This action might not be possible to undo. Are you sure you want to continue?
SPECIFICATION OF BRACHYTHERAPY SOURCE STRENGTH
Published for the American Association of Physicists in Medicine by the American institute of Physics
AAPM REPORT NO. 21
SPECIFICATION OF BRACHYTHERAPY SOURCE STRENGTH
REPORT OF AAPM Task Group No. 32*
Members Ravinder Nath, Yale University, Chairman Lowell Anderson, Memorial Sloan-Kettering Institute Douglas Jones, Northwest Medical Physics Center Clifton Ling, University of California at San Francisco Robert Loevinger, National Bureau of Standards Jeffrey Williamson, University of Arizona William Hanson, Radiological Physics Center Consultant *The Task Group is part of the AAPM Radiation Therapy Committee, Faiz M. Khan, Chairman.
Published for the American Association of Physicists in Medicine by the American Institute of Physics
45 Street New York. NY 10017 Library of Congress Catalog Card Number: 87-72124 International Standard Book Number: 0-88318-545-8 International Standard Serial Number: 0271-7344 Copyright © 1987 by the American Association of Physicists in Medicine All rights reserved. or otherwise) without the prior written permission of the publisher. recording. 335 East 45 Street. Inc. or transmitted in any form or by any means (electronic. photocopying. New York 10017 Printed in the United States of America .Further copies of this report may be obtained from Executive Officer American Association of Physicists in Medicine 335 E. No part of this publication may be reproduced. stored in a retrieval system.. Published by the American Institute of Physics. New York. mechanical.
. . . . . . . . .. . . . . . . . . . .S. .. . . .. . . .. .. . . . . . . . . . . . VII. . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . 17 Information Recommended for Manufacturer’s C e r t i f i c a t e o f C a l i b r a t i o n . . . . .Table of Contents I. . . . Activity of the Radionuclide . . . . . . . . . . . . .. . . . . . . . . 19 References . .. . . . . .. . . . . . . . 6 Exposure Rate at a Reference Point in Free Space . . . . . .. . . B. . . . . . .. . 6 A. . .. . . . Discussion . . . . . . . . . . . . . . . . 9 D. . . 13 Recommended Quantities and Their Relationships. . . . .. 10 IV. . . . . .. . . . . . .. . . . .. . . . . . . . . .. . . . C. . .. . . . . . . . . . . V. . . . . . . . . II. . . . . . . 4 Source Specification Methods Currently in Use . .. . Air-Kerma Rate at a Reference Point in Free Space. . . . . . . . . . . .. . . . . . . . . . . . 9 Equivalent Mass and Apparent Activity . . . . . . . 11 Recommendations . . . . . . . . . . . .. .. . . 3 U. . . .. .. . 14 Practical Considerations . . . . . . VI. . . . . .. . . . . . . . . . . . . . . . . . . . III. .. . . Standards for Brachytherapy Sources . . . 20 Appendix: . . . . . . . .. Introduction . . . . . . .. . . . . . . . . . . . . . . . ... . . . . . . . .. . . .
David Kubiatowicz and Jerome Meli are also gratefully acknowledged. and the Science Council f o r a careful review of this Many valuable comments from Montague Cohen. Deanna Jacobs for preparing this manuscript. . we would like to thank Ms.Acknowledgments We would like to thank the members of the Radiation Therapy Committee document. Finally.
Gibb and comite Loevinger 7. recommendations have been approved by the Radiation Therapy Committee and the Science Council of the American Association of Physicists in Medicine (AAPM) and thus represent the official policy of the AAPM regarding this matter. shortcomings of these methods. The BCRU and CFMRI have recommended specifying brachytherapy source strength in terms of air-kerma rate. A i r d a n d D a y4. Introduction It is common practice to express source strength of brachytherapy sources in terms of activity or equivalent mass of radium. Jayaraman. are recommendations are set forth that. and replacement of has reopened this discussion. can then be obtained by multiplying the source strength by the appropriate exposure-rate constant. Lanzl and Agarwa15. with a unit -1 of µGy m2 h .3 I. the National Council of Radiation Protection and Measurements (NCRP) pointed out several not specify strength in terms of directly measured quantities. Williamson and Morin1 4. these recommendations. little progress towards the use of this specification method in the clinical community. in terms of exposure rate in free space. In the present paper. This report considers the needs of the clinical community and includes a discussion of the ramifications of . in These similar to those cited above. The output of a brachytherapy source. A similar suggestion was made by Dutreix and Wambersie 2 Despite the sound rationale of this proposal there has been Recent adoption of SI units. and British Committee on Radiation Units and Measurements (BCRD)8 h a v e c o n t r i b u t e d t o t h e d i s c u s s i o n i n r e c e n t publications. In 1974. exposure by air kerma. the most important being that they do 1 The NCRP recommended that brachytherapy sources should be specified in terms of exposure rate at 1 m in free air with corrections for air attenuation. Francais Measure des Rayonnements Ionisants (CFMRI) 6. many r e s p e c t s . M a s s e y3 . in 1975.
