Absorbed Dose Distribution Research Articles

Dosimetry for nonuniform activity distributions: A method for the calculation of 3D absorbed‐dose distribution without the use of voxel S‐values, point kernels, or Monte Carlo simulations

Nonuniform activity within the target lesions and the critical organs constitutes an important limitation for dosimetric estimates in patients treated with tumor-seeking radiopharmaceuticals. The tumor control probability and the normal tissue complication probability are affected by the distribution of the radionuclide in the treated organ/tissue. In this paper, a straightforward method for calculating the absorbed dose at the voxel level is described. This new method takes into account a nonuniform activity distribution in the target/organ. The new method is based on the macroscopic S-values (i.e., the S-values calculated for the various organs, as defined in the MIRD approach), on the definition of the number of voxels, and on the raw-count 3D array, corrected for attenuation, scatter, and collimator resolution, in the lesion/organ considered. Starting from these parameters, the only mathematical operation required is to multiply the 3D array by a scalar value, thus avoiding all the complex operations involving the 3D arrays. A comparison with the MIRD approach, fully described in the MIRD Pamphlet No. 17, using S-values at the voxel level, showed a good agreement between the two methods for (131)I and for (90)Y. Voxel dosimetry is becoming more and more important when performing therapy with tumor-seeking radiopharmaceuticals. The method presented here does not require calculating the S-values at the voxel level, and thus bypasses the mathematical problems linked to the convolution of 3D arrays and to the voxel size. In the paper, the results obtained with this new simplified method as well as the possibility of using it for other radionuclides commonly employed in therapy are discussed. The possibility of using the correct density value of the tissue/organs involved is also discussed.

Absorbed dose simulations in near-surface regions using high dose rate Iridium-192 sources applied for brachytherapy

Brachytherapy treatment with Iridium-192 high dose rate (HDR) sources is widely used for various tumours and it could be developed in many anatomic regions. Iridium-192 sources are inserted inside or close to the region that will be treated. Usually, the treatment is performed in prostate, gynaecological, lung, breast and oral cavity regions for a better clinical dose coverage compared with other techniques, such as, high energy photons and Cobalt-60 machines. This work will evaluate absorbed dose distributions in near-surface regions around Ir-192 HDR sources. Near-surface dose measurements are a complex task, due to the contribution of beta particles in the near-surface regions. These dose distributions should be useful for non-tumour treatments, such as keloids, and other non-intracavitary technique. For the absorbed dose distribution simulations the Monte Carlo code PENELOPE with the general code penEasy was used. Ir-192 source geometry and a Polymethylmethacrylate (PMMA) tube, for beta particles shield were modelled to yield the percentage depth dose (PDD) on a cubic water phantom. Absorbed dose simulations were realized at the central axis to yield the Ir-192 dose fall-off along central axis. The results showed that more than 99.2% of the absorbed doses (relative to the surface) are deposited in 5cm depth but with slower rate at higher distances. Near-surface treatments with Ir-192 HDR sources yields achievable measurements and with proper clinical technique and accessories should apply as an alternative for treatment of lesions where only beta sources were used.

Monte Carlo modeling of converging small-field contrast-enhanced radiotherapy of prostate

Radiation therapy using a kilovoltage X-ray source to irradiate a target previously loaded with a radiological contrast agent, contrast-enhanced radiotherapy (CERT), has been shown both theoretically and in a preliminary experimental study to represent a potential alternative to high-energy treatments. It has also been shown, however, to produce an integral dose that can be up to twice that resulting from a conventional megavoltage treatment. In this work, using a realistic patient model and Monte Carlo simulation, a CERT prostate treatment plan is designed that makes use of a plurality of small circular beams aimed at the target in such a way as to minimize the radiological trajectory to the target volume. Gold nanoparticles are assumed to be the contrast agent. Two cases are examined, one with a concentration level in the target of 10 mg-Au per gram of tissue and the second with a concentration of 3 mg-Au per gram of tissue in the target. A background concentration of 1 mg of contrast agent per gram of tissue was assumed everywhere else in both cases. The Cimmino feasibility algorithm was then used to find each beam weight in order to obtain the prescribed target dose, set at 72 Gy to 100% of the tumor volume. It is shown that the approach using the small circular fields, a radiosurgery treatment, produces treatment plans with excellent absorbed dose distributions while at the same time it reduces by up to 60% the non-tumor integral dose imparted to the irradiated subject. A brief discussion on the technology necessary to clinically implement this treatment modality is also presented.

