Verification of Treatment Time in Interstitial Brachytherapy using Paris System
1
Sharif Ahmed, 2 Prof.Dr.Hasin Anupama Azhari
Department of CSE & MPBME
Gono Bishwabidyalay, Bangladesh
Email:diptosharifahmed@gmail.com
ahasinanupama@hotmail.com
Abstract: Brachytherapy (BT) is a one kind of radiation
therapy where sources are placed into or near the tumor for
giving a high radiation dose. Now a days, most of the
hospitals are doing intra cavitory treatment in Bangladesh
and interstitial brachytherapy is rarely practiced. Quality
assurance is a part and parcel of brachytherapy treatment
while appropriate quality assurance measures to minimize
risks to both patients and medical staff. One of the
important test of QA of brachytherapy treatment is
verification of TPS dose calculation. The purpose of study
is to verify the treatment time in interstitial brachytherapy
using Paris System. MATLAB (2016 a) and a test case of
Paris system has been used in this study. A case for a
single plane where 6 catheters (7cm length), 15dwell
position for each catheter and 0.15 cm distance between
dwell position have been used. This study has been done
according to the principle of Paris System, all catheters has
been inserted according to the ICRU 58 and dose rate
calculation was done according to TG 43 protocol. This
study identified the central plane from which the basal
points were determined between the wires. The co-
ordinates of basal point and dwell position are needed for
determination of distance as well as mean basal dose rate
(BDR) for each catheter using Mat lab. As 85 % of BDR is
the RDR (reference dose rate) so treatment time has been
calculated after correcting BDR and RDR.The total
treatment time for calculated and test case were 225.4 sec.
and 225.7 sec. The deviation between these is only 0 .3
second, which is acceptable. It is standard practice in BT to
have a second, independent check of the treatment plan. It
is one and utmost duty of a medical physicist to perform
the TPS dose verification other than electrical check,
mechanical
Keywords:check, dosimetry and
Interstitial radiation safety Paris
Brachytherapy, check
Therefore this study will be helpful for the practicing of
system, Treatment time verification.
Paris system for the interstitial brachytherapy besides
intracavitary brachytherapy that might open the new era of
cancer treatment Introduction
in Bangladesh.
Brachytherapy is a form of radiotherapy where a
Introduction
sealed radiation source is placed inside or next to
the area requiring treatment. Brachytherapy is
commonly used as an effective treatment for
cervical, prostate, breast, and skin cancer and can
also be used to treat tumors in many other body
sites[1].
Sujan Mahamud
Department of Medical Physics
&Biomedical Engineering (MPBME)
Gono Bishwabidyalay, Bangladesh
Email:sujan.mpbme@gmail.com
Interstitial breast brachytherapy involves
the temporary placement of several
flexible plastic catheters in the breast
tissue. These are carefully positioned to
allow optimal targeting of radiation to the
treatment area while sparing the
Surrounding breast tissue. The catheters
are connected to an afterloader, which
delivers the planned radiation dose to the
treatment area [2]. The Paris System is a
complete dosimetric system which greatly
facilitates brachytherapy, using iridium 192
sources at low, pulsed or high dose-rate.
The briefly of the part of the system
dedicated to interstitial brachytherapy.
After a short description of the sources
which can be used, the three basic
principles of the Paris System are
presented together with its particular
mode of dose specification within the
implanted volume, and the fixed value of
the Reference Isodose (RI) equal to 85% of
the Basal Dose-rate (BD), representative of
the arithmetic mean of the minimal dose-
rates in the central region of the implant
[3].
To treatment according to brachytherapy
every checking part is important. Checking
system means here comes QA and QC.The
widespread adoption of high dose rate
brachytherapy with its inherent dangers
necessitates adoption of appropriate
quality assurance measures to minimize
risks to both patients and medical staff.
Quality control, or QC for short, is a
process by which entities review the
quality of all factors involved in
production. ISO 9000 defines quality
control as "A part of quality management
focused on fulfilling quality
requirements[4].
