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Purpose Eye plaque brachytherapy is the most common approach for intraocular cancer treatment. It is, however, invasive and subject to large setup uncertainty due to the surgical operation. We propose a novel-focused kV x-ray technique with potential nanoparticle (NP) enhancement and evaluate its application in treating choroidal melanoma and iris melanoma by Monte Carlo (MC) dosimetry modeling. Methods A polycapillary x-ray lens was used to focus 45 kVp x rays to achieve pinpoint accuracy of dose delivery to small tumors near critical structures. In addition to allowing for beam focusing, the use of kV x rays takes advantage of the strong photoelectric absorption of metallic NPs in that energy regime and hence strong radiosensitization. We constructed an MC simulation program that takes into account the x-ray optic modeling and used GEANT4 for dosimetric calculation. Extensive phantom measurements using a prototype-focused x-ray system were carried out. The MC simulation of simple geometry phantom irradiation was first compared to measurements to verify the x-ray optic lens modeling in conjunction with the Geant4 dosimetric calculation. To simulate tumor treatment, a geometric eye model and two tumor models were constructed. Dose distributions of the simulated treatments were then calculated. NP radiosensitization was also simulated for two concentrations of 2 nm gold NP (AuNP) uniformly distributed in the tumor. Results The MC-simulated full width at half maximum (FWHM) and central-axis depth dose of the focused kV x-ray beam match those measured on EBT3 films within ~10% around the depth of focus of the beam. Dose distributions of the simulated ocular tumor treatments show that focused x-ray beams can concentrate the high-dose region in or close to the tumor plus margin. For the simulated posterior choroidal tumor treatment, with sufficient tumor coverage, the doses to the optic disc and fovea are substantially reduced with focused x-ray therapy compared to eye plaque treatment (3.8 vs 39.8 Gy and 11.1 vs 53.8 Gy, respectively). The eye plaque treatment was calculated using an Eye Physics plaque with I-125 seeds under TG43 assumption. For the energy spectrum used in this study, the average simulated dose enhancement ratios (DERs) are roughly 2.1 and 1.1 for 1.0% and 0.1% AuNP mass concentration in the tumor, respectively. Conclusion Compared to eye plaque brachytherapy, the proposed focused kV x-ray technique is noninvasive and shows great advantage in sparing healthy critical organs without sacrificing the tumor control. The NP radiation dose enhancement is considerable at our proposed kV range even with a low NP concentration in the tumor, providing better critical structure protection and more flexibility for treatment planning.

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-ESTRO) have prepared another supplement containing recommended brachytherapy dosimetry parameters for eleven low-energy photon-emitting brachytherapy sources. The current report presents consensus datasets approved by the AAPM and GEC-ESTRO. The following sources are included: 125I sources (BEBIG model I25.S17, BEBIG model I25.S17plus, BEBIG model I25.S18, Elekta model 130.002, Oncura model 9011, and Theragenics model AgX100); 103Pd sources (CivaTech Oncology model CS10, IBt model 1031L, IBt model 1032P, and IsoAid model IAPd-103A); and 131Cs (IsoRay Medical model CS-1 Rev2). Observations are included on the behavior of these dosimetry parameters as a function of radionuclide. Recommendations are presented on the selection of dosimetry parameters, such as from societal reports issuing consensus datasets (e.g., TG-43U1, AAPM Report #229), the joint AAPM/IROC Houston Registry, the GEC-ESTRO website, the Carleton University website, and those included in software releases from vendors of treatment planning systems. Aspects such as timeliness, maintenance, and rigor of these resources are discussed. Links to reference data are provided for radionuclides (radiation spectra and half-lives) and dose scoring materials (compositions and mass densities). The recent literature is examined on photon energy response corrections for thermoluminescent dosimetry of low-energy photon-emitting brachytherapy sources. Depending upon the dosimetry parameters currently used by individual physicists, use of these recommended consensus datasets may result in changes to patient dose calculations. These changes must be carefully evaluated and reviewed with the radiation oncologist prior to their implementation. This article is protected by copyright. All rights reserved.

Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used in the evaluation of innovative devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining the equivalence of the innovative treatment modality to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of innovative radiotherapy devices or applications is a critical part in which physicists should be actively involved. The physicist's role, along with physician colleagues, in this process is highlighted for innovative brachytherapy devices and applications and includes evaluation of (1) dosimetric considerations for clinical implementation (including calibrations, dose calculations, and radiobiological aspects) to comply with existing societal dosimetric prerequisites for sources in routine clinical use, (2) risks and benefits from a regulatory and safety perspective, and (3) resource assessment and preparedness. Further, it is suggested that any developed calibration methods be traceable to a primary standards dosimetry laboratory (PSDL) such as the National Institute of Standards and Technology in the U.S. or to other PSDLs located elsewhere such as in Europe. Clinical users should follow standards as approved by their country's regulatory agencies that approved such a brachytherapy device. Integration of this system into the medical source calibration infrastructure of secondary standard dosimetry laboratories such as the Accredited Dosimetry Calibration Laboratories in the U.S. is encouraged before a source is introduced into widespread routine clinical use. The American Association of Physicists in Medicine and the Groupe Europeen de Curietherapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) have developed guidelines for the safe and consistent application of brachytherapy using innovative devices and applications. The current report covers regulatory approvals, calibration, dose calculations, radiobiological issues, and overall safety concerns that should be addressed during the commissioning stage preceding clinical use. These guidelines are based on review of requirements of the U.S. Nuclear Regulatory Commission, U.S. Department of Transportation, International Electrotechnical Commission Medical Electrical Equipment Standard 60601, U.S. Food and Drug Administration, European Commission for CE Marking (Conformite Europeenne), and institutional review boards and radiation safety committees.

Purpose: To investigate the utility and accuracy of high‐sensitivity TLD for dosimetric characterization of low‐energy brachytherapy sources. Methods: One hundred high‐sensitivity (TLD‐100H) and 100 normal‐sensitivity (TLD‐100) TLDs were used in this study. The TLD‐100s were annealed at 400°C for one hour and then kept at room temperature for 45 minutes followed by 80°C heating for 24 hours. To prevent temperature overshot from reducing the sensitivity of TLD‐100Hs, a novel thermal reservoir was built, tested, and used to anneal TLD‐100H at 240 0C for 15 minutes and then kept at room temperature for 45 minutes followed by 100 0C heating for one hour. These TLDs were then irradiated uniformly in a large cavity Cs‐137 irradiator for biomedical research (Shepherd, Mark III) to test their reproducibility and to establish their relative sensitivities. The radial dose function of a Model AgX100 125I source was measured using both types of TLDs in water‐equivalent solid phantoms as a test case. The radial dose function measured by the TLD‐100H was compared with that measured by TLD‐100 to determine its utility in brachytherapydosimetry characterization. Results: Consistent and accurate annealing of high‐sensitivity TLDs was achieved by using a custom‐built thermal reservoir system. TLD‐100H was found to be about 18 times more sensitive than TLD‐100. For a 125I source with a source‐strength of 2.7U, the irradiation time for radial dose function characterization up to 7 cm can be cut down from 38 days to 3 days. The radial dose function measured by TLD‐100H agreed well (within ±6%) with that measured by TLD‐100. Conclusions: A novel thermal reservoir was used for consistent annealing of high‐sensitivity TLDs. TLD‐100H can significantly shorten the irradiation time needed for a complete characterization of radial dose function. Investigation of TLD‐100H for complete brachytherapy source characterization is in progress. Supported in part by NIH grant R01‐CA134627

Purpose: To evaluate the replacement of Cerrobend by copper for electron beam cutouts. Methods: The dosimetric comparisons for circular copper‐and Cerrobend‐cutouts with diameters (1.0, 2.0, 3.0, 5.0, 7.5, 10.0, and 12.5 cm) were made using electron beams with energies (6, 9, 12, 16, and 20 MeV) from 3 Varian accelerators. A PTW Farmer chamber (0.125cc‐volume) was used for larger cutouts (diameters > 2cm), and an electron‐diode for the 2 smallest cutouts. Also a Markus parallel plate chamber was used. Results: (1) The tests showed little difference for the electron dosimetric characteristics, Eo, Eop, R50, Rp, and dmax. For larger cutout, the parameters were virtually the same for copper and Cerrobend. for smaller cutout (diameter = 3cm), small discrepancies were observed i.e. differences < 1mm for R50, Rp and dmax, =0.1MeV for Eop, and =0.3MeV for Eo. (2) The larger‐cutout outputs at dmax were also virtually the same (difference = 0.6%). For smaller cutouts (diameters = 3cm), the copper outputs were 2.0%∼5.0% higher than Cerrobend. (3) For lower energy electrons (

