Reference Air Kerma Rate Research Articles

TRAK Relates to Prescription Isodose Surface Volume and Treatment Time in Vaginal Cylinder HDR Brachytherapy

Total Reference Air Kerma (TRAK) is defined as the integral of the reference air-Kerma rate at a reference distance from the source over the treatment period. Reporting of TRAK as one of the treatment parameters is highly recommended in gynecological brachytherapy. In this study, we correlated TRAK to Prescription isodose surface volume and the total Treatment time in Vaginal Cylinder (VC) high dose-rate (HDR) Brachytherapy.

Multicenter Survey of the Display Air Kerma and Actual Measured Values in IVR X-ray Apparatus

We conducted a multicenter study to investigate the current status of difference between the actual values at the patient entrance reference point (PERP) and display air kerma. We exposure dose and fluoroscopy dose were measured by 32 apparatuses at 32 member institutions of the Japanese Society of Circulation Imaging Technology (CITEC) under unified conditions, and the actual measured values and display air kerma were compared. We entrance doses during fluoroscopy and imaging were measured at the PERP, with focus detector distance (FDD) 110 cm, a copper plate of 3.5 mm in thickness adhered to the front face of flat panel detector (FPD) as absorber, field-of-view (FOV) 18 cm, and the frame rate of 15 f/s, excluding the bed. Display air kerma were recorded at the same time. JIS (Z 4751-2-43: 2012) specify "The reference air kerma rate and the cumulative reference air kerma shall not deviate from their respective display air kerma by more than ±35% over the range of 6 mGy/min and 100 mGy to the maximum value." The number of apparatuses display air kerma deviated from this condition and its percentage were obtained. The mean difference percentage between actual measured values and display air kerma in 32 apparatuses was approximately 15.6%, with some apparatuses showing substantially different display air kerma. In order to estimate patients' skin exposure dose from display air kerma more accurately, it is necessary to perform calibration of the apparatus by regular dose measurement or convert values.

Re-evaluation of the correction factors for the GROVEX

The GROVEX (GROssVolumige EXtrapolationskammer, large-volume extrapolation chamber) is the primary standard for the dosimetry of low-dose-rate interstitial brachytherapy at the Physikalisch-Technische Bundesanstalt (PTB). In the course of setup modifications and re-measuring of several dimensions, the correction factors have been re-evaluated in this work. The correction factors for scatter and attenuation have been recalculated using the Monte Carlo software package EGSnrc, and a new expression has been found for the divergence correction. The obtained results decrease the measured reference air kerma rate by approximately 0.9% for the representative example of a seed of type Bebig I25.S16C. This lies within the expanded uncertainty (k = 2).

A new apparatus for on-site calibration of gamma dose rate monitors.

In order to carry out on-site calibrations of environmental gamma dose rate monitors, a new irradiation apparatus was developed in this study. The apparatus mainly consists of a piece of 137Cs source, a set of beam attenuators, and 3 built-in laser rangefinders, and it can be remotely controlled by using a laptop through WiFi network. With an activity of 4.6 × 108 Bq of 137Cs source, the reference air kerma rate could be adjusted from 0.26 μGy h-1 to 140 μGy h-1 by changing the calibration distance from 0.5 m to 5 m and using different beam attenuators (or none), and both the reproducibility and the homogeneity of reference radiation were better than 97%. The overall uncertainty of the calibration was estimated to be 6.5% (k = 2). Both the laboratory and field experiments confirmed that the calibration method met the requirements of ISO 4037-1. As the advantages of portability and simplicity, it is considered that the new irradiation apparatus is applicable to stationary gamma radiation monitors for on-site calibration.

High dose rate 192Ir source calibration: A single institution experience

Measurement of source strength of new high dose rate (HDR) 192Ir supplied by the manufacturer is part of quality assurance recommended by Radiation Safety Section, Ministry of Health of Malaysia. The source strength is determined in reference air kerma rate (RAKR). The purpose of this study was to evaluate RAKR measurement of 192Ir using well-type ionisation chamber with RAKR stated in the certificate provided by the manufacturer. A retrospective study on 19 MicroSelectron HDR 192Ir Classic from 2001 to 2009 and 12 MicroSelectron HDR 192Ir V2 sources from 2009 to 2016 supplied by manufacturer were compared. From the study, the agreement between measured RAKR and RAKR stated in the certificate by manufacturer for all 32 sources supplied were within ±2.5%. As a conclusion, a threshold level of ±2.5% can be used as suitable indicator to spot problems of the brachytherapy system in Department of Nuclear Medicine Radiotherapy and Oncology, Hospital USM.

