Interseed effects on dose for 125I brachytherapy implants.

Dose calculations in multiseed brachytherapy implants are done by adding the contribution of each individual seed and by assuming that radiation from each seed is unaffected by the presence of the other seeds. To test the validity of this assumption, dose measurements with various configurations of multiseed implants of 125I model 6702 and 125I model 6711 sources were performed. For a linear configuration of three 125I model 6702 seeds at 1-cm separation, with their transverse axes coincident, doses at distances of 3.05 and 5.09 cm from the center along the transverse axis were found to be about 8% lower than the sum of doses from the three individual seeds. However, for three seeds at 1-cm intervals with their longitudinal axes coincident, doses at 3.05 and 5.09 cm distances from the center along the longitudinal axis were found to be about equal to the dose sums from individual seeds. These initial experiments indicated that the magnitude of the interseed effect depends upon the orientation of the seed relative to each other in an implant. To evaluate the importance of this interseed effect for multiseed configurations of 125I model 6702 and 125I model 6711 seeds, dose rates at various distances from a two-plane implant (each plane containing a 3 x 3 array of sources in a 1-cm spacing square grid) were measured in a Solid Water phantom with LiF TLDs. These measurements were carried out in two different planes at different orientations relative to the implant. The average values of the interseed effect at distances ranging from 1 to 7 cm outside the implant were observed to be about the same for 125I model 6702 and model 6711 sources. The mean value of the interseed effect was 6% and the maximum was 12%. On the whole, the interseed effect reduces the dose at the periphery of the iodine implant by 6%.     

The effect of seed anisotrophy on brachytherapy dose distributions using 125I and 103Pd

We have evaluated the effect of the anisotropy of individual seeds on dose distributions for permanent prostate implants using 125I and 103Pd. The dose distributions were calculated for various implants using both the line source and point source calculational formalisms, for two different models of 125I and 103Pd seeds. The dose distributions were compared using cumulative dose volume histograms (DVH) and cumulative difference dose volume histograms (deltaDVH) for the prostate target volume and for the rectum surface. The DVHs could not distinguish between the dose distributions from isotropic and non-isotropic seeds. However, the deltaDVHs were useful in determining the fraction of the target volume for which the difference between the dose distribution for line sources and for point sources exceeded a threshold value. The dose distributions were calculated (1) for all the seeds oriented co-linearly, along either the x-, y-, or z-axis, and (2) for the seeds at randomized orientations, more closely resembling the clinical situation. For all cases, there was a significant difference in the effect of seed anisotropy from the different seed types. For the geometrically simpler test cases with a small number of seeds, the effect of anisotropy on the dose distribution was too large to ignore for any of the seed types investigated. For the idealized pre-plan case, the effect was much smaller. For clinical prostate implants, the calculations done with seeds oriented co-linearly along the z-axis (needle implant axis) were a reasonable approximation for those from simulations of seeds with randomized orientations. Again, the effect of anisotropy varied drastically between different seed models, and also between different clinical cases. However, the effect of anisotropy must be considered in the context of all the other uncertainties in clinical brachytherapy treatments.     

The impact of edema on planning 125I and 103Pd prostate implants.

Permanent transperineal interstitial 125I and 103Pd prostate implants are generally planned to deliver a specific dose to a clinically defined target volume; however, the post-implant evaluation usually reveals that the implant delivered a lower or higher dose than planned. This difference is generally attributed to such factors as source placement errors, overestimation of the prostate volume on CT, and post-implant edema. In the present work we investigate the impact of edema alone. In routine prostate implant planning, it is customary to assume that both the prostate and seeds are static throughout the entire treatment time, and post-implant edema is not taken into consideration in the dosimetry calculation. However, prostate becomes edematous after seed implantation, typically by 50% in volume [Int. J. Radiat. Oncol., Biol., Phys. 41, 1069-1077 (1998)]. The edema resolves itself exponentially with a typical half-life of 10 days. In this work, the impact of the edema-induced dynamic change in prostate volume and seed location on the dose coverage of the prostate is investigated. The total dose delivered to the prostate was calculated by use of a dynamic model, which takes edema into account. In the model, the edema resolves exponentially with time, as reported in a separate study based on serial CT scans [Int. J. Radiat. Oncol., Biol., Phys. 41, 1069-1077 (1998)]. The model assumes that the seeds were implanted exactly as planned, thus eliminating the effect of source placement errors. Implants based on the same transrectal ultrasound (TRUS) images were planned using both 125I and 103Pd sources separately. The preimplant volume and planned seed locations were expanded to different degrees of edema to simulate the postimplant edematous prostate on day 0. The model calculated the dose in increments of 24 h, appropriately adjusting the prostate volume, seed locations, and source strength prior to each time interval and compiled dose-volume histograms (DVH) of the total dose delivered. A total of 30 such DVHs were generated for each implant using different combinations of edema half-life and magnitude. In addition, a DVH of the plan was compiled in the conventional manner, assuming that the prostate volume and seeds were static during treatment. A comparison of the DVH of the static model to the 30 edema corrected DVHs revealed that the plan overestimated the total dose by an amount that increased with the magnitude of the edema and the edema half-life. The maximum overestimation was 15% for 125I and 32% for 103Pd. For more typical edema parameters (a 50% increase in volume and a 10 day half-life) the static plan for 125I overestimated the total dose by about 5%, whereas that for 103Pd overestimated it by about 12%.     

