HDR Brachytherapy
Topic 2; Session 4:
Source strength determination
date 19 Feb 2022
Educator: Adam Shulman, MS DABR
Institution: University of Colorado
Health, Colorado Springs
Learning Objectives
o Describe source strength determination methods and
the required equipment including:
• Recognize the traceability of calibration factors for chambers
used in brachytherapy
• Understand key principles of the protocol used for source
strength determination
• Perform source strength measurements
• Source strength (Air Kerma Rate) vs Apparent Activity (Ci)
• Recognize the uncertainty of source strength determination
• Understand the impact of calibration errors on overall patient
dose delivery
Outline
o Why air kerma strength/rate? (Sk)
o NIST and ADCL calibration process
o Source strength measurement:
• Well chamber
• In air
o QA of the well chamber and electrometer
o Excel sheet discussion
o Input of source strength in treatment unit and planning
computer
Exposure
o Exposure is often used to express the amount of radiation
delivered to a point (in air)
• Unit for exposure is the Roentgen (R)
• SI unit is the coulomb per kilogram of air (C/kg)
• 1 R = 2.58 x 10-4 C/kg
o Exposure is measured by placing a small volume of air at the
measurement point and measuring the amount of ionisation
produced within the air
• The enclosure for the air volume is known as the “ionization chamber”
o To be able to measure exposure we need:
• Range of the electrons produced in air to be less than the distance
between the charged collecting plates of the ionization chamber
• Radiation beam intensity to be uniform across the
measurement volume
Exposure
o Free-air ionization chamber
• Used by national standards
laboratories
• This is too big and
cumbersome to be used in a
clinic
• An ‘air equivalent’ walled
ionisation chamber is more
appropriate
Exposure
o An ionisation chamber is an easy way to measure exposure so long
as:
• The chamber wall is “air equivalent”
• The cavity volume is accurately known
• The cavity wall thickness is sufficient to create CPE (too small and the
chamber will under-respond, too large and the chamber will over-respond)
Exposure and air kerma
o Exposure measures charge produced in a mass of air
o Air kerma measures energy produced per unit mass
• Takes into account collisional, scatter and radiative energy
• Directly related to absorbed dose
o Air kerma has replaced exposure for expressing the amount of
radiation delivered to a point
• It is easy to measure with an ionization chamber
– Ionization chambers can measure air kerma as well as exposure
– Chamber needs to be calibrated to read air kerma (rather than exposure)
• It is expressed in a practical SI unit
– Joules per kg, or Gy
Exposure and air kerma
o To find air kerma rate (K,̇ in mGy/hr) from exposure rate (Ẋ, in
Roentgen/hr) use:
K̇ = X.W
̇
• Where W = average energy required to cause one ionization in air (33.97 J/C)
• Will need to convert Ẋ from R hr-1 to C/kg-1 hr-1 (recall: 1 R = 2.58 x 10-4 C/kg)
o Example:
• If the exposure is 0.6 R/hr, what is the air kerma rate (at the same point)?
K=XxW
= 0.6 (R/hr) x (2.58 x 10-4) ((C/kg)/R) x 33.97 (J/C)
= 5.2 x 10-3 (J kg-1 hr-1) = 5.2 x 10-3 (Gy/hr) = 5.2 mGy/hr
Activity
o Activity is related to exposure rate by:
Γ
Ẋ = A
𝑟!
• Where 𝑟 = distance from the source (cm)
Γ = exposure rate constant (R cm2 hr-1 mCi-1)
o Activity can therefore also be related to air kerma rate (K),̇ air kerma strength
(SK) or reference air kerma rate (K !̇ ) by an air kerma rate constant (ΓK)
o Both exposure and air kerma rate constants are source/manufacturer specific
o This is due to differences in radioactive content, encapsulation and geometry
o It is important to check this if you are doing a conversion. Failure to use the
correct value will result in systematic errors to all of your patients!!!
Kerma to activity conversion
Source certificate
Value: 4.071
Vendor
TPS Admin Manual
Kerma to activity conversion
Source certificate
Value = 4.071
These values are 0.8% different.
