PATIENT-SPECIFIC DOSE ESTIMATES IN DYNAMIC COMPUTED TOMOGRAPHY MYOCARDIAL PERFUSION EXAMINATION.

The study aimed to implement realistic source models of a computed tomography (CT) scanner and Monte Carlo simulations to actual patient data and to calculate patient-specific organ and effective dose estimates for patients undergoing dynamic CT myocardial perfusion examinations. Source models including bowtie filter, tube output and x-ray spectra were determined for a dual-source Siemens Somatom Definition Flash scanner. Twenty CT angiography patient datasets were merged with a scaled International Commission on Radiological Protection (ICRP) 110 voxel phantom. Dose simulations were conducted with ImpactMC software. Effective dose estimates varied from 5.0 to 14.6 mSv for the 80 kV spectrum and from 8.9 to 24.7 mSv for the 100 kV spectrum. Significant differences in organ doses and effective doses between patients emphasise the need to use actual patient data merged with matched anthropomorphic anatomy in the dose simulations to achieve a reasonable level of accuracy in the dose estimation procedure.

CT beam dosimetric characterization procedure for personalized dosimetry.

Personalized dosimetry in computed tomography (CT) can be realized by a full Monte Carlo (MC) simulation of the scan procedure. Essential input data needed for the simulation are appropriate CT x-ray source models and a model of the patient's body which is based on the CT image. The purpose of this work is to develop comprehensive procedures for the determination of CT x-ray source models and their verification by comparison of calculated and measured dose distributions in physical phantoms. Mobile equipment together with customized software was developed and used for non-invasive determination of equivalent source models of CT scanners under clinical conditions. Standard and physical anthropomorphic CT dose phantoms equipped with real-time CT dose probes at five representative positions were scanned. The accumulated dose was measured during the scan at the five positions. ImpactMC, an MC-based CT dose software program, was used to simulate the scan. The necessary inputs were obtained from the scan parameters, from the equivalent source models and from the material-segmented CT images of the phantoms. 3D dose distributions in the phantoms were simulated and the dose values calculated at the five positions inside the phantom were compared to measured dose values. Initial results were obtained by means of a General Electric Optima CT 660 and a Toshiba (Canon) Aquilion ONE. In general, the measured and calculated dose values were within relative uncertainties that had been estimated to be less than 10%. The procedures developed were found to be viable and rapid. The procedures are applicable to any scanner type under clinical conditions without making use of the service mode with stationary x-ray tube position. Results show that the procedures are well suited for determining and verifying the equivalent source models needed for personalized CT dosimetry based on post-scan MC calculations.

Calibration and features of air-kerma length product meters.

Pencil-type air-kerma length product meters are generally used for quality control and radiation exposure measurements in computed tomography. To ensure reliable results, these meters should be calibrated so that measurements are traceable to international standards. Suitable calibration procedures, together with the properties of these meters, were examined and compared with the international standards and recommendations. The calibration procedure and setup used in this study were slightly modified compared with international recommendations. The special collimator system was found to cause less scatter than similar setups in earlier studies. The energy dependence of the meter response was investigated for several types of meters with standard radiation qualities. With most tested meter types, the total variation due to energy dependence was <4 %, but some had strong energy dependence and the variation was up to 15 % or higher. This highlights the importance of a proper calibration. The response of one semiconductor meter type varied up to 8 % when rotating the meter around its axis; this should be taken into account when making calibrations with a static setup.

Effect of the calibration in water and the build-up cap on the Mg(Ar) ionization chamber measurements.

Magnesium-walled argon gas flow ionization chamber (Mg(Ar)) is used for photon dose measurements in the epithermal neutron beam of FiR 1 reactor in Finland. In this study, the photon dose measurements were re-evaluated against calculations applying a new chamber calibration factor defined in water instead of in air. Also, effect of the build-up cap on the measurements was investigated. The new calibration factor provides improved agreement between measured and calculated photon dose. Use of the build-up cap does not affect the measured signal in water in neutron beam.

The energy dependence of the response of a patient dose calibrator.

