A radiation quality correction factor k Q for well-type ionization chambers for the measurement of the reference air kerma rate of 60 Co HDR brachytherapy sources

Purpose: The aim of this study was to investigate whether a chamber-type-specific radiation quality correction factor k Q can be determined in order to measure the reference air kerma rate of 60 Co high-dose-rate (HDR) brachytherapy sources with acceptable uncertainty by means of a well-type ionization chamber calibrated for 192 Ir HDR sources. Methods: The calibration coe ffi cients of 35 well-type ionization chambers of two di ff erent chamber types for radiation fields of 60 Co and 192 Ir HDR brachytherapy sources were determined experimentally. A radiation quality correction factor k Q was determined as the ratio of the calibration coe ffi cients for 60 Co and 192 Ir. The dependence on chamber-to-chamber variations, source-to-source variations, and source strength was investigated. Results: For the PTW T x 33004 (Nucletron source dosimetry system (SDS)) well-type chamber, the type-specific radiation quality correction factor k Q is 1.19. Note that this value is valid for chambers with the serial number, SN ≥ 315 (Nucletron SDS SN ≥ 548) onward only. For the Standard Imaging HDR 1000 Plus well-type chambers, the type-specific correction factor k Q is 1.05. Both k Q values are independent of the source strengths in the complete clinically relevant range. The relative expanded uncertainty ( k = 2) of k Q is U k Q = 2 . 1% for both chamber types. Conclusions: The calibration coe ffi cient of a well-type chamber for radiation fields of 60 Co HDR brachytherapy sources can be calculated from a given calibration coe ffi cient for 192 Ir radiation by using a chamber-type-specific radiation quality correction factor k Q . However, the uncertainty of a 60 Co calibration coe ffi cient calculated via k Q is at least twice as large as that for a direct calibration with a 60 Co source. C 2015 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 Unported License. [http: // dx.doi.org / 10.1118 / 1.4922684]


INTRODUCTION
More than 10 years ago, a miniaturized 60 Co high-dose-rate (HDR) brachytherapy source with geometrical dimensions similar to the commonly used 192 Ir HDR sources was introduced into the clinics. Because of the long half-life of 60 Co (t 1/2 = 1924 days), afterloader systems based on 60 Co require a source replacement every 5 years at the most, while systems based on 192 Ir (t 1/2 = 73.8 days) require a replacement at least every 4 months. [1][2][3] In particular for hospitals in developing countries, the source exchange frequency is a crucial factor 1,3,4 due to the lack of the required infrastructure for the transport of highly radioactive sources and the efforts required for customs clearance which can take a long time compared to the halflife of 192 Ir. Delays during the transportation of 60 Co sources are less critical. The relatively small differences in the radial dose distribution of 60 Co sources compared to 192 Ir sources 5,6 do not result in clinically significant effects. 1,2,4,5,7,8 Different companies provide 60 Co HDR brachytherapy sources [9][10][11][12] and at least 200 remote afterloader systems equipped with 60 Co are presently in operation worldwide. 3 The dosimetric verification of a 60 Co brachytherapy source in a hospital using an in-air experimental set-up is complex and time-consuming [13][14][15][16][17] and may be error-prone, among other things, due to lack of guidelines for 60 Co sources in the existing dosimetry protocols. 15 For the commonly used radionuclides, well-type ionization chambers 17,18 are well established for routine calibrations of brachytherapy sources. 13,[18][19][20] Using a well-type chamber there is no need for accurate source-todetector distance measurement and owing to its large detection volume, the ionization current is high and thus easy to measure with high precision. For 192 Ir HDR brachytherapy sources the traceability to a national standard is provided by several national metrology institutes (NMIs), [20][21][22][23][24][25] whereas in the case of 60 Co only the German NMI-the Physikalisch-Technische Bundesanstalt (PTB)-offers a calibration service. 26 In this work, an investigation was performed to find out whether a chamber type-specific radiation quality correction factor k Q can be determined in order to enable the measurement of the reference air kerma rate (RAKR) of a 60 Co HDR brachytherapy source with acceptable uncertainty by means of a well-type ionization chamber calibrated for 192 Ir HDR sources.
The following procedure was used. First, the determination of the RAKR of 60 Co and 192 Ir brachytherapy sources was carried out with the PTB calibration facility for HDR brachy-therapy sources (Sec. 2.C). Subsequently, for each of 35 welltype chambers under study the calibration coefficients N  and N Co−60 for radiation fields of 192 Ir and 60 Co were determined (Sec. 2.D). The range of source strengths and the influence of source-to-source variations on the calibration coefficients were investigated (Secs. 3.A and 3.B), respectively. Finally, the radiation quality correction factor k Q = N Co-60 /N  was analyzed with respect to chamber-to-chamber variations (Sec. 3.C), and a detailed uncertainty analysis is presented (Sec. 3.D).

