Tissue composition effect on dose distribution in neutron brachytherapy/neutron capture therapy

Aim

The aim of this study is to assess the effect of the compositions of various soft tissues and tissue-equivalent materials on dose distribution in neutron brachytherapy/neutron capture therapy.

Background

Neutron brachytherapy and neutron capture therapy are two common radiotherapy modalities.

Materials and methods

Dose distributions were calculated around a low dose rate ²⁵²Cf source located in a spherical phantom with radius of 20.0 cm using the MCNPX code for seven soft tissues and three tissue-equivalent materials. Relative total dose rate, relative neutron dose rate, total dose rate, and neutron dose rate were calculated for each material. These values were determined at various radial distances ranging from 0.3 to 15.0 cm from the source.

Results

Among the soft tissues and tissue-equivalent materials studied, adipose tissue and plexiglass demonstrated the greatest differences for total dose rate compared to 9-component soft tissue. The difference in dose rate with respect to 9-component soft tissue varied with compositions of the materials and the radial distance from the source. Furthermore, the total dose rate in water was different from that in 9-component soft tissue.

Conclusion

Taking the same composition for various soft tissues and tissue-equivalent media can lead to error in treatment planning in neutron brachytherapy/neutron capture therapy. Since the International Commission on Radiation Units and Measurements (ICRU) recommends that the total dosimetric uncertainty in dose delivery in radiotherapy should be within ±5%, the compositions of various soft tissues and tissue-equivalent materials should be considered in dose calculation and treatment planning in neutron brachytherapy/neutron capture therapy.     

Measured microdosimetric spectra and therapeutic potential of boron neutron capture enhancement of 252Cf brachytherapy

Californium-252 is a neutron-emitting radioisotope used as a brachytherapy source for radioresistant tumors. Presented here are microdosimetric spectra measured as a function of simulated site diameter and distance from applicator tube 252Cf sources. These spectra were measured using miniature tissue-equivalent proportional counters (TEPCs). An investigation of the clinical potential of boron neutron capture (BNC) enhancement of 252Cf brachytherapy is also provided. The absorbed dose from the BNC reaction was measured using a boron-loaded miniature TEPC. Measured neutron, photon and BNC absorbed dose components are provided as a function of distance from the source. In general, the absorbed dose results show good agreement with results from other measurement techniques. A concomitant boost to 252Cf brachytherapy may be provided through the use of the BNC reaction. The potential magnitude of this BNC enhancement increases with increasing distance from the source and is capable of providing a therapeutic gain greater than 30% at a distance of 5 cm from the source, assuming currently achievable boron concentrations.     

Using matrix summation method for three dimensional dose calculation in brachytherapy

AimThe purpose of this study is to calculate radiation dose around a brachytherapy source in a water phantom for different seed locations or rotation the sources by the matrix summation method.BackgroundMonte Carlo based codes like MCNP are widely used for performing radiation transport calculations and dose evaluation in brachytherapy. But for complicated situations, like using more than one source, moving or rotating the source, the routine Monte Carlo method for dose calculation needs a long time running.Materials and methodsThe MCNPX code has been used to calculate radiation dose around a ¹⁹²Ir brachytherapy source and saved in a 3D matrix. Then, we used this matrix to evaluate the absorbed dose in any point due to some sources or a source which shifted or rotated in some places by the matrix summation method.ResultsThree dimensional (3D) dose results and isodose curves were presented for ¹⁹²Ir source in a water cube phantom shifted for 10 steps and rotated for 45 and 90° based on the matrix summation method. Also, we applied this method for some arrays of sources.ConclusionThe matrix summation method can be used for 3D dose calculations for any brachytherapy source which has moved or rotated. This simple method is very fast compared to routine Monte Carlo based methods. In addition, it can be applied for dose optimization study.     

Dosimetry of 252Cf sources for neutron radiotherapy with and without augmentation by boron neutron capture therapy.

