Studies on the application of a low-voltage peak to the postsurgical follow-up CT scan in abdominal cancer patients in order to reduce the exposure of patients to radiation

This study examined the radiation dose, computed tomography (CT) number, contrast and image quality of patients requiring periodic follow-up abdominal CT examinations at various tube voltages. The subjects were divided into two groups. One group consisted of patients who underwent a clinical analysis and the other group was a phantom one. Somatom Sensation 16 (Siemens, Erlangen, Germany) was used. Twenty patients who underwent a periodic follow-up examination by CT were selected randomly. The tube current was fixed to 150 mA, and the tube voltage was adjusted according to the appropriate value of each examination. The computed tomography dose index (CTDI) values were measured. The CT number of each organ was measured by setting up a 1 cm diameter return on investment (ROI) in the abdominal organs at the same height of the first lumbar vertebra using images of the arterial phase. Two radiologists in consensus graded the quality of the abdominal images into three groups. An abdomen-shaped acrylic phantom was used in the phantom study. An ion chamber was inserted into the holes located at the center and periphery of the phantom, where the radiation dose was automatically displayed on the reader. Tube voltages of 80, 100, 120 and 140 kVp were applied to the phantom (diluted contrast medium with water at 1:10 ratio) and the phantom was scanned. The CT number was measured from a 1 cm diameter ROI at the center of the image. The CTDI value decreased by 36% at 100 kVp (7.50 mGy) compared with that at 120 kVp (11.70 mGy). According to the radiologists’ evaluation, there were 17 equivalent, 3 acceptable and 0 unacceptable levels in the group of 20 subjects. The radiation dose in the phantom study decreased with increasing tube voltages from 80 to 140 kVp. The peripheral and central doses decreased by 38% and 41%, respectively. The CT numbers at 80, 100, 120 and 140 kVp were 1365.9±4.4, 1046.1±3.7, 862.8±3.2 and 737.5±3.0 HU, respectively. In conclusion, in a follow-up observation for the detection of a recurrence or metastasis after surgery or patients with chronic abdominal diseases, the exposure doses can be reduced using a low-voltage peak CT examination without greatly changing the image quality.     

Organ dose and scattering dose for CT coronary angiography and calcium scoring using automatic tube current modulation

Noninvasive coronary angiography and calcium scoring with the use of multi-detector computed tomography scanners are feasible for reliably detecting coronary artery disease. The purpose of this study is to investigate organ dose and scattering dose for CT coronary angiography and calcium scoring using automatic tube current modulation. Organ doses of an anthropomorphic phantom were estimated using LiF:Mg,Cu,P thermoluminescent dosimeter (TLD) chips. The dose profiles inside and outside the scanning regions were measured. Effective doses for coronary angiography and calcium scoring without using automatic tube current modulation are respectively 12.72 ± 2.06 and 1.69 ± 0.30 mSv. Using automatic tube current modulation can reduce effective dose by 43% for coronary angiography, and 24–32% for calcium scoring. Scatter doses at the point of 10 cm away from the margin of scanning region decreased to 5–9% of in-plane doses. Using automatic tube current modulation can effectively reduce radiation doses inside the CT scanning region.     

A novel dosimetry system for computed tomography using phototransistor

Computed tomography (CT) dosimetry normally uses an ionization chamber 100 mm long to estimate the computed tomography dose index (CTDI), however some reports have already indicated that small devices could replace the long ion chamber to improve quality assurance procedures in CT dosimetry. This paper presents a novel dosimetry system based in a commercial phototransistor evaluated for CT dosimetry. Three detector configurations were developed for this system: with a single, two and four devices. Dose profile measurements were obtained with them and their angular responses were evaluated. The results showed that the novel dosimetry system with the phototransistor could be an alternative for CT dosimetry. It allows to obtain the CT dose profile in details and also to estimate the CTDI in longer length than the 100 mm pencil chamber. The angular response showed that the one device detector configuration is the most adequate among the three configurations analyzed in this study.     

