Abstract: Purpose: The purpose of this study is to validate the PenRed Monte Carlo framework for clinical applications in brachytherapy. PenRed is a C++ version of Penelope Monte Carlo code with additional tallies and utilities. Methods and materials: Six benchmarking scenarios are explored to validate the use of PenRed and its improved bachytherapy-oriented capabilities for HDR brachytherapy. A new tally allowing the evaluation of collisional kerma for any material using the track length kerma estimator and the possibility to obtain the seed positions, weights and directions processing directly the DICOM file are now implemented in the PenRed distribution. The four non-clinical test cases developed by the Joint AAPM-ESTRO-ABG-ABS WG-DCAB were evaluated by comparing local and global absorbed dose differences with respect to established reference datasets. A prostate and a palliative lung cases, were also studied. For them, absorbed dose ratios, global absorbed dose differences, and cumulative dose-volume histograms were obtained and discussed. Results: The air-kerma strength and the dose rate constant corresponding to the two sources agree with the reference datatests within 0.3% (Sk) and 0.1% (K). With respect to the first three WG-DCAB test cases, more than 99.8% of the voxels present local (global) differences within +/- 1%(+/- 0.1%) of the reference datasets. For test Case 4 reference dataset, more than 94.9%(97.5%) of voxels show an agreement within +/- 1%(+/- 0.1%), better than similar benchmarking calculations in the literature. The track length kerma estimator scorer implemented increases the numerical efficiency of brachytherapy calculations two orders of magnitude, while the specific brachytherapy source allows the user to avoid the use of error-prone intermediate steps to translate the DICOM information into the simulation. In both clinical cases, only minor absorbed dose differences arise in the low-dose isodoses. 99.8% and 100% of the voxels have a global absorbed dose difference ratio within +/- 0.2%for the prostate and lung cases, respectively. The role played by the different segmentation and composition material in the bone structures was discussed, obtaining negligible absorbed dose differ-ences. Dose-volume histograms were in agreement with the reference data.Conclusions: PenRed incorporates new tallies and utilities and has been validated for its use for detailed and precise high-dose-rate brachytherapy simulations.

Abstract: Purpose: Recently, the manufacturer of the HDR Ir-192 mHDR-v2 brachytherapy source reported small design changes (referred to herein as mHDR-v2r) that are within the manufacturing tolerances but may alter the existing dosimetric data for this source. This study aimed to (1) check whether these changes affect the existing dosimetric data published for this source; (2) obtain new dosimetric data in close proximity to the source, including the contributions from 192Ir electrons and considering the absence of electronic equilibrium; and (3) obtain scatter dose components for collapsed cone treatment planning system implementation. Methods: Three different Monte Carlo (MC) radiation transport codes were used: MCNP5, PENELOPE2008, and GEANT4. The source was centrally positioned in a 40 cm radius water phantom. Absorbed dose and collision kerma were obtained using 0.1 mm (0.5 mm) thick voxels to provide high-resolution dosimetry near (far from) the source. Dose-rate distributions obtained with the three MC codes were compared. Results: Simulations of mHDR-v2 and mHDR-v2r designs performed with three radiation transport codes showed agreement typically within 0.2% for r >= 0.25 cm. Dosimetric contributions from source electrons were significant for r<0.25 cm. The dose-rate constant and radial dose function were similar to those from previous MC studies of the mHDR-v2 design. The 2D anisotropy function also coincided with that of the mHDR-v2 design for r >= 0.25 cm. Detailed results of dose distributions and scatter components are presented for the modified source design. Conclusions: Comparison of these results to prior MC studies showed agreement typically within 0.5% for r >= 0.25 cm. If dosimetric data for r<0.25 cm are not needed, dosimetric results from the prior MC studies will be adequate. c 2011 American Association of Physicists in Medicine.

Abstract: Purpose: In skin high-dose-rate (HDR) brachytherapy, sources are located outside, in contact with, or implanted at some depth below the skin surface. Most treatment planning systems use the TG-43 formalism, which is based on single-source dose superposition within an infinite water medium without accounting for the true geometry in which conditions for scattered radiation are altered by the presence of air. The purpose of this study is to evaluate the dosimetric limitations of the TG-43 formalism in HDR skin brachytherapy and the potential clinical impact. Methods: Dose rate distributions of typical configurations used in skin brachytherapy were obtained: a 5 cm x 5 cm superficial mould; a source inside a catheter located at the skin surface with and without backscatter bolus; and a typical interstitial implant consisting of an HDR source in a catheter located at a depth of 0.5 cm. Commercially available HDR Co-60 and Ir-192 sources and a hypothetical Yb-169 source were considered. The Geant4Monte Carlo radiation transport code was used to estimate dose rate distributions for the configurations considered. These results were then compared to those obtained with the TG-43 dose calculation formalism. In particular, the influence of adding bolus material over the implant was studied. Results: For a 5 cm x 5 cm Ir-192 superficial mould and 0.5 cm prescription depth, dose differences in comparison to the TG-43 method were about -3%. When the source was positioned at the skin surface, dose differences were smaller than -1% for Co-60 and Ir-192, yet -3% for Yb-169. For the interstitial implant, dose differences at the skin surface were -7% for Co-60, -0.6% for Ir-192, and -2.5% for Yb-169. Conclusions: This study indicates the following: (i) for the superficial mould, no bolus is needed; (ii) when the source is in contact with the skin surface, no bolus is needed for either Co-60 and Ir-192. For lower energy radionuclides like Yb-169, bolus may be needed; and (iii) for the interstitial case, at least a 0.1 cm bolus is advised for Co-60 to avoid underdosing superficial target layers. For Ir-192 and Yb-169, no bolus is needed. For those cases where no bolus is needed, its use might be detrimental as the lack of radiation scatter may be beneficial to the patient, although the 2% tolerance for dose calculation accuracy recommended in the AAPM TG-56 report is not fulfilled.