2021
Morcos, Marc; Viswanathan, Akila N.; Enger, Shirin A.
In: Medical Physics, vol. 48, no. 5, pp. 2604–2613, 2021, ISSN: 2473-4209.
Abstract | Links | BibTeX | Tags: Brachytherapy, Computer-Assisted, dynamic shield brachytherapy, Female, Humans, IMBT, Intensity modulated brachytherapy, Iridium Radioisotopes, Monte Carlo Method, MR-guided brachytherapy, Radiotherapy Dosage, Radiotherapy Planning, rotating shield brachytherapy, RSBT, Uterine Cervical Neoplasms
@article{morcos_impact_2021,
title = {On the impact of absorbed dose specification, tissue heterogeneities, and applicator heterogeneities on Monte Carlo-based dosimetry of Ir-192, Se-75, and Yb-169 in conventional and intensity-modulated brachytherapy for the treatment of cervical cancer},
author = {Marc Morcos and Akila N. Viswanathan and Shirin A. Enger},
doi = {10.1002/mp.14802},
issn = {2473-4209},
year = {2021},
date = {2021-05-01},
journal = {Medical Physics},
volume = {48},
number = {5},
pages = {2604--2613},
abstract = {PURPOSE: The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192 Ir-, 75 Se-, and 169 Yb-based MRI-guided conventional and intensity-modulated brachytherapy. METHODS AND MATERIALS: Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192 Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w ); (b) Dw,w taking the applicator material into consideration (Dw,wApp ); (c) dose to water in medium (Dw,m ); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom) ) or voxel-by-voxel (Dm,m ).
RESULTS: Ignoring the plastic Venezia applicator (Dw,wApp ) overestimates Dm,m by up to 1% (average) with high energy source (192 Ir and 75 Se) and up to 2% with 169 Yb. Scoring dose to water (Dw,wApp or Dw,m ) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom ) for 169 Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered.
CONCLUSIONS: The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192 Ir and 75 Se, but do for 169 Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.},
keywords = {Brachytherapy, Computer-Assisted, dynamic shield brachytherapy, Female, Humans, IMBT, Intensity modulated brachytherapy, Iridium Radioisotopes, Monte Carlo Method, MR-guided brachytherapy, Radiotherapy Dosage, Radiotherapy Planning, rotating shield brachytherapy, RSBT, Uterine Cervical Neoplasms},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192 Ir-, 75 Se-, and 169 Yb-based MRI-guided conventional and intensity-modulated brachytherapy. METHODS AND MATERIALS: Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192 Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w ); (b) Dw,w taking the applicator material into consideration (Dw,wApp ); (c) dose to water in medium (Dw,m ); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom) ) or voxel-by-voxel (Dm,m ).
RESULTS: Ignoring the plastic Venezia applicator (Dw,wApp ) overestimates Dm,m by up to 1% (average) with high energy source (192 Ir and 75 Se) and up to 2% with 169 Yb. Scoring dose to water (Dw,wApp or Dw,m ) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom ) for 169 Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered.
CONCLUSIONS: The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192 Ir and 75 Se, but do for 169 Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.
RESULTS: Ignoring the plastic Venezia applicator (Dw,wApp ) overestimates Dm,m by up to 1% (average) with high energy source (192 Ir and 75 Se) and up to 2% with 169 Yb. Scoring dose to water (Dw,wApp or Dw,m ) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom ) for 169 Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered.
CONCLUSIONS: The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192 Ir and 75 Se, but do for 169 Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.
Morcos, Marc; Viswanathan, Akila N.; Enger, Shirin A.
In: Medical Physics, vol. 48, no. 5, pp. 2604–2613, 2021, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14802).
