Professional Documents
Culture Documents
Aapm RPT 51 TG43
Aapm RPT 51 TG43
51
Members
Ravinder Nath
Lowell L. Anderson
Gary Luxton
Keith A. Weaver
Jeffrey F. Williamson
Ali S. Meigooni
March 1995
Lowell L. Anderson
Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York 10021
Gary Luxton
Department of Radiation Oncology, University of Southern California, Los Angeles, California 90033
Keith A. Weaver
Department of Radiation Oncology, University of California, San Francisco, California 94143
Jeffrey F. Williamson
of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110
Division
Ali S. Meigooni
Department of Radiation Medicine, Universlty of Kentucky, A. B. Chandler Medical Center, Lexington,
Kentucky 40536
217
217
217
217
217
APPENDIX A: RELATIONSHIP OF
RECOMMENDED DOSE
CALCULATION FORMALISM TO
SOURCE STRENGTH
QUANTITIES OTHER THAN AIR
KERMA STRENGTH. . . . . . . . . . . . .
APPENDIX B: RELATIONSHIP BETWEEN
RECOMMENDED FORMALISM
AND OTHER FORMALISMS.. . . . .
A. Radial dose distribution quantities. . . . . . . . . . . .
1. Energy absorption buildup factor: B ( r) . .
2. Tissue attenuation factor: T(r). . . . . . . . . . . .
3. The older (Dales) radial dose function:
g(r).................................
4. Relationship between dose rate constant
and traditional dosimetric quantities. . . . . . .
5. Implementation of point source model on
a commercial treatment planning computer.
B. Two-dimensional dose distribution and the
Sieverts integral model. . . . . . . . . . . . . . . . . . . .
APPENDIX C: REVIEW OF DOSIMETRY
CALCULATIONS AND
MEASUREMENTS FOR
INTERSTITIAL
BRACHYTHERAPY SOURCES.. . .
A. Iridium-192 sources. . . . . . . . . . . . . . . . . . . . . . .
B. Iodine-125 sources. . . . . . . . . . . . . . . . . . . . . . . .
C. Palladium-103 sources. . . . . . . , . . . . . . . . . . . . .
APPENDIX D: GLOSSARY OF DEFINITIONS
AND UNITS . . . . . . . . . . . . . . . . . . . .
ACKNOWLEDGMENTS . . . . . . . . . . . . . . . . . . . . . . .
REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
218
218
I. INTRODUCTION
TABLE OF CONTENTS
I. INTRODUCTION. . . . . . . . . . . . . . . . . . . . . . . . . . . .
II. DESCRIPTION OF SOURCES. . . . . . . . . . . . . . . .
A. Iridium-192 sources. . . . . . . . . . . . . . . . . . . . . . .
B. Iodine-135 sources. . . . . . . . . . . . . . . . . . . . . . . .
C. Palladium-l03 sources. . . . . . . . . . . . . . . . . . . . .
III. RECOMMENDED DOSE CALCULATION
FORMALISM. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. General formalism for two-dimensional case...
1. Reference point for dose calculations. . . . . .
2. Air kerma strength, Sk. . . . . . . . . . . . . . . . . .
3. Dose rate constant, ^. . . . . . . . . . . . . . . . . .
4. Geometry factor, G(r, ). . . . . . . . . . . . . . . . .
5. Radial dose function, g(r). . . . . . . . . . . . . . .
6. Anisotropy function, F(r, ). . . . . . . . . . . . . .
B. Point Isotropic Source Approximation. . . . . . . .
1. Anisotropy factor, an(r). . . . . . . . . . . . . . . .
2. Anisotropy constant, an . . . . . . . . . . . . . . . .
IV. RECOMMENDED DOSIMETRY
PARAMETERS. . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Dose rate constant, ^. . . . . . . . . . . . . . . . . . . . .
B. Radial dose function, g(r). . . . . . . . . . . . . . . . . .
C. Anisotropy parameters, F(r. ), an(r), and
an.......................................................................
an .
D. Point source approximation data. . . . . . . . . . . . .
V. SUMMARY OF RECOMMENDATIONS. . . . . . . .
VI. DISCUSSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
A. Choice of dose rate constants. . . . . . . . . . . . . . .
B. Impact of NIST standards for source strength
on the recommended protocol. . . . . . . . . . . . . . .
C. Uncertainty estimate. . . . . . . . . . . . . . . . . . . . . . .
D. Implementation of the recommended dosimetry
protocol. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
E. Clinical impact of recommendations. . . . . . . . . .
F. Impact of recommendations on radiobiological
studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
209
209
210
210
211
211
211
212
213
213
213
213
214
214
215
215
215
216
216
216
219
219
219
219
220
220
220
221
222
222
222
222
223
226
231
232
233
233
0094-2405/95/22(2)/209/26/$1.20
209
210
210
192
Ir radionuclide.
cluding dose rate constants, radial dose functions, and anisotropy functions for
192
Ir,
125
I, and
103
Pd sources. In particu-
with a confusing situation regarding the selection of dosimetry data. Therefore, the Radiation Therapy Committee of the
1988 formed Task Group No. 43 to review the recent publications on the dosimetry of interstitial brachytherapy sources
and recommend a dosimetry protocol which would include a
formalism for dose calculations and a data set for the values
of dosimetry parameters. In this final report of the task
group, which has been approved by the AAPM Radiation
Exposure rate and air kerma rate constants for ideal point source (Ref. 3):
( ) = 4 . 6 9 R c m2 m C i - 1h - 1
( ) = 0 . 1 1 1 G y m 2 M B q- 1h - 1
=4.11 cGy cm2 m C i -1 h - 1
= 1.00 cGy cm2 U -1 h -l
ropy function, dose rate constant, etc. All the equations re-
Pd is
125
I,
192
Ir, and
103
ever,
clides and will not be discussed further. Today the vast ma-
226
103
plants. A description of
1 9 2
Ir
ranged
from
3.9
to
5.0
R c m2 m C i - 1h - 1, p r o v i d i n g a g o o d e x a m p l e o f w h y i t i s
poor practice to specify source strength as activity, since the
A. Iridium-192 sources
192
191
370 keV (Attix and Goetch argue that the appropriate mean
192
dose rates in water medium near the actual source are used.
