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Granero, D., Candela-Juan, C., Vijande, J., Ballester, F., Perez-Calatayud, J., Jacob, D., et al. (2016). Technical Note: Dosimetry of Leipzig and Valencia applicators without the plastic cap. Med. Phys., 43(5), 2087–4pp.
Abstract: Purpose: High dose rate (HDR) brachytherapy for treatment of small skin lesions using the Leipzig and Valencia applicators is a widely used technique. These applicators are equipped with an attachable plastic cap to be placed during fraction delivery to ensure electronic equilibrium and to prevent secondary electrons from reaching the skin surface. The purpose of this study is to report on the dosimetric impact of the cap being absent during HDR fraction delivery, which has not been explored previously in the literature. Methods: GEANT4 Monte Carlo simulations (version 10.0) have been performed for the Leipzig and Valencia applicators with and without the plastic cap. In order to validate the Monte Carlo simulations, experimental measurements using radiochromic films have been done. Results: Dose absorbed within 1 mm of the skin surface increases by a factor of 1500% for the Leipzig applicators and of 180% for the Valencia applicators. Deeper than 1 mm, the overdosage flattens up to a 10% increase. Conclusions: Differences of treating with or without the plastic cap are significant. Users must check always that the plastic cap is in place before any treatment in order to avoid overdosage of the skin. Prior to skin HDR fraction delivery, the timeout checklist should include verification of the cap placement. (C) 2016 American Association of Physicists in Medicine.
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Gimenez-Alventosa, V., Gimenez, V., Ballester, F., Vijande, J., & Andreo, P. (2020). Monte Carlo calculation of beam quality correction factors for PTW cylindrical ionization chambers in photon beams. Phys. Med. Biol., 65(20), 205005–11pp.
Abstract: The beam quality correction factork(Q)for megavoltage photon beams has been calculated for eight PTW (Freiburg, Germany) ionization chambers (Farmer chambers PTW30010, PTW30011, PTW30012, and PTW30013, Semiflex 3D chambers PTW31021, PTW31010, and PTW31013, and the PinPoint 3D chamber PTW31016). Simulations performed on the widely used NE-2571 ionization chamber have been used to benchmark the results. The Monte Carlo code PENELOPE/penEasy was used to calculate the absorbed dose to a point in water and the absorbed dose to the active air volume of the chambers for photon beams in the range 4 to 24 MV. Of the nine ionization chambers analysed, only five are included in the current version of the International Code of Practice for dosimetry based on standards of absorbed dose to water (IAEA TRS 398). The values reported in this work agree with those in the literature within the uncertainty estimates and are to be included in the average values of the data obtained by different working groups for the forthcoming update of TRS 398.
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Gimenez-Alventosa, V., Vijande, J., Ballester, F., & Perez-Calatayud, J. (2016). Transit dose comparisons for Co-60 and Ir-192 HDR sources. J. Radiol. Prot., 36(4), 858–864.
Abstract: The goal of this study is to evaluate the ambient dose due to the transit of high dose rate (HDR) Co-60 sources along a transfer tube as compared to Ir-192 ones in a realistic clinical scenario. This goal is accomplished by evaluating air-kerma differences with Monte Carlo calculations using PENELOPE2011. Scatter from both the afterloader and the patient was not taken into account. Two sources, mHDR-v2 and Flexisource Co-60, (Elekta Brachytherapy, Veenendaal, the Netherlands) have been considered. These sources were simulated within a standard transfer tube located in an infinite air phantom. The movement of the source was included by displacing their positions along the connecting tube from z = – 75 cm to z = + 75 cm and combining them. Since modern afterloaders like Flexitron (Elekta) or Saginova (BEBIG GmbH) are able to use equally 192Ir and 60Co sources, it was assumed that both sources are displaced with equal speed. Typical HDR source activity content values were provided by the manufacturer. 2D distributions were obtained with type-A uncertainties (k = 2) less than 0.01%. From those, the air-kerma ratio Co-60/Ir-192 was evaluated weighted by their corresponding typical activities. It was found that it varies slowly with distance (less than 10% variation at 75 cm) but strongly in time due to the shorter half-life of the 192Ir (73.83 d). The maximum ratio is located close to the tube. It reaches a value of 0.57 when the typical activity of the sources at the time when they were installed by the vendor was used. Such ratio increases up to 1.28 at the end of the recommended working life (90 d) of the Ir-192 source. Co-60/Ir-192 air-kerma ratios are almost constant (0.51-0.57) in the vicinity of the source-tube with recent installed sources. Nevertheless, air-kerma ratios increase rapidly (1.15-1.29) whenever the Ir-192 is approaching the end of its life. In case of a medical event requiring the medical staff to access the treatment room, these ratios indicate that the dosimetric impact on the medical team will be lower, with a few exceptions, in the case of Co-60-based HDR brachytherapy as compared to Ir-192-based one when typical air-kerma strength values are considered.
