Design and evaluation of a HDR skin applicator with flattening filter.

The purposes of this study are: (i) to design field flattening filters for the Leipzig applicators of 2 and 3 cm of inner diameter with the source traveling parallel to the applicator contact surface, which are accessories of the microSelectron-HDR afterloader (Nucletron, Veenendaal, The Netherlands). These filters, made of tungsten, aim to flatten the heterogeneous dose distribution obtained with the Leipzig applicators. (ii) To estimate the dose rate distributions for these Leipzig+filter applicators by means of the Monte Carlo (MC) method. (iii) To experimentally verify these distributions for prototypes of these new applicators, and (iv) to obtain the correspondence factors to measure the output of the applicators by the user using an insert into a well chamber. The MC GEANT4 code has been used to design the filters and to obtain the dose rate distributions in liquid water for the two Leipzig+filter applicators. In order to validate this specific application and to guarantee that realistic source-applicator geometry has been considered, an experimental verification procedure was implemented in this study, in accordance with the updated recommendations of the American Association of Physicists in Medicine Task Group No. 43 U1 Report. Thermoluminescent dosimeters, radiochromic film, and a pin-point ionization chamber in a plastic [polymethylmethacrylate (PMMA)] phantom were used to verify the MC results for the two applicators of a microSelectron-HDR afterloader with the mHDR-v2 source. To verify the output of the Leipzig +filter applicators, correspondence factors were deduced for the well chambers HDR100-plus (Standard Imaging, Inc., Middleton, WI) and TM33004 (PTW, Freiburg, Germany) using a specific insert for both applicators. The doses measured in the PMMA phantom agree within experimental uncertainties with the dose obtained by the MC calculations. Percentage depth dose and off-axis profiles were obtained normalized at a depth of 3 mm along the central applicator axis in a cylindrical 20 x 20 cm water phantom. A table of output factors, normalized to 1 U of source air kerma strength at this depth, is presented. Correspondence factors were obtained for the two well chambers considered. The matrix data obtained in the MC simulation with a grid separation of 0.5 mm has been used to build a data set in a convenient format to model these distributions for routine use with a brachytherapy treatment planning system.

Partial placenta increta and methotrexate therapy: three case reports.

The term placenta accreta is used to describe any placental implantation in which there is abnormally firm adherence to the uterine wall. This condition complicates 1/2,500 deliveries and is rising in incidence. Abnormal placentation is associated with increased maternal morbidity and mortality from severe hemorrhage, uterine perforation, infection and loss of fertility. The reported experience of methotrexate treatment in the conservative management of placenta accreta is scant. Three cases of partial placenta increta managed with methotrexate are described. The patients were assessed with clinical surveillance, serum beta human chorionic gonadotrophin (beta-hCG) and imaging (ultrasonography and magnetic resonance in one case). In all cases conservative management with methotrexate resulted in undetectable serum beta-hCG, a decrease in the size of partial placenta retained, and undetectable vascularization.

A dosimetric study on the Ir-192 high dose rate flexisource.

In this work, the dose rate distribution of a new Ir-192 high dose rate source (Flexisource used in the afterloading Flexitron system, Isodose Control, Veenendaal, The Netherlands) is studied by means of Monte Carlo techniques using the GEANT4 code. The dosimetric parameters of the Task Group No. 43 Report (TG43) formalism and two-dimensional rectangular look-up tables have been obtained.

Use of chitosan for selective removal of beta-lactoglobulin from whey.

A method is described for selective removal of undenatured beta-lactoglobulin from cheese whey based on interactions between whey proteins and chitosan. Whey was previously clarified at pH 4.5 with addition of chitosan (25 mg/100 mL), and selective removal of beta-lactoglobulin was studied in the pH interval 4.6 to 6.5. Addition of chitosan caused selective precipitation of beta-lactoglobulin that increased with pH. The content of beta-lactoglobulin in whey decreased as the amount of chitosan added was increased. At pH 6.2, addition of 1.9 to 3.0 mg/mL of chitosan led to complete removal of beta-lactoglobulin, whereas at least 80% of the rest of whey proteins remained in solution. The production of cheese whey without beta-lactoglobulin could help to expand the applications of dairy by-products in food processing, and to isolate hypoallergenic whey protein concentrates.