211
211
125
I radionuclide.
loose seeds: additionally the low activity model is also available as strands of 10 seeds spaced 1 cm apart in absorbable
suture.
In this report, no data are presented on the newly intro125
I model 2300 source now marketed
duced double-walled
ding of stainless steel. The other (manufactured by Alpha-
by Best Industries.
C. Palladium-103 sources
103
102
Pd absorbs a neutron. It
excited states of
103
i n g f r o m 1 . 4 - 7 . 2 U ( e q u i v a l e n t t o a n M eq v a l u e o f 0 . 2 - 1 . 0
erties.
103
Pd sources are similar in size and encapsulation to
u p t o 7 2 U ( e q u i v a l e n t t o a n Me q v a l u e o f 1 0 m g R a E q ) .
Dosimetry data presented in this report applies to the
stainless-steel-clad
192
192
125
The
103
Ir seeds.
Ir is most commonly used in the form of
In Europe
192
FORMALISM
Dosimetry of
192
The dosimetry data endorsed by this report results in absolute dose rate changes as large as 17% relative to conventionally used treatment planning data.1,6-10 T h e r e f o r e , c a r e f u l
B. Iodine-125 sources
125
I is produced when
124
the form of small seed sources. Three models are available. Two of these seed types, manufactured by 3M until
Medical Physics, Vol. 22, No. 2, February 1995
212
212
l03
Pd radionuclide.
anisotropy constant,
an
the source;
T(r) is the tissue attenuation factor as defined by Eq. (B5)
in Appendix B;
an
is
the
anisotropy
constant.
The
new
approach
follows
t h e r e c o m m e n d a t i o n o f t h e I C W G ( C h a p . 3 )1 In the recom-
the radionuclide.
is that they are based upon photon fluence around the source
interest and is the angle with respect to the long axis of the
written as
(2)
w h e r e Sk =air kerma strength of the source (defined in Sec.
III A 2);
^=dose rate constant (defined in Sec. III A 3 in units of
c G y h - 1U
- 1
) ;
213
213
try calibration laboratories, ADCLs in the USA and the National Research Council of Canada). However, it is the responsibility of the user to verify the accuracy of source
strength provided by the vendor. Typically, the user has a
well-type ionization chamber that has a calibration traceable
to the national standards for each type of brachytherapy
source.
If kerma, time, and distance are assigned units of Gy, h,
a n d m , r e s p e c t i v e l y , Sk w i l l h a v e u n i t s G y m2 h - 1 a s r e c o m m e n d e d b y t h e T G - 3 2 r e p o r t .13 In this report, this unit is
denoted by the symbol U, that is,
1 U=l unit of air kerma strength
(4)
The conversion factors needed to renormalize Eq. (1) for
alternative source strength specifications are discussed in Appendix A and are summarized in Table IV. The geometric
relationship between the point of output determination and
an arbitrary filtered source and other details have been deFIG. 1. Illustration of geometry assumed in the dose calculation formalism.
Angle is that subtended by the active length at point P. The reference
p o i n t i s r e p r e s e n t e d b y P ( r0 , 0 ) .
( r0 , , ) a r e d e s c r i b e d b e l o w .
cation of the dose rate constant as well as relative dose distribution parameters, this report recommends that liquid
T h e r e f e r e n c e p o i n t ( ro , 0 ) i s c h o s e n i n t h i s r e p o r t t o l i e t h e v a l u e o f ^ , t h e 1 c m d i s t a n c e i s s p e c i f i e d a l o n g t h e
transverse axis of the actual source (rather than an idealized
on the transverse bisector of the source at a distance of 1 cm
point source) relative to its geometric center. Mathematically,
from its center, i.e., r o = 1 c m a n d 0 = / 2 . T h i s c h o i c e o f
reference point for dose calculation in a medium is consistent
(5)
2 . A i r k e r m a s t r e n g t h , Sk
d i s t a n c e , d , in free space, k ( d ) , m e a s u r e d a l o n g t h e t r a n s -
the value of
to
performed in air and corrections for air attenuation are applied if needed. Whereas the measurements for source
of a reference calibration distance, d o , which is usually chosen to be 1 m. It should be noted that the user typically does
(6)
not perform the in-air calibration, which is primarily performed by the standardization laboratories (National Institute
214
214
T ABLE IV. Source strength conversion factors for interstitial brachytherapy sources a
Sources
Source strength
quantity
Units
Exposure rate
constant () or
exposure rate
constant for
filtration (),1
R c m2 m C i- 1h - 1
All
Equivalent mass of
Radium
mgRaEq
8.25
7.227 U mgRaEq-1
All
Reference exposure
rate
m R m2 h - 1
...
n R m2 s - 1
C k g -1 m 2 s - 1
...
...
3.154x10-2
U/nR m2 s-1
1.222x10 11
U / C k g- 1m 2 s - 1
Apparent activity
mCi
4.60
4.030 U mci-1
Apparent activity
mCi
4.80 b
4.205 U mCi-1
Apparent activity
Apparent activity
mCi
mCi
1.45
1.48
1.270 U mCi-1
1.293 U mCi-1
192
Ir seed
t=0.2 mm Fe
192
lr seed
t=0.05 mm PtIr
125
I seeds
103
Pd seeds
3
125
in Appendix B3.
(9)
This two-dimensional function gives the angular variation of
dose rate about the source at each distance due to selffiltration, oblique filtration of primary photons through the
(deg)
r=0.5 cm
r=1.0 cm
r=2.0 cm
r=5.0 cm
0
10
20
30
40
50
60
90
1.099
1.094
1.081
1.062
1.039
1.018
0.9160
0.9715
1.023
1.022
1.019
1.015
1.010
1.005
0.9999
0.9926
1.006
1.006
1.005
1.004
1.002
1.001
1.000
0.9980
1.001
1.001
1.001
1.001
1.001
1.000
1.000
1.000
215
215
encapsulating material, and scattering of photons in the medium. The role of the geometry factor in Eq. (8) is to suppress the influence of inverse square law on the dose distribution around the source.
