Organ and effective dose evaluation in diagnostic radiology based on in-phantom dose measurements with novel photodiode-dosemeters

Organ and the effective doses of patients undergoing clinical X ray examinations of chest and abdomen were evaluated with an anthropomorphic phantom and a new dosimetry system. The system was comprised of 34 pin photodiode dosemeters placed in/on particular tissues or organs of the anthropomorphic phantom, where the tissues and organs are defined by the International Commission on Radiological Protection (ICRP) to estimate the effective doses. Dosemeter signals were acquired on a personal computer directly, and converted into absorbed doses, from which the organ and the effective doses were evaluated on the computer. Our study showed that organ doses ranged from <0.01 to 0.72 mGy in routine X-ray radiography of chest and of abdomen and from 0.07 to 55.91 mGy in routine computed tomography (CT) examinations with current multi-slice CT scanners. The effective dose observed in the chest CT examination was approximately 300 times higher than that in chest radiography.     

A study on optimal scan conditions of Big Bore multi-slice computed tomography based on radiation dose and image noise

The newly introduced Big Bore computed tomography (CT) has a possibility to increase the tube current product scan time (mA s) for compensation of image degradation due to larger gentry opening without sound guideline. The objective of this paper is to derive optimal scan conditions for Big Bore CT scanner, mainly relating to the dose of diagnostic CT. The weighted CT dose index (CTDI(w)) was estimated at five typical protocols, such as head and neck, brain, paediatric, chest and abdomen. Noises were analysed in a circle of 1 or 2 cm of diameter in CT image slice. The results showed that measured CTDI(w) values generally follow the theoretical rule at all scanning conditions of every protocol. Although image noises decrease with increment of mA s, analysed image noises do follow the theoretical rule, but only in specific protocols. This phenomenon is presumed to result from the photon energy spectra arriving at the detection system of the Big Bore scanner.     

CT dosimetry computer codes: their influence on radiation dose estimates and the necessity for their revision under new ICRP radiation protection standards

Computed tomography (CT) dosimetry computer codes have been most commonly used due to their user friendliness, but with little consideration for potential uncertainty in estimated organ dose and their underlying limitations. Generally, radiation doses calculated with different CT dosimetry computer codes were comparable, although relatively large differences were observed for some specific organs or tissues. The largest difference in radiation doses calculated using different computer codes was observed for Siemens Sensation CT scanners. Radiation doses varied with patient age and sex. Younger patients and adult females receive a higher radiation dose in general than adult males for the same CT technique factors. There are a number of limitations of current CT dosimetry computer codes. These include unrealistic modelling of the human anatomy, a limited number of organs and tissues for dose calculation, inability to alter patient height and weight, and non-applicability to new CT technologies. Therefore, further studies are needed to overcome these limitations and to improve CT dosimetry.     

Review of reconstruction of radiation incident air kerma by measurement of absorbed dose in tooth enamel with EPR

Electron paramagnetic resonance dosimetry with tooth enamel has been proved to be a reliable method to determine retrospectively exposures from photon fields with minimal detectable doses of 100 mGy or lower, which is lower than achievable with cytogenetic dose reconstruction methods. For risk assessment or validating dosimetry systems for specific radiation incidents, the relevant dose from the incident has to be calculated from the total absorbed dose in enamel by subtracting additional dose contributions from the radionuclide content in teeth, natural external background radiation and medical exposures. For calculating organ doses or evaluating dosimetry systems the absorbed dose in enamel from a radiation incident has to be converted to air kerma using dose conversion factors depending on the photon energy spectrum and geometry of the exposure scenario. This paper outlines the approach to assess individual dose contributions to absorbed dose in enamel and calculate individual air kerma of a radiation incident from the absorbed dose in tooth enamel.     