2.A. Well-type ionization chambers
In order to analyze the chamber-to-chamber variations, a large number of chambers of two different types were studied: nine chambers of the type HDR 1000 Plus from Standard Imaging (Standard Imaging Inc., Middleton, WI) with the source holder insert REF 70110 named "Bebig Co-60 and Ir-192 Afterloader Source Holder," and 26 chambers of the type Tx33004 from PTW (PTW-Freiburg, Freiburg, Germany) in connection with the source holder insert T33002.1.009 named "Adapter for Nucletron microSelectron afterloaders." The latter chamber type is distributed by Nucletron/Elekta (Nucletron B.V., Veenendaal, The Netherlands; Nucletron is now a member of the Elekta group of companies) as "Source Dosimetry System-SDS" under reference number 077.094 for the chamber and reference number 077.095 for the T33002.1.009 source holder insert.
PTW Tx33004 chambers are manufactured with different electrical connectors indicated by x = M, W, or N as listed in Table I. TM33004 chambers have the collecting electrode and the guard at ground potential, whereas for TW33004 and TN33004 chambers the collecting electrode and the guard are connected to high voltage. Douysset et al. 27 pointed out that there is an undesired collection volume, located in the region between the base plate of the chamber enclosure and the electrical terminal of the collecting electrode. For chambers of type x = W and N, about 1% of the total measured signal may originate from ionization in this region, whereas for the x = M model there is no evidence of a significant extra collecting volume. 27 A possible effect on the calibration coefficient was investigated as described below in Sec. 3.A.
The nine HDR 1000 Plus chambers under test all have the same connecting system (Triax BNC or TNC).

2.B. HDR brachytherapy sources
In order to analyze the influence of source variations, several exemplars of different source types have been  Table II). The surveyed 192 Ir HDR source types are: microSelectron HDR classic and microSelectron V2, both manufactured on behalf of Nucletron by Mallinckrodt Medical (Mallinckrodt Medical B.V., Petten, The Netherlands) as well as Gam-maMed 232 (for GammaMed Plus afterloaders) distributed by NTP (NTP Radioisotopes S.A., Fleurus, Belgium). Using a single microSelectron V2 source with an initial apparent activity of about 470 GBq, the measurements were repeated several times during approximately three half-life periods. This covers more than the clinically relevant range of source strengths between the source replacements (370-185 GBq). All three 192 Ir source types have a similar design with a slightly different radioactive component (see Table II). Influences on the chamber calibration coefficient were investigated as described below in Sec. 3.B.

2.C. Determination of the RAKR of HDR brachytherapy sources
The RAKRK R is the measurement quantity for specifying the strength of a brachytherapy gamma-emitting source recommended by the International Commission on Radiation Units and Measurements (ICRU). 14,[29][30][31] The numerical values of the RAKR and of the equivalent but dimensionally different quantity air kerma strength 19 S K are identical. 20,21 PTB has been offering calibrations of HDR brachytherapy sources in terms of RAKR for several years. 32 A photograph of the calibration facility at PTB is shown in Fig. 1. The HDR source to be calibrated is placed by means of a custom-