Due to the large dose rate gradients encountered near interstitial sources, it is difficult to measure dose rates accurately at distances less than 5 mm from the source. In addition, the large dose rate variation arising from inverse square
law makes accurate interpolation of intermediate dose rate
a
values difficult without an excessively large table of measured data. By suppressing inverse square law effects, extrapolation to small distances from dose rate profiles measured at distances of 5 and 10 mm as well as interpolation
an
an
(r)
The factor
an
2. Anisotropy constant,
a n
(r),
may
be
approximated
by
distance-
i n d e p e n d e n t c o n s t a n t , a n, which we call the anisotropy constant, which usually takes a value less than 1.00. Thus, the
anisotropy factor,
(r), i n E q . ( 1 3 ) c a n b e r e p l a c e d b y a
an
an
216
216
103
Pd.
125
I, and
and
192
Pd.
103
Pd, a
103
w h i c h c o m p a r e s t h e I C W G ( C h a p . 3 )1 m e a s u r e d d a t a t o
125
18
125
I and
192
W a t e r m e d i u m w e r e t a k e n f r o m t h e I C W G ( C h a p . 3 )1 F o r
103
l2
(14)
T ABLE VIII. Calculated anisotropy function, F(r, ), for a 103Pd Model 200
source.
FIG. 3. The isodose curves produced by 125I models 6711 and 6702, 103Pd
and 192Ir sources with air kerma strength of 100 U. The dose rates for the
isodose curves starting from the outside were 2, 5, 10, 20, 50, 100, and 200
cGy/h.
Medical Physics,Vol.22, No.2, February 1995
(deg)
r(cm)
0.0
10.0
20.0
30.0
40.0
50.0
60.0
1.0
2.0
3.0
4.0
5.0
0.523
0.526
0.533
0.544
0.624
0.575
0.544
0.575
0.442
0.574
0.700
0.590
0.520
0.463
0.627
0.741
0.615
0.572
0.646
0.758
0.843
0.748
0.791
0.773
0.777
0.939
0.876
0.658
0.848
0.901
1.00
0.962
0.838
0.887
0.939
1.03
1.08
1.04
0.94
1.04
1.02
1.06
0.948
0.963
0.992
1.00
1.00
1.00
1.00
1.00
217
217
T ABLE IX. Calculated anisotropy function, F(r, ). for a 125I Model 6711
source.
(deg)
r(cm)
1.0
2.0
3.0
4.0
5.0
6.0
7.0
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
10.0 20.0
192
Ir source.
60.0 70.0
80.0 90.0
0.966
0.941
0.936
0.996
1.03
0.928
0.969
0.958
0.968
1.03 1.03
0.953 0.989
0.977 1.03
1.04 1.01
1.03 1.01
0.954 0.996
1.01 1.02
0.970 0.983
1.01 1.02
1.02 1.00
0.991 1.00
1.03 1.00
1.01 1.00
1.02 1.00
0.997 1.00
0.979 1.00
0.994 1.00
0.987 1.00
90.0
1.00
1.00
1.00
1.00
1.00
1.00
1.00
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
0.806
0.788
0.769
0.868
0.831
0.819
0.844
0.824
0.889
0.843
0.906
0.813
0.949
0.931
0.899
0.944
0.933
0.962
0.947
0.947
0.893
1.01
0.994
0.920
0.985
0.926
0.990
1.00
0.945
1.03
1.02
1.07
0.973
0.962
0.970
0.996
1.02
0.949
0.984
1.03
1.05
0.959
0.967
0.982
0.992
Eq. (2) and based on the use of air kerma strength should be
used for interstitial brachytherapy dosimetry.
(2) Liquid water should be the reference medium for describing dose rate distributions around brachytherapy
sources.
C . A n i s o t r o p y p a r a m e t e r s , F ( r , q),
fa n( r ) , a n d f
an
125
I,
192
Ir, and
103
Pd sources.
(r), were
an
VI. DISCUSSION
XII.
For
125
I and
125
m e a s u r e d v a l u e s o f d o s e r a t e c o n s t a n t s f r o m I C W G1 o r
D. Point source approximation data
V. SUMMARY OF RECOMMENDATIONS
We recommend that
(1) The ICWG dose calculation formalism embodied in
0.477
0.528
0.711
0.550
0.697
0.600
0.701
10.0
20.0
30.0
40.0
50.0
60.0
125
I Model 6702
70.0
80.0
90.0
1.00
1.00
1.00
1.00
1.00
1.00
1.00
Distance, r
(cm)
1
2
3
4
5
6
7
8
9
Anisotropy
constants
an
125
I
model 6711
125
I
model 6702
0.921
0.889
0.820
0.834
0.888
0.944
0.936
0.893
0.887
0.884
0.880
0.901
0.968
0.928
0.897
0.942
0.959
0.891
0.907
0.991
0.947
0.970
0.989
0.998
0.949
0.965
0.955
0.974
0.90
0.93
0.95
0.98
103
Pd
192
Ir
218
218
T ABLE XIII. Average dose rate times distance squared for a source with an
air kerma strength of 1 U using the point source approximation.
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
Distance
along
transverse
axis (cm)
Dose rater
(cGy h- 1c m2)
unknown. Because the physical status of the vendors calibration is unknown, the average of the two published dose
125
125
103
I model
6702
I model
6711
Pd
0.848
0.818
0.758
0.681
0.598
0.517
0.443
0.379
0.325
0.281
0.246
0.216
0.191
0.167
0.857
0.666
0.510
0.383
0.283
0.206
0.150
0.110
0.0820
0.0595
192
Ir
0.915
0.884
0.825
0.752
0.672
0.592
0.518
0.451
0.393
0.343
0.302
0.266
0.235
0.207
1.09
1.10
1.10
1.11
1.11
1.11
1.11
1.11
1.10
1.09
1.08
1.07
1.05
1.03
1.02
1.00
0.988
0.978
In the cases of
103
Pd and
125
sets available as of 1992 and normalized to the vendormaintained calibration standard in use at that time. The continued accuracy of both the measured and Monte Carlo data
require that the vendors consistently apply the calibration
procedures and standards current at the time the measurements and calculations were made. An important consequence of this analysis is that when the
103
Pd and
125
I source
103
Pd sources
103
103
Pd sources
192
I seeds, there is
value as the Monte Carlo dose rate constant values used for
125
125
I seeds were
125
I and
192
103
tion is to increase the air kerma strength per contained millicurie by 7%-10% without affecting the dose rate in con-
C. Uncertainty estimate
125
219
219
compare their current dose calculation practice to the recommended protocol. Additionally, they should evaluate the differences between the current protocol and older dosimetry
methods assumed by clinical studies cited in support of dose
prescription practice.
