Variation in radiation doses in paediatric cardiac catheterisation procedures

Paediatric cardiac catheterisation involves diagnostic and therapeutic procedures that range from simple to complex and can subject paediatric patients to varying radiation doses. The study aims to determine the variation in entrance doses in patients in terms of dose-area product (DAP) values and to investigate the methods for optimising radiation protection. A total of 190 paediatric patients belonging to age groups 0, 1, 5 and 10 y who underwent diagnostic and six selected therapeutic procedures at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia were included in the study. Therapeutic procedures include coarctation (COA), patent ductus arteriosus (PDA), radiofrequency ablation, pulmonary, embolisation and septostomy. Fluoroscopy and cine radiography were used in all procedures. Patient demography (weight, age, gender and height), radiographic technique factors, fluoroscopy and cine time, frame rate, and DAP values were taken from patients records. Effective doses for each procedure were estimated from the DAP values. The mean DAP per procedure were analysed for correlation with patient equivalent cylindrical diameter, weight, fluoroscopy time and number of frames. Factors influencing the variation in doses were investigated. Initial results show that PDA occlusion has the highest mean DAP value of 23.21 Gy-cm(2), while the diagnostic and septostomy procedures have the lowest value of 7.77 and 6.95 Gy-cm(2), respectively.     

Radiation doses to patients from enteroclysis

The purpose of this study was to determine the patient doses during enteroclysis and compare them with the available bibliographical data. For 14 enteroclysis examinations, the dose-area product (DAP) meter readings, fluoroscopy time, number of radiographs and exposure data were recorded. From these data, the fluoroscopy and radiography contributions to DAP, the entrance surface dose (ESD) and the effective dose (E) for each examination were estimated. The mean DAP was 81 Gy cm(2) and the mean fluoroscopy time was 19.5 min. The fluoroscopy contribution to DAP was 77% and 8.7 films were acquired in each examination on average. The mean ESD and E were estimated to be 428 mGy and 21 mSv, respectively. The mean DAP and fluoroscopy time calculated in this study are quite high when compared with those reported in the literature, suggesting that the examination technique should be reviewed and the ways to reduce patient exposure without compromising the diagnostic quality should be acquired.     

Suggested diagnostic reference levels for paediatric X-ray examinations in India

Exposure of children to ionising radiation is considered to carry higher risk than that of adults; therefore a need to suggest diagnostic reference levels (DRLs) for the common paediatric diagnostic X-ray procedures was recognised for the X-ray machines meeting the requirements of the recently implemented Safety Code for Medical Diagnostic X-ray Equipment and Installations in India. Measurements were carried out for entrance surface air kerma (free in air) in conventional paediatric X-ray diagnostic examinations among four age groups: <1, 1-4, 5-9 and 10-15 y. A total of 2240 air kerma measurements at different fixed focus to skin distances were studied for 7 paediatric diagnostic examinations with 11 different projections on 62 X-ray machines installed in 22 selected hospitals in the country. The third quartile values of air kerma per paediatric examination for the age group of 5-9 y were considered as values of paediatric DRLs. The suggested values of DRLs are 0.2 mGy for chest AP/PA, 0.3 mGy for chest LAT, 0.7 mGy for lumber spine AP, 1.3 mGy for lumber spine LAT, 0.3 mGy for thoracic spine AP, 0.6 mGy for thoracic spine LAT, 0.5 mGy for abdomen AP, 0.7 mGy for pelvis AP, 0.6 mGy for skull PA, 0.5 mGy for skull LAT and 0.8 mGy for hip joints AP.     

The monetary value of the man-mSv for Korean NPP radiation workers assessed by the radiation aversion factor

The monetary value of the man-mSv for operators of Korean nuclear power plants (NPPs) was calculated using a radiation aversion factor based on a survey of NPP workers. Initially, the life expectancy in the population is 79.4 y, the average age of cancer occurrence is 60 y, the average annual wage for an electric worker is 56 000 $ y(-1) and the nominal risk coefficient induced by radiation is 4.2E(-5) mSv were used to evaluate the basic monetary value (α(base)) resulting in 45.6 $ mSv(-1). To investigate the degree of radiation aversion, the subject of the investigation was selected as the working radiation workers in 10 NPPs in Korea (Kori 1-2, Yeonggwang 1-3, Ulchin 1-3 and Wolseong 1-2). In August 2010, with the cooperation of KHNP and partner companies, a total of 2500 survey questionnaires to 10 NPPs (or 250 surveys to each NPP) were distributed to currently employed radiation workers. From these, 2157 responses were obtained between August and October 2010. The assessed radiation aversion factor and the monetary value of the man-mSv from the calculated radiation aversion factor were 1.26 and ～50 $ in the 0-1 mSv range, 1.38 and ～200 $ in the 1-5 mSv range, 1.52 and ～1000 $ in the 5-10 mSv range, 1.65 and ～4000 $ in the 10-20 mSv range and 1.74 and ～8500 $ >20 mSv.     