Reference air kerma rate calibration system for high dose rate Ir-192 brachytherapy sources in Taiwan

Ir-192 sources are widely used in brachytherapy and the number of treatments is around seven thousand for the use of the high dose rate (HDR) Ir-192 brachytherapy source per year in Taiwan. Due to its physical half-life of 73.8 days, the source should be replaced four times per year to maintain the HDR treatment mode (DDEP, 2005; Coursey et al., 1992). When doing this work, it must perform the source dose trace to assure the dose accuracy. To establish the primary measurement standard of reference air kerma rate(RAKR) for the HDR Ir-192 brachytherapy sources in Taiwan, the Institute of Nuclear Energy Research (INER) fabricated a dual spherical graphite-walled cavity ionization chambers system to directly measure the RAKR of the Ir-192 brachytherapy source.In this system, the ion-charge was accumulated by the two ionization chambers and after correction for the ion recombination, temperature, atmosphere pressure, room scattering, graphite-wall attenuation, air attenuation, source decay, stem effect, and so on. The RAKR of the Ir-192 source was obtained in the ambient conditions of 22°C and one atmosphere. The measurement uncertainty of the system was around 0.92% in 96% confidence level (k=2.0). To verify the accuracy of the result, the source calibration comparison has been made at the National Radiation Standard Laboratory (NRSL) of INER and Physikalisch-Technische Bundesanstalt (PTB, Germany) in 2015. The ratio of the measurement results between INER and PTB, INER/PTB, was 0.998±0.027 (k=2) which showed good consistency and the performance of the system was verified.

Air-kerma strength determination of an HDR 192 Ir source including a geometric sensitivity study of the seven-distance method.

To perform an in-air air-kerma strength (SK) calibration of the Bebig model Ir2.A85-2 192Ir high-dose rate (HDR) brachytherapy source manufactured by Mallinckrodt Medical (Westerduinweg, Germany) with the NIST-traceable seven-distance technique established by the University of Wisconsin. A comparison was made between the reference air-kerma rate (RAKR) reported on a certificate from the Physikalisch-Technische Bundesanstalt (Berlin, Germany) (PTB) primary laboratory and the SK determined at the University of Wisconsin Madison Radiation Research Center (UWMRRC). A theoretical sensitivity study was performed to investigate the impact that variations in the experimental setup have on the computed SK from the seven-distance algorithm in order to determine if the uncertainty budget for the seven-distance method should be expanded. The manufacturer-reported SK for the source was compared to the SK determined from the University of Wisconsin Accredited Dosimetry Calibration Laboratory (UWADCL) transfer standard well chambers and the seven-distance technique. Monte Carlo techniques (MCNP6) were employed to compare the theoretical SK calibration coefficients of a Standard Imaging (Middleton, WI) HDR1000 Plus well chamber using Standard Imaging model 70010 and model 70110 source holders to determine if a holder dependence was present. Radiochromic film (EBT3, Ashland) exposures were performed to assess the dose distribution of the source in phantom. The seven-distance algorithm was coded in MATLAB®(R2013b) and benchmarked with MCNP6 with the capacity to model distance offset behaviors among nominal positions. This offset model was used in a Monte Carlo simulation coded in MATLAB to determine the average uncertainty in the SK calculations from the seven-distance algorithm. The measured SK using the seven-distance technique at the UWMRRC agreed with the RAKR reported on the PTB source certificate and the SK on the Mallinckrodt source certificate to within 0.28% and -0.79%, respectively. It was found that the difference between the SK measured from the transfer standard well chambers at the UWADCL and the seven-distance method was between 0.13% and 0.30% at the 95% confidence level. Monte Carlo results showed negligible differences between the simulated SK calibration coefficient for an HDR1000 Plus well chamber using the model 70010 or model 70110 source holder. The autoradiographs from the source in Virtual WaterTM showed that the dose distribution is symmetric. Additionally, the sensitivity study performed in MATLAB showed that the SK calculated with the seven-distance algorithm could deviate by 0.24% from randomly generated distance offsets within 1mm in magnitude. The differences between the SK measurements determined from the seven-distance technique and the accredited UWADCL measurement results were within the k=2 uncertainty reported for an accredited calibration. Excellent agreement was found between the measured SK and RAKR methods used at the UWMRRC and PTB, respectively. Additionally, the sensitivity study has shown that the seven-distance algorithm accurately determines the SK of a source while having a variable chamber offset among nominal positions; the uncertainty budget for the seven-distance method does not need to be expanded at this time. It has been determined that the current standard used by the UWADCL for well chamber calibrations is valid for the Bebig model Ir2.A85-2 192Ir brachytherapy source.

