The use of low energy photons in brachytherapy : dosimetric and microdosimetric studies around 103Pd and 125I seeds
(2005)
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- (en) The general context of this work is the use of low energy photon sealed sources in brachytherapy. We have worked in particular on two isotopes: I-125 (mean energy of 27 keV) and Pd-103 (mean energy of 21 keV). The sealed sources are prepared as cylindrical seeds 4.5 mm in length and 0.8 mm in radius. Even if the external dimensions are standard, the internal design can be extremely different from one model to the other as the manufacturers try to improve the dosimetric characteristics of their sources. These isotopes are used mainly as permanent implants for prostate tumours but can also be used in the treatment of eye tumours. Compared to the higher energy photon sources, they offer the physical advantages of a safer manipulation from a radioprotection point of view and of the reduction of the dose to the surrounding healthy tissues. When performing a clinical treatment, it is absolutely mandatory to be able to report very precisely various parameters that can have an impact on the patient treatment outcomes. These parameters are, for example, the prescribed dose, the doses at different organs, the degree of uniformity that has been achieved on the target or some dose-volume information. The brachytherapy treatment planning systems (TPS) also permit more and more to conform the treatment to the patient anatomy, like in external treatments. In the case of prostate tumours, it has been possible for a few years, using ultrasound imaging, to check the positioning of the seeds and to calculate the dose distribution in real time during the implantation procedure. It is clear that to achieve a good precision in the treatment itself, the sources dosimetric characteristics must be known with a maximum of precision. As at these low energies the dosimetric characteristics are very dependant on the internal design, this implies a thorough study of any new source design. This is the subject of the first part of this work with the determination of the dosimetric characteristics of two new models of seed produced by the IBt Company. That determination has been done using measurements with thermoluminescent detectors and Monte Carlo calculations with two codes: MCNP4C and EGSnrc. The comparison of these two codes with the measurements has brought into evidence the necessity to use up to date cross section libraries during the calculations and to take into account the presence of the detectors during the measurements. However, the dosimetry is only one part of the problem when dealing with these low energy sources in radiotherapy. The irradiated materials are complex living tissues, composed of many substructures on which radiations have not always the same impact. It is now largely accepted that the most radiosensitive part of a living cell is the DNA. When photons interact with matter, they produce electrons that deposit their energy as ionisations and excitations of the atoms. These ionisations, if they occur with or close to the DNA molecule, are responsible for damaging it. That structure can support a certain amount of damage and stay functional thanks to repair mechanisms, but these mechanisms have limits in the way they can handle multiple breaks in the DNA strands. If these breaks are too close in space and time, repair is not possible and the cell dies. [...]
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Reniers, B. (2005). The use of low energy photons in brachytherapy : dosimetric and microdosimetric studies around 103Pd and 125I seeds. https://hdl.handle.net/2078.5/129694