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

In silico dosimetry of low-dose rate brachytherapy using radioactive nanoparticles

PURPOSE

Nanoparticles (NPs) with radioactive atoms incorporated within the structure of the NP or bound to its surface, functionalized with biomolecules are reported as an alternative to low-dose-rate seed-based brachytherapy. In this study, authors report a mathematical dosimetric study on low-dose rate brachytherapy using radioactive NPs.

METHOD

Single-cell dosimetry was performed by calculating cellular S-values for spherical cell model using Au-198, Pd-103 and Sm-153 NPs. The cell survival and tumor volume versus time curves were calculated and compared to the experimental studies on radiotherapeutic efficiency of radioactive NPs published in the literature. Finally, the radiotherapeutic efficiency of Au-198, Pd-103 and Sm-153 NPs was tested for variable: administered radioactivity, tumor volume and tumor cell type.

RESULT

At the cellular level Sm-153 presented the highest S-value, followed by Pd-103 and Au-198. The calculated cell survival and tumor volume curves match very well with the published experimental results. It was found that Au-198 and Sm-153 can effectively treat highly aggressive, large tumor volumes with low radioactivity.

CONCLUSION

The accurate knowledge of uptake rate, washout rate of NPs, radio-sensitivity and tumor repopulation rate is important for the calculation of cell survival curves. Self-absorption of emitted radiation and dose enhancement due to AuNPs must be considered in the calculations. Selection of radionuclide for radioactive NP must consider size of tumor, repopulation rate and radiosensitivity of tumor cells. Au-198 NPs functionalized with Mangiferin are a suitable choice for treating large, radioresistant and rapidly growing tumors.

Design of an Yb-169 source optimized for gold nanoparticle-aided radiation therapy

PURPOSE

To find an optimum design of a new high-dose rate ytterbium (Yb)-169 brachytherapy source that would maximize the dose enhancement during gold nanoparticle-aided radiation therapy (GNRT), while meeting practical constraints for manufacturing a clinically relevant brachytherapy source.

METHODS

Four different Yb-169 source designs were considered in this investigation. The first three source models had a single encapsulation made of one of the following materials: aluminum, titanium, and stainless steel. The last source model adopted a dual encapsulation design with an inner aluminum capsule surrounding the Yb-core and an outer titanium capsule. Monte Carlo (MC) simulations using the Monte Carlo N-Particle code version 5 (MCNP5) were conducted initially to investigate the spectral changes caused by these four source designs and the associated variations in macroscopic dose enhancement across the tumor loaded with gold nanoparticles (GNPs) at 0.7% by weight. Subsequent MC simulations were performed using the EGSnrc and norec codes to determine the secondary electron spectra and microscopic dose enhancement as a result of irradiating the GNP-loaded tumor with the mcnp-calculated source spectra.

RESULTS

Effects of the source filter design were apparent in the current MC results. The intensity-weighted average energy of the Yb-169 source varied from 108.9 to 122.9 keV, as the source encapsulation material changed from aluminum to stainless steel. Accordingly, the macroscopic dose enhancement calculated at 1 cm away from the source changed from 51.0% to 45.3%. The sources encapsulated by titanium and aluminum/titanium combination showed similar levels of dose enhancement, 49.3% at 1 cm, and average energies of 113.0 and 112.3 keV, respectively. While the secondary electron spectra due to the investigated source designs appeared to look similar in general, some differences were noted especially in the low energy region (<50 keV) of the spectra suggesting the dependence of the photoelectron yield on the atomic number of source filter material, consistent with the macroscopic dose enhancement results. A similar trend was also shown in the so-called microscopic dose enhancement factor, for example, resulting in the maximum values of 138 and 119 for the titanium- and the stainless steel-encapsulated Yb-169 sources, respectively.

CONCLUSIONS

The current results consistently show that the dose enhancement achievable from the Yb-169 source is closely related with the atomic number (Z) of source encapsulation material. While the observed range of improvement in the dose enhancement may be considered moderate after factoring all uncertainties in the MC results, the current study provides a reasonable support for the encapsulation of the Yb-core with lower-Z materials than stainless steel, for GNRT applications. Overall, the titanium capsule design can be favored over the aluminum or dual aluminum/titanium capsule designs, due to its superior structural integrity and improved safety during manufacturing and clinical use.

