External radiation protection audit in National Health Service hospitals. Radiation protecgtion advisors (RPA) of the Nottingham City Hospital NHS Trust and the Oxford Radcliffe Hospital NHS Trust.

Radiation protection advisers are accustomed to carrying out internal audit in organizations for which they provide services but, traditionally, external audit has not been a part of the radiation protection adviser function. To provide an external audit function, two teams of radiation protection advisers undertook external radiation protection audits of their respective organizations, including the radiation protection adviser function itself. These audits were more representative of audits or inspections carried out by government agencies, for example the Health and Safety Executive and the former Inspectorate of Pollution, now the Environment Agency. Subsequently, reports, including recommendations for remedial action, were prepared for each management by the external auditors. The process of setting up and carrying out the external audits is described. Guidelines are suggested for those seeking to carry out an external audit.

Dosimetric intercomparison in the British Institute of Radiology fractionation study of 3F/week versus 5F/week in radiotherapy of laryngo-pharynx cancer.

A dose intercomparison was carried out by the National Physical Laboratory between the seven radiotherapy centres which contributed the largest number of patients to the British Institute of Radiology fractionation study of three fractions per week versus five fractions per week in clinical cancer treatment. Six of the centres showed remarkable agreement within the acceptable limits of error of the measurements. In one centre there appeared to be a physical dose discrepancy of 2.8% which was materially less than could be detected clinically.

The influence of field size on the late tolerance of the rat spinal cord to single doses of X rays.

Varying lengths of the cervical spinal cord of rats were irradiated with single doses of X rays. Dose-related changes in the latency for the development of paralysis, or for the presence of histological lesions in the spinal cord, indicated a dependency on the length of spine irradiated. The dose associated with a specified latency increased as the field size was reduced from 16 mm to 4 mm. A more precise indication of the importance of field size came from a determination of the ED50 values for rats developing paralysis in less than 30 weeks of irradiation or from those that showed neurological signs, or histological evidence, of irradiation damage, occurring after latent periods of greater than 30 weeks. These end-points were primarily related to white-matter necrosis and gross vascular damage respectively. For paralysis in greater than 30 weeks the ED50 increased markedly from 21.5 +/- 0.3 Gy for a 16 mm field to 50.98 +/- 2.28 Gy when a 4 mm length of cord was irradiated. For vascular lesions only a small change in ED50 value was found, from 20.0 +/- 0.5 Gy to 25.58 +/- 2.78 Gy for 16 mm and 4 mm fields respectively. At less than or equal to ED25 no evidence for a field-size effect was seen for this late lesion. These results were examined in the light of some old and some more recently analysed clinical data for radiation myelopathy. It is hoped that this will initiate other investigations in this important area of radiotherapy practice.

Problems associated with iridium-192 wire implants.

Three incidents are reported, from different radiotherapy centres, in which an implanted iridium-192 wire remained in the tissues of a patient after withdrawal of the plastic tubing in which it was contained. In each case the instrument used to cut the wire had probably formed a hook on the end of the wire which caused it to catch in the tissues. Detailed recommendations are made for avoiding such incidents in the future, the most important of which is that the patient should be effectively monitored after the supposed removal of all radioactive sources.

Protocol for X-ray dosimetry and exposure arrangements employed in studies of late somatic effects in mammals.

A number of European laboratories studying the late effects of ionizing radiation in animals have established an effective cooperation within the European Late Effects Project Group (EULEP) since 1970. To facilitate the exchange of biological results several techniques, including quality control of the experimental animals, pathology and dosimetry, have to be standardized. The most important aspects of the procedures for X-irradiation and dosimetry of small animals are summarized. These include recommendations on irradiation conditions, dosimetry methods, characteristics of phantoms and factors affecting X-ray dosimetry. X-irradiation procedures employed by the participating institutes are described and the results of five X-ray dosimetry intercomparisons are reported. The introduction of a common dosimetry protocol has resulted in improvements in exposure arrangements and absolute dosimetry.

Calculation of dose distributions for iridium-192 implants.

After reviewing the method of Hall et coll. (1966) for calculating dose rates from 192Ir wire, small changes and improvements were made and a computer program was written to calculate dose distributions. It was found that the wire position data obtained from films and supplied to the program was the largest source of inaccuracy but that with care the maximum error in the calculated dose rates was 3 per cent. If the original cross-line curves are still used for calculations the additional error introduced into the dose rates at distances of up to 4 cm from the wire is less than one per cent.

Intercomparison of iridium-192 wire used in interstitial radiation therapy.

The results of an intercomparison which took place in 1976 when 2 sets of 192Ir wire, one English, the other French, were exchanged and their activities measured by the producers, one standardizing laboratory and two radiation therapy centres. The average differences ranged from 0.7 to 3.2 per cent. The differences in the derivation of basal dose rate as defined in the Paris system, by the two radiation therapy centres, were also investigated.

Gonad dose in cineurethrocystography.

The technical factors used for cineurethrocystography for the true lateral projection in females are given. The midline radiation dose has been measured with LiF TLD inserted into the vagina in 19 examinations. The average dose recorded was 148 mrad, the range being 50 to 306 mrad; the average number of cine frames exposed was 96. Data obtained using a Rando phantom indicated that the average ovary dose would be 30% greater than the mid-line dose since the near ovary receives a higher dose than the more distant one. The technique used for men is also given, the average gonad dose in six men being 123 mrad, range 56 to 243 mrad when simple lead foil gonad protection was used; the average number of cine frames was 107. The dose in one man without gonad protection was 1575 mrad for 112 cine frames. The results for both sexes compare favourably with those of others reported in the literature and with gonad doses recorded in typical IVP examinations.