In vivo dosimetry with luminescent microdosimeters in Ir-192 brachytherapy of breast cancer: development of technology and clinical testing

«Radiation and Risk», 2020, vol. 29, No. 2, pp.67-77

DOI: DOI: 10.21870/0131-3878-2020-29-2-67-77


Zharova E.P. – Researcher, Scientifical Secretary.
Kaprin A.D. – Director General, Academician RAS, MD, Prof. NMRRC.
Stepanenko V.F. – Head of Lab., D. Sc., Biol., Prof. Contacts: 4 Korolev Str., Obninsk, Kaluga region, 249035, Russia. Tel.: +7 (484) 399-70-02; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Kiseleva M.V. – Head of Dep., MD, Prof.
Bogacheva V.V. – Researcher.
Aminov G.G. – Physician, C. Sc., Med.
Kolyzhenkov T.V. – Sen. Researcher, C. Sc., Biol.
Petukhov A.D. – Researcher.
Zharikova I.A. – Lead. Researcher, C. Sc., Med.
Demyanovich A.V. – Researcher.
Borysheva N.B. – Head of Dep., C. Sc., Phys.-Math.
Ivanov S.A. – Director, MD, Prof. of RAS. A. Tsyb MRRC.

1 NMRRC, Moscow
2 A. Tsyb MRRC, Obninsk


International organizations – WHO, IAEA, ICRP strongly recommended to consider in vivo dosimetry (UVD) as an important part of a quality assurance program in radiotherapy and to use the technique for monitoring treatment delivery, errors detection, verification of dose delivering. It is particularly relevant for brachytherapy with high dose rate sources, such as 192Ir due to high absorbed dose gradient at small distance from the source. During multifractional adjuvant brachytherapy of breast cancer there is considerable difference between observed absorbed doses distribution in tissues and calculated dose distribution from the dosimetry plan. The difference is due to mobility of the breast gland tissue and change of the mammary gland (MG) shape resulted from radiotherapy. The study presents innovative technology, in vivo dosimetry with thermoluminiscent microdosimeters LiF:Mg,Ti, used for high-dose rate brachytherapy of breast cancer. The technique was applied to verify calculated doses. The method was tested during the performance of multifractional (10 fractions, two fractions a day) adjuvant brachytherapy of the breast cancer with 192Ir. Micro-sized luminescent dosimeters (about 100 μm) were assembled and placed on the points marked on the skin of healthy breast lobes near points of entry and exit of introducers guiding 192Ir sources. We assumed that breast skin areas around the points of entry and exit of the introducer with the 192Ir-source were the mostly affected areas of the breast, the critical area, resulted from exposure to radiation. Local doses were measured in 100 points (total) marked on the breast skin in 12 patients with breast cancers. The results of measurements were the following: in 34% of all measurements, the IVD results and calculated (planned) local doses fitted together within the limits of measurement errors; in 21%, IVD-measured local doses significantly exceeded the calculated doses, the excess ranged from 15 to 58%; in 45% of all measurements, the measured local doses were significantly lower than the calculated doses (the difference between the calculated and measured doses ranged from 26 to 58%. In eight patients, IVD-measured total (10 fractions of brachytherapy) local absorbed doses to the skin of the mammary gland exceeded 10 Gy (ranged from 10.1 to 27.0 Gy). From obtained results it is evident that calculated, planned, radiation doses to be delivered to the breast during brachytherapy procedure with 192Ir should be verified, and the use of in vivo dosimetry, reliable and effective technique, could be the best choice for these purposes. If measured local absorbed doses to the breast skin are equal to or exceed 10 Gy, that is a risk factor of radiation associated complications development after the treatment completion. That is a reason to conduct posttreatment monitoring of health status of patients in order to prevent development of adverse effects.

Key words
in vivo dosimetry, LiF:Mg,Ti, thermoluminescent dosimeters, TL microdosimeters, multifractional adjuvant brachytherapy, 192Ir, breast cancer.


