Ir-192 radioisotope replacement with a hand-portable 1 MeV Ku-band electron linear accelerator.

Although linear accelerators are used in many security, industrial and medical applications, the existing technologies are too large and expensive for several critical applications such as radioactive source replacement, field radiography and mobile cargo scanners. One of the main requirements for these sources is to be highly portable to allow field operation. In response to this problem, RadiaBeam has designed a hand-portable 1 MeV X-ray source, scalable to higher energies, based on Ku-band split electron linac, that can be used for Ir-192 radioisotope replacement. In this paper, we present its multiphysics and engineering design studies, as well as an accelerating structure prototype along with RF measurements.

Effect of Gold Nanoparticle Radiosensitization on Plasmid DNA Damage Induced by High-Dose-Rate Brachytherapy.

PURPOSE: Gold nanoparticles (AuNPs) are candidate radiosensitizers for medium-energy photon treatment, such as γ-ray radiation in high-dose-rate (HDR) brachytherapy. However, high AuNP concentrations are required for sufficient dose enhancement for clinical applications. Here, we investigated the effect of positively (+) charged AuNP radiosensitization of plasmid DNA damage induced by 192Ir γ-rays, and compared it with that of negatively (-) charged AuNPs. METHODS: We observed DNA breaks and reactive oxygen species (ROS) generation in the presence of AuNPs at low concentrations. pBR322 plasmid DNA exposed to 64 ng/mL AuNPs was irradiated with 192Ir γ-rays via HDR brachytherapy. DNA breaks were detected by observing the changes in the form of the plasmid and quantified by agarose gel electrophoresis. The ROS generated by the AuNPs were measured with the fluorescent probe sensitive to ROS. The effects of positively (+) and negatively (-) charged AuNPs were compared to study the effect of surface charge on dose enhancement. RESULTS: +AuNPs at lower concentrations promoted a comparable level of radiosensitization by producing both single-stranded breaks (SSBs) and double-stranded breaks (DSBs) than those used in cell assays and Monte Carlo simulation experiments. The dose enhancement factor (DEF) for +AuNPs was 1.3 ± 0.2 for SSBs and 1.5 ± 0.4 for DSBs. The ability of +AuNPs to augment plasmid DNA damage is due to enhanced ROS generation. While -AuNPs generated similar ROS levels, they did not cause significant DNA damage. Thus, dose enhancement using low concentrations of +AuNPs presumably occurred via DNA binding or increasing local +AuNP concentration around the DNA. CONCLUSION: +AuNPs at low concentrations displayed stronger radiosensitization compared to -AuNPs. Combining +AuNPs with 192Ir γ-rays in HDR brachytherapy is a candidate method for improving clinical outcomes. Future development of cancer cell-specific +AuNPs would allow their wider application for HDR brachytherapy.

An easy and novel method for safer brachytherapy: real-time fluoroscopic verification of high-dose-rate 192Ir source position using a flat-panel detector.

Real-time fluoroscopic verification of the active source position during actual treatment is the only established method to prevent high-dose-rate (HDR) brachytherapy events. The challenge is spurious signals from an HDR 192Ir source that result in image halation, making source positions indiscernible when using a non-modified image intensifier fluoroscope. We have previously reported a method for observing an HDR 192Ir source by using an elaborately modified image intensifier system. The newly developed flat-panel detector fluoroscope is, by contrast, inherently halation-free thanks to the wider dynamic range (12-14 bits), compared with image intensifier fluoroscopes (8 bits). To explore the feasibility, we applied a commercially available flat-panel detector fluoroscope without modification to actual treatment. We successfully observed source positions without halation for all 107 patients, with a total of 522 HDR treatment sessions during a 3-year period from 2014 to 2017. Actual source positions were compared with planned positions on the planning hard copy. With this method, we detected a total of 1 error (0.2%) among the 522 sessions, at a similar detection rate of 0.1% with our previous experience using a modified image intensifier fluoroscope. We found that a commercially available flat-panel detector fluoroscope is ready for use for real-time verification and outweighs the need for elaborate modifications of an image intensifier fluoroscope. A flat-panel detector fluoroscope will help the global radiation oncology community promote real-time verification programs, leading to safer HDR brachytherapy.

Determination of dose enhancement caused by AuNPs with Xoft® Axxent® Electronic (eBx™) and conventional brachytherapy: in vitro study.