Monte Carlo and experimental derivation of TG43 dosimetric parameters for CSM-type Cs-137 sources.

In this study, complete dosimetric datasets for the CSM2 and CSM3 Cs-137 sources were obtained using the Monte Carlo GEANT4 code. The application of this calculation method was experimentally validated with thermoluminescent dosimetry (TLD). Functions and parameters following the TG43 formalism are presented: the dose rate constant, the radial dose functional, and the anisotropy function. In addition, to aid the quality control process on treatment planning systems, a two-dimensional (2D) rectangular dose rate table (the traditional along-away table), coherent with the TG43 dose calculation formalism, is given. The data given in this study complement existing information for both sources on the following aspects: (i) the source asymmetries were considered explicitly in the Monte Carlo calculations, (ii) TG43 data were derived directly from Monte Carlo calculations, (iii) the radial range of the different tables was increased as well as the angular resolution in the anisotropy function, including angles close to the longitudinal source axis. The CSM2 source TG-43 data of Liu et al. [Med. Phys. 31, 477-483 (2004)] are not consistent with the Williamson 2D along-away data [Int. J. Radiat. Oncol., Biol., Phys. 15, 227-237 (1988)] at distances closer than approximately 2 cm from the source. The data presented here for this source are consistent with this 2D along-away table, and are suitable for use in clinical practice.

Technical note: Monte Carlo derivation of TG-43 dosimetric parameters for radiation therapy resources and 3M Cs-137 sources.

In clinical brachytherapy dosimetry, a detailed dose rate distribution of the radioactive source in water is needed in order to plan for quality treatment. Two Cs-137 sources are considered in this study; the Radiation Therapy Resources 67-800 source (Radiation Therapy Resources Inc., Valencia, CA) and the 3M model 6500/6D6C source. A complete dosimetric dataset for both sources has been obtained by means of the Monte Carlo GEANT4 code. Dose rate distributions are presented in two different ways; following the TG43 formalism and in a 2D rectangular dose rate table. This 2D dose rate table is helpful for the TPS quality control and is fully consistent with the TG43 dose calculation formalism. In this work, several improvements to the previously published data for these sources have been included: the source asymmetries were taken explicitly into account in the MC calculations, TG43 data were derived directly from MC calculations, the data radial range was increased, the angular grid in the anisotropy function was increased, and TG43 data is now consistent with the along and away dose rate table as recommended by the TG43 update.

Monte Carlo dosimetric study of the BEBIG Co-60 HDR source.

Although not as widespread as Ir-192, Co-60 is also available on afterloading equipment devoted to high dose rate brachytherapy, mainly addressed to the treatment of gynaecological lesions. The purpose of this study is to obtain the dosimetric parameters of the Co-60 source used by the BEBIG MultiSource remote afterloader (BEBIG GmbH, Germany) for which there are no dosimetric data available in the literature. The Monte Carlo code GEANT4 has been used to obtain the TG43 parameters and the 2D dose rate table in Cartesian coordinates of the BEBIG Co-60 HDR source. The dose rate constant, radial dose function and anisotropy function have been calculated and are presented in a tabular form as well as a detailed 2D dose rate table in Cartesian coordinates. These dosimetric datasets can be used as input data and to validate the treatment planning system calculations.

Selective recovery of glycosylated caseinmacropeptide with chitosan.

The use of chitosan, a partially deacetylated chitin, to fractionate aqueous solutions of caseinmacropeptides (CMPs) was studied. The polycationic character of chitosan at acidic pH values allows the formation of complexes with negatively charged CMP molecules, inducing their flocculation. Glycosylated CMP (GMP) has higher affinity for chitosan than nonglycosylated forms (NGMP). The carboxylic groups in the carbohydrate moiety of the GMP increase the negative charge of the molecule and may play a role in the selective precipitation. At pH 5.0, 0.08 mg/mL of chitosan completely removed the GMP whereas 70% of NGMP remained in solution. As the pH increased, the amount of chitosan to ensure complete removal of GMP increased up to 0.19 and 0.34 mg/mL for pH 6.0 and 6.6, respectively.

