A comparative assessment of inhomogeneity and finite patient dimension effects in (60)Co and (192)Ir high-dose-rate brachytherapy

PURPOSE: To perform a comparative study of heterogeneities and finite patient dimension effects in (60)Co and (192)Ir high-dose-rate (HDR) brachytherapy. MATERIAL AND METHODS: Clinically equivalent plans were prepared for 19 cases (8 breast, 5 esophagus, 6 gynecologic) using the Ir2.A85-2 and the Co0.A86 HDR sources, with a TG-43 based treatment planning system (TPS). Phase space files were obtained for the two source designs using MCNP6, and validated through comparison to a single source dosimetry results in the literature. Dose to water, taking into account the patient specific anatomy and materials (D(w,m)), was calculated for all plans using MCNP6, with input files prepared using the BrachyGuide software tool to analyze information from DICOM RT plan exports. RESULTS: A general TG-43 dose overestimation was observed, except for the lungs, with a greater magnitude for (192)Ir. The distribution of percentage differences between TG-43 and Monte Carlo (MC) in dose volume histogram (DVH) indices for the planning target volume (PTV) presented small median values (about 2%) for both (60)Co and (192)Ir, with a greater dispersion for (192)Ir. Regarding the organs at risk (OARs), median percentage differences for breast V(50%) were 3% (5%) for (60)Co ((192)Ir). Differences in median skin D(2cc) were found comparable, with a larger dispersion for (192)Ir, and the same applied to the lung D(10cc) and the aorta D(2cc). TG-43 overestimates D(2cc) for the rectum and the sigmoid, with median differences from MC within 2% and a greater dispersion for (192)Ir. For the bladder, the median of the difference is greater for (60)Co (~2%) than for (192)Ir (~0.75%), demonstrating however a greater dispersion again for (192)Ir. CONCLUSIONS: The magnitude of differences observed between TG-43 based and MC dosimetry and their smaller dispersion relative to (192)Ir, suggest that (60)Co HDR sources are more amenable to the TG-43 assumptions in clinical treatment planning dosimetry.