125I Sources Research Articles

A systematic evaluation of the dose-rate constant determined by photon spectrometry for 21 different models of low-energy photon-emitting brachytherapy sources

The aim of this study was to perform a systematic comparison of the dose-rate constant (Λ) determined by the photon spectrometry technique (PST) with the consensus value (CONΛ) recommended by the American Association of Physicists in Medicine (AAPM) for 21 low-energy photon-emitting interstitial brachytherapy sources. A total of 63 interstitial brachytherapy sources (21 different models with 3 sources per model) containing either 125I (14 models), 103Pd (6 models) or 131Cs (1 model) were included in this study. A PST described by Chen and Nath (2007 Med. Phys. 34 1412–30) was used to determine the dose-rate constant (PSTΛ) for each source model. Source-dependent variations in PSTΛ were analyzed systematically against the spectral characteristics of the emitted photons and the consensus values recommended by the AAPM brachytherapy subcommittee. The values of PSTΛ for the encapsulated sources of 103Pd, 125I and 131Cs varied from 0.661 to 0.678 cGyh−1 U−1, 0.959 to 1.024 cGyh−1U−1 and 1.066 to 1.073 cGyh−1U−1, respectively. The relative variation in PSTΛ among the six 103Pd source models, caused by variations in photon attenuation and in spatial distributions of radioactivity among the source models, was less than 3%. Greater variations in PSTΛ were observed among the 14 125I source models; the maximum relative difference was over 6%. These variations were caused primarily by the presence of silver in some 125I source models and, to a lesser degree, by the variations in photon attenuation and in spatial distribution of radioactivity among the source models. The presence of silver generates additional fluorescent x-rays with lower photon energies which caused the PSTΛ value to vary from 0.959 to 1.019 cGyh−1U−1 depending on the amount of silver used by a given source model. For those 125I sources that contain no silver, their PSTΛ was less variable and had values within 1% of 1.024 cGyh−1U−1. For the 16 source models that currently have an AAPM recommended CONΛ value, the agreement between PSTΛ and CONΛ was less than 2% for 15 models and was 2.6% for 1 103Pd source model. Excellent agreement between PSTΛ and CONΛ was observed for all source models that currently have an AAPM recommended consensus dose-rate constant value. These results demonstrate that the PST is an accurate and robust technique for the determination of the dose-rate constant for low-energy brachytherapy sources.

Sensitivity of low energy brachytherapy Monte Carlo dose calculations to uncertainties in human tissue composition

The objective of this work is to assess the sensitivity of Monte Carlo (MC) dose calculations to uncertainties in human tissue composition for a range of low photon energy brachytherapy sources: 125I, 103Pd, 131Cs, and an electronic brachytherapy source (EBS). The low energy photons emitted by these sources make the dosimetry sensitive to variations in tissue atomic number due to the dominance of the photoelectric effect. This work reports dose to a small mass of water in medium D(w,m) as opposed to dose to a small mass of medium in medium D(m,m). Mean adipose, mammary gland, and breast tissues (as uniform mixture of the aforementioned tissues) are investigated as well as compositions corresponding to one standard deviation from the mean. Prostate mean compositions from three different literature sources are also investigated. Three sets of MC simulations are performed with the GEANT4 code: (1) Dose calculations for idealized TG-43-like spherical geometries using point sources. Radial dose profiles obtained in different media are compared to assess the influence of compositional uncertainties. (2) Dose calculations for four clinical prostate LDR brachytherapy permanent seed implants using 125I seeds (Model 2301, Best Medical, Springfield, VA). The effect of varying the prostate composition in the planning target volume (PTV) is investigated by comparing PTV D90 values. (3) Dose calculations for four clinical breast LDR brachytherapy permanent seed implants using 103Pd seeds (Model 2335, Best Medical). The effects of varying the adipose/gland ratio in the PTV and of varying the elemental composition of adipose and gland within one standard deviation of the assumed mean composition are investigated by comparing PTV D90 values. For (2) and (3), the influence of using the mass density from CT scans instead of unit mass density is also assessed. Results from simulation (1) show that variations in the mean compositions of tissues affect low energy brachytherapy dosimetry. Dose differences between mean and one standard deviation of the mean composition increasing with distance from the source are observed. It is established that the 125I and 131Cs sources are the least sensitive to variations in elemental compositions while 103Pd is most sensitive. The EBS falls in between and exhibits complex behavior due to significant spectral hardening. Results from simulation (2) show that two prostate compositions are dosimetrically equivalent to water while the third shows D90 differences of up to 4%. Results from simulation (3) show that breast is more sensitive than prostate with dose variations of up to 30% from water for 70% adipose/30% gland breast. The variability of the breast composition adds a +/- 10% dose variation. Low energy brachytherapy dose distributions in tissue differ from water and are influenced by density, mean tissue composition, and patient-to-patient composition variations. The results support the use of a dose calculation algorithm accounting for heterogeneities such as MC. Since this work shows that variations in mean tissue compositions affect MC dosimetry and result in increased dose uncertainties, the authors conclude that imaging tools providing more accurate estimates of elemental compositions such as dual energy CT would be beneficial.