A large-scale multicentre study in Belgium of dose area product values and effective doses in interventional cardiology using contemporary X-ray equipment

In this paper, a large-scale multicentre patient dose study performed in eight Belgian interventional cardiology departments is presented. Effective dose (E) was calculated based on a detailed dose-area product (DAP)-registration during each procedure and by using conversion coefficients generated by the Monte Carlo-based computer program PCXMC. Conversion coefficients were found to be 0.177 mSv Gycm(-2) for systems that do not use any additional copper filtration in cineradiography and 0.207 mSv Gycm(-2) for systems that use additional copper filtration in cineradiography. Mean E values of 9.6 and 15.3 mSv for diagnostic and therapeutic procedures, respectively, were obtained. DAP distributions were investigated in order to derive dose reference levels: 71 and 106 Gycm2 for diagnostic and therapeutic procedures, respectively, are proposed. Significant differences were observed in DAP distributions taking into account whether additional copper filtration was used in the cineradiography mode. Apart from the skin, the organs most at risk are lungs and heart. The probability of fatal cancer for the studied population amounted to 1.1x10(-4) and 2.1x10(-4) for diagnostic and therapeutic procedures, respectively, for the age distribution of the patients considered in this multicentre study.     

Radiation doses to patients undergoing coronary angiography and percutaneous transluminal coronary angioplasty

A detailed study of radiation doses received by 168 patients who underwent coronary angiography (CAG) and 102 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) in two Greek hospitals is presented. Radiation dose was measured in terms of dose-area product (DAP). The contribution of fluoroscopy and cineradiography to the total DAP was examined separately for each radiological projection used in both procedures. Effective dose and doses to various organs were estimated with the help of the ODS-60 software. Total DAP was found to correlate linearly to fluoroscopy time and cine film length. Mean DAP values were found to be 80.8 +/- 28.0 Gy cm2 for CAG and 86.2 +/- 65.6 Gy cm2 for PTCAs, whereas the estimated mean values of effective dose were 20.9 +/- 7.5 and 23.2 +/- 18.1 mSv respectively. DAP to effective dose conversion coefficients were estimated to be 0.26 mSv/Gy cm2 for CAG and 0.27 mSv/Gy cm2 for PTCAs.     

A study of the correlation between dose area product and effective dose in vascular radiology

The purpose of the multi-centre study was to assess dose area product (DAP) and effective dose of patients undergoing angiography of the lower limbs in Belgium and to investigate the correlation between DAP and effective dose. DAP values were measured in 12 centres and compared with the national diagnostic reference levels (DRLs). The effective dose (E) was estimated by multiplying the DAP with case-specific conversion coefficients (CCs) that were calculated with Monte Carlo software MCNP5. As a model for the patient, a mathematical hermaphrodite phantom was used. Calculations showed that tube configurations and extra Cu filtration have a large influence on these CCs. Due to the use of Cu filtration, effective dose can be twice as high for comparable DAP values. Also the use of an over-couch tube configuration is a disadvantage when compared with the under-couch tube configuration. For centres working under-couch without the use of extra Cu-filtration, the DAP values correlate very well with effective dose (Spearman's rank correlation rho ; = 0.97). For these conditions, general CCs between DAP and E were calculated. They were 0.083 mSv Gy(-1) cm(-2) (ICRP 60) and 0.065 mSv Gy(-1) cm(-2) (ICRP 103).     

Fluroscopy in paediatric fractures--setting a local diagnostic reference level

BACKGROUND: The ionizing radiations (Medical Exposure) Regulation 2000 has made it mandatory to establish diagnostic reference levels (DRLs) for all typical radiological examinations. OBJECTIVES: We attempt to provide dose data for some common fluoroscopic procedures used in orthopaedic trauma that may be used as the basis for setting DRLs for paediatric patients. MATERIALS AND METHODS: The dose area product (DAP) in 865 paediatric trauma examinations was analysed. Median DAP values and screening times for each procedure type along with quartile values for each range are presented. RESULTS: In the upper limb, elbow examinations had maximum exposure with a median DAP value of 1.21 cGy cm2. Median DAP values for forearm and wrist examinations were 0.708 and 0.538 cGy cm2, respectively. In lower limb, tibia and fibula examinations had a median DAP value of 3.23 cGy cm2 followed by ankle examinations with a median DAP of 3.10 cGy cm2. The rounded third quartile DAP value for each distribution can be used as a provisional DRL for the specific procedure type.     