Theoretical Background
Verification of Treatment Time in Interstitial Brachytherapy using Paris System
Interstitial Brachytherapy: Radiotherapy by
implantation of radioactive needles or other sources
directly into and around tissue to be irradiated.
Interstitial brachytherapy has a long tradition,
starting with radium needles being implanted in
superficial tumors in the 1930s. The implant systems
developed at the time, Manchester and Quimby, still
guide the needle placement patterns used in
implants today. Though radium needles where
initially used for interstitial implants, other
radioactive nuclei were developed over time. Low
dose rate (LDR) ribbons of 192Ir or 137[5].
TG-43 Formalism:
The TG-43 formalism is
Dr,) =Sk..1/r2.gL(r).F(r,)
Where Sk= Reference Air Kerma Strength
=Dose rate constant
r=Distance between midpoint of dwell position and
basal point
gL(r)=Radial Function
F(r,)=Anisotropy Function
Sk= Reference Air Kerma Strength
Paris System Related Parameter: The Paris System-
The Paris system was proposed in the 1960s to fulfill
the requirements of after loading interstitial
implants with iridium-192 wires. The Paris system
adjusts the source spacing and source length within
limits to match the dimensions of the target volume.
The reference isodose, where the dose is prescribed,
is a fixed percentage of the basal dose so that the
reference dose is located outside the volume
[6defined by the sources. If the guidelines are
followed, then the reference isodose surface should
encompass the whole target volume [6].
Central Plane: For source patterns in which the
source lines are straight, parallel, of equal length,
and with centers, which lie in a plane perpendicular
to the direction of the source lines, this plane is the
central plane [7].
Dose related parameter in Paris System: Dose rate-
The dose delivered per unit time is called dose rate.
According to ICRU report 38, treatment dose rates
fall into three categories Low Dose Rate (LDR)
brachytherapy ranges between 0.4 and 2 Gy/h
Basal dose rate: Basal dose rate: The arithmetic
mean of the minimum dose rate, which is located
halfway between the sources in the well-defined
patterns used in the Paris System.
Reference Dose Rate: The reference dose
rate (RDR) is the dose rate used as the
basis for dose prescription and hence for
calculating the total time of the implant.
The reference dose rate is not defined as
85% of the basal dose rate. It can usually
be set to 85%, but the percentage can
vary in order to achieve less hot volume or
a better coverage of the target.
Reference Isodose, Treated volume, Hyper
dose volume: Reference Isodose - The
reference isodose has a value equal to
85% of the basal dose. This value is based
upon clinical experience.
Treated Volume - The volume surrounded
by the 85% isodose surface.
Hyper dose volume - The volume of the
170% of the basal dose (twice the
reference isodose)[8].
Materials
Mat lab Software (2016a): MATLAB
(matrix laboratory) is a multi-paradigm
numerical computing and proprietary
programming language developed by
math works. MATLAB allows matrix
manipulations, plotting of functions and
data, implementation of algorithms,
creation of user interfaces, and interfacing
with programs written in other languages,
including C,C++,C#, Java, Fortran and
Python[10].
A test case of Paris System that was
collected from Germany [11].
Method
Verification of Treatment Time in Interstitial Brachytherapy using Paris System
Identification of the central plane: In work used 6
catheters (Figure2.1), each catheter has 15 dwell
positions, 7 cm length, 0.5 cm distance between
dwell position and catheter separation 1 cm. As
catheter length 7cm /70 mm so used central
plane is 3.5 cm /35 mm.
Determination of the basal point between the
wires: In work used single plane and the catheter
separation is 100 mm. So the basal point is 50
mm between two wires.
Calculation the dose rate of dwell position for
each catheter: For dose rate calculation used TG-
43 equation- Dr,) = Sk..1/r2.gL(r).F(r,)
Step: 1 Calculation the distance between the
basal point co-ordinate and the midpoint of
dwell position co-ordinate- Given the X, Y, Z
value of basal point and the midpoint of dwell
position co ordinate. For easily calculation here
used basal point co ordinate A1, A2, A3 instead of
X, Y, Z and midpoint of dwell position co ordinate
S1, S2, S3 instead of X, Y, Z.