Monte Carlo investigation of energy response of various detector materials in ¹²⁵I and ¹⁶⁹Yb brachytherapy dosimetry.

Relative absorbed‐dose energy response correction R for different detector materials in water, PMMA and polystyrene phantoms are calculated using Monte Carlo‐based EGSnrc code system for I125 and Yb169 brachytherapy sources. The values of R obtained for I125 source are 1.41, 0.92, 3.97, 0.47, 8.32 and 1.10, respectively, for detector materials LiF, Li2B4O7,Al2O3, diamond, silicon diode and air. These values are insensitive to source‐to‐detector distance and phantom material. For Yb169 source, R is sensitive to source‐to‐detector distance for detector materials other than air and Li2B4O7. For silicon, R increases from 3 to 4.23 when depth in water is increased from 0.5 cm to 15 cm. For Yb169 source, the values of R obtained for air and Li2B4O7 in PMMA and polystyrene phantoms are comparable to that obtained in water. However, LiF, Si and Al2O3 show enhanced response and diamond shows decreased response in PMMA and polystyrene phantoms than in water.PACS number: 87.53.Jw

SU‐GG‐T‐438: Dose to Medium or Dose to a Water Cavity Embedded in Medium? A Monte Carlo Study

Purpose: The target for radiotherapy is to sterilize cells by imposing damage to their DNA content. It is therefore of interest to study the relations between the dose calculated to a tissue medium, Dm,m, with an representative average atomic composition versus the dose Dn,m specifically absorbed by the cell nuclei, and the dose Dw,m to a cell nuclei surrogate represented as a water cavity embedded into tissue. The simulations were performed for six types of tissues and three different brachytherapy sources. Methods and Materials: Absorbed dose calculations were performed by GEANT4 MC code version 9.2 using the Penelope physics package. Three different sources, 192Ir to represent high energy conditions, 169Yb for intermediate energies and a low energy brachytherapy source 125I, were simulated. The photon spectra used in this study were taken from http://www.physics.carleton.ca/clrp/seed_database. The 192Ir spectra was from Nucletron, microSelectron‐HDR v2 and for 125I from Nucletron, SelectSeed, 130.002. Particle spectra for 192Ir and energy spectra for 192I were also scored to calculate the dose with different cavity theories and compare it with MC calculated doses. Results: The MC calculated Dm,m, Dw,m and Dn,m ratio shows the largest value for 125I brachytherapy source and the cortical bone material, adipose tissue and prostate tissues(ICRU). The difference between Dw,m and Dn,m is also largest for the cortical bone and 125I source. For the 192Ir source, the ratio was 1 for the soft tissues while for the cortical bone it was higher. Conclusion: Monte Carlo calculations made it possible to report the dose as absorbed dose to medium. Accurate reporting of treatment planning requires a stringent standard for dose definition. MC calculations can be used to develop conversion factors to convert dose according to different definitions for different brachytherapy sources.