Physical analysis of breast cancer using dual-source computed tomography

This study was aimed to analyze various physical characteristics of breast cancer using dual-source computed tomography (CT). A phantom study and a clinical trial were performed in order and a 64-multidetector CT device was used for the examinations. In the phantom study, single-source (SS) CT was set up with a conventional scanning condition that is usually applied for breast CT examination and implementation was done at tube voltage of 120?kVp. Dual-source CT acquired images by irradiating X-ray sources with fast switching between two kilovoltage settings (80 and 140?kVp). After scanning, Hounsfield Unit (HU) values and radiation doses in a region of interest were measured and analyzed. In the clinical trial, the HU values were measured and analyzed after single-source computed tomography (SSCT) and dual-source CT in patients diagnosed with breast cancer. Also, the tumor size measured by dual-source CT was compared with the actual tumor size. The phantom study determined that the tumor region was especially measured by dual-source CT, while nylon fiber and specks region were especially measured by SSCT. The radiation dose was high with dual-source CT. The clinical trial showed a higher HU value of cancerous regions when scanned by dual-source CT compared with SSCT.     

Radiation dose reduction by using low dose CT protocol of thorax

CT makes up to 67% of radiation from medical sources. Therefore emphasizes is especially on the importance of reducing doses and the introduction of procedures with the lowest possible dose received by the patient. The so called low dose CT protocol was studied for some chest diagnosis however it was not investigated for the patients with lymphoproliferative diseases. Lymphoproliferative diseases, including most lymphomas involve a large number of younger and middle age patients i.e. patients in the reproductive period of life. A CT exam of these patients is indispensable method for the diagnosis, and later for long life monitoring of the effectiveness of therapy. The aim of this work was to compare the patient doses between two different CT protocols of thorax in patients with this diagnosis. The entrance surface doses were measured and compared using standard CT protocol of thorax which implies 120 kV and 160 mA conditions and low dose CT protocol using 120 kV and 30 mA conditions while maintaining image quality. The study involved 60 patients. Each patient underwent two different CT thorax protocols during regular follow up of the disease. The doses were measured using LiF:Mg,Ti (TLD-100) thermoluminescent (TL) and GD-352M radiophotoluminescent (RPL) dosimeters on the thyroid, eye lens, sternum and gonads. The results showed that low dose protocol yielded with the reduction of doses by the factor of 1.8–15 on the eye lens, 1.0–9.1 on the thyroid, 2.5–7.0 on sternum and 0.3–12.8 on gonads, respectively. The doses were significantly lower using low dose CT protocol while the image quality for lymph node presentation was satisfactory according to European criteria. Therefore the use of low dose CT protocol as a standard for patients with lymphoproliferative disorders is highly recommended.     

Measurement of rectum dose by in vivo alanine/ESR dosimetry in gynecological 192Ir HDR brachytherapy

High dose rate (HDR) brachytherapy (BT) used in treatments of gynecological cancer often results in high doses in the pelvic organs at risk (OARs) and the complications in the rectum are a serious concern. Dosimetry procedures in vivo can be used as an evaluation method of calculated dose in treatment planning. One dosimetric method is the use of alanine with electron spin resonance (ESR) that has been used in different clinical practices. The aim of this study was to indicate the dose level in the female rectum volume, using alanine dosimeters during ¹⁹²Ir HDR gynecological BT, for cervical cancer. Doses were compared with the values obtained using the computational treatment planning system based on two orthogonal radiographic images. Firstly a phantom study in water was performed, enabling the in vivo study. Ten patients had the dose in rectum measured, resulting from 10 points properly referred; variations found were in the range of +60% and −50% of the delivered doses compared to the treatment planning system. Differences between planned and measured doses can be mainly due to uncertainty of dosimeter position determination, averaging of dose points specified over the whole dosimeter position, uncontrolled changes in detector position during treatment due to rectum movement and to a simplified treatment system planning, that do not take into account the details of the patient anatomy and the difference among the tissues. Results show that improvements of the protocol treatment should be done to enhance the relation between treatment planning system and experimental results, nevertheless the dose at the OARs was lower than the recommended by the ICRU Report 38.     

