Endovascular brachytherapy: dosimetry and dose-area analysis of various radiation sources

With the increase in popularity of endovascular brachytherapy for prevention of restenosis following coronary angioplasty, it remains to be determined which isotope and isotope form is the most ideal. An issue concerning the use of wire sources is the influence of the centering of the wire on dose uniformity across the artery wall and the potential problems this can lead to in terms of underdosage of the target tissues. In this investigation, the dosimetric characteristics of three currently used sources (gamma-emitting 192Ir wire; beta-emitting 32P wire; and beta-emitting 188Re solution) were determined with EGS4 Monte Carlo. The dose results were then used to determine the dose-area relationships for the three sources in arteries with concentric and non-concentric lumens/walls, including situations in which the wire sources are moved away from the centre of the artery. It is found that, in order to ensure dose uniformity, centering is substantially more important for beta-emitting wire sources. This is highlighted most significantly in the case of an example large irregular artery. Although the suitability of a source depends on many criteria (e.g., cost, availability, radiation protection, possible radiation-induced late effects), the problem of centering a wire source in possibly large and/or irregular arteries is greatly eased by the use of a gamma-emitting source.