EQUIVALENT UNIFORM DOSE SENSITIVITY TO CHANGES IN ABSORBED DOSE DISTRIBUTION

Treatment planning in external beam radiation therapy (EBRT) utilizes dose volume histograms (DVHs) as optimization and evaluation tools. They present the fraction of planning target volume (PTV) receiving more than a given absorbed dose, against the absorbed dose values, and a number of radiobiological indices can be computed with their help. Equivalent uniform dose (EUD) is the absorbed dose that, uniformly imparted, would yield the same biological effect on a tumor as the dose distribution described by the DVH. Uncertainty and missing information can affect the dose distribution, therefore DVHs can be modeled as samples from a set of possible outcomes. This work studies the sensitivity of the EUD index when a small change in absorbed dose distribution takes place. EUD is treated as a functional on the set of DVHs. Defining a Lévy distance on this set and using a suitable expansion of the functional, a very simple expression for a bound on the variation of EUD when the dose distribution changes is found. This bound is easily interpreted in terms of standard treatment planning practice.

Review on the Pre-treatment Quality Assurance for Intensity Modulated Radiation Therapy

This review paper deals with the current statues of pre-treatment quality assurance conducted for Intensity modulated radiation therapy. Focusing on the issues relevant to two-dimensional verification of absorbed dose distribution, review was made for the papers published during the last 3∼4 years. Lastly, the future development direction was projected. 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Anatomy-based volumetric modulated arc therapy for a prostate cancer patient with a hip prosthesis

Anatomy-based volumetric modulated arc therapy for a prostate cancer patient with a hip prosthesis

Microdosimetric calculation of relative biological effectiveness for design of therapeutic proton beams.

The authors attempt to establish the relative biological effectiveness (RBE) calculation for designing therapeutic proton beams on the basis of microdosimetry. The tissue-equivalent proportional counter (TEPC) was used to measure microdosimetric lineal energy spectra for proton beams at various depths in a water phantom. An RBE-weighted absorbed dose is defined as an absorbed dose multiplied by an RBE for cell death of human salivary gland (HSG) tumor cells in this study. The RBE values were calculated by a modified microdosimetric kinetic model using the biological parameters for HSG tumor cells. The calculated RBE distributions showed a gradual increase to about 1cm short of a beam range and a steep increase around the beam range for both the mono-energetic and spread-out Bragg peak (SOBP) proton beams. The calculated RBE values were partially compared with a biological experiment in which the HSG tumor cells were irradiated by the SOBP beam except around the distal end. The RBE-weighted absorbed dose distribution for the SOBP beam was derived from the measured spectra for the mono-energetic beam by a mixing calculation, and it was confirmed that it agreed well with that directly derived from the microdosimetric spectra measured in the SOBP beam. The absorbed dose distributions to planarize the RBE-weighted absorbed dose were calculated in consideration of the RBE dependence on the prescribed absorbed dose and cellular radio-sensitivity. The results show that the microdosimetric measurement for the mono-energetic proton beam is also useful for designing RBE-weighted absorbed dose distributions for range-modulated proton beams.

DIAGNOSTIC REFERENCE LEVEL ARISING FROM DENTAL PANORAMIC RADIOGRAPHY

Introduction The present work describes a study in which, based on patient dose measurements, thermoluminescent dosimeters were used to obtain the diagnostic reference level arising from panoramic radiography. Materials and Methods Ten panoramic units and a sample of 15 patients per X-ray unit were studied. Two thermoluminescent dosimeter chips were placed on the skin surface of selected organs. Mean value of two ESDs was taken as the measured representation dose at the point of interest. Results Mean ESD on parotid glands derived from panoramic radiography was equal to 369.2 µGy. Individual patients' dose value varied from 180.1 to 470.3 µGy. Conclusion Third quartile of mean absorbed dose distribution arising from a particular examination has been adopted as diagnostic reference level. Based on this definition, local diagnostic reference level arising from panoramic radiography of the greater Khorasan province is equal to 400 µG.

