Monte Carlo simulation dosimetry is used to compare 169Yb to 192Ir for breast high dose rate (HDR) brachytherapy applications using multiple catheter implants. Results for bare point sources show that while 169Yb delivers a greater dose rate per unit air kerma strength at the radial distance range of interest to brachytherapy in homogeneous water phantoms, it suffers a greater dose rate deficit in missing scatter conditions relative to 192Ir. As a result of these two opposing factors, in the scatter conditions defined by the presence of the lung and the finite patient dimensions in breast brachytherapy the dose distributions calculated in a patient equivalent mathematical phantom by Monte Carlo simulations for the same implant of either 169Yb or 1921r commercially available sources are found comparable. Dose volume histogram results support that 169Yb could be at least as effective as 192Ir delivering the same dose to the lung and slightly reduced dose to the breast skin. The current treatment planning systems' approach of employing dosimetry data precalculated in a homogeneous water phantom of given shape and dimensions, however, is shown to notably overestimate the delivered dose distribution for 169Yb. Especially at the skin and the lung, the treatment planning system dose overestimation is on the order of 15%-30%. These findings do not undermine the potential of 169Yb HDR sources for breast brachytherapy relative to the most commonly used 192Ir HDR sources. They imply, however, that there could be a need for the amendment of dose calculation algorithms employed in clinical treatment planning of particular brachytherapy applications, especially for intermediate photon energy sources such as 169Yb.

Monte Carlo simulation and experimental thermoluminescence dosimetry were utilized for the dosimetric characterization of the new IsoSeed model I25.S17 125I interstitial brachytherapy seed. The new seed design is similar to that of the selectSeed and 6711 seeds, with the exception of its molybdenum marker. Full dosimetric data are presented following the recommendations in the Update of the AAPM Task Group 43 report (TG-43U1). A difference of 3.3% was found between Monte Carlo dose rate constant results calculated by air kerma strengths from simulations using a point detector and a detector resembling the solid angle subtended to the seed by the Wide Angle Free Air Chamber (WAFAC) in the primary standard calibration geometry. Following the TG-43U1 recommendations, an average value of lambdaMC = (0.929 +/- 0.014) cGy h(-1) U(-1) was adopted for the new seed. This value was then averaged with the measured value of lambdaEXP = (0.951 +/- 0.044) cGy h(-1) U(-1) to yield the proposed dose rate constant for the new seed that is equal to lambda = (0.940 +/- 0.051) cGy h(-1) U(-1). The Monte Carlo calculated radial dose function and two-dimensional (2-D) anisotropy function results for the new seed were found in agreement with experimental results to within statistical uncertainty of repeated measurements. Monte Carlo simulations were also performed for 125I seeds of similar geometry and dimensions for the purpose of comparison. The new seed presents dosimetric characteristics that are very similar to that of the selectSeed. In comparison to the most extensively studied Amersham 6711 seed, the new one presents similar dosimetric characteristics with a slightly reduced dose rate constant (1.5%).

For the purpose of evaluating the use of 169Yb for prostate High Dose Rate brachytherapy (HDR), a hypothetical 169Yb source is assumed with the exact same design of the new microSelectron source replacing the 192Ir active core by pure 169Yb metal. Monte Carlo simulation is employed for the full dosimetric characterization of both sources and results are compared following the AAPM TG-43 dosimetric formalism. Monte Carlo calculated dosimetry results are incorporated in a commercially available treatment planning system (SWIFT), which features an inverse treatment planning option based on a multiobjective dose optimization engine. The quality of prostate HDR brachytherapy using the real 192Ir and hypothetical 169Yb source is compared in a comprehensive analysis of different prostate implants in terms of the multiobjective dose optimization solutions as well as treatment quality indices such as Dose Volume Histograms (DVH) and the Conformal Index (COIN). Given that scattering overcompensates for absorption in intermediate photon energies and distances in the range of interest to prostate HDR brachytherapy, 169Yb proves at least equivalent to 192Ir irrespective of prostate volume. This has to be evaluated in view of the shielding requirements for the 169Yb energies that are minimal relative to that for 192Ir.