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Gimenez-Alventosa, V., Antunes, P. C. G., Vijande, J., Ballester, F., Perez-Calatayud, J., & Andreo, P. (2017). Collision-kerma conversion between dose-to-tissue and dose-to-water by photon energy-fluence corrections in low-energy brachytherapy. Phys. Med. Biol., 62(1), 146–164.
Abstract: The AAPM TG-43 brachytherapy dosimetry formalism, introduced in 1995, has become a standard for brachytherapy dosimetry worldwide; it implicitly assumes that charged-particle equilibrium (CPE) exists for the determination of absorbed dose to water at different locations, except in the vicinity of the source capsule. Subsequent dosimetry developments, based on Monte Carlo calculations or analytical solutions of transport equations, do not rely on the CPE assumption and determine directly the dose to different tissues. At the time of relating dose to tissue and dose to water, or vice versa, it is usually assumed that the photon fluence in water and in tissues are practically identical, so that the absorbed dose in the two media can be related by their ratio of mass energy-absorption coefficients. In this work, an efficient way to correlate absorbed dose to water and absorbed dose to tissue in brachytherapy calculations at clinically relevant distances for low-energy photon emitting seeds is proposed. A correction is introduced that is based on the ratio of the water-to-tissue photon energy-fluences. State-of-the art Monte Carlo calculations are used to score photon fluence differential in energy in water and in various human tissues (muscle, adipose and bone), which in all cases include a realistic modelling of low-energy brachytherapy sources in order to benchmark the formalism proposed. The energy-fluence based corrections given in this work are able to correlate absorbed dose to tissue and absorbed dose to water with an accuracy better than 0.5% in the most critical cases (e.g. bone tissue).
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Gimenez-Alventosa, V., Gimenez, V., Ballester, F., Vijande, J., & Andreo, P. (2018). Correction factors for ionization chamber measurements with the 'Valencia' and 'large field Valencia' brachytherapy applicators. Phys. Med. Biol., 63(12), 125004–10pp.
Abstract: Treatment of small skin lesions using HDR brachytherapy applicators is a widely used technique. The shielded applicators currently available in clinical practice are based on a tungsten-alloy cup that collimates the source-emitted radiation into a small region, hence protecting nearby tissues. The goal of this manuscript is to evaluate the correction factors required for dose measurements with a plane-parallel ionization chamber typically used in clinical brachytherapy for the 'Valencia' and 'large field Valencia' shielded applicators. Monte Carlo simulations have been performed using the PENELOPE-2014 system to determine the absorbed dose deposited in a water phantom and in the chamber active volume with a Type A uncertainty of the order of 0.1%. The average energies of the photon spectra arriving at the surface of the water phantom differ by approximately 10%, being 384 keV for the 'Valencia' and 343 keV for the 'large field Valencia'. The ionization chamber correction factors have been obtained for both applicators using three methods, their values depending on the applicator being considered. Using a depth-independent global chamber perturbation correction factor and no shift of the effective point of measurement yields depth-dose differences of up to 1% for the 'Valencia' applicator. Calculations using a depth-dependent global perturbation factor, or a shift of the effective point of measurement combined with a constant partial perturbation factor, result in differences of about 0.1% for both applicators. The results emphasize the relevance of carrying out detailed Monte Carlo studies for each shielded brachytherapy applicator and ionization chamber.
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