PURPOSE: The purpose of this study was to determine dose enhancement (DE) and the possible clinical benefits associated with the inclusion of gold nanoparticles (AuNPs) in cancer cells irradiated by either an 192Ir brachytherapy source or a Xoft® Axxent® Electronic (eBx™) Brachytherapy. PATIENTS AND METHODS: Brachytherapy DE caused by AuNPs is investigated using two methods, namely 192Ir and eBx™ Brachytherapy. The second method, which was recently introduced clinically, operates at ~50 kV, which is also the optimal beam energy for DE. In this in vitro study, two cancer cell lines, lung (A549) and prostate (DU145), were used. Cells were incubated with 1 mM (2% w/w) concentration of AuNPs of ~15 nm in size. The control groups were exposed to a range of doses from 0 (control) to 6 Gy, with eBx™ and 192Ir sources separately. A clonogenic assay was conducted to determine cell survival curves. RESULTS: High dose enhancement factor (DEF) values were achieved in treated groups with low concentration of AuNPs with the 50 kV energy associated with the eBx™. The DE levels in eBx™ for Du145 and A549 cells were found to be 2.90 and 2.06, respectively. The results showed DEFs measured for the same cell lines using 192Ir brachytherapy to be 1.67 and 1.54 for Du145 and A549 cancer cells, respectively. This clearly indicates that much higher DE values are obtained in the case of eBx™ X-ray brachytherapy compared to 192Ir gamma brachytherapy. CONCLUSION: The higher DE values obtained with eBx™ compared to 192Ir brachytherapy can be attributed to the lower average energy of the former and being closer to the optimal energy for DE. This could potentially be utilized by medical practitioners and clinicians to achieve the same tumor control with a significantly lower dose from the eBx™ compared to the 192Ir brachytherapy treatment, thus bringing huge benefits to the brachytherapy-treated patients.

A comprehensive dose assessment of irradiated hand by iridium-192 source in industrial radiography.

Among the various incidents in industrial radiography, inadvertent handling of sources by hands is one of the most frequent incidents in which some parts of the hands may be locally exposed to high doses. An accurate assessment of extremity dose assists medical doctors in selecting appropriate treatments, preventing the injury expansion in the region. In this study, a phantom was designed to simulate a fisted hand of a radiographer when the worker holds a radioactive source in their hands. The local doses were measured using implanted TLDs in the phantom at different distances from a source. Furthermore, skin dose distribution was measured by Gaf-chromic films in the palm region of the phantom. The reliability of the measurements has been studied via analytical as well as Monte-Carlo simulation methods. The results showed that the new phantom design can be used reliably in extremity dose assessments, particularly at the points next to the source.

Effect of gold nanoparticles on radiation doses in tumor treatment: a Monte Carlo study.

Radiotherapy is an extensively used treatment for most tumor types. However, ionizing radiation does not discriminate between cancerous and normal cells surrounding the tumor, which can be considered as a dose-limiting factor. This can lead to the reduction of the effectiveness of tumor cell eradication with this treatment. A potential solution to this problem is loading the tumor with high-Z materials prior to radiotherapy as this can induce higher toxicity in tumor cells compared to normal ones. New advances in nanotechnology have introduced the promising use of heavy metal nanoparticles to enhance tumor treatment. The primary studies showed that gold nanoparticles (GNPs) have unique characteristics as biocompatible radiosensitizers for tumor cells. This study aimed to quantify the dose enhancement effect and its radial dose distribution by Monte Carlo simulations utilizing the EGSnrc code for the water-gold phantom loaded with seven different concentrations of Au: 0, 7, 18, 30, 50, 75, and 100 mg-Au/g-water. The phantom was irradiated with two different radionuclide sources, Ir-192 and Cs-137, which are commonly used in brachytherapy, for all concentrations. The results exhibited that gold nanoparticle-aided radiotherapy (GNRT) increases the efficacy of radiotherapy with low-energy photon sources accompanied with high Au concentration loads of up to 30 mg-Au/g-water. Our finding conducts also to the detection of dose enhancement effects in a short average range of 650 µm outside the region loaded with Au. This can indicate that the location determination is highly important in this treatment method.

Evaluating the effect of various intracavitary applicators on dosimetric parameters of (192)Ir, (137)Cs, and (60)Co sources.