TPS Admin Which one would you choose to
Value = 4.037 convert air kerma rate to activity?
Air Kerma Rate
o The use of the term “Activity” is to be avoided whenever possible
o Air Kerma Rate/Strength is the recommended term to use for radioactive
source strength
o Recall from session 1:
• Air Kerma Strength (SK): the air kerma rate at a distance “d” from the source
multiplied by the distance squared
– Units are cGy h-1 cm2, µGy h-1 m2 or U
– Common in America, AAPM recommended, used in TG-43 dose calculation
• Reference Air Kerma Rate (KR): the air kerma rate at a reference distance of
1 meter from the source
– Units are mGy h-1 at 1 m
– Common in Europe, ICRU recommended
Air Kerma Rate
o Clarification:
o Air Kerma Strength (SK): units are: cGy*cm2/hr
o Reference Air Kerma Rate (KR): units are cGy/hr
o So,
• If all units are consistant (i.e., converting any units in cm to m, etc.) then the two are the
exact same numerical value! They are the same number with different unts.
• To account for this, the AAPM TG43 formulism has slightly different units depending on
whether Sk or RAKR is used. But the formula is the same!
• Note that the AAPM TG43 formallism is:
• Note that for Sk, has units of (1/cm2)
• And for RAKR instead of Sk, is unitless
How is Air Kerma Rate determined?
o First measured by the manufacturer and value
is provided on the source certificate
• Date and time of measurement provided on the
certificate
• The time zone of the measurement is important
o Confidence level of 99.7% at 1 m
Air kerma rate measurement
o The source manufacturer measured value MUST be validated by
the clinic before the source is used for patient treatment
• Mistakes by the manufacturer have happened in the past
o Most clinics will use a well-chamber to check source strength
Air kerma rate measurement (well chamber)
o A well chamber is BY FAR the easiest and most accurate way
to determine source strength in the clinic
o If you don’t have a well chamber – get one!!!!!
• Contact Rayos Contra Cancer or Radiating Hope if you need help
obtaining one.
o Well chambers should be calibrated by
NIST/ADCL to the specific source type
(Ir-192/Co-60) that your department is using
Air kerma rate measurement (well chamber)
o Your well chamber calibration certificate should be checked for some
key things
This may or may not be your electrometer
This should be
(depends if you sent it with the well chamber
YOUR chamber
for calibration)
Almost all well chambers are ‘open’
to the environment
The source doesn’t have to be from the same
manufacturer but it MUST be the same
radioisotope as your clinic (eg. Ir-192 or Co-60)
Air kerma rate measurement (well chamber)
o If the well chamber was calibrated with your own electrometer then
the units of the air kerma strength calibration coefficient (NSk) will be
in Gy.m2/h.Rdg
o Air kerma strength (SK) can be determined using the well chamber as
follows:
SK(Gy m2 h-1) = NSk(Gy m2 h-1A-1) x ECC (A/Rdg) x Electrometer Reading (Rdg) x CT,P
o Where:
• ECC = electrometer calibration coefficient (provided with your electrometer)
• CT,P = temperature/pressure correction factor
• NOTE: this value is 293.15 if the chamber was calibrated at 20 °C rather than 22 °C
Air kerma rate measurement (well chamber)
Air kerma rate measurement (well chamber)
o Basic procedure:
• Allow the well chamber to equilibrate with the ambient temperature
(ideally for a couple of hours)
• The temperature used to determine source strength is from inside the
well chamber, not the room temperature
• Allow the electrometer to stabilize (~30 min)
• Measurements should be made in low
scatter conditions
– No high density material near by
– Well chamber elevated off the floor & away
from walls or other objects
Air kerma rate measurement (well chamber)
o Multiple readings need to be taken at the well chamber ‘sweet
spot’ (the source position that gives the highest reading)
Air kerma rate measurement (well chamber)
o It is also good to check the treatment unit timer linearity & error
Air kerma rate measurement (well chamber)
o Use the provided excel
spreadsheet to ensure all
measurements are
completed
Poll Question #1
o The following well chamber calibration certificate was received in the
department. Why has this been marked as incorrect and not to be
used?
a) Source activity is too low
b) Chamber is listed as sealed
c) The uncertainty is too high
d) The units on the certificate
are wrong
Poll Question #1
o The following well chamber calibration certificate was received in the
department. Why has this been marked as incorrect and not to be
used?
a) Source activity is too low
b) Chamber is listed as sealed
c) The uncertainty is too high
d) The units on the certificate
are wrong
Most well chambers are ‘open’ to the atmosphere.