Study of the improvement of TLD cards for personal neutron dosimetry

In this work, personal thermoluminescence dosimeter (TLD) cards type of GN-6770 (holder type 8806) from Harshaw were used for personal neutron dosimetry. The response of the dosimeters has been determined in terms of the personal absorbed dose and personal dose equivalent for different neutron energy components, based on the recommendations of ICRP-60 and ICRU-49. Neutron irradiation was performed using a 5 mCi Am–Be neutron source. The TLD reader, type Harshaw 6600, was installed and calibrated for accurate neutron doses equivalent to gamma-ray doses. It was found that fast neutron doses measured by TLD (badges or cards) are in agreement with those measured by neutron TE (tissue equivalent gas) ionization chambers and neutron monitors. Thermal neutron doses measured by TLD cards were overestimated when compared with those measured by neutron monitors. Additional Cd was used to reduce thermal neutron doses to be in agreement with actual thermal doses. Other configurations for TLD crystals are also suggested for accurate thermal neutron dose measurements.     

Organ point dose measurements in clinical multi slice computed tomography (MSCT) examinations with the MOSkin™ radiation dosimeter

This study reports on the application of the MOSkin™ dosimeter in MSCT imaging for the real-time measurement of absorbed organ point doses in a tissue-equivalent female anthropomorphic phantom. MOSkin™ dosimeters were placed within the phantom to measure absorbed point organ doses for 2 commonly applied clinical scan protocols, namely the renal calculus scan and the pulmonary embolus scan. Measured organ doses in the imaged field of view were found to be in the dose range 4.7–9.5 mGy and 16.2–27.4 mGy for the renal calculus scan and pulmonary scan protocols respectively. For the derivation of effective dose, using the more recent ICRP 103 tissue weighting factors (w_T) compared to that of the ICRP 60 w_T resulted in a difference in the derived effective dose by up to 0.8 mSv (−20%) in the renal calculus protocol and up to 1.8 mSv (18%) in the pulmonary embolus protocol. This difference is attributed to the reduced radiosensitivity of the gonads and the increased radiosensitivity of breast tissue in the latest ICRP 103 assigned w_T. The results of this study show that the MOSkin™ dosimeter is a useful real-time tool for the direct assessment of organ doses in clinical MSCT examinations.     

Comparison of dose measurements in CT using a photodiode and a small ion chamber

Owing to the advance of multislice computed tomography (CT), the dosimetric protocol currently used in CT has become inadequate. Instead of dosimetry based on the measurement of the Computed Tomography Dosimetry Index (CTDI) using a pencil ion chamber (IC) 100 mm in length, the use of a short IC and the calculation of the dose equilibrium (D_eq) at the location of the chamber are proposed. The objective of this work was to compare the performance of a short IC and a commercial photodiode (BPW34FS) to measure the accumulated dose at the center of the scan length L, D_L(0), and to obtain the equilibrium dose D_eq using the two detectors. The result for L = 100 mm was compared with the result of the pencil chamber. The results indicate that the commercial photodiode is suitable to measure the accumulated dose at the center of the scan length L as compared with the ICs. This methodology allows measurements of the accumulated dose for any desired scan length, allowing measurement of the equilibrium dose D_eq if the phantom is long enough to allow it.     

Analysis of phantom centering positioning on image noise and radiation dose in axial scan type of brain CT