MO-EE-A1-04: A Generalized Dose-Rate Constant Formalism for Brachytherapy Sources Emitting Anisotropic Photon Energy Spectrum

Purpose: The aim of this work was to develop a generalized formalism for calculating the dose‐rate constant, A, of radioactive sources emitting anisotropicphoton energy spectra.Method and Materials: Although the Λ is defined on the transverse bisector of a brachytherapy source, its magnitude depends on both the primary photons emitted along the transverse bisector and the scatteredphotons arising from those primary photons emitted in other directions. For sources emitting nearly isotropic energy spectrum, the contribution of scatteredphotons can be taken into account easily by using Berger's energy‐buildup factor. For sources with anisotropicphoton emissions, a new dose‐rate deposition kernel for unidirectional photon sources of unit intensity and energy E was introduced. The dose‐rate produced by such a source at any location, r→, in water can then be determined by superposition of the angular photon energy spectrum with the dose‐deposition kernel. Results: A generalized formalism for Λ was obtained: Λ ≡ Ḋ(r→ 0 ) S k = ∑ i n(E i ;θ 0 ,φ 0 ) · E i · (μ en (E i )/ρ) air · Λ(E i ) ∑ i n(E i ;θ 0 ,φ 0 ) · E i · (μ en (E i )/ρ) air with Λ(E) = ∫ Ω n(E;θ s ,φ s ) n(E;θ 0 ,φ 0 ) k(r→ 0 ;E,θ s φ s ) E · (μ en (E)/ ρ) air dΩ s where k(r→; E, θ s , φ s ) is the dose‐rate‐deposition kernel with r→ denoting the dose‐rate deposition site and (θs, φs) the orientation of an unidirectional source, n(E; θ s , φ s ) is the number of photons emitted in the (θs, φs) direction, and μ en (E)/ ρ) air is the mass energy absorption coefficient of air. The subscript 0 denotes the reference point of Λ. This formalism exhibits two unique features essential for accurate Λ calculation: 1) it only requires relative photon energy spectra and 2) it does not depend on the methodology used in the determination of dose‐deposition kernels or angular energy spectra.Conclusion: A generalized formalism, based on the dose deposition kernels of mono‐energetic unidirectional photon sources, has been developed for calculating the Λ of low‐energy brachytherapy sources. In addition, this formalism can also be used in the calculation of other dosimetry parameters for interstitial brachytherapy sources. Numerical testing of this formalism for some 125I, 103Pd, and 131Cs sources will be presented.

A radiobiological investigation on dose and dose rate for permanent implant brachytherapy of breast using 125I or 103Pd sources.

The present report addresses the question of what could be the appropriate dose and dose rate for 125I and 103PD permanent seed implants for breast cancer as monotherapy for early stage breast cancer. This is addressed by employing a radiobiological methodology, which is based on the linear quadratic model, to identify a biologically effective dose (BED) to the prescription point of the brachytherapy implant, which would produce equivalent cell killing (or same cell survival) when compared to a specified external radiotherapy scheme. In the present analysis, the tumor and normal tissue BED ratios of brachytherapy and external radiotherapy are examined for different combinations of tumor proliferation constant (K), alpha/beta ratios, initial dose rate (R0), and reference external radiotherapy scheme (50 or 60 Gy in 2 Gy per fraction). The results of the radiobiological analysis are compared against other reports and clinical protocols in order to examine possible opportunities of improvement. The analysis indicates that physical doses of approximately 100-110 Gy delivered with an initial dose rate of around 0.05 Gyh(-1) and 78-80 Gy delivered at 0.135 Gyh(-1) for 125I and 103Pd permanent implants, respectively, are equivalent to 50 Gy external beam radiotherapy (EBRT) in 2 Gy per fraction. Similarly, for physical doses of approximately 115-127 Gy delivered with an initia dose rate of around 0.059 Gyh(-1) and 92 Gy delivered at 0.157 Gyh(-1) for 125I and 103Pd, respectively, are equivalent to 60 Gy EBRT in 2 Gy per fraction. It is shown that the initial dose rate required to produce isoeffective tumor response with 50 or 60 Gy EBRT in 2 Gy per fraction increases as the repopulation factor K increases, even though repopulation is also considered in EBRT. Also, the initial dose rate increases as the value of the alpha/beta ratio decreases. The impact of the different alpha/beta ratios on the ratio of the tumor BEDs is significantly large for both the 125I and 103Pd implants with the deviation between the alpha/beta = 10.0 Gy ratios and those using the 4.0 and 3.5 Gy values ranging between 18% and 22% in most of the cases. For the cases of 125I and 103Pd, the equivalent physical doses to 50 Gy EBRT in 2 Gy per fraction are associated with an overdosage of the involved normal tissue in the range of 4%-16% and an underdosage by 10%-15% for a BED for normal tissue, using an alpha/beta value of 3.0 Gy (BEDNT,3 Gy) of 100 Gy. These values are lower by 10%-20% than the published value of 124 Gy for 125I and by about 13% when compared to the published isoeffective dose of 90 Gy for 103Pd. Similarly, the equivalent physical doses to 60 Gy EBRT in 2 Gy per fraction are associated with an overdosage of the involved normal tissue by 10%-20% and an underdosage by 4%-10% for BEDNT,3 Gy of 110 Gy.