Interstitial and intracavity 252Cf sources have been used to treat a number of tumor types with encouraging results. In particular these tumors include a variety of cervical, head-and-neck, and oral-cavity cancers and possible malignant gliomas. As a neutron source, 252Cf offers certain theoretical advantages over photon therapy (i.e., in treating tumors with significant hypoxic or necrotic components). With the recent availability of 10B-labeled tumor-seeking compounds, the usefulness of 252Cf may be further improved by augmenting the 252Cf dose to the tumor with an additional dose due to the fission (following thermal neutron capture) of 10B located in the tumor itself. While the high mean neutron energy permits 252Cf to deliver a high-LET, low-OER dose to the tumor on a macroscopic scale, thermalization of neutrons followed by 10B capture may augment this dose at the cellular level if adequate loading of tumor cells with 10B is possible. This paper presents results of a Monte Carlo simulation study investigating the dosimetric characteristics of linear 252Cf sources both with and without the quantitative increase in tumor dose possible with the addition of 10B. Results are displayed in the form of "along and away" tables and dose profiles in a water phantom. Comparisons of Monte Carlo results with experimental and analytical dosimetry data available in the literature are also presented.     

A Monte Carlo study on dose distribution evaluation of Flexisource 192Ir brachytherapy source

Aim

The aim of this study is to evaluate the dose distribution of the Flexisource ¹⁹²Ir source.

Background

Dosimetric evaluation of brachytherapy sources is recommended by task group number 43 (TG. 43) of American Association of Physicists in Medicine (AAPM).

Materials and methods

MCNPX code was used to simulate Flexisource ¹⁹²Ir source. Dose rate constant and radial dose function were obtained for water and soft tissue phantoms and compared with previous data on this source. Furthermore, dose rate along the transverse axis was obtained by simulation of the Flexisource and a point source and the obtained data were compared with those from Flexiplan treatment planning system (TPS).

Results

The values of dose rate constant obtained for water and soft tissue phantoms were equal to 1.108 and 1.106, respectively. The values of the radial dose function are listed in the form of tabulated data. The values of dose rate (cGy/s) obtained are shown in the form of tabulated data and figures. The maximum difference between TPS and Monte Carlo (MC) dose rate values was 11% in a water phantom at 6.0 cm from the source.

Conclusion

Based on dosimetric parameter comparisons with values previously published, the accuracy of our simulation of Flexisource ¹⁹²Ir was verified. The results of dose rate constant and radial dose function in water and soft tissue phantoms were the same for Flexisource and point sources. For Flexisource ¹⁹²Ir source, the results of TPS calculations in a water phantom were in agreement with the simulations within the calculation uncertainties. Furthermore, the results from the TPS calculation for Flexisource and MC calculation for a point source were practically equal within the calculation uncertainties.     

Dosimetric effect of tissue heterogeneity for 125I prostate implants

AimTo use Monte Carlo (MC) together with voxel phantoms to analyze the tissue heterogeneity effect in the dose distributions and equivalent uniform dose (EUD) for ¹²⁵I prostate implants.BackgroundDose distribution calculations in low dose-rate brachytherapy are based on the dose deposition around a single source in a water phantom. This formalism does not take into account tissue heterogeneities, interseed attenuation, or finite patient dimensions effects. Tissue composition is especially important due to the photoelectric effect.Materials and methodsThe computed tomographies (CT) of two patients with prostate cancer were used to create voxel phantoms for the MC simulations. An elemental composition and density were assigned to each structure. Densities of the prostate, vesicles, rectum and bladder were determined through the CT electronic densities of 100 patients. The same simulations were performed considering the same phantom as pure water. Results were compared via dose–volume histograms and EUD for the prostate and rectum.ResultsThe mean absorbed doses presented deviations of 3.3–4.0% for the prostate and of 2.3–4.9% for the rectum, when comparing calculations in water with calculations in the heterogeneous phantom. In the calculations in water, the prostate D₉₀ was overestimated by 2.8–3.9% and the rectum D_0.1cc resulted in dose differences of 6–8%. The EUD resulted in an overestimation of 3.5–3.7% for the prostate and of 7.7–8.3% for the rectum.ConclusionsThe deposited dose was consistently overestimated for the simulation in water. In order to increase the accuracy in the determination of dose distributions, especially around the rectum, the introduction of the model-based algorithms is recommended.     

