Background and purposeA substantial reduction of uncertainties in clinical brachytherapy should result in improved outcome in terms of increased local control and reduced side effects. Types of uncertainties have to be identified, grouped, and quantified.MethodsA detailed literature review was performed to identify uncertainty components and their relative importance to the combined overall uncertainty.ResultsVery few components (e.g., source strength and afterloader timer) are independent of clinical disease site and location of administered dose. While the influence of medium on dose calculation can be substantial for low energy sources or non-deeply seated implants, the influence of medium is of minor importance for high-energy sources in the pelvic region. The level of uncertainties due to target, organ, applicator, and/or source movement in relation to the geometry assumed for treatment planning is highly dependent on fractionation and the level of image guided adaptive treatment. Most studies to date report the results in a manner that allows no direct reproduction and further comparison with other studies. Often, no distinction is made between variations, uncertainties, and errors or mistakes. The literature review facilitated the drafting of recommendations for uniform uncertainty reporting in clinical BT, which are also provided. The recommended comprehensive uncertainty investigations are key to obtain a general impression of uncertainties, and may help to identify elements of the brachytherapy treatment process that need improvement in terms of diminishing their dosimetric uncertainties. It is recommended to present data on the analyzed parameters (distance shifts, volume changes, source or applicator position, etc.), and also their influence on absorbed dose for clinically-relevant dose parameters (e.g., target parameters such as D90 or OAR doses). Publications on brachytherapy should include a statement of total dose uncertainty for the entire treatment course, taking into account the fractionation schedule and level of image guidance for adaptation.ConclusionsThis report on brachytherapy clinical uncertainties represents a working project developed by the Brachytherapy Physics Quality Assurances System (BRAPHYQS) subcommittee to the Physics Committee within GEC-ESTRO. Further, this report has been reviewed and approved by the American Association of Physicists in Medicine.

Cs (IsoRay Medical model CS-1 Rev2). Observations are included on the behavior of these dosimetry parameters as a function of radionuclide. Recommendations are presented on the selection of dosimetry parameters, such as from societal reports issuing consensus datasets (e.g., TG-43U1, AAPM Report #229), the joint AAPM/IROC Houston Registry, the GEC-ESTRO website, the Carleton University website, and those included in software releases from vendors of treatment planning systems. Aspects such as timeliness, maintenance, and rigor of these resources are discussed.Links to reference data are provided for radionuclides (radiation spectra and half-lives) and dose scoring materials (compositions and mass densities). The recent literature is examined on photon energy response corrections for thermoluminescent dosimetry of low-energy photon-emitting brachytherapy sources. Depending upon the dosimetry parameters currently used by individual physicists, use of these recommended consensus datasets may result in changes to patient dose calculations. These changes must be carefully evaluated and reviewed with the radiation oncologist prior to their implementation.

A hypothetical, generic HDR (192)Ir source was designed and implemented in two commercially available TPSs employing different MBDCAs. Reference dose distributions for this source were benchmarked and used for the evaluation of MBDCA calculations employing a virtual, cubic water phantom in the form of a CT DICOM image series. The implementation of a generic source of identical design in all TPSs using MBDCAs is an important step toward supporting univocal commissioning procedures and direct comparisons between TPSs.

This work provides full dosimetric data for the new selectSeed 125I prostate seed source to be distributed by Nucletron B.V. The AAPM TG-43 dosimetric formalism and the new 1999 NIST air kerma strength calibration standard have been followed. Air kerma strength, dose rate constant, radial dose functions, anisotropy functions, and anisotropy factors were calculated using Monte Carlo simulation. Corresponding calculations were also performed for the commercially available 6711 seed source, which is of similar design, for reasons of comparison. The calculated dose rate constant of the selectSeed was 0.954+/-0.005 cGy h(-1) U(-1) compared to 0.953+/-0.005 cGy h(-1) U(-1) for the 6711 source design. The latter value for the 6711 source suggests that the correction factor proposed by NIST for conversion of dose rate constants to the new 1999 NIST calibration standard may be overestimated by 2-3%. Radial dose functions of the two sources were found in good agreement for radial distances up to 4 cm, the selectSeed being less penetrating at greater radial distances (approximately 4% at 10 cm). The selectSeed source presents similar anisotropy characteristics with the 6711 source design. For both source designs, a distance and polar angle dependent discontinuity of anisotropy function values was observed owing to the dose contribution of radioactivity distributed on the ends of the cylindrical source cores. Variation of dosimetric parameters with possible variation in radioactive silver halide coating thickness of the silver source core of the new source was also investigated.