Gamma irradiation of cultural artifacts for disinfection using Monte Carlo simulations

In this study, it has been investigated the disinfection of Korean cultural artifacts by gamma irradiation, simulating the absorbed dose distribution on the object with the Monte Carlo methodology. Fungal contamination was identified on two traditional Korean agricultural tools, Hongdukkae and Holtae, which had been stored in a museum. Nine primary species were identified from these items: Bjerkandera adusta, Dothideomycetes sp., Penicillium sp., Cladosporium tenuissimum, Aspergillus versicolor, Penicillium sp., Entrophospora sp., Aspergillus sydowii, and Corynascus sepedonium. However, these fungi were completely inactivated by gamma irradiation at an absorbed dose of 20kGy on the front side. Monte Carlo N Particle Transport Code was used to simulate the doses applied to these cultural artifacts, and the measured dose distributions were well predicted by the simulations. These results show that irradiation is effective for the disinfection of cultural artifacts and that dose distribution can be predicted with Monte Carlo simulations, allowing the optimization of the radiation treatment.

Geant4-DICOM Interface-based Monte Carlo Simulation to Assess Dose Distributions inside the Human Body during X-Ray Irradiation

This study uses digital imaging and communications in medicine (DICOM) files acquired after CT scan to obtain the absorbed dose distribution inside the body by using the patient's actual anatomical data; uses geometry and tracking (Geant)4 as a way to obtain the accurate absorbed dose distribution inside the body. This method is easier to establish the radioprotection plan through estimating the absorbed dose distribution inside the body compared to the evaluation of absorbed dose using thermo-luminescence dosimeter (TLD) with inferior reliability and accuracy because many variables act on result values with respect to the evaluation of the patient's absorbed dose distribution in diagnostic imaging and the evaluation of absorbed dose using phantom; can contribute to improving reliability accuracy and reproducibility; it makes significance in that it can implement the actual patient's absorbed dose distribution, not just mere estimation using mathematical phantom or humanoid phantom. When comparing the absorbed dose in polymethly methacrylate (PMMA) phantom measured in metal oxide semiconductor field effect transistor (MOSFET) dosimeter for verification of Geant4 and the result of Geant4 simulation, there was <TEX>$0.46{\pm}4.69%$</TEX> (<TEX>$15{\times}15cm^2$</TEX>), and <TEX>$-0.75{\pm}5.19%$</TEX> (<TEX>$20{\times}20cm^2$</TEX>) difference according to the depth. This study, through the simulation by means of Geant4, suggests a new way to calculate the actual dose of radiation exposure of patients through DICOM interface.

SU-D-217BCD-02: Online Angular Tube Current Modulation in X-Ray Computed Tomography: Can Tube Current Be Modulated Appropriately?

In X-ray computed tomography (CT), X-rays are significantly less attenuated in the anteroposterior direction and more in the lateral direction. Therefore, the tube current should be adjusted within one gantry rotation using angular tube current modulation (TCM). The aim of this study was to evaluate whether online angular TCM could reduce radiation dose appropriately. A 128-detector dual-source CT (SOMATOM Definition Flash; Siemens Healthcare, Erlangen, Germany) and an online TCM system (CARE Dose 4D; Siemens Healthcare) were used. Dose profiles were acquired using the CT Dose Profiler (RTI Electronics, Molndal, Sweden) and an elliptical cylindrical phantom (MHT; Kyoto Kagaku, Kyoto, Japan) for helical CT scans with and without TCM. In addition, absorbed dose distributions within a single section were acquired using an anthropomorphic phantom (RANI 10; The Phantom Laboratory, Salem, NY) and radiophotoluminescent glass dosimeters (RPLDs) (GD- 302M; Chiyoda Technol, Tokyo, Japan) for helical CT scans with and without TCM after placing RPLDs within all holes of one section and pasting them around the section. A graph of each absorbed dose distribution was drawn using graphing software (ORIGIN 8.6; OriginLab, Northampton, MA). The acquired dose profiles suggested that online angular TCM could adjust the tube current in near-real time according to the attenuation measured from the previous projection. The profiles gradually stabilized because the tube current was adjusted properly. The absorbed doses were low and the distributions were stable with TCM compared with those without TCM. In X-ray CT, an online angular TCM can reduce radiation dose effectively by adjusting tube current within one gantry rotation in near-real time.