Abstract | Links | BibTeX | Tags: dynamic shield brachytherapy, IMBT, Intensity modulated brachytherapy, MR-guided brachytherapy, rotating shield brachytherapy, RSBT
@article{morcos_impact_2021b,
title = {On the impact of absorbed dose specification, tissue heterogeneities, and applicator heterogeneities on Monte Carlo-based dosimetry of Ir-192, Se-75, and Yb-169 in conventional and intensity-modulated brachytherapy for the treatment of cervical cancer},
author = {Marc Morcos and Akila N. Viswanathan and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.14802},
doi = {10.1002/mp.14802},
issn = {2473-4209},
year = {2021},
date = {2021-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {48},
number = {5},
pages = {2604--2613},
abstract = {Purpose The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192Ir-, 75Se-, and 169Yb-based MRI-guided conventional and intensity-modulated brachytherapy. Methods and Materials Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w); (b) Dw,w taking the applicator material into consideration (Dw,wApp); (c) dose to water in medium (Dw,m); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom)) or voxel-by-voxel (Dm,m). Results Ignoring the plastic Venezia applicator (Dw,wApp) overestimates Dm,m by up to 1% (average) with high energy source (192Ir and 75Se) and up to 2% with 169Yb. Scoring dose to water (Dw,wApp or Dw,m) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom) for 169Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered. Conclusions The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192Ir and 75Se, but do for 169Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14802},
keywords = {dynamic shield brachytherapy, IMBT, Intensity modulated brachytherapy, MR-guided brachytherapy, rotating shield brachytherapy, RSBT},
pubstate = {published},
tppubtype = {article}
}
Purpose The purpose of this study was to evaluate the impact of dose reporting schemes and tissue/applicator heterogeneities for 192Ir-, 75Se-, and 169Yb-based MRI-guided conventional and intensity-modulated brachytherapy. Methods and Materials Treatment plans using a variety of dose reporting and tissue/applicator segmentation schemes were generated for a cohort (n = 10) of cervical cancer patients treated with 192Ir-based Venezia brachytherapy. Dose calculations were performed using RapidBrachyMCTPS, a Geant4-based research Monte Carlo treatment planning system. Ultimately, five dose calculation scenarios were evaluated: (a) dose to water in water (Dw,w); (b) Dw,w taking the applicator material into consideration (Dw,wApp); (c) dose to water in medium (Dw,m); (d and e) dose to medium in medium with mass densities assigned either nominally per structure (Dm,m (Nom)) or voxel-by-voxel (Dm,m). Results Ignoring the plastic Venezia applicator (Dw,wApp) overestimates Dm,m by up to 1% (average) with high energy source (192Ir and 75Se) and up to 2% with 169Yb. Scoring dose to water (Dw,wApp or Dw,m) generally overestimates dose and this effect increases with decreasing photon energy. Reporting dose other than Dm,m (or Dm,m Nom) for 169Yb-based conventional and intensity-modulated brachytherapy leads to a simultaneous overestimation (up to 4%) of CTVHR D90 and underestimation (up to 2%) of bladder D2cc due to a significant dip in the mass-energy absorption ratios at the depths of nearby targets and OARs. Using a nominal mass-density assignment per structure, rather than a CT-derived voxel-by-voxel assignment for MRI-guided brachytherapy, amounts to a dose error up to 1% for all radionuclides considered. Conclusions The effects of the considered dose reporting schemes trend correspondingly between conventional and intensity-modulated brachytherapy. In the absence of CT-derived mass densities, MRI-only-based dosimetry can adequately approximate Dm,m by assigning nominal mass densities to structures. Tissue and applicator heterogeneities do not significantly impact dosimetry for 192Ir and 75Se, but do for 169Yb; dose reporting must be explicitly defined since Dw,m and Dw,w may overstate the dosimetric benefits.
2020
Famulari, Gabriel; Rosales, Haydee M. Linares; Dupere, Justine; Medich, David C.; Beaulieu, Luc; Enger, Shirin A.
In: Medical Physics, vol. 47, no. 9, pp. 4563–4573, 2020, ISSN: 2473-4209.
