Impact of the vaginal applicator and dummy pellets on the dosimetry parameters of Cs-137 brachytherapy source

MEASUREMENT OF ENTRANCE SKIN DOSE AND ABSORBED DOSE TO DIFFERENT ORGANS IN DUAL-ENERGY X-RAY ABSORPTIOMETRY SCANS USING THERMOLUMINESCENCE DOSIMETRY

Thermoluminescence dosimetry is considered as an effective method in estimating the absorbed doses to organs in different imaging modalities. The present study focuses on dosimetry in dual-energy X-ray absorptiometry scans, for patients, and phantoms in various imaging centres. The cubical LiF (Mg, Ti) thermoluminescence dosemeters were inserted inside the holes of the Rando phantom slabs, to measure the absorbed dose to different organs in the whole body and lumbar scans. According to the results the maximum entrance skin dose was found to be 202.06 μGy for Hologic discovery W, which uses the fan beam scanning mode. The Norland XR-800 device took the scans with a much lower dose, as it uses the pencil beam for scanning the patients. The results of the study show that the radiation beam type, patient thickness, imaging technique and scan time may affect the radiation dose received by patient.

Metal artifact reduction in cervix brachytherapy with titanium applicators using dual-energy CT through virtual monoenergetic images and an iterative algorithm: A phantom study

PURPOSE

To evaluate an iterative metal-artifact reduction (iMAR) algorithm, dual-energy CT (DECT) through virtual monoenergetic images (VMI), and a combination of iMAR and DECT for reducing metal artifact severity (AS) induced by Fletcher titanium applicators used in cervix brachytherapy, the efficacy of which are hitherto unreported.

METHODS AND MATERIALS

120 kV_p single-energy CT (SECT) (Siemens) of BEBIG tandem applicators, varying in shape (straight or curved) and diameter (3.5 mm or 5 mm) in a custom-made water-filled phantom, and their DECT images obtained from extrapolation of 80 kVp and 140 kVp, were reconstructed using four methods: DECT through VMI±iMAR, and SECT±iMAR. The DECT images were reconstructed monoenergetically at 70, 150, and 190 keV. AS was evaluated using measured values and statistical analysis.

RESULTS

iMAR, DECT, and combined DECT and iMAR reduced AS (p < 0.05). DECT had a lower AS than SECT, even without iMAR (p < 0.025). SECT+iMAR was more effective than DECT-iMAR with VMI at 70 and 190 keV (p < 0.05), whereas showing no statistically significant difference at 150 keV. With DECT and iMAR combined, AS was reduced more effectively compared to the SECT+iMAR or DECT alone. It also reduced the mean interobserver uncertainty by 0.2 mm.

CONCLUSIONS

These findings indicate that iMAR reduces the AS caused by Fletcher titanium applicators for both SECT and DECT, a combination of iMAR and DECT is superior to either strategy alone, and at low energies, DECT+iMAR also produces similar artifact reduction. These practical strategies promise more accurate source-position and structure definitions in CT-based gynecological brachytherapy treatment planning.

Studying the dose level for different X-ray energy conventional radiography by TLD-100