A comparative study of rectal dose histograms in prostate brachytherapy: some analytic and numerical results

A cumulative dose histogram is the graph of an integral function integrated over a domain VCR3 and is dubbed the dose-volume histogram (DVH), the dose-surface histogram (DSH) or the dose-wall histogram (DWH), depending on the dimension and structure of the region V. This paper presents a comparative study of the three rectal dose histograms for sixty patients as well as for a cylindrical model of the rectum; in particular, the DSH and DVH for the cylindrical model with one point source are computed analytically in terms of elliptic integrals. The difference among the three relative dose histograms, averaged over the sixty patients, is less than 5%, whereas that between DVH and DWH for various wall-thickness can be as large as 3-12 cm3 in the range 60-100 Gy. The paper also contains an error analysis using two simple models of the rectum, for which the true DSH and DWH can be computed via numerical integration, to evaluate the effect of digitization. The digitized computation agrees quite well with the pre-digitization numerical integration, within 1% or 0.2 cm3, because of the low dose-gradient effect near the rectum in prostate brachytherapy.     

Optimization of 125I ophthalmic plaque brachytherapy

Episcleral plaques containing 125I sources are often used in the treatment of ocular melanoma. Within four years post-treatment, however, the majority of patients experience some visual loss due to radiation retinopathy. The high incidence of late complications suggests that careful treatment optimization may lead to improved outcome. The goal of optimization would be to reduce the magnitude of vision-limiting complications without compromising tumor control. We have developed a three-dimensional computer model for ophthalmic plaque therapy which permits us to explore the potential of various optimization strategies. One simple strategy which shows promise is to maximize the ratio of dose to the tumor apex (T) compared to dose to the macula (M). By modifying the parameters of source location, activity distribution, source orientation, and shielding we find that the calculated T:M ratio can be varied by a factor of 2 for a common plaque design and posterior tumor location. Margins and dose to the tumor volume remain essentially unchanged.     

Lung density effect on 125I dose distribution

Perturbations in 125I implant dose distribution due to lung tissue variations have been investigated. Dose correction factors for a point source, a planar, and a volume implant have been calculated using a model which accounts for the changes in primary photon attenuation and in buildup factor when the medium is lung rather than water. Results of our calculation show that the change in dose is about 9% and 20% in the core and the periphery, respectively, of a representative implanted volume whose density is 0.25 relative to water.     

Dosimetric characteristics of a new 125I brachytherapy source

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a new 125I source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics of this source, including dose rate constant, radial dose function, and anisotropy function, were determined experimentally following the AAPM Task Group 43 recommendations. The characteristics were related to the 1999 NIST calibration assigned to this source [SK,99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of solid water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of solid water phantom material to provide full scattering conditions. The results indicated a dose rate constant, lambda, of 0.88 +/- 0.07cGyh(-1)U(-1) for the new 1251 source as compared to 0.98 and 1.04 cGy h(-1)U(-1) for the Nycomed/Amersham model 6711 and 6702 seeds, respectively. Per TG-43, the values reported here represent the dose absorbed by water at 1 cm from the source in a water medium. The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm. The anisotropy function, F(r,theta), of the new 125I source was measured at distances of 2 and 5 cm from the source center. Calculations of anisotropy and radial dose function were also made using a Monte Carlo code. These calculations were made for both solid water and liquid water, the former to validate the Monte Carlo code and the latter to provide results in liquid water for clinical use. All data compared favorably with those from the Nycomed/Amersham models 6711 and 6702 sources.     

Two-dimensional dose distribution of 125I seeds

Two-dimensional dose distribution has been measured for the new (model 6711) 125I seeds used in interstitial implants. Two independent methods, using a silicon diode or thermoluminescent dosimeters, yielded identical results. At any given distance r from the seed center, the dose varies with theta, the angle relative to the seed's axis. Similarly, the r dependence of the dose distribution is different at various theta values. These observations can be qualitatively understood in terms of several factors, namely, source encapsulation, geometrical relationship, and attenuation and scatter. Empirical expressions which approximate the measured results have been developed to facilitate clinical dose distribution calculations.     