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.

Comparative dosimetry of GammaMed Plus high-dose rate Ir brachytherapy source

The comparative dosimetry of GammaMed (GM) Plus high-dose rate brachytherapy source was performed by an experiment using 0.1-cc thimble ionization chamber and simulation-based study using EGSnrc code. In-water dose measurements were performed with 0.1-cc chamber to derive the radial dose function (r = 0.8 to 20.0 cm) and anisotropy function (r = 5.0 cm with polar angle from 10° to 170°). The nonuniformity correction factor for 0.1-cc chamber was applied for in-water measurements at shorter distances from the source. The EGSnrc code was used to derive the dose rate constant (Λ), radial dose function g(L)(r) and anisotropy function F(r, θ) of GM Plus source. The dosimetric data derived using EGSnrc code in our study were in very good agreement relative to published data for GM Plus source. The radial dose function up to 12 cm derived from measured dose using 0.1-cc chamber was in agreement within ±3% of data derived by the simulation study.

The dosimetric feasibility of gold nanoparticle-aided radiation therapy (GNRT) via brachytherapy using low-energy gamma-/x-ray sources

The preferential accumulation of gold nanoparticles within tumors and the increased photoelectric absorption due to the high atomic number of gold cooperatively account for the possibility of significant tumor dose enhancement during gold nanoparticle-aided radiation therapy (GNRT). Among the many conceivable ways to implement GNRT clinically, a brachytherapy approach using low-energy gamma-/x-ray sources (i.e. E(avg) < 100 keV) appears to be highly feasible and promising, because it may easily fulfill some of the technical and clinical requirements for GNRT. Therefore, the current study investigated the dosimetric feasibility of implementing GNRT using the following sources: (125)I, 50 kVp and (169)Yb. Specifically, Monte Carlo (MC) calculations were performed to determine the macroscopic dose enhancement factors (MDEF), defined as the ratio of the average dose in the tumor region with and without the presence of gold nanoparticles during the irradiation of the tumor, and the photo/Auger electron spectra within a tumor loaded with gold nanoparticles. The current study suggests that a significant tumor dose enhancement (e.g. >40%) could be achievable using (125)I, 50 kVp and (169)Yb sources and gold nanoparticles. When calculated at 1.0 cm from the center of the source within a tumor loaded with 18 mg Au g(-1), macroscopic dose enhancement was 116, 92 and 108% for (125)I, 50 kVp and (169)Yb, respectively. For a tumor loaded with 7 mg Au g(-1), it was 68, 57 and 44% at 1 cm from the center of the source for (125)I, 50 kVp and (169)Yb, respectively. The estimated MDEF values for (169)Yb were remarkably larger than those for (192)Ir, on average by up to about 70 and 30%, for 18 mg Au and 7 mg Au cases, respectively. The current MC study also shows a remarkable change in the photoelectron fluence and spectrum (e.g. more than two orders of magnitude) and a significant production (e.g. comparable to the number of photoelectrons) of the Auger electrons within the tumor region due to the presence of gold nanoparticles during low-energy gamma-/x-ray irradiation. The radiation sources considered in this study are currently available and tumor gold concentration levels considered in this investigation are deemed achievable. Therefore, the current results strongly suggest that GNRT can be successfully implemented via brachytherapy with low energy gamma-/x-ray sources, especially with a high dose rate (169)Yb source.

Evaluation of dosimetric parameters for various 192Ir brachytherapy sources under unbounded phantom geometry by Monte Carlo simulation

