Analytical approach to heterogeneity correction factor calculation for brachytherapy

Dose error from deviation of dwell time and source position for high dose-rate 192Ir in remote afterloading system

The influence of deviations in dwell times and source positions for (192)Ir HDR-RALS was investigated. The potential dose errors for various kinds of brachytherapy procedures were evaluated. The deviations of dwell time ΔT of a (192)Ir HDR source for the various dwell times were measured with a well-type ionization chamber. The deviations of source position ΔP were measured with two methods. One is to measure actual source position using a check ruler device. The other is to analyze peak distances from radiographic film irradiated with 20 mm gap between the dwell positions. The composite dose errors were calculated using Gaussian distribution with ΔT and ΔP as 1σ of the measurements. Dose errors depend on dwell time and distance from the point of interest to the dwell position. To evaluate the dose error in clinical practice, dwell times and point of interest distances were obtained from actual treatment plans involving cylinder, tandem-ovoid, tandem-ovoid with interstitial needles, multiple interstitial needles, and surface-mold applicators. The ΔT and ΔP were 32 ms (maximum for various dwell times) and 0.12 mm (ruler), 0.11 mm (radiographic film). The multiple interstitial needles represent the highest dose error of 2%, while the others represent less than approximately 1%. Potential dose error due to dwell time and source position deviation can depend on kinds of brachytherapy techniques. In all cases, the multiple interstitial needles is most susceptible.

Determination of the tissue inhomogeneity correction in high dose rate Brachytherapy for Iridium-192 source

In Brachytherapy treatment planning, the effects of tissue heterogeneities are commonly neglected due to lack of accurate, general and fast three-dimensional (3D) dose-computational algorithms. In performing dose calculations, it is assumed that the tumor and surrounding tissues constitute a uniform, homogeneous medium equivalent to water. In the recent past, three-dimensional computed tomography (3D-CT) based treatment planning for Brachytherapy applications has been popularly adopted. However, most of the current commercially available planning systems do not provide the heterogeneity corrections for Brachytherapy dosimetry. In the present study, we have measured and quantified the impact of inhomogeneity caused by different tissues with a 0.015 cc ion chamber. Measurements were carried out in wax phantom which was employed to measure the heterogeneity. Iridium-192 ((192)Ir) source from high dose rate (HDR) Brachytherapy machine was used as the radiation source. The reduction of dose due to tissue inhomogeneity was measured as the ratio of dose measured with different types of inhomogeneity (bone, spleen, liver, muscle and lung) to dose measured with homogeneous medium for different distances. It was observed that different tissues attenuate differently, with bone tissue showing maximum attenuation value and lung tissue resulting minimum value and rest of the tissues giving values lying in between those of bone and lung. It was also found that inhomogeneity at short distance is considerably more than that at larger distances.

Brachytherapy scatter dose calculation in heterogeneous media: II. Empirical formulation for the multiple-scatter contribution

The presence of heterogeneous media can produce significant perturbations of dose distribution in brachytherapy. In a companion paper, we proposed a dose decomposition approach for dose calculation in a heterogeneous medium, which separately treats dose contributions from primary, once-scattered and multiple-scattered photons. The companion paper also describes and verifies a micro-beam ray-tracing method for evaluating the once-scatter dose. This paper deals with the calculation of the multiple-scatter dose. We present two empirical formulations for evaluating the heterogeneity correction factor for a 27 keV point source in a water sphere containing a disc-shaped heterogeneity. The empirical formulations are based on nonlinear curve fitting of the Monte Carlo multiple-scatter dose estimates calculated for the heterogeneous system. Extensive benchmark comparisons show that these formulations provide results for the multiple-scatter dose that agree within 10% (and mostly within 5%) with corresponding Monte Carlo dose estimates. Combining them with the algorithms for primary and once-scatter dose calculation described in the companion paper yields results for the total dose of equivalent accuracy. The empirical formulations are expressed in simple mathematical forms which involve a separation of the geometry and position variables of the heterogeneous system. Such representation provides a good tool to investigate the heterogeneity-induced perturbation of a multiple-scatter dose at low photon energy.

Brachytherapy scatter dose calculation in heterogeneous media: I. A microbeam ray-tracing method for the single-scatter contribution

In this work, we propose a framework for calculating brachytherapy dose distributions in heterogeneous media. The approach taken includes analytical calculation of the primary dose, and separately treats contributions of the once-scatter photons and multiple-scatter photons to the total scatter dose. This paper focuses on the evaluation of the once-scatter dose, which is based on a micro-beam ray-tracing model developed by the authors that incorporates an accurate description of the physical scattering of photons (Compton and Rayleigh scattering) with considerable flexibility in accommodating diverse geometries in a heterogeneous medium. The accuracy of the ray-tracing model has been verified by comparing model-calculated once-scatter doses with corresponding Monte Carlo results. For a 22 keV, 27 keV and 300 keV point source in water containing a disc-shaped heterogeneity of whitlockite, stainless steel or lead, our calculated results for once-scatter doses are in excellent agreement with corresponding Monte Carlo results over a wide range of heterogeneity dimensions and positions. Our investigation also explores the differences between physical scattering and isotropic scattering in evaluating the once-scatter dose, and thus enables the domain of applicability of the latter to be assessed. An appropriate method for evaluating the multiple-scatter dose, which together with the micro-beam method described here provides a means to calculate the total dose, is the subject of a companion paper.

