Beta radiation exposure of medical staff and implications for extremity dose monitoring

Sealed and unsealed beta radiation sources come into use to a greater extent in radiation therapy, e.g. for treating inflammatory joint diseases by radiosynoviorthesis (RSO), by injecting (90)Y, (186)Re or (169)Er-solutions. Sealed (90)Sr/(90)Y and (32)P-sources or (188)Re-liquid-filled balloon catheter are applied in vascular brachytherapy. Recently, (90)Y-labelled antibodies are being successfully used in radioimmunotherapy (RIT) of malign lymphoma. Such practices require handling of high activities at small distances to the skin. Thus, the medical staff may be exposed to high beta doses. Investigations of the extremity exposure were performed at several workplaces, in particular during RSO treatments. The local skin dose (LSD), Hp(0,07), was measured with thin-layer TLD (LiF:Mg,P,Cu) fixed to the fingers (TLD-tapes). The findings indicate that the exposure of the staff can exceed the annual dose limit of 500 mSv when working at low protection standard. Routine monitoring of the extremity exposures with ring dosemeters appropriate to beta radiation and provided by the approved German dosimetry services was found to be needed. But even monitoring with these official 'beta-dosemeters' does mostly not give suitable results to demonstrate compliance with the dose limit. A study was conducted at RSO-workplaces in order reveal a correlation between doses measured with ring dosemeters and the maximum LSD obtained from the TLD-tapes. The results are discussed and conclusions for routine monitoring are drawn.     

90Sr/90Y放射源及外推电离室蒙特卡罗模型建立与实验验证

针对β射线次级标准装置(BSS2)中的⁹⁰Sr/⁹⁰Y放射源以及PTW23392型外推电离室进行蒙特卡罗(MC)建模。使用BEAMnrc计算⁹⁰Sr/⁹⁰Y放射源在不同校准位置处产生的组织深度剂量曲线,并与实验结果进行比较。根据模拟结果与实验结果的差异,修正放射源MC模型。此外,对外推电离室的外推曲线、校准位置处的组织透射因子和组织吸收剂量率进行模拟计算。在距离放射源30 cm和使用展平过滤的条件下,外推曲线的计算结果和实验结果基本吻合。组织透射因子和组织吸收剂量率的模拟结果与校准证书值相差分别在1.43%和2.11%之内。最终建立了较为准确的⁹⁰Sr/⁹⁰Y放射源和外推电离室的MC模型,研究结果可以为计算β参考辐射场中的注量谱、剂量转换系数和外推电离室相关的修正因子等提供参考。     

The dose-area product and assessment of the occupational dose in interventional radiology

This study used dose-area product (DAP) data to determine the relationship between the dose received by radiologists and the DAP. The working conditions were simulated by phantom measurements. The doses of scattered radiation were measured using various scattering angles, distances and tube voltages. The calculated doses of scattered radiation were compared with the measured doses of scattered radiation. To test the validity of using such data for assessing occupational doses, the scatter dose on the radiologist or cardiologist was calculated from the DAP using the measured scatter factors. The dose to the lenses of the eyes may exceed the annual limit, and may therefore restrict the number of interventional procedures. A relation between the DAP and the occupational dose is difficult to establish, especially because staff doses are associated with the use of protective devices, positions of projections with respect to the patient, and working methods. However, the DAP may provide a good reference value for the dosimetric monitoring of staff.     

Estimation of doses to personnel and patients during endovascular brachytherapy applications

In the last few years coronary endovascular brachytherapy using gamma- and beta-emitting radionuclides has been established as a standard treatment procedure to prevent restenosis after percutaneous coronary interventions. Direct measurements and calculations were made to determine personnel doses and organ doses of patients due to gamma rays of 192Ir and beta rays of 90Sr/90Y and 32P sources. In general, our results show that the dose levels are low compared with the X-ray exposure from angiography. The dose rate from bremsstrahlung at 1 m distance from a device containing a 90Sr/90Y source of 2.3 GBq is 4 micro Sv h(-1). The skin dose from beta rays during source transfer into and from the patient was estimated with the directional dose equivalent H'(0.07) of 10 micro Sv at 1 m distance from the catheter. By maintaining safe distances, the dose levels can be kept well within annual dose limits.     

Results of the EURADOS extremity dosemeter intercomparison 2009

This paper presents the results of an intercomparison for extremity dosemeters organised by the European radiation dosimetry group in 2009. In total, 59 systems were tested during this exercise including ring, stall and wrist dosemeters. A total of 1652 dosemeters were irradiated in the selected fields of photons and beta radiation qualities on appropriate phantoms (ISO finger and pillar phantom) in the dose quantity H(p)(0.07). All irradiations were carried out in selected accredited reference dosemetry laboratories (Seibersdorf Laboratories, Austria and IRSN, France). The results show that, especially at low-energy beta radiations ((85)Kr) and for beta irradiations with large angles of incidence (60°), many tested systems show pronounced under responses. On the other hand, for photon irradiations down to energies of 16 keV most systems showed good results. A participants meeting was held at IM2010 with discussion on both general aspects of this intercomparison and specific problems.     

