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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.
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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.
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