As per TG-43 dose calculation formalism, it is essential to obtain various dosimetric parameters such as the air-kerma strength, dose rate constant, radial dose function, and anisotropy function, as they account for accurate determination of dose rate distribution around brachytherapy sources. Most of the available reported Monte Carlo simulations were performed in liquid water phantoms with a bounded region of 30-cm diameter. In this context, an attempt was made to report the dosimetric parameters for various commercially available pulsed-dose rate (PDR) and high-dose rate (HDR) sources under unbounded phantom conditions, as the data may be used as input to treatment planning systems (TPSs) for quality control assistance. The air-kerma strength per unit activity, S(k)/A, was computed for various Iridium-192 ((192)Ir) sources in dry air medium. The air-kerma strength and dose rate constant for old PDR is (9.77 +/- 0.03) 10(-8) U/Bq and 1.124 +/- 0.001 cGyh(-1)U(-1); for new PDR, the values are (9.96 +/- 0.03) 10(-8) U/Bq and 1.124 +/- 0.001 cGyh(-1)U(-1); for old MHDR, the values are (9.80 +/- 0.01) 10(-8) U/Bq and 1.115 +/- 0.001 cGyh(-1)U(-1); for new MHDR, (9.80 +/- 0.01) 10(-8) U/Bq and 1.112 +/- 0.001cGyh(-1)U(-1); for old VHDR, the values are (10.32 +/- 0.01) 10(-8) U/Bq and 1.035 +/- 0.002 cGyh(-1)U(-1); for new VHDR, the values are (10.34 +/- 0.02) 10(-8) U/Bq and 1.096 +/- 0.001 cGyh(-1)U(-1). The computed radial dose function values and anisotropy function values are also in good agreement with available data.

Quality assurance of HDR 192Ir sources using a Fricke dosimeter

A prototype of a Fricke dosimetry system consisting of a 15 x 15 x 15 cm3 water phantom made of Plexiglas and a 11.3-ml Pyrex balloon fitted with a 0.2 cm thick Pyrex sleeve in its center was created to assess source strength and treatment planning algorithms for use in high dose rate (HDR) 192Ir afterloading units. In routine operation, the radioactive source is positioned at the end of a sleeve, which coincides with the center of the spherical balloon that is filled with Fricke solution, so that the solution is nearly isotropically irradiated. The Fricke system was calibrated in terms of source strength against a reference well-type ionization chamber, and in terms of radial dose by means of an existing algorithm from the HDR's treatment planning system. Because the system is based on the Fricke dosimeter itself, for a given type and model of 192Ir source, the system needs initial calibration but no recalibration. The results from measurements made over a 10 month period, including source decay and source substitutions, have shown the feasibility of using such a system for quality control (QC) of HDR afterloading equipment, including both the source activity and treatment planning parameters. The benefit of a large scale production and the use of this device for clinical HDR QC audits via mail are also discussed.

Estimation of tumour dose enhancement due to gold nanoparticles during typical radiation treatments: a preliminary Monte Carlo study

A recent mice study demonstrated that gold nanoparticles could be safely administered and used to enhance the tumour dose during radiation therapy. The use of gold nanoparticles seems more promising than earlier methods because of the high atomic number of gold and because nanoparticles can more easily penetrate the tumour vasculature. However, to date, possible dose enhancement due to the use of gold nanoparticles has not been well quantified, especially for common radiation treatment situations. Therefore, the current preliminary study estimated this dose enhancement by Monte Carlo calculations for several phantom test cases representing radiation treatments with the following modalities: 140 kVp x-rays, 4 and 6 MV photon beams, and 192Ir gamma rays. The current study considered three levels of gold concentration within the tumour, two of which are based on the aforementioned mice study, and assumed either no gold or a single gold concentration level outside the tumour. The dose enhancement over the tumour volume considered for the 140 kVp x-ray case can be at least a factor of 2 at an achievable gold concentration of 7 mg Au/g tumour assuming no gold outside the tumour. The tumour dose enhancement for the cases involving the 4 and 6 MV photon beams based on the same assumption ranged from about 1% to 7%, depending on the amount of gold within the tumour and photon beam qualities. For the 192Ir cases, the dose enhancement within the tumour region ranged from 5% to 31%, depending on radial distance and gold concentration level within the tumour. For the 7 mg Au/g tumour cases, the loading of gold into surrounding normal tissue at 2 mg Au/g resulted in an increase in the normal tissue dose, up to 30%, negligible, and about 2% for the 140 kVp x-rays, 6 MV photon beam, and 192Ir gamma rays, respectively, while the magnitude of dose enhancement within the tumour was essentially unchanged.