cm in diameter)
. By use of this set-up for realizing a collimated radiation field, the back-scattered radiation from walls and air is reduced from about 5% with an uncollimated 192 Ir source to (0.5±0.5)% with the used special collimation. By means of a commercially available industrial robot (C), a secondary standard ionization chamber (D) is positionedwith a positioning accuracy better than 0.1 mm-along the central axis of the radiation field which is perpendicular to the cylindrical axis of the source with an intersection at the source center. The secondary standard chamber is of the type LS01 (PTW TM32002 SN:0302) with a spherical shape and an active volume of 1000 cm 3 . The ionization current of the chamber is measured using a calibrated electrometer type Keithley 6517 in integrated mode.
In order to reduce the uncertainty in the positioning of the radiation source (<2 mm) and, therefore, in the measuring distance between source and chamber, measurements are carried out at five different distances d in the range of d = 80-160 cm. By applying the inverse square law, the offset d os is obtained from the axis intercept of a linear fit to the inverse square root of the ionization current, which is corrected for the contributions from scattered radiation and air attenuation. In this way, the uncertainty of the source-to-chamber distance is reduced to less than 0.4 mm.
In order to consider radial anisotropy of the radiation field of the source, the azimuthal angle of the source with respect to the chamber was varied: measurement series are repeated several times after arbitrary axial rotation of the source wire. Thus, differences due to radial anisotropy of the source are likely to average out. The radial anisotropy of each source was determined in a separate experimental set-up and was found to be less than 0.3% peak-to-peak variation in each case.
The RAKR at reference time t 0 is given bẏ where N LS01 R is the calibration coefficient of the LS01 chamber for 60 Co or 192 Ir radiation, I is the measured ionization current, k Tp = p 0 T/pT 0 is the correction factor for the deviation of the air density from reference conditions (T 0 = 293.15 K and p 0 = 1013.25 hPa), k att corrects the attenuation of the radiation by the air between source and chamber, k sc is the correction factor due to scattered radiation from surroundings and scattering in the air, k dec considers the radioactive decay between measurement time and reference time t 0 , d is the distance between the source and the middle of the spherical volume of the chamber corrected for the offset d os , and d ref is the reference distance which is specified as The calibration coefficient N LS01 Co-60 for 60 Co is derived by traceable calibration of the LS01 secondary standard chamber in a 60 Co reference field to a custom-built graphite walled cavity ionization chamber referred to as HRK-3. 33,34 The HRK-3 is one of PTB's primary standards for air kerma free in air for 60 Co and 192 Ir gamma radiation 35,36 based on the Bragg-Gray cavity theory.
The calibration coefficient N LS01 Ir-192 for 192 Ir was derived from an interpolation method, 17,37 where the response of the chamber for 137 Cs and 60 Co radiation as well as for ten different x-ray qualities at tube voltages in the range from 10 to 300 kV was measured. 36 A determination of the RAKR of the same 192 Ir source with the HRK-3 primary standard chamber and with the LS01 chamber agrees within 0.5%, within the estimated uncertainties. 36 Due to the low ionization current owing to the small dimensions of the HRK-3 chamber, the large-volume LS01 secondary standard chamber is used for routine calibrations.
The correction factors in Eq. (1) for the remaining scattered radiation from the collimator, air, and walls k sc (d) and for the attenuation of the primary radiation by air k att (d) are determined by MC calculations on the one hand and by experimental determination of k sc (d) applying the shadow shield method 32,37 and calculation of k att (d) from mass attenuation coefficient of dry air 38 on the other hand. The results of both procedures agree within 0.7%. The combined correction factor for attenuation and scattering k att (d) · k sc (d) is typically 0.975 for 60 Co and 1.01 for 192 Ir (for d = 1 m). Effects of the finite size of the spherical ionization chamber in a radiation field of a point-like source 39 are negligibly small (<0.1%).

