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Oliver, S., Vijande, J., Tejedor-Aguilar, N., Miro, R., Rovira-Escutia, J. J., Ballester, F., et al. (2023). Monte Carlo flattening filter design to high energy intraoperative electron beam homogenization. Radiat. Phys. Chem., 212, 111102–6pp.
Abstract: Intraoperative radiotherapy using mobile linear accelerators is used for a wide variety of malignancies. However, when large fields are used in combination with high energies, a deterioration of the flatness dose profile is measured with respect to smaller fields and lower energies. Indeed, for the LIAC HWL of Sordina, this deterioration is observed for the 12 MeV beam combined with 10 cm (or larger) diameter applicator. Aimed to solve this problem, a flattening filter has been designed and validated evaluating the feasibility of its usage at the upper part of the applicator. The design of the filter was based on Monte Carlo simulations because of its accuracy in modeling components of clinical devices, among other purposes. The LIAC 10 cm diameter applicator was modeled and simulated independently by two different research groups using two different MC codes, reproducing the heterogeneity of the 12 MeV energy beam. Then, an iterative process of filter design was carried out. Finally, the MC designed conical filter with the optimal size and height to obtain the desired flattened beam was built in-house using a 3D printer. During the experimental validation of the applicator-filter, percentage depth dose, beam profiles, absolute and peripheral dose measurements were performed to demonstrate the effectiveness of the filter addition in the applicator. These measurements conclude that the beam has been flattened, from 5.9% with the standard configuration to 1.6% for the configuration with the filter, without significant increase of the peripheral dose. Consequently, the new filter-applicator LIAC configuration can be used also in a conventional surgery room. A reduction of 16% of the output dose and a reduction of 1.1 mm in the D50 of the percentage depth dose was measured with respect to the original configuration. This work is a proof-of-concept that demonstrates that it is possible to add a filter able to flatten the beam delivered by the Sordina LIAC HWL. Future studies will focus on more refined technical solutions fully compatible with the integrity of the applicator, including its sterilization, to be safely introduced in the clinical practice.
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Palomo, R., Pujades, M. C., Gimeno-Olmos, J., Carmona, V., Lliso, F., Candela-Juan, C., et al. (2015). Evaluation of lens absorbed dose with Cone Beam IGRT procedures. J. Radiol. Prot., 35(4), N33–N41.
Abstract: The purpose of this work is to evaluate the absorbed dose to the eye lenses due to the cone beam computed tomography (CBCT) system used to accurately position the patient during head-and-neck image guided procedures. The on-board imaging (OBI) systems (v. 1.5) of Clinac iX and TrueBeam (Varian) accelerators were used to evaluate the imparted dose to the eye lenses and some additional points of the head. All CBCT scans were acquired with the Standard-Dose Head protocol from Varian. Doses were measured using thermoluminescence dosimeters (TLDs) placed in an anthropomorphic phantom. TLDs were calibrated at the beam quality used to reduce their energy dependence. Average dose to the lens due to the OBI systems of the Clinac iX and the TrueBeam were 0.71 +/- 0.07 mGy/CBCT and 0.70 +/- 0.08 mGy/CBCT, respectively. The extra absorbed dose received by the eye lenses due to one CBCT acquisition with the studied protocol is far below the 500 mGy threshold established by ICRP for cataract formation (ICRP 2011 Statement on Tissue Reactions). However, the incremental effect of several CBCT acquisitions during the whole treatment should be taken into account.
Keywords: IGRT; CBCT; lens absorbed dose; TLD
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Oliver-Canamas, L., Vijande, J., Candela-Juan, C., Gimeno-Olmos, J., Pujades-Claumarchirant, M. C., Rovira-Escutia, J. J., et al. (2023). A User-Friendly System for Mailed Dosimetric Audits of Ir-192 or Co-60 HDR Brachytherapy Sources. Cancers, 15(9), 2484–14pp.