Feasibility study on the use of 230 MeV proton cyclotron in proton therapy centers as a spallation neutron source for BNCT

AimThe feasibility of using 230 MeV proton cyclotrons in proton therapy centers as a spallation neutron source for Boron Neutron Capture Therapy (BNCT) was investigated.BackgroundBNCT is based on the neutron irradiation of a ¹⁰B-containing compound located selectively in tumor cells. Among various types of neutron generators, the spallation neutron source is a unique way to generate high-energy and high-flux neutrons.Materials and MethodsNeutron beam was generated by a proton accelerator via spallation reactions and then the produced neutron beam was shaped to be appropriate for BNCT. The proposed Beam Shaping Assembly (BSA) consists of different moderators, a reflector, a collimator, as well as thermal and gamma filters. In addition, the simulated Snyder head phantom was utilized to evaluate the dose distribution in tumor and normal tissue due to the irradiation by the designed beam. MCNPX2.6 Monte Carlo code was used to optimize BSA as well as evaluate dose evaluation.ResultsA BSA was designed. With the BSA configuration and a beam current of 104 nA, epithermal neutron flux of 3.94 × 10⁶ [n/cm²] can be achieved, which is very low. Provided that we use the beam current of 5.75 μA, epithermal neutron flux of 2.18 × 10⁸ [n/cm²] can be obtained and the maximum dose of 38.2 Gy-eq can be delivered to tumor tissue at 1.4 cm from the phantom surface.ConclusionsResults for 230 MeV protons show that with proposed BSA, proton beam current about 5.75 μA is required for this purpose.     

A radiobiological model for the relative biological effectiveness of high-dose-rate 252Cf brachytherapy

While there is significant clinical experience using both low- and high-dose-rate 252Cf brachytherapy, there are minimal data regarding values for the neutron relative biological effectiveness (RBE) with both modalities. The aim of this research was to derive a radiobiological model for 252Cf neutron RBE and to compare these results with neutron RBE values used clinically in Russia. The linear-quadratic (LQ) model was used as the basis to characterize cell survival after irradiation, with identical cell killing rates (S(N) = S(gamma)) between 252Cf neutrons and photons used for derivation of RBE. Using this equality, a relationship among neutron dose and LQ radiobiological parameter (i.e., alpha(N), beta(N), alpha(gamma), beta(gamma)) was obtained without the need to specify the photon dose. These results were used to derive the 252Cf neutron RBE, which was then compared with Russian neutron RBE values. The 252Cf neutron RBE was determined after incorporating the LQ radiobiological parameters obtained from cell survival studies with fast neutrons and teletherapy photons. For single-fraction high-dose-rate neutron doses of 0.5, 1.0, 1.5 and 2.0 Gy, the total biologically equivalent doses were 1.8, 3.4, 4.7 and 6.0 RBE Gy with 252Cf neutron RBE values of 3.2, 2.9, 2.7 and 2.5, respectively. Using clinical data for late-responding reactions from 252Cf, Russian investigators created an empirical model that predicted high-dose-rate 252Cf neutron RBE values ranging from 3.6 to 2.9 for similar doses and fractionation schemes and observed that 252Cf neutron RBE increases with the number of treatment fractions. Using these relationships, our results were in general concordance with high-dose-rate 252Cf RBE values obtained from Russian clinical experience.     