ABSTRACT

This study examined the dose and image quality according to the position change of a human phantom in a CT scan. This study used an MDCT 128 Slice CT Scanner instrument. An axial scan was performed with a 16 cm CTDI phantom of a human phantom, and the dose was measured using a pencil chamber meter. The phantom was scanned 10 cm above and below the isocenter and 15 cm above the right and left. The position of the phantom is indicated by C-0 in the isocenter position, S-10 in the upper 10 cm, I-10 in the lower 10 cm, R-15 in the right 15 cm, and L-15 in the left 15 cm. The test was performed 30 times using the brain CT protocol to calculate the dose and the dose width product (DWP). The acquired images were analyzed using the ImageJ program. Statistical analysis was performed using SPSS with one-way ANOVA (p < .05). The mean DWP values of the CT scanner were C-0 31.97 mGy·cm, S-10 24.52 mGy·cm, I-10 24.28 mGy· cm, R-15 17.95 mGy·cm, and L15 17.6 mGy·cm. Compared to the isocenter (C-0), the DLP values measured at each site were 23.3% for S-10, 24% for I-10, 43.8% for R-15, and 44.9% for L15. A significant difference in the one-way ANOVA statistical process was observed (p>0.05). C-0 was measured to be 7.42 HU, S-10 7.87 HU, I-10 8.4 HU, R-15 117 HU, and L-15 13.6 HU for evaluating the image quality. Compared to C-0, S-10 was 5.39%, I-10 was 13.2%, R-15 was 57.6%, and L-15 was 83.2%. The PSNR for S-10, I-10, R-15, and L-15 was 17.37, 17.5, 16.62, and 16.37 dB, respectively. A good quality image can be obtained by positioning the subject precisely in the isocenter in the axial scan, if possible, because the irradiated dose to the subject is low, which can lead to an increase in noise in image reconstruction.     

Development of high-radiation-sensitive polymer gel for magnetic resonance imaging in three-dimensional dosimetry

We developed a high radiation sensitive polymer gel by modifying the amounts of the gel components and the temperature for the gel preparation. We evaluated its relaxation time linearity against dose and compared the measured dose distribution with the calculated one. For the relaxation time-dose linearity, irradiations were carried out with a linear accelerator using 6 MV photons and doses ranging from 0-5.0 Gy. The relationship between dose and R(2) value (reciprocal of T(2) relaxation time) was measured and it had good linearity over a wide range (0.3-5 Gy). The measured dose distributions were in good agreement with calculated ones. Since the present gel has higher sensitivity and it is synthesized more easily at lower cost than conventional polymer gels, we expect to see improved three-dimensional (3D) dosimetry using it.     

Radiation dose measurement for patients undergoing common spine medical x-ray examinations and proposed local diagnostic reference levels

The main purposes of this study were to investigate patient dose in Spine radiographic examinations, as high dose procedures and propose the first LDRLs (Local Diagnostic Reference Levels) in Khuzestan region, southwest of Iran. ESD (Entrance Skin Dose) values of patients who underwent six spine radiographic procedures containing cervical (AP/LAT), thoracic (AP/LAT) and lumbar (AP/LAT), as high dose procedures, were evaluated. Patient doses were calculated from patient's individual anatomical data (weight, height and organ thickness) and exposure parameters (kVp, mAs, FFD and projection) based on the IAEA (International Atomic Energy Agency) Technical Report Series No.457. Indirect dosimetry method was conducted on 412 standard patients (57% men and 43% women) at seven high-patient-load hospitals. This survey reveals significant variations in the radiological practice. Despite large discrepancies found in the tube loadings (3–128 for lumbar AP and 3–200 for lumbar LAT), ESDs in all examinations were lower than the IAEA and EC (European Commission) DRLs (Diagnostic Reference Levels), 1.30, 1.65, 2.29, 3.09, 5, 7.5 mGy for cervical AP, cervical LAT, thoracic AP, lumbar AP, thoracic LAT and lumbar LAT respectively. Optimization of radiological practice could be accelerated by updating clinical audits and patient dose considerations, adequate training of students, implementation of systematic QA and QC programs and the use of qualified diagnostic medical physicists in the imaging sections. It is advisable that DRLs obtained in this study can be used as local DRL and dose surveys must be performed in all regions to establish NDRLs (National Diagnostic Reference Levels) in Iran. Also, national authorities must review periodically reference levels to ensure that it remains appropriate.     

Dose uncertainties for large solar particle events: input spectra variability and human geometry approximations.