A comprehensive dosimetric comparison between 131Cs and 125I brachytherapy sources for COMS eye plaque implant

Purpose To verify the dosimetric characteristics of 131Cs source in the Collaborative Ocular Melanoma Study (COMS) eye plaque brachytherapy, to compare 131Cs with 125I in a sample implant, and to examine the accuracy of treatment planning system in dose calculation. Methods and Materials Monte Carlo (MC) technique was used to generate three-dimensional dose distributions of a 16-mm COMS eye plaque loaded with 131Cs and 125I brachytherapy sources separately. A spherical eyeball, 24.6 mm in diameter, and an ellipsoidal tumor, 6 mm in height and 12 mm in diameter, were used to evaluate the doses delivered. The simulations were carried out both with and without the gold and gold alloy plaque. A water-equivalent seed carrier was used instead of the silastic insert designed for the traditional COMS eye plaque. The 13 sources involved were also individually simulated to evaluate the intersource effect. In addition, a treatment planning system was used to calculate the doses at the central axis for comparison with MC data. Results The gold plaque had significantly reduced the dose in the tumor volume; at the prescription point of this study, that is, 6 mm from the edge of inner sclera, the gold plaque reduced the dose by about 7% for both types of 131Cs and 125I sources, but the gold alloy plaque reduced the dose only by 4% for both types of sources. The intersource effect reduced the dose by 2% for both types of sources. At the same prescription dose, the treatment with the gold plaque applicator tended to create more hot regions for either type of sources than were seen with the homogeneous water phantom. The doses of TPS agree with the MC. Conclusion The 131Cs source is comparable to the 125I source in the eye plaque brachytherapy. The TPS can provide accurate dose calculations for eye plaque implants with either type of sources.

AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: report of Task Group 137.

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.

The dosimetric feasibility of gold nanoparticle-aided radiation therapy (GNRT) via brachytherapy using low-energy gamma-/x-ray sources