4 II. U. In the United the convention has been adopted that instruments used for calibration of radiation therapy beams shall have calibrations 9. establishing suitable traceability to NBS standards is more complicated than for instruments used for due to the wide range of half-lives encountered.S. 192 I r o r 125 I ) the comparison should be made using a sources (such as well-type ionization chamber (or equivalent detector) that has been calibrated using a directly traceable source. Secondary traceability is established when the source is calibrated by comparison with a source of the same kind. using either an external ionization For short-half-life chamber or a well-type ionization chamber.10 For that purpose. clinical procedures. For brachytherapy sources. traceable” is defined to mean that the instrument has been calibrated either at NBS or at one of the AAPM-accredited dosimetry calibration laboratories (ADCLs). and due also to the large number of sources used in some As a result. “directly directly traceable to NBS. calibration of therapy beams. The BIPM has the responsibility of comparing BIPM primary standards with those of the national standards laboratories. BIPM) Located in Paris. . two levels of traceability to NBS are defined and traceability by statistical inference is recognized as an existing practice. other national standards maintained by the International Bureau of Weights and Measures (Bureau International des Poid et Mesures. Direct traceability is established when the source is calibrated at NBS or at a suitably accredited brachytherapy calibration laboratory. long-half-life sources (such as the For calibration of which is directly traceable to NBS. Standards for Brachytherapy Sources In the United States. and the constancy of the well-type chamber should be assured by use of a suitable long-half-life source. the comparison should be made by the method of substitution. 137 Cs). the National Bureau of Standards (NBS) The NBS standards have been compared to and to the international standards provides standards for radiation dosimetry including the calibration of brachytherapy sources. States.
the same kind) that has previously been calibrated by using the spherical graphite ionization The source to be calibrated is compared to the working standard using a large-volume spherical aluminum chamber (2. 125 I were calibrated in terms of Brachytherapy sources of exposure rate in free space at 13 posure rate at 1 m. Brachytherapy sources other than radium are calibrated at NBS in terms of exposure rate. The comparison should be carried out in the same In this case the following number of sources in the manner as for secondary traceability. 1 m using a free-air ionization as for chamber . or for other potential brachytherapy sources. minimum information must be supplied: batch. and exposure rate from this composite source was measured in open-air scatter-free geometry at 1 m.5 Secondary traceability by statistical inference is established when a source is part of a group of sources. NBS does not offer calibration standards for 252 Cf and 1 9 8 Au. number of sources in the sample. in the same manner as for 137 c s sources.8 11 liter) . of which a suitable random sample has been calibrated by comparison with a directly traceable source. The routine calibration procedure is essentially the same 192 Ir seeds except for the use of a free-air chamber as the primary standard. mean and standard deviation of the sample and range of values in the sample. 192 Ir are calibrated in a different Brachytherapy sources of 12. using the spherical graphite ionization chambers. manner because of their lower exposure rate and shorter half-life A composite source containing about 50 seeds was prepared. Calibration of other well-type ionization chambers can be obtained by comparison 192 with the NBS well-type ionization chamber using an Ir source. Each 192 I r source was then measured individually in a well-type ionization chamber to establish the calibration of this chamber in terms of exThis well-type ionization chamber now serves 192 as the working standard for calibration of Ir sources. the NBS standards of exposure are spherical 137 graphite ionization chambers and free-air chambers. . At the time of writing. Cs sources are calibrated in terms of exposure rate at about one meter in air using a working standard source (of chambers.