Dosimetry on transverse axes of 125I and 192Ir interstitial brachytherapy sources

Dose rates along the transverse axes of 125I model 6702, 125I model 6711 and 192Ir 0.2-mm steel sources for interstitial brachytherapy have been measured in a solid-water phantom for distances up to 10 cm using LiF thermoluminescent dosimeters (TLDs). Specific dose rate constants, the dose rates in water per unit source strength 1 cm along the perpendicular bisector of the source, are determined to be 0.90 +/- 0.03, 0.85 +/- 0.03, and 1.09 +/- 0.03 cGy h-1 U-1 for 125I model 6702, 125I model 6711 and 192Ir 0.2-mm steel sources, respectively (1 U = unit of air kerma strength = 1 microGy m2 h-1 = 1 cGy cm2 h-1). In older and obsolete units of source strength (i.e., mCi apparent), these are 1.14 +/- 0.03, 1.08 +/- 0.03, and 4.59 +/- 0.15 cGy h-1 mCi-1 (apparent). Currently accepted values of specific dose rate constant for 125I sources are up to 20% higher than our measured values which are in good agreement with the results of our Monte Carlo simulations. But for 192Ir there is good agreement between our measured value of the specific dose rate constant and currently accepted values. The radial dose function for 125I model 6702 is found to be consistently larger than that for 125I model 6711, with an increasing difference as the distance from the source increases. Our measured values for the radial dose function for 125I sources are in good agreement with the results of our Monte Carlo simulation as well as the measured values of Schell et al. [Int. J. Radiat. Oncol. Biol. Phys. 13, 795-799 (1987)] for model 6702 and Ling et al.(ABSTRACT TRUNCATED AT 250 WORDS)     

Theoretical evaluation of dose distributions in water about models 6711 and 6702 125I seeds

The distribution of absorbed dose about models 6711 and 6702 125I seeds in water has been calculated from first principles using the Monte Carlo method. Dose is calculated as a function of angle with respect to the transverse seed bisector for distances from the seed center ranging from 0.1 to 7.5 cm. The computed results are compared to measured data. A truncated Fourier series is used to describe the Monte Carlo data in terms of a small number of coefficients, facilitating accurate and efficient dose calculations for clinical treatment planning.     

Radial dose functions for 103Pd, 125I, 169Yb and 192Ir brachytherapy sources: an EGS4 Monte Carlo study

Radial dose functions g(r) in water around 103Pd, 125I, 169Yb and 192Ir brachytherapy sources were estimated by means of the EGS4 simulation system and extensively compared with experimental as well as with theoretical results. The DLC-136/PHOTX cross section library, water molecular form factors, bound Compton scattering and Doppler broadening of the Compton-scattered photon energy were considered in the calculations. Use of the point source approach produces reasonably accurate values of the radial dose function only at distances beyond 0.5 cm for 103Pd sources. It is shown that binding corrections for Compton scattering have a negligible effect on radial dose function for 169Yb and 192Ir seeds and for 103Pd seeds under 5.0 cm from the source centre and for the 125I seed model 6702 under 8.0 cm. Beyond those limits there is an increasing influence of binding corrections on radial dose function for 103Pd and 125I sources. Results in solid water medium underestimate radial dose function for low-energy sources by as much as 6% for 103Pd and 2.5% for 125I already at 2 cm from source centre resulting in a direct underestimation of absolute dose rate values. It was found necessary to consider medium boundaries when comparing results for the radial dose function of 169Yb and 192Ir sources to avoid discrepancies due to the backscattering contribution in the phantom medium. Values of g(r) for all source types studied are presented. Uncertainties lie under 1% within one standard deviation.     

Thermoluminescent dosimetry of the selectseed 125I interstitial brachytherapy seed

This work presents experimental dosimetry results for the new selectSeed 125I prostate seed design for use with the seedSelectron afterloading device, in accordance with the AAPM advisory that all new low energy interstitial brachytherapy seeds should undergo one Monte Carlo (MC) and at least one experimental dosimetry characterization. TLD dosimetry was performed using 120 cylindrical LiF TLD type-100 rods calibrated using a 6 MV photon beam. They were irradiated in solid water phantoms for the experimental determination of the seed dose rate constant, radial dose functions and anisotropy functions. MC simulations were performed for the determination of the TLDs relative energy response that was found position independent and equal to 1.40+/-0.03, and for the calculation of the ratio of dose in liquid water to dose in solid water that was found to be well described by Dliquidwater/Dsolidwater= 1.013*r+0.030 presenting only a minor dependence on polar angle. The selectSeed dose rate constant in liquid water was found equal to 0.938+/-0.065 cGy h(-1) U(-1), which agrees within experimental uncertainties with corresponding MC results of lambdaselect Seed=0.954+/-0.005 cGy h(-1) U(-1). The experimental radial dose and anisotropy function results were also found in good agreement with corresponding MC calculations.     

