Plaque Simulator Research Articles

Evolution of dose distribution for a 125I eye plaque using MCNPX and Plaque Simulator software

AbstractObjectiveEye plaque radiation therapy is the treatment of choice for small‐ and medium‐sized choroidal melanomas. This study investigated the dose distribution around eye plaques containing 125I seeds to treat ocular melanoma using Monte Carlo N‐Particle eXtended (MCNPX) and Plaque Simulator (PS) software.MethodsDosimetry evaluation and comparison of the resulting isodose curves for 125I COMS plaques were performed using the MCNPX code. The isodose curves and dose distributions were calculated using PS treatment planning for a 125I COMS plaque.ResultsIn the validation, the maximum relative difference between the results of this study and those reported in other literature was approximately 9%–10% for the COMS plaques. The dose distributions of MCNPX were lower than those of PS with a relative difference of approximately 27.7%–35.4%. The dose distribution may differ depending on the 125I source spectra and seed design used in the two methods. In addition, the dose algorithm used in PS made a major contribution to the relative differences between the results.ConclusionThe PS did not provide accurate details of dose distribution near the surface of the plaque insert. The source parameters used in each program should be studied more carefully to determine the source of the differences in the estimated dose values.

Personalized treatment planning in eye brachytherapy for ocular melanoma: Dosimetric analysis on ophthalmic structure at risk

PurposeTo evaluate the impact on dose distribution to eye organs-at-risk (eOARs) of a computed tomography (CT)-based treatment planning in eye plaque brachytherapy (EPB) treatment. MethodsWe analyzed 19 ocular melanoma patients treated with ruthenium-106 plaques to a total dose of 100 Gy to tumor apex using conventional central-axis-point dose calculation. Treatments were re-planned using the Plaque Simulator (PS) software implementing two different strategies: a personalized CT-eye-model (CT-PS) and a standard-eye-model (SEM-PS) defined by Collaborative Ocular Melanoma Study. Dice coefficient and Hausdorff distance evaluated the concordance between eye-bulb-models. Mean doses (Dmean) to tumor and eOARs were extracted from Dose-Volume-Histograms and Retinal-Dose-Area-Histogram. Differences between planning approaches were tested by Wilcoxon signed-rank test. ResultsIn the analyzed cohort, 8 patients (42%) had posterior tumor location, 8 (42%) anterior, and 3 (16%) equatorial. The SEM did not accurately described the real CT eye-bulb geometry (median Hausdorff distance 0.8 mm, range: (0.4–1.3) mm). Significant differences in fovea and macula Dmean values were found (p = 0.04) between CT-PS and SEM-PS schemes. No significant dosimetric differences were found for tumor and other eOARs. The planning scheme particularly affects the OARs closest to the tumor with a general tendency of SEM-PS to overestimate the doses to the OARs closest to the tumor. ConclusionThe dosimetric accuracy achievable with CT-PS EPB treatment planning may help to identify ocular melanoma patients who could benefit the most from a personalized eye dosimetry for an optimal outcome in terms of tumor coverage and eOARs sparing. Further research and larger studies are underway.

Dosimetric validation of the Theragenics AgX-100® I-125 seed for ROPES eye plaque brachytherapy.

With the discontinued distribution of the I-125 Oncura Onco seed (model 6711), the Theragenics AgX100® I-125 seeds were considered as a suitable alternative for eye plaque brachytherapy as their physical properties matched the requirements for use with the ROPES eye plaques. The purpose of this study aims at validating the dosimetry of the AgX-100 loaded ROPES plaques (11mm diameter, 15mm diameter with flange, 15mm diameter with notch, 18mm diameter) and assess the differences with the discontinued I-125 6711 model. To independently verify the plaque dosimetry, the brachytherapy module of RADCALC® version 6.2.3.6 was commissioned for the new AgX-100 I-125 seed using the published AAPM TG43 data from the literature. Experimental dosimetry verification was performed using EBT3 Gafchromic™ film and TLD-100 micro-cubes in a specially designed Solid Water® phantom. Both RADCALC® and film confirmed the dosimetry calculated by Plaque Simulator (PS) version 6.4.6 The dose calculated by PS agrees with RADCALC® to within 2% for depths of 1-15mm for the 4 available ROPES plaques. The dosimetric measurements agreed with the calculations of PS for clinically relevant depths (4mm to 6mm) within the evaluated uncertainties of 4.7% and 7.2% for EBT3 film and TLDs respectively. The AgX-100 I-125 seed was a suitable replacement for the 6711 I-125 seed. Due to the introduction of the stainless-steel backscatter factor in PS v6.4.6, the department has decided to report both the homogenous dose and heterogeneity corrected dose for each eye plaque patient.