X(r. and a(r. A. L is the active length of the line source. Source Specification Methods Currently in Use Determination of the dose distribution from a brachytherapy source in tissue requires a knowledge of source strength and a number of conversion factors. the exposure rate at a point of interest in free space may be given by the . tissue. θ ) = A ( Γδ ) x G ( r . Activity of the Radionuclide The source strength can be specified in terms of the activity of the radionuclide in the source. expression For an activity A.6 III. θ) (1) The lengths and angles are shown in Fig. space are described. θ ) α (r. material.0) is a dimensionless quantity that accounts for absorption and scatter in the source material and encapsulation. µ t is the thickness of encapsulation i s t h e e f f e c t i v e a b s o r p t i o n c o e f f i c i e n t of t h e G(r. 1. currently used methods of source specification and the calculation of exposure rate in free Not treated is the calculation of dose rate in which may proceed from that of exposure rate in free space but is preferably based on dose measurements in phantom around a source of known strength.. In this section. θ) is a geometry factor encapsulation material and ( Γδ ) X is the exposure-rate constant for a bare point source of the radionuclide. .
Schematic drawing of the geometry of a line source calculation.7 Fig. . 1.
g. effect of anisotropy may be large.8 The concept of effective attenuation coefficient for these calculations has been a subject of many investigations. normalized to the calibration exposure rate. calculated values using mass energy-absorption coefficients have to be used 14 . The function F has been tabulated and these tables are used in some computerized dose calculation systems currently in clinical use.e. tional to the Sievert integral indicated. . when such values are not available. α is a constant that depends upon photon energy and encapsulation thickness. I t s h o u l d b e noted that. the effective attenuation coefficient depends on absorber thickness. due to selective absorption of the lower energy gamma rays. α is a function of r and 0 . j = x/L and k=y/L). 18. The same tables are also used for radium substitutes such as 137 Cs sources by some of the computer systems. One of the key advantages of the Young and Batho scheme is that the same function F can be used for radium sources of any length. including recent studies by Williamson and Morin 1 4 a n d C a s s e l l1 5. similar tables should be recalculated for each radionuclide. shown that the exposure be expressed in the form: For a linear source.19 I and 1 9 2 I. 2 2 6 Ra. For better accuracy. for polyenergetic radionuclides e.17 However. these factors can be significant. For heavily filtered sources with non-spherical encapsulation. m e a s u r e d v a l u e s o f µ a r e a v a i l a b l e a n d m a y b e u s e d 16. seeds. and is propor20 have Young and Batho rate from any linear radium source can where j and k are Cartesian coordinates of the point in terms of active length L (i. the Anisotropy correction factors F o r 1 2 5 have been calculated by using the angular exposure distribution. of 226 In the case R a . For a point source with spherical encapsulation.
5 mm Pt. which is defined as that mass of radium. as described above.9 B. For a source with an equivalent mass of radium m rate at the calibration distance the exposure eq is given by the expression. . X i s given by Exposure rate at any point in free space is given by The exposure rate at any point (r. can be specified in terms of equivalent mass of radium.Ra The source activity is is the exposure-rate constant for radium encapsulated in 0. in terms of exposure rate at a unit distance per unit mass of radium. f a c t o r l / r2 a n d α r e d u c e s t o e .01%) different from the point-source geometry . This method of specification is thus equivalent to the specification in terms of exposure rate. Exposure Rate at a Reference Point in Free Space at a specified distance Source strength can be specified in terms of exposure rate X a (usually 1 m) along the perpendicular If the source calibration is performed the line-source geometry factor is bisector of the line source. negligibly (less than 0. Equivalent Mass and Apparent Activity Brachytherapy sources for which exposure is well defined. (5) provided the specification point is far enough away that the source may be treated as a point source. C.µ t Under these conditions. . at (or if the result is corrected to) a point that is at a distance of 1 m from the source center. ( Γδ ) X. θ ) is calculated from the measured exposure rate at the calibration distance not implicitly required in equation 4. encapsulated in 0. The gamma-ray energy of radium is SO high that the air attenuation at one meter can be neglected. that produces the same exposure rate at the calibration distance as the source to be specified.5 mm Pt.