The purpose of this study was to investigate the x-ray energy dependence of the measured response of detectors (TLD-100) and to estimate the accurate dose delivered to patients during routine X-ray examinations. The response of thermoluminescent dosimeters TLD as a function of low energy range was determined using the X-ray tube at the Ionizing Radiation Met. Lab in the National Institute of Standards, (Secondary Standard Dosimetry Lab (SSLD) Cairo, Egypt. The X-ray dose was measured at 25, 50 and 100 kVp nominal x-ray energies. TLD-100 linearity, reproducibility and relative sensitivity were studied. Several sets of TLD-100 were to different x-ray beam energy to determine the calibration coefficient of the TLD system and the correction factors applied for the dose calculation (readings (nC)/radiation dose (mGy)) was determined in the dose range (0.69 mGy to 350 mGy). The radiation dose to the patient was estimated in diagnostic radiology for the existing working protocols (skull, pelvis, abdomen, and lumbar Spine). TLD-100 was exposed at various nominal energy used for diagnostic (40-100 kVp) and various tube current (50-120 mA) which is normally used in clinical X-ray examinations. The TLD-100 was exposed three times for each kVp value, and the exposure doses were measured in mGy. The obtained results showed a linear behavior of the TLD-100 response as a function of X-ray dose with estimated uncertainty within 10%. This indicates a good accuracy when assessing the entrance dose in diagnostic radiology procedures). The sensitivity of the TLD cards showed a standard deviation of 4.7%. Moreover, the dose-nC factor has the same value (within the standard uncertainty). Mean Entrance Skin Dose for skull, pelvis, abdomen, and lumbar spine were 0.46 ± 0.01, 1.5 ± 0.05, 7.3 ± 0.21 and 9.2 ± 0.29 mGy respectively. The obtained results reflect the agreement with the recommended values and will be useful for the formulation of national reference levels as recommended by the International Atomic Energy Agency (IAEA) SAFETY STANDARDS SERIES No. GSR Part 3 2014.

Measurement of Entrance Skin Dose and the Dose Received by Different Organs in Panoramic Dental Imaging

Background:

Thermoluminescence dosimetry(TLD) has been known as one of the most effective methods for dose estimation in diagnostic radiology. Orthopantomogram (OPG) imaging is used by many dentists, oral and maxillofacial surgeons as an effective tool for choosing an appropriate treatment plan.

Objective:

This study aims to measure the entrance skin dose and the dose values received by different head and neck organs in OPG imaging using TLD dosimeters (TLD-100).

Material and Methods:

In this experimental study, the entrance skin dose and doses of various organs during imaging were measured by TLD dosimeters inside and on the surface of the Rando-Phantom. Doses to various organs, including thyroid, eye, esophagus, parotid and sublingual and submandibular salivary glands were measured. The measurements were repeated twice, and the dose values obtained in the two steps were compared.

Results:

Based on the results obtained in this study, the minimum dose values were found in Esophagus; 65.81, and 59.31 µGy, respectively. The maximum organ dose value was found for left parotid glands, 3842.42, and 3399.58 for the two measurements, respectively.

Conclusion:

The results show that the dose values can vary based on devices, exposure conditions, and TLD positioning.

Comprehensive methodology for commissioning modern 3D-image-based treatment planning systems for high dose rate gynaecological brachytherapy: A review

PURPOSE

Correct commissioning of treatment planning systems (TPSs) is important for reducing treatment failure events. There is currently no comprehensive and robust methodology available for TPS commissioning in modern brachytherapy. This review aimed to develop a comprehensive template for commissioning modern 3D-image-based brachytherapy TPSs for high dose rate (HDR) gynaecological applications.

METHODS

The literature relevant to TPS commissioning, including both external beam radiation therapy (EBRT) and brachytherapy, as well as guidelines by the International Atomic Energy Agency (IAEA), the American Association of Physicists in Medicine (AAPM), and the European Society for Radiotherapy and Oncology (ESTRO) were searched, studied and appraised. The applied relevant EBRT TPS commissioning tests were applied to brachytherapy. The developed template aimed to cover all dosimetric and non-dosimetric issues.

RESULTS

The essential commissioning items could be categorized into six parts: geometry, dose calculation, plan evaluation tools, plan optimization, TPS output, and end-to-end verification. The final template consists of 43 items. This paper presents the purpose and role of each test, as well as tolerance limits, to facilitate the use of the template.

CONCLUSION

The information and recommendations available in a collection of publications over many years have been reviewed in order to develop a comprehensive template for commissioning complex modern 3D-image-based brachytherapy TPSs for HDR gynaecological applications. The up-to-date and concise information contained in the template can aid brachytherapy physicists during TPS commissioning as well as devising a regular quality assurance program and allocation of time and resources.