Monitoring unidirectional carbon/carbon composite processing by light microscopy.

Unidirectional carbon/carbon composites were prepared using polyacrylonitrile-based carbon fibres and a commercial coal-tar pitch. The preparation includes a three-sequential-step process: (i) prepreging, (ii) moulding/pressing, and (iii) carbonization to 1000 degrees C. The effect of the process parameters including pressure, mould characteristics, and temperature and duration of pressure application on the microstructure of composites was monitored by light microscopy. Results show that the application of a pressure of 1 MPa close to the temperature of pitch solidification produces lower porosity composites. This porosity is significantly reduced when the solidification of the pitch is tempered by the introduction of a soak time of 10 h at the temperature at which pressure is applied.

Oxidative stabilization of C/C tow pregs studied by light microscopy

Tow pregs obtained from polyacrylonitrile-based carbon fibres and a commercial binder coal-tar pitch were stabilized by oxidation at 548, 588 and 623 K for periods ranging between 1 and 15 h. The microstructural changes involved in the stabilization of tow pregs on the carbonized laminates were studied by light microscopy. Under the conditions studied, the oxidative stabilization of tow pregs produced a significant increase in carbon yield. At the same time, the development of porosity on carbonization was avoided and the size of the optical texture was reduced. However, the extreme oxidation of pitch components at the edges of the carbonized laminate adversely affected pitch binding capability and the sinterizability of the laminates.

Monte Carlo dosimetric study of best industries and Alpha Omega Ir-192 brachytherapy seeds.

Ir-192 seeds are widely used in the USA for low dose rate interstitial brachytherapy. There are two commercially available models: those manufactured by Best Industries filtered with stainless steel, and those manufactured by Alpha-Omega seeds filtered with Pt. Newly developed 3D correction algorithms for brachytherapy are based on dosimetry data obtained on unbounded phantom size, allowing corrections for heterogeneities and actual tissue boundaries. Published dosimetric datasets for both seeds have been obtained under bounded conditions. The aim of the present study is to obtain dosimetric datasets for these seeds under full scatter conditions. The Monte Carlo GEANT4 code has been used to estimate air-kerma strength and dose rate in water around the Ir-192 seeds. Functions and parameters following the TG43 formalism are obtained and presented in tabular forms: the dose rate constant, the radial dose function, and the anisotropy function. Tables for the anisotropy factor have been obtained in order to apply punctual approximation. Differences between dose rate distributions for both seeds show that specific dataset must be used for each type of seed in clinical dosimetry. The data in the present study improve on published data in the following aspects: (i) dosimetric data were obtained under full scatter conditions, which affect dose values at distances greater than 4-5 cm from the source; (ii) the dose rate tables are given at greater distances from the source; and (iii) the spatial resolution in high dose gradient areas, such as those near the longitudinal source axis, has been improved.

Monte Carlo dosimetric characterization of the Cs-137 selectron/LDR source: evaluation of applicator attenuation and superposition approximation effects.

The purpose of this study is to calculate the dose rate distribution for the Amersham Cs-137 pellet source used in brachytherapy with the Selectron low-dose-rate remote afterloading system in gynaecological applications using the Monte Carlo code GEANT4. The absolute dose rate distribution for the pellet source was obtained and presented as a one-dimensional absolute dose rate table as well as in the Task Group 43 dose-calculation formalism. In this study, excellent agreement was found between the point source theoretical model using fitted polynomial values and Monte Carlo calculations of the dose rate distribution for the pellet source. A comparison study was also made between the dose rate distribution obtained from a complete Monte Carlo simulation (Cs-137 pellet sources + remote afterloading system plastic guide tube + gynaecological applicator) and that calculated by applying the superposition principle to Monte Carlo data of the individual pellet sources. The data were obtained for a portion of uterine tandem of typical train source configurations. Significant differences with a strong dependence on polar angle have been found that must be kept in mind for clinical dosimetry.