90Y PET-based dosimetry after selective internal radiotherapy treatments

The decay of 90Y has a minor branch to the O+ first excited state of 89Zr, the de-excitation of which to the fundamental state is followed by a β+–β- emission that has been used recently for biodistribution assessment after selective internal radiotherapy (SIRT) treatments. The purpose of the present study is to demonstrate the feasibility of 90Y PET imaging for dose assessment after radioembolization with 90Y microspheres. Activity quantification was validated through preliminary phantom studies using a cylindrical body phantom composed of six inserts of different volumes filled with a calibrated amount of 90Y microspheres. A GE Discovery ST PET/CT scanner provided with bismuth germinate (BGO) crystals was used for image acquisition. Images were reconstructed with an ordered subset expectation–maximization method. The effect of object size and the effect of the number of iterations on dose evaluation and volume recovery were investigated. Microsphere dose distribution was then evaluated on one patient (one lesion) who underwent liver SIRT treatment. Dose calculations were made with a MATLAB-based code developed in our department. Dedicated Monte Carlo calculations were executed to evaluate dose S-values for the 90Y source. The activity distribution derived from 90Y PET acquisitions was convolved with the voxel S-values to obtain a three-dimensional absorbed dose distribution and dose–volume histograms. Dosimetry studies carried out on the body phantom with ordered subset expectation–maximization algorithm, three iterations, provided an accuracy of 7.62% in determining the absorbed dose in the largest insert. The dose difference increases as the insert size reduces. Preliminary results on a patient provided a high-resolution absorbed dose distribution map. An average dose of 139.3 Gy was evaluated for the tumor area, with a maximum dose as high as 237.9 Gy. The absorbed dose to the healthy liver was below the tolerance dose of 35 Gy (33.8 Gy). A clear correlation between absorbed dose and tumor response was observed at 18F-fluorodeoxyglucose PET acquired 6 months after treatment. According to our experience, 90Y PET is a promising and reliable technique for microsphere dose assessment and might pave the way for a patient-specific PET-based dosimetry after liver SIRT treatments.

Measurement of the absorbed dose distribution near an 192Ir intravascular brachytherapy seed using a high-spatial-resolution gel dosimetry system

The absorbed dose distribution at sub-millimeter distances from the Best single 192Ir intravascular brachytherapy seed was measured using a high-spatial-resolution gel dosimetry system. Two gel phantoms from the same batch were used; one for the seed irradiation and one for calibration. Since the response of this gel is energy independent for photons between 20 and 1250 keV, the gel was calibrated using a narrowly collimated 60Co gamma-ray beam (cross-sectional area ∼1 cm2). A small format laser computed tomography scanner was used to acquire the data. The measurements were carried out with a spatial resolution of 100 µm in all dimensions. The seed was calibrated at NIST in terms of air-kerma strength. The absorbed dose rate as well as the radial dose function, gL(r), was measured for radial distances between 0.6 and 12.6 mm from the seed center. The dose rate constant was measured, yielding a value of Λ = (1.122 ± 0.032) cGy h−1 U−1, which agrees with published data within the measurement uncertainty. For distances between 0.6 and 1.5 mm, gL(r) decreases from a maximum value of 1.06 down to 1.00; between 1.5 and 6.7 mm, an enhancement is clearly observed with a maximum value around 1.24 and beyond 6.7 mm, gL(r) has an approximately constant value around 1.0, which suggests that this seed can be considered as a point source only at distances larger than 6.7 mm. This latter observation agrees with data for the same seed reported previously using Gafchromic film MD-55-2. Additionally, published Monte Carlo (MC) calculations have predicted the observed behavior of the radial dose function resulting from the absorbed dose contributions of beta particles and electrons emitted by the 192Ir seed. Nonetheless, in the enhancement region, MC underestimates the dose by approximately 20%. This work suggests that beta particles and electrons emitted from the seed make a significant contribution to the total absorbed dose delivered at distances near the seed center (less than 6 mm) and therefore cannot be neglected, given the dimensions of blood vessel walls.

Optimization of electron beam crosslinking of wire and cable insulation

The computer simulations based on Monte Carlo (MC) method and the ModeCEB software were carried out in connection with electron beam (EB) radiation set-up for crosslinking of electric wire and cable insulation. The theoretical predictions for absorbed dose distribution in irradiated electric insulation induced by scanned EB were compared to the experimental results of irradiation that was carried out in the experimental set-up based on ILU 6 electron accelerator with electron energy 0.5–2.0MeV.The computer simulation of the dose distributions in two-sided irradiation system by a scanned electron beam in multilayer circular objects was performed for various process parameters, namely electric wire and cable geometry (thickness of insulation layers and copper wire diameter), type of polymer insulation, electron energy, energy spread and geometry of electron beam, electric wire and cable layout in irradiation zone. The geometry of electron beam distribution in the irradiation zone was measured using CTA and PVC foil dosimeters for available electron energy range. The temperature rise of the irradiated electric wire and irradiation homogeneity were evaluated for different experimental conditions to optimize technological process parameters. The results of computer simulation are consistent with the experimental data of dose distribution evaluated by gel-fraction measurements. Such conformity indicates that ModeCEB computer simulation is reliable and sufficient for optimization absorbed dose distribution in the multi-layer circular objects irradiated with scanned electron beams.