The preferential accumulation of gold nanoparticles within tumors and the increased photoelectric absorption due to the high atomic number of gold cooperatively account for the possibility of significant tumor dose enhancement during gold nanoparticle-aided radiation therapy (GNRT). Among the many conceivable ways to implement GNRT clinically, a brachytherapy approach using low-energy gamma-/x-ray sources (i.e. Eavg < 100 keV) appears to be highly feasible and promising, because it may easily fulfill some of the technical and clinical requirements for GNRT. Therefore, the current study investigated the dosimetric feasibility of implementing GNRT using the following sources: 125I, 50 kVp and 169Yb. Specifically, Monte Carlo (MC) calculations were performed to determine the macroscopic dose enhancement factors (MDEF), defined as the ratio of the average dose in the tumor region with and without the presence of gold nanoparticles during the irradiation of the tumor, and the photo/Auger electron spectra within a tumor loaded with gold nanoparticles. The current study suggests that a significant tumor dose enhancement (e.g. >40%) could be achievable using 125I, 50 kVp and 169Yb sources and gold nanoparticles. When calculated at 1.0 cm from the center of the source within a tumor loaded with 18 mg Au g−1, macroscopic dose enhancement was 116, 92 and 108% for 125I, 50 kVp and 169Yb, respectively. For a tumor loaded with 7 mg Au g−1, it was 68, 57 and 44% at 1 cm from the center of the source for 125I, 50 kVp and 169Yb, respectively. The estimated MDEF values for 169Yb were remarkably larger than those for 192Ir, on average by up to about 70 and 30%, for 18 mg Au and 7 mg Au cases, respectively. The current MC study also shows a remarkable change in the photoelectron fluence and spectrum (e.g. more than two orders of magnitude) and a significant production (e.g. comparable to the number of photoelectrons) of the Auger electrons within the tumor region due to the presence of gold nanoparticles during low-energy gamma-/x-ray irradiation. The radiation sources considered in this study are currently available and tumor gold concentration levels considered in this investigation are deemed achievable. Therefore, the current results strongly suggest that GNRT can be successfully implemented via brachytherapy with low energy gamma-/x-ray sources, especially with a high dose rate 169Yb source.

SU‐FF‐T‐290: A Practical Method of Composition Ratio QA for 103Pd and 125I Hybrid Seeds: Derivation and Monte Carlo Verification

Purpose: In prostate cancer treatment, Brachytherapy using radioactive seeds of 125I or 103Pd is a common practice. Studies using the concept of BED have shown that it would be beneficial to treat prostate cancer with mixture of radioactive seeds of isotopes with different half‐lives. Commercially, the technology to manufacture multi‐isotope seeds has been developed by IsoAid LLC (IsoAid, Port Richey, FL). To be used clinically, a method of QA regarding the composition ratios of the hybrid sources must be developed in addition to other physical quantities QA. Method and Materials: The difference in energy spectra between 125I and 103Pd determines that the attenuation of the two isotope components is different when the γ‐rays passing through the same material. Thus for hybrid sources, the attenuation magnitude through a certain thickness of a certain material depends on the composition ratio. Simple methods were derived based on attenuation measurements using a cylindrical chamber or well chamber. Monte Carlo simulations were performed to verify the methods. Doses at 1 cm depth in water were calculated with and without attenuation materials for pure 125I and 103Pd sources and hybrid sources of different composition ratios. Different measurement settings using a well chamber or cylindrical chamber were simulated. The energy spectra of the radioisotopes that were used in TG‐43 were used in the Monte Carlo calculations. Results: Monte Carlo simulations verified that the method based on attenuation measurement is accurate and practical. Corrections for measurement depth variation and measurement time are discussed. If the measurement depth is 0.5 mm off, the error of the composition ratio can be up to 1.6%. The advantages/disadvantages of different measurement techniques using a cylindrical chamber or well chamber are presented. Conclusions: composition ratios of hybrid seeds can be determined by attenuation measurement method presented in this work.

A dosimetric comparison of the model 6711 125I source and a new, smaller diameter brachytherapy seed (model 9011) using Monte Carlo methods

Purpose: Immediately after needle placement for transrectal ultrasound-guided permanent prostate brachytherapy, significant prostate swelling (i.e., edema) occurs. This surgical trauma may be minimized by using smaller diameter needles. To evaluate this, a new 125I source (model 9011) has been designed with a smaller diameter and subsequently 57% smaller cross-sectional area. The purpose of this study is to determine the brachytherapy dosimetry parameters needed for treatment planning preceding clinical implementation, and to compare to the model 6711 125I source.