Outcomes of choroidal melanomas treated with eye physics plaques: A 25-year review

PurposeTo review long-term outcomes of the University of Southern California Plaque Simulator (PS) software and Eye Physics (EP) plaques. We hypothesize that the PS/EP system delivers lower doses to critical ocular structures, resulting in lower rates of radiation toxicity and favorable visual outcomes compared to Collaborative Ocular Melanoma Study plaques, while maintaining adequate local tumor control. Methods and MaterialsRetrospective review of 133 patients treated for choroidal melanoma with 125I brachytherapy, using PS software and EP plaques, from 1990 through 2015. A dose of 85 Gy at a rate of 0.6 Gy/h was prescribed to the tumor apex (with a typical margin of 2 mm) over 7 days. Primary outcomes were local tumor recurrence, globe salvage, and metastasis. Secondary outcomes were changes in visual acuity and radiation complications. ResultsWith median followup of 42 months, 5-year Kaplan–Meier estimated rates for tumor control, globe salvage, and metastatic-free survival were 98.3%, 96.4%, and 88.2%, respectively. Median doses to the macula and optic nerve were 39.9 Gy and 30.0 Gy, respectively. Forty-three percent of patients developed radiation retinopathy, and 20% developed optic neuropathy; 39% lost ≥6 Snellen lines of vision. ConclusionsThe PS/EP system is designed to improve the accuracy and conformality of the radiation dose, creating a steep dose gradient outside the melanoma to decrease radiation to surrounding ocular structures. We report favorable rates of local tumor control, globe salvage, metastases, and radiation complications when compared to the Collaborative Ocular Melanoma Study and other studies. Overall, the PS/EP system results in excellent tumor control and appears to optimize long-term visual and radiation-related outcomes after brachytherapy.

Episcleral eye plaque dosimetry comparison for the Eye Physics EP917 using Plaque Simulator and Monte Carlo simulation.

This work is a comparative study of the dosimetry calculated by Plaque Simulator, a treatment planning system for eye plaque brachytherapy, to the dosimetry calculated using Monte Carlo simulation for an Eye Physics model EP917 eye plaque. Monte Carlo (MC) simulation using MCNPX 2.7 was used to calculate the central axis dose in water for an EP917 eye plaque fully loaded with 17 IsoAid Advantage 125I seeds. In addition, the dosimetry parameters Λ, gL(r), and F(r,θ) were calculated for the IsoAid Advantage model IAI‐125 125I seed and benchmarked against published data. Bebig Plaque Simulator (PS) v5.74 was used to calculate the central axis dose based on the AAPM Updated Task Group 43 (TG‐43U1) dose formalism. The calculated central axis dose from MC and PS was then compared. When the MC dosimetry parameters for the IsoAid Advantage 125I seed were compared with the consensus values, Λ agreed with the consensus value to within 2.3%. However, much larger differences were found between MC calculated gL(r) and F(r,θ) and the consensus values. The differences between MC‐calculated dosimetry parameters are much smaller when compared with recently published data. The differences between the calculated central axis absolute dose from MC and PS ranged from 5% to 10% for distances between 1 and 12 mm from the outer scleral surface. When the dosimetry parameters for the 125I seed from this study were used in PS, the calculated absolute central axis dose differences were reduced by 2.3% from depths of 4 to 12 mm from the outer scleral surface. We conclude that PS adequately models the central dose profile of this plaque using its defaults for the IsoAid model IAI‐125 at distances of 1 to 7 mm from the outer scleral surface. However, improved dose accuracy can be obtained by using updated dosimetry parameters for the IsoAid model IAI‐125 125I seed.PACS number: 87.55.K‐

Use of the Toric Surgical Marker to Aid in Intraoperative Plaque Placement for the USC Eye Physics Plaques to Treat Uveal Melanoma: A New Surgical Technique.

