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Valdes-Cortez, C., Niatsetski, Y., Perez-Calatayud, J., Ballester, F., & Vijande, J. (2022). A Monte Carlo study of the relative biological effectiveness in surface brachytherapy. Med. Phys., 49, 5576–5588.
Abstract: Purpose This work aims to simulate clustered DNA damage from ionizing radiation and estimate the relative biological effectiveness (RBE) for radionuclide (rBT)- and electronic (eBT)-based surface brachytherapy through a hybrid Monte Carlo (MC) approach, using realistic models of the sources and applicators. Methods Damage from ionizing radiation has been studied using the Monte Carlo Damage Simulation algorithm using as input the primary electron fluence simulated using a state-of-the-art MC code, PENELOPE-2018. Two Ir-192 rBT applicators, Valencia and Leipzig, one Co-60 source with a Freiburg Flap applicator (reference source), and two eBT systems, Esteya and INTRABEAM, have been included in this study implementing full realizations of their geometries as disclosed by the manufacturer. The role played by filtration and tube kilovoltage has also been addressed. Results For rBT, an RBE value of about 1.01 has been found for the applicators and phantoms considered. In the case of eBT, RBE values for the Esteya system show an almost constant RBE value of about 1.06 for all depths and materials. For INTRABEAM, variations in the range of 1.12-1.06 are reported depending on phantom composition and depth. Modifications in the Esteya system, filtration, and tube kilovoltage give rise to variations in the same range. Conclusions Current clinical practice does not incorporate biological effects in surface brachytherapy. Therefore, the same absorbed dose is administered to the patients independently on the particularities of the rBT or eBT system considered. The almost constant RBE values reported for rBT support that assumption regardless of the details of the patient geometry, the presence of a flattening filter in the applicator design, or even significant modifications in the photon energy spectra above 300 keV. That is not the case for eBT, where a clear dependence on the eBT system and the characteristics of the patient geometry are reported. A complete study specific for each eBT system, including detailed applicator characteristics (size, shape, filtering, among others) and common anatomical locations, should be performed before adopting an existing RBE value.
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Valdes-Cortez, C., Mansour, I., Rivard, M. J., Ballester, F., Mainegra-Hing, E., Thomson, R. M., et al. (2021). A study of Type B uncertainties associated with the photoelectric effect in low-energy Monte Carlo simulations. Phys. Med. Biol., 66(10), 105014–14pp.
Abstract: Purpose. To estimate Type B uncertainties in absorbed-dose calculations arising from the different implementations in current state-of-the-art Monte Carlo (MC) codes of low-energy photon cross-sections (<200 keV). Methods. MC simulations are carried out using three codes widely used in the low-energy domain: PENELOPE-2018, EGSnrc, and MCNP. Three dosimetry-relevant quantities are considered: mass energy-absorption coefficients for water, air, graphite, and their respective ratios; absorbed dose; and photon-fluence spectra. The absorbed dose and the photon-fluence spectra are scored in a spherical water phantom of 15 cm radius. Benchmark simulations using similar cross-sections have been performed. The differences observed between these quantities when different cross-sections are considered are taken to be a good estimator for the corresponding Type B uncertainties. Results. A conservative Type B uncertainty for the absorbed dose (k = 2) of 1.2%-1.7% (<50 keV), 0.6%-1.2% (50-100 keV), and 0.3% (100-200 keV) is estimated. The photon-fluence spectrum does not present clinically relevant differences that merit considering additional Type B uncertainties except for energies below 25 keV, where a Type B uncertainty of 0.5% is obtained. Below 30 keV, mass energy-absorption coefficients show Type B uncertainties (k = 2) of about 1.5% (water and air), and 2% (graphite), diminishing in all materials for larger energies and reaching values about 1% (40-50 keV) and 0.5% (50-75 keV). With respect to their ratios, the only significant Type B uncertainties are observed in the case of the water-to-graphite ratio for energies below 30 keV, being about 0.7% (k = 2). Conclusions. In contrast with the intermediate (about 500 keV) or high (about 1 MeV) energy domains, Type B uncertainties due to the different cross-sections implementation cannot be considered subdominant with respect to Type A uncertainties or even to other sources of Type B uncertainties (tally volume averaging, manufacturing tolerances, etc). Therefore, the values reported here should be accommodated within the uncertainty budget in low-energy photon dosimetry studies.
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Valdes-Cortez, C., Mansour, I., Ayala Alvarez, D. S., Berumen, F., Cote, J. S., Ndoutoume-Paquet, G., et al. (2025). Dosimetric impact of physics libraries for electronic brachytherapy Monte Carlo studies. Med. Phys., 52(4), 2520–2532.
