ICRU-58 RECOMMENDATIONS FOR

DOSE REPORTING

BY
PRATISHTHA SHARMA
ALKA KATARIA
SALONI CHAWLA
 INTERSTITIAL
IMPLANTS
Temporary Implant
• Radioactive source is removed
from the tissue after the
treatment.
• Total time of implantation
depends upon the no. of sources ,
their strength and pattern.
• Dose distribution can be changed
by the manipulation of dwell time.
Permanent Implant
• Radioactive source remain in
the tissue.
• No. of sources depends upon
their initial strength.
•No possibility of change in the
dose distribution.
 Source Specification

Total Reference Air Kerma :

Sum of the product of reference air Kerma rate and irradiation time for each
source where reference air Kerma rate is Kerma rate in air at reference
distance 1 m and corrected for air attenuation and scattering.
Units: μ Gy/hr at 1 m

The simple determination of the total reference air Kerma does

not, however, allow one to derive, even approximately, the
absorbed dose in the immediate vicinity of the sources ( in the
tumor or target volume).
 VOLUMES

VOLUMES

GTV (Gross CTV (Clinical PTV (Planning TV (Treated

Tumor Volume) Target Volume) Target Volume) Volume)

• Tissue volume
which contains GTV In interstitial That Volume which
Gross palpable or brachy therapy is encompassed by
and microscopic
visible extent and PTV is in general an isodose surface
malignant disease.
location of identical to CTV appropriate to
• This volume
malignant growth. with very few achieve the
should be treated
adequately in order exceptions. purpose of
to achieve the aim treatment.
of therapy.
DESCRIPTION OF SOURCE PATTERNS
 Essentially all implants are volume implants so it could not be used
to describe the specific implant .
 A single plane implant
An implant containing two or more sources which lie in the same
plane.
In some instances, the sources lie in a single curved surface.
 A two plane implant
Two planes which are generally parallel to each other.
 Larger implants can often be described according to the number of
planes of sources used.
If the implant is not formed in recognizable planes,
the location of the sources relative to a plane passing through the
center of the implant or by a specific geometrical configuration (e.g.,
sphere or cylinder).
 Planes

Central plane:
Plane perpendicular to the direction of the source lines.(where, source lines are
straight , parallel and of equal length.)

 LINEAR SOURCES WITH PARALLEL IMPLANTATION

 LINEAR SOURCES WITH NON PARALLEL IMPLANTATION
 COMPLEX IMPLANT
 DOSE DISTRIBUTION

1) One plane :Central plane of implant is chosen

2) Dose distribution in other areas: Multiple
planes for isodose calculation either
Parallel
OR
Perpendicular to the central plane.
DESCRIPTION OF DOSE DISTRIBUTION
 Non-homogenous
 Steep dose gradients

 Regions of high dose surrounding each source.

 Within the volume of the implant, there are regions where the dose
gradient approximates a plateau.
PLATEAU REGION
 The regions of plateau dose are equidistant between adjacent
neighbouring sources, for sources of identical linear activity.
 They are regions of local minimum doses.

 Variations in the dose between the different plateau doses can be used
t o describe the dose uniformity of an implant.
 A region of plateau dose is the place where the dose can be calculated
most reproducibly and compared easily by different departments.
Prescribed Dose :
 Dose defined at the time of planning by the team of radiation oncologist and
medical physicist.
Minimum Target Dose (MTD) :
 Minimum dose at the periphery of the CTV.
 It should be adequate to treat CTV.

 It defines the treatment volume and should entirely encompass the clinical
target volume.
MINIMUM PERIPHERAL DOSE : AMERICAN CENTRES (MISNOMER)
 90% of the Prescibed dose ( Manchester System For Interstitial Therapy.)

 The MTD is known as the reference dose in the PARIS system.