To describe a new surgical technique for intraoperative placement of Eye Physics (EP) plaques for uveal melanoma using a toric marker. A toric marker is designed for cataract surgery to align the axis of astigmatism; its use was modified in this protocol to mark the axis of suture coordinates as calculated by Plaque Simulator (PS) software. The toric marker can be used to localize suture coordinates, in degrees, during intraoperative plaque placement. Linear marking using the toric marker decreases potential inaccuracies associated with the surgeon estimating 'clock-hours' by dot placement. Use of the toric marker aided surgical placement of EP plaques. The EP planning protocol is now designed to display the suture coordinates either by clock-hours or degrees, per surgeon preference. Future research is necessary to determine whether routine use of the toric marker improves operative efficiency. [Ophthalmic Surg Lasers Imaging Retina. 2015;46:866-870.].

Outcomes of medium choroidal melanomas treated with ruthenium brachytherapy guided by three-dimensional pretreatment modeling.

The Collaborative Ocular Melanoma Study (COMS) established iodine-125 (I-125) plaque brachytherapy for eye preserving treatment of medium-sized choroidal melanomas in the United States. Eye Physics I-125 plaque treatment modeled with Plaque Simulator (PS) software yields similar results to COMS. Herein, we report results from a series of 15 patients treated with ruthenium-106 (Ru-106) plaque brachytherapy using PS pretreatment modeling for plaque localization and dosimetry. Fifteen patients with medium-sized choroidal melanomas (2.84-5.5mm in apical height and a basal diameter of 7.8-12.6mm) treated with ruthenium brachytherapy from 2003 to 2005 were evaluated retrospectively. Baseline and followup data were evaluated for tumor height, best corrected visual acuity, radiation retinopathy, radiation optic neuropathy, postradiation cataract formation, diplopia, and ptosis. Tumor response for both Ru-106 and I-125 plaques planned using the same PS pretreatment modeling was evaluated and compared. Isotope-specific radiation profiles were compared, and rates of local treatment failure (0%), optic neuropathy (6.7%), retinopathy (20%), and cataracts (33%) were evaluated. Five year-treated tumor heights were approximately 0.61 ± 0.29 (I-125, n= 16) and 0.53 ± 0.17 (Ru-106, n=6) of their heights at diagnosis. This patient subset had background characteristics very similar to those of the COMS and patients treated at our institution with I-125 plaques. Treatment response was equivalent although radiation complications occurred slightly less frequently in the Ru-106 group compared with those treated with I-125. Image-guided three-dimensional pretreatment modeling for plaque localization and dosimetry seems to work equally as well for Ru as for I-125 plaques and justifies more extensive investigation.

Independent dosimetric assessment of the model EP917 episcleral brachytherapy plaque.

To investigate the influence of slot design on dose distributions and dose-volume histograms (DVHs) for the model EP917 plaque for episcleral brachytherapy. Dimensions and orientations of the slots were measured for three model EP917 plaques and compared to data in the Plaque Simulator (PS) treatment planning software (version 5.7.6). These independently determined coordinates were incorporated into the MCNP Monte Carlo simulation environment to obtain dose from the plaques in a water environment and in a clinical environment with ocular structures. A tumor volume was simulated as 5 mm in apical height and 11 mm in basal diameter. Variations in plaque mass density and composition; slot length, width, and depth; seed positioning; and Ag-marker rod positioning were simulated to examine their influence on plaque central axis (CAX) and planar dose distributions, and DVHs. Seed shifts in a single slot toward the eye and shifts of the(125)I-coated Ag rod within the capsule had the greatest impact on CAX dose distribution. A shift of 0.0994 mm toward the eye increased dose by 14%, 9%, 4.3%, and 2.7% at 1, 2, 5, and 10 mm, respectively, from the inner sclera. When examining the fully-modeled plaque in the ocular geometry, the largest dose variations were caused by shifting the Ag rods toward the sclera and shifting the seeds away from the globe when the slots were made 0.51 mm deeper, causing +34.3% and -69.4% dose changes to the outer sclera, respectively. At points along the CAX, dose from the full plaque geometry using the measured slot design was 2.4%±1.1% higher than the manufacturer-provided slot design and 2.2%±2.3% higher than the homogeneous calculation of PS treatment planning results. The ratio of D10 values for the measured slot design to the D10 values for the manufacturer-provided slot design was higher by 9%, 10%, and 19% for the tumor, inner sclera, and outer sclera, respectively. In comparison to the measured slot design, a theoretical plaque having narrower and deeper slots delivered 30%, 37%, and 62% lower D10 doses to the tumor, inner sclera, and outer sclera, respectively. While the measured positions of the slots on the model EP917 plaque were in close agreement (<0.7 mm) with the PS values, small differences in the slot shape caused substantial differences in dose distributions and DVH metrics. Increasing slot depth by 0.1 mm decreased outer scleral dose by 20%, yet shifting the Ag rods in the seeds toward the globe by 0.1 mm increased outer scleral dose by 35%. The clinical medical physicist is advised to measure these types of plaques upon acceptance testing before clinical use to inspect slot shape and position for comparison with data used for treatment planning purposes.