2.D. Calibration of well-type chambers for 192 Ir and 60 Co HDR brachytherapy sources
Well-type chambers are used in combination with a replaceable source holder insert (also called an applicator adaptor) with a guide tube to hold the afterloader catheter, the applicator needle, or the source directly on the axis of the cylindrical well. The response of the chamber versus the source position along the guide tube has a maximum. The calibration coefficient of a well-type chamber is only valid if the source to be calibrated is positioned at this point.
The position of maximum response is determined during each calibration measurement by shifting the calibration source by means of the afterloader system in steps of about 2 mm from the bottom limit stop of the source holder insert F. 2. Normalized ionization current I /I max of a TM33004 well-type chamber as a function of source position p with respect to the point of maximum current for 60 Co. Full (blue) circles: 60 Co source. Well-type chamber "free in air," i.e., with >1 m distance from walls and floor. Open (red) squares: same, but for 192 Ir source instead of 60 Co. Open (gray) diamonds: same, except for chamber that is enclosed by a radiation shield of lead bricks. Normalization to maximum current without lead shield. Curves: parabola fits.
to the top. The position of maximum response depends on the source type, as becomes apparent in Fig. 2 by the comparison of the measured ionization currents versus the source position of an 192 Ir source (open red squares) and a 60 Co source (full blue circles).
The calibration coefficient N R of a well-type chamber in terms of RAKR is determined from whereK R (t 0 ) is the RAKR of the source at reference time t 0 , I max is the measured ionization current with the source at the point of maximum response, I leak takes into account the leakage current, and the correction factors are: k ion for recombination losses, k Tp = p 0 T/pT 0 for deviation of air density from reference conditions (T 0 = 293.15 K and p 0 = 1013.25 hPa), k dec for radioactive decay between the time of chamber calibration measurement and reference time t 0 , and k ins takes into account differences between source holder inserts. The well-type chamber to be calibrated is placed in the room "free in air," i.e., in a minimum scatter environment, with a distance >1 m from walls and floor as recommended. 30 Using a well-type chamber in the vicinity of a concrete wall can increase the ionization current from 192 Ir by up to 1.1%. 40 Due to radiation protection purposes for some measurements with 60 Co, the well-type chamber was placed inside a shield of lead which results in deviations of I max of only about 0.2% (open gray diamonds in Fig. 2).
All surveyed chambers exhibited a negligible leakage current I leak with a maximum value of 50 fA. For the calculation of k Tp , a temperature sensor is placed in contact with the outside wall of the chamber. The chambers were positioned in the measuring room the day before the calibration measurement in order to achieve equilibrium with the room temperature. The amount of ion recombination losses in the chamber volume depends on the chamber bias voltage, the source strength, and the radiation quality, i.e., the nuclide. The incomplete saturation due to ion recombination is taken into account by the correction factor k ion = 1/A ion = I sat /I 1 (U 1 ), where I sat is the saturation current and I 1 the measured current at chamber bias voltage U 1 used for calibration. A ion is the ion collection efficiency. I sat is determined by recording the ionization current I as a function of chamber bias voltage U and subsequent extrapolation of I for U → ∞. For continuous radiation and if volume recombination is the predominant process, a plot of 1/I versus 1/U 2 reveals a straight line with axial intercept of 1/I sat . 42 For ideal conditions, it is sufficient to carry out the extrapolation on the basis of only two data points by using the so-called two-voltage technique formula 30,43 where I 1 is the ionization current at chamber bias voltage U 1 and I 2 is the current at U 1 /2. bers of the type x = W feature a linear function of 1/I versus 1/U instead of 1/U 2 , as shown in Fig. 3(b). This is possibly an effect of the presence of the undesired collection volume 27 for Tx33004 chambers of the type x = W or N. Hence, Eq. (3) is not valid for this chamber type and the axial intercept of the linear fit in Fig. 3(b) deviates from unity. Instead of Eq. (3), the linear extrapolation 1/I vs 1/U based on the two currents at U 1 and U 1 /2 results in Note that Tx33004 well-type chambers show a voltage polarity effect of about 0.5% for 192 Ir and about 0.9% for 60 Co. All chambers are calibrated with respect to the standard polarity of positive voltage, i.e., +300 V (HDR 1000 Plus) and +400 V (PTW Tx33004).

