Ning Yue

Dosimetric effects of needle divergence in prostate seed implant using 125I and 103Pd radioactive seeds.

In prostate seed implants, radioactive seeds are implanted into the prostate through a guiding needle with the help of a template and real-time imaging. The ideal locations of the guiding needles and the relative positions of the seeds in each needle are determined before the implantation under the assumption that the needles inserted at different locations will remain parallel. In actual implantation, the direction of the needle is subject variation. In this work, we studied how the dosimetry quality of an implant may be affected when the guiding needles deviate from its planned orientations. Needle divergence of varying degree was simulated on spherical models and actual patient implants. It was found that needle divergence degraded the dosimetric quality of an implant: The minimum target dose, the target dose coverage and therefore the tumor biological effective dose were quantitatively decreased as compared to the reference implant. The magnitude of degradation increased almost linearly with respect to the magnitude of needle divergence. For iodine-125 implants, the average reduction in minimum target dose was about 10% and 20% for needle divergence of standard deviation of 5(0) and 10(0), respectively. The dose coverage in the target was reduced by about 1% and 3% for needle divergence of standard deviation of 5(0) and 10(0), respectively. Implants designed with palladium-103 showed additional 5% reduction in minimum target dose while the effect on dose coverage was about the same as compared to the iodine-125 implants. The degree of dosimetry degradation was shown to be dependent on the size of target volume, the seed spacing used, the use of seeding margin, and on the actual configuration of needle orientations in a given implant. One needs to minimize the physical causes of needle divergence in order to minimize its impact on planned dosimetry. The study suggests that the displacement between a needle image and its planned grid point at the base of prostate should be kept less than 5 mm in order to minimize the reduction in D(min)(<5%) and the increase in cell-survival (< a factor of 10) from the planned dosimetry.

The impact of edema on planning 125I and 103Pd prostate implants.

Permanent transperineal interstitial 125I and 103Pd prostate implants are generally planned to deliver a specific dose to a clinically defined target volume; however, the post-implant evaluation usually reveals that the implant delivered a lower or higher dose than planned. This difference is generally attributed to such factors as source placement errors, overestimation of the prostate volume on CT, and post-implant edema. In the present work we investigate the impact of edema alone. In routine prostate implant planning, it is customary to assume that both the prostate and seeds are static throughout the entire treatment time, and post-implant edema is not taken into consideration in the dosimetry calculation. However, prostate becomes edematous after seed implantation, typically by 50% in volume [Int. J. Radiat. Oncol., Biol., Phys. 41, 1069-1077 (1998)]. The edema resolves itself exponentially with a typical half-life of 10 days. In this work, the impact of the edema-induced dynamic change in prostate volume and seed location on the dose coverage of the prostate is investigated. The total dose delivered to the prostate was calculated by use of a dynamic model, which takes edema into account. In the model, the edema resolves exponentially with time, as reported in a separate study based on serial CT scans [Int. J. Radiat. Oncol., Biol., Phys. 41, 1069-1077 (1998)]. The model assumes that the seeds were implanted exactly as planned, thus eliminating the effect of source placement errors. Implants based on the same transrectal ultrasound (TRUS) images were planned using both 125I and 103Pd sources separately. The preimplant volume and planned seed locations were expanded to different degrees of edema to simulate the postimplant edematous prostate on day 0. The model calculated the dose in increments of 24 h, appropriately adjusting the prostate volume, seed locations, and source strength prior to each time interval and compiled dose-volume histograms (DVH) of the total dose delivered. A total of 30 such DVHs were generated for each implant using different combinations of edema half-life and magnitude. In addition, a DVH of the plan was compiled in the conventional manner, assuming that the prostate volume and seeds were static during treatment. A comparison of the DVH of the static model to the 30 edema corrected DVHs revealed that the plan overestimated the total dose by an amount that increased with the magnitude of the edema and the edema half-life. The maximum overestimation was 15% for 125I and 32% for 103Pd. For more typical edema parameters (a 50% increase in volume and a 10 day half-life) the static plan for 125I overestimated the total dose by about 5%, whereas that for 103Pd overestimated it by about 12%.

