Source strength assay of iodine-125 seeds sealed within sterile packaging

Current status and issues with the dosimetric assay of iodine-125 seed sources at medical facilities in Japan: a questionnaire-based survey†

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.

A method for confirming a third-party assay of I-125 seeds used for prostate implants

The purpose of this work is to describe a method and apparatus that can be used to confirm the source strength of a large number of I-125 seeds while maintaining sterility, accuracy, reproducibility, and time efficiency. Source strengths ranging from 0.395 to 0.504 U/seed were available for this study. Three different seed configurations were measured: loose, linked, and loaded needles. A third-party 10% assay (NIST traceable) was provided. A custom stand was built out of aluminum to hold an exposure meter [Inovision (Fluke) 451P pressurized ion chamber] at 25 cm above the I-125 sources to measure the exposure rate. The measurements were made in an operating room, and a sterile sheet was placed under the nonsterile aluminum stand on a sterile loading table. Seeds and needles were placed in a sterile tray for these measurements. Two hundred and six loose seeds in six batches (0.395, 0.395, 0.409, 0.444, 0.444, and 0.444 U/seed) and 1434 seeds in 10 batches containing various strands (0.444, 0.444, 0.444, 0.444, .0444, 0.466, 0.466, 0.504, and 0.504 U/seed) were measured. For the loose and stranded seeds, the average exposure rate per unit activity was measured to be 0.589 mR/h·U with a standard deviation of 0.017. Loaded needles were measured with an average exposure rate per unit activity to be 0.269 mR/h·U with a standard deviation of 0.014. We conclude that the method described here is capable of confirming a third-party assay when performed on a large number of loose or stranded seeds in bulk. It is less reliable for preloaded needles.

Shielding design for a Cs-137 rod-type standard point source for well chamber constancy checks

Well type chambers are used for radioactive source calibrations in brachytherapy, but do not provide radiation shielding. Routine constancy checks on a well chamber are required between periodic secondary standard laboratory calibrations to ensure consistent device performance, and ultimately to ensure accurate patient dose delivery. In this work, a method is described to provide suitable shielding for a Cs-137 rod-type point source to enable use for constancy checks. A novel plunger-type shielded housing was designed and constructed for the Cs-137 source that when combined with a suitably shielded well-chamber container minimised user exposure during constancy checks. The designed shielding proved effective, and a constancy test routine was established and used for the past 16 months. The well chamber showed consistent performance (0.12 ± 0.18 % from the baseline) and no increased exposure was reported on users' radiation badges.