Although a multicenter, Phase III, prospective, randomized trial is the gold standard for evidence-based medicine, it is rarely used in the evaluation of innovative devices because of many practical and ethical reasons. It is usually sufficient to compare the dose distributions and dose rates for determining the equivalence of the innovative treatment modality to an existing one. Thus, quantitative evaluation of the dosimetric characteristics of innovative radiotherapy devices or applications is a critical part in which physicists should be actively involved. The physicist's role, along with physician colleagues, in this process is highlighted for innovative brachytherapy devices and applications and includes evaluation of (1) dosimetric considerations for clinical implementation (including calibrations, dose calculations, and radiobiological aspects) to comply with existing societal dosimetric prerequisites for sources in routine clinical use, (2) risks and benefits from a regulatory and safety perspective, and (3) resource assessment and preparedness. Further, it is suggested that any developed calibration methods be traceable to a primary standards dosimetry laboratory (PSDL) such as the National Institute of Standards and Technology in the U.S. or to other PSDLs located elsewhere such as in Europe. Clinical users should follow standards as approved by their country's regulatory agencies that approved such a brachytherapy device. Integration of this system into the medical source calibration infrastructure of secondary standard dosimetry laboratories such as the Accredited Dosimetry Calibration Laboratories in the U.S. is encouraged before a source is introduced into widespread routine clinical use. The American Association of Physicists in Medicine and the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO) have developed guidelines for the safe and consistent application of brachytherapy using innovative devices and applications. The current report covers regulatory approvals, calibration, dose calculations, radiobiological issues, and overall safety concerns that should be addressed during the commissioning stage preceding clinical use. These guidelines are based on review of requirements of the U.S. Nuclear Regulatory Commission, U.S. Department of Transportation, International Electrotechnical Commission Medical Electrical Equipment Standard 60601, U.S. Food and Drug Administration, European Commission for CE Marking (Conformité Européenne), and institutional review boards and radiation safety committees.

Dosimetry of eye plaques for ocular tumors presents unique challenges in brachytherapy. The challenges in accurate dosimetry are in part related to the steep dose gradient in the tumor and critical structures that are within millimeters of radioactive sources. In most clinical applications, calculations of dose distributions around eye plaques assume a homogenous water medium and full scatter conditions. Recent Monte Carlo (MC)-based eye-plaque dosimetry simulations have demonstrated that the perturbation effects of heterogeneous materials in eye plaques, including the gold-alloy backing and Silastic insert, can be calculated with reasonable accuracy. Even additional levels of complexity introduced through the use of gold foil "seed-guides" and custom-designed plaques can be calculated accurately using modern MC techniques. Simulations accounting for the aforementioned complexities indicate dose discrepancies exceeding a factor of ten to selected critical structures compared to conventional dose calculations. Task Group 129 was formed to review the literature; re-examine the current dosimetry calculation formalism; and make recommendations for eye-plaque dosimetry, including evaluation of brachytherapy source dosimetry parameters and heterogeneity correction factors. A literature review identified modern assessments of dose calculations for Collaborative Ocular Melanoma Study (COMS) design plaques, including MC analyses and an intercomparison of treatment planning systems (TPS) detailing differences between homogeneous and heterogeneous plaque calculations using the American Association of Physicists in Medicine (AAPM) TG-43U1 brachytherapy dosimetry formalism and MC techniques. This review identified that a commonly used prescription dose of 85 Gy at 5 mm depth in homogeneous medium delivers about 75 Gy and 69 Gy at the same 5 mm depth for specific (125)I and (103)Pd sources, respectively, when accounting for COMS plaque heterogeneities. Thus, the adoption of heterogeneous dose calculation methods in clinical practice would result in dose differences >10% and warrant a careful evaluation of the corresponding changes in prescription doses. Doses to normal ocular structures vary with choice of radionuclide, plaque location, and prescription depth, such that further dosimetric evaluations of the adoption of MC-based dosimetry methods are needed. The AAPM and American Brachytherapy Society (ABS) recommend that clinical medical physicists should make concurrent estimates of heterogeneity-corrected delivered dose using the information in this report's tables to prepare for brachytherapy TPS that can account for material heterogeneities and for a transition to heterogeneity-corrected prescriptive goals. It is recommended that brachytherapy TPS vendors include material heterogeneity corrections in their systems and take steps to integrate planned plaque localization and image guidance. In the interim, before the availability of commercial MC-based brachytherapy TPS, it is recommended that clinical medical physicists use the line-source approximation in homogeneous water medium and the 2D AAPM TG-43U1 dosimetry formalism and brachytherapy source dosimetry parameter datasets for treatment planning calculations. Furthermore, this report includes quality management program recommendations for eye-plaque brachytherapy.