Abstract: Nowadays, the options available to perform external dosimetric audits of the high dose rate (HDR) brachytherapy treatment process are limited. In this work, we present a methodology that allows for performing dosimetric audits in this field. A phantom was designed and manufactured for this purpose. The criteria for its design, together with the in-house measurements for its characterization, are presented. The result is a user-friendly system that can be mailed to perform dosimetric audits in HDR brachytherapy on-site for systems using either Iridium-192 (Ir-192) or Cobalt-60 (Co-60) sources. Objectives: The main goal of this work is to design and characterize a user-friendly methodology to perform mailed dosimetric audits in high dose rate (HDR) brachytherapy for systems using either Iridium-192 (Ir-192) or Cobalt-60 (Co-60) sources. Methods: A solid phantom was designed and manufactured with four catheters and a central slot to place one dosimeter. Irradiations with an Elekta MicroSelectron V2 for Ir-192, and with a BEBIG Multisource for Co-60 were performed for its characterization. For the dose measurements, nanoDots, a type of optically stimulated luminescent dosimeters (OSLDs), were characterized. Monte Carlo (MC) simulations were performed to evaluate the scatter conditions of the irradiation set-up and to study differences in the photon spectra of different Ir-192 sources (Microselectron V2, Flexisource, BEBIG Ir2.A85-2 and Varisource VS2000) reaching the dosimeter in the irradiation set-up. Results: MC simulations indicate that the surface material on which the phantom is supported during the irradiations does not affect the absorbed dose in the nanoDot. Generally, differences below 5% were found in the photon spectra reaching the detector when comparing the Microselectron V2, the Flexisource and the BEBIG models. However, differences up to 20% are observed between the V2 and the Varisource VS2000 models. The calibration coefficients and the uncertainty in the dose measurement were evaluated. Conclusions: The system described here is able to perform dosimetric audits in HDR brachytherapy for systems using either Ir-192 or Co-60 sources. No significant differences are observed between the photon spectra reaching the detector for the MicroSelectron V2, the Flexisource and the BEBIG Ir-192 sources. For the Varisource VS2000, a higher uncertainty is considered in the dose measurement to allow for the nanoDot response.
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Granero, D., Perez-Calatayud, J., Vijande, J., Ballester, F., & Rivard, M. J. (2014). Limitations of the TG-43 formalism for skin high-dose-rate brachytherapy dose calculations. Med. Phys., 41(2), 021703–8pp.
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.
Keywords: HDR; brachytherapy; skin; Monte Carlo; Geant4; Co-60; Ir-192; Yb-169
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Ibanez-Rosello, B., Bautista-Ballesteros, J. A., Candela-Juan, C., Villaescusa, J. I., Ballester, F., Vijande, J., et al. (2017). Evaluation of the shielding in a treatment room with an electronic brachytherapy unit. J. Radiol. Prot., 37(2), N5–N12.
Abstract: Esteya (R) (Elekta Brachytherapy, Veenendaal, The Netherlands) is an electronic brachytherapy (eBT) system based on a 69.5 kVp x-ray source and a set of collimators of 1 to 3 cm in diameter, used for treating non-melanoma skin cancer lesions. This study aims to estimate room shielding requirements for this unit. The non-primary (scattered and leakage) ambient dose equivalent rates were measured with a Berthold LB-133 monitor (Berthold Technologies, Bad Wildbad, Germany). The latter ranges from 17 mSv h(-1) at 0.25 m distance from the x-ray source to 0.1 mSv h(-1) at 2.5 m. The necessary room shielding was then estimated following US and some European guidelines. The room shielding for all barriers considered was below 2 mmPb. The dose to a companion who, exceptionally, would stay with the patient during all treatment was estimated to be below 1 mSv if a leaded apron is used. In conclusion, Esteya shielding requirements are minimal.
Keywords: Esteya; electronic brachytherapy; shielding; radiation protection
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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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Otal, A., Celada, F., Chimeno, J., Vijande, J., Pellejero, S., Perez-Calatayud, M. J., et al. (2022). Review on Treatment Planning Systems for Cervix Brachytherapy (Interventional Radiotherapy): Some Desirable and Convenient Practical Aspects to Be Implemented from Radiation Oncologist and Medical Physics Perspectives. Cancers, 14(14), 3467–15pp.