Dose optimization in 125I permanent prostate seed implants using the Monte Carlo method

The aim of this work consisted in using the Monte Carlo code MCNP and computational phantoms to assess the absorbed dose distributions in the prostate, due to a radiotherapy treatment using 125I radioactive seeds. The intention was to develop a tool that can serve as a complement of the treatment planning system of radiotherapy procedures, reproducing accurately the exact geometry of the sources and the composition of the media where the seeds are inserted. The radiation activities of the simulated seeds varied from 0.27 mCi to 0.38 mCi, for hypothetical treatments employing 80, 88 or 100 125I sources, typical parameters for this technique. The prostate volumes where the seeds were virtually inserted were simulated with spherical or voxel computational phantoms. The configuration containing 88 seeds with initial radiation activity of 0.27 mCi resulted in a final absorbed dose near 144 Gy, in accordance with the recommendations of the American Association of Physicists in Medicine (AAPM). Based on this configuration, it was possible to obtain the radiation absorbed dose distributions for the voxel phantom, which allowed the determination of treatment quality indicators. The obtained results are in good agreement with experimental data presented by other authors.

Inhomogeneous activity distribution of 177Lu-DOTA0-Tyr3-octreotate and effects on somatostatin receptor expression in human carcinoid GOT1 tumors in nude mice

The aim of this study was to investigate the activity distribution in neouroendocrine tumors after diagnostic, or therapeutic, amounts of [(177)Lu-DOTA(0)-Tyr(3)]-octreotate and to investigate how the activity distribution influences the absorbed dose. Furthermore, the activity distribution of a second administration of radiolabeled octreotate was studied. Nude mice with subcutaneously grown human midgut carcinoid (GOT1) were injected intravenously with different amounts of (177)Lu-octreotate. At different time points thereafter (4 h to 13 days), a second injection of [(111)In-DOTA(0)-Tyr(3)]-octreotate was given to estimate the somatostatin receptor (sstr) expression. The activity distribution in the tumors was then determined. Monte Carlo simulations with PENELOPE were performed for dosimetry. Fifty-one out of 58 investigated tumors showed a lower activity concentration in the peripheral part than in the central part of the tumor. The amount of activity injected, or time after administration, did neither influence the relative activity nor the sstr distribution in the tumor. After an initial down-regulation (at 4-24 h), there was an up-regulation of sstr (1.5-2 times, at 7-14 days). Monte Carlo simulations demonstrated an inhomogeneous absorbed dose distribution in the tumor using (177)Lu, with twice as high absorbed dose centrally than peripherally. The high activity concentration centrally and the up-regulation of sstr demonstrated will facilitate fractionated therapy using radiolabeled somatostatin analogues if similar results will be obtained also in patients. The inhomogeneous activity distribution in the tumor has to be taken into account when the absorbed dose distribution in tumor is calculated.

Interaction between the biological effects of high- and low-LET radiation dose components in a mixed field exposure

