A user-oriented procedure for the commissioning and quality assurance testing of treatment planning system dosimetry in high-dose-rate brachytherapy

Published:December 22, 2015DOI:



      To develop a user-oriented procedure for testing treatment planning system (TPS) dosimetry in high-dose-rate brachytherapy, with particular focus to TPSs using model-based dose calculation algorithms (MBDCAs).

      Methods and Materials

      Identical plans were prepared for three computational models using two commercially available systems and the same 192Ir source. Reference dose distributions were obtained for each plan using the MCNP v.6.1 Monte Carlo (MC) simulation code with input files prepared via automatic parsing of plan information using a custom software tool. The same tool was used for the comparison of reference dose distributions with corresponding MBDCA exports.


      The single source test case yielded differences due to the MBDCA spatial discretization settings. These affect points at relatively increased distance from the source, and they are abated in test cases with multiple source dwells. Differences beyond MC Type A uncertainty were also observed very close to the source(s), close to the test geometry boundaries, and within heterogeneities. Both MBDCAs studied were found equivalent to MC within 5 cm from the target volume for a clinical breast brachytherapy test case. These are in agreement with previous findings of MBDCA benchmarking in the literature.


      The data and the tools presented in this work, that are freely available via the web, can serve as a benchmark for advanced clinical users developing their own tests, a complete commissioning procedure for new adopters of currently available TPSs using MBDCAs, a quality assurance testing tool for future updates of already installed TPSs, or as an admission prerequisite in multicentric clinical trials.