The purpose of this research is to study the effect of various applicator compositions on dosimetric parameters and dose distribution of (192)Ir, (137)Cs, and (60)Co sources, using Monte Carlo simulation techniques. To study the effect of applicators on source dosimetry, the dose rate constant, and radial dose function and isodose curves for the above noted sources were calculated in the presence and absence of plastic, titanium, and a stainless steel applicators. The effects of the applicators on the dosimetric parameters and isodose curves of these sources were dependent of the source type and materials of the applicator. The (192)Ir source with the stainless steel applicator has the maximum difference of dose rate (4.2 %) relative to the without applicator case. The (60)Co source with plastic applicator has the minimum dose variation. Moreover, this effect is higher for lower energy sources. Ignoring the effect of applicator composition and geometry on dose distribution may cause discrepancies in treatment planning. Plastic applicators have the least radiation attenuation compared to the other applicators, therefore, they are recommended for use in brachytherapy. A table of correction factors has been introduced for different sources and applicators with different materials for the clinical applications.

Monte Carlo dosimetry of the IRAsource high dose rate (192)Ir brachytherapy source.

High-dose-rate (HDR) brachytherapy is a common method for cancer treatment in clinical brachytherapy. Because of the different source designs, there is a need for specific dosimetry data set for each HDR model. The purpose of this study is to obtain detailed dose rate distributions in water phantom for a first prototype HDR (192)Ir brachytherapy source model, IRAsource, and compare with the other published works. In this study, Monte Carlo N-particle (MCNP version 4C) code was used to simulate the dose rate distributions around the HDR source. A full set of dosimetry parameters reported by the American Association of Physicists in Medicine Task Group No. 43U1 was evaluated. Also, the absorbed dose rate distributions in water, were obtained in an along-away look-up table. The dose rate constant, Λ, of the IRAsource was evaluated to be equal to 1.112 ± 0.005 cGy h(-1) U(-1). The results of dosimetry parameters are presented in tabulated and graphical formats and compared with those reported from other commercially available HDR (192)Ir sources, which are in good agreement. This justifies the use of specific data sets for this new source. The results obtained in this study can be used as input data in the conventional treatment planning systems.

Characterization of commercial MOSFET detectors and their feasibility for in-vivo HDR brachytherapy.

AIM: The present study was to investigate the use of MOSFET as an vivo dosimeter for the application of Ir-192 HDR brachytherapy treatments. MATERIAL AND METHODS: MOSFET was characterized for dose linearity in the range of 50-1000 cGy, depth dose dependence from 2 to 7 cm, angular dependence. Signal fading was checked for two weeks. RESULT AND DISCUSSION: Dose linearity was found to be within 2% in the dose range (50-1000 cGy). The response varied within 8.07% for detector-source distance of 2-7 cm. The response of MOSFET with the epoxy side facing the source (0 degree) is the highest and the lowest response was observed at 90 and 270 degrees. Signal was stable during the study period. CONCLUSION: The detector showed high dose linearity and insignificant fading. But due to angular and depth dependence, care should be taken and corrections must be applied for clinical dosimetry.

Calculation of the TLD700:LiF energy response from Ir-192 using novel Monte Carlo and empirical methods.

Lithium fluoride thermoluminescent dosimeters (TLDs) exhibit a dependence on the energy of the radiation beam of interest so need to be carefully calibrated for different energy spectra if used for clinical radiation oncology beam dosimetry and quality assurance. TLD energy response was investigated for a specific set of TLD700:LiF(Mg,Ti) chips for a high dose rate (192)Ir brachytherapy source. A novel method of energy response calculation for (192)Ir was developed where dose was determined through Monte Carlo modelling in Geant4. The TLD response was then measured experimentally. Results showed that TLD700 has a depth dependent response in water ranging from 1.170 ± 0.125 at 20 mm to 0.976 ± 0.043 at 50 mm (normalised to a nominal 6 MV beam response). The method of calibration and Monte Carlo data developed through this study could be easily applied by other Medical Physics departments seeking to use TLDs for (192)Ir patient dosimetry or treatment planning system experimental verification.

Brachytherapy dose-volume histogram commissioning with multiple planning systems.

