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Title: SU-F-T-30: Comprehensive Dosimetric Characterization of the Novel Direction Modulation Brachytherapy (DMBT) Tandem Applicator Using Monte Carlo Simulations

Abstract

Purpose: To characterize the dosimetric properties/distributions of the novel proposed direction modulated brachytherapy (DMBT) tandem applicator in combination with 192Ir HDR source, and compare against conventional tandem design, using Monte Carlo simulations. Methods: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy, especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18.0 g/cc, capable of generating directional dose profiles – leading to enhanced dose sculpting capacity through inverse planning. In-water dosimetric parameters for the DMBT and conventional tandems have been calculated for various radial distances away and around the tandems. For the DMBT tandem, the cumulative dose from the 192Ir source occupying 1) one and 2) all six holes in equal dwell times was calculated and normalized to match the dose rate of the open source (in conventional tandem) at 1 cm from the center. This is done to compare and contrast the characteristic dose distributions to that of the isotropic TG43-based 192Ir source. Results: All dose rates were normalized at 1-cm radius from the center of the applicators, containing source(s). The normalized dose rates at 0.5, 3.0, and 5.0-cm radiuses were thenmore » 388, 11.3, and 4.1% for conventional tandem, 657, 8.1, and 2.7% for DMBT tandem with the source in one hole at front entrance, and 436, 10.9, and 3.8% for DMBT tandem with the source in all six holes. For the DMBT tandem case with the source in one hole, the backside transmissions were 47, 2.4, and 0.9%, respectively. Conclusion: The DMBT tandem is able to generate closely similar dosimetric characteristics as that of the single-channel conventional tandem if needed (with the source occupying all six holes), at the same time, generate directional radiation profile(s) for favorably enabling 3D dose sculpting capability.« less

Authors:
; ; ; ;  [1];  [1];  [2]
  1. Deprtment of Medical Physics, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada)
  2. (United States)
Publication Date:
OSTI Identifier:
22642280
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; BRACHYTHERAPY; COMPUTERIZED SIMULATION; DESIGN; DOSE RATES; IMAGES; IRIDIUM 192; MODULATION; MONTE CARLO METHOD; NEOPLASMS; NMR IMAGING; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; TUNGSTEN; TUNGSTEN ALLOYS

