EP-1186: Accuracy of the TG-43 dose calculation formalism for HDR skin brachytherapy

Backscatter and Transmission through a Lead Shield Used in Surface and Interstitial HDR Brachytherapy

Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma

Purpose : The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using60Co or 192 Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods : Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference…

SU-GG-T-70: A Dosimetric Study of the MicroSelectron HDR Ir-192 Brachytherapy Source

Purpose: Recently the manufacturer of the mHDR‐v2 HDR Ir‐192 brachytherapy source clarified design changes that may alter the existing dosimetric data for this source. The object of this study was to obtain new dose rate tables following the TG‐43 formalism and to provide these data in close proximity to the source with high spatial resolution including the electron dosimetric contributions from Ir‐192 disintegration. Methods and Material: To study the source we used three different Monte Carlo codes: MCNP5, GEANT4, and Penelope. The source was located inside a 40 cm radius water phantom. Dose and kerma were obtained using 0.1 mm thick voxels to provide high‐resolution dosimetry near the so…

Physics Contributions Evaluation of interpolation methods for TG-43 dosimetric parameters based on comparison with Monte Carlo data for high-energy brachytherapy sources

Purpose: The aim of this work was to determine dose distributions for high-energy brachytherapy sources at spa- tial locations not included in the radial dose function gL(r) and 2D anisotropy function F(r,θ) table entries for radial dis- tance r and polar angle θ. The objectives of this study are as follows: 1) to evaluate interpolation methods in order to accurately derive gL(r) and F(r,θ) from the reported data; 2) to determine the minimum number of entries in gL(r) and F(r,θ) that allow reproduction of dose distributions with sufficient accuracy. Material and methods: Four high-energy photon-emitting brachytherapy sources were studied: 60Co model Co0.A86, 137Cs model CSM-3, 192Ir model I…

MO-D-AUD B-08: Treatment Planning for Complex Brachytherapy Dose Distributions Using High-Z Shields and Conventional Software

Purpose: Certain brachytherapydose distributions, like for LDR prostate implants, are readily modeled by treatment planningsoftware using the superposition principle of individual seeds to replicate the total dose distribution. However, dose distributions for brachytherapy treatments using high‐Z shields are currently not well‐modeled using conventional software.Method and Materials:Dose distributions from complex brachytherapy plaques determined using Monte Carlo methods were used as input data, and included COMS‐based eye plaques using 125 I , 103 Pd , and 131 Cs ; 4–8cm diameter AccuBoost peripheral breast brachytherapy applicators from Advanced Radiation Therapy; and the 2 and 3cm diame…

Influence of photon energy spectra from brachytherapy sources on Monte Carlo simulations of kerma and dose rates in water and air

Purpose: For a given radionuclide, there are several photonspectrum choices available to dosimetry investigators for simulating the radiation emissions from brachytherapy sources. This study examines the dosimetric influence of selecting the spectra for I 192 r , I 125 , and P 103 d on the final estimations of kerma and dose. Methods: For I 192 r , I 125 , and P 103 d , the authors considered from two to five published spectra. Spherical sources approximating common brachytherapy sources were assessed. Kerma and dose results from GEANT4, MCNP5, and PENELOPE-2008 were compared for water and air. The dosimetric influence of I 192 r , I 125 , and P 103 d spectral choice was determined. Results…

A generic TG-186 shielded applicator for commissioning model-based dose calculation algorithms for high-dose-rate Ir-192 brachytherapy

PurposeA joint working group was created by the American Association of Physicists in Medicine (AAPM), the European Society for Radiotherapy and Oncology (ESTRO), and the Australasian Brachytherapy Group (ABG) with the charge, among others, to develop a set of well-defined test case plans and perform calculations and comparisons with model-based dose calculation algorithms (MBDCAs). Its main goal is to facilitate a smooth transition from the AAPM Task Group No. 43 (TG-43) dose calculation formalism, widely being used in clinical practice for brachytherapy, to the one proposed by Task Group No. 186 (TG-186) for MBDCAs. To do so, in this work a hypothetical, generic high-dose rate (HDR) Ir-19…

Model-Based Dose Calculation Algorithms for Brachytherapy Dosimetry

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 …

SU-E-T-516: Limitations and Clinical Implications of the TG-43 Formalism for High-Dose-Rate Skin Brachytherapy

