Abstract: The introduction of model-based dose calculation algorithms (MBDCAs) in brachytherapy provides an opportunity for a more accurate dose calculation and opens the possibility for novel, innovative treatment modalities. The joint AAPM, ESTRO, and ABG Task Group 186 (TG-186) report provided guidance to early adopters. However, the commissioning aspect of these algorithms was described only in general terms with no quantitative goals. This report, from the Working Group on Model-Based Dose Calculation Algorithms in Brachytherapy, introduced a field-tested approach to MBDCA commissioning. It is based on a set of well-characterized test cases for which reference Monte Carlo (MC) and vendor-specific MBDCA dose distributions are available in a Digital Imaging and Communications in Medicine-Radiotherapy (DICOM-RT) format to the clinical users. The key elements of the TG-186 commissioning workflow are now described in detail, and quantitative goals are provided. This approach leverages the well-known Brachytherapy Source Registry jointly managed by the AAPM and the Imaging and Radiation Oncology Core (IROC) Houston Quality Assurance Center (with associated links at ESTRO) to provide open access to test cases as well as step-by-step user guides. While the current report is limited to the two most widely commercially available MBDCAs and only for Ir-192-based afterloading brachytherapy at this time, this report establishes a general framework that can easily be extended to other brachytherapy MBDCAs and brachytherapy sources. The AAPM, ESTRO, ABG, and ABS recommend that clinical medical physicists implement the workflow presented in this report to validate both the basic and the advanced dose calculation features of their commercial MBDCAs. Recommendations are also given to vendors to integrate advanced analysis tools into their brachytherapy treatment planning system to facilitate extensive dose comparisons. The use of the test cases for research and educational purposes is further encouraged.

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.

Abstract: Given the strong variations in the sensitivity of Compton cameras for the detection of events originating from different points in the field of view (FoV), sensitivity correction is often necessary in Compton image reconstruction. Several approaches for the calculation of the sensitivity matrix have been proposed in the literature. While most of these models are easily implemented and can be useful in many cases, they usually assume high angular coverage over the scattered photon, which is not the case for our prototype. In this work, we have derived an analytical model that allows us to calculate a detailed sensitivity matrix, which has been compared to other sensitivity models in the literature. Specifically, the proposed model describes the probability of measuring a useful event in a two-plane Compton camera, including the most relevant physical processes involved. The model has been used to obtain an expression for the system and sensitivity matrices for iterative image reconstruction. These matrices have been validated taking Monte Carlo simulations as a reference. In order to study the impact of the sensitivity, images reconstructed with our sensitivity model and with other models have been compared. Images have been reconstructed from several simulated sources, including point-like sources and extended distributions of activity, and also from experimental data measured with Na-22 sources. Results show that our sensitivity model is the best suited for our prototype. Although other models in the literature perform successfully in many scenarios, they are not applicable in all the geometrical configurations of interest for our system. In general, our model allows to effectively recover the intensity of point-like sources at different positions in the FoV and to reconstruct regions of homogeneous activity with minimal variance. Moreover, it can be employed for all Compton camera configurations, including those with low angular coverage over the scatterer.