Determination of contributions of scatter and distance error to the source strength of 192Ir HDR brachytherapy source

Abstract High dose rate (HDR) brachytherapy commonly employs a 192Ir encapsulated source to deliver high dose to the malignant tissues. Calibrations of brachytherapy sources are performed by the manufacturer using a well-type chamber or by in-air measurement using a cylindrical ionization chamber. Calibration using the latter involves measurements to be carried out at several distances and room scatter can also be determined. The aim of the present study is to estimate the scatter contribution from the walls, floor and various materials in the room in order to determine the reference air kerma rate of an 192Ir HDR brachytherapy source by in-air measurements and also to evaluate the error in the setup distance between the source centre and chamber centre. Air kerma measurements were performed at multiple distances from 10 cm to 40 cm between the source and chamber. The room scatter correction factor was determined using the iterative technique. The distance error of −0.094 cm and −0.112 cm was observed for chamber with and without buildup cap respectively. The scatter component ranges from 0.3% to 5.4% for the chamber with buildup cap and 0.3% to 4.6% without buildup cap for distances between 10 to 40 cm respectively. Since the average of the results at multiple distances is considered to obtain the actual air kerma rate of the HDR source, the seven distance method and iterative technique are very effective in determining the scatter contribution and the error in the distance measurements.

SU‐F‐T‐64: An Alternative Approach to Determining the Reference Air‐Kerma Rate from Extrapolation Chamber Measurements

Purpose:Since 2008 the Physikalisch‐Technische Bundesanstalt (PTB) has been offering the calibration of 125I‐brachytherapy sources in terms of the reference air‐kerma rate (RAKR). The primary standard is a large air‐filled parallel‐plate extrapolation chamber. The measurement principle is based on the fact that the air‐kerma rate is proportional to the increment of ionization per increment of chamber volume at chamber depths greater than the range of secondary electrons originating from the electrode x0.Methods:Two methods for deriving the RAKR from the measured ionization charges are: (1) to determine the RAKR from the slope of the linear fit to the so‐called 'extrapolation curve’, the measured ionization charges Q vs. plate separations x or (2) to differentiate Q(x) and to derive the RAKR by a linear extrapolation towards zero plate separation. For both methods, correcting the measured data for all known influencing effects before the evaluation method is applied is a precondition. However, the discrepancy of their results is larger than the uncertainty given for the determination of the RAKR with both methods.Results:A new approach to derive the RAKR from the measurements is investigated as an alternative. The method was developed from the ground up, based on radiation transport theory. A conversion factor C(x1, x2) is applied to the difference of charges measured at the two plate separations x1 and x2. This factor is composed of quotients of three air‐kerma values calculated for different plate separations in the chamber: the air kerma Ka(0) for plate separation zero, and the mean air kermas at the plate separations x1 and x2, respectively. The RAKR determined with method (1) yields 4.877 µGy/h, and with method (2) 4.596 µGy/h. The application of the alternative approach results in 4.810 µGy/h.Conclusion:The alternative method shall be established in the future.