Abstract | Links | BibTeX | Tags: Brachytherapy, Geant4, IMBT, Monte Carlo Method, mPSD, Plastics, Radiometry, Radiotherapy Dosage, shielded applicator, TG-186, TG-43, Yb-169
@article{famulari_monte_2020,
title = {Monte Carlo dosimetric characterization of a new high dose rate 169 Yb brachytherapy source and independent verification using a multipoint plastic scintillator detector},
author = {Gabriel Famulari and Haydee M. Linares Rosales and Justine Dupere and David C. Medich and Luc Beaulieu and Shirin A. Enger},
doi = {10.1002/mp.14336},
issn = {2473-4209},
year = {2020},
date = {2020-09-01},
journal = {Medical Physics},
volume = {47},
number = {9},
pages = {4563--4573},
abstract = {PURPOSE: A prototype 169 Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded 169 Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD).
METHODS: The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( 0 ∘ , 9 0 ∘ , 18 0 ∘ , and 27 0 ∘ ).
RESULTS: The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5-10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6-6.2%) for BCF-10, 1.7% (0.9-2.9%) for BCF-12, and 2.2% (0.3-4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC.
CONCLUSIONS: The dose distribution for the bare/shielded 169 Yb source was independently verified using mPSD with good agreement in regions close to the source. The 169 Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.},
keywords = {Brachytherapy, Geant4, IMBT, Monte Carlo Method, mPSD, Plastics, Radiometry, Radiotherapy Dosage, shielded applicator, TG-186, TG-43, Yb-169},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: A prototype 169 Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded 169 Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD).
METHODS: The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( 0 ∘ , 9 0 ∘ , 18 0 ∘ , and 27 0 ∘ ).
RESULTS: The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5-10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6-6.2%) for BCF-10, 1.7% (0.9-2.9%) for BCF-12, and 2.2% (0.3-4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC.
CONCLUSIONS: The dose distribution for the bare/shielded 169 Yb source was independently verified using mPSD with good agreement in regions close to the source. The 169 Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.
METHODS: The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( 0 ∘ , 9 0 ∘ , 18 0 ∘ , and 27 0 ∘ ).
RESULTS: The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5-10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6-6.2%) for BCF-10, 1.7% (0.9-2.9%) for BCF-12, and 2.2% (0.3-4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC.
CONCLUSIONS: The dose distribution for the bare/shielded 169 Yb source was independently verified using mPSD with good agreement in regions close to the source. The 169 Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.
Famulari, Gabriel; Duclos, Marie; Enger, Shirin A.
A novel 169 Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer Journal Article
In: Medical Physics, vol. 47, no. 3, pp. 859–868, 2020, ISSN: 2473-4209.
Abstract | Links | BibTeX | Tags: Brachytherapy, Cohort Studies, Computer-Assisted, Humans, IMBT, Intensity-Modulated, Male, Monte Carlo, Monte Carlo Method, prostate cancer, Prostatic Neoplasms, Radioisotopes, Radiotherapy, Radiotherapy Planning, Uncertainty, Yb-169, Ytterbium
@article{famulari_novel_2020,
title = {A novel 169 Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer},
author = {Gabriel Famulari and Marie Duclos and Shirin A. Enger},
doi = {10.1002/mp.13959},
issn = {2473-4209},
year = {2020},
date = {2020-03-01},
journal = {Medical Physics},
volume = {47},
number = {3},
pages = {859--868},
abstract = {PURPOSE: Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer.
METHODS: The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169 Yb source. Conventional HDR BT (10 Ci 192 Ir) and IMBT (18 Ci 169 Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors ( ± 1 mm, ± 2 mm, and ± 3 mm) and rotational errors ( ± 5 ∘ , ± 10 ∘ , and ± 15 ∘ ) on clinically relevant parameters (PTV D90 and urethra D10 ).
RESULTS: The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% ± 4.7%, without change to other plan quality indices (PTV V100 , V150, V200 , bladder V75 , rectum V75 , HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors ( ± 1 mm, ± 5 ∘ ), the overall tolerance was textless2%.
CONCLUSIONS: The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.},
keywords = {Brachytherapy, Cohort Studies, Computer-Assisted, Humans, IMBT, Intensity-Modulated, Male, Monte Carlo, Monte Carlo Method, prostate cancer, Prostatic Neoplasms, Radioisotopes, Radiotherapy, Radiotherapy Planning, Uncertainty, Yb-169, Ytterbium},
pubstate = {published},
tppubtype = {article}
}
PURPOSE: Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer.