Purpose: In high‐dose‐rate (HDR) skin brachytherapy, sources are located outside, in contact with, or implanted at some depth below the skin surface. Nowadays, most TPS use the TG‐43 formalism that is based on sources within an infinite water medium, without accounting for the scatter defect due to surrounding air. The purpose of the present study is to evaluate the limitations of the TG‐43 formalism in HDR skin brachytherapy. Methods: This study examined two HDR sources (Ir‐192 and Co‐60) together with a hypothetical Yb‐169 source. Dose distributions were obtained using Monte Carlo methods (i.e., GEANT4). The following configurations were investigated: 1)A typical clinical case consisting …

EP-1590: Shielding design and fetal dose evaluation of a breast cancer pregnant patient undergoing HDR Ir-192 brachytherapy

TH-C-AUD A-08: Evaluation of Electronic Equilibrium Conditions Near Brachytherapy Sources

Purpose: For high‐energy photon‐emitting brachytherapysources such as 60 Co , 137 Cs , 192 Ir , and 169 Yb , the main contribution of the systematic uncertainty in the dose distributions near the sources is understanding of electronic equilibrium and the contribution of β‐rays due to radioactive disintegration. Thus, it is important to study these effects in detail to accurately depict dose distributions near these brachytherapysources. This work studies the relative importance of β‐ray contributions to total dose (β + γ + x‐ray), and feasibility of using the approximation “collision kerma equals dose in electronic equilibrium conditions.” Method and Materials:Characteristics of kerma and d…

Evaluation of methods of interpolation-extrapolation of g L (r) and F(r,θ) for high-energy brachytherapy sources

Limitations of the TG-43 formalism for skin high-dose-rate brachytherapy dose calculations

Purpose: In skin high-dose-rate (HDR) brachytherapy, sources are located outside, in contact with, or implanted at some depth below the skin surface. Most treatment planning systems use the TG-43 formalism, which is based on single-source dose superposition within an infinite water medium without accounting for the true geometry in which conditions for scattered radiation are altered by the presence of air. The purpose of this study is to evaluate the dosimetric limitations of the TG-43 formalism in HDR skin brachytherapy and the potential clinical impact. Methods: Dose rate distributions of typical configurations used in skin brachytherapy were obtained: a 5 cm × 5 cm superficial mould; a …

SU-FF-T-15: Comparison of Various Monte Carlo Codes for Brachytherapy Source Dosimetry

Purpose: Monte Carlo simulations are used for dosimetric evaluation of brachytherapysources. Various investigators had demonstrated good agreement between the measured and simulated data while some others have shown discrepancies between the two methods. These discrepancies were attributed to the errors in cross section data, differences in phantom and source geometry and composition. However, the exact causes of these differences have not yet fully explored. The goal of this project is to verify the differences among the widely available Monte Carlo codes for brachytherapysourcedosimetry.Material and method: These investigations are based on VariSource 192 Ir , Model VS2000, IsoAid Advanta…

Study of encapsulated T170m sources for their potential use in brachytherapy

Purpose: High dose-rate (HDR) brachytherapy is currently performed with {sup 192}Ir sources, and {sup 60}Co has returned recently into clinical use as a source for this kind of cancer treatment. Both radionuclides have mean photon energies high enough to require specific shielded treatment rooms. In recent years, {sup 169}Yb has been explored as an alternative for HDR-brachytherapy implants. Although it has mean photon energy lower than {sup 192}Ir, it still requires extensive shielding to deliver treatment. An alternative radionuclide for brachytherapy is {sup 170}Tm (Z=69) because it has three physical properties adequate for clinical practice: (a) 128.6 day half-life, (b) high specific a…

Implementation and Validation of an End-to-End Commissioning Process for Model-Based Dose Calculation Algorithms in Brachytherapy

WE-C-108-08: Organ Doses in a Male Phantom Undergoing High-Dose-Rate Brachytherapy Applied to the Prostate

Purpose: The aim of this study was to obtain equivalent doses to radiosensitive organs when applying high‐dose‐rate (HDR) brachytherapy to the prostate using60 Co or 192 Ir sources, and in comparison to external‐beam radiotherapy (EBRT) modalities. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized adult reference man described in Publication 110 by the International Commission on Radiological Protection (ICRP). Point sources of 60Co or 192Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate. Equivalent doses per therapeutic absorbed dose to the prostate were obtained in several radiosensitive organs. …

Dosimetric perturbations of a lead shield for surface and interstitial high-dose-rate brachytherapy.