Dosimetric verification of a high dose rate brachytherapy treatment planning system in homogeneous and heterogeneous media

ObjectivesTo verify the dosimetric accuracy of treatment plans in high dose rate (HDR) brachytherapy by using Gafchromic EBT2 film and to demonstrate the adequacy of dose calculations of a commercial treatment planning system (TPS) in a heterogeneous medium.MethodsAbsorbed doses at chosen points in anatomically different tissue equivalent phantoms were measured using Gafchromic EBT2 film. In one case, tandem ovoid brachytherapy was performed in a homogeneous cervix phantom, whereas in the other, organ heterogeneities were introduced in a phantom to replicate the upper thorax for esophageal brachytherapy treatment. A commercially available TPS was used to perform treatment planning in each case and the EBT2 films were irradiated with the HDR Ir-192 brachytherapy source.ResultsFilm measurements in the cervix phantom were found to agree with the TPS calculated values within 3% in the clinically relevant volume. In the thorax phantom, the presence of surrounding heterogeneities was not seen to affect the dose distribution in the volume being treated, whereas, a little dose perturbation was observed at the lung surface. Doses to the spinal cord and to the sternum bone were overestimated and underestimated by 14.6% and 16.5% respectively by the TPS relative to the film measurements. At the trachea wall facing the esophagus, a dose reduction of 10% was noticed in the measurements.ConclusionsThe dose calculation accuracy of the TPS was confirmed in homogeneous medium, whereas, it was proved inadequate to produce correct dosimetric results in conditions of tissue heterogeneity.     

Dosimetric perturbations at high-Z interfaces with high dose rate 192Ir source

PurposeTo investigate dose perturbations created by high-atomic number (Z) materials in high dose rate (HDR) Iridium-192 (¹⁹²Ir) treatment region.Methods and materialsA specially designed parallel plate ion chamber with 5 μm thick window was used to measure the dose rates from ¹⁹²Ir source downstream of the high-Z materials. A Monte Carlo (MC) code was employed to calculate the dose rates in both upstream and downstream of the high-Z interfaces at distances ranging from 0.01 to 2 mm. The dose perturbation factor (DPF) was defined as the ratio of dose rate with and without high-Z material in a water phantom. For verifying the Z dependence, both 0.1- and 1.0 mm-thick sheets of Pb, Au, Ta, Sn, Cu, Fe, Ti and Al were used.Results/conclusionsThe DPF depends on the Z and thickness of layer. At the downstream of a 0.1 mm layer of Pb, Au, Ta, Sn, Cu, Fe, Ti and Al, the DPF by MC were 3.73, 3.42, 3.04, 1.71, 1.04, 0.98, 0.92, or 0.94 respectively. When Z is greater than or equal to 50, the MC and experimental results disagree significantly (>20%) due to large DPF gradient but are in agreement for Z less than or equal to 29. Thin layers of Z greater than or equal to 50 near a ¹⁹²Ir source in water produce significant dose perturbations (i.e. increases) in the vicinity of the medium-high-Z interfaces and may thus cause local over-dose in ¹⁹²Ir brachytherapy. Conversely, this effect may potentially be used to deliver locally higher doses to targeted tissue.     

Dosimetric response of tooth enamel to 14 Mev neutrons

The electron paramagnetic resonance (EPR) response of tooth enamel in a monenergetic neutron beam of 14 MeV was studied, with the aim to evaluate the relative neutron to ⁶⁰Co sensitivity. Three samples of tooth enamel powder were irradiated in air. A whole tooth and a powdered sample were irradiated in a geometrical PMMA phantom, in order to simulate the real exposure of a tooth inside a human head. The measured dose in enamel was compared to the dose calculated by Monte Carlo simulation. The relative neutron to ⁶⁰Co sensitivity using different reference materials (air, water and enamel) was evaluated as well. Large differences in sensitivity values were found depending on the reference material: the obtained relative neutron to ⁶⁰Co sensitivity was 0.47±0.09 for enamel and 0.15±0.03 for water. A comparison with results in fast neutron fields is reported.     

