Implementation of the Sievert integral for the calculation of dose distribution around the BEBIG Co-60 high dose rate brachytherapy source

Introduction: In radiotherapy, a computerized treatment planning system (TPS) is used for performing treatment planning to estimate the dose distribution within a patient. To simplify the dose calculation, mathematical algorithms are employed. TG43 formalism is widely used for brachytherapy. Before the implementation of a particular dose calculation algorithm in clinical practice, it is imperative to acknowledge the limitations and uncertainties associated with the algorithm. Regarding this, outputs of the algorithm are compared to measurements or dose calculation approaches using simple source placement geometries. The manual dose calculation method has to be robust, straightforward, and devoid of complexities to reduce the likelihood of committing errors in the dose calculation process. A lot of manual dose calculation approaches have been proposed for Brachytherapy sources, but one needs to ascertain their reliability. Material and methods: Considering this, the output of an HDRplus treatment planning system dedicated to brachytherapy treatment planning and using the TG43 formalism to calculate the dose distribution around a BEBIG Co-60 source was validated with Sievert integral dose calculation approach. Simple source placement geometries were created with the TPS using the universal applicator, LLA1200-20, selected from the applicator library, and doses at various equidistant points from the applicator calculated with the TPS and the Sievert integral. Various steps to enhance the efficacy of the Sievert integral approach have been outlined. Results: The doses compared favourably well with deviations ranging from 0.03 - 10.51% (mean of 3.13%), and 0.03 - 5.63% (mean of 2.55%) for angles along the perpendicular bisector of the source, ranging from 0 degrees < theta < 70 degrees and 0 degrees < theta < 48 degrees, respectively. Conclusions: The Sievert integral breaks down at angles: theta > 60 degrees, and therefore, neglecting large angles, the Sievert integral would be an efficient, effective, and valid tool for quality control of the HDRplus TPS for the Co-60 source.