Purpose: To investigate dosimetric differences among several clinical treatment planning systems (TPS) and Monte Carlo(MC) codes for brachytherapy of intraocular tumors using I 125 or P 103 d plaques, and to evaluate the impact on the prescription dose of the adoption of MC codes and certain versions of a TPS (Plaque Simulator with optional modules). Methods: Three clinical brachytherapy TPS capable of intraocular brachytherapytreatment planning and two MC codes were compared. The TPS investigated were Pinnacle v8.0dp1, BrachyVision v8.1, and Plaque Simulator v5.3.9, all of which use the AAPM TG-43 formalism in water. The Plaque Simulator software can also handle some correction factors from MC simulations. The MC codes used areMCNP5 v1.40 and BrachyDose/EGSnrc. Using these TPS and MC codes, three types of calculations were performed: homogeneous medium with point sources (for the TPS only, using the 1D TG-43 dose calculation formalism); homogeneous medium with line sources (TPS with 2D TG-43 dose calculation formalism and MC codes); and plaque heterogeneity-corrected line sources (Plaque Simulator with modified 2D TG-43 dose calculation formalism and MC codes). Comparisons were made of doses calculated at points-of-interest on the plaque central-axis and at off-axis points of clinical interest within a standardized model of the right eye. Results: For the homogeneous water medium case, agreement was within ∼ 2 % for the point- and line-source models when comparing between TPS and between TPS and MC codes, respectively. For the heterogeneous medium case, dose differences (as calculated using the MC codes and Plaque Simulator) differ by up to 37% on the central-axis in comparison to the homogeneous water calculations. A prescription dose of 85 Gy at 5 mm depth based on calculations in a homogeneous medium delivers 76 Gy and 67 Gy for specific I 125 and P 103 d sources, respectively, when accounting for COMS-plaque heterogeneities. For off-axis points-of-interest, dose differences approached factors of 7 and 12 at some positions for I 125 and P 103 d , respectively. There was good agreement ( ∼ 3 % ) among MC codes and Plaque Simulator results when appropriate parameters calculated using MC codes were input into Plaque Simulator. Plaque Simulator and MC users are perhaps at risk of overdosing patients up to 20% if heterogeneity corrections are used and the prescribed dose is not modified appropriately. Conclusions: Agreement within 2% was observed among conventional brachytherapy TPS and MC codes for intraocular brachytherapydose calculations in a homogeneous water environment. In general, the magnitude of dose errors incurred by ignoring the effect of the plaque backing and Silastic insert (i.e., by using the TG-43 approach) increased with distance from the plaque’s central-axis. Considering the presence of material heterogeneities in a typical eye plaque, the best method in this study for dose calculations is a verified MC simulation.

Purpose: Since its introduction in 2004, the model CS-1 Rev.1 131Cs source has been used in many radiation therapy clinics for prostate brachytherapy. In 2006, this source model underwent a Rev.2 production revision. The aim of this work was to investigate the dosimetric influences of the Rev.2 production revision using high-resolution photon spectrometry. Methods: Three CS-1 Rev.1 and three CS-1 Rev.2 131Cs sources were used in this study. The relative photon energy spectrum emitted by each source in the transverse bisector of the source was measured using a high-resolution germanium detector designed for low-energy photon spectrometry. Based on the measured photon energy spectrum and the radioactivity distribution in the source, the dose-rate constant (Λ) of each source was determined. The effects of the Rev.2 production revision were quantified by comparing the emitted photon energy spectra and the Λ values determined for the sources manufactured before and after the production revision. Results: The relative photon energy spectrum originating from the principal emissions of 131Cs was found to be nearly identical before and after the Rev.2 revision. However, the portion of the spectrum originating from the production of fluorescent x rays in niobium, a trace element present in the source construction materials, was found to differ significantly between the Rev.1 and Rev.2 sources. The peak intensity of the Nb Kα and Nb Kβ fluorescent x rays from the Rev.2 source was approximately 35% of that from the Rev.1 source. Consequently, the nominal Λ value of the Rev.2 source was found to be greater than that determined for the Rev.1 source by approximately 0.7%±0.5%. Conclusions: A significant reduction (65%) in relative niobium fluorescent x-ray yield was observed in the Rev.2 131Cs sources. The impact of this reduction on the dose-rate constant was found to be small, with a relative difference of less than 1%. This study demonstrates that photon spectrometry can be used as a sensitive and convenient tool for monitoring and for quantifying the dosimetric effects of brachytherapy source-production revisions. Because production revision can change both the geometry and the atomic composition of brachytherapy sources, its dosimetric impact should be carefully monitored and evaluated for each production revision.