1. Radiotherapy Risk Profile. Technical Manual. WHO/IER/PSP/2008.12. Geneva: WHO, 2008. 51 p. Available at: (Accessed 21.01.2020).

2. Lessons learned from accidental exposures in radiotherapy. IAEA Safety Report Series No. 17. Vienna, IAEA, 2000. 96 p. Available at: (Accessed 21.01.2020).

3. ICRP, 2005. Prevention of high-dose-rate brachytherapy accidents. ICRP Publication 97. Ann. ICRP, 2005, vol. 35, no. 2, pp. 1-52. Available at: (Accessed 21.01.2020).

4. Kaprin A.D., Galkin V.N., Ivanov S.A. The role of brachytherapy in the treatment of localized prostate cancer. Biomedical Photonics, 2015, vol. 4, no. 4, pp. 21-26. (In Russian).

5. Ivanov S.A. Brakhiterapija kak metod radikal'nogo lechenija pri rake predstatel'noj zhelezy [Brachytherapy as a method of radical treatment of prostate cancer]. Dr. med. sci. diss. Moscow, 2011. 265 p.

6. Ivanov S.A., Kaprin A.D., Milenin K.N., Al'bickij I.A., Ivanenko K.V. Results of application of low-dose brachytherapy as a radical treatment of prostate cancer. Diagnosticheskaja i interventsionnaja radiologija – Diagnostical and Interventional Radiology, 2015, vol. 5, no. 1, pp. 73-76. (In Russian).

7. Kaprin A.D., Pan'shin G.A., Al'bickij I.A., Milenin K.N., Cybul'skij A.D. Brachytherapy of localized prostate cancer (medical technology). Moscow, 2009. Available at: (Accessed 21.01.2020). (In Russian).

8. Brachytherapy. Eds.: Acad. RAN A.D. Kaprin, corr. member RAN Yu.S. Mardinskiy. Obninsk, A.Tsyb MRRC, 2017. 245 p. (In Russian).

9. Kaprin A.D., Kiseleva M.V., Aminov G.G., Gulidov I.A., Zharikova I.A. High-power brachytherapy in the comprehensive treatment of breast cancer. Voprosy urologii i andrologii – Urology and Andrology, 2019, vol. 7, no. 2, pp. 54-55. (In Russian).

10. Kiseleva M.V., Aminov G.G., Gulidov I.A., Zharikova I.A. Comprehensive treatment of early breast cancer using high-power brachytherapy. Issledovaniya i praktika v medicine – Research and Practice in Medicine, 2019, vol. 6, no. 1S, p. 146. (In Russian).

11. Perera F., Chisela F., Stitt L., Engel L., Venkatesan V. TLD skin dose measurements and acute and late effects after lumpectomy and high-dose-rate brachytherapy only for early breast cancer. Int. J. Radiat. Oncol. Biol. Phys., 2005, vol. 62, no. 5, pp. 1283-1290.

12. Stepanenko V.F., Biryukov V.A, Karyakin O.B., Kaprin A.D., Galkin V.N., Ivanov S.A., Mardynskij Yu.S., Kolyzhenkov T.V., Petukhov A.D., Bogacheva V.V., Ahmedova U.A., Yas`kova E.K., Lepilina O.G., Sanin D.B., Skvortsov V.G., Ivannikov A.I., Khajlov A.M., Anokhin Yu.N. Local absorbed doses of irradiation of medical personnel at brachytherapy of prostate cancer using 125I microsources of Russian production. Radiatsiya i risk – Radiation and Risk, 2017, vol. 26, no. 1, pp. 44-59.