Mean Central Dose(MCD) :
 It is taken to be the arithmetic mean of the local minimum doses b/w sources
in the central plane OR central planes
 MEAN CENTRAL DOSE

Implant in more than Complex Implants

Implant in one plane
one plane

• Arithmetic mean of the •Single plane may

• MCD is in the
local minimum doses not include all the
central plane
b/w each set of three sources.
• Arithmetic
adjacent source lines. •Sub divide the
mean of the
• The minimum dose lies volume.
doses at mid
at the intersection of •Then choose a
distance b/w
perpendicular bisector separate central
each pair of
of sides of plane for each
adjacent source
triangles.(GEOMETRIC sub volume.
lines.
AND EQUIDSITANT )
Three practical methods are acceptable for determining mean central
dose.
1. Implants with Parallel Lines :

2. Evaluation of dose profiles:

 Calculate dose profiles for one or more axes through the center of the
implant
 expected to pass through as many local minima as possible.
 Determine, by inspection, the local minimum doses.
 The mean of these local minimum values is the mean central dose
3:Inspection of dose distribution:
 Plot the dose distribution in the central plane.
 Isodose lines varying by 5% (at most 10%) of the local dose in the
central region,
 the local minima can be determined by inspection
 Correlation between radiation dose with late effects and
recurrence

HIGH DOSE VOLUME LOW DOSE VOLUME

Volume encompassed by the

isodose corresponding to 150% of
• It is defined as the volume within
MCD around the source in any
the CTV ,encompassed by an
plane parallel to the central plane.
isodose corresponding to 90% of
the prescribed dose.
• To correlate radiation late damage
• If the CTV is not covered by the
,the high dose volume around
minimum target isodose ,there’ll be
sources should be assessed.
low dose region & local recurrence.
•DIMENSIONS
 Time and Dose rate for temporary implants

TIME DOSE

Avg. overall
Overall Instantaneous treatment dose
Irradiation time
treatment time dose rate rate

• It is the
quotient of the
• Time during • Total time • It is the total dose and
which the elapsed from the quotient of the the overall
radioactive beginning of the dose and the treatment time.
source is first irradiation to irradiation time , • It is useful for
present in the the end of last for a given continuous LDR
patient. one. fraction or pulse. irradiation with
or without
interruption.
 Time Dose Pattern for Temporary Implants

Continuous Non-Continuous Fractionated Pulsed

Irradiation Irradiation Irradiation Irradiation
•
• A single high
• The overall • Irradiation time dose source is
• The overall treatment time is sub-divided used to give a
treatment is greater than into multiple sequence of
time is the irradiation fractions . short
equal to the time due to the • The overall irradiation(pulses
irradiation planned short treatment time ) to simulate
time. interruption is much greater continuous LDR.
during the than the total • Time interval is
treatment . irradiation time. shorter than few
hours.
Hyperfractionated Irradiation :

 When two or more fractions are

given per day.
 When the time interval between
short high dose rate irradiation
reaches or exceeds four hours,
irradiation should be considered as
hyperfractionated.
 If the time interval is equal to one
or several days then it should be
considered as fractionated
irradiation.
RECOMMENDATION FOR
RECORDING AND
REPORTING
DESCRIPTION OF VOLUME

 Description should as a minimum include as

a minimum gross tumor volume , clinical
target volume , treated volume
 Description of Sources

 Radionuclide used (with or

without filtration).
 Type of source used : wires ,
seeds ,seed ribbons ,hairpin ,
needle etc.
 Length of each line source.
 Reference air kerma rate of
each source and source line.
 The distribution of strength
within the source should be
described (uniform or
differential loading).
 DESCRIPTION OF TECHNIQUE AND SOURCE PATTERN

 No. Of sources used.

 Separation between source lines and plane.
 Geometric pattern form by the sources with the central plane of implant(e.g.-
triangles , squares ).
 The surfaces in which the implant lies i.e ; planes or curved surfaces.
 Crossing sources are placed at one or more ends.
 The material used to carry the radioactive substance (flexible and rigid).
 Type of remote after loading if used.
DESCRIPTION OF TIME PATTERN
 The description of the time pattern should include the type of irradiation
with the necessary data on treatment and irradiation times. The information
on dose and time should provide the necessary data to calculate
instantaneous and average dose rates.
 Continuous irradiation- the overall treatment time should be recorded.
 Non-continuous irradiation-both the overall treatment time and the total
irradiation time should be recorded, together with information about lengths
of gaps.
 Fractionated and hyperfractionated irradiation the irradiation time of each
fraction or pulse, the interval between fractions and the overall treatment
time should be recorded.
When the irradiation times of the different sourcesare not identical, they should
be recorded.Moving sources:
(i) Stepping sources
(ii) Oscillating sources
DESCRIPTION OF DOSE DISTRIBUTION

 PRESCRIBED DOSE
 MINIMUM TARGET DOSE
 MEAN CENTRAL DOSE
 Additional information such as :
Dimension of high dose volume
Dimension of low dose volume
Any dose uniformity data