The effect of tandem-ovoid titanium applicator on points A, B, bladder, and rectum doses in gynecological brachytherapy using 192Ir

PURPOSE

The dosimetry procedure by simple superposition accounts only for the self-shielding of the source and does not take into account the attenuation of photons by the applicators. The purpose of this investigation is an estimation of the effects of the tandem and ovoid applicator on dose distribution inside the phantom by MCNP5 Monte Carlo simulations.

MATERIAL AND METHODS

In this study, the superposition method is used for obtaining the dose distribution in the phantom without using the applicator for a typical gynecological brachytherapy (superposition-1). Then, the sources are simulated inside the tandem and ovoid applicator to identify the effect of applicator attenuation (superposition-2), and the dose at points A, B, bladder, and rectum were compared with the results of superposition. The exact dwell positions, times of the source, and positions of the dosimetry points were determined in images of a patient and treatment data of an adult woman patient from a cancer center. The MCNP5 Monte Carlo (MC) code was used for simulation of the phantoms, applicators, and the sources.

RESULTS

The results of this study showed no significant differences between the results of superposition method and the MC simulations for different dosimetry points. The difference in all important dosimetry points was found to be less than 5%.

CONCLUSIONS

According to the results, applicator attenuation has no significant effect on the calculated points dose, the superposition method, adding the dose of each source obtained by the MC simulation, can estimate the dose to points A, B, bladder, and rectum with good accuracy.

Measurement of the Dose to the Family Members Taking Care of Thyroid Cancer Patients Undergoing I-131 Therapy in Nuclear Medicine Using TLD-100

The family members or friends of the patients undergoing treatment using radioiodine in nuclear medicine are inevitably exposed to ionization radiation. The purpose of this study is measurement of the dose received by the people taking care of the thyroid cancer patients treated by 131I. For this purpose, the dose amounts received by 29 people accompanying patients were measured using thermoluminescence dosimeters. A badge containing three TLD-100 chips was given to each caregiver. The people were asked to wear the badges for 24 days, when they are taking care of the patients. Finally the dose to each person was estimated by averaging the readings of the three TLDs. The measured dose amounts to the people were compared with the recommendations of international commitions. According to the results obtained in this study, the amounts of dose received by the caregivers were between 0.03 and 0.38 mSv, with the average of 0.12 mSv. By comparison of the results of this study with the recommendations of International Commission on Radiological Protection (ICRP), it can be observed that the dose to family members of the patients is less than the dose constraints. However, it is recommended that the caregivers be aware of the radiation protection principles in order to reduce their dose.

Dose distribution verification for GYN brachytherapy using EBT Gafchromic film and TG-43 calculation

AIM

Verification of dose distributions for gynecological (GYN) brachytherapy implants using EBT Gafchromic film.

BACKGROUND

One major challenge in brachytherapy is to verify the accuracy of dose distributions calculated by a treatment planning system.

MATERIALS AND METHODS

A new phantom was designed and fabricated using 90 slabs of 18 cm × 16 cm × 0.2 cm Perspex to accommodate a tandem and Ovoid assembly, which is normally used for GYN brachytherapy treatment. This phantom design allows the use of EBT Gafchromic films for dosimetric verification of GYN implants with a cobalt-60 HDR system or a LDR Cs-137 system. Gafchromic films were exposed using a plan that was designed to deliver 1.5 Gy of dose to 0.5 cm distance from the lateral surface of ovoids from a pair of ovoid assembly that was used for treatment vaginal cuff. For a quantitative analysis of the results for both LDR and HDR systems, the measured dose values at several points of interests were compared with the calculated data from a commercially available treatment planning system. This planning system was utilizing the TG-43 formalism and parameters for calculation of dose distributions around a brachytherapy implant.

RESULTS

The results of these investigations indicated that the differences between the calculated and measured data at different points were ranging from 2.4% to 3.8% for the LDR Cs-137 and HDR Co-60 systems, respectively.

CONCLUSION

The EBT Gafchromic films combined with the newly designed phantom could be utilized for verification of the dose distributions around different GYN implants treated with either LDR or HDR brachytherapy procedures.