Kerma-area product (KAP) meters used for patient exposure monitoring in diagnostic x-ray imaging can be calibrated in situ with a reference KAP meter. The drawback of this tandem calibration method is the large energy dependence of the response of the reference KAP meter when typical KAP ionization chambers are used for this purpose. The energy dependence of a novel, large-area KAP meter (patient dose calibrator, PDC, Radcal) was therefore experimentally investigated. Its response was examined by measuring the calibration coefficients for standard calibration radiation qualities and several radiation qualities in the range generally used in diagnostic x-ray imaging. The PDC type of KAP meter has a smaller energy dependence than conventional KAP meters, and the half-value layer can be used as a radiation quality specifier for PDC-type chambers with an uncertainty of less than 2%. The accuracy of the tandem calibration method can be improved by using this type of KAP meter as a reference meter.

Effects of radiation quality on the calibration of kerma-area product meters in x-ray beams.

The calibration coefficients of kerma-area product meters significantly depend on the energy spectrum of the x-ray beam. This effect was examined by measuring the calibration coefficients for several radiation qualities in the range generally used in diagnostic x-ray imaging. The intention was to determine the calibration coefficients for other radiation qualities by interpolation between the measured values, relative to one or more suitable parameters. The x-ray tube voltage, total filtration and half-value thickness were examined as possible specifiers of the energy distribution. No single parameter provided an interpolation of calibration coefficients with the accuracy recommended by the ICRU and IAEA, except for a narrow range of radiation qualities. At least two of the parameters are needed to reliably specify the radiation quality for the interpolation of calibration coefficients.

A tandem calibration method for kerma-area product meters.

For measurements of the kerma-area product (KAP) in diagnostic x-ray imaging, a method for calibrating field KAP meters with a reference KAP meter is presented. In this tandem calibration method, the field KAP chamber is positioned similarly as in measurements with patients. The reference KAP chamber is placed at a specified distance and used in the x-ray beam simultaneously with the field KAP chamber. The tandem method provides a feasible and practical way for calibrating field KAP meters of any type in their clinical position. Accurate measurements of the irradiation geometry are not required, but comprehensive calibration for the reference KAP meter is needed.

Development of training syllabi for radiation protection and quality assurance of dual-energy X-ray absorptiometry (DXA) systems.

The use of dual-energy X-ray absorptiometry (DXA) scanners for measuring bone mineral density (BMD) is on the increase. A single DXA scan is a relatively low-dose diagnostic X-ray examination; however, radiation protection (RP) issues should not be trivialised. One objective of the EU 6th Framework SENTINEL co-ordination action was to develop training syllabi in RP and quality assurance (QA) for BMD, and this study presents the results. An EU-wide survey was carried out which confirmed that there was a need for an accredited DXA RP training course in many EU states. There is also limited published guidance on acceptance testing/QA for DXA. Two training syllabi were developed: one on RP and one on QA of DXA systems. A training course was delivered in Ireland in 2006 by the Medical Physics & Bioengineering Department of St James's Hospital, Dublin. Following the training course, a PC-based training CD was developed and will be made available. A harmonised approach to training will promote consistent approaches to radiation safety across the EU.

Results of a European survey on patient doses in paediatric radiology.

Paediatric patients represent a very specific group within the radiology department. Compared to adult patients, they are more sensitive to radiation. As they are sometimes submitted to several radiology procedures, dose and image quality should be well balanced. Nowadays, only a few centres specialize in paediatric imaging, and knowledge of paediatric patient doses is, therefore, very scattered. The effect of the introduction of digital technology on paediatric patient doses remains largely undocumented. Data collected in the present survey illustrate that there is a clear need for standardisation in this domain. The proposal of a European diagnostic reference level (DRL) is quite difficult. Preliminary DRLs, based on typically 5-7 radiology centres per examination are proposed. The 'effective dose' may or may not be a very rigorous parameter, but it still remains useful nowadays to calculate a parameter that summarises the possible radiation-induced detriment to these young patients. However, conversion factors for calculation of the effective dose should be harmonised. Future studies should include an image quality evaluation study, using criteria that account for digital equipment. Data collection would be straightforward and could be performed in a systematic and automatic way if DICOM headers of digital images would include appropriate as well as relevant information for the particular case of paediatric examinations.

Occupational radiation doses in interventional radiology: simulations.

In interventional radiology, occupational radiation doses can be high. Therefore, many authors have established conversion coefficients from the dose-area product data or from the personal dosemeter reading to the effective dose of the radiologist. These conversion coefficients are studied also in this work, with an emphasis on sensitivity of the results to changes in exposure conditions. Comparison to earlier works indicates that, for the exposure conditions examined in this work, all previous models discussed in this work overestimate the effective dose of the radiologist when a lead apron and a thyroid shield are used. Without the thyroid shield, underestimation may occur with some models.