The new dosimetry may also affect values used for the
125
I relative to
125
(for those who have not adopted the ICWG data presented in
C h a p . 3 )1 a n d t h e y d i f f e r f r o m t h e n e w v a l u e s b y v a r y i n g
amounts, i.e., 10% and 17%, respectively. Therefore, the dosimetry in current use results in a larger dose to the tumor by
7% in the case of 6702 compared to 6711 seeds. This, in
effect, can be misinterpreted as an RBE of 1.06. Clearly, it is
essential to use the best available values for dosimetry in
radiation oncology and biology. Otherwise quantitative conclusions about the relative efficacy and RBEs of different
isotopes may not be valid.
R a s u b s t i t u t e s , s u c h a s 1 3 7C s a n d
Ir, have usually been specified in terms of equivalent
226
192
f e c t i v e a c t i v i t y ( Aa p p) h a s b e e n u s e d i n
192
125
125
I and
198
Au do-
125
I sources needs to
125
125
I model
t r y b a s e d u p o n L = 1 . 3 2 c G y h- lm C i - 1 ( e x c l u d i n g a n i s o t -
ropy), then the actual dose according to the new data would
fined as follows:
220
220
(Al)
ratios used in the brachytherapy dosimetry literature is beyond the scope of this report. A few of the more influential
(A5)
(A6)
(A7)
d r y a i r a n d h a s t h e v a l u e 3 3 . 9 7 J / C = 0 . 8 7 6 c G y / R .2 1
( ) , R a , t i s t h e e x p o s u r e r a t e c o n s t a n t f o r
226
Ra filtered by
the thickness, t, of platinum and has the value (Ref. 22) 8.25
R c m2 m g- 1h - 1 w h e n t = 0 . 5 m m P t . ( ) i s t h e a s s u m e d
d i o n u c l i d e a n d u s u a l l y h a s u n i t s o f R c m 2 m C i- 1 h - 1 . I n
( ) v a l u e a s a s s u m e d b y t h e v e n d o r i n c a l c u l a t i n g A a p p
f r o m t h e m e a s u r e d S k. S o u r c e - s t r e n g t h c o n v e r s i o n f a c t o r s
for the sources covered in this report are given in Table IV.
(A8)
be related rigorously to the quantities g(r) and F(r, ) r e c ommended by this report because the latter are derived from
where
where
fined as
(B2)
125
I sources. Meisberger
For a real source, theoretical values of B(r) are approximately related to the actual radial dose function, g(r), by
221
221
(B3)
This approximation is valid only if filtration and selfabsorption do not alter the primary photon spectrum or the
balance between buildup of scattered photons and attenua-
137
Cs and
and
125
defined as
g(r) is defined as
nition in Eq. (B5), the measured dose and kerma rates must
(B8)
Cs,
226
Ra,
6 0
Co, and
198
192
Ir,
(B9)
tion between the source used for measurement and the source
data
(B10)
(B7)
above we have
g(r) g(r).
(B11)
d o s e d i s t r i b u t i o n s m e a s u r e d a r o u n d a c t u a l s o u r c e s ( L i n g ,6
S c h e l l ,7 M e i g o o n i2 6), Monte Carlo estimates of dose around
t w o - d i m e n s i o n a l s o u r c e s ( W i l l i a m s o n2 7) , a n d t h e o r e t i c a l
p o i n t - s o u r c e d i s t r i b u t i o n s ( D a l e1 5 - 1 7 ) . T h e s y m b o l g ( r ) i s
Medical Physics, Vol. 22, No. 2, February 1995
(B12)
222
222
l i s h e d v a l u e s o f B , T , G , a n d med d e r i v e d f r o m i d e a l i z e d
103
Pd and
125
-1
-1
and
cGymCi - 1h - 1,
or equivalently, cm-,
respectively,
are
given
by
the effective attenuation coefficient of the filter material. Notice that the angle i s m e a s u r e d r e l a t i v e t o t h e t r a n s v e r s e
bisector rather than the longitudinal axis of the source.
Equating the general expression (1) for 2-D dose rate distribution with Eq. (B19)
(B21)
Duplication of the two-dimensional data recommended by
this report by the Sievert model requires that be treated as
a parameter of best fit, chosen to minimize the deviations
137
d o s e r a t e a s a f u n c t i o n o f ( ) , m e d , a n d T o r g ( r ) :
125
I , L a r k e3 0 s h o w s t h a t t h e
this report
BRACHYTHERAPY
SOURCES
192
Ir (Sec. A),
125
I (Sec.
B), and
223
223
192
radius
water
sphere.
c G y h - 1m C i - 1,
A. Iridium-192 sources
192
Their
Ir at the center of a 25 cm
value
at
cm,
4.26
did not report using the same code to calculate exposure rate.
I r w e r e t h o s e o f M e r e d i t h et al.,3 1 w h o h a d u s e d a c y l i n -
192
comparison, the authors have taken into account the fact that
192
while Webb and Fox data were normalized at 1.0 cm; Meis-
F o x3 3 c o u l d b e r e p r e s e n t e d b y e - rB / r 2 w h e r e i s a l i n e a r
a n d k a a n d k b a r e c o n s t a n t s . W i t h a v a l u e o f 0 . 1 1 3 c m -1 f o r
, l e a s t - s q u a r e s f i t t i n g r e s u l t e d i n k a= 1 . 5 9 a n d k b= 1 . 3 6
for the
192
Ir data.