A dynamic model for the estimation of optimum timing of computed tomography scan for dose evaluation of 125I or 103Pd seed implant of prostate

PURPOSE/OBJECTIVE The dosimetric evaluation of permanent 125I or 103Pd prostate implant is based on the assumption that both prostate and seeds are static throughout the entire treatment time which lasts months. However, the prostate is often edematous after the surgical implantation of seeds. Therefore, both the volume of the prostate and the seed locations change dynamically as the edema resolves. This effect has impact on the validity of postimplant analysis based upon a CT scan. If a CT scan is taken too early after implantation while there is edema in the prostate, the dose delivered by the implant may be underestimated. If the imaging is delayed too long, the dose may be overestimated. The magnitude of this effect depends on both of the half-life of the isotope used and the half-life and magnitude of the edema. This study describes a dynamic biomathematical model which takes edema into account in calculating the dose delivered by the implant and is used to investigate the optimum time to obtain the postimplant CT scan. MATERIALS AND METHODS The dynamic biomathematical model is a numerical integration of the accumulated dose in which the prostate dimensions, the seed locations, and the source strength are all functions of time. The function which describes the change in prostate dimensions and seed locations as a function of time was determined in a separate study by analysis of serial postimplant CT scans. Dose-volume histograms (DVH) of the prostate for the total dose generated by the dynamic model are compared to DVHs generated by CT scans simulated for postimplant intervals ranging from 0 to 300 days after the implantation for 30 different combinations of the magnitude and duration of edema. RESULTS DVHs of the prostate calculated by taking edema into account show that the time of obtaining a CT scan for postimplant analysis is critical to the accuracy of dose evaluations. The comparison of the DVHs generated by the dynamic model to those generated by the CT scans simulated for a range of postimplant intervals show that obtaining the CT scan too early tends to underestimate the total dose while obtaining the CT scan after the edema is resolved tends to overestimate it. The results show that the optimum timing of the CT scan depends upon the duration of the edema and the half-life of the radioisotope used. It is almost independent of the magnitude of the edema. Thus, a unique optimum time window for the imaging study cannot be defined for either 125I or 103Pd implants. However, an optimum time window can be identified for which the calculated dose, on the average, will generally differ from the actual dose by less than 5%, with a maximum error not exceeding 15%. Such a window is 4 to 10 weeks after the implantation for an 125I implant, and 2 to 4 weeks for a 103Pd implant. CONCLUSIONS A dynamic biomathematical model to correct for the effects of edema in calculating the total dose delivered by an 125I or 103Pd seed implant has been developed. The model has been used to investigate the optimum time window during which the postimplant CT scans for analysis should be obtained.

A method to implement full six-degree target shift corrections for rigid body in image-guided radiotherapy

Treatment position setup errors often introduce temporal variations in the position of target relative to the planned external radiation beams. The errors can be introduced by the movement of a target relative to external setup marks or to other relevant landmarks that are used to position a patient for radiotherapy. Those variations can cause dose deviations from the planned doses and result in suboptimal treatments where part of the target is not fully irradiated or a critical structure receives more than desired radiation doses. Clinically available technology for image-guided radiotherapy can detect variations of target position. In this study, a method has been developed to correct for target position variations and restore the original beam geometries relative to the target. The technique involves three matrix transformations: (1) transformation of beams from the machine coordinate system to the patient coordinate system as in the patient geometry in the approved dosimetric plan; (2) transformation of beams from the patient coordinate system in the approved plan to the patient coordinate system that is identified at the time of treatment; (3) transformation of beams from the patient coordinate system at the time of treatment in the treatment patient geometry back to the machine coordinate system. The transformation matrix used for the second transformation is determined through the use of image-guided radiotherapy technology and image registration. By using these matrix transformations, the isocenter shift, the gantry, couch and collimator angles of the beams for the treatment, adjusted for the target shift, can be derived. With the new beam parameters, the beams will possess the same positions and orientations relative to the target as in the plan for a rigid body. This method was applied to a head phantom study, and it was found that the target shift was fully corrected in treatment and excellent agreement was found in target dose coverage between the plan and the treatment.

Optimum timing for image-based dose evaluation of 125I and 103PD prostate seed implants.