SU‐F‐T‐05: Dosimetric Evaluation and Validation of Newlydeveloped Well Chamber for Use in the Calibration of Brachytherapy Sources

Purpose:To evaluate the dosimetric characteristics of newly developed well type ionization chamber and to validate the results with the commercially available calibrated well chambers that are being used for the calibration of brachytherapy sources.Methods:The newly developed well type ionization chamber (BDS 1000) has been designed for the convenient use in brachytherapy which is open to atmospheric condition. The chamber has a volume of 240 cm3 and weight of 2.5 Kg. The calibration of the radioactive source with activities from 0.01 mCi to 20 Ci can be carried out using this chamber. The dosimetric parameters such as leakage current, stability, scattering effect, ion collection efficiency, reference air kerma rate and nominal response with energy were carried out with the BDS 1000 well type ion chamber. The evaluated dosimetric characteristics of BDS1000 well chamber were validated with two other commercially available well chambers (HDR 1000 plus and BTC/3007).Results:The measured leakage current observed was negligible for the newly developed BDS 1000 well type ion chamber. The ion collection efficiency was close to 1 and the response of the chamber was found to be very stable. The determined sweet spot was at 42 mm from bottom of the chamber insert. The reference air kerma rate was found to be 4.634 × 105 Gym2hr‐1A‐1 for the BDS 1000 well chamber. The overall dosimetric characteristics of BDS 1000 well chamber was in good agreement with the dosimetric properties of other two well chambers.Conclusion:The dosimetric study shows that the newly developed BDS 1000 well type ionization chamber is high sensitive and reliable chamber for reference air kerma strength calibration. The results obtained confirm that this chamber can be used for the calibration of HDR and LDR brachytherapy sources.

SU‐F‐T‐16: Experimental Determination of Ionization Chamber Correction Factors for In‐Phantom Measurements of Reference Air Kerma Rate and Absorbed Water Dose Rate of Brachytherapy 192Ir Source

Purpose:Following the method of in‐phantom measurements of reference air kerma rate (Ka) at 100cm and absorbed water dose rate (Dw1) at 1cm of high‐dose‐rate 192Ir brachytherapy source using 60Co absorbed‐dose‐to‐water calibrated (ND,w,60Co) ionization chamber (IC), we experimentally determined the in‐phantom correction factors (kglob) of the PTW30013 (PTW, Freiburg, Germany) IC by comparing the Monte Carlo (MC)‐calculated kglob of the other PTW30016 IC.Methods:The Dw1 formalism of in‐phantom measurement is: M*ND,w,60Co*(kglob)Dw1, where M is the collected charges, and (kglob)Dw1 the in‐phantom Dw1 correction factor. Similarly, Ka is determined by M*ND,w,60Co*(kglob)ka, where (kglob)ka the in‐phantom Ka correction factor. Two thimble ICs PTW30013 and another PTW30016 having a ND,w,60Co from the German primary standard laboratory (PTB) were simultaneously exposed to the microselectron 192Ir v2 source at 8cm in a PMMA phantom. A reference well chamber (PTW33004) with a PTB transfer Ka calibration Nka was used for comparing the in‐phantom measurements to derive the experimental (kglob)ka factors. We determined the experimental (kglob)Dw1 of the PTW30013 by comparing the PTW30016 measurements with MC‐calculated (kglob)Dw1.Results:Ka results of the PTW30016 based on ND,w,60Co and MC‐calculated (kglob)ka differ from the well chamber results based on Nka by 1.6% and from the manufacturer by 1.0%. Experimental (kglob)ka factors for the PTW30016 and two other PTW30013 are 0.00683, 0.00681 and 0.00679, and vary <0.5% with 1mm source positioning uncertainty. Experimental (kglob)Dw1 of the PTW30013 ICs are 75.3 and 75.6, and differ by 1.6% from the conversion by dose rate constant from the AAPM report 229.Conclusion:The 1.7% difference between MC and experimental (kglob)ka for the PTW30016 IC is within the PTB 2.5% expanded uncertainty in Ka calibration standard. Using a single IC with ND,w,60Co to calibrate the brachytherapy source and dose output in external radiotherapy is feasible. MC validation of the PTW30013(kglob)Dw1 is warranted.

Commissioning of a well type chamber for HDR and LDR brachytherapy applications: a review of methodology and outcomes.