1 9 8 1 : B o y e r e t a l .3 5 h a v e m e a s u r e d e x p o s u r e r a t e c o n -
platinum clad
192
I r s o u r c e t o b e 4 . 6 R c m 2 h - 1m C i - 1 w i t h a
137
Cs intracavitary
tion of
192
192
I r s e e d s .3 6 S p h e r i c a l a i r f i l l e d g r a p h i t e c h a m b e r s
c m2 m C i - 1 h - 1 , p r o v i d i n g a g o o d e x a m p l e o f w h y i t i s
R c m2 m C i- 1h
- 1
array to the sum of the measured ion currents for the seeds.
192
224
224
tered
192
that for angles greater than 50 deg relative to the source axis,
I as well as
192
Ir, in water and other body tissues, Dale pointed out that
the sampling method used by Webb and Fox 33 did not accu-
on the seed axis. He used the same data to depict the (fluence
192
Ir photon en-
c G y h- 1m C i - 1 i n
rectum
to
4.13
cGyh - 1m C i-1 in
body
fat. Similarly, the radial dose functions show only a few per-
cent variation with tissue type. The radial dose function re-
p o r t e d b y D a l e1 5 f o r
192
25
192
e d i t o r f r o m M a y l e s a n d T u r n e r ,3 7 w h o s u g g e s t e d t h a t t h e
activity.
1 9 8 3 : L i n g et al.4 0 h a v e d e t e r m i n e d t h a t t h e r e i s s o m e
anisotropy in photon emission associated even with the
stainless-steel
bring his results into better agreement with the Webb and
F o x3 3 d a t a a n d t h e M e i s b e r g e r d a t a . I n t h i s s a m e a r t i c l e ,
only 78% of that on the transverse axis, the value was greater
192
Ir,
192
scheme, however).
1983: For
192
loader
192
192
Ir wire
cm.
192
192
Ir
gooni, and Nath et al.42 for Lucite, Solid Water, and water, in
platinum. For the two wire diameters in use, 0.3 and 0.6 mm,
192
Ir source
1 9 8 3 : I t w a s p o i n t e d o u t b y W i l l i a m s o n e t a l .3 9 t h a t
capsulation was seen, and the expected shift toward low en-
225
225
and calculations for all materials, and the water/air dose ratio
192
lated
M e l i , a n d N a t h e t a l .4 3 d e t e r m i n e d t h e e f f e c t o f s p e c t r a l
response per unit dose) of LiF (TLD) chips. Using the same
192
seed axis, where the measured dose was 9.5% greater if an-
was verified experimentally with 60, 80, 100, and 250 keV
w a s a s s u m e d , u s i n g d a t a f r o m W i l l i a m s o n e t a l .39 i n b o t h
of
192
placed
ters and the chamber center. Introducing the air gap was
192
at five phantom depths (1.36, 3.34, 5.32, 7.27, and 10.27 cm)
data are identified as the ratio of the average dose over the
44
1 9 8 8 : G i l l i n et al. h a v e r e p o r t e d T L D m e a s u r e m e n t s i n
Solid Water phantom with LiF cubes 1 mm on an edge, in the
192
I r s e e d s b y T h o m a s o n a n d H i g g i n s ,4 6 u s i n g L i F r o d s 1
Ir wire 0.3 mm in
center) along the wire, plus a few points on the source axis,
sured data at 0.25 and 0.5 cm away but there is good agree-
both seed types, the RDFs from this work were 2%-3% less
phantom. The fact that the calculated values are smaller than
10 cm. For both the Meisberger data and the data from this
226
226
ing again. The dose rate constants in water inferred from this
article
are
-1
4.0
-1
cGyh m C i and
-1
4.2
-1
cGyh m C i ,
125
mended a new set of values for the dose rate constant and
re-
192
Ir source
(Chap. 3). This data set was an average of the data obtained
192
47
et al. I n a j u x t a p o s e d r e s p o n s e , T h o m a s o n a n d H i g g i n s
46
I data, the ICWG found that the dose rate constant of 4.55
c G y m C i - 1h -1 for
192
d a t a . 25 A s b e f o r e , t h e a n i s o t r o p y c o n s t a n t w a s f o u n d t o b e
1.00 within experimental uncertainty of 33%.
1 9 9 1 : R e c e n t l y , T h o m a s o n e t a l .d 8 h a v e r e p o r t e d a m e a -
1 9 2
192
60
factor
of
4.550.07
cGycm 2 m C i - 1h -1 was
found.
192
Ir
a n a c c o m p a n y i n g a r t i c l e , T h o m a s o n e t a l .4 9 a l s o p r e s e n t a n
( 0 . 9 9 2 6 ) ( 4 . 5 5 ) = 4 . 5 2 c G y m C i - 1h - 1. T h e a u t h o r s c o m p a r e
energy spectra of
their dose factor with the analogous value for a point source
in air, i.e., the product of the factor (0.973 cGy/R) and the
exposure
rate
constant
(4.69
Rcm 2 m C i - 1h - l),
which
is
192
4 . 5 6 c G y m C i - 1h - 1. T h e r a d i a l d o s e f a c t o r , w h i c h , b e c a u s e
platinum-encapsulated
B. Iodine-125 sources
Because of the relatively low energy of 1 9 2I photons, significant absorption occurs in the titanium encapsulation of
192
192
Ir source,
125
192
Ir source is
1 9 6 0 s : A n h i s t o r i c a l r e v i e w o f 1 2 5I d o s i m e t r y i n d i c a t e s
that dose rate data for this isotope has undergone a nearly
activity
192
227
227
rate
constant
of
1.4
cm 2 m C i - 1h - 1,
this
work
implied
125
125
of
only
1.3
cm 2 m C i - 1h -1 at
rad
distance
of
about
125
ence exposure rate or air kerma strength, can dose rates de-
p l a s t i c , o f 1 . 1 8 r a d c m 2 m C i- 1 h - 1 , w i t h a n i m p l i e d a n i s o t -
r o p y f a c t o r o f 0 . 8 7 .5 4 T h e s e v a l u e s w o u l d h a v e b e e n a b o u t
125
I photons.
b a s e d o n b u i l d u p f a c t o r s b y B e r g e r23 a n d c o m p o s e a t w o -
c u l a t e d b y B e r g e r ,2 3 s h o w e d i n c r e a s i n g l y m o r e p r o m i n e n t
rad
125
125
I seed dose
cm2 m C i- 1h -1 and
the
measured
value
was
only
2%
125
I s e e d s w a s m e a s u r e d b y L i n g e t a l .5 6
l i t h i u m - d r i f t e d s i l i c o n d e t e c t o r 5 m m t h i c k .5 7 F o r t h e 2 7 . 4
along the seed axis was only 15% of the fluence along the
125
I seed pho-
a t Y a l e .5 8 U s i n g a s o d i u m i o d i n e s c i n t i l l a t i o n d e t e c t o r t o
e r g m C i - 1h - 1, c o r r e s p o n d i n g t o a p h o t o n e n e r g y o u t p u t o f
constant
-l
rad mCi h
- 1
-1
-1
of
1.089
Rcm 2 m C i- 1h -1 on
the
transverse
axis.
