A New Approach for Heterogeneity Corrections for Cs-137 Brachytherapy Sources.

BACKGROUND: Most of the current brachytherapy treatment planning systems (TPS) use the TG-43U1 recommendations for dosimetry in water phantom, not considering the heterogeneity effects. OBJECTIVE: The purpose of this study is developing a method for obtaining correction factors for heterogeneity for Cs-137 brachytherapy sources based on pre-calculated MC simulations and interpolation. METHOD: To simulate the effect of phantom heterogeneity on dose distribution around Cs-137 sources, spherical water phantoms were simulated in which there were spherical shells of bone with different thicknesses (0.2cm to 1.8cm with 0.1cm increment) at different distances (from 0.1cm to 10cm, with 0.5cm increment) from the source center. The spherical shells with 0.1cm thickness at different distances from 0.1cm to 10cm were used as tally cells. The doses at these cells were obtained by tally types F6, *F8, and *F4.The results indicate that the percentage differences between the doses in heterogeneity sections with the dose at the same positions inside the homogeneous water phantom vary when the distance of bone section from the source center increases, because of decreasing the average energy of photons reaching the bone layer. Finally, the results of Monte Carlo simulations were used as the input data of MATLAB software, and the percentage dose difference for each new configuration (i.e. different thickness of inhomogenity at different distances from the source) was estimated using the 2D interpolation of MATLAB. RESULTS: According to the results, the algorithm used in this study, is capable of dose estimation with high accuracy. CONCLUSION: The developed method using the results of Monte Carlo simulations and the dose interpolation can be used in treatment planning systems for heterogeneity corrections.

EchoSeed Model 6733 Iodine-125 brachytherapy source: improved dosimetric characterization using the MCNP5 Monte Carlo code.

This study primarily aimed to obtain the dosimetric characteristics of the Model 6733 (125)I seed (EchoSeed) with improved precision and accuracy using a more up-to-date Monte-Carlo code and data (MCNP5) compared to previously published results, including an uncertainty analysis. Its secondary aim was to compare the results obtained using the MCNP5, MCNP4c2, and PTRAN codes for simulation of this low-energy photon-emitting source. The EchoSeed geometry and chemical compositions together with a published (125)I spectrum were used to perform dosimetric characterization of this source as per the updated AAPM TG-43 protocol. These simulations were performed in liquid water material in order to obtain the clinically applicable dosimetric parameters for this source model. Dose rate constants in liquid water, derived from MCNP4c2 and MCNP5 simulations, were found to be 0.993 cGyh(-1) U(-1) (±1.73%) and 0.965 cGyh(-1) U(-1) (±1.68%), respectively. Overall, the MCNP5 derived radial dose and 2D anisotropy functions results were generally closer to the measured data (within ±4%) than MCNP4c and the published data for PTRAN code (Version 7.43), while the opposite was seen for dose rate constant. The generally improved MCNP5 Monte Carlo simulation may be attributed to a more recent and accurate cross-section library. However, some of the data points in the results obtained from the above-mentioned Monte Carlo codes showed no statistically significant differences. Derived dosimetric characteristics in liquid water are provided for clinical applications of this source model.

A novel device for automatic withdrawal and accurate calibration of 99m-technetium radiopharmaceuticals to minimise radiation exposure to nuclear medicine staff and patient.

A Joint Automatic Dispenser Equipment (JADE) has been designed and fabricated for automatic withdrawal and calibration of radiopharmaceutical materials. The thermoluminescent dosemeter procedures have shown a reduction in dose to the technician's hand with this novel dose dispenser system JADE when compared with the manual withdrawal of (99m)Tc. This system helps to increase the precision of calibration and to minimise the radiation dose to the hands and body of the workers. This paper describes the structure of this device, its function and user-friendliness, and its efficacy. The efficacy of this device was determined by measuring the radiation dose delivered to the hands of the nuclear medicine laboratory technician. The user-friendliness of JADE has been examined. The automatic withdrawal and calibration offered by this system reduces the dose to the technician's hand to a level below the maximum permissible dose stipulated by the international protocols. This research will serve as a backbone for future study about the safe use of ionising radiation in medicine.