Citation Formats

Safigholi, H, Mashouf, S, Soliman, Abraam, Owrangi, A, Song, W Y, Han, D, and Department of Radiation Oncology, University of California San Francisco, San Francisco, CA. SU-F-T-30: Comprehensive Dosimetric Characterization of the Novel Direction Modulation Brachytherapy (DMBT) Tandem Applicator Using Monte Carlo Simulations. United States: N. p., 2016. Web. doi:10.1118/1.4956165.
Safigholi, H, Mashouf, S, Soliman, Abraam, Owrangi, A, Song, W Y, Han, D, & Department of Radiation Oncology, University of California San Francisco, San Francisco, CA. SU-F-T-30: Comprehensive Dosimetric Characterization of the Novel Direction Modulation Brachytherapy (DMBT) Tandem Applicator Using Monte Carlo Simulations. United States. doi:10.1118/1.4956165.
Safigholi, H, Mashouf, S, Soliman, Abraam, Owrangi, A, Song, W Y, Han, D, and Department of Radiation Oncology, University of California San Francisco, San Francisco, CA. 2016. "SU-F-T-30: Comprehensive Dosimetric Characterization of the Novel Direction Modulation Brachytherapy (DMBT) Tandem Applicator Using Monte Carlo Simulations". United States. doi:10.1118/1.4956165.
@article{osti_22642280,
title = {SU-F-T-30: Comprehensive Dosimetric Characterization of the Novel Direction Modulation Brachytherapy (DMBT) Tandem Applicator Using Monte Carlo Simulations},
author = {Safigholi, H and Mashouf, S and Soliman, Abraam and Owrangi, A and Song, W Y and Han, D and Department of Radiation Oncology, University of California San Francisco, San Francisco, CA},
abstractNote = {Purpose: To characterize the dosimetric properties/distributions of the novel proposed direction modulated brachytherapy (DMBT) tandem applicator in combination with 192Ir HDR source, and compare against conventional tandem design, using Monte Carlo simulations. Methods: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy, especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18.0 g/cc, capable of generating directional dose profiles – leading to enhanced dose sculpting capacity through inverse planning. In-water dosimetric parameters for the DMBT and conventional tandems have been calculated for various radial distances away and around the tandems. For the DMBT tandem, the cumulative dose from the 192Ir source occupying 1) one and 2) all six holes in equal dwell times was calculated and normalized to match the dose rate of the open source (in conventional tandem) at 1 cm from the center. This is done to compare and contrast the characteristic dose distributions to that of the isotropic TG43-based 192Ir source. Results: All dose rates were normalized at 1-cm radius from the center of the applicators, containing source(s). The normalized dose rates at 0.5, 3.0, and 5.0-cm radiuses were then 388, 11.3, and 4.1% for conventional tandem, 657, 8.1, and 2.7% for DMBT tandem with the source in one hole at front entrance, and 436, 10.9, and 3.8% for DMBT tandem with the source in all six holes. For the DMBT tandem case with the source in one hole, the backside transmissions were 47, 2.4, and 0.9%, respectively. Conclusion: The DMBT tandem is able to generate closely similar dosimetric characteristics as that of the single-channel conventional tandem if needed (with the source occupying all six holes), at the same time, generate directional radiation profile(s) for favorably enabling 3D dose sculpting capability.},
doi = {10.1118/1.4956165},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To maximize the dose to HRCTV while minimizing dose to the OARs, the combination of two HDR brachytherapy sources, 192-Ir and 169-Yb, used in combination with the recently-proposed novel direction modulated brachytherapy (DMBT) tandem applicator were examined. Methods: The DMBT tandem, made from nonmagnetic tungsten-alloy rod, with diameter of 5.4mm, has 6 symmetric peripheral holes of 1.3mm diameter. The 0.3mm thick bio-compatible plastic tubing wraps the tandem. MCNPX v.2.6 was used to simulate the mHDR 192-Ir V2 and 4140 HDR 169-Yb sources inside the DMBT applicator. Thought was by combining the higher energy 192-Ir (380keV) and lower energy 169-Ybmore » (92.7keV) sources could create unprecedented level of dose conformality when combined with the high-degree intensity modulation capable DMBT tandem applicator. 3D dose matrices, with 1 mm3 resolution, were imported into an in-house-coded inverse optimization planning system to evaluate plan quality of 19 clinical patient cases. Prescription dose was 15Gy. All plans were normalized to receive the same HRCTV D90. Results: Generally, the use of dual sources produced better plans than using either of the sources alone, with significantly better performance in some patients. The mean D2cc for bladder, rectum, and sigmoid were 11.65±2.30Gy, 7.47±3.05Gy, and 9.84±2.48Gy for 192-Ir-only, respectively. For 169 -Yb-only, they were 11.67±2.26Gy, 7.44±3.02Gy, and 9.83±2.38Gy, respectively. The corresponding data for the dual sources were 11.51±2.24Gy, 7.30±3.00Gy, and 9.68 ±2.39Gy, respectively. The HRCTV D98 and V100 were 16.37±1.86Gy and 97.37±1.92Gy for Ir-192-only, respectively. For 169-Yb-only, they were 16.43±1.86Gy, and 97.51±1.91Gy, respectively. For the dual source, they were 16.42±1.87Gy and 97.47±1.93Gy, respectively. Conclusion: The plan quality improves, in some cases quite significantly, for when dual 192-Ir and 169-Yb sources are used in combination with highly intensity modulation capable DMBT tandem applicator for image guided cervical cancer brachytherapy.« less
  • Purpose: To examine CT metal image artifact from a novel direction-modulated brachytherapy (DMBT) tandem applicator (95% tungsten) for cervical cancer using a commercially available orthopedic metal artifact reduction (O-MAR) algorithm. Comparison to a conventional stainless steel applicator is also performed. Methods: Each applicator was placed in a water-filled phantom resembling the female pelvis and scanned in a Philips Brilliance 16-slice CT scanner using two pelvis protocols: a typical clinical protocol (120kVp, 16×0.75mm collimation, 0.692 pitch, 1.0s rotation, 350mm field of view (FOV), 600mAs, 1.5mm slices) and a protocol with a higher kVp and mAs setting useful for larger patients (140kVp,more » 16×0.75mm collimation, 0.688 pitch, 1.5s rotation, 350mm FOV, 870mAs, 1.5mm slices). Images of each tandem were acquired with and without the application of the O-MAR algorithm. Baseline scans of the phantom (no applicator) were also collected. CT numbers were quantified at distances from 5 to 30 mm away from the applicator’s edge (in increments of 5mm) using measurements at eight angles around the applicator, on three consecutive slices. Results: While the presence of both applicators degraded image quality, the DMBT applicator resulted in larger streaking artifacts and dark areas in the image compared to the stainless steel applicator. Application of the O-MAR algorithm improved all acquired images, both visually and quantitatively. The use of low and high kVp and mAs settings (120 kVp/600mAs and 140 kVp/870mAs) in conjunction with the O-MAR algorithm lead to similar CT numbers in the vicinity of the applicator and a similar reduction of the induced metal artifact. Conclusion: This work indicated that metal artifacts induced by the DMBT and the stainless steel applicator are greatly reduced when using the O-MAR algorithm, leading to better quality phantom images. The use of a high dose protocol provided similar improvements in metal artifacts compared to the clinical protocol.« less
