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Brachytherapy BRACHYTHERAPY Edited by Kazushi Kishi Brachytherapy Edited by Kazushi Kishi Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Vana Persen Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published April, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from [email protected] Brachytherapy, Edited by Kazushi Kishi p. cm. ISBN 978-953-51-0602-9 Contents Preface IX Section 1 In Physics of Brachytherapy 1 Chapter 1 A Review on Main Defects of TG-43 3 Mehdi Zehtabian, Reza Faghihi and Sedigheh Sina Chapter 2 Dose Calculations of the Ru/Rh-106 CCA and CCB Eyes Applicators 17 Itzhak Orion and Emanuel Rubin Section 2 Californium 31 Chapter 3 Progress in Californium-252 Neutron Brachytherapy 33 C.-K. Chris Wang Section 3 Practice of Brachytherapy 59 Chapter 4 Theoretical, Manufacturing and Clinical Application Aspects of a Prostate Brachytherapy I-125 Source in Brazil 61 Carlos A. Zeituni, Carla D. Souza, Eduardo S. Moura, Roberto Kenji Sakuraba, Maria Elisa C.M. Rostelato, Anselmo Feher, João A. Moura, Samir Somessari and Osvaldo L. Costa Chapter 5 High Dose Rate Endobronchial Brachytherapy in Lung Cancer in Patients with Central Airway Obstruction 79 Alejandro B. Santini, Benjamín G. Bianchi, Dionis D. Isamitt, Claudia C. Carvajal and Gonzalo P. Silva Section 4 Novel Strategy and Applications 89 Chapter 6 Stereotactic Brachytherapy for Brain Tumors 91 Maximilian I. Ruge, Stefan Grau, Harald Treuer and Volker Sturm VI Contents Chapter 7 Safe and Curative Brachytherapy Reirradiation with Organ-Sparing Hyaluronate Gel Injection 109 Kazushi Kishi, Yasutaka Noda and Morio Sato Preface Science of brachytherapy is currently increasing in the field of cancer therapy. By virtue of the development of computer assisted technologies, we can reap the benefits of accurate radiotherapies more than ever, which enabled precise irradiation to a target safely avoiding unnecessary involvement of the surrounding normal tissue. Unlike teleradiotherapy provided by X-ray linear accelerator, brachytherapy utilizes radiation source placing inside or close to the target. Taking advantage of practical availability of the physical characters including decay modes, half-lives, and decay energies of the radioisotopes, various practical insertion or deployment methods have been developed. Some of these are technically sophisticated. A precise treatment planning requires accurate dose calculation algorithm even in brachytherapy. In the clinical practice of brachytherapy, safe interventional procedures are indispensable. Reverse, a simultaneous intervention modifying the surrounding structure may be practically applicable. In the first section, In Physics of Brachytherapy, Zehtabian et al. addresses the problem of currently popular dosimetric method (AAPM TG-43) based on experimental data. Orion et al. reports a potential benefit of Monte Carlo method in dose calculations of ruthenim-106/rhodium-106 (beta emitters) eyes applicators. In the second section, Californium, Wang present an excellent review of Progress in Californium-252 (Cf-252) Neutron Brachytherapy, including history, availability, fabrication, biological basis, dosimetry and clinical data including promising future possibilities. In the third section, Practice of Brachytherapy, Santini et al. reports their clinical case series study of high dose rate endobronchial brachytherapy in central airway tumor obstruction. Impressive result indicate a singinficant rationale of brachytherapy in this situation. Zeituni et al. elaborate a comprehensive review from principle and techniques of Iodine-125 production at nuclear reactor plant to their clinical practive in prostate cancer treatment. In the last section, Novel Strategy and Applications, Ruge et al present a very interesting review with their clinical practices of Stereotactic Brachytherapy for Brain Tumors using Iodine-125 seed. We may reappraise our current concepts in the treatment of gliomas that has never been satisfactory controlled. In the last chapter, Kishi et al introduce a brachytherapy procedure with organ-sparing hyaluronate gel injection as a simultaneous intervention, which enabled safe and eradicative reirradiation, by modifying the surrounding structure during the irradiation. X Preface Though this book is not an unabridged review of brachytherapy, it is full of essences to make a breakthrough in radiation