SU-E-T-320: A New Verification Phantom for GYN Brachytherapy Applicators Using GafChromic - Films.

PURPOSE: Brachytherapy plays an important role in radiation therapy a wide range of tumor sits such as vaginal, cervical and endometrial cancers. The purpose of this project was to design, fabricate and verify a new phantom for dosimetric verification at small distances from GYN applicators used with GZP6 cobalt-60 HDR system. METHODS: A new phantom has been designed and fabricated from 90 slabs of 18×16×0.2 cm3 Perspex to accommodate one tandem and two ovoids. The thin layer of the slabs was chosen to place GafChromic films in between the slabs for dosimetry with GZP6 cobalt-60 HDR system. For verification of this device, an assembly composed of a large ovoid size (3cm diameter) and tandem #1 with the least curvature was selected in this study. With this assembly, GafChromic films were exposed using a plan with 500 cGy dose delivery to point "A". The irradiated films were scanned. The responses of the films were converted to dose by calibrating samples of these films using a cobalt-60 teletherapy system in the range of 25 to 800 cGy dose. The measured isodose curves with the films were compared to calculated isodose lines by the treatment planning software. RESULTS: The Result of these investigations indicated differences of up to ± 23 % between the planning and measured dosimetry at different points in GYN implant with cobalt-60 HDR source of GZP6 system. Therefore, this phantom enabled us to confirm the accuracy of radiation delivery to the GYN patients with cobalt-60 HDR source of GZP6 system. CONCLUSIONS: The new phantom design could be utilized for the QA procedure of the GZP6 cobalt-60 HDR system as well as the Ir-192 HDR system to confirmation the accuracy of dose distribution in GYN implants, especially in non-traditional implants. The Radiotherapy Department of Shahid Beheshti University at Shohada hospital sponsored the purchase of the phantom materials and films used in the investigations.

SU-E-T-480: Updating the Planar Patterson-Parker Table Using the TG-43U1 Recommended Dosimetric Parameters.

PURPOSE: In this project, the Patterson-Parker Table has been updated for Cs-137 and Ir-192 sources using their recent TG-43U1 dosimetric data. In addition, dose uniformity for the different loading schemes as a function of implant area has been verified. METHODS: The updated Paterson-Parker tables have been generated for planar implants with Cs-137 and Ir-192 sources using their published TG-43U1 dosimetric parameters. Accuracies of the updated tables were examined by two independent methods, namely, Monte Carlo simulation technique and using a commercially available treatment planning system. In addition to the dose values along the central axis of the implant, dose profiles along two orthogonal directions have been evaluated for selection of the optimum radioactivity distribution in each implant geometry. RESULTS: The results of these investigations show that for the same implant size the mg.hr required for delivery of a given dose with Cs-137 is not identical to that of Ir-192. In addition, some differences between the updated Table and the published Paterson-Parkers Tables have been observed. Independent Monte Carlo simulations and treatment planning data for multi-seed implant indicated the accuracy (less than ±5%) of the updated Table. CONCLUSIONS: This work gives complete updated Paterson-Parker Tables for two of the commonly utilized brachytherapy sources. For delivery of a given dose, significant differences (approximately 35%) have been observed between the traditional Paterson-Parker Table and the updated Tables. These differences are attributed to the differences of tissue attenuation, 2D anisotropy functions as well as the availability of the new source dosimetry.

MO-F-BRB-01: Extracting Material Information from the CT Numbers by Artificial Neural Network for Use in the Monte Carlo Simulations of Tissues in Brachytherapy.