Patient dose reduction in CT examinations by optimising scanogram acquisition

The objective was to determine the optimum settings of the scanogram performed in computed tomography (CT) examinations for scan localisation. Head, abdomen and thorax scanograms were performed on a Rando anthropomorphic phantom using various selectable combinations of tube voltage and tube current values. Thermoluminescence dosemeters were used to obtain entrance skin dose data. Effective dose was estimated using normalised organ dose data provided by the National Radiological Protection Board. One hundred and twelve head, 114 thoracic and 111 abdominal patient scanograms were obtained with lower settings than those recommended by the operator's manual. Scanogram sufficiency was assessed by four observers. Head and thoracic scanograms obtained with 80 kV/50 mA and abdominal scanograms obtained with 80 kV/75 mA were found to be acceptable, even though the operator's manual recommendation was 120 kV/100 mA. Thus, the scanogram effective dose was reduced by 72%, 84% and 88% for head, thorax and abdomen examination respectively. Effective dose from a complete CT examination may be reduced by up to 3.5% without any subsequent image quality degradation of the diagnostically important sectional images.     

低管电压CT扫描在新型冠状病毒肺炎患者复查中的应用价值

目的:分析低管电压CT扫描在新型冠状病毒肺炎(新冠肺炎)复查中的应用价值.方法:抽取我院2020年1月-12月收治的58例新冠肺炎患者的首次检查、复查资料,进行回顾性分析,首次检查、复查管电压分别为100kV、70kV,以双盲法评价复查时肺窗、纵膈窗图像质量,辐射剂量相关指标.结果:与首次检查比较,复查时图像质量评分显...     

Monte Carlo calculation of radiation dose in CT examinations using phantom and patient tomographic models

By using a voxel-based Monte Carlo simulation technique, we developed and validated a method to calculate radiation-absorbed dose in the computed tomography (CT) examinations from the images of phantoms and patients. The ionising radiation transport was simulated using the EGS4 code system. The geometry of the X-ray beam (focus-to-axis distance, field of view, collimation, and primary and beam-shaper filtration) and the X-ray spectral distribution (HiSpeed LX/i) were included in the simulation. Each axial CT image was reduced to a 256 x 256 matrix and stacked in a volume. The patient images were segmented before the simulation of radiation transport by using four categories of materials, such as air, lung, muscle and bone. To test the voxel-based method, the values of the radiation dose derived from a simulated CT exposure were calculated and compared with those obtained from the measurements performed within the dosimetry phantoms. To complete the scope of the work, series of CT scans of the trunk of an anthropomorphic phantom and patients were simulated to calculate the average dose in each 1-cm-wide transverse slice (ADS). The comparison between the simulated and measured dose data for the CT indices showed a difference of <5% in all the cases. The estimated mean values of ADS from the chest, abdomen and pelvis of the anthropomorphic phantom were approximately 1.7-2 times the weighted CT dose index (CTDI(w)) value, whereas the mean ADS values for these anatomical areas were 1.3-2 times the CTDI(w) of patients. The voxel-based simulation method provided a technique for estimating the individual patient doses in the CT examinations.     

Assessment of patient organ doses and effective doses using the VIP-Man adult male phantom for selected cone-beam CT imaging procedures during image guided radiation therapy

A Monte Carlo based computational procedure for determining organ doses and effective doses has been described for two procedures used in newly developed image-guided radiation treatment: kilovoltage cone-beam computed tomography (kV CBCT) and mega-voltage computed tomography (MV CBCT). A whole-body patient computational phantom, VIP-Man phantom, is employed for Monte Carlo dose calculations. Results indicate that the thyroid dose is always the highest in head and neck (H&N) scan for both kV and MV CBCT, and the bladder dose is the highest in prostate scan for both kV and MV CBCT. For the VIP-Man phantom, it has been found that the effective dose for kV CBCT (assuming a total exposure of 1350 mAs) is approximately 9.5 mSv for the two anatomical sites, whereas the effective dose for MV CBCT (assuming a total of 6 monitor unit) ranges from 5.10 mSv for the H&N case to 8.39 mSv for the prostate scan. The estimated whole-body effective doses allow different imaging procedures to be compared and evaluated.     

