{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:02:15Z","timestamp":1778824935585,"version":"3.51.4"},"reference-count":11,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T00:00:00Z","timestamp":1519862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Applied Clin Med Phys"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>As an alternative to cylindrical applicators, air\u2010inflated balloon applicators have been introduced into high\u2010dose\u2010rate (<jats:styled-content style=\"fixed-case\">HDR<\/jats:styled-content>) vaginal cuff brachytherapy to achieve sufficient dose to the vagina mucosa as well as to spare organs at risk, mainly the rectum and bladder. Commercial treatment planning systems which employ formulae in the <jats:styled-content style=\"fixed-case\">AAPM<\/jats:styled-content> Task Group No. 43 (<jats:styled-content style=\"fixed-case\">TG<\/jats:styled-content> 43) report do not take into account tissue inhomogeneity. Consequently, the low\u2010density air in a balloon applicator induces different doses delivered to the mucosa from planned by these planning systems. In this study, we investigated the dosimetric effects of the air in a balloon applicator using the Monte Carlo (MC) method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The thirteen\u2010catheter Capri\u2122 applicator by Varian\u2122 for vaginal cuff brachytherapy was modeled together with the Ir\u2010192 radioactive source for the microSelectron\u2122 Digital (<jats:styled-content style=\"fixed-case\">HDR<\/jats:styled-content>\u2010V3) afterloader by Elekta\u2122 using the <jats:styled-content style=\"fixed-case\">MCNP<\/jats:styled-content> MC code. The validity of charged particle equilibrium (<jats:styled-content style=\"fixed-case\">CPE<\/jats:styled-content>) with an air balloon present was evaluated by comparing the kerma and the absorbed dose at various distances from the applicator surface. By comparing MC results with and without air cavity present, dosimetric effects of the air cavity were studied. Clinical patient cases with optimized multiple Ir\u2010192 source dwell positions were also explored. Four treatment plans by the Oncentra Brachy\u2122 treatment planning system were re\u2010calculated with <jats:styled-content style=\"fixed-case\">MCNP<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">CPE<\/jats:styled-content> fails in the vicinity of the air\u2010water interface. One millimeter beyond the air\u2010water boundary the kerma and the absorbed dose are equal (0.2% difference), regardless of air cavity dimensions or iridium source locations in the balloon. The air cavity results in dose increase, due to less photon absorption in the air than in water or solid materials. The extent of the increase depends on the diameter of the air balloon. The average increment is 3.8%, 4.5% and 5.3% for 3.0, 3.5, and 4.0 cm applicators, respectively. In patient cases, the dose to the mucosa is also increased with the air cavity present. The point dose difference between Oncentra Brachy and MC at 5 mm prescription depth is 8% at most and 5% on average.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Except in the vicinity of the air\u2010mucosa interface, the dosimetric difference is not significant enough to mandate tissue inhomogeneity correction in <jats:styled-content style=\"fixed-case\">HDR<\/jats:styled-content> treatment planning.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acm2.12298","type":"journal-article","created":{"date-parts":[[2018,3,1]],"date-time":"2018-03-01T05:08:42Z","timestamp":1519880922000},"page":"101-107","source":"Crossref","is-referenced-by-count":3,"title":["Dosimetric assessment of an air\u2010filled balloon applicator in <scp>HDR<\/scp> vaginal cuff brachytherapy using the Monte Carlo method"],"prefix":"10.1002","volume":"19","author":[{"given":"Hongyu","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology The University of Kansas Cancer Center Kansas City KS USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajeev","family":"Badkul","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Kansas Cancer Center Kansas City KS USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Damodar","family":"Pokhrel","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Kansas Cancer Center Kansas City KS USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2009.10.044"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brachy.2011.08.005"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.11.004"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.5114\/jcb.2014.45436"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2015.07.1231"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.597458"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.3457328"},{"key":"e_1_2_7_9_1","unstructured":"Monte Carlo N\u2010Particle Transport Code MCNP6\/MCNP5\/MCNPX. Available at:https:\/\/rsicc.ornl.org\/codes\/ccc\/ccc8\/ccc-810.html."},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.598418"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1118\/1.594551"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(00)00689-1"}],"container-title":["Journal of Applied Clinical Medical Physics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facm2.12298","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acm2.12298","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T21:39:23Z","timestamp":1695505163000},"score":1,"resource":{"primary":{"URL":"https:\/\/aapm.onlinelibrary.wiley.com\/doi\/10.1002\/acm2.12298"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":11,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2018,5]]}},"alternative-id":["10.1002\/acm2.12298"],"URL":"https:\/\/doi.org\/10.1002\/acm2.12298","archive":["Portico"],"relation":{},"ISSN":["1526-9914","1526-9914"],"issn-type":[{"value":"1526-9914","type":"print"},{"value":"1526-9914","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}