The true uncertainties in estimates of body organ absorbed dose and dose equivalent, from exposures of interplanetary astronauts to large solar particle events (SPEs), are essentially unknown. Variations in models used to parameterize SPE proton spectra for input into space radiation transport and shielding computer codes can result in uncertainty about the reliability of dose predictions for these events. Also, different radiation transport codes and their input databases can yield significant differences in dose predictions, even for the same input spectra. Different results may also be obtained for the same input spectra and transport codes if different spacecraft and body self-shielding distributions are assumed. Heretofore there have been no systematic investigations of the variations in dose and dose equivalent resulting from these assumptions and models. In this work we present a study of the variability in predictions of organ dose and dose equivalent arising from the use of different parameters to represent the same incident SPE proton data and from the use of equivalent sphere approximations to represent human body geometry. The study uses the BRYNTRN space radiation transport code to calculate dose and dose equivalent for the skin, ocular lens and bone marrow using the October 1989 SPE as a model event. Comparisons of organ dose and dose equivalent, obtained with a realistic human geometry model and with the oft-used equivalent sphere approximation, are also made. It is demonstrated that variations of 30-40% in organ dose and dose equivalent are obtained for slight variations in spectral fitting parameters obtained when various data points are included or excluded from the fitting procedure. It is further demonstrated that extrapolating spectra from low energy (< or = 30 MeV) proton fluence measurements, rather than using fluence data extending out to 100 MeV results in dose and dose equivalent predictions that are underestimated by factors as large as 2-3. Finally, it is also demonstrated that the use of equivalent sphere approximations to represent body organ self-shielding distributions results in organ doses and dose equivalent predictions that are 2-3 times larger than values obtained with anthropomorphic shielding configurations.     

Experimental measurement of radiation dose in a dedicated breast CT system

Radiation dose is an important performance indicator of a dedicated breast CT (DBCT). In this paper, the method of putting thermoluminescent dosimeters (TLD) into a breast shaped PMMA phantom to study the dose distribution in breasts was improved by using smaller TLDs and a new half-ellipsoid PMMA phantom. Then the weighted CT dose index (CTDI_w) was introduced to average glandular assessment in DBCT for the first time and two measurement modes were proposed for different sizes of breasts. The dose deviations caused by using cylindrical phantoms were simulated using the Monte Carlo method and a set of correction factors were calculated. The results of the confirmatory measurement with a cylindrical phantom (11 cm/8 cm) show that CTDI_w gives a relatively conservative overestimate of the average glandular dose comparing to the results of Monte Carlo simulation and TLDs measurement. But with better practicability and stability, the CTDI_w is suitable for dose evaluations in daily clinical practice. Both of the TLDs and CTDI_w measurements demonstrate that the radiation dose of our DBCT system is lower than conventional two-view mammography.     

Validation of Monte Carlo simulation of 6 MV photon beam produced by Varian Clinac 2100 linear accelerator using BEAMnrc code and DOSXYZnrc code

The Monte Carlo model for the photon-beam output from the Varian Clinac 2100 linear accelerator was validated to compare the calculated to measured PDD and beam dose profiles The Monte Carlo calculation method is considered to be the most accurate method for dose calculation in radiotherapy. The objective of this study is to build a Monte Carlo geometry of Varian Clinac 2100 linear accelerator as realistically as possible. The Monte Carlo codes used in this work were the BEAMnrc code to simulate the photons beam and the DOSXYZnrc code to examinate the absorbed dose in the water phantom. We have calculated percentage depth dose (PDD) and beam profiles of the 6 MV photon beam for the 6 × 6 cm², 10 × 10 cm² and 15 × 15 cm² field sizes. We have used the gamma index technique for the quantitative evaluation to compare the measured and calculated distributions. Good agreement was found between calculated PDD and beam profile compared to measured data. The comparison was evaluated using the gamma index method and the criterions were 3% for dose difference and 3 mm for distance to agreement. The gamma index acceptance rate was more than 97% of both distribution comparisons PDDs and dose profiles and our results were more developed and accurate. The Varian Clinac 2100 linear accelerator was accurately modeled using Monte Carlo codes: BEAMnrc and DOSXYZnrc codes package.     