oncology by brachytherapy. I hope this book will encourage all people from related fields. Acknowledgement I would like to thank all contributors, all people related and especially Ms. Vana Persen, the wonderful Publishing Process Manager, my mentors, and my family who have supported me throughout the term. Dr Kazushi Kishi M.D., Ph.D., Department of Radiology, Wakayama Medical University, Japan Section 1 In Physics of Brachytherapy 1 A Review on Main Defects of TG-43 Mehdi Zehtabian1, Reza Faghihi1,2 and Sedigheh Sina1,2 1Nuclear Engineering Department, School of Mechanical Engineering, Shiraz University, 2Radiation Research Center, School of Mechanical Engineering, Shiraz University, Iran 1. Introduction The Sivert integral and modular dose calculation models (TG-43) are two methods used for calculation of dose distributions around a brachytherapy source (Khan, 2003). Among all methods used for calculation of dose distributions, TG-43 has become most popular and most promising method because it uses the quantities measured in the medium to calculate dose rates. In this chapter, we will explain the TG-43 dose calculation formalism and after verification of the main reason of its popularity, we will review main defects of this formalism. 1.1 TG-43 formalism In 1995, the American Association of Physicists in Medicine (AAPM)) published a report on the dosimetry of sources used in interstitial brachytherapy, Task Group No. 43 (TG-43) (Nath et al., 1995). This report introduces dose calculation formalism utilizing new quantities like air kerma strength (SK), dose rate constant (Λ), geometry function (G (r,θ)), radial dose function (g (r)), and anisotropy function (F (r,θ)). These dosimetry parameters consider geometry, encapsulation and self-filtration of the source, the spatial distribution of radioactivity within the source, and scattering in water surrounding the source. According to this protocol, the absorbed dose rate distribution around a sealed brachytherapy source at point P with polar coordinates (r, ) can be determined using the following formalism: . Gr,θ , Λ , (1) Gr, θ where r is the distance to the point P and is the angle with respect to the long axis of the source, and (r0, 0) is reference point that r0= 1 cm and 0= /2 (Fig. 1). 1.1.1 Air kerma strength Air kerma strength, Sk, acounts for brachytherapy source strength and is defined as the product of air kerma rate at a calibration distance (d) in free space, which is usually chosen to be 1 m, along the transverse axis of the source and the square of the distance (d2), Sk=K (d)d2 (2) 4 Brachytherapy Fig. 1. The geometry of brachytherapy sources used in TG-43 formalism (Nath et al., 1995). Where K (d) is the air kerma rate, and d is the calibration distance (d). The unit of SK is U (1 U =1 cGy cm2 h-1). 1.1.2 Dose rate constant Dose rate constant, , is defined as dose rate at 1 cm along transverse axis (0=/2) of the source per unit air kerma strength (U) in a water phantom. Dose rate constant of a brachytherapy source is obtained as below: ,/ (3) Λ has units of cGy h-1 U-1. As indicated in Task Group No. 43, the effects of source geometry, the spatial distribution of radioactivity within the source, encapsulation, and self-filtration within the source and scattering in water surrounding the source is considered by this parameter. 1.1.3 Geometry function Spatial distribution of radioactivity within the source and the slump of the photon fluence with distance from the source are considered by Geometry function, G (r, ), with the unit of cm-2. For point sources, the geometry function indicates the inverse square law. , , (4) , As it is shown in Figure 1, L is the source active length and β =2-1 is the angle covering active source from the point (r, ). A Review on Main Defects of TG-43 5 1.1.4 Radial dose function Radial dose function, g (r), takes into account slump of dose rate arising from absorption and scattering in the medium on the transverse axis of the source and can be affected by self filtration, and encapsulation. According to AAPM Task Group 43, radial dose function is defined as: ., , (5) . ,, This quantity is defined just on transverse axis, i.e., 0=/2. As it is obvious from equation 9.5, effect of the geometric falloff of the photon fluence with distance from the source (inverse square law) has been suppressed by G (r0, 0)/G (r, 0).
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