In surface and interstitial high-dose-rate brachytherapy with either (60)Co, (192)Ir, or (169)Yb sources, some radiosensitive organs near the surface may be exposed to high absorbed doses. This may be reduced by covering the implants with a lead shield on the body surface, which results in dosimetric perturbations. Monte Carlo simulations in Geant4 were performed for the three radionuclides placed at a single dwell position. Four different shield thicknesses (0, 3, 6, and 10 mm) and three different source depths (0, 5, and 10 mm) in water were considered, with the lead shield placed at the phantom surface. Backscatter dose enhancement and transmission data were obtained for the lead shields…

A Generic High-Dose-Rate 192Ir Source Model for Model-Based Dose Calculation Methods in Brachytherapy Beyond the TG-43 Formalism

Influence of Photon Energy Spectra from 192Ir and 125I Brachytherapy Sources on Kerma and Dose Rates in Water and Air

A study of Type B uncertainties associated with the photoelectric effect in low-energy Monte Carlo simulations

The goal of this manuscript is to estimate Type B uncertainties in absorbed-dose calculations arising from the different implementations in current state-of-the-art Monte Carlo codes of low-energy photon cross-sections (<200 keV). Monte Carlo simulations are carried out using three codes widely used in the low-energy domain: PENELOPE-2018, EGSnrc, and MCNP. Mass energy-absorption coefficients for water, air, graphite, and their respective ratios; absorbed dose; and photon-fluence spectra are considered. Benchmark simulations using similar cross-sections have been performed. The differences observed between these quantities when different cross-sections are considered are taken to be a go…

Equivalent phantom sizes in Ir-192 source brachytherapy dosimetric studies

Source strength determination in iridium-192 and cobalt-60 brachytherapy : A European survey on the level of agreement between clinical measurements and manufacturer certificates

Background and purpose: Brachytherapy treatment outcomes depend on the accuracy of the delivered dose distribution, which is proportional to the reference air-kerma rate (RAKR). Current societal recommendations require the medical physicist to compare the measured RAKR values to the manufacturer source calibration certificate. The purpose of this work was to report agreement observed in current clinical practice in the European Union. Materials and methods: A European survey was performed for high- and pulsed-dose-rate (HDR and PDR) highenergy sources (Ir-192 and Co-60), to quantify observed RAKR differences. Medical physicists at eighteen hospitals from eight European countries were contac…

GEC-ESTRO ACROP recommendations on calibration and traceability of LE-LDR photon-emitting brachytherapy sources at the hospital level

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 aspect…

Review of clinical brachytherapy uncertainties: Analysis guidelines of GEC-ESTRO and the AAPM

Background and purpose: A substantial reduction of uncertainties in clinical brachytherapy should result in improved outcome in terms of increased local control and reduced side effects. Types of uncertainties have to be identified, grouped, and quantified. Methods: A detailed literature review was performed to identify uncertainty components and their relative importance to the combined overall uncertainty. Results: Very few components (e.g., source strength and afterloader timer) are independent of clinical disease site and location of administered dose. While the influence of medium on dose calculation can be substantial for low energy sources or non-deeply seated implants, the influence…

Dosimetry revisited for the HDR I192r brachytherapy source model mHDR-v2

Purpose: Recently, the manufacturer of the HDR I 192 r mHDR-v2 brachytherapysource reported small design changes (referred to herein as mHDR-v2r) that are within the manufacturing tolerances but may alter the existing dosimetric data for this source. This study aimed to (1) check whether these changes affect the existing dosimetric data published for this source; (2) obtain new dosimetric data in close proximity to the source, including the contributions from I 192 r electrons and considering the absence of electronic equilibrium; and (3) obtain scatterdose components for collapsed cone treatment planning system implementation. Methods: Three different Monte Carlo(MC) radiation transport co…

SU-E-T-509: DICOM Test Case Plans for Model-Based Dose Calculations Methods in Brachytherapy

Purpose: The TG‐186 report provides guidance to early adopters of model‐based dose calculation algorithms (MBDCAs) for brachytherapy. A charge of the AAPM‐ESTRO Working Group on MBDCA is to develop well‐defined test case plans, available as references for the software commissioning process to be performed by end‐users. The aim of this work is to develop test case plans for a generic HDR 192 Ir source alone and in combination with a vaginal cylinder applicator with 180° tungsten‐alloy shielding in a DICOM‐based water phantom. Methods: A DICOM CT dataset was created with a 30 cm diameter water sphere surrounded by air. The voxel size was 1.33×1.33×1.33 mm3 for evaluating absorbed dose rate (c…

Brachytherapy treatment planning for complex applicators based on the AAPM TG-43 dosimetry algorithm: Case studies and clinical impact

Fetal dose measurements and shielding efficiency assessment in a custom setup of (192)Ir brachytherapy for a pregnant woman with breast cancer.