For safe and accurate dose delivery in brachytherapy, associated equipment is subject to commissioning and ongoing quality assurance (QA). Many centres depend on the use of a well-type chamber ('well chamber') for performing brachytherapy dosimetry. Documentation of well chamber commissioning is scarce despite the important role the chamber plays in the whole brachytherapy QA process. An extensive and structured commissioning of the HDR 1000 plus well chamber (Standard Imaging Inc, Middleton WI) for HDR and LDR dosimetry was undertaken at Sir Charles Gairdner Hospital. The methodology and outcomes of this commissioning is documented and presented as a guideline to others involved in brachytherapy. The commissioning tests described include mechanical integrity, leakage current, directional dependence, response, length of uniform response, the influence of insert holders, ion collection efficiency, polarity effect, accuracy of measured air kerma strength (S(K)) or reference air kerma rate (K(R)) and baseline setting (for ongoing constancy checks). For the HDR 1000 plus well chamber, some of the insert holders modify the response curve. The measured sweet length was 2.5 cm which is within 0.5% of that specified by the manufacturer. Correction for polarity was negligible (0.9999) and ion recombination was small (0.9994). Directional dependence was small (less than 0.2%) and leakage current was negligible. The measured K(R) for (192)Ir agreed within 0.11% compared with a second well chamber of similar model and was within 0.5% of that determined via a free-in-air measurement method. Routine constancy checks over a year agreed with the baseline within 0.4%.

Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the NMIJ and the BIPM

An indirect comparison of the standards for reference air kerma rate for 192Ir high dose rate (HDR) brachytherapy sources of the National Metrology Institute of Japan (AIST-NMIJ), Japan, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the Japan Radioisotope Association (JRIA) in April 2015. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the NMIJ and the BIPM standards for reference air kerma rate, is 1.0036 with a combined standard uncertainty of 0.0054.Main textTo reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

O.29 - Traceability for the quantity: Reference Air Kerma Rate (RAKR) for HDR Ir-192 and Co-60 sources

Introduction: Brachytherapy uses encapsulated radioactive sources to deliver a high dose to cancerous cells during radiotherapy. Thus, end-user calibration of brachytherapy sources is necessary, not only to check vendor stated calibration but also to ensure traceability to internationally accepted standards. The NMISA is introducing a new service: traceability for the quantity Reference Air Kerma Rate (RAKR) for HDR Ir-192 and Co-60 sources, used by the radiotherapy community in brachytherapy.

A radiation quality correction factor k for well-type ionization chambers for the measurement of the reference air kerma rate of (60)Co HDR brachytherapy sources.

The aim of this study was to investigate whether a chamber-type-specific radiation quality correction factor kQ can be determined in order to measure the reference air kerma rate of (60)Co high-dose-rate (HDR) brachytherapy sources with acceptable uncertainty by means of a well-type ionization chamber calibrated for (192)Ir HDR sources. The calibration coefficients of 35 well-type ionization chambers of two different chamber types for radiation fields of (60)Co and (192)Ir HDR brachytherapy sources were determined experimentally. A radiation quality correction factor kQ was determined as the ratio of the calibration coefficients for (60)Co and (192)Ir. The dependence on chamber-to-chamber variations, source-to-source variations, and source strength was investigated. For the PTW Tx33004 (Nucletron source dosimetry system (SDS)) well-type chamber, the type-specific radiation quality correction factor kQ is 1.19. Note that this value is valid for chambers with the serial number, SN ≥ 315 (Nucletron SDS SN ≥ 548) onward only. For the Standard Imaging HDR 1000 Plus well-type chambers, the type-specific correction factor kQ is 1.05. Both kQ values are independent of the source strengths in the complete clinically relevant range. The relative expanded uncertainty (k = 2) of kQ is UkQ = 2.1% for both chamber types. The calibration coefficient of a well-type chamber for radiation fields of (60)Co HDR brachytherapy sources can be calculated from a given calibration coefficient for (192)Ir radiation by using a chamber-type-specific radiation quality correction factor kQ. However, the uncertainty of a (60)Co calibration coefficient calculated via kQ is at least twice as large as that for a direct calibration with a (60)Co source.

Source geometry factors for HDR 192Ir brachytherapy secondary standard well-type ionization chamber calibrations