PURPOSE/OBJECTIVE Image-based dose evaluation of permanent brachytherapy implants for prostate cancer is important for optimal patient management after implantation. Because of edema caused by the surgical procedure in the implantation, if the dose evaluation is based on the images obtained too early after implantation, dose coverage will usually be underestimated. Conversely, if the images are obtained too late, the dose coverage will be overestimated. This study uses a biomathematical model to simulate edema and its resolution on 29 patients, so that the optimum time to obtain image scans and perform dose evaluation can be investigated and estimated. METHODS AND MATERIALS Edema of a prostate and its resolution has been shown to follow an exponential function V(t) = V(0)(1 + deltaV[e-0.693t/Te - 1]) where deltaV is the initial relative increase in the prostate volume due to edema (and is related to edema magnitude), and Te (edema half-life) is the time for the edema to decrease by half in volume. In this study, edema was simulated by increasing the volume of preimplant prostate (obtained from ultrasound volume study) to a given magnitude of edema. Similarly, the locations of planned seeds were changed to their corresponding locations in the edematous prostate proportionally. The edema was then allowed to resolve according to the exponential function. The correct dose distribution was calculated by taking into account the dynamic variations of the prostate volume, seed locations, and source strengths with respect to time. Dose volume histograms (DVHs) were then generated from this dose distribution. The conventional postimplant DVHs, which assume the prostate volume and seed locations are as in the image scans and constant in time, were also calculated based on the simulated image scans for various days postimplantation. The conventional DVHs of prostate on various days after implantation were compared to the DVH calculated assuming dynamic conditions. The optimum timing for conventional postimplant dose evaluation was identified as the time at which a minimum difference between the conventional DVH and the dynamic model DVH was achieved. The analysis was done on 29 prostate seed implant patients for both 125I and 103Pd. The edema magnitude was assumed to be 30%, 40%, 50%, 75%, and 100% of original prostate volume, and the half-life of edema was assumed to be 4, 7, 10, 15, 20, and 25 days. In this study, the original volume of prostate varied from 17 cm3 to 91 cm3, and number of seeds in the implants varied from 57 to 119. RESULTS The optimum timing was mainly dependent on the half-lives of edema and radionuclides, and varied slightly with edema magnitude, prostate volume, and number of seeds. It can be expressed as a function of edema half-life in the form of C0 + C1exp(-C2Te). However, if the dose evaluation was performed based on the image scans taken too early or too late, the error became larger, as the edema magnitude was larger. By averaging all 29 patients and various edemas, it was found that for 125I seed implants, if the postimplant dose evaluation is performed based on image scans taken between 5 and 9 weeks, the average error will be less than 5%, with a maximum possible error less than 10% in 80% coverage dose; for 103Pd seed implants, if the postimplant dose evaluation is performed based on image scans taken between 2 and 4 weeks, the average error will be less than 5%, with a maximum error less than 15% in 80% coverage dose. Because of edema, a conventional preimplant plan also overestimates dose coverage of prostate. On the average, a standard preimplant planning overestimates dose coverage by about 6% for 125I implants and 14% for 103Pd implants in our study. CONCLUSION Based on the dynamic model, the optimum timing of image scans for postimplant dose evaluation of prostate seed implantation is 7 weeks postimplantation for 125I implants and about 3 weeks for 103Pd implants. (ABSTRACT TRUNCATED)

Measurement of dose-rate constant for 103Pd seeds with air kerma strength calibration based upon a primary national standard

