Larry A. DeWerd

Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies.

Yttrium-90 microsphere brachytherapy of the liver exploits the distinctive features of the liver anatomy to treat liver malignancies with beta radiation and is gaining more wide spread clinical use. This report provides a general overview of microsphere liver brachytherapy and assists the treatment team in creating local treatment practices to provide safe and efficient patient treatment. Suggestions for future improvements are incorporated with the basic rationale for the therapy and currently used procedures. Imaging modalities utilized and their respective quality assurance are discussed. General as well as vendor specific delivery procedures are reviewed. The current dosimetry models are reviewed and suggestions for dosimetry advancement are made. Beta activity standards are reviewed and vendor implementation strategies are discussed. Radioactive material licensing and radiation safety are discussed given the unique requirements of microsphere brachytherapy. A general, team-based quality assurance program is reviewed to provide guidance for the creation of the local procedures. Finally, recommendations are given on how to deliver the current state of the art treatments and directions for future improvements in the therapy.

Dose calculation for photon‐emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO

PURPOSE Recommendations of the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO) on dose calculations for high-energy (average energy higher than 50 keV) photon-emitting brachytherapy sources are presented, including the physical characteristics of specific (192)Ir, (137)Cs, and (60)Co source models. METHODS This report has been prepared by the High Energy Brachytherapy Source Dosimetry (HEBD) Working Group. This report includes considerations in the application of the TG-43U1 formalism to high-energy photon-emitting sources with particular attention to phantom size effects, interpolation accuracy dependence on dose calculation grid size, and dosimetry parameter dependence on source active length. RESULTS Consensus datasets for commercially available high-energy photon sources are provided, along with recommended methods for evaluating these datasets. Recommendations on dosimetry characterization methods, mainly using experimental procedures and Monte Carlo, are established and discussed. Also included are methodological recommendations on detector choice, detector energy response characterization and phantom materials, and measurement specification methodology. Uncertainty analyses are discussed and recommendations for high-energy sources without consensus datasets are given. CONCLUSIONS Recommended consensus datasets for high-energy sources have been derived for sources that were commercially available as of January 2010. Data are presented according to the AAPM TG-43U1 formalism, with modified interpolation and extrapolation techniques of the AAPM TG-43U1S1 report for the 2D anisotropy function and radial dose function.

Addendum to the AAPM's TG-51 protocol for clinical reference dosimetry of high-energy photon beams

An addendum to the AAPMs TG-51 protocol for the determination of absorbed dose to water in megavoltage photon beams is presented. This addendum continues the procedure laid out in TG-51 but new kQ data for photon beams, based on Monte Carlo simulations, are presented and recommendations are given to improve the accuracy and consistency of the protocols implementation. The components of the uncertainty budget in determining absorbed dose to water at the reference point are introduced and the magnitude of each component discussed. Finally, the consistency of experimental determination of ND,w coefficients is discussed. It is expected that the implementation of this addendum will be straightforward, assuming that the user is already familiar with TG-51. The changes introduced by this report are generally minor, although new recommendations could result in procedural changes for individual users. It is expected that the effort on the medical physicists part to implement this addendum will not be significant and could be done as part of the annual linac calibration.

Characterizing the marker-dye correction for Gafchromic(®) EBT2 film: a comparison of three analysis methods.

