The influence of tissue composition uncertainty on dose distributions in brachytherapy

Background and purpose: Model-based dose calculation algorithms (MBDCAs) have evolved from serving as a research tool into clinical practice in brachytherapy. This study investigates primary sources of tissue elemental compositions used as input to MBDCAs and the impact of their variability on MBDCA-based dosimetry. Materials and methods: Relevant studies were retrieved through PubMed. Minimum dose delivered to 90% of the target (D-90), minimum dose delivered to the hottest specified volume for organs at risk (OAR) and mass energy-absorption coefficients (mu(en)/rho) generated by using EGSnrc "g" user-code were compared to assess the impact of compositional variability. Results: Elemental composition for hydrogen, carbon, oxygen and nitrogen are derived from the gross contents of fats, proteins and carbohydrates for any given tissue, the compositions of which are taken from literature dating back to 1940-1950. Heavier elements are derived from studies performed in the 1950-1960. Variability in elemental composition impacts greatly D90 for target tissues and doses to OAR for brachytherapy with low energy sources and less for Ir-192-based brachytherapy. Discrepancies in mu(en)/rho are also indicative of dose differences. Conclusions: Updated elemental compositions are needed to optimize MBDCA-based dosimetry. Until then, tissue compositions based on gross simplifications in early studies will dominate the uncertainties in tissue heterogeneity. Crown Copyright (C) 2018 Published by Elsevier B.V. All rights reserved.