Preliminary Research of Tissue Heterogeneity Correction for Dose Distribution of 125I Brachytherapy Source

Tissue heterogeneity is commonly observed in clinical brachytherapy source implants. In some cases, an obvious variance in dose distribution will be caused by application of the AAPM recommended formulas, which are only valid for a homogeneous medium. By taking soft tissue as the base and considering adipose, air and bone as the separate interlayers, an evaluation model is established and dose correction formulas are derived for a single 125I source in this study. The applicability of correction formulas is validated at different interlayer thicknesses and angles by Monte Carlo (MCNP 4C) simulations. The results show fairly good agreement between correction formulas and MC simulations with overall maximum variances of 1.62 ± 0.06, 5.93 ± 0.23, and 8.41 ± 0.33% for adipose, air, and bone, respectively.

Development of a new design 125I-brachytherapy seed for its application in the treatment of eye and prostate cancer

Palladium coated silver beads of 0.5 mm (∅) were used to adsorb 125I and encapsulated inside a titanium capsule by Nd:YAG laser, for use as a brachytherapy source. Experimental conditions were optimized for maximum adsorption of 125I and uniformity of radioactivity was ascertained. Leachability of 125I was found to be<0.01%. The dose rate constant of the new source was estimated to be 1.045 cGy h −1 U −1. This newly developed source could be an alternative to other 125I sources.

Robotic Brachytherapy of the Prostate

Recent applications of robotics in the field of prostate brachytherapy are seeding the future and could potentially lead to a fully automated prostate brachytherapy surgery. Currently, a typical prostate brachytherapy surgery involves the implantation of upwards of 100 radioactive I-125 seeds by a surgeon. This review supplies background information on prostate biology, brachytherapy of the prostate, robotic brachytherapy, and transrectal ultrasound. Subsequently, it examines the physics involved in ultrasound, radiation from an I-125 source, dosimetry, and robotics. A current semi-automated robotic brachytherapy system is examined in detail and a discussion on future improvements is outlined. Finally, future work to improve prostate brachytherapy is postulated, most notably, phantom optimization using polyvinyl alcohol cryogel. The future of robotic brachytherapy lies in the advent of more sophisticated robotics. This review will give the reader a superior understanding of brachytherapy and its recent robotic advancements. Hopefully, this review will generate new ideas needed to advance prostate brachytherapy procedures leading to more accurate dosimetry, faster procedure time, less ionizing radiation received by surgery staff, more rapid patient recovery, and an overall safer procedure.

Evaluation of Dosimetric Parameters and Disease Response After 125Iodine Transperineal Brachytherapy for Low- and Intermediate-Risk Prostate Cancer

To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and "low-tier" intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi 125I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% +/- 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p < 0.001), but this did not translate into improved bNED. In contrast to some previous studies, dosimetric outcomes did not correlate with biochemical recurrence in the first 1,006 patients treated with 125I prostate brachytherapy at the British Columbia Cancer Agency. Despite a median D90 of only 105% of MPD, our bNED rates are indistinguishable from series that reported higher D90 values.

An experimental palladium‐103 seed in a biocompatible polymer without a gold marker: Characterization of dosimetric parameters including the interseed effect