METHODS: The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169 Yb source. Conventional HDR BT (10 Ci 192 Ir) and IMBT (18 Ci 169 Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors ( ± 1 mm, ± 2 mm, and ± 3 mm) and rotational errors ( ± 5 ∘ , ± 10 ∘ , and ± 15 ∘ ) on clinically relevant parameters (PTV D90 and urethra D10 ).
RESULTS: The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% ± 4.7%, without change to other plan quality indices (PTV V100 , V150, V200 , bladder V75 , rectum V75 , HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors ( ± 1 mm, ± 5 ∘ ), the overall tolerance was textless2%.
CONCLUSIONS: The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.
METHODS: The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169 Yb source. Conventional HDR BT (10 Ci 192 Ir) and IMBT (18 Ci 169 Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors ( ± 1 mm, ± 2 mm, and ± 3 mm) and rotational errors ( ± 5 ∘ , ± 10 ∘ , and ± 15 ∘ ) on clinically relevant parameters (PTV D90 and urethra D10 ).
RESULTS: The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% ± 4.7%, without change to other plan quality indices (PTV V100 , V150, V200 , bladder V75 , rectum V75 , HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors ( ± 1 mm, ± 5 ∘ ), the overall tolerance was textless2%.
CONCLUSIONS: The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.
Famulari, Gabriel; Rosales, Haydee M. Linares; Dupere, Justine; Medich, David C.; Beaulieu, Luc; Enger, Shirin A.
In: Medical Physics, vol. 47, no. 9, pp. 4563–4573, 2020, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14336).
Abstract | Links | BibTeX | Tags: Geant4, IMBT, mPSD, shielded applicator, TG-186, TG-43, Yb-169
@article{famulari_monte_2020b,
title = {Monte Carlo dosimetric characterization of a new high dose rate Yb brachytherapy source and independent verification using a multipoint plastic scintillator detector},
author = {Gabriel Famulari and Haydee M. Linares Rosales and Justine Dupere and David C. Medich and Luc Beaulieu and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.14336},
doi = {10.1002/mp.14336},
issn = {2473-4209},
year = {2020},
date = {2020-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {47},
number = {9},
pages = {4563--4573},
abstract = {Purpose A prototype Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD). Methods The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( , 9 , 18 , and 27 ). Results The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5–10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6–6.2%) for BCF-10, 1.7% (0.9–2.9%) for BCF-12, and 2.2% (0.3–4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC. Conclusions The dose distribution for the bare/shielded Yb source was independently verified using mPSD with good agreement in regions close to the source. The Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.14336},
keywords = {Geant4, IMBT, mPSD, shielded applicator, TG-186, TG-43, Yb-169},
pubstate = {published},
tppubtype = {article}
}
Purpose A prototype Yb source was developed in combination with a dynamic rotating platinum shield system (AIM-Brachy) to deliver intensity modulated brachytherapy (IMBT). The purpose of this study was to evaluate the dosimetric characteristics of the bare/shielded Yb source using Monte Carlo (MC) simulations and perform an independent dose verification using a dosimetry platform based on a multipoint plastic scintillator detector (mPSD). Methods The TG-43U1 dosimetric parameters were calculated for the source model using RapidBrachyMCTPS. Real-time dose rate measurements were performed in a water tank for both the bare/shielded source using a custom remote afterloader. For each dwell position, the dose rate was independently measured by the three scintillators (BCF-10, BCF-12, and BCF-60). For the bare source, dose rate was measured at distances up to 3 cm away from the source over a range of 7 cm along the catheter. For the shielded source, measurements were performed with the mPSD placed at 1 cm from the source at four different azimuthal angles ( , 9 , 18 , and 27 ). Results The dosimetric parameters were tabulated for the source model. For the bare source, differences between measured and calculated along-away dose rates were generally below 5–10%. Along the transverse axis, deviations were, on average (range), 3.3% (0.6–6.2%) for BCF-10, 1.7% (0.9–2.9%) for BCF-12, and 2.2% (0.3–4.4%) for BCF-60. The maximum dose rate reduction due to shielding at a radial distance of 1 cm was 88.8 ± 1.2%, compared to 83.5 ± 0.5% as calculated by MC. Conclusions The dose distribution for the bare/shielded Yb source was independently verified using mPSD with good agreement in regions close to the source. The Yb source coupled with the partial-shielding system is an effective technique to deliver IMBT.