During the past decade, permanent radioactive source implantation of the prostate has become the standard of care for selected prostate cancer patients, and the techniques for implantation have evolved in many different forms. Although most implants use 125I or 103Pd sources, clinical use of 131Cs sources has also recently been introduced. These sources produce different dose distributions and irradiate the tumors at different dose rates. Ultrasound was used originally to guide the planning and implantation of sources in the tumor. More recently, CT and/or MR are used routinely in many clinics for dose evaluation and planning. Several investigators reported that the tumor volumes and target volumes delineated from ultrasound, CT, and MR can vary substantially because of the inherent differences in these imaging modalities. It has also been reported that these volumes depend critically on the time of imaging after the implant. Many clinics, in particular those using intraoperative implantation, perform imaging only on the day of the implant. Because the effects of edema caused by surgical trauma can vary from one patient to another and resolve at different rates, the timing of imaging for dosimetry evaluation can have a profound effect on the dose reported (to have been delivered), i.e., for the same implant (same dose delivered), CT at different timing can yield different doses reported. Also, many different loading patterns and margins around the tumor volumes have been used, and these may lead to variations in the dose delivered. In this report, the current literature on these issues is reviewed, and the impact of these issues on the radiobiological response is estimated. The radiobiological models for the biological equivalent dose (BED) are reviewed. Starting with the BED model for acute single doses, the models for fractionated doses, continuous low-dose-rate irradiation, and both homogeneous and inhomogeneous dose distributions, as well as tumor cure probability models, are reviewed. Based on these developments in literature, the AAPM recommends guidelines for dose prescription from a physics perspective for routine patient treatment, clinical trials, and for treatment planning software developers. The authors continue to follow the current recommendations on using D90 and V100 as the primary quantitles, with more specific guidelines on the use of the imaging modalities and the timing of the imaging. The AAPM recommends that the postimplant evaluation should be performed at the optimum time for specific radionuclides. In addition, they encourage the use of a radiobiological model with a specific set of parameters to facilitate relative comparisons of treatment plans reported by different institutions using different loading patterns or radionuclides.

Two independent groups have published intrinsic dosimetry parameters for the recently introduced OptiSeed103 interstitial brachytherapy source which contains 103Pd encapsulated by a novel polymer shell. The dose rate constant (Λ) reported by the two groups, however, differed by more than 6% and there is currently no AAPM recommended consensus value for this source in clinical dosimetry. The aim of this work was to perform an independent determination of Λ for the OptiSeed103 source using a recently developed photon spectrometry technique. Three OptiSeed103 sources (model 1032P) with known air-kerma strength were used in this study. The photon energy spectrum emitted along the radial direction on the source’s bisector was measured in air using a high-resolution intrinsic germanium spectrometer designed and established for low-energy brachytherapy source spectrometry. The dose rate constant of each source was determined from its emitted energy spectrum and the spatial distribution of radioactivity in the source. Unlike other sources made with traditional titanium encapsulation, the photons emitted by the OptiSeed103 sources exhibited only slight spectral hardening, yielding a relative energy spectrum closer to that emitted by bare 103Pd. The dose rate constant determined by the photon spectrometry technique for water was 0.664±0.025 cGy h−1 U−1. This value agreed, within experimental uncertainties, with the Monte Carlo-calculated value (MCΛ) of 0.665±0.014 cGy h−1 U−1 and the TLD-measured value (with a Monte Carlo-calculated solid-phantom-to-water conversion factor) of 0.675±0.051 cGy h−1 U−1 reported by Wang and Hertel [Appl. Radiat. Isot. 63, 311–321 (2005)]. However, it differed by −6.7% from the MCΛ of 0.712±0.043 cGy h−1 U−1 reported by Bernard and Vynckier [Phys. Med. Biol. 50, 1493–1504 (2005)]. The results obtained in this work provide additional information needed for establishing a consensus value for the dose rate constant for the OptiSeed103 source. It suggests that an eventual consensus value of Λ for the OptiSeed103 source is likely to be closer to a value of 0.668 cGy h−1 U−1 rather than 0.693 cGy h−1U−1 as initially recommended by the source manufacturer based on the two previously published results.

Since the publication of AAPM Task Group 60 report in 1999, a considerable amount of dosimetry data for the three coronary brachytherapy systems in use in the United States has been reported. A subgroup, Task Group 149, of the AAPM working group on Special Brachytherapy Modalities (Bruce Thomadsen, Chair) was charged to develop recommendations for dose calculation formalisms and the related consensus dosimetry parameters. The recommendations of this group are presented here. For the Cordis Ir 192 and Novoste Sr 90 ∕ Y 90 systems, the original TG-43 formalism in spherical coordinates should be used along with the consensus values of the dose rate constant, geometry function, radial dose function, and anisotropy function for the single seeds. Contributions from the single seeds should be added linearly for the calculation of dose distributions from a source train. For the Guidant P 32 wire system, the modified TG-43 formalism in cylindrical coordinates along with the recommended data for the 20 and 27 mm wires should be used. Data tables for the 6, 10, 14, 18, and 22 seed trains of the Cordis system, 30, 40, and 60 mm seed trains of the Novoste system, and the 20 and 27 mm wires of the Guidant system are presented along with our rationale and methodology for selecting the consensus data. Briefly, all available datasets were compared with each other and the consensus dataset was either an average of available data or the one obtained from the most densely populated study; in most cases this was a Monte Carlo calculation.