The first quality assurance process for validating dose-volume histogram data involving brachytherapy procedures in radiation therapy is presented. The process is demonstrated using both low dose-rate and high dose-rate radionuclide sources. A rectangular cuboid was contoured in five commercially available brachytherapy treatment planning systems. A single radioactive source commissioned for QA testing was positioned coplanar and concentric with one end. Using the brachytherapy dosimetry formalism defined in the AAPM Task Group 43 report series, calculations were performed to estimate dose deposition in partial volumes of the cuboid structure. The point-source approximation was used for a 125I source and the line-source approximation was used for a 192Ir source in simulated permanent and temporary implants, respectively. Hand-calculated, dose-volume results were compared to TPS-generated, dose-volume histogram (DVH) data to ascertain acceptance. The average disagreement observed between hand calculations and the treatment planning system DVH was less than 1% for the five treatment planning systems and less than 5% for 1 cm ≤ r ≤ 5 cm. A reproducible method for verifying the accuracy of volumetric statistics from a radiation therapy TPS can be employed. The process satisfies QA requirements for TPS commissioning, upgrading, and annual testing. We suggest that investigations be performed if the DVH %Vol(TPS) "actual variance" calculations differ by more than 5% at any specific radial distance with respect to %Vol(TG-43), or if the "average variance" DVH %Vol(TPS) calculations differ by more than 2% over all radial distances with respect to %Vol(TG-43).

Source position verification and dosimetry in HDR brachytherapy using an EPID.

PURPOSE: Accurate treatment delivery in high dose rate (HDR) brachytherapy requires correct source dwell positions and dwell times to be administered relative to each other and to the surrounding anatomy. Treatment delivery inaccuracies predominantly occur for two reasons: (i) anatomical movement or (ii) as a result of human errors that are usually related to incorrect implementation of the planned treatment. Electronic portal imaging devices (EPIDs) were originally developed for patient position verification in external beam radiotherapy and their application has been extended to provide dosimetric information. The authors have characterized the response of an EPID for use with an (192)Ir brachytherapy source to demonstrate its use as a verification device, providing both source position and dosimetric information. METHODS: Characterization of the EPID response using an (192)Ir brachytherapy source included investigations of reproducibility, linearity with dose rate, photon energy dependence, and charge build-up effects associated with exposure time and image acquisition time. Source position resolution in three dimensions was determined. To illustrate treatment verification, a simple treatment plan was delivered to a phantom and the measured EPID dose distribution compared with the planned dose. RESULTS: The mean absolute source position error in the plane parallel to the EPID, for dwells measured at 50, 100, and 150 mm source to detector distances (SDD), was determined to be 0.26 mm. The resolution of the z coordinate (perpendicular distance from detector plane) is SDD dependent with 95% confidence intervals of ± 0.1, ± 0.5, and ± 2.0 mm at SDDs of 50, 100, and 150 mm, respectively. The response of the EPID is highly linear to dose rate. The EPID exhibits an over-response to low energy incident photons and this nonlinearity is incorporated into the dose calibration procedure. A distance (spectral) dependent dose rate calibration procedure has been developed. The difference between measured and planned dose is less than 2% for 98.0% of pixels in a two-dimensional plane at an SDD of 100 mm. CONCLUSIONS: Our application of EPID dosimetry to HDR brachytherapy provides a quality assurance measure of the geometrical distribution of the delivered dose as well as the source positions, which is not possible with any current HDR brachytherapy verification system.

A BrachyPhantom for verification of dose calculation of HDR brachytherapy planning system.

PURPOSE: To develop a calibration phantom for (192)Ir high dose rate (HDR) brachytherapy units that renders possible the direct measurement of absorbed dose to water and verification of treatment planning system. METHODS: A phantom, herein designated BrachyPhantom, consists of a Solid Water™ 8-cm high cylinder with a diameter of 14 cm cavity in its axis that allows the positioning of an A1SL ionization chamber with its reference measuring point at the midheight of the cylinder's axis. Inside the BrachyPhantom, at a 3-cm radial distance from the chamber's reference measuring point, there is a circular channel connected to a cylindrical-guide cavity that allows the insertion of a 6-French flexible plastic catheter from the BrachyPhantom surface. The PENELOPE Monte Carlo code was used to calculate a factor, P(sw)(lw), to correct the reading of the ionization chamber to a full scatter condition in liquid water. The verification of dose calculation of a HDR brachytherapy treatment planning system was performed by inserting a catheter with a dummy source in the phantom channel and scanning it with a CT. The CT scan was then transferred to the HDR computer program in which a multiple treatment plan was programmed to deliver a total dose of 150 cGy to the ionization chamber. The instrument reading was then converted to absorbed dose to water using the N(gas) formalism and the P(sw)(lw) factor. Likewise, the absorbed dose to water was calculated using the source strength, Sk, values provided by 15 institutions visited in this work. RESULTS: A value of 1.020 (0.09%, k = 2) was found for P(sw)(lw). The expanded uncertainty in the absorbed dose assessed with the BrachyPhantom was found to be 2.12% (k = 1). To an associated Sk of 27.8 cGy m(2) h(-1), the total irradiation time to deliver 150 cGy to the ionization chamber point of reference was 161.0 s. The deviation between the absorbed doses to water assessed with the BrachyPhantom and those calculated by the treatment plans and using the Sk values did not exceed ± 3% and ± 1.6%, respectively. CONCLUSIONS: The BrachyPhantom may be conveniently used for quality assurance and/or verification of HDR planning system with a priori threshold level to spot problems of 2% and ± 3%, respectively, and in the long run save time for the medical physicist.