RESULTS
The radiation quality correction factor k Q = N Co-60 /N Ir-192 was derived and the dependence on chamber-to-chamber variations, source-to-source variations, and source strength was investigated as described in the following.  Even for bias voltages of U > 250 V, saturation is achieved, i.e., A ion > 99.99%, also for apparent activities >400 GBq. Thus k ion can be set to 1 in the complete clinically relevant range of source strengths. For chambers of the type x = W (full symbols), deviations of about 0.3% due to incomplete saturation are observed also for U =U 1 = 400 V. However, the neglect of the incomplete saturation by setting k ion = 1 results in differences between strong and weak sources of <0.2%. Figure 5 shows the saturation curves of the PTW Tx33004 chambers for 60 Co. For chambers of the type x = M, saturation is achieved even for U > 300 V and also for the strong source at the upper limit of the clinically relevant range of source strengths. For chambers of the type x = W, deviations are obvious here too, but differences between strong and weak sources are negligible (<0.1%).

3.A. Range of source strength
F. 5. Ionization current I normalized to saturation current I sat of different PTW Tx33004 (x = M, W) well-type chambers as a function of chamber bias potential U for the radiation of 60 Co HDR sources with apparent activities of 33 and 73 GBq. Similar results are obtained with HDR 1000 Plus welltype chambers. Figures 6 and 7 show the saturation curves of different HDR 1000 Plus chambers for 192 Ir and 60 Co HDR sources, respectively. The saturation curves are nearly the same for similar apparent activities, so ion collection efficiency A ion is a chamber-type specific value. Even for the strong sources with apparent activities at the upper limit of the clinically relevant range, A ion is larger than 99.9% (for U = U 1 = 300 V). Differences between strong and weak sources are negligible (<0.1%) and k ion can be set to 1.
Douysset et al. 27 have observed for a well-type chamber of type TW33004 a decrease of about 0.6% in the 192 Ir calibration coefficient upon the decrease of the source strength of the calibration source after some half-life periods. In order to investigate this effect, the calibration of eight TM33004 welltype chambers was repeated with the same 192 Ir source at F. 7. Ionization current I normalized to saturation current I sat of different HDR 1000 Plus well-type chambers as a function of chamber bias potential U for the radiation of 60 Co HDR sources with apparent activities of 33 and 73 GBq.  The 60 Co calibration coefficient is also unaffected by the source strength: the eight TM33004 chambers were calibrated with a 60 Co source with an apparent activity of 75 GBq as with an additional source with an apparent activity of about 34 GBq. Thereby, both limits of the clinically relevant range between the source replacements are reached. As shown in Fig. 8, the normalized calibration coefficients agree within ±0.05% (full red symbols).
Since the calibration coefficients for both 60 Co and 192 Ir are independent of the source strength within the clinically relevant range of source strengths, k Q is independent as well.

3.B. Source-to-source variation
The length of the active part of a source and also the shape and thickness of its encapsulation differ between the different F. 9. Deviation from mean calibration factor ∆N R ( j) = N R ( j)/N R ( j) − 1 of the same well-type chamber for different calibration sources j for 192 Ir and 60 Co, respectively. Full symbols: HDR 1000 Plus chamber. Open symbols: TM33004 chamber. Squares: GammaMed 232 sources. Circles: microSelectron V2 sources. Triangles: microSelectron HDR classic sources. Diamonds: 60 Co sources. source types (see Table II) and may vary slightly from source to source due to manufacturing tolerances. In particular for 192 Ir, the self-absorption of photons along the source axis is considerable. Thus, the photon fluence is a function of the angle with respect to the source axis (polar angle). According to the RAKR definition, this anisotropy is not taken into account for source calibrations. However, well-type ionization chambers are sensitive to almost 4π and, thus, differences in the polar anisotropy from one source to another might have an effect on the induced ionization current and the calibration coefficient of the chamber. Figure 9 shows for the same well-type chamber the deviations ∆N R ( j) = N R ( j)/N R ( j) − 1 of the calibration coefficient N R ( j) of different sources j from their mean value N R ( j) for 192 Ir and 60 Co, respectively. Both chamber types-TM33004 (open symbols) and HDR 1000 Plus (full symbols)-reveal similar deviations for the same source. The differences between the three 192 Ir source types can be neglected compared to the individual differences due to manufacturing tolerances and to the uncertainty of the source calibration procedure. The standard deviation is about ±0.3%. The expanded uncertainty (k = 2) of the mean value of the 18 sources is 0.14%. In the case of 60 Co sources, differences in absorption by the source components due to manufacturing tolerances have less influence owing to the higher photon energy. The maximum deviations are less than ±0.2% (diamonds).
The sources with number j = 10 and 11 are used for the measurement of the individual 192 Ir calibration coefficients N Ir-192 (i) of the 35 well-type chambers i. The deviations from the mean calibration coefficient for these sources are at least −0.2% and +0.2%, respectively. In order to determine a source-to-source variation independent k Q value, these deviations are corrected to match the mean calibration coefficient N Ir-192 ( j)(i).