PURPOSE Gafchromic(®) EBT2 film has a yellow marker dye incorporated into the active layer of the film that can be used to correct the film response for small variations in thickness. This work characterizes the effect of the marker-dye correction on the uniformity and uncertainty of dose measurements with EBT2 film. The effect of variations in time postexposure on the uniformity of EBT2 is also investigated. METHODS EBT2 films were used to measure the flatness of a (60)Co field to provide a high-spatial resolution evaluation of the film uniformity. As a reference, the flatness of the (60)Co field was also measured with Kodak EDR2 films. The EBT2 films were digitized with a flatbed document scanner 24, 48, and 72 h postexposure, and the images were analyzed using three methods: (1) the manufacturer-recommended marker-dye correction, (2) an in-house marker-dye correction, and (3) a net optical density (OD) measurement in the red color channel. The field flatness was calculated from orthogonal profiles through the center of the field using each analysis method, and the results were compared with the EDR2 measurements. Uncertainty was propagated through a dose calculation for each analysis method. The change in the measured field flatness for increasing times postexposure was also determined. RESULTS Both marker-dye correction methods improved the field flatness measured with EBT2 film relative to the net OD method, with a maximum improvement of 1% using the manufacturer-recommended correction. However, the manufacturer-recommended correction also resulted in a dose uncertainty an order of magnitude greater than the other two methods. The in-house marker-dye correction lowered the dose uncertainty relative to the net OD method. The measured field flatness did not exhibit any unidirectional change with increasing time postexposure and showed a maximum change of 0.3%. CONCLUSIONS The marker dye in EBT2 can be used to improve the response uniformity of the film. Depending on the film analysis method used, however, application of a marker-dye correction can improve or degrade the dose uncertainty relative to the net OD method. The uniformity of EBT2 was found to be independent of the time postexposure.

Tomotherapy dose distribution verification using MAGIC-f polymer gel dosimetry.

PURPOSE This paper presents the application of MAGIC-f gel in a three-dimensional dose distribution measurement and its ability to accurately measure the dose distribution from a tomotherapy unit. METHODS A prostate intensity-modulated radiation therapy (IMRT) irradiation was simulated in the gel phantom and the treatment was delivered by a TomoTherapy equipment. Dose distribution was evaluated by the R2 distribution measured in magnetic resonance imaging. RESULTS A high similarity was found by overlapping of isodoses of the dose distribution measured with the gel and expected by the treatment planning system (TPS). Another analysis was done by comparing the relative absorbed dose profiles in the measured and in the expected dose distributions extracted along indicated lines of the volume and the results were also in agreement. The gamma index analysis was also applied to the data and a high pass rate was achieved (88.4% for analysis using 3%∕3 mm and of 96.5% using 4%∕4 mm). The real three-dimensional analysis compared the dose-volume histograms measured for the planning volumes and expected by the treatment planning, being the results also in good agreement by the overlapping of the curves. CONCLUSIONS These results show that MAGIC-f gel is a promise for tridimensional dose distribution measurements.

The Phantoms of Medical and Health Physics

Masuo Aizawa, Yokohama, Japan Olaf S. Andersen, New York, USA Robert H. Austin, Princeton, USA James Barber, London, England Howard C. Berg, Cambridge, USA Victor Bloomfield, St. Paul, USA Robert Callender, Bronx, USA Britton Chance, Philadelphia, USA Steven Chu, Berkeley, USA Louis J. DeFelice, Nashville, USA Johann Deisenhofer, Dallas, USA George Feher, San Diego, La Jolla, USA Hans Frauenfelder, Los Alamos, USA Ivar Giaever, Troy, USA Sol M. Gruner, Ithaca, USA Judith Herzfeld, Waltham, USA Mark S. Humayun, Los Angeles, USA Pierre Joliot, Paris, France Lajos Keszthelyi, Szeged, Hungary Robert S. Knox, Rochester, USA Aaron Lewis, Jerusalem, Israel Stuart M. Lindsay, Tempe, USA David Mauzerall, New York, USA Eugenie V. Mielczarek, Fairfax, USA Markolf Niemz, Mannheim, Germany V. Adrian Parsegian, Bethesda, USA Linda S. Powers, Tucson, USA Earl W. Prohofsky, West Lafayette, USA Andrew Rubin, Moscow, Russia Michael Seibert, Golden, USA David Thomas, Minneapolis, USA

Microionization chamber air-kerma calibration coefficients as a function of photon energy for x-ray spectra in the range of 20–250 kVp relative to 60Co