CT dosimetry: getting the best from the adult Cristy phantom

The use of geometrical phantoms for computed tomography (CT) dosimetry can incur errors in the calculation of effective dose due to the anatomically incorrect organ shapes and distributions, and unrepresentative body dimensions. A Monte Carlo program that makes use of an anatomically correct voxel phantom has been developed to calculate effective doses in CT and to compare with conventional dosimetric techniques. The code was validated against the latter by matching the phantom dimensions and simulating whole-body irradiation; agreement to within 6% was found. Effective doses were calculated for brain, lung, abdomen and pelvis CT scans for voxel phantom sizes corresponding to those of standard-sized adult, a teenager and 10% greater than those of standard-sized adult. Errors incurred by using the conventional techniques are minimised if the scan range is set by matching the fractions of radiosensitive organs that are irradiated directly. Under these circumstances, the conventional techniques will underestimate the dose to a 15 y old by up to 22% while the dose to a large subject is overestimated by up to 11%.     

Patient-specific dosimetry in radionuclide therapy

This study presents an attempt to compare individualised palliative treatment absorbed doses, by planar images data and Monte Carlo simulation, in two in vivo treatment cases, one of bone metastases and the other of liver lesions. Medical Internal Radiation Dose schema was employed to estimate the absorbed doses. Radiopharmaceutical volume distributions and absorbed doses in the lesions as well as in critical organs were also calculated by Monte Carlo simulation. Individualised planar data calculations remain the method of choice in internal dosimetry in nuclear medicine, but with the disadvantage of attenuation and scatter corrections lack and organ overlay. The overall error is about 7 % for planar data calculations compared with that using Monte Carlo simulation. Patient-specific three-dimensional dosimetric calculations using single-photon emission computed tomography with a parallel computed tomography study is proposed as an accurate internal dosimetry with the additional use of dose-volume histograms, which express dose distributions in cases with obvious inhomogeneity.     

Patient doses in CT examinations in Switzerland: implementation of national diagnostic reference levels

Diagnostic reference levels (DRLs) were established for 21 indication-based CT examinations for adults in Switzerland. One hundred and seventy-nine of 225 computed tomography (CT) scanners operated in hospitals and private radiology institutes were audited on-site and patient doses were collected. For each CT scanner, a correction factor was calculated expressing the deviation of the measured weighted computed tomography dose index (CTDI) to the nominal weighted CTDI as displayed on the workstation. Patient doses were corrected by this factor providing a realistic basis for establishing national DRLs. Results showed large variations in doses between different radiology departments in Switzerland, especially for examinations of the petrous bone, pelvis, lower limbs and heart. This indicates that the concept of DRLs has not yet been correctly applied for CT examinations in clinical routine. A close collaboration of all stakeholders is mandatory to assure an effective radiation protection of patients. On-site audits will be intensified to further establish the concept of DRLs in Switzerland.     

Relations between tooth enamel dose and organ doses for electron spin resonance dosimetry against external photon exposure

An analysis of doses to tooth enamel and to organs was carried out to develop a method that can predict the organ doses and the effective dose by electron spin resonance (ESR) dosimetry using tooth samples for external photon exposure. Absorbed dose to tooth enamel and organ doses were obtained by Monte Carlo calculations using the EGS4 code in combination with a mathematical human model with a newly defined teeth part. The calculations gave quantitative relations between tooth enamel dose and organ doses for some cases of external photon exposure. It was also found that tooth enamel dose depends more significantly on energy of incident photons than the other organ dose or the effective dose. The obtained data are to be useful for the assessment of individual dose in past exposure events by the ESR dosimetry using tooth enamel.     

The ICRU (International Commission on Radiation Units and Measurements): its contribution to dosimetry in diagnostic and interventional radiology

The ICRU (International Commission on Radiation Units and Measurements was created to develop a coherent system of quantities and units, universally accepted in all fields where ionizing radiation is used. Although the accuracy of dose or kerma may be low for most radiological applications, the quantity which is measured must be clearly specified. Radiological dosimetry instruments are generally calibrated free-in-air in terms of air kerma. However, to estimate the probability of harm at low dose, the mean absorbed dose for organs is used. In contrast, at high doses, the likelihood of harm is related to the absorbed dose at the site receiving the highest dose. Therefore, to assess the risk of deterministic and stochastic effects, a detailed knowledge of absorbed dose distribution, organ doses, patient age and gender is required. For interventional radiology, where the avoidance of deterministic effects becomes important, dose conversion coefficients are generally not yet developed.     

