A dosimetry system for 192IR interstitial breast implants performed at the time of lumpectomy

Abstract

Purpose : 192Ir interstitial breast implants performed at the time of lumpectomy present a unique problem because they cannot be preplanned, and yet they are expected to produce a treatment dose rate (TDR) from 0.3 to 0.5 Gy/h using sources already procured. The purpose of this work is to describe a system of dosimetry that works within these constraints and has been used to perform more than 600 such implants. Methods and Materials : The underlying principle is to fix the ribbon spacing, the interplaner separation, and the linear activity (1 mCi/cm) so that the TDR will depend only on the area (L × W) implanted. The ribbons are spaced 1.5 cm and 2.0 cm apart in single plane and double implants, respectively. Idealized implants were used to study the TDR as a function of the implant dimensions, and to study the effects of varying the ribbon spacing and interplanar separation. Volume-dose histograms were generated to study the homogeneity of dose. Results : The TDRs of single plane implants range from 0.3 Gy/h for small 4 × 4 cm 2 implants to 0.4 Gy/h for large 10 × 10 cm 2 implants. The TDRs for double plane implants are similar for the same range of dimensions. Conclusions : Implants with a TDR between 0.3 and 0.5 Gy/h can be performed for a wide range of geometries without preplanning using fixed ribbons spacings of 1.5 and 2.0 cm for single and double plane implants, respectively, and a linear activity of 1 mCi/cm.