PURPOSE To investigate the applicability of a wide range of microionization chambers for reference dosimetry measurements in low- and medium-energy x-ray beams. METHODS Measurements were performed with six cylindrical microchamber models, as well as one scanning chamber and two Farmer-type chambers for comparison purposes. Air-kerma calibration coefficients were determined at the University of Wisconsin Accredited Dosimetry Calibration Laboratory for each chamber for a range of low- and medium-energy x-ray beams (20-250 kVp), with effective energies ranging from 11.5 keV to 145 keV, and a (60)Co beam. A low-Z proof-of-concept microchamber was developed and calibrated with and without a high-Z silver epoxy on the collecting electrode. RESULTS All chambers composed of low-Z materials (Z ≤ 13), including the Farmer-type chambers, the scanning chamber, and the PTW TN31014 and the proof-of-concept microchambers, exhibited air-kerma calibration coefficients with little dependence on the quality of the beam. These chambers typically exhibited variations in calibration coefficients of less than 3% with the beam quality, for medium energy beams. However, variations in air-kerma calibration coefficients of greater than 50% were measured over the range of medium-energy x-ray beams for each of the microchambers containing high-Z collecting electrodes (Z > 13). For these high-Z chambers, which include the Exradin A14SL and A16 chambers, the PTW TN31006 chamber, the IBA CC01 chamber, and the proof-of-concept chamber containing silver, the average variation in air-kerma calibration coefficients between any two calibration beams was nearly 25% over the entire range of beam qualities investigated. CONCLUSIONS Due to the strong energy dependence observed with microchambers containing high-Z components, these chambers may not be suitable dosimeters for kilovoltage x-ray applications, as they do not meet the TG-61 requirements. It is recommended that only microchambers containing low-Z materials (Z ≤ 13) be considered for air-kerma calibrations for reference dosimetry in low- and medium-energy x-ray beams.

103Pd strings: Monte Carlo assessment of a new approach to brachytherapy source design

PURPOSE A new type of (103)Pd source (CivaString and CivaThin by CivaTech Oncology, Inc.) is examined. The source contains (103)Pd and Au radio-opaque marker(s), all contained within low-Zeff organic polymers that permit source flexibility. The CivaString source is available in lengths L of 10, 20, 30, 40, 50, and 60 mm, and referred to in the current study as CS10-CS60, respectively. A thinner design, CivaThin, has sources designated as CT10-CT60, respectively. The CivaString and CivaThin sources are 0.85 and 0.60 mm in diameter, respectively. The source design is novel and offers an opportunity to examine its interesting dosimetric properties in comparison to conventional (103)Pd seeds. METHODS The MCNP5 radiation transport code was used to estimate air-kerma rate and dose rate distributions with polar and cylindrical coordinate systems. Doses in water and prostate tissue phantoms were compared to determine differences between the TG-43 formalism and realistic clinical circumstances. The influence of Ti encapsulation and 2.7 keV photons was examined. The accuracy of superposition of dose distributions from shorter sources to create longer source dose distributions was also assessed. RESULTS The normalized air-kerma rate was not highly dependent on L or the polar angle θ, with results being nearly identical between the CivaString and CivaThin sources for common L. The air-kerma strength was also weakly dependent on L. The uncertainty analysis established a standard uncertainty of 1.3% for the dose-rate constant Λ, where the largest contributors were μen/ρ and μ/ρ. The Λ values decreased with increasing L, which was largely explained by differences in solid angle. The radial dose function did not substantially vary among the CivaString and CivaThin sources for r ≥ 1 cm. However, behavior for r < 1 cm indicated that the Au marker(s) shielded radiation for the sources having L = 10, 30, and 50 mm. The 2D anisotropy function exhibited peaks and valleys that corresponded to positions adjacent to (103)Pd wells and Au markers, respectively. Dose distributions of both source types had minimal anisotropy in comparison to conventional (103)Pd seeds. Contributions by 2.7 keV photons comprised ≤ 0.1% of the dose from all photons at positions farther than 0.13 mm from the polymer source surface. Differences between absorbed dose to water and prostate became more substantial as distance from the sources increased, with prostate dose being about 13% lower for r = 5 cm. Using a cylindrical coordinate system, dose superposition of small length sources to replicate the dose distribution for a long length source proved to be a robust technique; a 2.0% tolerance compared with the reference dose distribution did not exceed 0.1 cm(3) for any of the examined source combinations. CONCLUSIONS By design, the CivaString and CivaThin sources have novel dosimetric characteristics in comparison to Ti-encapsulated (103)Pd seeds. The dosimetric characterization has determined the reasons for these differences through analysis using Monte Carlo-based radiation transport simulations.