Optimisation strategies and justification: an example in uterine artery embolisation for fibroids

Radiation risk has to be justified and optimised. This study discusses the radiation risk of uterine artery embolisation (UAE) for the treatment of fibroids. A total of 70 consecutive UAE dosimetry parameters were assessed. Using Monte Carlo simulation, organ and effective doses and dose conversion coefficients (DCCs) (mSv Gy cm(-2)) were calculated. During UAE optimisation, avoidance of oblique views and use of last-image-hold (LIH) documentation instead of digital subtraction angiography (DSA) were investigated. Mean dose-area product (DAP) was 37.1 Gy cm2 (median 23.7 Gy cm2) and mean fluoroscopy time was 18.4 min (median 16.6 min). Dose values decreased as the study progressed: mean DAP for patients 1-21, 68.5 Gy cm2; patients 22-43, 35.7 Gy cm2; and patients 44-69, 13.0 Gy cm2. Average DCC for DSA image procedures was 0.572, yielding a mean effective dose of 29.6 mSv (median 17.1 mSv). For LIH-only procedures, an average DCC of 0.813 was estimated [using mean effective dose: 10.6 mSv (median 8.1 mSv)].     

Influence of patient thickness and operation modes on occupational and patient radiation doses in interventional cardiology

Patient and staff dose values in an interventional cardiology laboratory for different operational modes and several patient thicknesses (from 16 to 28 cm, simulated using polymethylmethacrylate) are presented. When increasing patient thicknesses and depending on fluoroscopy and cine modes, occupational doses can increase >30 times the baseline level. Scatter dose rates at the cardiologist's position with no radiation protective tools ranged from 1 to 14 mSv h(-1) for fluoroscopy, and from 10 to 47 mSv h(-1) during cine acquisition. Patient entrance surface air kerma rates increased by nearly 3 and staff dose rates by up to 2.6 when fluoroscopy was moved from the low to the high mode, for a typical 20 cm thickness. The respective increase factors were 6 and 4.2 when patient thickness rose from 16 to 28 cm, and by 10 and 8.3, when comparing cine acquisition with the low fluoroscopy mode. The knowledge of typical dose rates for each X-ray system in use in catheterisation laboratories is essential in order to optimise protection of patients and staff.     

Measurement of natural radioactivity in bottled drinking water in Pakistan and consequent dose estimates

Natural radioactivity was determined in 11 different brands of commonly sold bottled drinking water in the federal capital Islamabad and Rawalpindi city of Pakistan using gamma spectrometry technique. Mean concentrations of 226Ra, 232Th and (40)K were found to be 11.3 +/- 2.3, 5.2 +/- 0.4 and 140.9 +/- 30.6 mBq l(-1), respectively. The annual cumulative effective doses due to all three natural radionuclides for different age groups of 1-5 y, 5-10 y, 10-15 y and adults (>or=18 y) were estimated to be 4.0, 3.4, 3.1 and 4.1 microSv y(-1), respectively. Among the three natural radionuclides, annual effective doses for all age groups from 226Ra were significant. Children in the age group of 1-5 y appeared to be at risk with respect to the annual effective doses from 226Ra as compared to the other age groups. Results obtained in this study are compared with the reported values from other countries of the world and it was observed that measured activity concentrations of three natural radionuclides in the bottled drinking water were lower than these values. Annual estimated effective doses for all four age groups from the intake of natural radionuclides in bottled drinking water were also found below the World Health Organisation (WHO) recommended limit of 0.1 mSv y(-1) as well as the average radiation dose of 0.29 mSv y(-1) received per head worldwide due to ingestion of natural radionuclides assessed by UNSCEAR (2000).     