Recent developments in the past two years require a significant change in the dosimetry of 103Pd brachytherapy sources (Theraseed model 200, manufactured by Theragenics Corp., Atlanta, GA). Since their introduction in 1987, the air kerma strength of 103Pd sources for interstitial brachytherapy has been determined using a system of apparent activity measurement based upon the measurement of photon fluence at a reference distance along the transverse axis of the source free in air, using a NaI (T1) scintillation detector at the manufacturers facilities. This detection system has been calibrated against a National Institute of Standards and Technology (NIST)-traceable activity standard of a 109Cd source. This system produced a highly consistent standard (within +/-2%) for over 12 years, with the exception of the last 109Cd source change in September 1997, which resulted in a change of 9% from the original 1987 standard. The second major development affecting 103Pd dosimetry is that on 13 January 1999 a primary national standard for the air kerma strength of 103Pd seeds was developed by NIST. This primary standard is based upon an absolute measurement of air kerma rate free in air at a reference distance from the source along its transverse axis using a wide angle free air chamber (WAFAC). In order to implement this new standard for the calibration of source strength in clinical dosimetry for interstitial implants, it is necessary to measure the dose-rate constant for the 103Pd seeds using a calibration of source strength based on the NIST 99 standard. In this work, a measurement of the dose-rate constant using lithium fluoride (LiF) thermoluminescent dosimeters (TLDs) in a water equivalent solid phantom is reported. The measured value of this constant is 0.65 +/- 0.05 cGy h(-1) U(-1), where the unit air kerma strength is 1 U = 1 cGy h(-1) cm2 = 1 microGy h(-1) m2, and is directly traceable to the NIST 99 standard. The implementation of the NIST 99 standard for 103Pd should be accompanied by a simultaneous adoption of the new dose-rate constant reported here. No changes in radial dose function, anisotropy function, anisotropy factor, and geometry function are needed. However, a change in prescribed dose may be necessary to deliver the same physical dose as before.

Dosimetric effects of edema in permanent prostate seed implants: a rigorous solution

PURPOSE To derive a rigorous analytic solution to the dosimetric effects of prostate edema so that its impact on the conventional pre-implant and post-implant dosimetry can be studied for any given radioactive isotope and edema characteristics. METHODS AND MATERIALS The edema characteristics observed by Waterman et al (Int. J. Rad. Onc. Biol. Phys, 41:1069-1077; 1998) was used to model the time evolution of the prostate and the seed locations. The total dose to any part of prostate tissue from a seed implant was calculated analytically by parameterizing the dose fall-off from a radioactive seed as a single inverse power function of distance, with proper account of the edema-induced time evolution. The dosimetric impact of prostate edema was determined by comparing the dose calculated with full consideration of prostate edema to that calculated with the conventional dosimetry approach where the seed locations and the target volume are assumed to be stationary. RESULTS A rigorous analytic solution on the relative dosimetric effects of prostate edema was obtained. This solution proved explicitly that the relative dosimetric effects of edema, as found in the previous numerical studies by Yue et. al. (Int. J. Radiat. Oncol. Biol. Phys. 43, 447-454, 1999), are independent of the size and the shape of the implant target volume and are independent of the number and the locations of the seeds implanted. It also showed that the magnitude of relative dosimetric effects is independent of the location of dose evaluation point within the edematous target volume. It implies that the relative dosimetric effects of prostate edema are universal with respect to a given isotope and edema characteristic. A set of master tables for the relative dosimetric effects of edema were obtained for a wide range of edema characteristics for both (125)I and (103)Pd prostate seed implants. CONCLUSIONS A rigorous analytic solution of the relative dosimetric effects of prostate edema has been derived for a class of edema characterized by Waterman et al. The solution proved that the dosimetric effects caused by the edema are universal functions of edema characteristics for a given isotope. It provides an efficient tool to examine the relative dosimetric effects of edema for any given edema characteristics and for any isotopes that may be considered for prostate implants.

ON THE DEPTH OF PENETRATION OF PHOTONS AND ELECTRONS FOR INTRAVASCULAR BRACHYTHERAPY

PURPOSE To investigate the depth dose characteristics of various radionuclides under consideration for intravascular brachytherapy (IVB). MATERIALS AND METHODS In the past few years, various preclinical studies have shown that 10-30 Gy of ionizing radiation delivered by a brachytherapy treatment may inhibit restenosis following angioplasty. A number of new delivery systems using various radionuclides have been developed and are being investigated for IVB. Typical target size for IVB is in the range of millimeters, in contrast to conventional brachytherapy for cancer in which the target may be 1-5 cm in size. The question addressed in this paper is: whether lower energy photon emitters and even beta emitters, which are not commonly used for intracavitary brachytherapy of cancer, may provide a depth of penetration adequate for IVB. To explore this issue, radial dose functions for photons and electrons in the range of 1-10 mm in water were calculated using Monte Carlo simulation. Reference depth for normalization of the radial dose funtion was chosen to be 2 mm. RESULTS Radial dose functions have been calculated for monoenergetic photons with energies of 0.01, 0.02, 0.04, 0.06, 0.08, 0.10, 0.20, 0.40, and 1.00 MeV and monoenergetic electrons with energies of 0.5, 1.0, 1.5 and 2.0 MeV. Also, the same calculations have been performed for 192Ir, 125I, and 103Pd gamma or x-ray sources as well as 90Sr-90Y, 32P, and 188Re beta-emitting sources. Results are also provided for selected cases in a simulated calcified lesion in water. CONCLUSIONS It is concluded that photons above an energy of 20 keV and electrons above an energy of 1.0 MeV are acceptable from the point of view of adequate depth of penetration for IVB in tissue.