Permanent implantation of 125I (iodine) or 103Pd (palladium) sources is a popular treatment option in the management of early stage prostate cancer. New sources are being developed, some of which are being marketed for different clinical applications. A new technique of adjuvant stereotactic permanent seed breast implant, similar to that used in the treatment of prostate cancer, has been proposed by [N. Jansen et al., Int. J. Radiat. Oncol. Biol. Phys. 67, 1052-1058 (2007)] with encouraging results. The presence of artifacts from the metallic seeds, however, can disturb follow-up imaging. The development of plastic seeds has reduced these artifacts. This paper presents a feasibility study of the advantages of palladium-103 seeds, encapsulated with a biocompatible polymer, for future clinical applications, and on the effect of the gold marker on the dosimetric characteristics of such seeds. Experimental palladium seeds, OptiSeedexp, were manufactured by International Brachytherapy (IBt), Seneffe, Belgium, from a biocompatible polymer, including the marker. Apart from the absence of a gold marker, the studied seed has an identical design to the OptiSeed103 [Phys. Med. Biol. 50, 1493-1504 (2005)]; [Appl. Radiat. Isot. 63, 311-321 (2005)]. Polymer encapsulation was preferred by IBt in order to reduce the quantity of radioactive material needed for a given dose rate and to reduce the anisotropy of the radiation field around the seed. In addition, this design is intended to decrease the interseed effects that can occur as a result of the marker and the encapsulation. Dosimetric measurements were performed using LiF thermoluminescent dosimeters (1 mm3) in solid water phantoms (WT1). Measured data were compared to Monte Carlo simulated data in solid water using the MCNP code, version 4C. Updated cross sections [Med. Phys. 30, 701-711 (2003)] were used. As the measured and calculated data were in agreement, Monte Carlo calculations were then performed in liquid water to obtain relevant dosimetric data as required by TG-43U1 recommendations. Comparison of the results with previous studies of OptiSeed103 [Phys. Med. Biol. 50, 1493-1504 (2005)]; [Appl. Radiat. Isot. 63, 311-321 (2005)], and of InterSource103 [Appl. Radiat. Isot. 57, 805-811 (2002)] showed very good agreement for the dose rate constant and for the radial dose function. With respect to the anisotropy function, the relative dose (anisotropy value relative to 90 degrees) from the polymer seed at a distance of 3 cm was close to unity (105%) at 0 degrees, whereas the relative values for the OptiSeed103 with a gold marker and the titanium-encapsulated InterSource103 seed decreased to 70% and 40%, respectively. The interseed effect from one seed was negligible and in the order of calculation uncertainty, making calculation of the dose rate distribution of the studied seeds, according to TG43U1 recommendations, more accurate and closer to reality. This feasibility study shows that due to the low energy of palladium-103, the negligible interseed effect and the reduced artifacts in postimplant medical imaging, this experimental plastic seed would be a good source for breast brachytherapy. This feasibility study was carried out in collaboration with IBt and will be continued with a study of its visibility in different tissues.

A Dual Scintillator - Dual Silicon Photodiode Detector Module for Intraoperative Gamma\\Beta Probe and Portable Anti-Compton Spectrometer

A new approach has been investigated for the miniaturization and simplification of intraoperative gamma and beta probes that have recently found application in radioguided surgery and sentinel lymph node biopsy. The probe design that is based on dual annular scintillators coupled to specially designed silicon concentric dual photodiode (CDPD). This approach allows us to avoid fiber optics coupling and PMTs. Two channels readout front-end electronics including shaper amplifier attached directly to the back of the detector module has been proposed. Two geometries of Si dual photodiodes coupled to CsI(Tl) annular scintillators with light masking between them were fabricated and investigated. CDPDs have size 10 and 6 mm as well as 6 and 3 mm outer and inner diameters respectively. The spectroscopy properties of CDPD separately and coupled to CsI(Tl) dual scintillator were investigated on I-125, Co-57 and Na-22 photon sources. Both detectors have demonstrated acceptable energy resolution (10% for 511-keV) for the proposed application with FDG isotopes. In the smaller detector the amplitude of the 511 keV photopeak from outer detector was less than in inner and is related to the light collection in the current geometry. When used in coincidence mode operation we observe a significant reduction in the measured Compton continuum level relative to the photopeak which is not significantly attenuated. The spatial resolution of detector module measured in the horizontal plane was 2-mm FWHM using a 0.5-mm collimated Tc-99m source.

Dosimetry and treatment planning of Occu-Prosta I-125 seeds for intraocular lesions.

Intraocular malignant lesions are frequently encountered in clinical practice. Plaque brachytherapy represents an effective means of treatment for intraocular lesions. Recently Radiopharmaceutical Division, BARC, Mumbai, has indigenously fabricated reasonable-cost I-125 sources. Here we are presenting the preliminary experience of dosimetry of sources, configuration of treatment planning system (TPS) and quality assurance (QA) for eye plaque therapy with Occu-Prosta I-125 seeds, treated in our hospital, for a patient with ocular lesions. I-125 seeds were calibrated using well-type chamber. BrachyVision TPS was configured with Monte Carlo computed radial dose functions and anisotropy functions for I-125 sources. Dose calculated by TPS at different points in central axis and off axis was compared with manually calculated dose. Eye plaque was fabricated of 17 karat pure gold, locally. The seeds were arranged in an outer ring near the edge of the plaque and in concentric rings throughout the plaque. The sources were manually digitized on the TPS, and dose distribution was calculated in three dimensions. Measured activity using cross-calibrated well-type chamber was within ±10% of the activity specified by the supplier. Difference in TPS-calculated dose and manually calculated dose was within 5%. Treatment time calculated by TPS was in concordance with published data for similar plaque arrangement.