BCRU8 and CFMRI6 have ICRU h a s e m p l o y e d t h i s strength in its report on This method of specification of i n t r a c a v i t a r y t h e r a p y2 4 and has recommended the name “reference source strength is currently being used in most of Europe. recommended this method of specification.e. i. method of specification of source air-kerma rate” for source strength. . In analogy with the equivalent mass of radium method. Air-Kerma Rate at a Reference Point in Free Space Source strength can be specified in terms of air-kerma rate at a specified distance in free space (usually 1 m) along the perpendicular bisector of the line source. the “apparent” source activity A app is defined by its calibration-distance exposure rate. D. (6) This method has been extensively applied for 125 I s e e d s 2 1..10 A similar method is that of specifying source strength as the activity of a bare point source (of the same radionuclide) that produces the same exposure rate at the calibration distance as the source to be specified.
radionuclides. exposure-rate constant need be known: a purely arbitrary value would d o f o r o n e o r t h e o t h e r .11 IV. especially In practice neither activity nor for encapsulated sources. for some brachytherapy source. the equivalent mass of radium is now fast Although radium becoming a matter of historical interest only. activity and exposure-rate When constant are treated as separate Not parameters in the dose calculation. to determine the exposure-rate constant. and lead to incorrect values of the For these desired quantity. t i s s u e . and a knowledge of the exposure (or air-kerma) rate constant is unnecessary. Specification in terms of equivalent mass of radium also facilitates the use of radium dosage tables (e. Source strength specification in terms of the exposure (or air-kerma) rate at a specified distance (Section III B and D) is recommended. Discussion Using the activity of the radionuclide in the source as the method of specification (Section III A) suffers from a number of problems. the quantity of interest in clinical dosimetry. Manchester System tables) 2 2 f o r c l i n i c a l dosimetry. 6 8 the AAPM is in agreement with NCRP 1. reasons. Exposure (or air-kerma) rate is a measured quantity Dose rate in that can be directly traceable to a national standard. . is much more closely related to exposure (or air-kerma) rate than to the activity encapsulated in a source. The equivalent mass of radium (Section III C) is essentially the same as exposure-rate specification since equality of exposure rate is used to define the equivalent mass of radium. However. it is inevitable that attempts will be made to determine them with ever-increasing accuracy. o n l y i s t h i s w a s t e d e f f o r t .g. provided the product of the two gives an accurate value of the exposure rate at the calibration point. from the viewpoint of brachytherapy. CFMRI . but it is inevitable that independent choice of these parameters will in some cases be inappropriate. exposure rate at the calibration point. It is difficult to determine the actual activity in a and different methods of determination may Likewise. yield different values. and BCRU in concluding that activity is an unsuitable method of specifying brachytherapy source strength. it is difficult.
among the four methods currently in use. institutions than would air-kerma rate. However. they may be readily converted to convenient computer-generated planning aids (such as planning n o m o g r a p h s ) 2 3 and. individual patients. it must be noted that the quantity The BIPM and most exposure is in the process of being phased out. and the multiplication by the user using another value.12 tables may still be of some procedures. “dummy” to get the source strength and then multiplying by the exposure-rate constant to calculate the exposure Aside from the obvious redundancy. Thus. especially since the division may be performed by the manufacturer using one value. dose distributions on which clinical decisions may be based for It should be noted that both the radium-equivalence method and the apparent-activity method involve dividing exposure rate by the exposure-rate constant rate. it may concluded that exposure (or air-kerma) rate at a specified distance is the method of choice. kerma) rate. a n d t h e U . standards and would result in much greater variability among . this manipulation of a constant leads to the real possibility of error. S . this quantity. Another quantity that might be used to specify source strength is dose rate at a specified distance in the medium. reflect source strength defined on the basis of exposure (or airRadium tables should generally not be used for final Computerized systems should be used to obtain dosimetric evaluation. although more directly currently lacks national related to clinically desired dose. i s e x p e c t e d t o f o l l o w s u i t i n t h e near future. The reason for not recommending this quantity is that it is very difficult to measure dose rate accurately around sources at distances of clinical interest. In consequence. European standards laboratories have already replaced exposure by the quantity air kerma. utility in planning brachytherapy it is probable that they will be replaced by more La any case.
