History of dose specification in Brachytherapy: From Threshold Erythema Dose to Computational Dosimetry Available to Purchase

This paper briefly reviews the evolution of brachytherapy dosimetry from 1900 to the present. Dosimetric practices in brachytherapy fall into three distinct eras: During the era of biological dosimetry (1900–1938), radium pioneers could only specify Ra‐226 and Rn‐222 implants in terms of the mass of radium encapsulated within the implanted sources. Due to the high energy of its emitted gamma rays and the long range of its secondary electrons in air, free‐air chambers could not be used to quantify the output of Ra‐226 sources in terms of exposure. Biological dosimetry, most prominently the threshold erythema dose, gained currency as a means of intercomparing radium treatments with exposure‐calibrated orthovoltage x‐ray units. The classical dosimetry era (1940–1980) began with successful exposure standardization of Ra‐226 sources by Bragg‐Gray cavity chambers. Classical dose‐computation algorithms, based upon 1‐D buildup factor measurements and point‐source superposition computational algorithms, were able to accommodate artificial radionuclides such as Co‐60, Ir‐192, and Cs‐137. The quantitative dosimetry era (1980‐ ) arose in response to the increasing utilization of low energy K‐capture radionuclides such as I‐125 and Pd‐103 for which classical approaches could not be expected to estimate accurate correct doses. This led to intensive development of both experimental (largely TLD‐100 dosimetry) and Monte Carlo dosimetry techniques along with more accurate air‐kerma strength standards. As a result of extensive benchmarking and intercomparison of these different methods, single‐seed low‐energy radionuclide dose distributions are now known with a total uncertainty of 3%–5%.