Dosimetric effects of seed anisotropy and interseed attenuation for Pd103 and I125 prostate implants

A Monte Carlo study is carried out to quantify the effects of seed anisotropy and interseed attenuation for 103Pd and 125I prostate implants. Two idealized and two real prostate implants are considered. Full Monte Carlo simulation (FMCS) of implants (seeds are physically and simultaneously simulated) is compared with isotropic point-source dose-kernel superposition (PSKS) and line-source dose-kernel superposition (LSKS) methods. For clinical pre- and post-procedure implants, the dose to the different structures (prostate, rectum wall, and urethra) is calculated. The discretized volumes of these structures are reconstructed using transrectal ultrasound contours. Local dose differences (PSKS versus FMCS and LSKS versus FMCS) are investigated. The dose contributions from primary versus scattered photons are calculated separately. For 103Pd, the average absolute total dose difference between FMCS and PSKS can be as high as 7.4% for the idealized model and 6.1% for the clinical preprocedure implant. Similarly, the total dose difference is lower for the case of 125I: 4.4% for the idealized model and 4.6% for a clinical post-procedure implant. Average absolute dose differences between LSKS and FMCS are less significant for both seed models: 3 to 3.6% for the idealized models and 2.9 to 3.2% for the clinical plans. Dose differences between PSKS and FMCS are due to the absence of both seed anisotropy and interseed attenuation modeling in the PSKS approach. LSKS accounts for seed anisotropy but not for the interseed effect, leading to systematically overestimated dose values in comparison with the more accurate FMCS method. For both idealized and clinical implants the dose from scattered photons represent less than 1/3 of the total dose. For all studied cases, LSKS prostate DVHs overestimate D90 by 2 to 5% because of the missing interseed attenuation effect. PSKS and LSKS predictions of V150 and V200 are overestimated by up to 9% in comparison with the FMCS results. Finally, effects of seed anisotropy and interseed attenuation must be viewed in the context of other significant sources of dose uncertainty, namely seed orientation, source misplacement, prostate morphological changes and tissue heterogeneity.

A Monte Carlo dosimetry study of vaginal Ir192 brachytherapy applications with a shielded cylindrical applicator set

A durable recommendation for brachytherapy treatment planning systems to account for the effect of tissue, applicator and shielding material heterogeneities exists. As different proposed approaches have not been integrated in clinical treatment planning routine yet, currently utilized systems disregard or, most commonly, do not fully account for the aforementioned effects. Therefore, it is of interest to evaluate the efficacy of current treatment planning in clinical applications susceptible to errors due to heterogeneities. In this work the effect of the internal structure as well as the shielding used with a commercially available cylindrical shielded applicator set (Nucletron part # 084.320) for vaginal and rectum treatments is studied using three-dimensional Monte Carlo simulation for a clinical treatment plan involving seven source dwell positions of the classic microSelectron HDR 192Ir source. Results are compared to calculations of a treatment planning system (Plato BPS v.14.2.7), which assumes homogeneous water medium and applies a constant, multiplicative transmission factor only at points lying in the shadow of the shield. It is found that the internal structure of the applicator (which includes stainless steel, air and plastic materials) with no shield loaded does not affect the dose distribution relative to homogeneous water. In the unshielded side of the applicator with a 90 degrees, 180 degrees, or 270 degrees tungsten alloy shield loaded, an overestimation of treatment planning system calculations relative to Monte Carlo results was observed which is both shield and position dependent. While significant (up to 15%) at increased distances, which are not of major clinical importance, this overestimation does not affect dose prescription distances by more than 3%. The inverse effect of approx. 3% dose increase at dose prescription distances is observed for stainless steel shields. Regarding the shielded side of the applicator, it is shown that the default treatment planning system transmission factors for tungsten alloy result in a consistent dose over-estimation thus constituting a safe approach given the nature of associated clinical applications. Stainless steel is shown to be an ineffective shielding material with transmission factors reaching up to 0.68 at increased distances irrespective of shield geometry.