(vi) calculations and should constant. existence of this practice is recognized but no recommendation is made for or against it.13 V. an The calibration certificate estimate of the activity contained. n o t u s e a c t i v i t y . The calibration measurement between detector and source treated as a point source and detector. (v) The source supplier should furnish a certificate that The supplier should gives the air-kerma strength of each source. Traceability by statistical inference is used by at (iii) least one manufacturer of short-lived sources and is frequently used The i n t h e c l i n i c a l s e t t i n g to verify a shipment of sources. Recommended units must be performed with the distance l a r g e enough that the source can be the detector can be treated as a point for air-kerma strength are µGy m 2h . . T h e l e v e l o f traceability should be stated in appropriate documentation accompanying each source. i.1.. a s d e f i n e d i n S e c t i o n I I a b o v e . and appropriate changes should be made in dose calculation algorithms as well as other treatment-planning aids. a l s o s t a t e . The supplier should make available. or The physicist or radiotherapist performing brachytherapy should use the air-kerma strength for dose calculations. Recommendations (i) Specification of brachytherapy sources should be in terms of the quantity air-kerma strength. should provide the information shown in the Appendix. d e f i n e d a s t h e p r o d u c t o f a i r kerma rate in free space and the square of the distance of the c a l i b r a t i o n p o i n t f r o m t h e s o u r c e center along the perpendicular bisector. (iv) Calibration laboratories should specify the strength of brachytherapy sources in terms of air-kerma strength. ( v i i ) C o m p u t e r i z e d systems o f d o s e c a l c u l a t i o n f o r brachytherapy should be modified to accept air-kerma strength as the s p e c i f i c a t i o n o f s o u r c e s . exposure-rate constant. documentation that supports such claims as: the uncertainty of the measurements is within ±5% and the precision of the measurements is within ±2% with 95% confidence limits. on request by the purchaser. for regulatory and radiation protection purposes.e. air-kerma rate equivalent mass of radium. Brachytherapy sources used in radiation therapy (ii) should have calibrations that establish direct or secondary traceability to NBS.
of a reasonable approximation for Thus.14 VI. multiplicative factor. For a source with activity. brachytherapy photon energies. (11) kerma and exposure differ from each other only by a constant Exposure rate at the calibration point >> L is given by (12) Equivalent mass of radium is given by (13) . air air kerma is negligibly small. A. for brachytherapy purposes. the air-kerma strength is given by (9) This expression can be reformulated as (10) where ( Γ δ ) K is the air -kerma rate constant for the bare source. Recommended Quantities and Their Relationships Air kerma is related to exposure as K ≈ X (W/e) (8) where W/e is the mean energy expended per unit charge released in air. This relationship assumes that the radiative fraction. Exposure rate at any point in free space is given by the expressions. g.
The recommended unit for air-kerma strength is The numerical calculations can.R a a n d ( Γ δ ) K.5 mm Pt) expressed in terms of mass of radium (instead of activity). i . however. teaching and clinical use.1. h .R a are exposure-rate and air-kerma-rate constants for encapsulated radium (0. units can be used. and gives the units for three systems suitable for use with these equations.l 2 -1 2 µ G y m2 h . the equations can be used with without introduction of numerical any consistent set of units. CPMRI6. factors. times distance squared. e . scientific purposes.1 w h i c h i s n u m e r i c a l l y e q u a l t o c G y c m h . and ICRU 24 in that the source strength is specified directly in terms of The name “reference air-kerma rate in free space at one meter. Air-kerma rate at any point in free space is given by (14) The equations used in this report represent relationships between physical quantities.15 w h e r e ( Γ δ ) X. be rads. air-kerma rate” as used by the BCRU and CFMRI is. which may lead to confusion in The name “air-kerma strength” as defined here is appropriate for a quantity with the dimensions kerma rate . . Table I lists the symbols for the dimensional quantities Any one of these three systems of u s e d i n t h i s p a p e r . simplified by using convenient multiples or submultiples of the units of air kerma and absorbed dose. calculation. Our recommendations agree with those of the BCRU 8. if desired. e t c . 1 µGy m = 1 cGy cm 2 h . not used here since the source strength defined in that manner does not have the dimensions of a kerma rate. provided it is used consistently throughout a SI units are now in international use for “Traditional” brachytherapy units involve roentgena. c e n t i m e t e r s . As such.