The physical characteristics of the photons emitted by a low-energy brachytherapy source are strongly dependent on the source’s construction. Aside from absorption and scattering caused by the internal structures and the source encapsulation, the photoelectric interactions occurred in certain type of source-construction materials can generate additional energetic characteristic x rays with energies different from those emitted by the bare radionuclide. As a result, the same radionuclide encapsulated in different source models can result in dose rate constants and other dosimetric parameters that are strikingly different from each other. The aim of this work was to perform a systematic study on the yield of silver fluorescent x rays produced in nine I 125 sources that are known to contain silver and its impact on the dose-rate constant. Using a high-resolution germanium spectrometer, the relative I 125 spectra emitted by the nine sources on its bisector were measured and found to be similar to each other (the maximum variation in the I 125 - K β relative intensity was less than 4%). On the other hand, the measured silver fluorescent x-ray spectra exhibited much greater variations from model to model; the maximum change in the measured Ag - K α relative intensity was over 95%. This larger variation in the measured silver fluorescent x-ray yield was caused by (1) the different amount of silver that was directly exposed to the I 125 radionuclide in different source models and (2) the stronger influence of the source’s internal geometry on the silver fluorescent x rays. Because the addition of silver fluorescent x rays can significantly alter the photon characteristics emitted by the radioactive sources, a precise knowledge on the silver fluorescent x-ray yield is needed in theoretical calculations of the sources’ intrinsic dosimetric properties. This study concludes that the differences in silver fluorescent yield are the primary causes of the variable dose rate constant observed among these source models.

Since publication of the 2004 update to the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report (TG-43U1), several new low-energy photon-emitting brachytherapy sources have become available. Many of these sources have satisfied the AAPM prerequisites for routine clinical use as of January 10, 2005, and are posted on the Joint AAPM/RPC Brachytherapy Seed Registry. Consequently, the AAPM has prepared this supplement to the 2004 AAPM TG-43 update. This paper presents the AAPM-approved consensus datasets for these sources, and includes the following 125I sources: Amersham model 6733, Draximage model LS-1, Implant Sciences model 3500, IBt model 1251L, IsoAid model IAI-125A, Mentor model SL-125/ SH-125, and SourceTech Medical model STM1251. The Best Medical model 2335 103Pd source is also included. While the methodology used to determine these data sets is identical to that published in the AAPM TG-43U1 report, additional information and discussion are presented here on some questions that arose since the publication of the TG-43U1 report. Specifically, details of interpolation and extrapolation methods are described further, new methodologies are recommended, and example calculations are provided. Despite these changes, additions, and clarifications, the overall methodology, the procedures for developing consensus data sets, and the dose calculation formalism largely remain the same as in the TG-43U1 report. Thus, the AAPM recommends that the consensus data sets and resultant source-specific dose-rate distributions included in this supplement be adopted by all end users for clinical treatment planning of low-energy photon-emitting brachytherapy sources. Adoption of these recommendations may result in changes to patient dose calculations, and these changes should be carefully evaluated and reviewed with the radiation oncologist prior to implementation of the current protocol.

Accurate determination of dose-rate constant ({lambda}) for interstitial brachytherapy sources emitting low-energy photons (

The methodology of brachytherapy source dosimetry with Gafchromic® MD 55-2 film (ISP Technologies, Inc.) is examined with an emphasis on the nonlinearity of the optical density-dose relation within the dynamic dose range, the radial distance-dependent measurement uncertainty, and the format of data presentation. The specific source chosen for this study was a Checkmate™ (Cordis Corporation) intravascular brachytherapy system. The two-dimensional dose distribution around the source was characterized by a comprehensive analysis of measurement uncertainties. A comparative analysis of the dosimetric data from the vendor and from the scientific literature showed a substantial consistency of the information available for the Checkmate™ source. Our two-dimensional dosimetric data for the Checkmate™ source trains is presented in the form of measured along and away dose tables.

