Dosimetric characterization of the GammaClip™ 169Yb low dose rate permanent implant brachytherapy source for the treatment of nonsmall cell lung cancer postwedge resection

Purpose: A novel169Yb low dose rate permanent implant brachytherapy source, the GammaClip™, was developed by Source Production & Equipment Co. (New Orleans, LA) which is designed similar to a surgical staple while delivering therapeutic radiation. In this report, the brachytherapy source was characterized in terms of “Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV: Report of the AAPM and ESTRO” by Perez-Calatayud et al. [Med. Phys. 39, 2904–2929 (2012)]10.1118/1.3703892 using the updated AAPM Task Group Report No. 43 formalism. Methods: Monte Carlo calculations were performed using Monte Carlo N-Particle 5, version 1.6 in water and air, the in-air photon spectrum filtered to remove photon energies below 10 keV in accordance with TG-43U1 recommendations and previously reviewed169Yb energy cutoff levels [D. C. Medich, M. A. Tries, and J. M. Munro, “Monte Carlo characterization of an Ytterbium-169 high dose rate brachytherapy source with analysis of statistical uncertainty,” Med. Phys. 33, 163–172 (2006)]10.1118/1.2147767 . TG-43U1 dosimetric data, including S K , $\dot D(r,\theta)$ D ̇ ( r , θ ) , Λ, g L (r), F(r, θ), ϕ an (r), and $\bar \phi _{an}$ ϕ ¯ a n were calculated along with their statistical uncertainties. Since the source is not axially symmetric, an additional set of calculations were performed to assess the resulting axial anisotropy. Results: The brachytherapy source's dose rate constant was calculated to be (1.22 ± 0.03) cGy h−1 U−1. The uncertainty in the dose to water calculations, $\dot D(r,\theta)$ D ̇ ( r , θ ) , was determined to be 2.5%, dominated by the uncertainties in the cross sections. The anisotropy constant, $\bar \phi _{an}$ ϕ ¯ a n , was calculated to be 0.960 ± 0.011 and was obtained by integrating the anisotropy factor between 1 and 10 cm using a weighting factor proportional to r −2. The radial dose function was calculated at distances between 0.5 and 12 cm, with a maximum value of 1.20 at 5.15 ± 0.03 cm. Radial dose values were fit to a fifth order polynomial and dual exponential regression. Since the source is not axially symmetric, angular Monte Carlo calculations were performed at 1 cm which determined that the maximum azimuthal anisotropy was less than 8%. Conclusions: With a higher photon energy, shorter half-life and higher initial dose rate169Yb is an interesting alternative to 125I for the treatment of nonsmall cell lung cancer.