Quality assurance measurements for high-dose-rate brachytherapy without film

The purpose of this study was to develop new and modified tools that allow HDR brachytherapy quality assurance tests to be carried out efficiently without film, video cameras, stopwatches, and mechanical rulers; and to devise methods that use these new tools for daily and quarterly check procedures, which are efficient and provide increased accuracy compared to previous methods. The HDR brachytherapy system tested was the GammaMedplus iX, Ir-192 HDR. Various catheters and treatment applicators designed for this system were tested. To measure the absolute position of the source, a simple tool was built that uses a Plexiglas frame, a template for applicator positioning, and a diode for radiation detection. For daily reproducibility and source strength tests, modifications were made of a Model 70008, HDR brachytherapy Ir-192 quality assurance tool, which is used with the HDR-1000-Plus well-type reentrant chamber. Measurement procedures and analysis protocols were developed that use the Microsoft Excel spreadsheet program. Independent determination of source positions was made with a computer video camera and radiochromic film. Using the new tool, for a straight catheter the measured source position is found to be within ± 0.1 mm of the mechanically set distance, for a ring applicator ± 0.3 mm, for a tandem ± 0.2 mm, and for an ovoid ± 0.2 mm. Using the modified insert, daily dwell position can be determined with an accuracy of 0.3 mm and timer accuracy can be determined with an accuracy of 0.3% over a 20 s time frame. The time needed to carry out quarterly tests is estimated to be reduced by two- to four-fold compared to previous methods. New and modified equipment and procedures have been developed for measuring HDR brachytherapy dwell position and dwell times efficiently with high accuracy. The equipment described in this work can be built and modifications can be made in most clinics. Location of dwell position can be determined in straight catheters and ring and ovoid applicators. Timer linearity and accuracy can be determined. Source strength can be confirmed. Measurement efficiency is improved compared to previous methods that used film, video cameras, mechanical rulers, and stopwatches.