Evaluation of patient exposure in computerised tomogram in Poland

The increasing number of computerised tomography (CT) procedures performed in Poland in recent years has resulted in a growing contribution of these examinations to the whole exposure of the population to ionising radiation from medical sources. (The number of CT examinations in Poland was 170,000 in 1995 and 460,000 in 1999.) An evaluation is presented of doses to patients in CT examinations performed with different types of CT unit. To evaluate the exposure to patients dose linear product (DLP) was measured using a NOMEX dosemeter with a pencil chamber (PTW, Frieburg) and the cylindrical PMMA phantoms 'head' and 'body'. CTDI values were evaluated according to current methodology as described in European Guidelines (EUR 16262). The measurements were performed for seven types of CT unit made by different companies. The CTDI values were also compared to reference levels recommended by IAEA. In conclusion it was found that the value of collective effective dose (2200 man.Sv), has increased in Poland nearly 4 times in comparison to 1995, whereas the number of CT examinations increased nearly 3 times in this period. For most of the 'controlled' CT scanners the values of CTDI in head procedures are near to or higher than the IAEA Reference Level (50 mGy); this can result from the protocols, which are chosen without a dose analysis.     

Monte Carlo calculation and experimental verification of the photon energy response of tooth enamel in a head-sized plexiglas phantom

The use of electron paramagnetic resonance (EPR) tooth dosimetry for calculation of organ doses requires conversion of the measured absorbed dose in enamel. Before deriving conversion factors from simulation calculations with a realistic anthropomorphic human phantom, in the current study a simplified phantom was chosen to compare EPR measurement and Monte Carlo calculation. The dose response of tooth enamel of molars at various positions inside a cylindrical Plexiglas phantom of head-size was calculated hy Monte Carlo modelling in parallel photon beams of X rays of 63 keV equivalent energy and 60Co gamma rays (1.25 Mev). For X ray exposure, preliminary results of EPR dosimetry with tooth enamel samples prepared from molars irradiated in the phantom were in agreement with calculation. The mean value of the ratio of the measured to the calculated dose was 0.93 +/- 0.08.     

ESR dosimetry for atomic bomb survivors and radiologic technologists

An individual absorbed dose for atomic bomb (A-bomb) survivors and radiologic technologists has been estimated using a new personal dosimetry. This dosimetry is based on the electron spin resonance (ESR) spectroscopy of the CO₃³⁻ radicals, which are produced in their teeth by radiation. Measurements were carried out to study the characteristics of the dosimetry; the ESR signals of the CO₃³⁻ radicals were stable and increased linearly with the radiation dose. In the evaluation of the absorbed dose, the ESR signals were considered to be a function of photon energy. The absorbed doses in ten cases of A-bomb victims and eight cases of radiologic technologists were determined. For A-bomb survivors, the adsorbed doses, which were estimated using the ESR dosimetry, were consistent with the ones obtained using the calculations of the tissue dose in air of A-bomb, and also with the ones obtained using the chromosome measurements. For radiologic technologists, the absorbed doses, which were estimated using the ESR dosimetry, agreed with the ones calculated using the information on the occupational history and conditions. The advantages of this method are that the absorbed dose can be directly estimated by measuring the ESR signals obtained from the teeth of persons, who are exposed to radiation. Therefore, the ESR dosimetry is useful to estimate the accidental exposure and the long term cumulative dose.     

Dose distribution around a needle-like anode X-ray tube: dye-film vs. planar thermoluminescent detectors

The dosimetry around the X-ray tube with a needle-like anode (NAXT), developed at the Institute of Nuclear Studies, for interstitial brachytherapy has been performed using (1) dye films (Gafchromic XR-T), (2) large-area thermoluminescent (TL) detectors--prepared either by gluing TL powder onto thin Al foil (so-called planar detectors with spatial resolution of 0.1 mm) and (3) miniature (2 mm diameter and 0.5 mm thick) TL detectors. The measurements were performed in following geometries. (1) Needle inside a PMMA cylinder--the planar TL detector mounted on the surface of the cylinder. (2) Needle inside a thick block of PMMA and TL detector mounted vertically 7 mm from needle axis. TL detectors were read with the planar (2D) thermoluminescence reader, developed at IFJ, with a sensitive CCD (charge couple device) camera. Gafchromic films were evaluated with a system based on Agfa Arcus 1200 scanner and calibrated with X rays (35 kV) filtered with 0.03 mm Mo and with Co-60 photons. The intensity distribution of TL light on the planar detector was calibrated in terms of absorbed dose to water, using (137)Cs gamma-rays. TL planar detectors seem to be a promising tool for 2D dosimetry of miniature X-ray sources. Obtained results for TLDs and Gafchromic films seem to be comparable but differences have been found. Both methods are useful for measurements of dose distribution around the NAXT X-rays source.     

