Calibration and validation of a quality assurance system for 90Sr/90Y radiation source trains

Comparison between beta radiation dose distribution due to LDR and HDR ocular brachytherapy applicators using GATE Monte Carlo platform

Eye applicators with 90Sr/90Y and 106Ru/106Rh beta-ray sources are generally used in brachytherapy for the treatment of eye diseases as uveal melanoma. Whenever, radiation is used in treatment, dosimetry is essential. However, knowledge of the exact dose distribution is a critical decision-making to the outcome of the treatment. The Monte Carlo technique provides a powerful tool for calculation of the dose and dose distributions which helps to predict and determine the doses from different shapes of various types of eye applicators more accurately. The aim of this work consisted in using the Monte Carlo GATE platform to calculate the 3D dose distribution on a mathematical model of the human eye according to international recommendations. Mathematical models were developed for four ophthalmic applicators, two HDR 90Sr applicators SIA.20 and SIA.6, and two LDR 106Ru applicators, a concave CCB model and a flat CCB model. In present work, considering a heterogeneous eye phantom and the chosen tumor, obtained results with the use of GATE for mean doses distributions in a phantom and according to international recommendations show a discrepancy with respect to those specified by the manufacturers. The QC of dosimetric parameters shows that contrarily to the other applicators, the SIA.20 applicator is consistent with recommendations. The GATE platform show that the SIA.20 applicator present better results, namely the dose delivered to critical structures were lower compared to those obtained for the other applicators, and the SIA.6 applicator, simulated with MCNPX generates higher lens doses than those generated by GATE.

Verification and uniformity control of doses for Sr/Y intravascular brachytherapy sources using radiochromic film dosimetry

Intravascular brachytherapy (IVBT) is a useful treatment modality for the recurrence of in-stent restenosis following drug-eluting stents (DES) or IVBT failure. The objective of this study was to measure the dose rate of (90)Sr/(90)Y IVBT sources for comparison with that given by the manufacturer and to control the dose uniformities of these sources along the source axis. The dose rates of (90)Sr/(90)Y beta sources were measured with a radiochromic film in a custom-made phantom. The films for calibration were irradiated using (60)Co photon beams. The results for the three sources were 4.5%, 2.3%, and 3.5% higher than the corresponding certificate values. Maximum and minimum of the dose rates varied within +/-10% of those at source center; and maximum dose discrepancy for the first (90)Sr/(90)Y source train was 8.2%; for the second source train, 7.1%; and for the third source train, 5.1%. Our study showed that the dose rates given by the manufacturer for the three (90)Sr/(90)Y IVBT sources were reliable and dose uniformities were within +/-10% along two thirds of the treatment length.

Monte Carlo dose calculations using MCNP4C and EGSnrc/BEAMnrc codes to study the energy dependence of the radiochromic film response to beta-emitting sources

The energy dependence of the radiochromic film (RCF) response to beta-emitting sources was studied by dose theoretical calculations, employing the MCNP4C and EGSnrc/BEAMnrc Monte Carlo codes. Irradiations with virtual monochromatic electron sources, electron and photon clinical beams, a (32)P intravascular brachytherapy (IVB) source and other beta-emitting radioisotopes ((188)Re, (90)Y, (90)Sr/(90)Y,(32)P) were simulated. The MD-55-2 and HS radiochromic films (RCFs) were considered, in a planar or cylindrical irradiation geometry, with water or polystyrene as the surrounding medium. For virtual monochromatic sources, a monotonic decrease with energy of the dose absorbed to the film, with respect to that absorbed to the surrounding medium, was evidenced. Considering the IVB (32)P source and the MD-55-2 in a cylindrical geometry, the calibration with a 6 MeV electron beam would yield dose underestimations from 14 to 23%, increasing the source-to-film radial distance from 1 to 6 mm. For the planar beta-emitting sources in water, calibrations with photon or electron clinical beams would yield dose underestimations between 5 and 12%. Calibrating the RCF with (90)Sr/(90)Y, the MD-55-2 would yield dose underestimations between 3 and 5% for (32)P and discrepancies within +/-2% for (188)Re and (90)Y, whereas for the HS the dose underestimation would reach 4% with (188)Re and 6% with (32)P.