In vivo assessment of the tolerance dose of small liver volumes after single-fraction HDR irradiation

PURPOSE

To prospectively assess a dose-response relationship for small volumes of liver parenchyma after single-fraction irradiation.

METHODS AND MATERIALS

Twenty-five liver metastases were treated by computed tomography (CT)-guided interstitial brachytherapy. Magnetic resonance imaging was performed 1 day before and 3 days and 6, 12, and 24 weeks after therapy. MR sequences included T1-w gradient echo (GRE) enhanced by hepatocyte-targeted gadobenate dimeglumine. All MRI data sets were merged with 3D dosimetry data and evaluated by two radiologists. The reviewers indicated the border of hyperintensity on T2-w images (edema) or hypointensity on T1-w images (loss of hepatocyte function). Based on the total 3D data, a dose-volume histogram was calculated. We estimated the threshold dose for either edema or function loss as the D(90), i.e., the dose achieved in at least 90% of the pseudolesion volume.

RESULTS

Between 3 days and 6 weeks, the extension of the edema increased significantly from the 12.9 Gy isosurface to 9.9 Gy (standard deviation [SD], 3.3 and 2.6). No significant change was detected between 6 and 12 weeks. After 24 weeks, the edematous tissue had shrunk significantly to 14.7 Gy (SD, 4.2). Three days postbrachytherapy, the D(90) for hepatocyte function loss reached the 14.9 Gy isosurface (SD, 3.9). At 6 weeks, the respective zone had increased significantly to 9.9 Gy (SD, 2.3). After 12 and 24 weeks, the dysfunction volume had decreased significantly to the 11.9 Gy and 15.2 Gy isosurface, respectively (SD, 3 and 4.1).

CONCLUSIONS

The 95% interval from 7.6 to 12.2 Gy found as the minimal hepatocyte tolerance after 6 weeks accounts for the radiobiologic variations found in CT-guided brachytherapy, including heterogeneous dose rates by variable catheter arrays.

Dosimetry of the Au198 source used in interstitial brachytherapy

The American Association of Physicists in Medicine Task Group 43 reports, AAPM TG-43 and its update TG-43U1, provide an analytical model and a dosimetry protocol for brachytherapy dose calculations, as well as documentation and results for some sealed sources. The radionuclide 198Au (T(1/2)=2.70 days, Egamma=412 keV) has been used in the form of seeds for brachytherapy treatments including brain, eye, and prostate tumors. However, TG-43 reports have no data for 198Au seeds, and none have previously been obtained. For that reason, and because of the conversion of most treatment planning systems to TG-43 based methods, both Monte Carlo calculations (MCNP 4C2) and thermoluminescent dosimeters (TLDs) are used in this work to determine these data. The geometric variation in dose is measured using an array of TLDs in a solid water phantom, and the seed activity is determined using a high purity germanium detector (HPGe) and a well ionization chamber. The results for air kerma strength, Sk, per unit apparent activity, are 2.063 (MCNP) and 2.089 (measured) U mCi(-1), values close to those published in 1991 in the AAPM Task Group 32 report. The dose rate constant, lambda, is found equal to 1.115 (MCNP) and 1.095 (measured) cGy h(-1) U(-1). The radial dose function, g(r), anisotropy function, F(r, theta), and anisotropy factor, phi(an)(r), are also given.

[A fast algorithm for homogeneous Ir-192--afterloading irradiation of cylindrical surfaces]

A fast algorithm was required to homogenise the dose on a cylinder mantle around a single straight applicator for Ir-192 afterloading. For linear applicators, an approximation formula for homogenisation of dose on one arbitrary cylinder mantle around the catheter is derived that predicts the required rise of dwell time tEnd at the end of the applicator. The other positions are loaded with a constant dwell time tMitte. The dwell time at the end tEnd appears to be independent of applicator length and can be described as a function of tMitte. In contrast to homogeneous loaded applicator, the dwell time in the central positions becomes also almost independent of catheter length, and is strictly proportional to the optimisation radius. TLD measurements and comparisons with a commercial planning system show the applicability of the procedure. This guarantees a homogeneous dose distribution even when modifications of the application length or optimisation distance become necessary. The algorithm can also be used to control the results of a planning system independently.