  • Purpose: To explore and quantify the upper limits in dose sculpting capacity of the novel direction modulated brachytherapy (DMBT) tandem applicator compared with conventional tandem design for {sup 192}Ir-based HDR planning. Methods: The proposed DMBT tandem applicator is designed for image-guided adaptive brachytherapy (IGABT), especially MRI, of cervical cancer. It has 6 peripheral holes of 1.3-mm width, grooved along a 5.4-mm diameter nonmagnetic tungsten alloy rod of density 18.0 g/cc, capable of generating directional dose profiles – leading to enhanced dose sculpting capacity through inverse planning. The external dimensions are identical to that of conventional tandem design to ensure clinicalmore » compatibility. To explore the expansive dose sculpting capacity, we constructed a hypothetical circular target with 20-mm radius and positioned the DMBT and conventional tandems at the center. We then incrementally shifted the positions laterally away from the center of up to 15 mm, at 1-mm steps. The in-house coded gradient projection-based inverse planning system was then used to generate inverse optimized plans ensuring identical V100=100% coverage. Conformity index (CI) was calculated for all plans. Results: Overall, the DMBT tandem generates more conformal dose distributions than conventional tandem for all lateral positional shifts of 0-15 mm (CI=0.91–0.52 and 0.99–0.34, respectively), with an exception at the central position due to the ideal circular dose distribution, generated by the {sup 192}Ir, fitting tightly around the circular target (CI = 0.91 and 0.99, respectively). The DMBT tandem is able to generate dose conformity of CI>0.8 at up to 6-mm positional shift while the conventional tandem violates this past 2-mm shift. Also, the CI ratio (=DMBT/conv.) increases rapidly until about 8 mm and then stabilizes beyond. Conclusion: A substantial enhancement in the dose sculpting capacity has been demonstrated for the novel DMBT tandem applicator. While further studies are warranted, the concept is promising for potential clinical translation.« less
  • Purpose: To demonstrate that utilization of a novel, intensity modulation capable, direction modulated brachytherapy (DMBT) tandem applicator can improve plan quality compared with conventional T&R applicator during an image guided cervical cancer brachytherapy. Methods: 45 cervical cancer patients treated with PDR brachytherapy were reviewed. Of them, a) 27 were treated using T&R only, b) 9 were treated using T&R with needles attached to the ring, and c) the remaining 9 were treated using T&R with needles attached to the ring (AN) as well as additional free-hand-loaded needles (FN). The DMBT tandem design has 6 peripheral holes of 1.3-mm diameter, groovedmore » along a nonmagnetic tungsten alloy rod, enclosed in a plastic sheath with total 6.0-mm diameter. An in-house-coded inverse planning system was used for planning DMBT and T&R cases. All typical clinical constraints including OAR dose limits, dwell times, and loading patterns were respected. For the DMBT and T&R applicators, the plans were optimized with the same conventional ring in place, but repeatedly planned with and without AN/FN needles. All generated plans were normalized to the same D90 of the clinically treated plans. Results: For the plans in category a), DMBT generally outperformed T&R with average reduction in D2cc of −2.39%, −5.21%, and −2.69% for bladder, rectum, and sigmoid, respectively. For the plans in category b) and c), DMBT generally outperformed T&R if the same needles in AN/FN were utilized in both cases with average reduction in D2cc of −1.82%, −3.40%, and −6.04%, respectively. For the cases where the needles were not utilized for both applicators, an average D2cc reduction of −7.45%, −7.61%, and 17.47% were observed, respectively. Conclusions: Under the same clinical conditions, with/without needles, the DMBT applicator tends to generate more favorable plans compared with the conventional T&R applicator, and hence, is a promising technology.« less
  • Purpose: To evaluate various shielding materials such as Gold (Au), Osmium (Os), Tantalum (Ta), and Tungsten (W) based alloys for use with a novel intensity modulation capable direction modulated brachytherapy (DMBT) tandem applicator for image guided cervical cancer HDR brachytherapy. Methods: The novel MRI-compatible DMBT tandem, made from nonmagnetic tungsten-alloy rod with diameter of 5.4 mm, has 6 symmetric peripheral holes of 1.3 mm diameter with 2.05 mm distance from the center for a high degree intensity modulation capacity. The 0.3 mm thickness of bio-compatible plastic tubing wraps the tandem. MCNPX was used for Monte Carlo simulations of the shieldsmore » and the mHDR Ir-192 V2 source. MC-generated 3D dose matrices of different shielding materials of Au, Os, Ta, and W with 1 mm3 resolution were imported into an in-house-coded inverse optimization planning system to evaluate 19 clinical patient plans. Prescription dose was 15Gy. All plans were normalized to receive the same HRCTV D90. Results: In general, the plan qualities for various shielding materials were similar. The OAR D2cc for bladder was very similar for Au, Os, and Ta with 11.64±2.30Gy. For W, it was very close 11.65±2.30Gy. The sigmoid D2cc was 9.82±2.46Gy for Au and Os while it was 9.84±2.48Gy for Ta and W. The rectum D2cc was 7.44±3.06Gy for Au, 7.43±3.07Gy for Os, 7.48±3.05Gy for Ta, and 7.47±3.05Gy for W. The HRCTV D98 and V100 were very close with 16.37±1.87 Gy and 97.37±1.93 Gy, on average, respectively. Conclusion: Various MRI-compatible shielding alloys were investigated for the DMBT tandem applicator. The clinical plan qualities were not significantly different among these various alloys, however. Therefore, the candidate metals (or in combination) can be used to select best alloys for MRI image guided cervical cancer brachytherapy using the novel DMBT applicator that is capable of unprecedented level of intensity modulation.« less