Validation of HDR brachytherapy doses in the treatment of keloid scars using the egs_brachy Monte Carlo application.

Objective. Radiotherapy is a well-known alternative in the treatment of keloid scars to reduce the recurrence of scars. The purpose of this study was to investigate the feasibility and accuracy of dose delivered from a high-dose-rate (HDR) afterloaders in keloid scar brachytherapy using Monte Carlo (MC) simulations and measurements.Approach. Treatment doses and central axis dose profiles were measured using radiophotoluminescence dosimeters and radiochromic films, respectively, with two HDR afterloaders, both using an Ir-192 source, in a phantom made of solid water and polycarbonate sheets. The nominal treatment dose calculated by the AAPM Task Group No. 43 (TG-43) dose model was set to 8.5 Gy at a distance of 0.5 cm laterally from the middle of the source line located in a plastic applicator simulating a 15 cm long surgically removed scar treatment with 30 equally spaced (0.5 cm) source positions. The dose profiles were measured at three different distances from the applicator and the absolute doses at four points at different distances. MC simulations were performed using the egs_brachy, which is based on EGSnrc code system.Main results. The measured and simulated dose profiles match well, especially at 10.0 mm (difference <1%) and 15.0 mm depths (difference <4%), and with a small dose difference at 5.0 mm depth (difference <4%). Point dose measurements agreed well in the dose maximum area (difference <7%) with the simulated dose profiles, although the largest difference near the edge of the profile was <30%. The dose differences between the TG-43 dose model and the MC simulation were small (differences <4%).Significance. Simulated and measured dose levels at a depth of 0.5 cm showed that the nominal treatment dose can be achieved with the utilized setup. The measurement results of the absolute dose agree well with the corresponding simulation results.

Monte Carlo investigation on the effect of air gap under bolus in post-mastectomy radiotherapy.

OBJECTIVES: To investigate the dosimetric effect of air gaps under bolus on skin dose for left-sided post-mastectomy radiotherapy with loco regional involvement. METHODS: Eight patients were planned retrospectively with volume modulated arc therapy (VMAT) and conventional static Field-in-Field (FinF) methods. Three different setups were applied for the 5-mm bolus over the chest wall having 0, 5 or 10 mm air gap under the bolus. The dose calculation was performed using Monte Carlo (MC) simulation. In addition, Analytic Anisotropic Algorithm (AAA) was used to demonstrate the differences observed in clinical setting. RESULTS: The investigated air gaps under the bolus had minimal effect on surface dose for FinF plans (relative difference ≤ 2.6%), whereas for VMAT plans the surface dose decreased 13.6% when compared to the case with no air gap. In both FinF and VMAT, the largest differences between AAA and MC were seen at the surface where AAA underestimated the dose by 1.5 Gy (p < 0.05) on average; while the dose in the target volume excluding the surface was relatively similar being on average 0.3 Gy (p > 0.05) larger with AAA than with MC calculations. CONCLUSIONS: The surface dose was significantly lower with VMAT technique than with FinF technique. Possible air gaps under the bolus reduced the surface dose significantly further for VMAT but not for FinF treatments, which may have clinical impact on recurrence rate. AAA was shown to underestimate the surface dose when compared to MC calculation.

The validity of Acuros BV and TG-43 for high-dose-rate brachytherapy superficial mold treatments.

PURPOSE: The purpose of this work is to validate the Acuros BV dose calculation algorithm for high-dose-rate (HDR) brachytherapy superficial mold treatments in the absence of full scatter conditions and compare this with TG-43 dose calculations. We also investigate the impact of additional back scatter material (bolus) applied above surface molds to the dose distributions under the mold. METHODS AND MATERIALS: The absorbed dose at various depths was compared for simulations performed using either TG-43 or Acuros BV dose calculations. Parameter variations included treatment area, thickness of the bolus, and surface shape (flat or spherical). Film measurements were carried out in a flat phantom. RESULTS: Acuros BV calculations and film measurements agreed within 1.5% but were up to 15% lower than TG-43 dose calculations when no bolus was applied above the treatment catheters. The difference in dose at the prescription depth (1 cm below the central catheter) increased with increasing treatment area: 3.3% difference for a 3 × 3.5 cm2 source loading area, 7.4% for 8 × 9 cm2, and 13.4% for 18 × 19 cm2. The dose overestimation of the TG-43 model decreased when bolus was added above the treatment catheters. CONCLUSIONS: The TG-43 dosimetry formalism cannot model surface mold treatments in the absence of full scatter conditions within 5% for loading areas larger than approximately 5 × 5 cm2. The TG-43 model results in an overestimation of the delivered dose, which increases with treatment area. This confirms the need for model-based dose calculation algorithms as discussed in TG-186.