Beta dosimetry with microMOSFETs for endovascular brachytherapy

The aim of this study was to investigate if microMOSFETs are suitable for the dosimetry and quality assurance of beta sources. The microMOSFET dosimeters have been tested for their angular dependence in a 6 MeV electron beam. The dose rate dependence was measured with an iridium-192 afterloading source. By varying the source-to-surface distance (SSD) in a 12 MeV electron beam the dose rate dependence in an electron beam was also investigated. To measure a depth dose curve the dose rate at 2, 5, 8 and 12 mm distance from the beta source train axis was determined with the OPTIDOS and the microMOSFET detector. A comparison between the two detector types shows that the microMOSFET is suitable for quality assurance of beta sources for endovascular brachytherapy (EVBT). The homogeneity of the source is checked by measurements at five points (for the 60 mm source at 10, 20, 30, 40 and 50 mm) along the source train. The microMOSFET was then used to evaluate the influence of a common stent type (single layer stainless steel) on the dose distribution in water. The stent led to a dose inhomogeneity of +/-8.5%. Additionally the percentage depth dose curves with and without a stent were compared. The depth dose curves show good agreement which means that the stent does not change the beta spectrum significantly.

A plastic scintillation dosimeter for high dose rate brachytherapy

In vivo dose verification in brachytherapy requires a small insertable dosimeter with a real-time readout capability. Fibre optic scintillation dosimeters, consisting of a plastic scintillator coupled to an optical fibre, are one of the most promising dosimeters for this application. We have developed two sizes of the BrachyFOD scintillation dosimeter which have external diameters of 2.2 mm and 1 mm and have determined their important dosimetric characteristics (depth dose relation, angular dependence, temperature dependence, energy dependence). We have shown that the background signal created by Cerenkov and fibre fluorescence does not significantly affect the performance in most clinical geometries using an (192)Ir source from an HDR brachytherapy unit. The dosimeter design enables readout at less than 0.5 s intervals. The BrachyFOD satisfies the need for a real-time in vivo brachytherapy dosimeter.

Recommendations on detectors and quality control procedures for brachytherapy beta sources

BACKGROUND AND PURPOSE

It is estimated that one third of the institutes applying clinical beta sources does not perform independent dosimetry. The Netherlands commission on radiation dosimetry (NCS) recently published recommended quality control procedures and detectors for the dosimetry of beta sources. The main issues of NCS Report 14 are summarized here.

MATERIALS AND METHODS

A dosimetry survey was performed among 23 institutes in The Netherlands and Belgium. Well ionization chambers, a plastic scintillator, plane-parallel ionization chamber, diode and radiochromic film were used for determination of source strength (dose rate at reference distance) and uniformity of intravascular and ophthalmic sources. The source strength of multiple sources of each type was measured and compared with the source strength specified by the manufacturer.

RESULTS

The standard deviation of the difference between measured and specified source strength was mostly about 3%, but varied between 0.8 and 15.8% depending on factors such as source type, detector, phantom and manufacturers calibration. The average non-uniformity was about 7% for intravascular sources and 20% for ophthalmic sources. It is estimated that the total relative standard uncertainty can be kept below +/-4% (1 sigma) with all detectors tested. Maximum deviations in source strength of 10% and a non-uniformity below 10% (intravascular) and 30% (ophthalmic) are recommended.

CONCLUSIONS

Dosimetric and non-dosimetric quality control procedures on beta sources are recommended. They enable standardized measurements, including the determination of relative source strength and non-uniformity. Absolute calibrations depend on the future introduction of primary standards for clinical beta sources.

Intracoronary Brachytherapy for Treatment of In-Stent Restenosis

Randomized, double-blind, placebo-controlled trials have demonstrated that intracoronary brachytherapy is more efficacious than placebo in reducing death, myocardial infarction, and target vessel revascularization at long-term follow up of patients with in-stent restenosis. Intracoronary brachytherapy is efficacious in treating totally occluded in-stent restenotic lesions, in treating de novo and in-stent restenotic lesions in saphenous vein grafts, in treating diffuse in-stent restenosis, in treating native coronary ostial in-stent restenotic lesions, in treating patients with diabetes with in-stent restenosis, in treating patients at high-risk for recurrence of restenosis, in treating elderly patients, and in treating patients who failed intracoronary radiation. Beta and gamma intracoronary brachytherapy are equally effective in treating in-stent restenosis. Long-term aspirin and clopidogrel should be administered for at least 1 year to reduce late vessel thrombosis. Inadequate radiation may cause edge stenosis.