Investigation of LiF, Mg and Ti (TLD-100) Reproducibility

LiF, Mg and Ti cubical TLD chips (known as TLD-100) are widely used for dosimetry purposes. The repeatability of TL dosimetry is investigated by exposing them to doses of (81, 162 and 40.5 mGy) with 662keV photons of Cs-137. A group of 40 cubical TLD chips was randomly selected from a batch and the values of Element Correction Coefficient (ECC) were obtained 4 times by irradiating them to doses of 81 mGy (two times), 162mGy and 40.5mGy. Results of this study indicate that the average reproducibility of ECC calculation for 40 TLDs is 1.5%, while these values for all chips do not exceed 5%.

Fast and accurate Monte Carlo modeling of a kilovoltage X-ray therapy unit using a photon-source approximation for treatment planning in complex media

To accurately recompute dose distributions in chest-wall radiotherapy with 120 kVp kilovoltage X-rays, an MCNP4C Monte Carlo model is presented using a fast method that obviates the need to fully model the tube components. To validate the model, half-value layer (HVL), percentage depth doses (PDDs) and beam profiles were measured. Dose measurements were performed for a more complex situation using thermoluminescence dosimeters (TLDs) placed within a Rando phantom. The measured and computed first and second HVLs were 3.8, 10.3 mm Al and 3.8, 10.6 mm Al, respectively. The differences between measured and calculated PDDs and beam profiles in water were within 2 mm/2% for all data points. In the Rando phantom, differences for majority of data points were within 2%. The proposed model offered an approximately 9500-fold reduced run time compared to the conventional full simulation. The acceptable agreement, based on international criteria, between the simulations and the measurements validates the accuracy of the model for its use in treatment planning and radiobiological modeling studies of superficial therapies including chest-wall irradiation using kilovoltage beam.

A New Approach for Heterogeneity Corrections for Cs-137 Brachytherapy Sources

BACKGROUND

Most of the current brachytherapy treatment planning systems (TPS) use the TG-43U1 recommendations for dosimetry in water phantom, not considering the heterogeneity effects.

OBJECTIVE

The purpose of this study is developing a method for obtaining correction factors for heterogeneity for Cs-137 brachytherapy sources based on pre-calculated MC simulations and interpolation.

METHOD

To simulate the effect of phantom heterogeneity on dose distribution around Cs-137 sources, spherical water phantoms were simulated in which there were spherical shells of bone with different thicknesses (0.2cm to 1.8cm with 0.1cm increment) at different distances (from 0.1cm to 10cm, with 0.5cm increment) from the source center. The spherical shells with 0.1cm thickness at different distances from 0.1cm to 10cm were used as tally cells. The doses at these cells were obtained by tally types F6, *F8, and *F4.The results indicate that the percentage differences between the doses in heterogeneity sections with the dose at the same positions inside the homogeneous water phantom vary when the distance of bone section from the source center increases, because of decreasing the average energy of photons reaching the bone layer. Finally, the results of Monte Carlo simulations were used as the input data of MATLAB software, and the percentage dose difference for each new configuration (i.e. different thickness of inhomogenity at different distances from the source) was estimated using the 2D interpolation of MATLAB.

RESULTS

According to the results, the algorithm used in this study, is capable of dose estimation with high accuracy.

CONCLUSION

The developed method using the results of Monte Carlo simulations and the dose interpolation can be used in treatment planning systems for heterogeneity corrections.

Developing a Treatment Planning Software Based on TG-43U1 Formalism for Cs-137 LDR Brachytherapy

Background

The old Treatment Planning Systems (TPSs) used for intracavitary brachytherapy with Cs-137 Selectron source utilize traditional dose calculation methods, considering each source as a point source. Using such methods introduces significant errors in dose estimation. As of 1995, TG-43 is used as the main dose calculation formalism in treatment TPSs.

Objectives

The purpose of this study is to design and establish a treatment planning software for Cs-137 Solectron brachytherapy source, based on TG-43U1 formalism by applying the effects of the applicator and dummy spacers.

