Evaluation of brachytherapy lung implant dose distributions from photon-emitting sources due to tissue heterogeneities

Journal Article · Tue Nov 15 00:00:00 EST 2011 · Medical Physics

DOI:https://doi.org/10.1118/1.3641872· OSTI ID:22098659

Yun, Yang; Rivard, Mark J. ^[1]

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1. Tufts University School of Medicine, Boston, Massachusetts 02111 (United States)

Purpose: Photon-emitting brachytherapy sources are used for permanent implantation to treat lung cancer. However, the current brachytherapy dose calculation formalism assumes a homogeneous water medium without considering the influence of radiation scatter or tissue heterogeneities. The purpose of this study was to determine the dosimetric effects of tissue heterogeneities for permanent lung brachytherapy. Methods: The MCNP5 v1.40 radiation transport code was used for Monte Carlo (MC) simulations. Point sources with energies of 0.02, 0.03, 0.05, 0.1, 0.2, and 0.4 MeV were simulated to cover the range of pertinent brachytherapy energies and to glean dosimetric trends independent of specific radionuclide emissions. Source positions from postimplant CT scans of five patient implants were used for source coordinates, with dose normalized to 200 Gy at the center of each implant. With the presence of fibrosis (around the implant), cortical bone, lung, and healthy tissues, dose distributions and {sub PTV}DVH were calculated using the MCNP *FMESH4 tally and the NIST mass-energy absorption coefficients. This process was repeated upon replacing all tissues with water. For all photon energies, 10{sup 9} histories were simulated to achieve statistical errors (k = 1) typically of 1%. Results: The mean PTV doses calculated using tissue heterogeneities for all five patients changed (compared to dose to water) by only a few percent over the examined photon energy range, as did PTV dose at the implant center. The {sub PTV}V{sub 100} values were 81.2%, 90.0% (as normalized), 94.3%, 93.9%, 92.7%, and 92.2% for 0.02, 0.03, 0.05, 0.1, 0.2, and 0.4 MeV source photons, respectively. Relative to water, the maximum bone doses were higher by factors of 3.7, 5.1, 5.2, 2.4, 1.2, and 1.0 The maximum lung doses were about 0.98, 0.94, 0.91, 0.94, 0.97, and 0.99. Relative to water, the maximum healthy tissue doses at the mediastinal position were higher by factors of 9.8, 2.2, 1.3, 1.1, 1.1, and 1.1. However, the maximum doses to these healthy tissues were only 3.1, 7.2, 11.3, 10.9, 9.0, and 8.1 Gy while maximum bone doses were 66, 177, 236, 106, 49, and 39 Gy, respectively. Similarly, maximum lung doses were 55, 66, 73, 74, 73, and 73 Gy, respectively. Conclusions: The current brachytherapy dose calculation formalism overestimates PTV dose and significantly underestimates doses to bone and healthy tissue. Further investigation using specific brachytherapy source models and patient-based CT datasets as MC input may indicate whether the observed trends can be generalized for low-energy lung brachytherapy dosimetry.

• OSTI ID: 22098659
• Journal Information: Medical Physics, Vol. 38, Issue 11; Other Information: (c) 2011 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA); ISSN 0094-2405
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
61 RADIATION PROTECTION AND DOSIMETRY
BRACHYTHERAPY
CAT SCANNING
DOSIMETRY
EMISSION
ENERGY ABSORPTION
FIBROSIS
IMPLANTS
KEV RANGE
LUNGS
MONTE CARLO METHOD
NEOPLASMS
PATIENTS
PHOTONS
POINT SOURCES
RADIATION DOSE DISTRIBUTIONS
RADIATION DOSES
RADIATION TRANSPORT
SIMULATION
SKELETON