[Investigations of beta-dosimetry at two different sources for the cardiovascular brachytherapy]

The intracoronary brachytherapy is used at the Hamburg University Hospital as a method to treat in-stent restenosis. Two different radiochromic film types were applied to obtain dosimetric information of the beta-sources used (32P and 90Sr/90Y). First, these films were analyzed for their suitability for dosimetry. Within the investigated dose range (MD-55-2: 0 to 33 Gy, HD-810: 0 to 105 Gy), both films showed a linear behavior between the dose and the optical density (OD). Because radiochromic films are subject to time-based changes in OD, a method for colour stabilization was investigated (RCS-method). This method allowed to greatly shorten the time between irradiation and evaluation from 24 hours (time necessary for the film to reach a quasi-stable status) to 2.5 hours. Colour-stabilized films can also be stored for a long time and reanalyzed with almost the same results. Within the limits of the measurements error, both film types showed an energy independent response. Within the dose profiles, analyses of the two source types resulted in differences of 13.5% (32P) and 21% (90Sr/90Y). These inhomogenities are consistent with the fabrication tolerances given by the manufactures.

Patient and personnel dosimetry in endovascular radiotherapy with 90Sr/90Y sources

Endovascular brachytherapy (EVBT) is an established treatment to reduce the probability of restenosis after a percutaneous coronary intervention. The purpose of this study was to assess (1) the manufacturer's stated dosimetric data for (90)Sr/(90)Y source trains to be used in EVBT and (2) the procedure-related radiation burden. The radiation fields in water around six (90)Sr/(90)Y source trains were studied using phantoms made of 'solid water' and MD55-2 radiochromic films. The water equivalence of the phantom material was tested by applying quantitative computed tomography. Thermoluminescence dosemeters were used to assess personal radiation burden and crosscheck the dose distribution along the source trains. Technical failure was observed in one source train and this train was excluded from analysis. The measured dose rate in water at 2 mm radial distance was on average 8% higher than the manufacture's stated value (range of measured to stated values 1.05--1.15). The dose rate decreased exponentially with radial distance between 2 and 6 mm. The dose rate in contact with the source viewing window of the delivery devices ranged between 0.5 and 7.5 mGy h(-1). Low-energy photons were the main contributors to personal dose.

EPR study of radiation stability of organic plastic scintillator for cardiovascular brachytherapy Sr90-Y90 beta dosimetry

Nowadays, more than one million percutaneous transluminal coronary angioplasties are being performed annually throughout the world. Restenosis is a significant problem associated with these angioplasty procedures. Radiation treatment with catheter-based beta-emitter sources is currently under clinical trial to prevent this problem. Due to fast and worldwide introduction of beta-sources for intravascular application, there is a growing interest in the dosimetry aspects. However, accurate dosimetry of beta-radiation is more difficult than that of gamma-radiation. Suitable detectors are not yet available with accuracy down to a tenth of a millimeter. Conventional measuring systems are not capable of such spatial resolution, except radiochromic film. However, film dosimeters have limited sensitivity and their radiation characteristics are different than those of tissue; therefore dose measurements require corrections. An alternative is to use water-equivalent plastic scintillators. In this work, organic plastic scintillator (BCF-10) dosimetry is studied using the Monte Carlo (MC) technique PENELOPE, and its radiation stability, after irradiation, is experimentally studied through electron paramagnetic resonance (EPR). Depth dose and dose profile are measured and compared to film dosimetry results. The EPR technique shows that the recovery time is dose independent in this kind of fiber and shows good stability.

Calibration of a scintillation dosemeter for beta rays using an extrapolation ionization chamber

A scintillation dosemeter is calibrated for 90Sr/90Y beta rays from an ophthalmic applicator, using an extrapolation ionization chamber as a reference instrument. The calibration factor for the scintillation dosemeter agrees with that given by the manufacturer of the dosemeter within ca. 2%. The estimated overall uncertainty of the present calibration is ca. 6% (2 sd). A calibrated beta-ray ophthalmic applicator can be used as a reference source for further calibrations performed in the laboratory or in the hospital.