3.C. Chamber-to-chamber variation
The individual calibration coefficients N Co-60 (i) and N Ir-192 ( j)(i) were determined for a large number of chambers i. The individual radiation quality correction factors k Q (i) = N Co-60 (i)/N Ir-192 ( j)(i) are analyzed with respect to chamberto-chamber variances due to manufacturing tolerances. Figure 10 shows the individual radiation quality correction factors k Q (i) of 26 PTW Tx33004 well-type ionization chambers in connection with a T33002.1.009 source holder as a function of the serial number (SN) of the chamber. In order to uncover the chamber-to-chamber variances, the error bars do not include the contribution due to the systematic uncertainties of the RAKR of the sources, which are the same for all chamber calibrations. For the same chamber, the k Q (i) values obtained with the Bebig Co-60 sources (full circles) and of the Flexisource Co-60 (open squares) agree within their uncertainties. Chambers with higher SN feature k Q (i) values which agree within ±0.4%, whereas chambers with a lower SN differ by up to about 3%. At the request of PTB, the manufacturer PTW states that well-type chambers of the type Tx33004 (and Nucletron SDS) are manufactured by identical methods and with significantly smaller tolerances due to improved machinery and improved manufacturing methods, from serial number 315 (and Nucletron SDS serial number 548) onward. 44 Chambers built before 2009 with PTW SN < 315, Nucletron SDS SN < 548, as well as with the obsolete Nucletron serial number 25x x x (left of dashed vertical line in Fig. 10) may differ from up-to-date chambers. The chamber-type-specific radiation quality correction factor is derived from the average over the individual correction factors of all investigated chambers with SN > 315 to k Q = k Q (i) = 1.190 (continuous horizontal line in Fig. 10). The determined 60 Co calibration coefficients differ from the manufacturer's data by more than 2%, as the radiation quality correction factor currently used by PTW was derived from measurements using older chambers with SN < 315. The uncertainty of the 60 Co calibration coefficient stated in the manufacturer's data is 3%. Figure 11 shows the individual radiation quality correction factors k Q (i) of nine HDR 1000 Plus well-type chambers with widely spread serial numbers (manufacturing dates between 2001 and 2011) in combination with source holder REF 70110. All values agree within ±0.3%. The type-specific radiation quality correction factor is derived from the average over the individual correction factors to k Q = k Q (i) = 1.050 (continuous horizontal line in Fig. 11). The manufacturer Standard Imaging states that well-type chambers of the type HDR 1000 Plus have not undergone any significant technical changes since their release in 1998 and source holder inserts REF 70010 and REF 70110 have been built without changes over the years. 41 The determined 192 Ir calibration coefficients N Ir-192 of all studied HDR 1000 Plus chambers and Tx33004 chambers with SN > 315 show only small chamber-to-chamber variations (maximal 1.5% difference). The approximation by a linear relationship between N Ir-192 and the 60 Co calibration coefficient N Co-60 is suitable as obvious in Fig. 12. A deviation of N Ir-192 of more than 1.2% from the typical value of 0.468 (mGy/h)/nA (for HDR 1000 Plus) or 0.972 (mGy/h)/nA (for Tx33004), respectively, is an indication of an abnormal chamber with possible deviations from the linear relationship as observed for Tx33004 chambers with SN < 315. In this case, a direct calibration with a 60 Co source is advisable and the quality correction factor should not be applied for the calculation of a 60 Co calibration coefficient. Table IV summarizes the results of the determined type-specific radiation quality correction factors k Q and specifies the range within a calibration The significant difference of the k Q values (14%) between the two chamber types probably originates from the different response for photons from the low-energy fraction of the spectral fluence of 192 Ir. The HDR 1000 Plus chamber can be used for measuring the RAKR of low-energy photon emitting brachytherapy sources like 125 I or 103 Pd whereas the Tx33004 chamber is not suitable for this purpose. There is a new welltype chamber from PTW called Sourcecheck 4π -Tx33005 which can be used for 125 I as well. The ratio of the calibration coefficients for 60 Co and 192 Ir of one chamber of this type measured up to now is clearly smaller than the k Q value for Tx33004 chambers. The determination of the type-specific radiation quality correction factor k Q from measurements with several additional Sourcecheck 4π chambers is currently in preparation.

