Dosimetric consequences of manual pullback procedure for coronary artery radiotherapy with 90Sr/90Y β-source

Purpose This work presents a quantitative dosimetric analysis of the Novoste 90Sr/90Y β-source cardiovascular brachytherapy treatments using a manual pullback technique for patients with in-stent restenosis. Methods and materials Based on our previous measurements, a model was developed to estimate the dose in the middle of the junction region for tandem irradiation expressed as fraction of prescription dose (FPD) and dosimetric overlap length (DOL) receiving more/less than a threshold dose. The overlap/gap size was measured using the digital cine images recorded during treatment and then FPD and DOL were quantified. Results Statistical analysis of 55 patients showed that the overlap size and the FPD at 2 mm radial distance were in range of 0 to 23 mm and 13–200% of prescription dose (Rx), respectively. Four gaps out of 76 pullback cases were found, but their size was at most 5 mm. Conclusion Use of a 5 mm overlap avoided underdosed regions in the vast majority of the cases. These results are the first step towards an analysis of the clinical outcome of these patients.