Purpose: The relative biological effectiveness of two epithermal neutron sources, a reactor based source at Studsvik, Sweden, and a proton accelerator-based source in Birmingham, UK, was studied in relation to the proportional absorbed dose distribution as a function of neutron energy. Evidence for any interactions between the effects of biological damage induced by high- and low-linear energy transfer (LET) dose components, in this ‘mixed field’ irradiation, was also examinedMaterials and methods: Clonogenic survival in Chinese Hamster-derived V79 cells was used to assess biological effectiveness in this study. Cells were irradiated in suspension at 4°C at depths of 20, 35, 50 and 65 mm in a water phantom. This prevented the repair of sublethal damage, predominantly that produced by both incident and induced γ-rays in the field, over the variable periods of exposure required to irradiate cells with the same total absorbed dose. Cell survival, as a function of the absorbed radiation dose and depth in the phantom, was compared with Monte Carlo N-Particle (MCNP) calculations of the proportional absorbed dose distribution as a function of neutron energy for the two sources.Results: In terms of the dose-related reduction in clonogenic cell survival, the epithermal neutron source at Studsvik was more biologically effective than the Birmingham source at all depths considered in the phantom. Although the contribution from the high-LET dose component was greater for the Studsvik source at 20 mm depth in the phantom, at greater depths the dose contribution from the high-LET dose component at Studsvik overlap with those for the Birmingham source. However, the most striking difference is in the fast neutron component to the dose of the two sources, neutron energies > 1 MeV were only associated with the Studsvik source. The relative biological effectiveness (RBE) of both sources declined slightly with depth in the phantom, as the total high-LET dose component declined. The maximum source RBE for Studsvik was 2.70 ± 0.50 at 20 mm; reduced to 2.10 ± 0.35 at depths of 50 and 65 mm. The corresponding values for Birmingham were 1.68 ± 0.25 and 1.31 ± 0.19, all values relate only to the surviving fraction of V79 cells at 37%, since RBE values are only applicable to the selected endpoint. Based on a dose reduction factor (DRF) of 1.0 for the total low-LET component to the absorbed dose, the RBE values for the high-LET dose component (fast neutrons and induced protons from the nitrogen capture reaction) was 14.5 and 7.05 for the Studsvik and Birmingham neutron sources, respectively. This is well outside the range of RBE historically reported values for V79 cells for the same level of cell survival for fast neutrons. The calculation of RBE values, based on the proportional absorbed dose distribution as a function of neutron energy, from historical data, and using a RBE of 1.8 for the dose from the nitrogen capture reaction, suggests RBE values for the total high-LET dose component of 3.1–2.8 and 2.5–2.0 for Studsvik and Birmingham, respectively, values again declining with depth in the phantom.Conclusions: The overall biological effectiveness of the mixed field irradiation from an epithermal neutron sources depends on the composition and quality of the different dose components. The experimentally derived RBE values for the total high-LET dose components in these ‘mixed field’ irradiations are well in excess of historical data for fast neutrons. The difference between the historically expected and the observed RBE values is attributed to the interactions between the damage produced by high- and low-LET radiation.

Tissue modeling schemes in low energy breast brachytherapy**This work was presented at the 2011 Annual Meeting of the American Brachytherapy Society, 13–16 April, San Diego, CA.

Breast tissue is heterogeneous and is mainly composed of glandular (G) and adipose (A) tissues. The proportion of G versus A varies considerably among the population. The absorbed dose distributions in accelerated partial breast irradiation therapy with low energy photon brachytherapy sources are very sensitive to tissue heterogeneities. Current clinical algorithms use the recommendations of the AAPM TG43 report which approximates the human tissues by unit density water. The aim of this study is to investigate various breast tissue modeling schemes for low energy brachytherapy. A special case of breast permanent seed implant is considered here. Six modeling schemes are considered. Uniform and non-uniform water breast (UWB and NUWB) consider the density but neglect the effect of the composition of tissues. The uniform and the non-uniform G/A breast (UGAB and NUGAB) as well the age-dependent breast (ADB) models consider the effect of the composition. The segmented breast tissue (SBT) method uses a density threshold to distinguish between G and A tissues. The PTV D90 metric is used for the analysis and is based on the dose to water (D90(w,m)). D90(m,m) is also reported for comparison to D90(w,m). The two-month post-implant D90(w,m) averaged over 38 patients is smaller in NUWB than in UWB by about 4.6% on average (ranging from 5% to 13%). Large average differences of G/A breast models with TG43 (17% and 26% in UGAB and NUGAB, respectively) show that the effect of the chemical composition dominates the effect of the density on dose distributions. D90(w,m) is 12% larger in SBT than in TG43 when averaged. These differences can be as low as 4% or as high as 20% when the individual patients are considered. The high sensitivity of dosimetry on the modeling scheme argues in favor of an agreement on a standard tissue modeling approach to be used in low energy breast brachytherapy. SBT appears to generate the most geometrically reliable breast tissue models in this report.