Temperature and pressure correction factors need to be applied.
Air kerma rate measurement
o A well chamber is BY FAR the best way to determine source strength
o If you don’t have a well chamber – get one!!!!!
o If your source strength as measured by the well chamber differs from
the manufacturer certificate by more than 2%:
• Double check and repeat your measurement
• Perform an “in air” source strength measurement to verify
o If your source strength still differs from the manufacturer certificate by
more than 2%, or differs by more than 5% initially:
• Contact the manufacturer
• DO NOT USE THE SOURCE FOR TREATMENT UNTIL THE DISCREPANCY IS
RESOLVED
Air kerma rate measurement (in air)
o If you don’t have a well chamber, or you want to double check the
source strength, you can use an “in air” method
o Traditionally, in-air “jigs” are required to perform this measurement,
and involves readings at multiple distances from the source
Air kerma rate measurement (in air)
o Equipment required:
• Farmer 0.6cc ion chamber (or calibrated ion chamber with volume > 0.5cc)
• In air “jig”
– Can be a commercial jig or a home-made one (eg. cardboard box style)
– Distance between the source and the ionisation chamber must be
accurately known (for multiple distances)
• Straight HDR applicator (eg. needle – preferably plastic rather than metal)
• Electrometer with calibration coefficent
o Process:
• Please refer to IAEA TecDoc 1274 (chapter 6) for
detailed instructions
Air kerma rate measurement (in air)
o Your ion chamber for the in-air measurement will still need a
calibration coefficient (NSk or Nk) provided by NIST/ACDL for the
specific energy/source type that you are using in the clinic (eg. Ir-192
or Co-60). Note this is NOT your NdwCo-60 calibration value used in
external beam—this could introduce around a 10% error in your
measurement.
o IAEA TecDoc 1274 gives a method of generating an Nk,Ir from Nk,Co (or
Nk,Cs) and Nk,250kV with values for individual ionisation chamber types
• This is complicated and easy to get wrong so avoid doing this unless
absolutely necessary
• You may contact Rayos Contra Cancer for assistance if performing this
method.
Air kerma rate measurement (in air)
o Formalism:
Measured charge collected during Distance between the centre
the time (t). Corrected for temp, of source & ion chamber (d)
pressure, electrometer. etc and the reference distance of
1 m (dref)
Ion chamber calibration Correction factors for attenuation
coefficient (source/energy in air (kair), scatter (kscatt) and
specific) radiation non-uniformity (kn) –
refer to IAEA TecDoc 1274
Air kerma rate measurement (in air)
o Factors explained:
o Where:
• = correction for air attenuation between the source and the chamber
d = 1.001 @ 10cm, 1.005 @ 40cm and 1.012 @ 100cm for Ir-192
F = 1.000 at all distances for Co-60 (See IAEA TecDoc 1274, Table XI)
• = correction for scattered radiation from walls, floor, setup equipment, etc
a = determined using multiple distance measurements
• = correction for non-uniform radiation fluence across the chamber cavity
a = dependent on ion chamber type used
Air kerma rate measurement (uncertainty)
o Standard uncertainties with air kerma rate measurement
o Well chamber:
• Calibration coefficient: < 3 %
o In-air measurement:
• Calibration coefficient: < 3 %
• kair : 0.1 %
• kscatt : 0.2 %
• kn : 0.4 %
• (d/dref)2 : 0.6 %
Quality assurance
o Quality assurance for your measurement system
o Well chamber calibration/reading can drift over time
• You must check for consistency of the system
o Simple approach:
• Use your HDR machine!