(Depth-dose curves of the beta reference fields (147)Pm, (85)Kr and (90)Sr/(90)Y produced by the beta secondary standard BSS2

The most common reference fields in beta dosimetry are the ISO 6980 series 1 radiation fields produced by the beta secondary standard BSS2 and its predecessor BSS. These reference fields require sealed beta radiation sources ((147)Pm, (85)Kr or (90)Sr/(90)Y) in combination with a source-specific beam-flattening filter, and are defined only at a given distance from the source. Every radiation sources shipped with the BSS2 is sold with a calibration certificate of the Physikalisch-Technische Bundesanstalt. The calibration workflow also comprises regular depth-dose measurements. This work publishes complete depth-dose curves of the series 1 sources (147)Pm, (85)Kr and (90)Sr/(90)Y in ICRU tissue up to a depth of 11 mm,when all electrons are stopped. For this purpose, the individual depth-dose curves of all BSS2 sources calibrated so far have been determined, i.e. the complete datasets of all BSS2 beta sources have been re-evaluated. It includes 191 depth-dose curves of 116 different sources comprising more than 2200 data points in total. Appropriate analytical representations of the nuclide-specific depth-dose curves are provided for the first time.     

Radiation protection of staff in 111In radionuclide therapy--is the lead apron shielding effective?

(111)In (Eγ = 171-245 keV, t1/2 = 2.83 d) is used for targeted therapies of endocrine tumours. An average activity of 6.3 GBq is injected into the liver by catheterisation of the hepatic artery. This procedure is time-consuming (4-5 min) and as a result, both the physicians and the technical staff involved are subjected to radiation exposure. In this research, the efficiency of the use of lead apron has been studied as far as the radiation protection of the working staff is concerned. A solution of (111)In in a cylindrical scattering phantom was used as a source. Close to the scattering phantom, an anthropomorphic male Alderson RANDO phantom was positioned. Thermoluminescent dosemeters were located in triplets on the front surface, in the exit and in various depths in the 26th slice of the RANDO phantom. The experiment was repeated by covering the RANDO phantom by a lead apron 0.25 mm Pb equivalent. The unshielded dose rates and the shielded photon dose rates were measured. Calculations of dose rates by Monte Carlo N-particle transport code were compared with this study's measurements. A significant reduction of 65 % on surface dose was observed when using lead apron. A decrease of 30 % in the mean absorbed dose among the different depths of the 26th slice of the RANDO phantom has also been noticed. An accurate correlation of the experimental results with Monte Carlo simulation has been achieved.     

Medical application of 3-D polymer gel dosemeter evaluated by nuclear magnetic resonance

A polymer-gel dosemeter, which can be evaluated by nuclear magnetic resonance (NMR), was prepared and then a few samples were homogeneously irradiated by a Leksell gamma knife using an 18 mm collimator (60Co gamma photons) to obtain a calibration curve (NMR 1/T2 response to absorbed dose). To measure dose distribution from the Leksell gamma knife, a testing flask tilled with the gel was fixed in the head phantom and then irradiated based on a calculated treatment plan. Evaluation of dosemeters was performed on a Siemens EXPERT 1T NMR scanner. Dose profiles in X, Y and Z coordinates through the ellipsoidal shape of the dose distribution were obtained to compare experimental results from the irradiated phantom with the treatment planning system calculations. The use of a polymer-gel dosemeter for a verification of stereotactic procedures has some unique advantages which can be summarised as follows: (1) the dosemeter itself is tissue equivalent, (2) three-dimensional dose distributions can be measured, (3) the dosemeter allows patient's procedures to be simulated without any limitations.     

Dose conversion coefficients calculated using tomographic phantom, KTMAN-2, for X-ray examination of cardiac catheterisation

In this study, organ-absorbed doses and effective doses to patient during interventional radiological procedures were estimated using tomographic phantom, Korean Typical Man-2 (KTMAN-2). Four projections of cardiac catheterisation were simulated for dose calculation by Monte Carlo technique. The parameters of X-ray source and exposure conditions were obtained from literature data. Particle transport was simulated using general purposed Monte Carlo code, MCNPX 2.5.0. Organ-absorbed doses and effective doses were normalised to dose area product (DAP). The effective doses per DAP were between 0.1 and 0.5 mSv Gy(-1) per cm2. The results were compared with those derived from adult stylised phantom. KTMAN-2 received up to 105% higher effective doses than stylised phantom. The dose differences were mainly caused by more realistic internal topology of KTMAN-2 compared to stylised phantom that are closely positioned organs near the heart and shift of abdominal organs to the thoracic region due to supine position. The results of this study showed that tomographic phantoms are more suitable for dose assessment of supine patients undergoing the interventional radiology. The results derived from KTMAN-2 were the first radiation dose data based on non-Caucasian individuals for interventional procedures.     

