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Candela-Juan, C., Ballester, F., Perez-Calatayud, J., & Vijande, J. (2015). Assaying multiple I-125 seeds with the well-ionization chamber SourceCheck(4 Pi) 33005 and a new insert. J. Contemp. Brachytherapy, 7(6), 492–496.
Abstract: Purpose: To provide a practical solution that can be adopted in clinical routine to fulfill the AAPM-ESTRO recommendations regarding quality assurance of seeds used in prostate permanent brachytherapy. The aim is to design a new insert for the well-ionization chamber SourceCheck(4 Pi) 33005 (PTW, Germany) that allows evaluating the mean air-kerma strength of up to ten I-125 seeds with one single measurement instead of measuring each seed individually. Material and methods: The material required is: a) the SourceCheck(4 Pi) 33005 well-ionization chamber provided with a PTW insert to measure the air-kerma strength S-K of one single seed at a time; b) a newly designed insert that accommodates ten seeds in one column, which allows measuring the mean S-K of the ten seeds in one single measurement; and c) a container with ten seeds from the same batch and class of the seeds used for the patient implant, and a set of nine non-radioactive seeds.The new insert is characterized by determining its calibration coefficient, used to convert the reading of the well-chamber when ten seeds are measured to their mean S-K. The proposed method is validated by comparing the mean S-K of the ten seeds obtained from the new insert with the individual measurement of S-K of each seed, evaluated with the PTW insert. Results: The ratio between the calibration coefficient of the new insert and the calibration coefficient of the PTW insert for the SourceCheck(4 Pi) 33005 is 1.135 +/- 0.007 (k = 1). The mean S-K of a set of ten seeds evaluated with this new system is in agreement with the mean value obtained from measuring independently the S-K of each seed. Conclusions: The new insert and procedure allow evaluating the mean S-K of ten seeds prior to the implant in a single measurement. The method is faster and more efficient from radiation protection point of view than measuring the individual S-K of each seed.
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Richart, J., Otal, A., Rodriguez, S., Nicolas, A. I., DePiaggio, M., Santos, M., et al. (2015). A practical MRI-based reconstruction method for a new endocavitary and interstitial gynaecological template. J. Contemp. Brachytherapy, 7(5), 407–414.
Abstract: Purpose: There are perineal templates for interstitial implants such as MUPIT and Syed applicators. Their limitations are the intracavitary component deficit and the necessity to use computed tomography (CT) for treatment planning since both applicators are non-magnetic resonance imaging (MRI) compatibles. To overcome these problems, a new template named Template Benidorm (TB) has been recently developed. Titanium needles are usually reconstructed based on their own artifacts, mainly in T1-weighted sequence, using the void on the tip as the needle tip position. Nevertheless, patient tissues surrounding the needles present heterogeneities that complicate the accurate identification of these artifact patterns. The purpose of this work is to improve the titanium needle reconstruction uncertainty for the TB case using a simple method based on the free needle lengths and typical MRI pellets markers. Material and methods: The proposed procedure consists on the inclusion of three small A-vitamin pellets (hyper-intense on MRI images) compressed by both applicator plates defining the central plane of the plate's arrangement. The needles used are typically 20 cm in length. For each needle, two points are selected defining the straight line. From such line and the plane equations, the intersection can be obtained, and using the free length (knowing the offset distance), the coordinates of the needle tip can be obtained. The method is applied in both T1W and T2W acquisition sequences. To evaluate the inter-observer variation of the method, three implants of T1W and another three of T2W have been reconstructed by two different medical physicists with experience on these reconstructions. Results and conclusions: The differences observed in the positioning were significantly smaller than 1 mm in all cases. The presented algorithm also allows the use of only T2W sequence either for contouring or reconstruction purposes. The proposed method is robust and independent of the visibility of the artifact at the tip of the needle.
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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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Ballester, F., Granero, D., Perez-Calatayud, J., Venselaar, J. L. M., & Rivard, M. J. (2010). Study of encapsulated Tm-170 sources for their potential use in brachytherapy. Med. Phys., 37(4), 1629–1637.
Abstract: Methods: The authors have assumed a theoretical Tm-170 cylindrical source encapsulated with stainless steel and typical dimensions taken from the currently available HDR Ir-192 brachytherapy sources. The dose-rate distribution was calculated for this source using the GEANT4 Monte Carlo (MC) code considering both photon and electron Tm-170 spectra. The AAPM TG-43 U1 brachytherapy dosimetry parameters were derived. To study general properties of Tm-170 encapsulated sources, spherical sources encapsulated with stainless steel and platinum were also studied. Moreover, the influence of small variations in the active core and capsule dimensions on the dosimetric characteristics was assessed. Treatment times required for a Tm-170 source were compared to those for Ir-192 and Yb-169 for the same contained activity. Results: Due to the energetic beta spectrum and the large electron yield, the bremsstrahlung contribution to the dose was of the same order of magnitude as from the emitted gammas and characteristic x rays. Moreover, the electron spectrum contribution to the dose was significant up to 4 mm from the source center compared to the photon contribution. The dose-rate constant Lambda of the cylindrical source was 1.23 cGy h(-1) U-1. The behavior of the radial dose function showed promise for applications in brachytherapy. Due to the electron spectrum, the anisotropy was large for r < 6 mm. Variations in manufacturing tolerances did not significantly influence the final dosimetry data when expressed in cGy h(-1) U-1. For typical capsule dimensions, maximum reference dose rates of about 0.2, 10, and 2 Gy min(-1) would then be obtained for Tm-170, Ir-192, and Yb-169, respectively, resulting in treatment times greater than those for HDR Ir-192 brachytherapy. Conclusions: The dosimetric characteristics of source designs exploiting the low photon energy of Tm-170 were studied for potential application in HDR-brachytherapy. Dose-rate distributions were obtained for cylindrical and simplified spherical Tm-170 source designs (stainless steel and platinum capsule materials) using MC calculations. Despite the high activity of Tm-170, calculated treatment times were much longer than for Ir-192.
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Pujades, M. C., Granero, D., Vijande, J., Ballester, F., Perez-Calatayud, J., Papagiannis, P., et al. (2014). Air-kerma evaluation at the maze entrance of HDR brachytherapy facilities. J. Radiol. Prot., 34(4), 741–753.
Abstract: In the absence of procedures for evaluating the design of brachytherapy (BT) facilities for radiation protection purposes, the methodology used for external beam radiotherapy facilities is often adapted. The purpose of this study is to adapt the NCRP 151 methodology for estimating the air-kerma rate at the door in BT facilities. Such methodology was checked against Monte Carlo (MC) techniques using the code Geant4. Five different facility designs were studied for Ir-192 and Co-60 HDR applications to account for several different bunker layouts. For the estimation of the lead thickness needed at the door, the use of transmission data for the real spectra at the door instead of the ones emitted by Ir-192 and Co-60 will reduce the lead thickness by a factor of five for Ir-192 and ten for Co-60. This will significantly lighten the door and hence simplify construction and operating requirements for all bunkers. The adaptation proposed in this study to estimate the air-kerma rate at the door depends on the complexity of the maze: it provides good results for bunkers with a maze (i.e. similar to those used for linacs for which the NCRP 151 methodology was developed) but fails for less conventional designs. For those facilities, a specific Monte Carlo study is in order for reasons of safety and cost-effectiveness.
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