PURPOSE: The Artificial Neural Networks (ANNs) are useful in solving nonlinear processes, without the need to mathematical models of the parameters. Since the relationship between the CT numbers and material compositions is not linear, we can use the AANs for tissue density calibration. The aim of this study is to obtain the composition and mass density of different tissues which are necessary in Monte Carlo simulation of different tissues in brachytherapy treatment planning using ANNs. METHODS: The ANNs were used for mass density calibration. First, the density and composition of several tissues of the body, along with their corresponding CT numbers are used as the training samples. After the network is trained, it would give us the material information, i.e. mass density, and material composition corresponding to each CT numbers. The tissue compositions and densities predicted by the ANN for each CT number, were compared with the real values of such parameters. The tissue parameters predicted by the ANN were used as the phantom materials for obtaining the dose at different distances from Pd-103, and Cs-137 brachytherapy sources. Finally the dose at different distances of the real phantoms were compared with dose around the phantoms predicted by ANN. RESULTS: The ANN used in this study, can predict the material compositions of different tissues precisely. For example, it can give the mass densities of bone, water, and muscle with the percentage differences of 0.62%, - 1.1%, and 0.33% respectively. Comparing the dose distribution inside the water phantom predicted by Artificial Neural Networks and the real water phantom, shows the percentage difference of less than 0.7% and 2% for Cs-137 and Pd-103 respectively. CONCLUSIONS: The ANNs are applicable in determination of tissue parameters from the CT images data, and the material compositions and density obtained by this methods can be used for material definition in Monte Carlo simulations.

SU-E-T-501: Perturbation of TG-43 Parameters of the Brachytherapy Sources under Insufficient Scattering Materials.

PURPOSE: According to the TG-43 recommendations of American Association of Physicist in Medicine (AAPM), the dosimetry parameters of brachytherapy sources are obtained in a water phantom with full scattering conditions. However, in many actual clinical treatments the source are not surrounded with sufficient tissue in all directions to provide the full scattering condition. HDR brachytherapy of the breast or 125I eye-plaque treatment of the ocular melanoma are among the treatment sites that fits this category. In this project, the impact of insufficient phantom material surrounding the 137Cs, 192Ir, and 103Pd brachytherapy source on their TG43 dosimetric characteristics has been investigated. METHODS: In this study, the effect of the insufficient tissue (referred here as missing tissues) around the brachytherapy sources on their TG-43 dosimetric parameters have been investigated using MCNP5 Monte Carlo code. The brachytherapy sources were simulated in different locations inside a cubical water phantom with the dimensions of 30*30*30 cm3 . The variation of the dosimetric parameters of the three sources (i.e. Î>, g(r), and F(r,θ)) were compared to the values from full scattering conditions (i.e. source at the center of the phantom). RESULTS: The results of this study indicate the variation of g(r)and 2D anisotropy function of the brachytherapy sources as a function of the missing tissue thickness. These changes increase by decreasing the energy of the photons emitted by the brachytherapy sources. These differences are mainly due to the lack of full scattering condition for the points near the phantom boundary. CONCLUSIONS: Unlike the published data for symmetric, but insufficient phantom material around the source, the impact of asymmetric phantom materials have been evaluated on dosimetric characteristics of the brachytherapy sources.

Dosimetric characteristics of the new RadioCoil 103Pd wire line source for use in permanent brachytherapy implants.

Recently, a novel linear brachytherapy source in the form of a coiled wire has become available for use in interstitial implants of various treatment sites such as prostate gland. This source type employs a design completely different from that of most "seed" sources currently on the market, one which improves upon or eliminates several common problems with such sources. Dosimetric characteristics of these sources with active lengths 0.5 cm to 5.0 cm were determined for clinical application. For 0.5 cm and 1.0 cm active length sources, the dose rate constant, radial dose function, and two-dimensional (2D) anisotropy function were experimentally and theoretically determined following the updated AAPM Task Group 43 (TG-43U1) recommendations. Radial dose functions and/or "along-away" matrix functions were also obtained for sources with active lengths 2.0 cm to 5.0 cm. Measurements were performed with LiF thermoluminescent dosimeters in Solid Water phantoms. Measured data was compared to Monte Carlo simulated data in Solid Water utilizing the PTRAN code, version 7.43. After finding the data to be in agreement, Monte Carlo calculations were performed in liquid water to obtain clinically applicable dosimetric data as per TG-43U1 recommendations. The results indicated the dose rate constant of the 0.5 cm long RadioCoil 103Pd source in Solid Water to be 0.641 cGy h(-1) U(-1) when measured, and 0.636 cGy h(-1) U(-1) when simulated by Monte Carlo. The calculated dose rate constant in liquid water was found to be 0.650 cGy h(-1) U(-1). These values are comparable to other commercially available sources. Complete dosimetric data and simulation results are described in this paper. Per TG-43U1, clinical treatment planning systems should utilize the values reported for liquid water.