Evaluation of paediatric X-ray doses in Moroccan university hospitals

This work evaluates the entrance skin dose (ESD), the body organ dose (BOD) and the effective dose (E) for chest X-ray exposures of paediatric patients. Two Moroccan university hospitals in Rabat, composed of two departments, and one in Casablanca with one paediatric compartment has been considered. For reasons of confidentiality, the departments are named A, B and C. Patients were divided into four age groups: 0-1, 1-5, 5-10 and 10-15 y, so that the results could be compared with previous published data found in the literature. The results have been calculated with the use of the Dose Cal software. Results of mean ESD for the age interval 1-5 y and antero-posterior (AP) projection are: 162 μGy for hospital A, 91 μGy for hospital B and 105 μGy for hospital C. The diagnostic reference levels (DRLs) of 100 μGy for this age range is exceeded in hospital A, while in the other two hospitals results were within the DRL and comparable with the results found in Brazil, Soudan, Nigeria and other radiological centres inpean Countries. The results of BOD and E showed that for the three departments, the BOD varies in the same proportion as the ESD. The highest values are those of hospital A. For the PA examination, the dose is reduced compared with the AP projection, especially for sensitive organs.     

Discussion on optimisation below dose limit for public using background-cancer-risk-based approach

To improve a radiological protection system, the lower bound of optimisation was discussed using a newly proposed background-cancer-risk-based approach. This approach provides a new finding that the standard deviation of the background cancer risk in Japan is 7.4 × 10(-5) y(-1). If this risk level corresponding to 1σ can be regarded as a non-concern level, it would be possible that the lower bound of optimisation of radiological protection could be set at 1 mSv y(-1), since the assumed risk of 1 mSv y(-1) is equivalent to ~5 × 10(-5) y(-1) obtained using the overall fatal risk coefficient of 5 % Sv(-1), which is lower than the non-concern level.     

Organ and effective doses of patients arising from coronary angiography and percutaneous transluminal coronary angioplasty at two hospitals in Mashhad-Iran

A detailed study of radiation doses received by 83 patients who underwent coronary angiography (CA) and 26 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) by the femoral route in two hospitals in Mashhad-Iran is presented. All procedures were undertaken with Siemens angioscope X-ray equipment. Thermoluminescent dosimeters (TLD-100), suitably calibrated, were used to measure the dose received at five locations on the patient's skin (on the thyroid, gonads and lens of eyes). A dose area product (DAP) meter was also used. DAP values and fluoroscopy times were recorded for each patient. The mean values for DAP were 32.47+/-4.03 and 44.49+/-5.64 Gy cm2 for CA and PTCA, respectively. The patient dosimetry results revealed the thyroid receives the highest dose in CA and PTCA examinations. Also, in this study, DAP to effective dose conversion factors were estimated by means of a Rando phantom and the effective dose received by the patients was estimated for CA and PTCA examinations. The estimated mean values of effective dose were 6.75+/-0.85 and 9.61+/-1.24 mSv, respectively.     

Radiation exposure to children in intraoral dental radiology

In this study, dose area product (DAP) measurements have been performed aiming at establishing diagnostic reference levels (DRLs) in paediatric intraoral dental radiology. Measurements were carried out at 52 X-ray units for all types of intraoral examinations performed in clinical routine. Not all X-ray units have pre-set child exposure settings with reduced exposure time or in some cases lower tube voltage. Child examinations are carried out using adult exposure settings at these units, which increases the DAP third quartile values by up to 50%. For example, third quartile values for periapical examination ranges from 14.4 to 40.9 mGy cm(2) for child settings and 20.6 to 48.8 mGy cm(2) when the adult settings are included. The results show that there exists a large difference between the patient exposures among different dental facilities. It was also observed that clinics working with faster film type or higher tube voltage are not always associated with lower exposure.     

Uranium and thorium series radionuclides in drinking water from drilled bedrock wells: correlation to geology and bedrock radioactivity and dose estimation

Natural radioactivity in drinking water from 328 drilled wells was studied in correlation to source parameters. Poor correlation to both aquifer geology and bedrock radioactivity was observed. Concentrations of 238U, 226Ra, 228Ra, 222Rn and 210Po in groundwater samples was in the ranges <0.027-5.3, <0.016-4.9, <0.014-1.24, 5-8105 and <0.05-0.947 Bq.l(-1) respectively. In about 80% of the sites the radon concentration exceeds the Nordic recommended exemption level for radon in drinking water and 15% of the sites exceed the action limit. The effective doses from ingestion were calculated and presented in association with geology. Doses due to ingestion ranged between 0.05 and 20.4 mSv.y(-1), where the average contribution from 222Rn amounted to 75%. In comparison, the effective doses from inhalation of indoor 222Rn ranged between 0.2 and 20 mSv.y(-1). The average contribution from inhalation of 222Rn in air to the total effective dose (ingestion+inhalation) was 58 +/- 22%, 73 +/- 18% and 77 +/- 16% (1 SD) for the age categories 1 y, 10 y and adults respectively.     