228
228
R c m 2 m C i - 1h - 1 t r a n s v e r s e a x i s v a l u e o f t h e e x p o s u r e r a t e
125
I w e r e t h o s e r e p o r t e d b y D a l e .1 5 H e e v a l u a t e d d o s e a s a
1.35
rad
-1
-1
result
cm m C i h and
he
mentions
that
this
the specific dose constant for adipose tissue and body fat
water. In his data for water, the relative dose rate normalized
Rcm2mCi-1h-1),
the
factor
(0.9
rad
for model 6711 at 6.0 cm was about 17% lower than that for
model 6701.
RDF, i.e., lower-Z tissues have lower SDCs but their RDFs
125
125
198
less than 60% of its original value. Further. the dose contri-
125
I as opposed to 6.4
A u . I n a f u r t h e r c o m m u n i c a t i o n 1 9 8 6 , D a l e17 o f -
were taken at distances from about 1.1 to 5.5 cm. Thus, the
cm for
198
125
125
60
lating
B e r g e r . 2 3 B u r n s a n d R a e s i d e l a t e r e x p a n d e d5 9 t h i s s t u d y t o
calculations for not only point sources but 6701 and 6702
0.5 to 5 cm radially from the seed axis and from the O-5 cm
229
229
val) was estimated at 5%, 3%, and 4% for model 6701, 6702,
distance.
et al.6 was reported by Schell et al.7 for the model 6702 seed.
previous study, but the angles used and the method of data
60
dose to muscle).
1985: Following the introduction of seed-strength stan-
by the method of Berger and the fact that Monte Carlo data
d a r d i z a t i o n b y N B S , L i n g e t a l .1 6 u n d e r t o o k a t w o -
b y D a l e1 5 - 1 7 a r e i n c r e a s i n g l y g r e a t e r a s a f u n c t i o n o f d i s -
1 9 8 7 : B u m s a n d R a e s i d e6 5 i n 1 9 8 7 , u s i n g t h e i r M o n t e
t i o n o f a n g l e b e t w e e n 0 a n d 9 0 f r o m t h e s e e d a x i s a n d
t a i n e d b y W i l l i a m s o n a n d Q u i n t e r o .2 7 A s i n t h e i r e a r l i e r
study of the model 6702 seed, they calculated the dose rate
mann et al. for the model 6701 seed, Ling et al. found a
variation in the radial distance dependence as a function of
angle, with less angular dependence at greater distances. To
accommodate this variation, they developed a matrix fit to
their data, consisting of the product of a distance-dependent
exponential with an angle-dependent extinction coefficient
and a distance-dependent quadratic having angle-dependent
coefficients, all divided by the square of the distance. A matrix of values tabulated for the four angle-dependent parameters includes data for angles of 0, 60, 70, 80, and 90
from the seed axis.
1 9 8 5 : K u b o63 has called attention to the fact that 4.5 keV
titanium K x rays emitted as fluorescent radiation from the
capsule of
125
ent activity) measurements using thin-window mammography ion chambers. Although these photons make no significant contribution to dose in water beyond about 1 mm from
the seed, they are shown to contribute to exposure in air at 30
cm from the seed by about 4%. However, comparison performed at NBS resulted in differences of only 0.2% for a
constant
in
cm2 m C i- 1h - 1,
water
11.6%
for
higher
this
than
seed
the
is
1.288
value
recom-
m e n d e d b y W i l l i a m s o n i n 1 9 8 8 ,6 6 w h o h a d r e f e r e n c e d h i s
value to his own estimate of the NIST evaluation of air
kerma strength, which explains 7% of the difference.
1988: A specific dose constant in water of 1.24
cGy
cm2 m C i - 1h -1 for
point
source
in
large,
homoge-
125
I seeds.
has
I with
of
multiplied
by
1.27
cGy
cm 2 m C i - 1h -1 to
permit
60
been
1.33
cGy
-1
-1
assumed
value 53 of
1.32
cGy
cm 2 m C i - 1h -1 f o r
v a l u e o f 1 . 1 9 c G y c m2 m C i - lh - 1 ( p r i v a t e c o m m u n i c a t i o n
6711 and of Schell et al7 for model 6702 shows fairly good
-1
-1
230
230
c a l c u l a t i o n s ( f o r e x a m p l e , b y D a l e ,1 5 B u r n s , 5 9 a n d
64
125
having been made, as well, for the model 6711 seed. In Solid
from 0.5 to 8.0 cm. The TLD material was calibrated against
libraries and the fact that Solid Water has significantly dif-
125
I seed
dosimetry.
