The evaluation of optimized implants for idealized implant geometries

The purpose of this paper is to investigate the utility of implant quality measures on single stepping-source brachytherapy treatment plans. Four dwell weight optimization algorithms were applied to four regular geometric implants: single plane, double plane, cuboid, and cylindrical. The dwell weight optimization schemes included equal weighing, two commercial optimization schemes (dose-point and geometric) and a variation of the Paterson-Parker distribution rules. The implant quality measures were investigated as a function of dose-per-integrated reference air kerma (IRAK) to eliminate bias resulting from a prescription choice. A particular dose per IRAK refers to a dose surface that is a function only of the relative dwell weight distribution and is therefore well suited to investigate dwell weight optimization schemes. The implant quality measures included the dose-nonuniformity ratio (DNR) developed by Saw and a coverage index to assess the isodose coverage relative to the implanted volume. These were termed direct quantities due to their clear clinical significance. Additional measures include the ratio of the implant dose-volume histogram (DVH) to that of a point source exhibiting the same IRAK (Rp) and the ratio of the optimized DVH to the equally weighted DVH (EWR). The widths of the Rp curves and depths of the EWR curves were used to characterize these indirect implant quality measures. To evaluate the effectiveness of both the direct and indirect measures, they were correlated with the DNR for an isodose surface that covered the implant (D0). The efficiency of the dwell weight distribution was examined by noting the dose-per-IRAK surface D0.(ABSTRACT TRUNCATED AT 400 WORDS)