13. Stepanenko V.F., Biryukov V.A., Kaprin A.D., Galkin V.N., Ivanov S.A., Karyakin O.B., Mardynskij Yu.S., Gulidov I.A., Kolyzhenkov T.V., Ivannikov A.I., Borysheva N.B., Skvorczov V.G., Ahmedova U.A., Bogacheva V.V., Petukhov A.D., Yaskova E.K., Hajlov A.M., Lepilina O.G., Sanin D.B., Korotkov V.A., Obukhov A.A., Anokhin Yu.N. Intracavitary offline "in vivo" dosimetry for high dose-rate prostate brachytherapy with 192Ir: development of technology and first results of its application. Radiatsiya i risk – Radiation and Risk, 2017, vol. 26, no. 2, pp. 72-82. (In Russian).

14. Stepanenko V.F., Biryukov V.A., Kaprin A.D., Galkin V.N., Ivanov S.A., Borysheva N.B., Karyakin O.B., Mardynskij Yu.S., Gulidov I.A., Kolyzhenkov T.V., Obuhov A.A., Ivannikov A.I., Skvorczov V.G., Ah-medova U.A., Bogacheva V.V., Petuhov A.D., Yas`kova E.K., Hajlov A.M., Lepilina O.G., Sanin D.B., Korotkov V.A., Anokhin Yu.N. In vivo dosimetry at high dose rate brachytherpapy for prostate cancer using 192Ir: comparison of dose distribution between planned and measured doses with intracavitary placement of autonomous luminescence microdosimeters. Radiatsiya i risk – Radiation and Risk, 2018, vol. 27, no. 1, pp. 77-87. (In Russian).

15. Korotkov V.A., Biryukov V.A., Kaprin A.D., Ivanov S.A., Stepanenko V.F., Borysheva N.B., Obukhov A.A., Kolyzhenkov T.V., Ahmedova U.A., Bogacheva V.V., Petuhov A.D., Zharova E.P. Manifestations of late radiation urethritis in comparison with instrumental assessments of the spatial intracavity distribution of doses in the organ after high dose rate brachytherapy of prostate cancer with the use of 192Ir: preliminary results. Radiatsiya i risk – Radiation and Risk, 2019, vol. 28, no. 1, pp. 110-123. (In Russian).

16. Normy radiatsionnoj bezopasnosti (NRB-99/2009). SanPin [Radiation Safety standards (RSS-99/2009]. Moscow, Federal Center of Hygiene and Epidemiology of Rospoterbnadzor, 2009. 100 p. (In Russian).

17. BrachyVision Treatment Planning System. Feature sheet. RAD 4241A A4. Varian Medical Systems International AG. Cham, Switzerland, 2014. Available at: zg8mrymbds/BrachyVision_FeatureSheet_A4_RAD4241A_Mar2014.pdf?u=wefire (Accessed 21.01.2020).

18. Kaprin A.D., Galkin V.N., Zhavoronkov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu.S. Synthesis of basic and applied research is the basis of obtaining high-quality findings and translating them into clinical practice. Radiatsiya i risk – Radiation and Risk, 2017, vol. 26, no. 2, pp. 26-40. (In Russian).

19. Kaprin A.D., Mardinskiy Yu.S., Smirnov V.P., Ivanov S.A., Kostin A.A., Polikhov S.A., Reshetov I.V., Fatianova A.S., Denisenko M.V., Epatova T.V., Korenev S.V., Tereshchenko A.V., Filonenko E.V., Gafarov M.M., Romanko Yu.S. The history of radiation therapy (part I). Biomedical Photonic, 2019, vol. 8, no. 1, pp. 52-62. (In Russian).

20. Kaprin A.D., Smirnov V.P., Ivanov S.A., Polikhov S.A., Reshetov I.V., Fatyanova A.S., Babaeva Yu.V., Denisenko M.V., Semenova N.M., Korenev S.V., Tereshchenko A.V., Filonenko E.V., Yuzhakov V.V., Koryakin S.N., Sukhova T.E., Gafarov M.M., Ogdanskaya K.V., Romanko Yu.S. To the 115th anniversary of Russian radiology. The history of the development of radiation therapy: radiation diagnosis in the A. Tsyb MRRC. Biomedical Photonic, 2019, vol. 8, no. 2, pp. 47-50. (In Russian).

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