Microdosimetric measurements in the secondary radiation field produced in 12C-therapy irradiations

The ambient dose equivalent from the secondary radiation produced during irradiation of a cylindrical water phantom with 200 MeV/u ¹²C-ions was investigated at the biophysics cave at GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt, Germany. Pencil-like ion beams were delivered by the heavy-ion synchrotron SIS18 using the slow extraction mode. Since the secondary radiation field outside the phantom is complex in its particle composition and particle energy distribution, microdosimetric methods developed for the dosimetry of the cosmic radiation field at flight altitudes, which is similar in terms of complexity, were applied. Lineal energy distributions and the ambient dose equivalent were measured with a tissue-equivalent proportional counter at different particle emission angles. An additional veto counter allowed the identification of the different contributions of charged and neutral particles. A significant increase in the mean quality factor was observed at large emission angles which could be attributed to the decreasing contributions of charged particles compared to the (relative) contributions from neutrons.     

eXaSkin: A novel high-density bolus for 6MV X-rays radiotherapy

PurposeTo evaluate eXaSkin, a novel high-density bolus alternative to commercial tissue-equivalent Superflab, for 6MV photon-beam radiotherapy.Materials and methodsWe delivered a 10 × 10 cm² open field at 90° and head-and-neck clinical plan, generated with the volumetric modulated arc therapy (VMAT) technique, to an anthropomorphic phantom in three scenarios: with no bolus on the phantom’s surface, with Superflab, and with eXaSkin. In each scenario, we measured dose to a central planning target volume (PTV) in the nasopharynx region with an ionization chamber, and we measured dose to the skin, at three different positions within the vicinity of a neck lymph node PTV, with MOSkin™, a semiconductor dosimeter. Measurements were compared against calculations with the treatment planning system (TPS).ResultsFor the static field, MOSkin results underneath the eXaSkin were in agreement with calculations to within 1.22%; for VMAT, to within 5.68%. Underneath Superflab, those values were 3.36% and 11.66%. The inferior agreement can be explained by suboptimal adherence of Superflab to the phantom’s surface as well as difficulties in accurately reproducing its placement between imaging and treatment session. In all scenarios, dose measured at the central target agreed to within 1% with calculations.ConclusionseXaSkin was shown to have superior adaptation to the phantom’s surface, producing minimal air gaps between the skin surface and bolus, allowing for accurate positioning and reproducibility of set-up conditions. eXaSkin with its high density material provides sufficient build-up to achieve full skin dose with less material thickness than Superflab.     

Relative biological effectiveness (RBE) of low-dose californium-252

Relative biological effectiveness (RBE) of 252Cf, with respect to 192Ir, has been determined at the low dose rates commonly used in interstitial and intracavitary therapy. The biological criterion was growth reduction in Vicia faba bean roots. Two varieties of Vicia faba were used. For Vicia faba Sutton's seeds, an RBE of 5.7 to 6.6 was obtained for 252Cf Dn + gamma doses of 0.5 to 0.2 Gy respectively and at a Dn + gamma dose rate of 0.11 Gy-1. The gamma contribution D gamma/Dn + gamma at the level of the root tipes was 0.35 and the derived RBE of the neutron emission of 252Cf was then 8.2 to 9.7. For Vicia faba Be1B and in the same irradiation conditions, an RBE of 5.1 to 6.2 was obtained for the total (n + gamma) 252Cf emission and for Dn + gamma doses of 0.4 to 0.2 Gy respectively. These values lead to an RBE of 7.4 to 9.0 for the neutron emission of 252Cf. For Vicia faba BelB, but for another source arrangement (Dn + gamma dose rate of 0.13 Gy . h-1 for 252Cf), an RBE of 5.6 to 7.5 was obtained for the total (n + gamma) emission of 252Cf and for Dn + gamma doses of 0.4 to 0.1 Gy respectively. The gamma contribution (D gamma/Dn + gamma) at the level of the root tips was 0.42, and the derived RBE of the neutron emission of 252Cf was then 8.9-12.3.     