Experimental determination of the TG-43 dosimetric characteristics of EchoSeed model 6733 I25I brachytherapy source.

Recently an improved design of a 125I brachytherapy source has been introduced for interstitial seed implants, particularly for prostate seed implants. This design improves the in situ ultrasound visualization of the source compared to the conventional seed. In this project, the TG-43 recommended dosimetric characteristics of the new brachytherapy source have been experimentally determined in Solid Water phantom material. The measured dosimetric characteristics of the new source have been compared with data reported in the literature for other source designs. The measured dose rate constant, A, in Solid Water was multiplied by 1.05 to extract the dose rate constant in water. The dose rate constant of the new source in water was found to be 0.99 +/- 8% cGy h(-1) U(-1). The radial dose function was measured at distances between 0.5 and 10 cm using LiF TLDs in Solid Water phantom. The anisotropy function, F(r, theta), was measured at distances of 2, 3, 5, and 7 cm.

Dosimetric characteristics with spatial fractionation using electron grid therapy.

Recently, promising clinical results have been shown in the delivery of palliative treatments using megavoltage photon grid therapy. However, the use of megavoltage photon grid therapy is limited in the treatment of bulky superficial lesions where critical radiosensitive anatomical structures are present beyond tumor volumes. As a result, spatially fractionated electron grid therapy was investigated in this project. Dose distributions of 1.4-cm-thick cerrobend grid blocks were experimentally determined for electron beams ranging from 6 to 20 MeV. These blocks were designed and fabricated at out institution to fit into a 20 x 20-cm(2) electron cone of a commercially available linear accelerator. Beam profiles and percentage depth dose (PDD) curves were measured in Solid Water phantom material using radiographic film, LiF TLD, and ionometric techniques. Open-field PDD curves were compared with those of single holes grid with diameters of 1.5, 2.0, 2.5, 3.0, and 3.5 cm to find the optimum diameter. A 2.5-cm hole diameter was found to be the optimal size for all electron energies between 6 and 20 MeV. The results indicate peak-to-valley ratios decrease with depth and the largest ratio is found at Dmax. Also, the TLD measurements show that the dose under the blocked regions of the grid ranged from 9.7% to 39% of the dose beneath the grid holes, depending on the measurement location and beam energy.

Dosimetric characteristics of the bests double-wall 103Pd brachytherapy source.

103Pd and 125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a double-wall 103Pd source has been introduced, which has a design different from that of sources presently on the market. Dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 recommendations and were related to the October 10, 2000 revision of the NIST 1999 SK Standard for 103Pd. Measurements were performed in a Solid Water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of Solid Water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of Solid Water phantom material to provide full scattering conditions. The Monte Carlo simulations were performed in Solid Water and liquid water using the PTRAN code. The results of this investigation show an excellent agreement (within 5%) between the measured (0.67+/-8% cGy h(-1) U(-1)) and calculated (to be 0.65+/-3% cGy h(-1) U(-1)) dose rate constant in Solid Water. The Monte Carlo calculated dose rate constant of the Best 103Pd in water was found to be 0.67+/-0.02 cGy h(-1) U(-1). The radial dose function, g(r), of the new 103Pd source was measured at distances ranging from 0.5 and 7 cm using LiF TLD in Solid Water phantom material. Moreover, the radial dose function of the new source was calculated in liquid water and Solid Water at distances ranging from 0.1 to 7 cm using the PTRAN Monte Carlo Code. The anisotropy function, F(r, theta), of the new 103Pd source was also measured in Solid Water and calculated in both Solid Water and water phantom material. From the anisotropy functions, the anisotropy factors, and anisotropy constant were calculated for each medium. The results indicated that the measured anisotropy constant of the Best 103Pd source in Solid Water was 0.89+/-5%. Complete dosimetric data are described in this manuscript.

