Automated air kerma strength quality assurance of permanent seed implant prostate brachytherapy sources using vendor autoradiographs.

Purpose: To develop a novel quality assurance (QA) program to determine the air kerma strength (AKS) of brachytherapy seeds within preloaded needles using autoradiographs alone, without jeopardizing sterility or necessitating procedural changes either by the vendor or in the operating room.
Methods and Materials: Digital autoradiographs of QA seed orders and sterile preloaded needles were acquired. Regions of interest of each preloaded seed were determined through an iterative scanning process identifying changes from background levels to radioactivity exposure. Average exposure values through the center of each region of interest were fitted with a Gaussian curve and Full Width at Half Maximums (FWHMs) were calculated. The two-dimensional exposure-scaled FWHM (Exp _2D ) measurements for the QA seed orders were plotted against measured AKS values and related using a linear curve fit that was adjusted using the third-party assay average AKS and applied as a calibration curve to convert Exp _2D to AKS.
Results: Estimated seed AKS was found to have a strong dependence on position within the holding tray because of imager positioning inconsistencies. Calculated seed AKS for patient-specific seed orders using the curve scaling factor varied from the nominal order AKS by 1.1 ± 0.9% and from the third-party assay measurements by 0.0 ± 0.4%.
Conclusions: This work depicts a clinically useful tool to aid in QA of preloaded brachytherapy permanent seed implant needles without compromising sterility or increasing clinical workloads. With this procedure, each individual seed's AKS can be verified automatically before a patient's scheduled implant or retroactively when auditing patient records.
(Copyright © 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)