Automatic tube-current modulation in CT--a comparison between different solutions

In this study, tube-current modulation systems on two different CT equipments have been evaluated: Care Dose from Siemens and Auto mA from GE Medical Systems. Care Dose modulates the tube current in the xy-plane during rotation whereas Auto mA modulates the tube current in the z-direction. xy-Plane modulation was investigated by using an elliptic Polymethylmethacrylate phantom and a CTDI-ion chamber. To investigate modulation in the z-direction, an anthropomorphic dosimetry phantom (Atom) was used. Tests performed with and without tube-current modulation were compared with respect to absorbed dose and image quality. In the anthropomorphic phantom measurements, the dose savings were 15% using Care Dose and the photon starvation artefacts were negligible. Using Auto mA the absorbed dose depends on the chosen noise level. Image noise becomes more constant throughout the patient but photon starvation artefacts remain. We conclude that the two tube-current modulation techniques show different dose advantages and image quality artefacts.     

Organ and effective doses from verification techniques in image-guided radiotherapy

The purpose of this work was an evaluation of organ doses and effective doses from three verification techniques in Image-Guided Radiotherapy: from kilovoltage (kV) cone beam computed tomography (CBCT) scans, from two orthogonal kV images and from two orthogonal megavoltage (MV) images for two different treatment sites: pelvis and head and neck (H&N). For comparison reasons, organ doses and effective doses from prostate and H&N radiotherapy were also evaluated. Measurements of organ doses were performed in a male anthropomorphic Rando phantom by means of thermoluminescent dosemeters. In this investigation, measured organ doses from one CBCT scan, from two MV images and from two kV images of pelvis represent typically 1-6, 1-10 and 0.05-1 %, respectively, of organ doses resulting from one fraction of prostate radiotherapy. The maximum effective doses from CBCT scans, kV images and MV images of pelvis are 5.6, 0.8 and 11.9 mSv, respectively.     

3D calculation of absorbed dose for 131I-targeted radiotherapy: a Monte Carlo study

Various methods, such as those developed by the Medical Internal Radiation Dosimetry (MIRD) Committee of the Society of Nuclear Medicine or employing dose point kernels, have been applied to the radiation dosimetry of (131)I radionuclide therapy. However, studies have not shown a strong relationship between tumour absorbed dose and its overall therapeutic response, probably due in part to inaccuracies in activity and dose estimation. In the current study, the GATE Monte Carlo computer code was used to facilitate voxel-level radiation dosimetry for organ activities measured in an (131)I-treated thyroid cancer patient. This approach allows incorporation of the size, shape and composition of organs (in the current study, in the Zubal anthropomorphic phantom) and intra-organ and intra-tumour inhomogeneities in the activity distributions. The total activities of the tumours and their heterogeneous distributions were measured from the SPECT images to calculate the dose maps. For investigating the effect of activity distribution on dose distribution, a hypothetical homogeneous distribution of the same total activity was considered in the tumours. It was observed that the tumour mean absorbed dose rates per unit cumulated activity were 0.65E-5 and 0.61E-5 mGY MBq(-1) s(-1) for the uniform and non-uniform distributions in the tumour, respectively, which do not differ considerably. However, the dose-volume histograms (DVH) show that the tumour non-uniform activity distribution decreases the absorbed dose to portions of the tumour volume. In such a case, it can be misleading to quote the mean or maximum absorbed dose, because overall response is likely limited by the tumour volume that receives low (i.e. non-cytocidal) doses. Three-dimensional radiation dosimetry, and calculation of tumour DVHs, may lead to the derivation of clinically reliable dose-response relationships and therefore may ultimately improve treatment planning as well as response assessment for radionuclide therapy.