Abstract: Background Low-energy x-ray beams used in electronic brachytherapy (eBT) present significant dosimetric challenges due to their high depth-dose gradients, the dependence of detector response on materials, and the lack of standardized dose-to-water references. These challenges have driven the need for Monte Carlo (MC) simulations to ensure accurate dosimetry. However, discrepancies in the physics models used by different MC systems have raised concerns about their dosimetric consistency, particularly in modeling bremsstrahlung interactions. Purpose To assess the dosimetric impact of using different physics approaches in three state-of-the-art MC systems for eBT, focusing on the disagreements observed when different MC methods are used to evaluate bremsstrahlung interactions. Methods The MC studies of the Axxent S700, the Esteya, and the INTRABEAM eBT systems were performed using two EGSnrc applications (egsbrachy and egskerma), TOPAS, and PENELOPE-2018 (PEN18). The fluence spectra and depth doses were compared for simplified x-ray tube models, which maintain the target mode (transmission or reflection), the target material and thickness, and the surface applicators' source-to-surface distance. An extra simulation was made to evaluate the utility of the simplified models as proxies in predicting the most important characteristics of an accurate applicator's simulation (detailed model of INTRABEAM's 30 mm surface applicator). The EGSnrc applications and PEN18 utilized their default bremsstrahlung angular emission approaches. TOPAS used two physics lists: g4em-livermore (TOPAS(liv)) and g4em-penelope (TOPAS(pen)). Results The most significant differences between MC codes were observed for the transmission target mode. The bremsstrahlung component of the fluence spectra differed by about 15% on average, comparing PEN18, EGSnrc applications, and TOPAS(liv), with PEN18's fluences consistently lower. EGSnrc and PEN18 agreed within 3% for their characteristic spectrum components. However, PEN18's characteristic lines overreached TOPAS(liv)'s by 40%. Those spectral characteristics generated depth dose differences, where PEN18, on average, scored 9% lower than EGSnrc and TOPAS(liv). Considering TOPAS(pen) in the transmission mode, PEN18's fluence spectrum presented a lower bremsstrahlung (5%) but a higher characteristic component (10%); these spectral differences compensated, generating depth dose differences within 1% average. In the reflection target mode, EGSnrc and PEN18 agreed within 4% for the bremsstrahlung and characteristic components of the fluence spectra. With TOPAS(pen) in the reflection mode, PEN18 presents 12% lower fluences in the bremsstrahlung component but 6% higher characteristic lines. This spectral behavior diminished the depth dose differences up to 3%. Conclusion This work found considerable disagreements between three state-of-the-art MC systems commonly used in medical applications when simulating bremsstrahlung in eBT. The differences arose when the bremsstrahlung angular distribution and the atomic relaxation processes in the target became relevant. More theoretical and experimental studies are necessary to evaluate the impact of these differences on related calculations.
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Valdes-Cortez, C., Ballester, F., Vijande, J., Gimenez, V., Gimenez-Alventosa, V., Perez-Calatayud, J., et al. (2020). Depth-dose measurement corrections for the surface electronic brachytherapy beams of an Esteya(R) unit: a Monte Carlo study. Phys. Med. Biol., 65(24), 245026–12pp.
Abstract: Three different correction factors for measurements with the parallel-plate ionization chamber PTW T34013 on the Esteya electronic brachytherapy unit have been investigated. This chamber type is recommended by AAPM TG-253 for depth-dose measurements in the 69.5 kV x-ray beam generated by the Esteya unit. Monte Carlo simulations using the PENELOPE-2018 system were performed to determine the absorbed dose deposited in water and in the chamber sensitive volume at different depths with a Type A uncertainty smaller than 0.1%. Chamber-to-chamber differences have been explored performing measurements using three different chambers. The range of conical applicators available, from 10 to 30 mm in diameter, has been explored. Using a depth-independent global chamber perturbation correction factor without a shift of the effective point of measurement yielded differences between the absorbed dose to water and the corrected absorbed dose in the sensitive volume of the chamber of up to 1% and 0.6% for the 10 mm and 30 mm applicators, respectively. Calculations using a depth-dependent perturbation factor, including or excluding a shift of the effective point of measurement, resulted in depth-dose differences of about +/- 0.5% or less for both applicators. The smallest depth-dose differences were obtained when a shift of the effective point of measurement was implemented, being displaced 0.4 mm towards the center of the sensitive volume of the chamber. The correction factors were obtained with combined uncertainties of 0.4% (k = 2). Uncertainties due to chamber-to-chamber differences are found to be lower than 2%. The results emphasize the relevance of carrying out detailed Monte Carlo studies for each electronic brachytherapy device and ionization chamber used for its dosimetry.
Keywords: electronic brachytherapy; eBT; dosimetry; ionization chamber; Monte Carlo
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Mansour, I. R., Valdes-Cortez, C., Ayala Alvarez, D. S., Berumen, F., Côte, J. S., Ndoutoume-Paquet, G., et al. (2025). Reference datasets for commissioning of model-based dose calculation algorithms for electronic brachytherapy. Med. Phys., , 11pp.
Abstract: PurposeThis work provides the first two clinical test cases for commissioning electronic brachytherapy (eBT) model-based dose calculation algorithms (MBDCAs) for skin irradiation using surface applicators.Acquisition and Validation MethodsThe test cases utilize the INTRABEAM 30 mm surface applicator. Test Case I: water phantom is used to evaluate the algorithm's performance in a uniform medium consisting of a voxelized water cube surrounded by air. Test Case II: Surface eBT represents a heterogeneous medium with four distinct layers: skin tissue, adipose tissue, cortical bone, and soft tissue. Treatment plans for both cases were created and exported into the Radiance treatment planning system (TPS). Dose-to-medium calculations were then performed using this Monte Carlo (MC)-based TPS and compared with MC simulations conducted independently by three different groups using two codes: EGSnrc and PENELOPE. The results agreed within expected Type A and B statistical uncertainties.Data Format and Usage NotesThe dataset is available online at https://doi.org/10.52519/00005. A proprietary file designed for use within Radiance containing CT images and the treatment plan for both test cases, the LINAC modeling, and the CT calibration are included, as well as reference MC and TPS dose data in RTdose format and all files required to run the MC simulations.Potential ApplicationsThis dataset serves as a valuable resource for commissioning eBT MBDCAs and lays the groundwork for developing clinical test cases for other eBT systems. It is also a helpful educational tool for exploring various eBT devices and their advantages and drawbacks. Furthermore, brachytherapy researchers seeking a benchmark for dosimetric calculations in the low-energy domain will find this dataset indispensable.
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