Measurement of doses to the extremities of nuclear medicine staff

Medical uses of ionizing radiation now represent>95% of all man-made radiation exposure, and is the largest single radiation source after natural background radiation. Therefore, it is important to quantify the amount of radiation received by occupational individuals to optimize the working conditions for staff, and further, to compare doses in different departments to ensure compatibility with the recommended standards. For some groups working with unsealed sources in nuclear medicine units, the hands are more heavily exposed to ionizing radiation than the rest of the body. A personal dosimetry service runs extensively in Egypt. But doses to extremities have not been measured to a wide extent. The purpose of this study was to investigate the equivalent radiation doses to the fingers for five different nuclear medicine staff occupational groups for which heavy irradiation of the hands was suspected. Finger doses were measured for (1) nuclear medicine physicians, (2) technologists, (3) nurses and (4) physicists. The fifth group contains three technicians handling ¹³¹I, while the others handled ^99mTc. Each staff member working with the radioactive material wore two thermoluminescent dosimeters (TLDs) during the whole testing period, which lasted from 1 to 4 weeks. Staff performed their work on a regular basis throughout the month, and mean annual doses were calculated for these groups. Results showed that the mean equivalent doses to the fingers of technologist, nurse and physicist groups were 30.24±14.5, 30.37±17.5 and 16.3±7.7 μSv/GBq, respectively. Equivalent doses for the physicians could not be calculated per unit of activity because they did not handle the radiopharmaceuticals directly. Their doses were reported in millisieverts (mSv) that accumulated in one week. Similarly, the dose to the fingers of individuals in Group 5 was estimated to be 126.13±38.2 μSv/GBq. The maximum average finger dose, in this study, was noted in the technologists who handled therapeutic ¹³¹I (2.5 mSv). In conclusion, the maximum expected annual dose to extremities is less than the annual limit (500 mSv/y).     

The Bland–Altman analysis: Does it have a role in assessing radiation dosimeter performance relative to an established standard?

Bland–Altman analysis is used to compare two different methods of measurement and to determine whether a new method of measurement may replace an existing accepted ‘gold standard’ method. In this work, Bland–Altman analysis has been applied to radiation dosimetry to compare the PTW Markus and Roos parallel plate ionisation chambers and a PTW PinPoint chamber against a Farmer type ionisation chamber which is accepted as the gold standard for radiation dosimetry in the clinic. Depth doses for low energy x-rays beams with energies of 50, 75 and 100 kVp were measured using each of the ionisation chambers. Depth doses were also calculated by interpolation of the data in the British Journal of Radiology (BJR) Report 25. From the Bland–Altman analysis, the mean dose difference between the two parallel plate chambers and the Farmer chambers was 1% over the range of depths measured. The PinPoint chamber gave significant dose differences compared to the Farmer chamber. There were also differences of up to 12% between the BJR Report 25 depth doses and the measured data. For the Bland–Altman plots, the lines representing the limits of agreement were selected to be a particular percentage agreement e.g. 1 or 2%, instead of being based on the standard deviation (σ) of the differences. The Bland–Altman statistical analysis is a powerful tool for making comparisons of ionisation chambers with an ionisation chamber that has been accepted as a ‘gold standard’. Therefore we conclude that Bland–Altman analysis does have a role in assessing radiation dosimeter performance relative to an established standard.     

基于蒙特卡罗方法的6 MV Truebeam剂量计算

使用蒙特卡罗方法快速准确地模拟6 MV Varian Truebeam医用电子直线加速器射野剂量特性,探究厂家提供相位空间源的可用性及模拟方法的准确性。以Varian公司提供的出束窗口位置处相位空间文件作为Beamnrc/EGSnrc输入源,模拟射野形成结构并计算10 cm10 cm射野下的均匀水体模中的剂量分布,将计算结果与相同条件下的实验测量数据进行比较。同一计算机模拟时,传统完整机头模拟方法需4~5 h,文中所述方法模拟时间可缩减至48 min,剂量计算结果与相同条件下所得实际测量数据可较好地吻合,两者的百分深度剂量差异低于3%,且建成区吻合良好;不同深度处80%等剂量线所包含的射野区域内百分离轴剂量比差异均低于3%,且半影区效果好。使用厂家提供相位空间文件作为EGSnrc入射源,能快速模拟治疗头,得到剂量计算结果与实际测量值的差异满足剂量计算精度要求。