Dosimetric characterization of a newly designed encapsulated interstitial brachytherapy source of iodine-125—model LS-1 BrachyseedTM☆

A newly designed encapsulated 125I source has been introduced (Model LS-1 BrachySeed manufactured by DRAXIMAGE Inc.) for interstitial brachytherapy. In this source 125I radionuclide is contained in two ceramic beads positioned at each end of a titanium capsule. The source contains a rod of Pt-Ir, which serves as a radiographic marker for source localization in the patient. Principle photon emissions are 27.4 and 31.0 keV X-rays and a 35.5 keV gamma-ray. The 22.2 and 25.5 keV silver X-rays produced by fluorescence of the silver dopant in the ceramic bead radioisotope carriers, are also emitted. In this work, the dosimetric characteristics of the 125I source were measured with micro LiF TLD chips and dosimetry parameters were characterized based upon the American Association of Physicists in Medicine, Task Group, No. 43 formalism. The corrected 1999 National Institute of Standards and Technology standard for low energy interstitial brachytherapy sources was used to specify the air kerma strength of the sources used in this study. The dose rate constant of the sources was determined to be 1.02+/-0.07 cGy h(-1) U(-1). The radial dose function was measured and was found to be similar to that of the silver-based model 6711 125I source. However, the anisotropy function of the Model LS-1 BrachySeed source is considerably better than that of model 6711 125I source, especially on the points along and close to the longitudinal axis of the source. The BrachySeed model LS-1 provides more isotropic angular dose distribution in tissue than model 6711 125I source. The anisotropy constant for the model LS-1 source was determined to be 1.006, which is considerably better than the value of 0.93 for the model 6711 source.

Dose perturbations by high atomic number materials in intravascular brachytherapy

PURPOSE In intravascular brachytherapy, use of high atomic number materials, such as contrast agents and metallic stents, can introduce significant dose perturbations, especially for low energy photons. The purpose of this study is to investigate dose perturbation at the interfaces of high atomic number materials and tissue. METHODS To investigate this issue, the radial dose functions across the interface between different materials and soft tissue were calculated by using Monte Carlo simulations. Various interfaces, including contrast agent to water, stainless steel to water, and bone (simulating a calcified plaque) to water, were investigated for photon energies between 20 keV and 1 MeV. RESULTS It was found that the dose to water near the interface is enhanced considerably by photons of energies between 0.020 and 0.200 MeV. For example, the maximum dose enhancement factors for the Hypaque-tissue interface ranged from 2.2 to 18.3 for photons in this energy range. The enhancement factor is almost equal to 1 for photon energy between 0.400 and 1.000 MeV. It appears that the maximum enhancement occurs around 60 keV. For 60-keV photons, the maximum dose enhancement factors are about 18.3, 18.7, 19.1, and 3.1 for Hypaque, Omnipaque, stainless steel, and calcified plaque, respectively. The dose enhancement decreases exponentially with distance from the interface. The affected tissue thickness is dependent on the photon energy. As expected, the higher the photon energy is, the larger is the affected tissue thickness. Depending on the type of interface and the energy of photons, the dose enhancement distance (defined as the thickness receiving more than twice the dose without interface) ranges from 1.3 to 72 microm for photons of energy from 0.020 to 0.100 MeV, respectively. CONCLUSIONS The existense of high atomic number materials could introduce significant dose enhancement at the interfaces between these materials and tissue. This dose enhancement can be higher than an order of magnitude for photon energies around 60 keV, and should be considered in evaluation of the efficacy of intravascular brachytherapy.