The use of teeth as the site for the in vivo or ex vivo quantification of skeletal strontium by energy-dispersive X-ray fluorescence spectrometry: A feasibility study

The use of an energy-dispersive X-ray fluorescence spectrometry (EDXRF) system equipped with an 125I source was validated for in vivo and ex vivo quantification of strontium in human teeth. The mean concentration of enamel strontium for an area with a high influx of immigration (Toronto, Ontario, Canada) is also reported. It was found that the mass attenuation of the strontium and calcium X-rays allows for a probing depth of 1.8 mm (Sr Kα) allowing the front central incisors to act as the site for the in vivo or ex vivo quantification of strontium as well as for molars to be used ex vivo for the quantification of enamel strontium. The calcium signal for all teeth studied (n = 42) was found to have a relative standard deviation of 5.7% which allowed for successful normalization of the strontium signal to that of calcium. Validation of the EDXRF method was performed on human molars (enamel thickness of (1.9 ± 0.7) mm, p < 0.05), by graphite furnace atomic absorption spectrometry (GFAAS). The EDXRF method was found to produce equivalent strontium determinations to that of GFAAS (p < 0.05). Our results also demonstrate that for a sample from a large metropolitan area, the fresh enamel strontium concentrations range from 42–301 ppm with a mean strontium concentration of (169 ± 80) ppm (p < 0.05).

The use of directional interstitial sources to improve dosimetry in breast brachytherapy

The purposes of this study were to investigate the feasibility of improving dosimetry with temporary low-dose-rate (LDR) multicatheter breast implants using directional 125I (iodine) interstitial sources and to provide a comparison of a patient treatment plan to that achieved by conventional high-dose-rate (HDR) interstitial breast brachytherapy. A novel 125I source emitting radiation in a specified direction has been developed. The directional sources contain an internal radiation shield that greatly reduces the intensity of radiation in the shielded direction. The sources have a similar dose distribution to conventional nondirectional sources on the unshielded side. The treatment plan for a patient treated with HDR interstitial brachytherapy with 192Ir (iridium) was compared with a directional 125I treatment plan using the same data set. Several dosimetric parameters are compared including target volume coverage, volume receiving 50%, 100%, and 150% of the prescription dose (V50, V100, and V150, respectively), dose homogeneity index (DHI), and the skin surface areas receiving 30%, 50%, and 80% of the prescription dose (S30, S50, and S80, respectively). The HDR and LDR prescription doses were 34 Gy in ten fractions delivered over five days and 45 Gy in 108 h, respectively. Similar and excellent target volume coverage was achieved by both directional LDR and HDR plans (99.2% and 97.5%, respectively). For a 170 cm3 target volume, the dosimetric parameters were similar for LDR and HDR: DHI was 0.82 in both cases, V100 was 214.4 cm3 and 225.7 cm3, and V150 was 39.1 cm3 and 40.4 cm3, respectively. However, with directional LDR, significant reductions in skin dose were achieved: S30 was reduced from 100.6 to 62.5 cm2, S50 from 50.6 to 16.1 cm2, and S80 from 2 cm2 to zero. The reduction in V50 for the whole breast was more than 100 cm3 (386.1 cm3 for LDR versus 489.2 cm3 for HDR). In this case study, compared with HDR, directional interstitial LDR 125I sources allow similar dose coverage to the subcutaneous target volume while lowering the skin dose due to a more conformal dose distribution and quicker falloff beyond the target. The improved dose distribution provided by directional interstitial brachytherapy might enable partial breast treatment to tumors closer to the skin or chest wall or in relatively small breasts.