Dosimetric characteristics of a new 125I brachytherapy source.

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, a new 125I source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics of this source, including dose rate constant, radial dose function, and anisotropy function, were determined experimentally following the AAPM Task Group 43 recommendations. The characteristics were related to the 1999 NIST calibration assigned to this source [SK,99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. For these measurements, slabs of solid water phantom material were machined to accommodate the source and LiF TLD chips of dimensions (3.1 x 3.1 x 0.8 mm3) and (1.0 x 1.0 x 1.0 mm3). The TLD chips were surrounded by at least 10 cm of solid water phantom material to provide full scattering conditions. The results indicated a dose rate constant, lambda, of 0.88 +/- 0.07cGyh(-1)U(-1) for the new 1251 source as compared to 0.98 and 1.04 cGy h(-1)U(-1) for the Nycomed/Amersham model 6711 and 6702 seeds, respectively. Per TG-43, the values reported here represent the dose absorbed by water at 1 cm from the source in a water medium. The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm. The anisotropy function, F(r,theta), of the new 125I source was measured at distances of 2 and 5 cm from the source center. Calculations of anisotropy and radial dose function were also made using a Monte Carlo code. These calculations were made for both solid water and liquid water, the former to validate the Monte Carlo code and the latter to provide results in liquid water for clinical use. All data compared favorably with those from the Nycomed/Amersham models 6711 and 6702 sources.

Experimental determination of dosimetric characteristics of Best 125I brachytherapy source.

125I brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, the Best 125I source became commercially available for interstitial brachytherapy treatment. Dosimetric characteristics (dose rate constant, radial dose function, and anisotropy function) of this source were experimentally determined, following the AAPM Task Group 43 recommendations, and were related to the NIST 1999 calibration assigned to this source. Measurements were performed in Solid Water phantom using LiF thermoluminescent dosimeters. The results indicated a dose rate constant, lambda, of 1.01 +/- 0.08 cGy h(-1) U(-1) for the new source. The radial dose function, g(r), of the new source was measured at distances ranging from 0.5 to 10.0 cm. The anisotropy function, F(r, theta), of the new source was measured at distances of 2, 5, and 7 cm from the source center. These data compare favorably with those from the Nycomed/Amersham Models 6711 and 6702 sources. The anisotropy constant, phi(an), of the Best 125I source was found to be 0.982. Complete dosimetric parameters of the new source are presented in this paper.

Dosimetric characteristics of the Pharma Seed model BT-125-I source.