Development and implementation of a remote audit tool for high dose rate (HDR) Ir-192 brachytherapy using optically stimulated luminescence dosimetry.

PURPOSE: The aim of this work was to create a mailable phantom with measurement accuracy suitable for Radiological Physics Center (RPC) audits of high dose-rate (HDR) brachytherapy sources at institutions participating in National Cancer Institute-funded cooperative clinical trials. Optically stimulated luminescence dosimeters (OSLDs) were chosen as the dosimeter to be used with the phantom. METHODS: The authors designed and built an 8 × 8 × 10 cm(3) prototype phantom that had two slots capable of holding Al2O3:C OSLDs (nanoDots; Landauer, Glenwood, IL) and a single channel capable of accepting all (192)Ir HDR brachytherapy sources in current clinical use in the United States. The authors irradiated the phantom with Nucletron and Varian (192)Ir HDR sources in order to determine correction factors for linearity with dose and the combined effects of irradiation energy and phantom characteristics. The phantom was then sent to eight institutions which volunteered to perform trial remote audits. RESULTS: The linearity correction factor was kL = (-9.43 × 10(-5) × dose) + 1.009, where dose is in cGy, which differed from that determined by the RPC for the same batch of dosimeters using (60)Co irradiation. Separate block correction factors were determined for current versions of both Nucletron and Varian (192)Ir HDR sources and these vendor-specific correction factors differed by almost 2.6%. For the Nucletron source, the correction factor was 1.026 [95% confidence interval (CI) = 1.023-1.028], and for the Varian source, it was 1.000 (95% CI = 0.995-1.005). Variations in lateral source positioning up to 0.8 mm and distal∕proximal source positioning up to 10 mm had minimal effect on dose measurement accuracy. The overall dose measurement uncertainty of the system was estimated to be 2.4% and 2.5% for the Nucletron and Varian sources, respectively (95% CI). This uncertainty was sufficient to establish a ± 5% acceptance criterion for source strength audits under a formal RPC audit program. Trial audits of four Nucletron sources and four Varian sources revealed an average RPC-to-institution dose ratio of 1.000 (standard deviation = 0.011). CONCLUSIONS: The authors have created an OSLD-based (192)Ir HDR brachytherapy source remote audit tool which offers sufficient dose measurement accuracy to allow the RPC to establish a remote audit program with a ± 5% acceptance criterion. The feasibility of the system has been demonstrated with eight trial audits to date.

Lessons learned from a HDR brachytherapy well ionisation chamber calibration error.

The outcomes of a recent brachytherapy well-type ionization chamber calibration error are given in the hope that other brachytherapy treatment centres may better understand the importance of each entry stated in a well chamber calibration certificate. A Nucletron Source Dosimetry System (SDS) PTW well-type ionization chamber was sent for a biennial calibration in September 2010. Upon calibration of the chamber, it was discovered that the previous calibration (in July 2008) contained a +2.6% error in the chamber calibration coefficient. Investigation of the information on the 2008 well chamber calibration certificate indicated the source of the error, which could or should have been detected by both the calibration laboratory and/or the radiation therapy department upon return of the chamber. Consideration must be given to all values and conditions given on the calibration certificate when accepting a ionization chamber back from a calibration laboratory. The issue of whether the source strength from the source calibration certificate or the measured source strength from the calibrated ionization chamber should be entered into the treatment unit is also raised.

Development of a water calorimetry-based standard for absorbed dose to water in HDR 192Ir brachytherapy.