Dose-area product measurements in panoramic dental radiology

In this study, dose-area product (DAP) measurements in panoramic dental radiology have been performed in Germany. The results obtained in this study were proposed as diagnostic reference levels (DRLs). A representative number of dental panoramic units, both with digital and conventional image receptors, have been chosen. Common statistical parameters such as mean, standard deviation and 3rd quartile have been calculated. For four different standard programmes, 'large adult', 'adult male', 'adult female' and 'child', the proposed DRLs are 101, 87, 84 and 75 mGy cm(2), respectively. No clear tendency to a generalised dose reduction from the transition to digital techniques has been observed. Effective doses have been calculated from E/DAP conversion factors published in literature. Even though these values differ by a factor of approximately 3, upper limits of 15.8-21.2 microSv for the four different exposure settings were derived from the data.     

Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland

This study has gathered data across Ireland to determine the range of radiation doses received during interventional cardiology (IC) investigations. Radiation doses for three common types of IC examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). A total of 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Individual patient DAP values ranged from 136-23 101 cGy cm(2), 475-41 038 cGy cm(2) and 45-17 192 cGy cm(2) for CA, PCI and PPI respectively, with third quartile values of 4654 cGy cm(2), 10 650 cGy cm(2) and 1686 cGy cm(2). The importance of optimising radiation dose, while not compromising diagnostic efficacy is clear. Although setting reference levels for these complex procedures has some difficulties, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high dose procedures. The third quartile values as described by this paper may offer such guidance.     

Assessment of annual whole-body occupational radiation exposure in medical practice in Ghana (2000-09)

Occupational exposure to radiation in medical practice in Ghana has been analysed for a 10-y period between 2000 and 2009. Monitored dose data in the medical institution in Ghana from the Radiation Protection Institute's database were extracted and analysed in terms of three categories: diagnostic radiology, radiotherapy and nuclear medicine. One hundred and eighty medical facilities were monitored for the 10-y period, out of which ~98% were diagnostic radiology facilities. Only one nuclear medicine and two radiotherapy facilities have been operational in the country since 2000. During the 10-y study period, monitored medical facilities increased by 18.8%, while the exposed workers decreased by 23.0%. Average exposed worker per entire medical institution for the 10-y study period was 4.3. Annual collective dose received by all the exposed workers reduced by a factor of 4 between 2000 and 2009. This is seen as reduction in annual collective doses in diagnostic radiology, radiotherapy and nuclear medicine facilities by ~76, ~72 and ~55%, respectively, for the 10-y period. Highest annual collective dose of 601.2 man mSv was recorded in 2002 and the least of 142.6 man mSv was recorded in 2009. Annual average values for dose per institution and dose per exposed worker decreased by 79 and 67.6%, respectively between 2000 and 2009. Average dose per exposed worker for the 10-y period was least in radiotherapy and highest in diagnostic radiology with values 0.14 and 1.05 mSv, respectively. Nuclear medicine however recorded average dose per worker of 0.72 mSv. Correspondingly, range of average effective doses within the diagnostic radiology, radiotherapy and nuclear medicine facilities were 0.328-2.614, 0.383-0.728 and 0.448-0.695 mSv, respectively. Throughout the study period, an average dose per medical institution of 3 mSv and an average dose per exposed worker of 0.69 mSv were realised. Exposed workers in diagnostic radiology primarily received most of the individual annual doses >1 mSv. The entire study period had 705 instances in which exposed workers received individual annual doses >1 mSv. On thermoluminescent dosemeter (TLD) return rates, facilities in Volta and Eastern Regions recorded highest return rates of 94.3% each. Ashanti Region recorded the least TLD return rate with 76.7%.     

CFD modelling of thoron and thoron progeny in the indoor environment

Thoron (220Rn) exhalation from building materials has become increasingly recognised as a potential source for radiation exposure in residences. However, contrary to radon (222Rn), limited information on thoron exposure is available. The purpose of this study is to estimate the concentration of thoron and its progeny products in a typical Dutch living room using computational fluid dynamics. The predicted thoron concentration is ～9 Bq m(-3) using a source term of 14 Bq s(-1) for the thoron exhalation from building materials. The concentration varies from 15 Bq m(-3) near the building materials to 2.7 Bq m(-3) in the centre of the living room. The mean effective dose from thoron progeny is calculated as 0.09 mSv y(-1), with a total effective dose from radon and thoron progeny of 0.38 mSv y(-1).