Monte Carlo calculations of dose rate distributions around the Amersham CDCS-M-type 137Cs source.

The Amersham CDCS-M-type 137Cs stainless-steel encapsulated source is widely used in low dose rate brachytherapy with manual afterloading. However there is a need for more accurate dosimetry data. In this study we present Monte Carlo calculations of absolute dose rate in water around this source using the Monte Carlo code GEANT, discuss dosimetric features of these data, and compare them with Krishnaswamy's results for 137Cs intracavitary sources. Dose rate distributions are presented in the form of along-away tables and in the TG43 formalism. Simulated absolute dose rate values can be used as benchmark data to verify the treatment planning system calculation results or directly as input data for treatment planning. Best-fit values of attenuation coefficients suitable for use in Sievert integral type calculations have been derived comparing dose rate distributions calculated using this algorithm with those obtained from Monte Carlo calculations.

Dosimetric study of the 15 mm ROPES eye plaque.

The main aim of this paper is to make a study of dose-rate distributions obtained around the 15 mm, radiation oncology physics and engineering services, Australia (ROPES) eye plaque loaded with 125I model 6711 radioactive seeds. In this study, we have carried out a comparison of the dose-rate distributions obtained by the algorithm used by the Plaque Simulator (PS) (BEBIG GmbH, Berlin, Germany) treatment planning system with those obtained by means of the Monte Carlo method for the ROPES eye plaque. A simple method to obtain the dose-rate distributions in a treatment planning system via the superposition of the dose-rate distributions of a seed placed in the eye plaque has been developed. The method uses eye plaque located in a simplified geometry of the head anatomy and distributions obtained by means of the Monte Carlo code GEANT4. The favorable results obtained in the development of this method suggest that it could be implemented on a treatment planning system to improve dose-rate calculations. We have also found that the dose-rate falls sharply along the eye and that outside the eye the dose-rate is very low. Furthermore, the lack of backscatter photons from the air located outside the eye-head phantom produces a dose reduction negligible for distances from the eye-plaque r<1 cm but reaches up to 20% near the air-eye interface. Results showed that the treatment planning system lacks accuracy around the border of the eye (in the sclera and the surrounding area) due to the simplicity of the algorithm used. The BEBIG treatment planning system uses a global attenuation factor that takes into account the effect of the eye plaque seed carrier and the lack of backscatter photons caused by the metallic cover, which in the case of a ROPES eye plaque has a default value of T= 1 (no correction). In the present study, a global attenuation factor T=0.96 and an air-interface correction factor which improve on treatment planning system calculations were obtained.

A Monte Carlo investigation of the dosimetric characteristics of the CSM11 137Cs source from CIS.

The purpose of this study is to calculate basic dosimetry data for a CSM11 low dose rate 137Cs source in water. This source is widely used in afterloadable dome cylinders designed to homogeneously irradiate the vaginal cuff alone or additional areas of the vagina in hysterectomized patients. In this study, the Monte Carlo simulation code GEANT, incorporating in detail source geometry, is used to investigate the dosimetric characteristics of the source. The calculated data were analyzed using a fitting procedure that is described in detail. Absolute dose rate distributions in water were calculated around this source and are presented as conventional 2D Cartesian lookup tables (classically along-away tables). Also, the dose calculation formalism endorsed by the Interstitial Collaborative Working Group and the AAPM Task Group 43 have been calculated. The calculated dose rate constant for this source is lambda = 1.096 +/- 0.002 cGy h(-1) U(-1). The anisotropy function results in about 50% deviations from isotropy at positions near the long axis of the source. The radial dose function is given as a polynomial that reproduces the calculated data up to 20 cm. Best-fit values of attenuation coefficients suitable for use in Sievert integral calculations have been derived.

Technical note: Monte-Carlo dosimetry of the HDR 12i and Plus 192Ir sources.