876 cGy R -1 = 8.76 mGy R = 33. is for dry air 2 5. quoted above. Quantities and Units Used in Brachytherapy Some of the conversion factors are: 1 Gy = 1 J kg-l 1 Gy = 100 rad 1 mCi = 37 MBq W/e -1 -1 = 0.16 Table I.97 Gy kg C-1 = 33.97 J C The value of W/e. . at the time of writing. It is the value used at NBS.
17 VII. and regulatory agencies.1 has an equivalent mass of radium given by R a source with an air-kerma strength of 100 µGy m 2h .0 cGy cm h . a number of changes are required in clinical practice. With the proposed specification in terms of air-kerma strength. as well as more uniform clinical dosimetry for individual patients. a from the air-kerma strength by using equation 13. We suggest that activity (in mCi or MBq) of the radionuclide in the source be estimated from the air-kerma strength using equation 9 or 10 and the best-known value. calibration laboratories. which can result from mishandling of unnecessary factors in dose calculations. software vendors. 1.0 µGy m h 2 For example. An estimate of the activity of a radioactive source is still required for regulatory and radiation protection purposes. dosimetrists.1 = 100 Gy . probability of gross dosimetry errors.86 mCi ≈ 32 MBq Some changes will be necessary in patient dosimetry. exposure-rate and air-kerma-rate constants are not required for dose calculations.1 (15) = 0. an -1 2 1 2 5 I seed with an air-kerma strength of has an estimated activity given by = 1. the ramifications are mentioned in this physicists. Practical Considerations If brachytherapy sources are specified in terms of air-kerma Some of section as guidelines to r a t e . 226 If it is desired to employ radium dosage tables for pre-planning and the equivalent mass of radium can be calculated For example. source suppliers. The recommended method of specification will result in It will reduce the better consistency among suppliers and users. m 2 h . of the exposure-rate or air-kerma-rate constant. estimating dosages.
obliquity effect. Since (W/e) is a constant.8 mg Currently. It is recommended that air-kerma strength be It should be noted specified as input in these algorithms. . this recommendation is replacing two variables A and ( Γ δ ) X by a single variable SK . All other aspects of the dose calculation programs such as tissue attenuation factors. e t c .18 (16) = 13. that this requires a minor change in the currently employed algorithms for exposure-rate calculations: specifically the product A ( Γ δ ) X must be replaced by S K /(W/e). treatment planning systems specify the source strength as the activity of the radionuclide or the equivalent mass of radium and then employ approximate forms of equation 1 to compute exposure rate. and that equation 11 or its equivalent be employed for exposure computations. are unaffected by this change. Sievert integrals.
result of test. model number. Certificate number. volume. materials of construction. Air-kerma strength. Radionuclide. source strength. traceability to NBS standards. dimensions. The air-kerma rate is not isotropic around the source. method of test. mass. date of test. Surface contamination: Leakage : method of test. can be obtained by . date of test. result of test. Documentation of the calibration procedures employed is available on application to (name to be supplied by manufacturer). Manufacturer’s name and address.19 Appendix: Information Recommended for Manufacturer’s Certificate of Calibration. and level of averaged over all directions. nominal activity. half-life. Serial or lot number. in µGy m 2 h -1. applying the factor _____ to the air-kerma strength. diagrams Active contents: Encapsulation: illustrating all dimensions. chemical and physical form. The certificate should also contain statements such as the following: Air-kerma strength is the product of air-kerma rate in free space and the square of the distance of the calibration point from the source center along the perpendicular bisector. The mean Date of calibration.