This equation used to calculate the distance r
r= √ (𝑆1 –𝐴1)2 + (𝑆2 –𝐴2)2 + (𝑆3−𝐴3)2
Like as catheter 1 first dwell position
r =√ (-1.3+1.3) 2+(-40.7+55.7)2+ (63.1-58.1) 2
=15.811mm
=1.5 cm
Step: 2
Sk= Reference Air Kerma Strength
Given treatment case air kerma strength is
41.48854
Step: 3
=Dose rate constant
From treatment case dose rate constant is 1.111
Step: 4
gL(r) =Radial Function
The radial dose function, g(r), is calculated using
both line and point source
Geometry functions and tabulated at 36 different
radial distances ranging from 0.2 cm to 20 cm.
Fitting coefficients for g L (r) = (a0 r-2 + a1 r-1 + a2 +
a3r + a4r2 + a5 r3) e-a6r
Step: 5
F(r,) =Anisotropy Function
Anisotropy functions are calculated using the line and
point source approximation and tabulated at 12 radii
from 0.25 cm to 20 cm.
The anisotropy factor, φ an (r), was
calculated by integrating the solid angle
weighted dose rate over 0° ≤ ϑ ≤ 180°.
Step: 6 TG-43 protocols: For dose rate
calculation used this equation
Dr,) = Sk..1/r2.gL(r).F(r,)
Catheter 1 dwell position P1
Dr,) = Sk..1/r2.gL(r).F(r,)
=41.48854 * 1.111 * 1/1.52 * .62 * 1
=11.4312544 cGy.h-1
=0.114312544 Gy.h-1
Verification of dose rate using Mat lab
software2016 a.
Mean basal dose rate: Mean basal dose
rate for each catheter .6914Gy.h-1
Corrected mean basal dose rate: Correcting
for the wire strength used: i.e. 450nGy.h-
1mm-1 at 1metre.
= 0.45μGy.h-1mm -1 at 1metre
Therefore multiply the totals by 0.45
Corrected Mean Basal Dose
Rate=0.31113Gy.h-1
Reference dose rate: Reference dose rate
multiply the mean basal dose rate has to
calculated by 85%. Reference Dose
Rate=0.85*0.3113Gy.h-1
=0.2644605Gy.
Treatment time- The ratio of total dose
and reference dose rate will be treatment
time.
Time for 65Gy = 65/0.28826194=
225.4second
Results
The distance between the basal point co
ordinate and the midpoint of dwell position
co ordinate for 6 catheters.
Table 1: Number of Catheter 1
Verification of Treatment Time in Interstitial Brachytherapy using Paris System
Table 2: Number of Catheter 2
Table 3: Number of Catheter 3
Table 4: Number of Catheter 4
Table 5: Number of Catheter 5
Table 6: Number of Catheter 6
Treatment Time verification:
Treatment time 224.4s
Treatment time for test case 225.7s
Time error 0.3 s
Conclusion
Brachytherapy is used to destroy cancer
cells by using an internal source of
radiation. Radiation from internally
placed radioactive seeds disrupts the
growth of cancer cells. Radiated cancer
cells are not able to repair themselves or
replicate. Radiation damages all cells-
both healthy and cancerous, in the
exposed area. Brachytherapy spares as
many healthy cells as possible because it
directs radiation to only a specific area.
Brachytherapy is used as a treatment for
many types of cancer, including sarcomas
and prostate, breast, lung, gynecological,
headanneck,andcolorectalcancers.
Brachytherapy can be delivered in high
dose rates (HDR) or low dose rates (LDR).
HDR brachytherapy is delivered for
several minutes and then withdrawn.
LDR brachytherapy remains in the body
longer. Brachytherapy procedure may
result in acute tissue reactions like
edema, causing deviations between
planned and measured doses.
Verification of treatment time is a part of
QA. It is important to check for interstitial
brachytherapy treatment
Verification of Treatment Time in Interstitial Brachytherapy using Paris System

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