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        • DeWerd L.A.
        • Ibbott G.S.
        • Meigooni A.S.
        • et al.
        A dosimetric uncertainty analysis for photon-emitting brachytherapy sources: report of AAPM Task Group No. 138 and GEC-ESTRO.
        Med Phys. 2011; 38: 782-801
        • Kirisits C.
        • Rivard M.J.
        • Baltas D.
        • et al.
        Review of clinical brachytherapy uncertainties: analysis guidelines of GEC-ESTRO and the AAPM.
        Radiother Oncol. 2014; 110: 199-212
        • Nath R.
        • Anderson L.L.
        • Luxton G.
        • et al.
        Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine.
        Med Phys. 1995; 22: 209-234
        • Perez-Calatayud J.
        • Ballester F.
        • Das R.K.
        • et al.
        Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: report of the AAPM and ESTRO.
        Med Phys. 2012; 39: 2904-2929
        • Papagiannis P.
        • Pantelis E.
        • Karaiskos P.
        Current state of the art brachytherapy treatment planning dosimetry algorithms.
        Br J Radiol. 2014; 87: 20140163
        • Beaulieu L.
        • Carlsson Tedgren A.
        • Carrier J.-F.
        • et al.
        Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: current status and recommendations for clinical implementation.
        Med Phys. 2012; 39: 6208-6236
        • Palmer A.L.
        • Lee C.
        • Ratcliffe A.J.
        • et al.
        Design and implementation of a film dosimetry audit tool for comparison of planned and delivered dose distributions in high dose rate (HDR) brachytherapy.
        Phys Med Biol. 2013; 58: 6623-6640
        • Palmer A.L.
        • Bradley D.
        • Nisbet A.
        Dosimetric audit in brachytherapy.
        Br J Radiol. 2014; 87: 20140105
        • Petrokokkinos L.
        • Zourari K.
        • Pantelis E.
        • et al.
        Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part II: Monte Carlo and experimental verification of a multiple source dwell position plan employing a shielded applicator.
        Med Phys. 2011; 38: 1981
        • Palmer A.L.
        • Diez P.
        • Gandon L.
        • et al.
        A multicentre “end to end” dosimetry audit for cervix HDR brachytherapy treatment.
        Radiother Oncol. 2015; 114: 264-271
        • Moura E.S.
        • Micka J.A.
        • Hammer C.G.
        • et al.
        Development of a phantom to validate high-dose-rate brachytherapy treatment planning systems with heterogeneous algorithms.
        Med Phys. 2015; 42: 1566-1574
        • Tanderup K.
        • Beddar S.
        • Andersen C.E.
        • et al.
        In vivo dosimetry in brachytherapy.
        Med Phys. 2013; 40: 070902
        • Zourari K.
        • Pantelis E.
        • Moutsatsos A.
        • et al.
        Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part I: single sources and bounded homogeneous geometries.
        Med Phys. 2010; 37: 649
        • Mikell J.K.
        • Mourtada F.
        Dosimetric impact of an 192Ir brachytherapy source cable length modeled using a grid-based Boltzmann transport equation solver.
        Med Phys. 2010; 37: 4733
        • Zourari K.
        • Pantelis E.
        • Moutsatsos A.
        • et al.
        Dosimetric accuracy of a deterministic radiation transport based 192Ir brachytherapy treatment planning system. Part III. Comparison to Monte Carlo simulation in voxelized anatomical computational models.
        Med Phys. 2013; 40: 011712
        • Afsharpour H.
        • Landry G.
        • D’Amours M.
        • et al.
        ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.
        Phys Med Biol. 2012; 57: 3273-3280
        • Le Y.
        • Chibani O.
        • Todor D.
        • et al.
        MO-E-T-618-01: an integrated CT-based Monte Carlo dose-evaluation system for brachytherapy and its application to permanent prostate implant postprocedure dosimetric analysis.
        Med Phys. 2005; 32: 2068
        • Fonseca G.P.
        • Reniers B.
        • Landry G.
        • et al.
        A medical image-based graphical platform-features, applications and relevance for brachytherapy.
        Brachytherapy. 2014; 13: 632-639
        • Pantelis E.
        • Peppa V.
        • Lahanas V.
        • et al.
        BrachyGuide: a brachytherapy-dedicated DICOM RT viewer and interface to Monte Carlo simulation software.
        J Appl Clin Med Phys. 2015; 16: 208-218
        • Ballester F.
        • Carlsson Tedgren Å.
        • Granero D.
        • et al.
        A generic high-dose rate 192Ir brachytherapy source for evaluation of model-based dose calculations beyond the TG-43 formalism.
        Med Phys. 2015; 42: 3048-3062
        • ICRU. International Commission on Radiation Units and Measurements
        Photon, electron, proton and neutron interaction data for body tissues.
        ICRU Report 46, Bethesda, MD1992
        • Major T.
        • Fröhlich G.
        • Lövey K.
        • et al.
        Dosimetric experience with accelerated partial breast irradiation using image-guided interstitial brachytherapy.
        Radiother Oncol. 2009; 90: 48-55
        • Major T.
        • Polgár C.
        • Lövey K.
        • et al.
        Dosimetric characteristics of accelerated partial breast irradiation with CT image-based multicatheter interstitial brachytherapy: a single institution’s experience.
        Brachytherapy. 2011; 10: 421-426
        • Van Limbergen E.
        • Briot E.
        • Drijkoningen M.
        The source-skin distance measuring bridge: a method to avoid radiation teleangiectasia in the skin after interstitial therapy for breast cancer.
        Int J Radiat Oncol Biol Phys. 1990; 18: 1239-1244
        • Lettmaier S.
        • Kreppner S.
        • Lotter M.
        • et al.
        Radiation exposure of the heart, lung and skin by radiation therapy for breast cancer: a dosimetric comparison between partial breast irradiation using multicatheter brachytherapy and whole breast teletherapy.
        Radiother Oncol. 2011; 100: 189-194
        • Berger D.
        • Kauer-Dorner D.
        • Seitz W.
        • et al.
        Concepts for critical organ dosimetry in three-dimensional image-based breast brachytherapy.
        Brachytherapy. 2008; 7: 320-326
        • Van Veelen B.
        • Ma Y.
        • Beaulieu L.
        ACE advanced collapsed cone engine.
        white paper. 2014; (Available at: 1-16
        • ICRP. ICRP Publication 23
        Reference man: anatomical physiological and metabolic characteristics.
        Pergamon Press, Oxford, UK1975
        • Peppa V.
        • Zourari K.
        • Pantelis E.
        • Papagiannis P.
        Tissue segmentation significance for individualized 192Ir brachytherapy dosimetry.
        Radiother Oncol. 2013; 106: S371
        • Goorley T.
        • James M.
        • Booth T.
        • et al.
        Initial MCNP6 Release Overview.
        Nucl Technol. 2012; 180: 298-315
        • Schneider W.
        • Bortfeld T.
        • Schlegel W.
        Correlation between CT numbers and tissue parameters needed for Monte Carlo simulations of clinical dose distributions.
        Phys Med Biol. 2000; 459: 459-478
        • Carlsson Tedgren A.
        • Ahnesjö A.
        Optimization of the computational efficiency of a 3D, collapsed cone dose calculation algorithm for brachytherapy.
        Med Phys. 2008; 35: 1611
        • Tedgren Å.C.
        • Plamondon M.
        • Beaulieu L.
        The collapsed cone algorithm for 192Ir dosimetry using phantom-size adaptive multiple-scatter point kernels.
        Phys Med Biol. 2015; 60: 5313-5323
        • Gifford K.A.
        • Horton J.L.
        • Wareing T.A.
        • et al.
        Comparison of a finite-element multigroup discrete-ordinates code with Monte Carlo for radiotherapy calculations.
        Phys Med Biol. 2006; 51: 2253-2265
        • Pantelis E.
        • Papagiannis P.
        • Karaiskos P.
        • et al.
        The effect of finite patient dimensions and tissue inhomogeneities on dosimetry planning of 192Ir HDR breast brachytherapy: a Monte Carlo dose verification study.
        Int J Radiat Oncol Biol Phys. 2005; 61: 1596-1602
        • Shi C.
        • Guo B.
        • Cheng C.-Y.
        • et al.
        Applications of tissue heterogeneity corrections and biologically effective dose volume histograms in assessing the doses for accelerated partial breast irradiation using an electronic brachytherapy source.
        Phys Med Biol. 2010; 55: 5283-5297
        • Zourari K.
        • Major T.
        • Herein A.
        • et al.
        A retrospective dosimetric comparison of TG43 and a commercially available MBDCA for an APBI brachytherapy patient cohort.
        Phys Med. 2015; 31: 669-676