APENELOPE‐based system for the automated Monte Carlo simulation of clinacs and voxelized geometries—application to far‐from‐axis fields

Two new codes, PENEASY and PENEASYLINAC, which automate the Monte Carlo simulation of Varian Clinacs of the 600, 1800, 2100, and 2300 series, together with their electron applicators and multileaf collimators, are introduced. The challenging case of a relatively small and far-from-axis field has been studied with these tools. PENEASY is a modular, general-purpose main program for the PENELOPE Monte Carlo system that includes various source models, tallies and variance-reduction techniques (VRT). The code includes a new geometry model that allows the superposition of voxels and objects limited by quadric surfaces. A variant of the VRT known as particle splitting, called fan splitting, is also introduced. PENEASYLINAC, in turn, automatically generates detailed geometry and configuration files to simulate linacs with PENEASY. These tools are applied to the generation of phase-space files, and of the corresponding absorbed dose distributions in water, for two 6 MV photon beams from a Varian Clinac 2100 C∕D: a 40 × 40 cm(2) centered field; and a 3 × 5 cm(2) field centered at (4.5, -11.5) cm from the beam central axis. This latter configuration implies the largest possible over-traveling values of two of the jaws. Simulation results for the depth dose and lateral profiles at various depths are compared, by using the gamma index, with experimental values obtained with a PTW 31002 ionization chamber. The contribution of several VRTs to the computing speed of the more demanding off-axis case is analyzed. For the 40 × 40 cm(2) field, the percentages γ(1) and γ(1.2) of voxels with gamma indices (using 0.2 cm and 2% criteria) larger than unity and larger than 1.2 are 0.2% and 0%, respectively. For the 3 × 5 cm(2) field, γ(1) = 0%. These figures indicate an excellent agreement between simulation and experiment. The dose distribution for the off-axis case with voxels of 2.5 × 2.5 × 2.5 mm(3) and an average standard statistical uncertainty of 2% (1σ) is computed in 3.1 h on a single core of a 2.8 GHz Intel Core 2 Duo processor. This result is obtained with the optimal combination of the tested VRTs. In particular, fan splitting for the off-axis case accelerates execution by a factor of 240 with respect to standard particle splitting. PENEASY and PENEASYLINAC can simulate the considered Varian Clinacs both in an accurate and efficient manner. Fan splitting is crucial to achieve simulation results for the off-axis field in an affordable amount of CPU time. Work to include Elekta linacs and to develop a graphical interface that will facilitate user input is underway.

Modeling a Hypothetical170Tm Source for Brachytherapy Applications

Purpose: To perform absorbed dose calculations based on Monte Carlo simulations for a hypothetical170Tm source and to investigate the influence of encapsulating material on the energy spectrum of the emitted electrons and photons. Methods: GEANT4 Monte Carlo code version 9.2 patch 2 was used to simulate the decay process of170Tm and to calculate the absorbed dose distribution using the GEANT4 Penelope physics models. A hypothetical 170Tm source based on the Flexisource brachytherapy design with the active core set as a pure thulium cylinder (length 3.5 mm and diameter 0.6 mm) and different cylindrical source encapsulations (length 5 mm and thickness 0.125 mm) constructed of titanium, stainless-steel, gold, or platinum were simulated. The radial dose function for the line source approximation was calculated following the TG-43U1 formalism for the stainless-steel encapsulation. Results: For the titanium and stainless-steel encapsulation, 94% of the total bremsstrahlung is produced inside the core, 4.8 and 5.5% in titanium and stainless-steel capsules, respectively, and less than 1% in water. For the gold capsule, 85% is produced inside the core, 14.2% inside the gold capsule, and a negligible amount (<1%) in water. Platinum encapsulation resulted in bremsstrahlung effects similar to those with the gold encapsulation. The range of the beta particles decreases by 1.1 mm with the stainless-steel encapsulation compared to the bare source but the tissue will still receive dose from the beta particles several millimeters from the source capsule. The gold and platinum capsules not only absorb most of the electrons but also attenuate low energy photons. The mean energy of the photons escaping the core and the stainless-steel capsule is 113 keV while for the gold and platinum the mean energy is 160 keV and 165 keV, respectively. Conclusions: A170Tm source is primarily a bremsstrahlung source, with the majority of bremsstrahlung photons being generated in the source core and experiencing little attenuation in the source encapsulation. Electrons are efficiently absorbed by the gold and platinum encapsulations. However, for the stainless-steel capsule (or other lower Z encapsulations) electrons will escape. The dose from these electrons is dominant over the photon dose in the first few millimeter but is not taken into account by current standard treatment planning systems. The total energy spectrum of photons emerging from the source depends on the encapsulation composition and results in mean photon energies well above 100 keV. This is higher than the main gamma-ray energy peak at 84 keV. Based on our results, the use of 170Tm as a brachytherapy source presents notable challenges.