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.

Abstract: Purpose Monte Carlo (MC) simulation studies, aimed at evaluating the magnitude of tissue heterogeneity in I-125 prostate permanent seed implant brachytherapy (BT), customarily use clinical post-implant CT images to generate a virtual representation of a realistic patient model (virtual patient model). Metallic artifact reduction (MAR) techniques and tissue assignment schemes (TAS) are implemented on the post-implant CT images to mollify metallic artifacts due to BT seeds and to assign tissue types to the voxels corresponding to the bright seed spots and streaking artifacts, respectively. The objective of this study is to assess the combined influence of MAR and TAS on MC absorbed dose calculations in post-implant CT-based phantoms. The virtual patient models used for I-125 prostate implant MC absorbed dose calculations in this study are derived from the CT images of an external radiotherapy prostate patient without BT seeds and prostatic calcifications, thus averting the need to implement MAR and TAS. Methods The geometry of the IsoSeed I25.S17plus source is validated by comparing the MC calculated results of the TG-43 parameters for the line source approximation with the TG-43U1S2 consensus data. Four MC absorbed dose calculations are performed in two virtual patient models using the egs_brachy MC code: (1) TG-43-based D-w,w-TG(43), (2) D-w,D-w-MBDC that accounts for interseed scattering and attenuation (ISA), (3) D-m,D-m that examines ISA and tissue heterogeneity by scoring absorbed dose in tissue, and (4) D-w,D-m that unlike D-m,D-m scores absorbed dose in water. The MC absorbed doses (1) and (2) are simulated in a TG-43 patient phantom derived by assigning the densities of every voxel to 1.00 g cm(-3) (water), whereas MC absorbed doses (3) and (4) are scored in the TG-186 patient phantom generated by mapping the mass density of each voxel to tissue according to a CT calibration curve. The MC absorbed doses calculated in this study are compared with VariSeed v8.0 calculated absorbed doses. To evaluate the dosimetric effect of MAR and TAS, the MC absorbed doses of this work (independent of MAR and TAS) are compared to the MC absorbed doses of different I-125 source models from previous studies that were calculated with different MC codes using post-implant CT-based phantoms generated by implementing MAR and TAS on post-implant CT images. Results The very good agreement of TG-43 parameters of this study and the published consensus data within 3% validates the geometry of the IsoSeed I25.S17plus source. For the clinical studies, the TG-43-based calculations show a D-90 overestimation of more than 4% compared to the more realistic MC methods due to ISA and tissue composition. The results of this work generally show few discrepancies with the post-implant CT-based dosimetry studies with respect to the D-90 absorbed dose metric parameter. These discrepancies are mainly Type B uncertainties due to the different I-125 source models and MC codes. Conclusions The implementation of MAR and TAS on post-implant CT images have no dosimetric effect on the I-125 prostate MC absorbed dose calculation in post-implant CT-based phantoms.

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.