In this study a complete set of dosimetric data for the GammaMed high dose rate (HDR) 12i and Plus 192Ir sources are presented. These data have been calculated by means of the Monte Carlo simulation code GEANT3. Absolute dose rate distributions in water are presented as conventional two dimensional (2D) Cartesian look-up tables, and in the TG43 formalism.

Dosimetric characteristics of the CDC-type miniature cylindrical 137Cs brachytherapy sources.

The low dose rate CDC-type miniature cylindrical 137Cs sources are available, with one or three active beads, for use in source trains in automatic and manual afterloading systems for gynecological brachytherapy. Absolute dose rate distributions in water have been calculated around these sources using the Monte Carlo GEANT3 code and they are presented as conventional two-dimensional Cartesian lookup tables. The AAPM Task Group 43 formalism for dose calculation has been also applied. The dose rate constant obtained for the one bead source is lambda = 1.113 +/- 0.003cGyh(-1) U(-1), and the value for the three bead source is A= 1.103 +/- 0.003cGyh(-1) U(-1). Finally, for the treatment planning systems based on Sievert-type algorithms, the attenuation coefficients that best reproduce Monte Carlo dose rate distribution are given.

Fitted dosimetric parameters of high dose-rate 192Ir sources according to the AAPM TG43 formalism.

The purpose of this study is to find fitted functional forms to the anisotropy function, F(r, theta), and the radial dose function, g(r), in order to characterize dose-rate distributions around all the high-intensity 192Ir sources currently in use. Dosimetry data are at present available as tables for: the microSelectron HDR ("classic" and "new" design models), the PDR source, and the VariSource HDR source, expressed in terms of the AAPM Task Group No. 43 recommendations. There is only one paper out which introduces a functional form to fit the anisotropy function, but only for symmetric sources with respect to the transverse axis. However, dosimetric data of the HDR and PDR sources mentioned above cannot be reproduced with these functional forms. In our study F(r,theta) and g(r) published data are fitted with functional forms in such a way that appropriate limits are reached for both functions and the maximum fit error approaches the data uncertainty. The average fit error is less than 1% in all cases. These functional forms make handling data easier within the treatment planning system, avoiding the use of tabulated data.

Dosimetric characteristics of backscattered electrons in lead.

In electron beam therapy, tissue overdose due to electrons backscattered from lead has been profusely studied. To quantify this dose enhancement effect, an electron backscatter factor (EBF) was defined as the ratio of dose at the tissue-inhomogeneity interface with and without the scatterer present. The dependence of the EBF on energy at the scatterer surface is not well known for energies lower than 3 MeV which is the most frequent clinical situation. In this work, we have done Monte Carlo calculations with the GEANT code to study EBF in lead at this energy range. The applicability of this code and the developed procedure for dose estimation has been experimentally verified. The dependence of the EBF on the beam energy incident on the scatterer has been studied for different nominal beam energies incident at the phantom's surface. The results show a trend of increase of EBF with the beam energy incident on the scatterer between 0.5 and 1.5 MeV, keeping practically constant above this energy up to 3 MeV. Backscattered electron energy spectra and depth dose curves in the 'up-stream' direction have been obtained at the various energies of the primary electron beam striking on the lead scatterer. The results of this work are compared with previously published data.

Monte Carlo dosimetry of the Buchler high dose rate 192Ir source.

In this study a complete set of dosimetric data is presented for the high dose rate (HDR) source from Amersham used in the Buchler remote afterloading HDR unit. These data have been calculated by means of the Monte Carlo simulation code GEANT taking into account the detailed geometry of the source. Absolute dose rate distributions in water were calculated around this source and are presented as conventional 2D Cartesian look-up tables. All dosimetric quantities recommended by the AAPM Task Group 43 report have been calculated. Quantities determined are: dose rate constant, radial dose function, anisotropy function, anisotropy factor and anisotropy constant. The dose rate distributions of the Buchler HDR source are compared with those of other HDR sources used in brachytherapy, showing that the differences are large in zones near the long source axis due to oblique filtration. These Monte Carlo simulated data in water can be used for clinical applications.