Response of TLD-100 in mixed fields of photons and electrons.

PURPOSE Thermoluminescent dosimeters (TLDs) are routinely used for dosimetric measurements of high energy photon and electron fields. However, TLD response in combined fields of photon and electron beam qualities has not been characterized. This work investigates the response of TLD-100 (LiF:Mg,Ti) to sequential irradiation by high-energy photon and electron beam qualities. METHODS TLDs were irradiated to a known dose by a linear accelerator with a 6 MV photon beam, a 6 MeV electron beam, and a NIST-traceable (60)Co beam. TLDs were also irradiated in a mixed field of the 6 MeV electron beam and the 6 MV photon beam. The average TLD response per unit dose of the TLDs for each linac beam quality was normalized to the average response per unit dose of the TLDs irradiated by the (60)Co beam. Irradiations were performed in water and in a Virtual Water™ phantom. The 6 MV photon beam and 6 MeV electron beam were used to create dose calibration curves relating TLD response to absorbed dose to water, which were applied to the TLDs irradiated in the mixed field. RESULTS TLD relative response per unit dose in the mixed field was less sensitive than the relative response in the photon field and more sensitive than the relative response in the electron field. Application of the photon dose calibration curve to the TLDs irradiated in a mixed field resulted in an underestimation of the delivered dose, while application of the electron dose calibration curve resulted in an overestimation of the dose. CONCLUSIONS The relative response of TLD-100 in mixed fields fell between the relative response in the photon-only and electron-only fields. TLD-100 dosimetry of mixed fields must account for this intermediate response to minimize the estimation errors associated with calibration factors obtained from a single beam quality.

Technical Note: Improved implementation of doppler broadening in MCNP5

PURPOSE Incoherent scattering has a substantial effect on spectroscopic measurements and simulations. Many general-purpose Monte Carlo codes include models that account for the effects of bound electrons on incoherent scattering, including Doppler broadening (DB). This work investigates the DB model used in the Monte Carlo N-particle transport code (MCNP5). METHODS Simulations were run with three versions of MCNP5: v1.51, v1.60, and a modified form of v1.60 (v1.60m). All simulations used the MCPLIB04 photon data library, which presents the electron subshell data for incoherent scattering in the form of a probability density function. In v1.60m, the source code was altered to sample the electron subshell from a cumulative density function instead. Each version of the code was tested using an identical set of simulations that investigated DB in a slab of silicon at scattering angles of 15°, 30°, and 45°. For each angle, simulations were run for multiple energies between 200 keV and 800 keV. The spectrum of singly-scattered photons at the exit of the slab was scored. Spectra were analytically calculated for comparison. RESULTS In v1.51, DB was modeled for incident photon energies below 760 keV, 384 keV, and 260 keV at scattering angles of 15°, 30°, and 45°, respectively. Above these energy thresholds, v1.51 did not model DB. The spectra calculated using v1.60 and v1.60m exhibited DB for all energy-angle combinations; however, v1.60m, exhibited more energy broadening than did v1.60. The spectra calculated with v1.60m agreed with the analytical calculations. CONCLUSIONS MCNP5 v1.51 and v1.60 model partial broadening when used with the MCPLIB04 data library. MCNP5 v1.60m models DB more accurately due to the form of the electron subshell data. In response to these results, Los Alamos National Laboratory has released a new photon data library, MCPLIB84, that presents the electron subshell data in cumulative distribution form. MCNP5 v1.60 should be used with this library when incoherent scattering has a significant impact on simulation results.