PURPOSE: The aim of this article is to develop and evaluate a primary standard for HDR 192Ir brachytherapy based on 4 degrees C stagnant water calorimetry. METHODS: The absolute absorbed dose to water was directly measured for several different Nucletron microSelectron 192Ir sources of air kerma strength ranging between 21,000 and 38,000 U and for source-to-detector separations ranging between 25 and 70 mm. The COMSOL MULTIPHYSICS software was used to accurately calculate the heat transport in a detailed model geometry. Through a coupling of the "conduction and convection" module with the "Navier-Stokes incompressible fluid" module in the software, both the conductive and convective effects were modeled. RESULTS: A detailed uncertainty analysis resulted in an overall uncertainty in the absorbed dose of 1.90% (1 sigma). However, this includes a 1.5% uncertainty associated with a nonlinear predrift correction which can be substantially reduced if sufficient time is provided for the system to come to a new equilibrium in between successive calorimetric runs, an opportunity not available to the authors in their clinical setting due to time constraints on the machine. An average normalized dose rate of 361 +/- 7 microGy/(h U) at a source-to-detector separation of 55 mm was measured for the microSelectron 192Ir source based on water calorimetry. The measured absorbed dose per air kerma strength agreed to better than 0.8% (1 sigma) with independent ionization chamber and EBT-1 Gafchromic film reference dosimetry as well as with the currently accepted AAPM TG-43 protocol measurements. CONCLUSIONS: This work paves the way toward a primary absorbed dose to water standard in 192Ir brachytherapy.

Direct measurement of absorbed dose to water in HDR 192Ir brachytherapy: water calorimetry, ionization chamber, Gafchromic film, and TG-43.

PURPOSE: Gafchromic film and ionometric calibration procedures for HDR 192Ir brachytherapy sources in terms of dose rate to water are presented and the experimental results are compared to the TG-43 protocol as well as with the absolute dose measurement results from a water calorimetry-based primary standard. METHODS: EBT-1 Gafchromic films, an A1SL Exradin miniature Shonka thimble type chamber, and an SI HDR 1000 Plus well-type chamber (Standard Imaging, Inc., Middleton, WI) with an ADCL traceable Sk calibration coefficient (following the AAPM TG-43 protocol) were used. The Farmer chamber and Gafchromic film measurements were performed directly in water. All results were compared to direct and absolute absorbed dose to water measurements from a 4 degrees C stagnant water calorimeter. RESULTS: Based on water calorimetry, the authors measured the dose rate to water to be 361 +/- 7 microGy/(h U) at a 55 mm source-to-detector separation. The dose rate normalized to air-kerma strength for all the techniques agree with the water calorimetry results to within 0.83%. The overall 1-sigma uncertainty on water calorimetry, ionization chamber, Gafchromic film, and TG-43 dose rate measurement amounts to 1.90%, 1.44%, 1.78%, and 2.50%, respectively. CONCLUSIONS: This work allows us to build a more realistic uncertainty estimate for absorbed dose to water determination using the TG-43 protocol. Furthermore, it provides the framework necessary for a shift from indirect HDR 192Ir brachytherapy dosimetry to a more accurate, direct, and absolute measurement of absorbed dose to water.

A study of experimental measurements of dosimetric parameters in HDR IR-192 source.

Thermoluminescent dosimeters have been used to perform dosimetry measurements for the widely used Ir-192 microSelectron-HDR source with an improved polystyrene phantom. Radial dose functions and anisotropy functions, main parameters of 2D dose-rate formalism from the TG-43U1 protocol, have been obtained experimentally. Measurement results are compared with that of the Monte Carlo calculations reported, and no difference has been found between them.

Tracking brachytherapy sources using emission imaging with one flat panel detector.

This work proposes to use the radiation from brachytherapy sources to track their dwell positions in three-dimensional (3D) space. The prototype device uses a single flat panel detector and a BB tray. The BBs are arranged in a defined pattern. The shadow of the BBs on the flat panel is analyzed to derive the 3D coordinates of the illumination source, i.e., the dwell position of the brachytherapy source. A kilovoltage x-ray source located 3.3 m away was used to align the center BB with the center pixel on the flat panel detector. For a test plan of 11 dwell positions, with an Ir-192 high dose rate unit, one projection was taken for each dwell point, and locations of the BB shadows were manually identified on the projection images. The 3D coordinates for the 11 dwell positions were reconstructed based on two BBs. The distances between dwell points were compared with the expected values. The average difference was 0.07 cm with a standard deviation of 0.15 cm. With automated BB shadow recognition in the future, this technique possesses the potential of tracking the 3D trajectory and the dwell times of a brachytherapy source in real time, enabling real time source position verification.