Double-dosimetry algorithm for workers in interventional radiology

Based on double-dosemeter readings, a conservative effective dose (E) estimation algorithm for lead apron workers in interventional radiology is proposed. Typical radiation conditions for various exposure geometries were simulated using the MCNPX 2.4.0 code. The simulation model consisted of an X-ray source and image intensifier, a patient phantom and a voxelised staff member phantom with lead apron. The effective staff dose and dosemeter readings for several positions of the worker were calculated. The effective dose to a physician, positioned in close proximity to the primary beam, can be estimated within a 10% underestimation margin by E = 1.64 H(p)(10)(thorax,under) + 0.075 H(p)(10)(neck,over). The dose to the eye lens can be estimated by a dosemeter reading at collar level (R(2) = 0.98).     

Dose reduction using bismuth shielding during paediatric CT examinations in Slovakia

Considering the massive increase of computer tomography (CT) examinations in Slovakia during the last 10 y, it can be expected that a higher radiation load may be observed in the Slovak population. Since child population is more sensitive to radiation than adult population, a monitoring has started to see how high the radiation dose is for paediatric patients during CT examinations in chosen departments in Slovakia. The CT examination of the head is one of the most frequently done examinations in Slovakian departments and that is why measurements were done to clarify how usage of bismuth shields for eyes and thyroid can affect the eye and thyroid doses. For simulation, 215 thermoluminescent dosimeters were exposed on anthropomorphic phantom of a child with and without usage of bismuth shields. The result was that only two of the three chosen departments confirmed a reduction. On the other hand, one of the departments confirmed that the reduction can be up to 56-65 %, which is significant.     

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.     

Preliminary dosimetric characterisation of thermoluminescent materials for beta radiation monitoring at nuclear medicine services

Beta emitters are widely used in nuclear medicine for diagnostic and therapeutic purposes. The critical groups exposed to a radioactive patient include the staff, other patients and members of the public accompanying the patient. The aim of this work is to characterise thermoluminescent (TL) materials for the staff monitoring of nuclear medicine services that manipulate beta radiation solutions of (153)Sm. This study was performed using CaSO(4):Dy + Teflon pellets, produced at IPEN, with different dimensions. For the dosimetric characterisation, these TL dosemeters were exposed to gamma source ((60)Co) and to beta sealed sources ((90)Sr + (90)Y, (204)Tl and (147)Pm) and to a non-sealed source ((153)Sm). Results were obtained related to reproducibility, lower detection limits, calibration curves, angle and energy dependence of response. All tested materials show usefulness for monitoring of workers exposed to beta radiation.     

Dose evaluation of selective collimation effect in cephalography by measurement and Monte Carlo simulation

Recently, simulations based on the Monte Carlo code have been increasingly applied for physics phenomena, patient dose and quality assurance of radiation systems. The objective of this study was to use Monte Carlo simulation and measurement to verify dose and dose reduction in cephalography. The collimator was constructed with 3-mm thick lead plate, and attached to the tube head to remove regions of disinterest in the radiation field. A digital phantom patient was constructed to evaluate patient dose. In addition, detectors of pixel size 1×1 cm2 and 0.1×0.1 cm2 were constructed to check collimator location. The effective dose according to International Commission on Radiological Protection 103 was calculated with and without collimation. The effective doses for simulation with and without collimation were 5.09 and 11.32 μSv, respectively. The results of the calculated effective dose show 61.7 % reduction of field area and 55 % of effective dose. The Monte Carlo simulation is a good evaluation tool for patient dose.     

Extremity exposure in nuclear medicine: preliminary results of a European study

The Work Package 4 of the ORAMED project, a collaborative project (2008-11) supported by the European Commission within its seventh Framework Programme, is concerned with the optimisation of the extremity dosimetry of medical staff in nuclear medicine. To evaluate the extremity doses and dose distributions across the hands of medical staff working in nuclear medicine departments, an extensive measurement programme has been started in 32 nuclear medicine departments in Europe. This was done using a standard protocol recording all relevant information for radiation exposure, i.e. radiation protection devices and tools. This study shows the preliminary results obtained for this measurement campaign. For diagnostic purposes, the two most-used radionuclides were considered: (99m)Tc and (18)F. For therapeutic treatments, Zevalin(?) and DOTATOC (both labelled with (90)Y) were chosen. Large variations of doses were observed across the hands depending on different parameters. Furthermore, this study highlights the importance of the positioning of the extremity dosemeter for a correct estimate of the maximum skin doses.     

