PO18: An Efficient and Reproducible Autoradiography Technique for HDR-Gynecological Applicators Commissioning

Abstract

<h3>Purpose</h3> High Dose Rate (HDR) brachytherapy commissioning of Elekta's gynecological (Gyn) applicator sets include a large inventory of CT/MR compatible plastic, applicator tubes of varying shapes and sizes. This often present a challenge to the efficiency of source autoradiography - an essential test to determine and verify final dwell position of the HDR source and its positioning/stepping accuracy. We present a technique of acquiring radiograph-autoradiograph combinations of HDR-Gyn applicators that allows testing of several applicators simultaneously, in a rigid and reproducible set-up. <h3>Materials Methods</h3> Elekta provides x-ray catheter (marker) sets as a required accessory to verify source positioning inside Gyn applicators. Once the markers are calibrated & Final Marker Position (FMP) characterized, using Elekta's Source Position Check Ruler & CT-scans, the technique of radiograph-autoradiograph superposition is recommended for determination of final dwell position (FDP) & verification of source positioning accuracy. To ensure a rigid & reproducible set-up, template trays to hold multiple applicator tubes & Gafochromic EBT3 film for recording multiple radiographs in unison were built using Styrofoam. Channels were carved in styrofoam creating tight narrow groves fitting applicators in place. Applicators were taped with tips laid flat & flush with the film secured to styrofoam base independently. Primary advantage of using styrofoam is that it offers no backscatter to radiography as well as gamma photons from the Ir-192 source. Additionally, it is readily available and easy to work with. Each tray held 4-6 applicators with markers allowing a simultaneous radiograph acquisition, &∼ 5 cm lateral spacing enabled independent images. Truebeam^TM Linear accelerator was used for radiography. Multiple pre-prepared template trays with applicators were exposed at a source-to-film-distance of 100 cm with 400 monitor units using 2.5 MV imaging beam. This technique provided best visualization of the plastic applicator & marker on a gafochromic EBT3 film. Once the multiple-applicator-radiograph is acquired, templates were transported to adjacent HDR suite, set on a rigid couch, markers carefully removed & transfer tube connected for acquisition of autoradiograph coincident with recently acquired radiograph, using Flexitron afterloader. For Ir-192 source's autoradiograph, a 10-15 seconds dwell time is adequate to darken film with marker visualization reasonably intact for analysis. Pre-prepared templates and availability of personnel allowed simultaneous use of linear accelerator & afterloader, for radiograph & autoradiograph acquisition, adding further efficiency. Source positioning & stepping accuracy was verified by coincidence of center of darkening at the exposed dwell-position & center of visualized markers, on a viewbox illuminator. <h3>Results</h3> Using techniques and workflow developed, 60 CT/MR compatible HDR-Gyn plastic applicators were commissioned. Autoradiography-radiography superposition with x-ray markers enabled verification of Elekta specified distances between the outer tip of the IU/ovoid tubes, inner tip & the final dwell position, & HDR source positioning & stepping accuracy within 1 mm. Figure 1-A shows Styrofoam templates with multiple channels for affixing applicators over EBT3 Gafochromic film for radiography, 1-B is HDR room setup for autoradiography and 1-C shows images of multiple different applicator tubes depicting the radiograph-autoradiograph overlay with marker visualization and HDR source positioning. <h3>Conclusion</h3> We present an efficient autoradiography technique for commissioning of a large inventory HDR-Gyn plastic applicators using a linear accelerator & HDR afterloader.