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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., 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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Vijande, J., Ballester, F., Ouhib, Z., Granero, D., Pujades-Claumarchirant, M. C., & Perez-Calatayud, J. (2012). Dosimetry comparison between TG-43 and Monte Carlo calculations using the Freiburg flap for skin high-dose-rate brachytherapy. Brachytherapy, 11(6), 528–535.
Abstract: PURPOSE: The purpose of this work was to evaluate whether the delivered dose to the skin surface and at the prescription depth when using a Freiburg flap applicator is in agreement with the one predicted by the treatment planning system (TPS) using the TG-43 dose-calculation formalism. METHODS AND MATERIALS: Monte Carlo (MC) simulations and radiochromic film measurements have been performed to obtain dose distributions with the source located at the center of one of the spheres and between two spheres. Primary and scatter dose contributions were evaluated to understand the role played by the scatter component. A standard treatment plan was generated using MC- and TG-43-based TPS applying the superposition principle. RESULTS: The MC model has been validated by performing additional simulations in the same conditions but transforming air and Freiburg flap materials into water to match TG-43 parameters. Both dose distributions differ less than 1%. Scatter defect compared with TG-43 data is up to 15% when the source is located at the center of the sphere and up to 25% when the source is between two spheres. Maximum deviations between TPS- and MC-based distributions are of 5%. CONCLUSIONS: The deviations in the TG-43-based dose distributions for a standard treatment plan with respect to the MC dose distribution calculated taking into account the composition and shape of the applicator and the surrounding air are lower than 5%. Therefore, this study supports the validity of the TPS used in clinical practice. (C) 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Keywords: Ir-192; Brachytherapy; Dosimetry; Penelope2008; Freiburg flap
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Vijande, J., Carmona, V., Lliso, F., Ballester, F., & Perez-Calatayud, J. (2024). An efficient component of the redundancy calibration program to ensure equipment stability by assaying HDR Ir-192 sources at the time of replacement. J. Appl. Clin. Med. Phys, 25(12), e14509–5pp.
Abstract: BackgroundBrachytherapy (BT) treatments involving temporary high-dose rate (HDR) sources are extensively employed in clinical practice. Ensuring the consistency of all measurement equipment at the hospital level is crucial, requiring a robust redundancy and consistency program. This enables the institution to verify the stability of the dosimetry system over time.PurposeTo describe, justify, and analyze a component of the redundancy program of the calibration protocols followed by the Radiotherapy Department of the Hospital Universitari i Polit & egrave;cnic La Fe (Val & egrave;ncia, Spain) during the last 10 years for the case of HDR BT as an additional component to ensure long term stability of the measurement equipment.MethodsAt the time the HDR BT source is replaced, its Air Kerma Strength (SK) is measured. By comparing this value with the one obtained at the time of installation (corrected by decay), a clear determination of the stability of the measurement equipment can be performed.ResultsDifference between SK,vendor and SK,hosp as a function of the measurement date is reported for a 10 years' period. All measurements are well within the +/- 3% tolerance level recommended in current international guidelines. Percentage differences of SK,hosp values at the time of replacement compared to SK,hosp ones at the time when the source was installed are within the +/- 0.5% range, reflecting oscillations around a null deviation.ConclusionsThe method proposed allows any hospital to ensure a redundancy component of the long-term stability of all equipment involved in BT measurements in a very simple and time efficient manner. Additionally, it enables the hospital to maintain a detailed log of historical differences, facilitating the identification and correction of potential systematic deviations over time.
Keywords: brachytherapy
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Vijande, J., Granero, D., Perez-Calatayud, J., & Ballester, F. (2013). Monte Carlo dosimetric study of the medium dose rate CSM40 source. Appl. Radiat. Isot., 82, 283–288.