Abstract: Simple Summary There are no brachytherapy treatment planning systems (TPS) exclusively for the treatment of cervical tumours, so general-purpose TPSs are used. However, these treatments have some particular features concerning the treatment of other pathologies, especially in the case of exclusive use of MRI as an imaging modality and the presence of gynaecological applicators in combination with an interstitial part. That is why it is essential to review the latest versions of commercial TPSs to find the potential features to improve with the help of a group of experimented medical physicists and radiation oncologists. Furthermore, after reviewing the recent literature for advances applicable to cervical brachytherapy and through his own clinical experience, possible improvements are proposed to software providers for the development of new tools. Intracavitary brachytherapy (BT, Interventional Radiotherapy, IRT), plays an essential role in the curative intent of locally advanced cervical cancer, for which the conventional approach involves external beam radiotherapy with concurrent chemotherapy followed by BT. This work aims to review the different methodologies used by commercially available treatment planning systems (TPSs) in exclusive magnetic resonance imaging-based (MRI) cervix BT with interstitial component treatments. Practical aspects and improvements to be implemented into the TPSs are discussed. This review is based on the clinical expertise of a group of radiation oncologists and medical physicists and on interactive demos provided by the software manufacturers. The TPS versions considered include all the new tools currently in development for future commercial releases. The specialists from the supplier companies were asked to propose solutions to some of the challenges often encountered in a clinical environment through a questionnaire. The results include not only such answers but also comments by the authors that, in their opinion, could help solve the challenges covered in these questions. This study summarizes the possibilities offered nowadays by commercial TPSs, highlighting the absence of some useful tools that would notably improve the planning of MR-based interstitial component cervix brachytherapy.
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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.
Keywords: bunker; shielding; NCRP 151; brachytherapy; Monte Carlo
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Hueso-Gonzalez, F., Ballester, F., Perez-Calatayud, J., Siebert, F. A., & Vijande, J. (2017). Towards clinical application of RayStretch for heterogeneity corrections in LDR permanent I-125 prostate brachytherapy. Brachytherapy, 16(3), 616–623.
Abstract: PURPOSE: RayStretch is a simple algorithm proposed for heterogeneity corrections in low-dose-rate brachytherapy. It is built on top of TG-43 consensus data, and it has been validated with Monte Carlo (MC) simulations. In this study, we take a real clinical prostate implant with 71 1251 seeds as reference and we apply RayStretch to analyze its performance in worst-case scenarios. METHODS AND MATERIALS: To do so, we design two cases where large calcifications are located in the prostate lobules. RayStretch resilience under various calcification density values is also explored. Comparisons against MC calculations are performed. RESULTS: Dose volume histogram related parameters like prostate D-90, rectum D-2cc, or urethra D-10 obtained with RayStretch agree within a few percent with the detailed MC results for all cases considered. CONCLUSIONS: The robustness and compatibility of RayStretch with commercial treatment planning systems indicate its applicability in clinical practice for dosimetric corrections in prostate calcifications. Its use during intraoperative ultrasound planning is foreseen.
Keywords: Brachytherapy; Low-dose rate; Heterogeneities; Prostate; Calcifications; Dosimetry
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Hueso-Gonzalez, F., Vijande, J., Ballester, F., Perez-Calatayud, J., & Siebert, F. A. (2015). A simple analytical method for heterogeneity corrections in low dose rate prostate brachytherapy. Phys. Med. Biol., 60(14), 5455–5469.
Abstract: In low energy brachytherapy, the presence of tissue heterogeneities contributes significantly to the discrepancies observed between treatment plan and delivered dose. In this work, we present a simplified analytical dose calculation algorithm for heterogeneous tissue. We compare it with Monte Carlo computations and assess its suitability for integration in clinical treatment planning systems. The algorithm, named as RayStretch, is based on the classic equivalent path length method and TG-43 reference data. Analytical and Monte Carlo dose calculations using Penelope2008 are compared for a benchmark case: a prostate patient with calcifications. The results show a remarkable agreement between simulation and algorithm, the latter having, in addition, a high calculation speed. The proposed analytical model is compatible with clinical real-time treatment planning systems based on TG-43 consensus datasets for improving dose calculation and treatment quality in heterogeneous tissue. Moreover, the algorithm is applicable for any type of heterogeneities.
Keywords: brachytherapy; low dose rate; heterogeneities; prostate; calcifications
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