The data used in brachytherapy planning are obtained from homogeneous mediums. In practice, the heterogeneous tissues and materials affect the dose distribution of brachytherapy. It is aimed to investigate the effect of air cavities on brachytherapy dose distribution using a specially designed device.

In this study, the special device designed with different volumes of air and water to be irradiated and measured at different depths using EBT3 Gafchromic films. EBT3 Gafchromic films were preferred for this study because they can be cut to the shape of the experimental geometry, are water resistance and double directional usability.

In our study, sudden dose increases and decreases were observed at the water–air–water interfaces. Increases were 9, 11·8 and 15% in the 13, 18 and 22 mm apparatus, respectively. These effects were expected and the results were consistent with the literature and within the tolerance limits stated in the clinical dose guidelines. The most important result is that the percent depth–dose curve of the radiation passing through the air to the water and only passing through the water medium is different. The average differences were 1·97, 2·97 and 2·31% for the 13, 18 and 22 mm apparatus, respectively.

Although the effect of heterogeneity may be neglected according to clinical guidelines, it is suggested that the dose effect of heterogeneity is taken into account so that the dose can be estimated sensitively. Brachytherapy plans using dose data without considering air gaps may cause erroneous dose distributions due to heterogeneity of tissue.