1 9 8 8 : P i e r m a t t e i e t a l .6 8 h a v e r e p o r t e d t h e i r t w o dimensional measurements in water, perspex, and three tissue substitute materials (muscle, adipose, and breast) for the
model 6711 seed, using Harshaw lithium fluoride TLD chips
(3.1 X3.1 X0.89 mm) and Kodak X-Omat V film. The TLDs
tive dose rate versus distance are about 15% higher than
m e a s u r e d r e s u l t s b y M e i g o o n i e t a l .2 6 O n e m i g h t e x p e c t
near-perfect agreement if the calculation had assumed a
Solid Water phantom. Relative measured data (normalized to
1.0 at 1 cm) for the model 6711 seed appear to show a value
about 25% less at 8 cm than for the model 6702. Measured
dose factors in Solid Water phantom (same as specific
d o s e c o n s t a n t ) w e r e 1 . 1 8 a n d 1 . 0 6 c G y c m 2 m C i - 1h - 1, r e -
energy and a response per unit exposure 1.27 times that for a
60
seed. The film was used to get off-axis dose rate data. The
authors found their relative dose rate data. both on and off
0.3, 0.5, and 1.0 cm from the seed. The specific dose con-
data of Ling et al.6 The specific dose constant found for both
stant
-1
-1
was
found
to
be
1.184
cGy
cm 2 m C i - 1h -1 in
water,
posure rate constant for the model 6711 seed. The photon
e x p o s u r e r a t e c o n s t a n t o f 1 . 3 6 1 R c m 2 m C i - 1h - 1.
125
I dose distri-
1 . 0 8 0 . 0 3 a n d 1 . 1 4 0 . 0 3 c G y m C i - 1h - 1 f o r t h e 6 7 1 1 a n d
125
two materials.
Medical Physics, Vol. 22, No. 2, February 1995
method have been performed by Chiu-Tsao et al. 10 to determine dose rate distributions around
125
231
231
the
factor,
i.e.,
1.28
cm 2 m C i- 1h - 1. At 1 cm,
cGy
however, the ratios were 0.87 and 0.91, respectively, for the
6711 and 6702 seeds, indicating that the dose rate constants
at
underestimate
small
distances
and
3.13.10.89mm chips
for
larger
dis-
I in
125
125
water. For model 6711 and model 6702 seeds, Monte Carlo
l i q u i d w a t e r m e d i u m ) o f 0 . 8 7 7 a n d 0 . 9 3 2 c G y c m2h -1 p e r
cepted values are 18% and 11% larger than values reported
125
institutions, namely,
125
s o u r c e s w e r e 1 . 1 6 a n d 1 . 0 7 c G y m C i - 1h - 1, r e s p e c t i v e l y .
-1
The ICWG also noted that the value of 1.30 cGy mCi h
in current use for both models of
-1
125
125
I currently ac-
125
around
125
Pd,
125
I, and
192
Ir
192
103
Pd,
125
I model 6711,
125
I model
function for the model 6711 source falls off slightly more
rapidly than that for the model 6702 source, because of the
125
I seed modifies
the dose rate on the side away from the backing material.
There is a small increase close to the gold, but a decrease of
about 10% further away. Prior to this study several contra-
125
I and
103
Pd in water
d i c t o r y s t u d i e s h a v e b e e n p u b l i s h e d .7 4 - 7 8 M o r e r e c e n t l y ,
t h o s e r e p o r t e d e a r l i e r b y W i l l i a m s o n .1 8 F o r t h e
the dose.
0 . 8 8 c G y h- 1U - 1, w h i c h i s i n e x a c t a g r e e m e n t w i t h t h e
18
1 9 9 1 : R e c e n t l y , W i l l i a m s o n has reported a detailed comMedical Physics, Vol. 22, No. 2, February 1995
125
I model
232
232
C. Palladium-103 sources
1 9 9 1 : D o s e m e a s u r e m e n t s u s i n g LiF TLDs h a v e a l s o
103
butions around
P d s o u r c e s u s i n g LiF TLDs i n a S o l i d
Pd source
3.13.1 0.89
103
mm3
dimension
were
used
at
distances
of
2,
by irradiating
103
103
seed center along the transverse axis this product was found
Pd on graphite
to be 0.88 cGy c m2 m C i - 1h - 1, w h i c h i s 8 % s m a l l e r t h a n t h e
d a t a p r e s e n t e d b y M e i g o o n i e t a l .1 2 O n e o f t h e r e a s o n s f o r
12
The dosimetry measurements were made in a twodimensional Cartesian grid with a spacing of 0.5 cm for distances less than 3 cm and 1 cm for distances greater than 3
cm. The sensitivity of LiF TLD for
the same as that for
103
Pd was assumed to be
125
data were fitted to analytical expressions, and twodimensional tables in both Cartesian and polar coordinates
were generated. Dose rate constant in a Solid Water phantom
for the
103
lytical expression.
- 1
- 1
233
ACKNOWLEDGMENTS
The authors thank Anjali Nath and Deanna Jacobs for
preparing this document and Anthony Melillo for the analysis of some of the data presented in this document. We would
also like to thank Stuart Smolen for a careful reading of the
manuscript and his suggestions.
1
Interstitial Collaborative Working Group (ICWG). Interstitial Brachytherapy: Physical, Biological. and Clinical Considerations. edited by L.
L. Anderson, R. Nath, and K. A. Weaver (Raven, New York, 1990).
2
M. B. Podgorsak, L. A. DeWerd, and B. R. Paliwal. The half life of high
dose rate Ir-192 sources, Med. Phys. 20, 1257-1259 (1993).
3
G. P. Glasgow and L. T. Dillman, Specific-ray constant and exposure
rate constant for 192Ir, Med. Phys. 6, 49-52 (1979).
4
T. Altzitzoglou, The half life of 125I, Appl. Radiat. Isot. 42, 493-494
(1991).
5
T. P. Loftus, Exposure standardization of 125I seeds used for brachytherapy, J. Res. Natl. Bur. Stand. 89, 295-303 (1984).
6
C. C. Ling, M. C. Schell, E. D. Yorke, B. B. Palos, and D. O. Kubiatowicz. Two-dimensional dose distribution of 125I seeds, Med. Phys. 12,
657-655 (1985).
7
M. C. Schell, C. C. Ling, Z. C. Gromadzki, and K. R. Working, Dose
distribution of model 6702 125I seeds in water, Int. J. Radiat. Oncol.
Biol. Phys. 13, 795-799 (1987).
8
K. A. Weaver, V. Smith, D. Huang, C. Barnett, M. C. Schell, and C. C.
Ling, Dose parameters of 125I and 192Ir seed sources, Med. Phys. 16,
636-643 (1989).
9
R. Nath, A. S. Meigooni, and J. A. Meli, Dosimetry on the transverse
axis of 125I and 192Ir interstitial brachytherapy sources, Med. Phys. 17,
1032-1040 (1990).