125I brachytherapy sources are being used with increasing frequency for interstitial implants in tumor sites, especially the prostate. Recently, a new 125I source design has become commercially available for clinical applications. Dosimetric characteristics (i.e., dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 (TG-43) recommendations and were related to the 1999 NIST calibration assigned to this source [S(k), 99std]. Measurements were performed in a Solid Water phantom using LiF thermoluminescent dosimeters. The measured data were used to validate the Monte Carlo simulations that were performed in Solid Water using the PTRAN code. The Monte Carlo calculations were then performed in liquid water to obtain the dosimetric information for clinical applications in accordance with TG-43 recommendations. The results indicated that the dose rate constant, lambda, of the Pharma Seed model BT-125-I 125I source was 0.90 +/- 0.06 cGy h(-1) U(-1) using thermoluminescent dosimeter (TLD) measurements and 0.92 +/- 0.03 cGy h(-1) U(-1) using Monte Carlo simulations in Solid Water. The calculated value in liquid water was found to be 0.95 +/- 0.03 cGy h(-1) U(-1). The radial dose function, g(r), of the new 125I source was measured at distances ranging from 0.5 to 10 cm using LiF TLD in Solid Water phantom material. The Monte Carlo simulations were performed for distances ranging from 0.1 to 10 cm from the source center in Solid Water and liquid water. The anisotropy function, F(r, theta), was measured at distances of 2, 5, and 7 cm from the source center and calculated at distances of 0.5, 1, 2, 3, 5, and 7 cm from the source center. The anisotropy constant, phi(an), of the Pharma Seed source in water was found to be 0.975. Complete dosimetric data are described in this manuscript. Per TG-43, the values reported in water should be used for clinical treatment planning systems.

Preliminary report of a phase I study of combined fractionated stereotactic radiosurgery and conventional external beam radiation therapy for unfavorable gliomas.

PURPOSE: To determine the tolerance and toxicities of fractionated stereotactic radiosurgery (FSRS) given in combination with conventional external beam radiation therapy (CEBRT). METHODS AND MATERIALS: From March 1995 to September 1998, 14 patients with previously unirradiated and unfavorable glioma (malignant glioma, n = 8; unfavorable low-grade glioma, n = 5; and recurrent glioma, n = 1) were stratified into 3 groups according to tumor volume (TV) to determine the initial FSRS dose schedule: Group A (n = 3): TV /=50% reduction, n = 2) or minor (>20% reduction, n = 9) imaging response. Follow-up ranged from 9 to 51 months (median 15 months), with 7 patients alive at 22-51 months. CONCLUSIONS: Imaging response and the ability of these patients with unfavorable intracranial gliomas to complete therapy without interruption or experiencing disease progression is very encouraging. Excessive toxicity of combined FSRS and CEBRT as evaluated thus far in this study was seen for patients with group B/C lesions. Evaluation of this novel treatment strategy with dose modification is ongoing.

Dosimetric characteristics of the InterSource103 palladium brachytherapy source.

103Pd brachytherapy sources are being used for interstitial implants in tumor sites such as the prostate. Recently, the InterSource103 palladium source has been introduced, which has a design different from that of other sources presently on the market. Dosimetric characteristics (i.e., dose rate constant, radial dose function, and anisotropy function) of this source were experimentally and theoretically determined following the AAPM Task Group 43 (TG-43) recommendations and were related to the 1999 NIST calibration assigned to this source [Sk, 99std]. Measurements were performed in a solid water phantom using LiF thermoluminescent dosimeters. The measured data was compared with Monte Carlo simulations performed in solid water using the PTRAN code. The calculations were then performed in liquid water to obtain the dosimetric information for clinical applications as per TG-43 recommendation. The results indicated that the dose rate constant, lambda, of the InterSource103 palladium source was 0.664+/-5% cGy/h/U using TLD measurements and 0.660+/-3% cGy/h/U using Monte Carlo simulations in solid water. The calculated value in liquid water was found to be 0.696 +/- 3 % cGy/h/U. The radial dose function, g(r), of the new 103Pd source was measured at distances ranging from 0.5 to 10 cm using LiF TLD in solid water phantom material. The Monte Carlo simulations were performed at distances ranging from 0.1 to 10 cm from the source center in solid water and liquid water. The anisotropy function, F(r, theta), was measured at distances of 2, 3, 5, and 7 cm from the source center and calculated at distances of 0.5, 1, 2, 3, 5, and 7 cm from the source center. Complete dosimetric data are described in this paper. Per TG-43, the values reported in water should be used for clinical treatment planning systems.

Gamma knife radiosurgery using 90 Gy for trigeminal neuralgia.

