high affinity for Gd before encapsulation.
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Affiliation(s)
- Gabriel Famulari
- Medical Physics Unit, McGill University, Montreal, QC, Canada H4A 3J1.
| | - Tomas Urlich
- Department of Radiation Sciences, McMaster University, Hamilton, ON, Canada L8S 4L8
| | - Andrea Armstrong
- McMaster Nuclear Reactor (Isotope Development), McMaster University, Hamilton, ON, Canada L8S 4L8
| | - Shirin A Enger
- Medical Physics Unit, McGill University, Montreal, QC, Canada H4A 3J1; Department of Oncology, McGill University, Montreal, Quebec, Canada H4A 3J1; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada H3H 2L9
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Safigholi H, Meigooni AS, Song WY. Comparison of192Ir,169Yb, and60Co high-dose rate brachytherapy sources for skin cancer treatment. Med Phys 2017; 44:4426-4436. [DOI: 10.1002/mp.12335] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 02/06/2023] Open
Affiliation(s)
- Habib Safigholi
- Department of Medical Physics; Odette Cancer Centre; Sunnybrook Research Institute; Sunnybrook Hospital; University of Toronto; Toronto ON Canada
- Department of Electrical Engineering; Shiraz Branch; Islamic Azad University; Shiraz Iran
| | - Ali S. Meigooni
- School of Allied Health Science; University of Nevada Las Vegas (UNLV); Las Vegas NV USA
| | - William Y. Song
- Department of Medical Physics; Odette Cancer Centre; Sunnybrook Research Institute; Sunnybrook Hospital; University of Toronto; Toronto ON Canada
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Kim Y, Huynh JWY, Gonzalez VJ. Evaluation of impact of an external breast shield (FlexiShield) in electronic brachytherapy for breast IORT: A phantom study. Brachytherapy 2017; 16:597-607. [PMID: 28237430 DOI: 10.1016/j.brachy.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate Axxent (iCAD, Inc., San Jose, CA) electronic brachytherapy balloon deformation and its dosimetric impact because of an external flexible shield (FlexiShield [FS]; iCAD, Inc.). METHODS AND MATERIALS Prostheses breast tissue phantom overlaid three spherical balloon applicators to simulate three clinical scenarios depending on minimum skin-to-balloon surface spacing (SS): balloon with SS of 2 cm, 1 cm, and balloon with 1 cm SS and touching the chest wall. Two sets of megavoltage CT (MVCT) scans were obtained with or without FS for 15 different sizes of balloons. For 45 pairs of MVCT scans, balloon deformation was measured in superior-inferior (dSI) dimension on coronal and sagittal planes and anterior-posterior (dAP) and lateral (dLAT) dimensions on the equatorial plane of balloon. SS was also compared. A treatment plan was made on each MVCT scan. Doses at four balloon surface points and skin were compared. Conformity index value was also compared to evaluate three-dimensional dose distribution. Clinically, 20 Gy was prescribed to the surface of balloon. RESULTS Balloon deformation was observed with compression in SI and AP dimensions and expansion in lateral dimension. Average SI compression was 0.5 mm. Average dLat - dAP was 2.4 mm, which resulted in elevated point doses at AP dimension by 10.8% of prescribed dose and reduced point doses at lateral dimension by 4.6%. FS decreased SS by 1.8 mm, increasing skin dose by 1.2 Gy, on average. Conformity index value was decreased from 0.922 to 0.908, on average. CONCLUSIONS This phantom study demonstrates that use of skin shielding during breast intraoperative radiation therapy can cause balloon deformation and SS reduction, resulting in dosimetric changes that are disregarded in current practice.
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Affiliation(s)
- Yongbok Kim
- Department of Radiation Oncology, The University of Arizona, Tucson, AZ.
| | | | - Victor J Gonzalez
- Department of Radiation Oncology, The University of Arizona, Tucson, AZ
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Extra-peritoneal laparoscopic para-aortic lymphadenectomy for staging of uterine cervix carcinoma. J Visc Surg 2017; 154:115-122. [PMID: 28153518 DOI: 10.1016/j.jviscsurg.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rivard MJ. A directional 103Pd brachytherapy device: Dosimetric characterization and practical aspects for clinical use. Brachytherapy 2016; 16:421-432. [PMID: 28039011 DOI: 10.1016/j.brachy.2016.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 11/10/2016] [Accepted: 11/29/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE A brachytherapy (BT) device has been developed with shielding to provide directional BT for preferentially irradiating malignancies while sparing healthy tissues. The CivaSheet is a flexible low-dose-rate BT device containing CivaDots with 103Pd shielded by a thin Au disk. This is the first report of a clinical dosimetric characterization of the CivaSheet device. METHODS AND MATERIALS Radiation dose distributions near a CivaDot were estimated using the MCNP6 radiation transport code. CivaSheet arrays were also modeled to evaluate the dose superposition principle for treatment planning. The resultant data were commissioned in a treatment planning system (TPS) (VariSeed 9.0), and the accuracy of the dose superposition principle was evaluated for summing individual elements comprising a planar CivaSheet. RESULTS The dose-rate constant (0.579 cGy/h/U) was lower than for 103Pd seeds due to Au L-shell x-rays increasing the air-kerma strength. Radial dose function values at 0.1, 0.5, 2, 5, and 10 cm were 1.884, 1.344, 0.558, 0.088, and 0.0046, respectively. The two-dimensional anisotropy function exhibited dramatic reduction between the forward (0°) and rearward (180°) directions by a factor of 276 at r = 0.1 cm, 24 at r = 1 cm, and 5.3 at r = 10 cm. This effect diminished due to increasingly scattered radiation. The largest gradient in the two-dimensional anisotropy function was in contact with the device at 92° due to the Au disk shielding. TPS commissioning and dose superposition accuracies were typically within 2%. CONCLUSIONS Simulations of the CivaDot yielded comprehensive dosimetry parameters that were entered into a TPS and deemed acceptable for clinical use. Dosimetry measurements of the CivaSheet are also of interest to the BT community.
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Affiliation(s)
- Mark J Rivard
- Department of Radiation Oncology, Tufts University School of Medicine, Boston, MA.
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