Effect of air cavities on the dose delivered to the lung during high-dose brachytherapy

In the treatment of lung cancer using the radiotherapy technique of intracavitary brachytherapy with an¹⁹²Ir source, the lung is normally assumed to be entirely composed of a homogenous mass of soft tissue. The aim of this study is to investigate whether there is the possibility that the air cavities in the lung influence the dose delivered to the lung at a prescribed distance from the source. The Monte Carlo code MCNP-4A was used to model the dose delivered by both¹⁹²Ir and¹⁹⁸Au as a function of treatment medium, density and composition, photon energy, and distance from the source. The suitability of MCNP-4A for this study was tested by producing depth-dose profiles for photons in water and comparing these to calculated profiles produced using well-documented methods.     

Monte Carlo Dosimetry of the 60Co BEBIG High Dose Rate for Brachytherapy

Introduction

The use of high-dose-rate brachytherapy is currently a widespread practice worldwide. The most common isotope source is ¹⁹²Ir, but ⁶⁰Co is also becoming available for HDR. One of main advantages of ⁶⁰Co compared to ¹⁹²Ir is the economic and practical benefit because of its longer half-live, which is 5.27 years. Recently, Eckert & Ziegler BEBIG, Germany, introduced a new afterloading brachytherapy machine (MultiSource^®); it has the option to use either the ⁶⁰Co or ¹⁹²Ir HDR source. The source for the Monte Carlo calculations is the new ⁶⁰Co source (model Co0.A86), which is referred to as the new BEBIG ⁶⁰Co HDR source and is a modified version of the ⁶⁰Co source (model GK60M21), which is also from BEBIG.

Objective and Methods

The purpose of this work is to obtain the dosimetry parameters in accordance with the AAPM TG-43U1 formalism with Monte Carlo calculations regarding the BEBIG ⁶⁰Co high-dose-rate brachytherapy to investigate the required treatment-planning parameters. The geometric design and material details of the source was provided by the manufacturer and was used to define the Monte Carlo geometry. To validate the source geometry, a few dosimetry parameters had to be calculated according to the AAPM TG-43U1 formalism. The dosimetry studies included the calculation of the air kerma strength S _k, collision kerma in water along the transverse axis with an unbounded phantom, dose rate constant and radial dose function. The Monte Carlo code system that was used was EGSnrc with a new cavity code, which is a part of EGS++ that allows calculating the radial dose function around the source. The spectrum to simulate ⁶⁰Co was composed of two photon energies, 1.17 and 1.33 MeV. Only the gamma part of the spectrum was used; the contribution of the electrons to the dose is negligible because of the full absorption by the stainless-steel wall around the metallic ⁶⁰Co. The XCOM photon cross-section library was used in subsequent simulations, and the photoelectric effect, pair production, Rayleigh scattering and bound Compton scattering were included in the simulation. Variance reduction techniques were used to speed up the calculation and to considerably reduce the computer time. The cut-off energy was 10 keV for electrons and photons. To obtain the dose rate distributions of the source in an unbounded liquid water phantom, the source was immersed at the center of a cube phantom of 100 cm³. The liquid water density was 0.998 g/cm³, and photon histories of up to 10¹⁰ were used to obtain the results with a standard deviation of less than 0.5% (k = 1). The obtained dose rate constant for the BEBIG ⁶⁰Co source was 1.108±0.001 cGyh^-1U^-1, which is consistent with the values in the literature. The radial dose functions were compared with the values of the consensus data set in the literature, and they are consistent with the published data for this energy range.     