Staff dosimetry in interventional cardiology: survey on methods and level of exposure.

In interventional cardiac procedures, staff operates near the patient in a non-uniformly scattered radiation field. Consequently, workers may receive, over a period, relatively high radiation doses. The measurement of individual doses to personnel becomes critical due to the use of protective devices and, as a consequence of the large number of methods proposed to assess the effective dose, great variability in monitoring programmes is expected among European countries. SENTINEL consortium has conducted a survey on staff dosimetry methods and on the level of staff exposure in 12 European cardiac centres demonstrating the urgent need to harmonise dosimetry methods. From the dosimetry survey, constraint annual effective dose of 1.4 mSv and Hp(0.07) over the protective apron of 14 mSv are proposed for the optimisation the exposure the most-exposed operator.

Patient dose in interventional radiology: a European survey.

Patient doses for a few common fluoroscopy-guided procedures in interventional radiology (IR) (excluding cardiology) were collected from a few radiological departments in 13 European countries. The major aim was to evaluate patient doses for the basis of the reference levels. In total, data for 20 procedures for about 1300 patients were collected. There were many-fold variations in the number of IR equipment and procedures per population, in the entrance dose rates, and in the patient dose data (total dose area product or DAP, fluoroscopy time and number of frames). There was no clear correlation between the total DAP and entrance dose rate, or between the total DAP and fluoroscopy time, indicating that a number of parameters affect the differences. Because of the limited number of patients, preliminary reference levels were proposed only for a few procedures. There is a need to improve the optimisation of IR procedures and their definitions and grouping, in order to account for their different complexities.

Proposal for a patient database on cardiac interventional exposures for epidemiological studies.

Relatively high organ doses absorbed by patients in interventional cardiology suggest the opportunity to define these patients as a cohort to be followed forward in time in an epidemiological study of the cancer risks associated with exposure to low-dose ionising radiation. In this paper, the UNSCEAR 2000 Report risk estimates for the most exposed organs/tissues in cardiac interventional procedures are reviewed, as well as the critical features of such an epidemiological study that is anticipated to have an intrinsically low statistical power because of the low levels of risk and possible confounding factors. To overcome these limitations, data collected in different institutions can be combined provided that a common design and conduct are used for dose assessment. A minimum dataset to be collected on a patient basis is proposed that can be implemented routinely in most facilities. This data should be linked to the local patient information system in order to retrieve all the exposures of a given patient.

CD44 expression and its relationship with MMP-9, clinicopathological factors and survival in oral squamous cell carcinoma.

We investigated the expression of CD44 and MMP-9 in primary oral squamous cell carcinoma (OSCC) and evaluated their association with each other and clinicopathological factors as well as their prognostic value during long term follow up. Histological samples from 138 OSCC patients were immunohistochemically stained for the expression of CD44 and MMP-9. The staining results were compared with conventional prognostic factors and their impacts to patients' prognosis were also studied with survival analyses. Irregular staining of CD44 in tumour cells was associated with poor tumour differentiation (p=0.003), higher clinical stage (III-IV) (p=0.049), and the presence of T3-4 tumour stage (p=0.03). Strong stromal MMP-9 staining intensity was correlated with poor tumour differentiation (p=0.03). In univariate survival analysis irregular staining of CD44 in tumour cells was related to poor disease free and overall survival (p=0.001 and p<0.001, respectively). In multivariate analysis CD44 staining was a significant independent predictor for overall (p=0.03) and disease free survival (p=0.003). MMP-9 expression showed no statistical significance in survival analyses. Strong stromal staining intensity of MMP-9 correlated with irregular staining of CD44 in tumour cells, but had no prognostic significance in the present cohort. However, irregular staining of CD44 predicted more advanced disease and shortened survival of the patients.

Monte Carlo simulations of occupational radiation doses in interventional radiology.