SU‐E‐T‐452: Episcleral Eye Plaque Dosimetry Comparison for the Eye Physics EP917 Using Plaque Simulator and Monte Carlo Simulation

Purpose: To compare the dosimetry calculated by the treatment planning software, Plaque Simulator™, to the dosimetry calculated using Monte Carlo methods. Methods: MCNPX 2.6.0 Monte Carlo Simulation (MC) code was used to model the Eye Physics model EP917 eye plaque. The IsoAid Advantage, IA1‐125A, 125I seed was also modeled using MCNPX and compared to published data by Meigooni et al. Energy deposition tally in unit of MeV/g was used to calculate the dose averaged over a cell.Bebig Plaque Simulator (PS) v574 treatment‐planning software was used to calculate the dose based on AAPM TG‐43U1 dose formalism; single factors are used to account for source collimation and backscattering from the gold alloy plaque.Relative doses, normalized to a prescription point of 6 mm (5 mm from the inner sclera surface), from MCNPX and PS, along the eye central axis from 1 mm to 12 mm from the scleral surface, were compared for a single seed in the plaque. Results: The IsoAid Advantage, IA1‐125A, 125I seed dose rate constant and radial dose function were calculated and agreed within 5% and 4% respectively with Meigooni et al. published data. For the central seed position, the dose differences between the MC simulation along the central axis of the eye at 1 mm and 2 mm from the scleral surface and the predicted doses by the Plaque Simulator were 32.4% and 15.2%, respectively. For distances from 3 mm to 12 mm from the scleral surface, MCNPX agreed with PS within 5%. Conclusion: For the first source position, Plaque Simulator underestimated the dose at 1 mm and 2 mm from the scleral surface by 32.4% and 12.5%. Beyond 3 mm, PS agrees within uncertainties with MCNPX results. Further investigation is needed to better identify the sources of these differences.

Dosimetric study of the ROPES eye plaque

The main aim of this paper is to make a study of dose‐rate distributions obtained around the , radiation oncology physics and engineering services, Australia (ROPES) eye plaque loaded with model 6711 radioactive seeds. In this study, we have carried out a comparison of the dose‐rate distributions obtained by the algorithm used by the Plaque Simulator (PS) (BEBIG GmbH, Berlin, Germany) treatment planning system with those obtained by means of the Monte Carlo method for the ROPES eye plaque. A simple method to obtain the dose‐rate distributions in a treatment planning system via the superposition of the dose‐rate distributions of a seed placed in the eye plaque has been developed. The method uses eye plaque located in a simplified geometry of the head anatomy and distributions obtained by means of the Monte Carlo code GEANT4. The favorable results obtained in the development of this method suggest that it could be implemented on a treatment planning system to improve dose‐rate calculations. We have also found that the dose‐rate falls sharply along the eye and that outside the eye the dose‐rate is very low. Furthermore, the lack of backscatter photons from the air located outside the eye‐head phantom produces a dose reduction negligible for distances from the eye‐plaque but reaches up to 20% near the air‐eye interface. Results showed that the treatment planning system lacks accuracy around the border of the eye (in the sclera and the surrounding area) due to the simplicity of the algorithm used. The BEBIG treatment planning system uses a global attenuation factor that takes into account the effect of the eye plaque seed carrier and the lack of backscatter photons caused by the metallic cover, which in the case of a ROPES eye plaque has a default value of (no correction). In the present study, a global attenuation factor and an air‐interface correction factor which improve on treatment planning system calculations were obtained.