To assess the radiation dose to the fetus of a pregnant patient undergoing high-dose-rate (HDR) (192)Ir interstitial breast brachytherapy, and to design a new patient setup and lead shielding technique that minimizes the fetal dose.Radiochromic films were placed between the slices of an anthropomorphic phantom modeling the patient. The pregnant woman was seated in a chair with the breast over a table and inside a leaded box. Dose variation as a function of distance from the implant volume as well as dose homogeneity within a representative slice of the fetal position was evaluated without and with shielding.With shielding, the peripheral dose after a complete treatment ranged from 50 cGy at…

Supplement 2 for the 2004 update of the AAPM Task Group No. 43 Report: Joint recommendations by the AAPM and GEC-ESTRO

Since publication of the 2004 update to the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report (TG-43U1) and its 2007 supplement (TG-43U1S1), several new low-energy photon-emitting brachytherapy sources have become available. Many of these sources have satisfied the AAPM prerequisites for routine clinical purposes and are posted on the Brachytherapy Seed Registry managed jointly by the AAPM and the Imaging and Radiation Oncology Core Houston Quality Assurance Center (IROC Houston). Given increasingly closer interactions among physicists in North America and Europe, the AAPM and the Groupe Europeen de Curietherapie-European Society for Radiotherapy & Oncology (GEC…

An approach to using conventional brachytherapy software for clinical treatment planning of complex, Monte Carlo-based brachytherapy dose distributionsa)

Certain brachytherapy dose distributions, such as those for LDR prostate implants, are readily modeled by treatment planning systems (TPS) that use the superposition principle of individual seed dose distributions to calculate the total dose distribution. However, dose distributions for brachytherapy treatments using high-Z shields or having significant material heterogeneities are not currently well modeled using conventional TPS. The purpose of this study is to establish a new treatment planning technique (Tufts technique) that could be applied in some clinical situations where the conventional approach is not acceptable and dose distributions present cylindrical symmetry. Dose distributi…

A generic high-dose rate192Ir brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism

Purpose: In order to facilitate a smooth transition for brachytherapy dose calculations from the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) formalism to model-b ...

Surface brachytherapy: Joint report of the AAPM and the GEC-ESTRO Task Group No. 253.

The surface brachytherapy Task Group report number 253 discusses the common treatment modalities and applicators typically used to treat lesions on the body surface. Details of commissioning and calibration of the applicators and systems are discussed and examples are given for a risk-based analysis approach to the quality assurance measures that are necessary to consider when establishing a surface brachytherapy program.

Dosimetric Uncertainties in the Practice of Clinical Brachytherapy

Erratum: “Supplement 2 for the 2004 update of the AAPM Task Group No. 43 Report: Joint recommendations by the AAPM and GEC-ESTRO” [Med. Phys. Vol 44 (9), e297-e338 (2017)]

Evaluation of high-energy brachytherapy source electronic disequilibrium and dose from emitted electrons

Purpose: The region of electronic disequilibrium near photon-emitting brachytherapysources of high-energy radionuclides ( C 60 o , C 137 s , I 192 r , and Y 169 b ) and contributions to total dose from emitted electrons were studied using the GEANT4 and PENELOPEMonte Carlo codes. Methods: Hypothetical sources with active and capsule materials mimicking those of actual sources but with spherical shape were examined. Dose contributions due to sourcephotons, x rays, and bremsstrahlung; source β − , Auger electrons, and internal conversionelectrons; and water collisional kerma were scored. To determine if conclusions obtained for electronic equilibrium conditions and electrondose contribution t…

TH-C-AUD A-07: Evaluation of the Correction Factor Due to the Lack of Full Scatter Conditions in Cs-137 and Ir-192 Brachytherapy Dosimetric Studies

Purpose: Use of a finite phantom to derive dose rate distributions around brachytherapysources implies a lack of backscattering material near the phantom periphery. Conventional planning algorithms and newly‐developed 3D correction algorithms are based on physics data under full scatter conditions. Presently, most published Monte Carlodosimetric studies have been obtained using either a spherical phantom (15cm in radius) or a cylinder phantom (40×40cm2). The study objective was to derive a simple relationship to correlate the radial dose function, g(r), obtained for each one of these phantoms to that obtained for an unbounded phantom. Method and Materials: Assuming bare point sources of 137…