Development of a deformable phantom for experimental verification of 4D Monte Carlo simulations in a deforming anatomy

PurposeTo verify the accuracy of 4D Monte Carlo (MC) simulations, using the 4DdefDOSXYZnrc user code, in a deforming anatomy. We developed a tissue-equivalent and reproducible deformable lung phantom and evaluated 4D simulations of delivered dose to the phantom by comparing calculations against measurements.MethodsA novel deformable phantom consisting of flexible foam, emulating lung tissue, inside a Lucite external body was constructed. A removable plug, containing an elastic tumor that can hold film and other dosimeters, was inserted in the phantom. Point dose and position measurements were performed inside and outside the tumor using RADPOS 4D dosimetry system. The phantom was irradiated on an Elekta Infinity linac in both stationary and moving states. The dose delivery was simulated using delivery log files and the phantom motion recorded with RADPOS.ResultsReproducibility of the phantom motion was determined to be within 1 mm. The phantom motion presented realistic features like hysteresis. MC calculations and measurements agreed within 2% at the center of tumor. Outside the tumor agreements were better than 5% which were within the positional/dose reading uncertainties at the measurement points. More than 94% of dose points from MC simulations agreed within 2%/2 mm compared to film measurements.ConclusionThe deformable lung phantom presented realistic and reproducible motion characteristics and its use for verification of 4D dose calculations was demonstrated. Our 4DMC method is capable of accurate calculations of the realistic dose delivered to a moving and deforming anatomy during static and dynamic beam delivery techniques.     

In vivo dosimetry of the rectum in image-guided adaptive interstitial-intracavitary brachytherapy of cervix cancer – A feasibility study

Aim and backgroundTo investigate the feasibility of in vivo rectal dosimetry in image-guided adaptive brachytherapy of cervical cancer.Materials and methodsError of measurement of dose rate in a semiconductor diode probe was investigated depending on the distance and angle in water, and on temperature in a polymethyl methacrylate phantom using an Ir-192 source. Furthermore, the difference between the measured and calculated dose was analysed in the interstitial brachytherapy of 30 cervix cancer patients. The relationship between in vivo measured dose, calculated dose in the point of the diode, calculated maximal dose in the point of the diodes and calculated maximal dose of the rectum were examined.ResultsThe dosimeter measured with 85% accuracy at more than 5 cm from the source, but within a closer distance the accuracy decreased significantly. At 45–90° angle, the device measured with a 15% error. The error increased with the temperature, 22% at 35 °C. In 8 cases (26.7%) the maximal dose was measured in the correct diode. The device measured 73% of the calculated dose in the point of the diode. The maximum of the calculated doses of diodes was 60% of the calculated maximal dose. The in vivo measured dose was 35% of the calculated maximal dose.ConclusionsUnder treatment conditions, the semiconductor diode does not provide reliable measured data. The probe pushes the rectal wall closer to the high dose areas and underestimates the dose of it. Semiconductor probe is not recommended for in vivo dosimetry of the rectum in image-guided brachytherapy of cervical cancer.     

Dose calculation validation of a convolution algorithm in a solid water phantom

PurposeThe dose calculated using a convolution algorithm should be validated in a simple homogeneous water-equivalent phantom before clinical use. The dose calculation accuracy within a solid water phantom was investigated.MethodsThe specific Gamma knife design requires a dose rate calibration within a spherical solid water phantom. The TMR10 algorithm, which approximates the phantom material as liquid water, correctly computes the absolute dose in water. The convolution algorithm, which considers electron density miscalculates the dose in water as the phantom Hounsfield units were converted into higher electron density when the original CT calibration curve was used. To address this issue, the electron density of liquid water was affected by modifying the CT calibration curve. The absolute dose calculated using the convolution algorithm was compared with that computed by the TMR10. The measured depth dose profiles were also compared to those computed by the convolution and TMR10 algorithms. A patient treatment was recalculated in the solid-water phantom and the delivery quality assurance was checked.ResultsThe convolution algorithm and the TMR10 calculate an absolute dose within 1% when using the modified CT calibration curve. The dose depth profile calculated using the convolution algorithms was superimposed on the TMR10 and measured dose profiles when the modified CT calibration curve was applied. The Gamma index was better than 93%.ConclusionsDose calculation algorithms, which consider electron density, require a CT calibration curve adapted to the phantom material to correctly compute the dose in water.