Calculated angular responses of an RPL dosemeter to photon and beta radiation

The calculated dose equivalent response as a function of the angle has been examined for the radiophotoluminescent (RPL) glass dosemeter that was exposed to narrow series X-ray, N-60, N-80, N-100, N-150, N-200, N-250, N-300, photon sources ((60)Co and (137)Cs) and beta-ray emitter ((90)Sr/(90)Y) while mounted on an ISO water slab phantom. The angular dose equivalent responses H(p)(10) and H(p)(0.07) were calculated using the Monte Carlo MCNPX code. The RPL dosemeter and the phantom were rotated in the horizontal and vertical planes from a variety of angles of interest. The results were compared with the experimental data. Good agreement was found between the measured and calculated values of the relative dose equivalent angular responses of the RPL dosemeter.     

In situ long-term monitoring system for radioactive contaminants

A long-term in situ subsurface instrument for monitoring radioactive contaminant plumes, as an alternative to soil analysis, is described. A portable, laser-based reader optically stimulates luminescence from sensors, each containing an Al2O3:C dosemeter. The sensors, designed for placement at various subsurface locations around a waste site, are allowed to accumulate dose for a predetermined time that is based on the instrument's minimum detectable dose (MDD). The reader is then attached to the sensor by fibre optic cable to read the accumulated dose; an increase above natural background levels indicating the presence of leaked radioactivity. Based on an MDD of 5 microGy, it is shown that the sensor can measure soil concentrations of 1.85 Bq cm(-3) after an exposure time of 50 h for 137Cs and 67 h for 90Sr/90Y. Discrimination between beta and gamma radiation is possible using an end cap placed over one of the two paired sensors, allowing simultaneous measurement of 137Cs and 90Sr/90Y in a mixed field. The monitor system represents a substantial improvement over quarterly soil sampling because of a greatly increased measurement frequency and the ability to perform measurements reproducibly.     

Estimation of uncertainties on dose calculations of the 99mTc-MDP-injected patients in nuclear medicine

The internal exposures of the patients in nuclear medicine can be calculated based on the equations and data in ICRP Publications 53 and 80. Physical and biological parameters are used for the calculation, and both include uncertainties. Physical parameters can be considered as more precise than biological parameters, so that uncertainties originated from biological parameters are more important. Absorbed fractions (AFs) have been calculated by Monte-Carlo method using medical internal radiation dose (MIRD)-type mathematical phantoms. They depend on the shapes and sizes of the phantoms used in simulations. For estimating shape- and size-related uncertainties, AFs of pairs of source regions and target tissues of the patient-injected 99mTc-MDP were calculated by using EGS4 codes and a voxel phantom of Japanese male. By simply resizing the voxels of the phantom, the dependencies of size for AFs were calculated, and the uncertainties caused by the cumulated activities in source regions were also estimated by assuming these parameters distributions as Gaussian.     

Extremity ring dosimetry intercomparison in reference and workplace fields

An intercomparison of ring dosemeters has been organised with the aim of assessing the technical capabilities of available extremity dosemeters and focusing on their performance at clinical workplaces with potentially high extremity doses. Twenty-four services from 16 countries participated in the intercomparison. The dosemeters were exposed to reference photon ((137)Cs) and beta ((147)Pm, (85)Kr and (90)Sr/(90)Y) fields together with fields representing realistic exposure situations in interventional radiology (direct and scattered radiation) and nuclear medicine ((99 m)Tc and (18)F). It has been found that most dosemeters provided satisfactory measurements of H(p)(0.07) for photon radiation, both in reference and realistic fields. However, only four dosemeters fulfilled the established requirements for all radiation qualities. The main difficulties were found for the measurement of low-energy beta radiation. Finally, the results also showed a general under-response of detectors to (18)F, which was attributed to the difficulties of the dosimetric systems to measure the positron contribution to the dose.     

Calibration of personal dosemeters in mixed neutron-photon fields: some problems and their solution

In neutron reference radiation fields, the conventional true value of the personal dose equivalent, H(p)(10), is derived from the spectral neutron fluence and recommended conversion coefficients. This procedure requires the phantom on which the personal dosemeter is mounted to be irradiated with a broad and parallel beam. In many practical situations, the change of the neutron fluence and/or the energy distribution over the surface of the phantom may not be neglected. For a selection of typical irradiation conditions in neutron reference radiation fields, the influence of this effect has been analysed using numerical methods. A further problem, which is of relevance for the calibration of dosemeters measuring both the neutron and the photon component of mixed fields, is the 'double counting' of the dose equivalent due to neutron-induced photons. The relevance of this conceptual problem for calibrations in mixed-field dosimetry was analysed.