Empirical dosimetric characterization of model I125-SL 125iodine brachytherapy source in phantom

Low-energy photon emitting radionuclides encapsulated for a permanent implant are routinely applied in prostate cancer brachytherapy. Before clinical use, a new source design requires full dosimetric analysis and calibration standardization. The results of one such experimental measurement and analysis are reported here for a new design of 125I source, model I125-SL. Dose measurements were made using standard methods employing thermoluminscent dosimeters in a water equivalent plastic phantom, in accord with the AAPM Task Group #43 recommendation of liquid water reference material. Precision machined bores in the phantom located dosimeters and source(s) in a reproducible fixed geometry providing for transverse-axis and angular dose profiles over a range of distances from 0.17 to 10 cm. The data were analyzed in terms of parameters recommended by AAPM TG43. The dose-rate constant, lambda, was evaluated by two methods, the first with reference to a 60Cobalt standard, accounting for response variation with photon energy spectrum. Second, the dose-rate constant was determined with reference to phantom measurements using NIST traceable calibrated model 6702 and 6711 sources. The radial dose function, g(r), the anisotropy function, F(r,theta), the anisotropy factor, phi(an)(r), and the point-source approximation anisotropy constant, phi(an), were derived from one- and two-dimensional dose distribution data measured in the phantom, accounting for finite dosimeter volume and with attention to interchip effects. The results are compared to TG43 and other existing data for 125I sources. The new source is comparable to the model 6711 source design.     

A comparison of solid phantoms with water for dosimetry of 125I brachytherapy sources

Dosimetry of brachytherapy sources is critically dependent on precise measurement of the source-detector distance. A solid phantom can be precisely machined and hence distances can be accurately determined. In this work LiF thermoluminescent chips are used for absolute dose rate measurements in solid water, polymethylmethacrylate (PMMA), and polystyrene. These media are examined for their suitability in the dosimetry of 125I by comparing depth doses in each phantom. Measurements and Monte Carlo calculations show that solid water is equivalent to water for the dosimetry of 125I seeds, however, polystyrene and PMMA are not equivalent to water. Also, photon energy spectra for several depths in each phantom material have been calculated and are used to determine average photon energy and mass energy absorption coefficients as a function of depth.     

Experimental validation of dose calculation algorithms for the GliaSite RTS, a novel 125I liquid-filled balloon brachytherapy applicator

This paper compares experimentally measured and calculated dose-rate distributions for a novel 125I liquid-filled brachytherapy balloon applicator (the GliaSite RTS), designed for the treatment of malignant brain-tumor resection-cavity margins. This work is intended to comply with the American Association of Physicists in Medicine (AAPM) Radiation Therapy Committee's recommendations [Med. Phys. 25, 2269-2270 (1998)] for dosimetric characterization of low-energy photon interstitial brachytherapy sources. Absolute low dose-rate radiochromic film (RCF) dosimetry measurements were performed in coronal planes about the applicator. The applicator was placed in a solid water phantom, machined to conform to the inflated applicator's surface. The results were used to validate the accuracy of Monte Carlo photon transport (MCPT) simulations and a point-source dose-kernel algorithm in predicting dose to water. The absolute activity of the 125I solution was determined by intercomparing a National Institute of Standards and Technology (NIST) 125I standard with a known mass of radiotherapy solution (Iotrex) in an identical vial and geometry. For the two films not in contact with applicator, the average agreement between RCF and MCPT (specified as the mean absolute deviation in successive 4 mm rings) was found to be within +/-5% at distances 0.2-25 mm from the film centers. For the two films touching the catheter, the mean agreement was +/-14.5% and 7.5% near the balloon surface but improving to 7.5% and 6% by 3.5 mm from the surface. These errors, as large as 20% in isolated pixels, are likely due to trim damage, 125I contamination, and poor conformance with the balloon. At larger distances where the radiation doses were very low, the observed discrepancies were significantly larger than expected. We hypothesize that they are due to a dose-rate dependence of the RCF response. A 1%-10% average difference between a simple one-dimensional path-length semiempirical dose-kernel model and the MCPT calculations was observed over clinically relevant distances.