Our aim in this work was to study the potential dosimetric effect of prostate edema on the accuracy of conventional pre- and post-implant dosimetry for prostate seed implants using the newly introduced 131Cs seed, whose radioactive decay half-life (approximately 9.7 days) is directly comparable to the average edema resolution half-life (approximately 10 days) observed previously by Waterman et al. for 125I implants [Int. J. Radiat. Oncol. Biol. Phys. 41, 1069-1077 (1998)]. A systematic calculation of the relative dosimetry effect of prostate edema on the 131Cs implant was performed by using an analytic solution obtained previously [Int. J. Radiat. Oncol. Biol. Phys. 47, 1405-1419 (2000)]. It was found that conventional preimplant dosimetry always overestimates the true delivered dose as it ignores the temporary increase of the interseed distance caused by edema. The overestimation for 131Cs implants ranged from 1.2% (for a small edema with a magnitude of 10% and a half-life of 2 days) to approximately 45% (for larger degree edema with a magnitude of 100% and a half-life of 25 days). The magnitude of pre- and post-implant dosimetry error for 131Cs implants was found to be similar to that of 103Pd implants for typical edema characteristics (magnitude < 100%, and half-life

Treatment position setup errors often introduce temporal variations in the position of target relative to the planned external radiation beams. The errors can be introduced by the movement of a target relative to external setup marks or to other relevant landmarks that are used to position a patient for radiotherapy. Those variations can cause dose deviations from the planned doses and result in suboptimal treatments where part of the target is not fully irradiated or a critical structure receives more than desired radiationdoses. Clinically available technology for image-guidedradiotherapy can detect variations of target position. In this study, a method has been developed to correct for target position variations and restore the original beam geometries relative to the target. The technique involves three matrix transformations: (1) transformation of beams from the machine coordinate system to the patient coordinate system as in the patient geometry in the approved dosimetric plan; (2) transformation of beams from the patient coordinate system in the approved plan to the patient coordinate system that is identified at the time of treatment; (3) transformation of beams from the patient coordinate system at the time of treatment in the treatment patient geometry back to the machine coordinate system. The transformation matrix used for the second transformation is determined through the use of image-guidedradiotherapy technology and image registration. By using these matrix transformations, the isocenter shift, the gantry, couch and collimator angles of the beams for the treatment, adjusted for the target shift, can be derived. With the new beam parameters, the beams will possess the same positions and orientations relative to the target as in the plan for a rigid body. This method was applied to a head phantom study, and it was found that the target shift was fully corrected in treatment and excellent agreement was found in target dose coverage between the plan and the treatment.

The aim of this work was to conduct an independent determination of the dose rate constant of the newly introduced Model CS-1 131Cs seed. A total of eight 131Cs seeds were obtained from the seed manufacturer. The air-kerma strength of each seed was measured by the manufacturer whose calibration is traceable to the air-kerma strength standard established for the 131Cs seeds at the National Institute of Standards and Technology (1 sigma uncertainty < 1%). The dose rate constant of each seed was measured by two independent methods: One based on the actual photon energy spectrum emitted by the seed using gamma-ray spectrometry and the other based on the dose-rate measured by thermoluminescent dosimeter (TLD) in a Solid Water phantom. The dose rate constant in water determined by the gamma-ray spectrometry technique and by the TLD dosimetry are 1.066 +/- 0.064 cGyh(-1)U(-1) and 1.058 +/- 0.106 cGyh(-1)U(-1), respectively, showing excellent agreement with each other. These values, however, are approximately 15% greater than a previously reported value of 0.915 cGyh(-1)U(-1) [Med. Phys. 31, 1529-1538 (2004)]. Although low-energy fluorescent x rays at 16.6 and 18.7 keV, originating from niobium present in the seed construction, were measured in the energy spectrum of the 131Cs seeds, their yields were not sufficient to lower the dose rate constant to the value of 0.915 cGyh(-1)U(-1). Additional determinations of the dose rate constant may be needed to establish an AAPM recommended consensus value for routine clinical use of the 131Cs seed.

In March 2004, the recommendations of the American Association of Physicists in Medicine (AAPM) on the interstitial brachytherapy dosimetry using 125I and 103Pd were reported in Medical Physics [TG-43 Update: Rivard et al., 31, 633-674 (2004)]. These recommendations include some minor changes in the dose-calculation formalism and a major update of the dosimetry parameters for eight widely used interstitial brachytherapy sources. A full implementation of these recommendations could result in unintended changes in delivered dose without corresponding revisions in the prescribed dose. Because most published clinical experience with permanent brachytherapy is based upon two widely used source models, the 125I Model 6711 and 103Pd Model 200 sources, in this report we present an analysis of the dosimetric impact of the 2004 TG-43 dosimetry parameters on the history of dose delivery for these two source models. Our analysis indicates that the currently recommended prescribed dose of 125 Gy for Model 200 103Pd implants planned using previously recommended dosimetry parameters [AAPM 103Pd dose prescription: Williamson et al., Med. Phys. 27, 634-642 (2000)] results in a delivered dose of 120 Gy according to dose calculations based on the 2004 TG-43 update. Further, delivered doses prior to October 1997 varied from 113 to 119 Gy for a prescribed dose of 115 Gy compared to 124 Gy estimated by the AAPM 2000 report. For 125I implants using Model 6711 seeds, there are no significant changes (less than 2%). Practicing physicians should take these results into account when selecting the clinically appropriate prescribed dose for 103Pd interstitial implant patients following implementation of the 2004 TG-43 update dose-calculation recommendations. The AAPM recommends that the radiation oncology community review this report and consider whether the currently recommended dose level (125 Gy) needs to be revised.