Occupational radiation doses in interventional radiology can potentially be high. Therefore, reliable methods to assess the effective dose are needed. In the present work, the relationship between the personal dose equivalent, H(p)(10), the reading of a personal dosimeter and the effective dose of the radiologist were studied using Monte Carlo simulations. In particular, the protection provided by a lead apron was investigated. Emphasis was placed on sensitivity of the results to changes in irradiation conditions. In our simulations a 0.35 mm thick lead apron and thyroid shield reduced the effective dose, on average, by a factor of 27 (the range of these data was 15-41). Without the thyroid shield the average reduction factor was 15 (range 6-22). The reduction sensitively depended on the projection and the X-ray tube voltage. The dosimeter reading, when the dosimeter was worn above the apron and a thyroid shield was used, overestimated the effective dose on average by a factor of 130 (range 44-258) when the dosimeter was located on the breast closest to the primary X-ray beam. Without the thyroid shield the average overestimation was 69 (range 32-127). If the dosimeter was worn under the apron its reading generally underestimated the effective dose (on average by 20% with the thyroid shield). Our study indicates that, even though large variations are present, the often used conversion coefficient from the dosimeter reading above the apron to the effective dose, around 1/30, generally overestimates the effective dose by a factor of two or more.

Microbially treated peat-cellulose fabric as a biodegradable oil-collection cloth.

The aim of this work was to study the use of a fully biodegradable peat-cellulose fabric as a first aid in collecting and removing spilled oil. The fabric itself was made from entirely biodegradable natural components. Another aspect investigated was whether drying microbial suspension--specifically enriched for the degradation of oil hydrocarbons while maintaining a high survival rate and rapid initial growth--to the fabric would improve the degradation of absorbed oil along with the fabric. The results show that the oil absorption capacity of the biodegradable fabric was comparable to commercial products, and that the oil absorbed to the fabric degraded readily when incubated at various conditions. The microbial inoculum enhanced the degradation rate to some degree in sand, but in garden soil no significant difference existed. It was concluded that an oily fabric can be disposed of by biodegradation, e.g., by composting, but that a microbial inoculum is not essential for this purpose.

Evaluation of methods to estimate the patient dose in interventional radiology.

Dosimetric methods used for interventional and diagnostic radiology are reviewed and evaluated, including terms, quantities, equipment, calibration and measurements. Measurement of local skin dose and estimation of maximum local skin dose are emphasised. Aspects related to dosimetry in computed tomography and to methods of determining organ and tissue doses are not considered.

Use of a by-product of peat excavation, cotton grass fibre, as a sorbent for oil-spills.

The sorbents used to collect oil in case of oil-spills are mostly synthetic, which limits the possibilities of their disposal. We studied the absorption capacities and rates of cotton grass fibre, a by-product of peat excavation, and cotton grass mats for several oil types and compared them with a synthetic, commercially available oil sorbent. We found cotton grass fibre to have superior absorption properties: Cotton grass sorbent absorbed oil approximately two to three times as much, and two to three times as fast as the synthetic one. Cotton grass fibre absorbed no measurable amount of water in the conditions used in the tests making it ideal for absorbing oil from the surface of water. In removing diesel oil from the surface of water, the efficiency was over 99% up to an absorbing factor of 20 times its own weight. The biodegradable cotton grass fibre proved to be an effective oil sorbent with low raw-material costs.

Dosimetric comparison at FiR 1 using microdosimetry, ionisation chambers and computer simulation.

Tissue equivalent proportional counter microdosimetry has been applied in the dosimetry of epithermal neutron beams as they can provide an independent and accurate method to determine gamma ray and neutron absorbed doses. Dosimetric comparison has been performed using a tissue equivalent proportional counter, dual ionisation chambers and DORT computer code at FiR 1 boron neutron capture therapy facility in Espoo, Finland. The three methods were applied to determine neutron and gamma ray absorbed doses at 25, 40, 60 and 120 mm depths along the beam centerline in a water-filled PMMA phantom. The determined absorbed doses were found to agree within the limits of the estimated uncertainties.

Measurement of free beam neutron spectra at eight BNCT facilities worldwide.

Eight epithermal neutron beams, constructed for clinical or preclinical studies of NCT, have been dosimetrically characterized by in-air measurements with a set of activation foils for the determination of the neutron energy spectra in free beam. Measurements have been made on the already closed epithermal BNCT facility at the BMRR of the Brookhaven National Laboratory, on the HFR at JRC in Petten, The Netherlands, on the epithermal mode beam at KURRI, Japan, on the fission converter beam at MIT, USA, on the epithermal beam of the RA-6 facility in Bariloche, Argentina, on the epithermal beam at WSU, USA, on the mixed mode beam at JRR-4 at JAERI, Japan, as well as on the epithermal beam at FiR 1 at VTT, Espoo, Finland.