"The Role of the Standards Laboratory in Brachytherapy. Nat. Day. 19 (1980). Stand. Bur. Loevinger. S. D u t r e i x and A. L . 7. 56. 5. Gibb and J.P. 978 (1983). 89. NCRP Report No." J. Stand." B r i t . pp." Brie. " A n O v e r v i e w o f Errors in Line Source Dosimetry for Gamma-Ray Brachytherapy. 8. R." M e d . Bur. J.C.P.A. 3. Aird and M. A g a r w a l . 295 (1984). (1974). "Recommendations Pour la Determination Des Doses Absorbees En "Standardization of 137 Cs Gamma-Ray Sources in Terms of Exposure Units (Roentgens). National Council on Radiation Protection. "Quantities and SI U n i t s f o r D o s e Rate Calculations from Radionuclide Sources. Res. British Committee on Radiat. Units and Measurements. Radiol." in Recent Advances in Brachytherapy Physics. Nat. Comite' Francais Measure des Rayonnements Curietherapie. 7. "Radium Dosage: E. 11. "Specification of Brachytherapy Sources." Brit. Washington." Brie. Radiol. (1981). R. 1 (1983). Shearer. Loftus." CFMRI Report No. 1100 (1980). 1 (1970).20 References 1. 10." J. 2. Wambersie. Massey.R. AAPM Task Group 21. D. Res. 10. 22-31. "A Protocol for the Determination of Absorbed Dose from High-Energy Photon and Electron Beams.P. American Institute of Physics. New York (1981). "Dosimetry of X-Ray and Gamma-Ray Beams for Radiation Therapy in the Energy Range 10 keV to 50 MeV. A. J. Machester System. Loftus. 10. 4. T. 69. 741 (1983).B. edited by D. . Stand. 41. Radiol." Med. D. "Standardization of 192 Ionisants. 871 (1983). 13. J. 12. 1034 (1975). National Commission on Radiation Protection and Measurements.J. 941 (1984). 6. Jayaraman. T. 57." NCRP Report No. 85. Phys. H .C. 9. Washington. Lanzl a n d S .G. 74A. Specification of Gamma-Ray Brachytherapy Sources. Radiol. Loftus. Medical Physics Monograph No. Ir Gamma-Ray Sources in 1 2 5 Terms of Exposure. 53. K . Res. Bur." J. "Specification of Gamma-Ray SI Units and the Brachytherapy Sources. T. Nat. "Exposure Standardization of I Seeds Used for Brachytherapy. 48. Phys. J.
C. MD. "Clinical Dosimetry in Modern Interstitial and Intracavitary edited by F. I.C. G. Hilaris and L. "Monte Carlo Evalution of the Sievert Integral for Brachytherapy Dosimetry.M. Morin and F.L. Spiro. 1747 Ir and Au Sources . "Absorption Corrections for Radium Standardization. pp. 1985. J. Biol. L. K. 1." Can. "A Fundamental Approach to the Design of a Dose-Rate Calculation Program for Use in Brachytherapy Planning. H. Boutillon and A. "Physical Dosimetry of (1983). 38 (1964). 635 (1955). Radiol.J." Phys.21 14." Int. Radiol. Young and H. "Re-evaluation of the W Value for Electrons in Dry Air.). 21." Brit. Edinburgh and London (1947).J. 29. Wagner. 19. George III. 17. C. S. 56. "Directional Dependence of Radiation Fluence from 198 1 9 2 1 2 5 I Seeds of a New Design for Interstitial Implant. "Radiol. J. Anderson.D.N. 146. Z.L.S. Bethesda. B. R. 28. 37. 213 (1987).J. G. 9-15. Bennett. "Attenuation of Radium Gamma Radiation in Cylindrical Geometry." Endocurietherapy/Hyperthermia . E." Brit.M. 32. Meredith (Ed." Brit. 113 (1983). Whyte. 791 (1983). "A Nomograph for Oncol.C. Khan. Perroche-Roux. W. Int.M." ICRU Report No. Cundiff. Rustgi and J. Kubiatowicz and D. Anderson. with 125 Sources Calculated by an Electronic Computer. 301 (1951). Masson I Seeds.J. Radium Dosage: The Manchester System. Phys. 9. Livingstone Publishers. Oncol. 1021 (1983). Cassell.Y.L. "Dose a n d V o l u m e S p e c i f i c a t i o n f o r Reporting Intracavitary Therapy in Gynecology. Publishing Co. 2 4 .H. (1981). Radiat. 16. J. Phys. Med. 28. Med. 22.W. Bio. Keyser. Batho. Williamson.F. C." Radiation Cancer Management. D. 38. Ding.K. 18." Phys. Biol.E. L. Commission on Radiation Units and Measurements. Planar Implants Planning. Ling. Ling. 25.M. M. 23.N. J. J.F. M. "Dose Tables for Linear Radium 20. J. Yorke. Radiol. 15. Kuan and I. Gromadzki. 9-15 (1985).