The dosimetric characteristics were measured for two types of I 125 low-energy photon-emitting sources by using a wide and highly sensitive thermoluminescent (TL) sheet film, which was developed for two-dimensional dose distribution measurements. The TL film is made of Teflon homogeneously mixed with small powders of thermoluminescence ( Ba S O 4 :Eu doped). Various dosimetric parameters (i.e., radial dose function, 2D and 1D anisotropy functions) of model 6711 and 6702 I 125 sources were obtained at various distances from the source surfaces to 15 mm . These parameters obtained with TL sheet were compared with the data recommended in the updated AAPM TG-43 report. The radial dose functions measured with TL sheet are in agreement with those established data of model 6711 I 125 seed and model 6702 I 125 seed at most of the distances within 5% and 7%, respectively. All the measuredanisotropy functions showed symmetry about the longitudinal source axis. The anisotropy of dose distributions was clearly present in the immediate vicinity of the source edges. The measured 2D anisotropy function values at 1 cm are in reasonably good agreement with the recommended values. The differences at two points in the 1D anisotropy functions measured with TL sheet and the established data at 1 cm from source center were 0.7% and 1.9% for model 6711 and 6702 I 125 sources, respectively; the differences at 0.5 cm were 1.5% and 1.7% for model 6711 and 6702 I 125 sources, respectively. The relative dosimetric characteristics in the vicinity of actual interstitial brachytherapy sources containing I 125 have been experimentally determined by using the TL sheet as a 2D dosimeter.

Since publication of the American Association of Physicists in Medicine (AAPM) Task Group No. 43 Report in 1995 (TG-43), both the utilization of permanent source implantation and the number of low-energy interstitial brachytherapy source models commercially available have dramatically increased. In addition, the National Institute of Standards and Technology has introduced a new primary standard of air-kerma strength, and the brachytherapy dosimetry literature has grown substantially, documenting both improved dosimetry methodologies and dosimetric characterization of particular source models. In response to these advances, the AAPM Low-energy Interstitial Brachytherapy Dosimetry subcommittee (LIBD) herein presents an update of the TG-43 protocol for calculation of dose-rate distributions around photon-emitting brachytherapy sources. The updated protocol (TG-43U1) includes (a) a revised definition of air-kerma strength; (b) elimination of apparent activity for specification of source strength; (c) elimination of the anisotropy constant in favor of the distance-dependent one-dimensional anisotropy function; (d) guidance on extrapolating tabulated TG-43 parameters to longer and shorter distances; and (e) correction for minor inconsistencies and omissions in the original protocol and its implementation. Among the corrections are consistent guidelines for use of point- and line-source geometry functions. In addition, this report recommends a unified approach to comparing reference dose distributions derived from different investigators to develop a single critically evaluated consensus dataset as well as guidelines for performing and describing future theoretical and experimental single-source dosimetry studies. Finally, the report includes consensus datasets, in the form of dose-rate constants, radial dose functions, and one-dimensional (1D) and two-dimensional (2D) anisotropy functions, for all low-energy brachytherapy source models that met the AAPM dosimetric prerequisites [Med. Phys. 25, 2269 (1998)] as of July 15, 2001. These include the following 125I sources: Amersham Health models 6702 and 6711, Best Medical model 2301, North American Scientific Inc. (NASI) model MED3631-A/M, Bebig/Theragenics model I25.S06, and the Imagyn Medical Technologies Inc. isostar model IS-12501. The 103Pd sources included are the Theragenics Corporation model 200 and NASI model MED3633. The AAPM recommends that the revised dose-calculation protocol and revised source-specific dose-rate distributions be adopted by all end users for clinical treatment planning of low energy brachytherapy interstitial sources. Depending upon the dose-calculation protocol and parameters currently used by individual physicists, adoption of this protocol may result in changes to patient dose calculations. These changes should be carefully evaluated and reviewed with the radiation oncologist preceding implementation of the current protocol.