Well-type ionization chambers are used for measuring the source strength of radioactive brachytherapy sources before clinical use. Initially, the well chambers are calibrated against a suitable national standard. For high dose rate (HDR) 192Ir, this calibration is usually a two-step process. Firstly, the calibration source is traceably calibrated against an air kerma primary standard in terms of either reference air kerma rate or air kerma strength. The calibrated 192Ir source is then used to calibrate the secondary standard well-type ionization chamber.Calibration laboratories are usually only equipped with one type of HDR 192Ir source. If the clinical source type is different from that used for the calibration of the well chamber at the standards laboratory, a source geometry factor, ksg, is required to correct the calibration coefficient for any change of the well chamber response due to geometric differences between the sources.In this work we present source geometry factors for six different HDR 192Ir brachytherapy sources which have been determined using Monte Carlo techniques for a specific ionization chamber, the Standard Imaging HDR 1000 Plus well chamber with a type 70010 HDR iridium source holder. The calculated correction factors were normalized to the old and new type of calibration source used at the National Physical Laboratory. With the old Nucletron microSelectron-v1 (classic) HDR 192Ir calibration source, ksg was found to be in the range 0.983 to 0.999 and with the new Isodose Control HDR 192Ir Flexisource ksg was found to be in the range 0.987 to 1.004 with a relative uncertainty of 0.4% (k = 2). Source geometry factors for different combinations of calibration sources, clinical sources, well chambers and associated source holders, can be calculated with the formalism discussed in this paper.

Brachytherapy source calibration, reviews, and consistency of192Ir high-dose rate afterloading sources supplied over the period of 10 years: A retrospective analysis

Measurement and verification of strength of monomodal high-dose rate (mHDR)192 Ir source supplied by the vendor is a major part of quality assurance program. Reference air kerma rate (RAKR) or air kerma strength (AKS) is the recommended quantity to specify the strength of gamma emitting brachytherapy sources. Physicist in our institution performed the source calibration as soon as each 192 Ir new source was loaded on the mHDR afterloading machine. The AKS accurately measured using a physikalisch technische werkstatten (PTW) re-entrant chamber-electrometer system in a scatter-free geometry was used to compute the air kerma rate (AKR) at one-meter distance in the air. To ensure accurate dose delivery to brachytherapy patients, measured AKS or RAKR should be entered correctly in both HDR treatment console station (TCS) as well as treatment planning system (TPS) associated with it. The clinical outcome mainly depends not only on the accuracy of the source strength measurement in the hospital but also on the correct source strength entered into both TCS and TPS software. A retrospective study on 22 mHDR V2 sources supplied by the vendor for the period of 10 years was taken up to access the accuracy of source strength supplied to the Radiotherapy department. The results are analyzed and reported. The accuracy in measured RAKR of all 22 sources supplied by vendor was well within the tolerance limits set by the national regulatory body and international recommendations. The deviations observed between measured RAKR versus manufacturer's quoted RAKR were in the range from −1.71% to +1.15%. In conclusion, the measured RAKR have good agreement with vendor quoted RAKR values.

Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the PTB and the BIPM

An indirect comparison of the standards for reference air kerma rate (RAKR) for 192Ir high dose rate (HDR) brachytherapy sources of the Physikalisch-Technische Bundesanstalt (PTB), Germany, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the PTB in September 2011. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the PTB and the BIPM standards for reference air kerma rate, is 1.0003 with a combined standard uncertainty of 0.0099.Main text.To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Comparison BIPM.RI(I)-K8 of high dose-rate Ir-192 brachytherapy standards for reference air kerma rate of the NRC and the BIPM

An indirect comparison of the standards for reference air kerma rate for 192Ir high dose rate (HDR) brachytherapy sources of the National Research Council (NRC), Canada, and of the Bureau International des Poids et Mesures (BIPM) was carried out at the NRC in August 2014. The comparison result, based on the calibration coefficients for a transfer standard and expressed as a ratio of the NRC and the BIPM standards for reference air kerma rate, is 0.9966 with a combined standard uncertainty of 0.0050.Main text.To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Air kerma and absorbed dose standards for reference dosimetry in brachytherapy.

This article reviews recent developments in primary standards for the calibration of brachytherapy sources, with an emphasis on the currently most common photon-emitting radionuclides. The introduction discusses the need for reference dosimetry in brachytherapy in general. The following section focuses on the three main quantities, i.e. reference air kerma rate, air kerma strength and absorbed dose rate to water, which are currently used for the specification of brachytherapy photon sources and which can be realized with primary standards from first principles. An overview of different air kerma and absorbed dose standards, which have been independently developed by various national metrology institutes over the past two decades, is given in the next two sections. Other dosimetry techniques for brachytherapy will also be discussed. The review closes with an outlook on a possible transition from air kerma to absorbed dose to water-based calibrations for brachytherapy sources in the future.