3.D. Uncertainities
For both chamber types, the contribution to the uncertainty of k Q due to chamber-to-chamber variations is less than 0.4% T IV. Results for the type-specific radiation quality correction factor k Q . The last column specifies the range within a calibration coefficient N Ir-192 of a chamber must be for the application of k Q .

Chamber
Source (k = 2). This is small compared to the uncertainties for the determination of the RAKR of 192 Ir (1.5%, k = 2) and 60 Co (1.3%, k = 2) sources. The expanded uncertainty of k Q was determined according to the GUM (Ref. 45) and is U k Q = 2.1% (k = 2) for both chamber types. The uncertainty components are listed in Table V.

SUMMARY
Well-type ionization chambers are well suited as a secondary standard device for the calibration of 60 Co HDR brachytherapy sources. They can be applied to the quality assurance in clinical routine, the same as for 192 Ir HDR sources.
Within the scope of the presented study, radiation quality correction factors k Q for two types of well-type chambers were determined as the ratio of the chamber calibration coefficient for 60 Co HDR sources N Co-60 and that of 192 Ir HDR sources N Ir-192 . In this way, a well-type chamber calibrated for radiation fields of 192 Ir sources can be used for the measurement of the reference air kerma rate of 60 Co HDR brachytherapy sources without any additional calibration of the chamber. The calibration coefficient N Co-60 for 60 Co can be calculated from a given calibration coefficient N Ir-192 for 192 Ir radiation by N Co-60 = k Q · N Ir-192 .
The correction factor k Q was determined for well-type chambers of the type PTW Tx33004 (x = M, W, N) with source holder T33002.1.009 to be k Q = 1.19 and for well-type chambers of the type Standard Imaging HDR 1000 Plus with source holder REF 70110 to be k Q = 1.05. In the case of the Tx33004 chambers, the determined k Q value is valid for chambers with SN ≥ 315 (Nucletron SDS SN ≥ 548) onward only. For older chambers, discrepancies of greater than 3% have been observed. For these chambers, a direct calibration with a 60 Co source is necessary. Both k Q values are valid in the complete clinically relevant range of source strengths. Effects due to incomplete saturation owing to ion recombination at high dose rates were not detectable or negligible. The influence of source-to-source variations of 192 Ir is taken into account for the determination of the k Q values. For both chamber types, the contribution to the uncertainty of k Q due to chamber-to-chamber variations is less than 0.4% (k = 2). This is small compared to the contributions from the currently achievable uncertainties for the determination of the RAKR for 192 Ir (1.5%, k = 2) and 60 Co (1.3%, k = 2) sources.
The uncertainty of k Q is dominated by the contributions due to the uncertainties of the RAKR of the calibration sources and amounts to U k Q = 2.1% (k = 2). The uncertainty of a 60 Co calibration coefficient calculated via Eq. (5) from an 192 Ir calibration coefficient is given by U N Co-60 =  (U k Q ) 2 + (U N Ir-192 ) 2 . For a well-type chamber with a calibration coefficient with an uncertainty of, e.g., U N Ir−192 = 1.6% (k = 2) this results in an uncertainty of U N Co-60 = 2.6% (k = 2). This is twice as large as that obtained by direct calibration with a 60 Co source.
If small uncertainties are important or if the 192 Ir calibration coefficient of the chamber shows abnormal deviations from the typical value, a direct calibration with a 60 Co source is advisable instead of the application of a radiation quality correction factor.