Famulari, Gabriel; Duclos, Marie; Enger, Shirin A.
A novel 169Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer Journal Article
In: Medical Physics, vol. 47, no. 3, pp. 859–868, 2020, ISSN: 2473-4209, (_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.13959).
Abstract | Links | BibTeX | Tags: Brachytherapy, IMBT, Monte Carlo, prostate cancer, Yb-169
@article{famulari_novel_2020b,
title = {A novel 169Yb-based dynamic-shield intensity modulated brachytherapy delivery system for prostate cancer},
author = {Gabriel Famulari and Marie Duclos and Shirin A. Enger},
url = {https://aapm.onlinelibrary.wiley.com/doi/abs/10.1002/mp.13959},
doi = {10.1002/mp.13959},
issn = {2473-4209},
year = {2020},
date = {2020-01-01},
urldate = {2021-09-08},
journal = {Medical Physics},
volume = {47},
number = {3},
pages = {859--868},
abstract = {Purpose Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer. Methods The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169Yb source. Conventional HDR BT (10 Ci 192Ir) and IMBT (18 Ci 169Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors (1 mm, 2 mm, and 3 mm) and rotational errors (5, 10 and 15) on clinically relevant parameters (PTV D90 and urethra D10). Results The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% 4.7%, without change to other plan quality indices (PTV V100, V150, V200, bladder V75, rectum V75, HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors (1 mm, 5), the overall tolerance was textless2%. Conclusions The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.},
note = {_eprint: https://aapm.onlinelibrary.wiley.com/doi/pdf/10.1002/mp.13959},
keywords = {Brachytherapy, IMBT, Monte Carlo, prostate cancer, Yb-169},
pubstate = {published},
tppubtype = {article}
}
Purpose Intensity modulated brachytherapy (IMBT) is a novel high dose rate brachytherapy (HDR BT) technique which incorporates static or dynamic shielding to increase tumor coverage and/or spare healthy tissues. The purpose of this study is to present a novel delivery system (AIM-Brachy) design that can enable dynamic-shield IMBT for prostate cancer. Methods The AIM-Brachy system dynamically controls the rotation of platinum shields, placed within interstitial catheters, which partially collimate the radiation emitted from an 169Yb source. Conventional HDR BT (10 Ci 192Ir) and IMBT (18 Ci 169Yb) plans were generated for 12 patients using an in-house column generation-based optimizer, coupled to a Geant4-based dose calculation engine, RapidBrachyMC. Treatment plans were normalized to match the same PTV D90 coverage as the clinical plan. Intershield attenuation effects were taken into account. A sensitivity analysis was performed to evaluate the dosimetric impact of systematic longitudinal source positioning errors (1 mm, 2 mm, and 3 mm) and rotational errors (5, 10 and 15) on clinically relevant parameters (PTV D90 and urethra D10). Results The platinum shield reduced the dose rate on the shielded side at 1 cm to 18.1% of the dose rate on the unshielded side. For equal PTV D90 coverage, the urethral D10 was reduced by 13.3% 4.7%, without change to other plan quality indices (PTV V100, V150, V200, bladder V75, rectum V75, HI, COIN). Delivery times for HDR BT and IMBT were 9.2 ± 1.6 min and 18.6 ± 4.0 min, respectively. In general, the PTV D90 was more sensitive to source positioning errors than rotational errors, while the urethral D10 was more sensitive to rotational errors than source positioning errors. For a typical range of positioning errors (1 mm, 5), the overall tolerance was textless2%. Conclusions The AIM-Brachy system was proposed to deliver dynamic-shield IMBT for prostate cancer with the potential to create a low dose tunnel within the urethra. The urethra-sparing properties are desirable to minimize the occurrence and severity of urethral strictures or, alternatively, to provide a method for dose escalation.