• Before removing the current source during a source exchange, take a source
strength measurement with your well-chamber
• Should get the same value as when you first measured this source during
installation (accounting for the decay of the source of course)
• This is your constancy check for your well chamber/electrometer system before
performing the source exchange
Data input
o Once you are confident that your source strength is accurate, you will need
to input this into your treatment unit and treatment planning system
o Note! Understand how your system works. And pay attention to dates!
o At the console:
• Some vendors decay the source once per day at midnight. What source strength
would you want used for 24 hours? At midnight? At noon? Other
• Perhaps choose a time close to your average treatment time: eg. Noon
• Some vendors use exact time
o At the TPS:
• Some vendors use a nominal source strength (eg.40700 cGy cm2 h-1 = 10 Ci)
• With this method, some vendors use the date closest to your actual source
strength, then rounds off (THIS MUST BE CHECKED)
• Some vendors use actual activity
Data input
o Note! Pay attention to units!
o Double check
o Triple check
o Independent check
o You will also need to update the new source information everywhere else:
• Source decay table posted on your wall
• All values in any Excel sheets
• Your Daily QA plan
In the treatment planning system
Elekta TPS
Varian TPS
At the treatment console
Elekta Treatment Console
Remember from TPS
At the treatment console
Varian Treatment Console
Remember from TPS
For a complete video demonstration of the QA process for
source exchanges, including equipment descriptions, use
of well chamber, safety, etc. please go to:
https://i.treatsafely.org/
And create a login for free!
Follow this link to go directly to the HDR source exchange
series of videos:
https://i.treatsafely.org/processcoach-qa-
series/68038/clinical/2
Watch lots of educational videos on many aspects of your
clinic!
HDR Source Exchange
Videos!
Poll Question #2
o You have completed a source strength measurement with a well
chamber. The results show a difference from the source calibration
certificate of 2.5%. What is the next step?
a) Put the source certificate value into the afterloader and TPS using the
certificate time/date (corrected to local time)
b) Perform post-source exchange HDR afterloader QA tests
c) Check the source strength measurement to determine the source of the
discrepancy. Repeat the source strength measurement
d) Update your past treatment plans with the new source activity
Poll Question #2
o You have completed a source strength measurement with a well
chamber. The results show a difference from the source calibration
certificate of 2.5%. What is the next step?
a) Put the source certificate value into the afterloader and TPS using the
certificate time/date (corrected to local time)
b) Perform post-source exchange HDR afterloader QA tests
c) Check the source strength measurement to determine the source of the
discrepancy. Repeat the source strength measurement
d) Update your past treatment plans with the new source activity
References
• IAEA TecDoc 1274
https://www-pubiaea.org/MTCD/Publications/PDR/te-1274-prn.pdf
• ESTRO Booklet 8.a
https://www.estro.org/ESTRO/media/ESTRO/About/Physics%20booklets/booklet-8-a-practical-guide-to-quality-control-of-brachytherapy-equipment.pdf
• Khan’s The Physics of Radiation Therapy, Fifth Ed.
• IAEA-SM-222/58: Medical Dosimetry Standards Programme of the National Bureau of
Standards
https://www.nist.gov/sites/default/files/documents/calibrations/iaea-222.pdf
• AAPM TG 32
https://www.aapm.org/pubs/reports/rpt_21.pdf
• AAPM TG 43
https://www.aapm.org/pubs/reports/rpt_84.pdf
• IAEA RPD-P-04: CALIBRATION OF RADIATION DETECTORS IN TERMS OF AIR-KERMA
USING GAMMA-RAY BEAMS
https://www.nist.gov/sites/default/files/documents/2016/10/18/procedure04v500.pdf
• NBS Special Publication 250-19
https://nvlpubs.nist.gov/nistpubs/Legacy/SP/nbsspecialpublication250-19.pdf
• Dosimetry for Ir-192 HDR Brachytherapy-Present Status and Future Direction; Larry
DeWerd, AAPM
https://vimeo.com/75237977
http://amos3.aapm.org/abstracts/pdf/68-19959-234349-85701.pdf