Materials and Methods

Two softwares used for treatment planning of Cs-137 sources in Iran (STPS and PLATO), are based on old formalisms. The purpose of this work is to establish and develop a TPS for Selectron source based on TG-43 formalism. In this planning system, the dosimetry parameters of each pellet in different places inside applicators were obtained by MCNP4c code. Then the dose distribution around every combination of active and inactive pellets was obtained by summing the doses. The accuracy of this algorithm was checked by comparing its results for special combination of active and inactive pellets with MC simulations. Finally, the uncertainty of old dose calculation formalism was investigated by comparing the results of STPS and PLATO softwares with those obtained by the new algorithm.

Results

For a typical arrangement of 10 active pellets in the applicator, the percentage difference between doses obtained by the new algorithm at 1cm distance from the tip of the applicator and those obtained by old formalisms is about 30%, while the difference between the results of MCNP and the new algorithm is less than 5%.

Conclusions

According to the results, the old dosimetry formalisms, overestimate the dose especially towards the applicator’s tip. While the TG-43U1 based software perform the calculations more accurately.

Dosimetry of gamma chamber blood irradiator using PAGAT gel dosimeter and Monte Carlo simulations

Currently, the use of blood irradiation for inactivating pathogenic microbes in infected blood products and preventing graft‐versus‐host disease (GVHD) in immune suppressed patients is greater than ever before. In these systems, dose distribution and uniformity are two important concepts that should be checked. In this study, dosimetry of the gamma chamber blood irradiator model Gammacell 3000 Elan was performed by several dosimeter methods including thermoluminescence dosimeters (TLD), PAGAT gel dosimetry, and Monte Carlo simulations using MCNP4C code. The gel dosimeter was put inside a glass phantom and the TL dosimeters were placed on its surface, and the phantom was then irradiated for 5 min and 27 sec. The dose values at each point inside the vials were obtained from the magnetic resonance imaging of the phantom. For Monte Carlo simulations, all components of the irradiator were simulated and the dose values in a fine cubical lattice were calculated using tally F6. This study shows that PAGAT gel dosimetry results are in close agreement with the results of TL dosimetry, Monte Carlo simulations, and the results given by the vendor, and the percentage difference between the different methods is less than 4% at different points inside the phantom. According to the results obtained in this study, PAGAT gel dosimetry is a reliable method for dosimetry of the blood irradiator. The major advantage of this kind of dosimetry is that it is capable of 3D dose calculation.

PACS number: 87.53.Bn

Independent evaluation of an in-house brachytherapy treatment planning system using simulation, measurement and calculation methods

Accuracy of treatment planning systems may significantly influence the efficacy of brachytherapy. The purpose of this work is a detailed, varied and independent evaluation of an in-house brachytherapy treatment planning software called STPS. Operational accuracy of STPS was investigated. Geometric tests were performed to validate entry and reconstruction of positional information from scanned orthogonal films. MCNP4C Monte Carlo code and TLDs were used for simulation and experimental measurement, respectively. STPS data were also compared with those from a commercial planning system (Nucletron PLATO). Discrepancy values between MCNP and STPS data and also those of PLATO and STPS at Manchester system dose prescription points (AL and AR) of tandem and ovoid configurations were 2.5% ± 0.5% and 5.4% ± 0.4%, respectively. Similar results were achieved for other investigated configurations. Observed discrepancies between MCNP and STPS at the dose prescription point and at 1 cm from the tip of the vaginal applicator were 4.5% and 25.6% respectively, while the discrepancy between the STPS and PLATO data at those points was 2.3%. The software showed submillimeter accuracy in its geometrical reconstructions. In terms of calculation accuracy, similar to PLATO, as attenuation of the sources and applicator body is not considered, dose was overestimated at the tip of the applicator, but based on the available criteria, dose accuracy at most points were acceptable. Our results confirm STPS's geometrical and operational reliability, and show that its dose computation accuracy is comparable to an established commercial TPS using the same algorithm.