10
S. -T. Chiu-Tsao, L. L. Anderson, K. OBrien, and R. Sanna, Dose rate
determination for 125I seeds, Med. Phys. 17, 815-825 (1990).
11
E Browne and R. B. Firestone, Table of Isotopes (Wiley, New York,
1986).
12
A. S. Meigooni, S. Sabnis, and R. Nath, Dosimetry of 103Pd brachytherapy sources for permanent implant, Endocurietherapy Hypertherm.
Oncol. 6, 107-117 (1990).
13
AAPM Report No. 21, Recommendations of AAPM Task Group 32:
Specification of Brachytherapy Source Strength (American Institute of
Physics, New York, 1987).
Medical Physics, Vol. 22, No. 2, February 1995
233
14
234
234
(Robert Gold and Assoc., New York, 1975). pp. 63-72.
V. Krishnaswamy. Dose distribution around an 125I seed source in tissue, Radiology 126, 489-491 (1978).
56
C. C. Ling, L. L. Anderson, and W. U. Shipley, Dose inhomogeneity in
interstitial implants using 125I seeds, Int. J. Radiat. Oncol. Biol. Phys. 5,
419-425 (1979).
57
C. C. Ling and P. J. Biggs, Coincidence sum peak array of 125I activity
using solid state detectors, Med. Phys. 7, 551-554 (1980).
58
R. J. Schulz, P. Chandra, and R. Nath, Determination of the exposure
rate constant for 125I using a scintillation detector, Med. Phys. 7, 355361 (1980).
59
G. S. Bums and D. E. Raeside, Monte Carlo simulation on the dose
distribution around a commercial 125I seed, Med. Phys. 15, 56-60
(1988).
60
C. C. Ling, E. D. Yorke, I. J. Spiro, D. Kubiatowicz, and D. Bennett,
125
Physical dosimetry of I seeds of a new design for interstitial implant, Int. J. Radiat. Oncol. Biol. Phys. 9, 1747-1752 (1983).
61
G. H. Hartmann, W. Schlegel, and H. Scharfenberg, The threedimensional dose distribution of 125I seeds in tissue, Phys. Med. Biol.
28, 693-699 (1983).
125
62
K A Weaver, Response of LiF powder to I photons, Med. Phys. 11,
850-854 (1984).
63
H. Kubo, Exposure contribution from Ti K x rays produced in the titanium capsule of the clinical 125I seed, Med. Phys. 12, 215-220 (1985).
64
S.-T. Chiu-Tsao, K. OBrien, R. Sanna, H.-S. Tsao, C. Vialotti, Y. S.
Chang, M. Rotman. and S. Packer, Monte Carlo dosimetry for 125I and
60
Co in eye plaque therapy, Med. Phys. 13, 678-682 (1986).
65
G. S. Bums and D. E. Raeside. Two-dimensional dose distribution
around 125I seeds, Med. Phys. 14, 420-424 (1987).
66
J. F. Williamson, Monte Carlo evaluation of specific dose constants in
water for 125I seeds, Med. Phys. 15. 686-694 (1988).
67
G. Herbold, G. Hartmann, H. Treuer, and W. J. Lorenz, Monte Carlo
calculation of energy buildup factors in the range from 15 to 100 keV,
with special reference to the dosimetry of 125I seeds, Phys. Med. Biol.
33,1037-1053 (1988).
68
A. Piermattei, G. Arcovito, and F. Andreasi Bassi, Experimental dosim125
etry of I new seeds (mod. 6711) for brachytherapy treatments, Phys.
Med. 1,59-70 (19881.
69
A. M. Hashemi, M. D. Mills, K. R. Hogstrom, and P. R. Almond, The
exposure rate constant for a silver wire 125I seed, Med. Phys. 15, 228234 (1988).
70
J. Halbleib, Structure and operation of the ITS code system, in Monte
Carlo Transport of Electrons and Photons, edited by T. M. Jenkins, W. R.
Nelson, and A. Rindi (Plenum, New York, 1988), pp. 249-262.
71
G. Luxton, M. A. Astrahan, D. O. Findley, and Z. Petrovich, Measurement of dose rate from exposure-calibrated 125I seeds, Int. J. Radiat.
Oncol. Biol. Phys. 8, 1199-1207 (1990).
72
J. Cygler, J. Szanto, M. Soubra. and D. W. O. Rogers, Effects of gold
and silver backings on the dose rate around an 125I seed, Med. Phys. 17,
172-178 (1990).
73
W. R. Nelson and D. W. Rogers, Structure and operation of the EGS-4
code system, in Monte Carlo Transport of Electrons and Photons, edited
by T. M. Jenkins, W. R. Nelson, and A Rindi (Plenum, New York, 1988),
pp. 287-306.
74
G. Luxton, M. A. Astrahan, and Z. Petrovich, Backscatter measurements
125
from a single seed of I for ophthalmic plaque dosimetry, Med. Phys.
15, 397-400 (1988).
75
K. A. Weaver, The Dosimetry of 125I seed eye plaques, Med. Phys. 13,
73-83 (1986).
76
A. Wu, E. S. Sternick, and D. J. Muse, Effect of gold shielding on the
dosimetry of an 125I seed at close range, Med. Phys. 15, 627-628
(1988).
77
A. N. Harnett and E. S. Thomson, An 125I plaque for radiotherapy of the
eye: Manufacture and dosimetric calculations, Br. J. Radiol. 61, 835838 (1988).
78
S. T. Chiu-Tsao, L. L. Anderson, and I. Stabile, TLD Dosimetry for
125
I eye plaque, Phys. Med. Biol. 33 Supp 1 (1988) 128 (abstract).
79
J. A. Meli and K. A. Motakabbir, The effect of lead, gold, and silver
backings on dose near 125I seeds, Med. Phys. A 20, 1251-1256 (1993).
80
G. Luxton, Comparison of radiation dosimetry in water and in solid
phantom materials for I-125 and Ir-192 brachytherapy sources: EGS4
Monte Carlo study, Med. Phys. 21, 631-641 (1994).
55