The effect of patient inhomogeneities in oesophageal192Ir HDR brachytherapy: a Monte Carlo and analytical dosimetry study

The effect of patient inhomogeneities surrounding the oesophagus on the dosimetry planning of an upper thoracic oesophageal 192Ir HDR brachytherapy treatment is studied. The MCNPX Monte Carlo code is used for dosimetry in a patient-equivalent phantom geometry and results are compared in terms of isodose contours as well as dose volume histograms with corresponding calculations by a contemporary treatment planning system software featuring a full TG-43 dose calculation algorithm (PLATO BPS version 14.2.4). It is found that the presence of patient inhomogeneities does not alter the delivery of the planned dose distribution to the planning treatment volume. Regarding the organs at risk, the common practice of current treatment planning systems (TPSs) to consider the patient geometry as a homogeneous water medium leads to a dose overestimation of up to 13% to the spinal cord and an underestimation of up to 15% to the sternum bone. These findings which correspond to the dose region of about 5-10% of the prescribed dose could only be of significance when brachytherapy is used as a boost to external beam therapy. Additionally, an analytical dosimetry model, which is efficient in calculating dose in mathematical phantoms containing inhomogeneity shells of materials of radiobiological interest, is utilized for dosimetry in the patient-equivalent inhomogeneous phantom geometry. Analytical calculations in this work are in good agreement with corresponding Monte Carlo results within the bone inhomogeneities of spinal cord and sternum bone but, like treatment planning system calculations, the model fails to predict the dose distribution in the proximal lung surface as well as within the lungs just as the TPS does, due to its inherent limitation in treating lateral scatter and backscatter radiation.

Dose perturbation induced by radiographic contrast inside brachytherapy balloon applicators

Phantom measurements and Monte Carlo calculations have been performed for the purpose of characterizing the dose perturbation caused by radiographic contrast inside the MammoSite breast brachytherapy applicator. Specifically, the dose perturbation is quantified as a heterogeneity correction factor (HCF) for various balloon radii and contrast concentration levels. The dose perturbation is larger for larger balloon radii and higher contrast concentrations. Based on a validated Monte Carlo simulation, the calculated HCF values are 0.99 for a 2 cm radius balloon and 0.98 for a 3 cm radius balloon at 6% contrast concentration levels, and 0.89 and 0.87 for 2 and 3 cm radius balloons, respectively, at 100% contrast concentrations. For a typical implanted balloon radius of 2.4 cm, the HCF values decrease from 0.99 at 6% contrast concentration to 0.90 at 100% contrast concentration. For balloons implanted in patients at our institution, the mean HCF is 0.99, corresponding to a dose reduction of approximately 1%. The contrast effect results in a systematic reduction in the delivered dose, therefore the minimal amount of radiographic contrast necessary should be used.

An analytical dosimetry model as a step towards accounting for inhomogeneities and bounded geometries in 192Ir brachytherapy treatment planning

A simple analytical dose rate calculation model based on primary and scatter separation that treats 192Ir as a monoenergetic source by use of appropriate attenuation and mass energy absorption coefficients is documented for accurate dosimetry in water. This model is then generalized and tested for use in any homogeneous tissue material of radiobiological interest using scatter to primary ratios calculated in water with a material density scaling to account for the difference in the scattering properties of these materials and water. The potential of the analytical model for predicting the effect of the interference of an inhomogeneity is then evaluated by comparison with corresponding Monte Carlo calculations. It is found that regardless of the inhomogeneity dimensions and position relative to the source, the model is capable of increased accuracy (better than 2%) in calculating the primary dose rate at any point not only for low-Z tissue materials but also for high-Z shielding materials where a severe hardening of the primary photons occurs. Overall, for low-Z tissue inhomogeneities the proposed model succeeds in correcting dosimetry results towards the right direction compared to commercial treatment planning systems that currently ignore the effect of phantom dimensions and inhomogeneity interference. Regarding high-Z shielding materials the proposed model accurately predicts the dose reduction just beyond the inhomogeneity (for example it predicts a dose reduction of 47% just behind a tungsten alloy cylinder of 1 cm diameter and 2 mm thickness placed at 1.4 cm away from an 192Ir source, in agreement with corresponding results in the literature) but does not account for the increasing contribution of the laterally scattered photons with increasing distance from the bounded inhomogeneity.

Determination of the tissue attenuation factor along two major axes of a high dose rate (HDR) 192Ir source

Quantitative information on photon scattering around brachytherapy sources is needed to develop dose calculation formalisms capable of predicting dosimetric parameters with minimal empiricism. Photon absorption and scatter around brachytherapy sources can be characterized using the tissue attenuation factor, defined as the ratio of dose in water to water kerma in free space. In this study, the tissue attenuation factor along two major axes of a high dose rate (HDR) 192Ir source was determined by TLD measurements and MCNP Monte Carlo calculations. A calculational method is also suggested to derive the tissue attenuation factor along the longitudinal source axis from the factor along the transverse axis, using published anisotropy data as input. TLD and Monte Carlo results agreed with each other for both source axes within the statistical uncertainty (approximately +/- 5%) of Monte Carlo calculations. Comparison with published data, available only for the transverse source axis, also showed good agreement within +/- 5%. The shape and magnitude of the tissue attenuation factor are found to be remarkably different between the two axes. The tissue attenuation factor reaches a maximum value of about 1.4 at 8 cm from the source along the longitudinal source axis, while a maximum value of about 1.04 occurs at 3-4 cm from the source along the transverse axis. The calculated tissue attenuation factor along the longitudinal source axis generally reproduced the TLD and Monte Carlo results within +/- 5% at most radial distances.