OBJECT: The purpose of this paper was to assess the treatment of trigeminal neuralgia (TN) with the higher than normal dose of 90 Gy. METHODS: Forty-two patients with typical TN were treated over a 3-year period with gamma knife radiosurgery. Every patient received a maximum dose of 90 Gy in a single 4-mm isocenter targeted to the root entry zone of the trigeminal nerve. Thirty of 42 patients had undergone no prior treatments. The median follow-up period was 14 months (range 2-30 months). Thirty-one patients (73.8%) achieved complete relief of pain. Nine patients (21.4%) obtained good pain control. Complications were limited to increased facial paresthesia in seven patients (16.7%) and dysgeusia in four patients (9.5%). CONCLUSIONS: The authors conclude that the use of 90 Gy is a safe and effective dose for the treatment of TN.

Combined stereotactic split-course fractionated gamma knife radiosurgery and conventional radiation therapy for unfavorable gliomas: a phase I study.

OBJECT: This investigation was performed to determine the tolerance and toxicities of split-course fractionated gamma knife radiosurgery (FSRS) given in combination with conventional external-beam radiation therapy (CEBRT). METHODS: Eighteen patients with previously unirradiated, gliomas treated between March 1995 and January 2000 form the substrate of this report. These included 11 patients with malignant gliomas, six with low-grade gliomas, and one with a recurrent glioma. They were stratified into three groups according to tumor volume (TV). Fifteen were treated using the initial FSRS dose schedule and form the subject of this report. Group A (four patients), had TV of 5 cm3 or less (7 Gy twice pre- and twice post-CEBRT); Group B (six patients), TV greater than 5 cm3 but less than or equal to 15 cm3 (7 Gy twice pre-CEBRT and once post-CEBRT); and Group C (five patients), TV greater than 15 cm3 but less than or equal to 30 cm3 (7 Gy once pre- and once post-CEBRT). All patients received CEBRT to 59.4 Gy in 1.8-Gy fractions. Dose escalation was planned, provided the level of toxicity was acceptable. All patients were able to complete CEBRT without interruption or experiencing disease progression. Unacceptable toxicity was observed in two Grade 4/Group B patients and two Grade 4/Group C patients. Eight patients required reoperation. In three (38%) there was necrosis without evidence of tumor. Neuroimaging studies were available for evaluation in 14 patients. Two had a partial (> or = 50%) reduction in volume and nine had a minor (> 20%) reduction in size. The median follow-up period was 15 months (range 9-60 months). Six patients remained alive for 3 to 60 months. CONCLUSIONS: The imaging responses and the ability of these patients with intracranial gliomas to complete therapy without interruption or experiencing disease progression is encouraging. Excessive toxicity derived from combined FSRS and CEBRT treatment, as evaluated thus far in this study, was seen in patients with Group B and C lesions at the 7-Gy dose level. Evaluation of this novel treatment strategy with dose modification is ongoing.

Review of AAPM Task Group No. 43 recommendations on interstitial brachytherapy sources dosimetry. American Association of Physicists in Medicine.

In 1995, the American Association of Physicists in Medicine (AAPM) Task Group No. 43 (TG-43) published its recommendations on the dosimetry of interstitial brachytherapy sources. The report recommended the use of a new dose calculation formalism based on measured quantities. The formalism in modular form permits the computation of doses in two dimensions for 103Pd, 125I, and 192Ir sources. The TG-43 dose calculation formalism introduced new and updated quantities such as air kerma strength, dose rate constant, radial dose function, anisotropy function and anisotropy factor. The dose rate obtained using the TG-43 dose calculation formalism and updated source dosimetry data can be expected to be different from some of the currently used systems by as much as 17%. For the same treatment and implementing the TG-43 dosimetry with point source approximation, the widely prescribed dose of 160 Gy for 125I permanent implants using model 6711 sources changes to 144 Gy. In addition to the dose calculation formalism, TG-43 report also stated that the air kerma strength provided by NIST is estimated to be approximately 7-10% higher than it should be, due to low energy photon contamination for 125I. This difference has not been accounted for in the TG-43 report.