Abstract: The Cs-137 medium dose rate (MDR) CSM40 source model (Eckert & Ziegler BEBIG, Germany) is in clinical use but no dosimetric dataset has been published. This study aims to obtain dosimetric data for the CSM40 source for its use in clinical practice as required by the American Association of Physicists in Medicine (AAPM) and the European Society for Radiotherapy and Oncology (ESTRO). Penelope2008 and Geant4 Monte Carlo codes were used to characterize this source dosimetrically. It was located in an unbounded water phantom with composition and mass density as recommended by AAPM and ESTRO. Due to the low photon energies of Cs-137, absorbed dose was approximated by collisional kerma. Additional simulations were performed to obtain the air-kerma strength, sic. Mass-energy absorption coefficients in water and air were consistently derived and used to calculate collisional kerma. Results performed with both radiation transport codes showed agreement typically within 0.05%. Dose rate constant, radial dose function and anisotropy function are provided for the CSM40 and compared with published data for other commercially available Cs-137 sources. An uncertainty analysis has been performed. The data provided by this study can be used as input data and verification in the treatment planning systems. (C) 2013 Elsevier Ltd. All rights reserved.
Keywords: Brachytherapy; Cs-137 seed; TG-43 based dosimetry; Monte Carlo
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Vijande, J., Johansen, J. G., De Brabandere, M., Hellebust, T. P., Herreros, A., Kirisits, C., et al. (2025). Temporal drift in calibration of Ir-192 brachytherapy sources: A multi-center study on dosimetric discrepancies and metrological consistency. Phys. Imag. Radiat. Oncol., 35, 100801–6pp.
Abstract: Background and purpose: High-dose-rate (HDR) brachytherapy relies on accurate and metrologically traceable source strength determination. Recent anecdotal reports and preliminary studies have suggested a possible temporal drift in the reference air kerma rate (RAKR) measured by clinical users compared to manufacturer certificates for 192Ir sources. This study investigates the existence and magnitude of such drift across a large, multicenter European dataset and explores potential underlying causes. Materials and methods: A total of over 1700 RAKR measurements for HDR and PDR brachytherapy sources, collected over two decades from 29 centers in 10 European countries, were analyzed. The ratio of hospital-measured RAKR to manufacturer-certified RAKR was assessed using linear regression and t-tests to evaluate drift. Data were corrected for center-dependent systematics and segmented around key dates corresponding to changes in primary standards. Supplementary analyses included leave-one-out testing and time-segmented trend assessment. Results: A statistically significant drift (+0.15 %/year) was detected for all 192Ir source types after 2018, correlating temporally with updates in the German Physikalisch-Technische Bundesanstalt (PTB) primary standards laboratory. Removing PTB corrections from manufacturer values nearly eliminated the observed drift. No such trend was observed for 60Co sources. Conclusion: The findings reveal a drift in hospital-to-manufacturer Ir-192 RAKR ratios that is temporally correlated with changes in metrology standards, not uniformly implemented across calibration chains. The true cause is however still unknown. The study aimed to investigate that greater transparency and harmonization among all stakeholders are essential to ensure dosimetric accuracy in HDR brachytherapy.
Keywords: HDR brachytherapy; QA; Reference air kerma rate; RAKR
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Vijande, J., Tedgren, A. C., Ballester, F., Baltas, D., Papagiannis, P., Rivard, M. J., et al. (2021). Source strength determination in iridium-192 and cobalt-60 brachytherapy: A European survey on the level of agreement between clinical measurements and manufacturer certificates. Phys. Imag. Radiat. Oncol., 19, 108–111.
Abstract: Background and purpose: Brachytherapy treatment outcomes depend on the accuracy of the delivered dose distribution, which is proportional to the reference air-kerma rate (RAKR). Current societal recommendations require the medical physicist to compare the measured RAKR values to the manufacturer source calibration certificate. The purpose of this work was to report agreement observed in current clinical practice in the European Union. Materials and methods: A European survey was performed for high- and pulsed-dose-rate (HDR and PDR) highenergy sources (Ir-192 and Co-60), to quantify observed RAKR differences. Medical physicists at eighteen hospitals from eight European countries were contacted, providing 1,032 data points from 2001 to 2020. Results: Over the survey period, 77% of the Ir-192 measurements used a well chamber instead of the older Krieger phantom method. Mean differences with the manufacturer calibration certificate were 0.01% +/- 1.15% for Ir-192 and -0.1% +/- 1.3% for Co-60. Over 95% of RAKR measurements in the clinic were within 3% of the manufacturer calibration certificate. Conclusions: This study showed that the agreement level was generally better than that reflected in prior societal recommendations positing 5%. Future recommendations on high-energy HDR and PDR source calibrations in the clinic may consider tightened agreements levels.
Keywords: RAKR; Calibration; HDR; PDR; Brachytherapy
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