Age-specific calibration for in vivo monitoring of thyroid: is it necessary?

Usually, an age-specific calibration of detectors used for in vivo monitoring of 131I thyroid radioactivity is not performed in practice. This study aimed to investigate the reduction in uncertainty that one can expect if an age-specific calibration is performed. For this, voxel and stylized computational phantoms of the thyroid, corresponding to children at different age groups, were used to simulate the calibration process of 131I detectors used for thyroid monitoring. SCK•CEN physical phantoms were also used for this purpose. Both analytical and Monte Carlo methods (MCNPX version 2.6.0) were used to estimate the counting efficiencies of the considered detectors. The results show that the uncertainties in the assessment of thyroid activity at a distance of 20 cm would be reduced from a range of +8% to +30%, to a range from - 6% to +15% when age-specific calibration was performed. Using a calibration based on thyroids of adults would result in an overestimation of the thyroid activity for children by up to 30% at a detector-neck distance of about 20 cm; a larger overestimation may be expected at closer distances. It is concluded that age-specific calibration of in vivo monitoring systems for the thyroid is important and has to be taken into consideration to improve the reliability of thyroid dose assessment for children.

Radiobiological comparison between Cobalt-60 and Iridium-192 high-dose-rate brachytherapy sources: Part I-cervical cancer.

PURPOSE: This study aimed to compare the biological effective doses (BEDs) to clinical target volume (CTV) and organs at risk (OARs) for cervical cancer patients treated with high-dose-rate (HDR) Iridium-192 (192 Ir) or Cobalt-60 (60 Co) brachytherapy (BT) boost and to determine if the radiobiological differences between the two isotopes are clinically relevant. METHODS: Considering all radiosensitivity parameters and their reported variations, the BEDs to CTV and OARs during HDR 60 Co/192 Ir BT boost were evaluated at the voxel level. The anatomical differences between individuals were also taken into account by retrospectively considering 25 cervical cancer patients. The intrafraction repair, proliferation, hypoxia-induced radiosensitivity heterogeneity, relative biological effectiveness (RBE), and source aging dose-rate variation were also taken into account. The comparisons in CTV were performed based on equivalent uniform BED (EUBED). RESULTS: Considering nominal parameters with no RBE correction, the CTV EUBEDs were almost similar with a median ratio of ∼1.00 (p < 0.00001), whereas RBE correction resulted in 3.9%-5.5% (p = 0.005, median = 4.8%) decrease for 60 Co with respect to 192 Ir. For OARs, the median values of D2cc (in EQD23 ) for 60 Co were lower than that of 192 Ir up to 9.2% and 11.3% (p < 0.00001) for nominal parameters and fast repair conditions, respectively. In addition, for a nominal value (reported range) of radiosensitive parameters, the CTV EUBED differences of up to 6% (5%-10%) were assessed for HDR-BT component. CONCLUSION: The RBE values are the most important cause of discrepancies between the two sources. By comparing BED/EUBEDs to CTV and OARs between 60 Co and 192 Ir sources, this numerical study suggests that a dose escalation to ∼4% is feasible and safe while sparing well the surrounding normal tissues. This 4% dose escalation should be benchmarked with clinical evidences (such as the results of clinical trials) before it can be used in clinical practice.

Patient-specific anatomical models for radioiodine dosimetry in treatment of hyperthyroidism: is it necessary?

PURPOSE: To investigate the necessity of patient-specific dosimetry calculations using individualized models for hyperthyroid patients treated with radioactive iodine (RAI). This treatment modality was considered to be safe and effective; however, a recent publication indicated associations between greater organ-absorbed doses of RAI and risk of cancer death. METHODS: Ten patient-specific models which ranged in size were used (from 152.5 to 184 cm in height and from 44 to 88 kg in mass). The time-integrated activity coefficients (TIAC) were evaluated from the 2017 Leggett's model assuming 24 h radioactive iodine uptakes (RAIU) of 30, 50, 70, and 90% and two intake routes for normal uptake (ingestion and injection). A set of 131 I S factors (mGy MBq-1  h-1 ) from the patient-specific phantoms including 12 source regions were provided in this study. These S factors were used together with the new TIACs to present dose coefficients. RESULTS: The MC-based patient-specific S factors were compared with the ICRP standard data and the variation ranges (%) of (-65, +210) and (-57, +193) were reported for self and cross S factors, respectively. However, for self S factors, those intervals were reduced to (-8.3, +4.6) when mass correction was applied. Moreover, variations on organ dose coefficients were evaluated and the thyroid contributions were also assessed for 24 h RAIU of 30, 50, 70, and 90%. Considering that the thyroid contribution to adjacent normal organs is high and the variations on cross dose coefficients are also considerable, variations (%) on normal organ doses were estimated to be up to (-63, +132), with a planned thyroid absorbed dose of 150 Gy. CONCLUSION: Given the large variations on organ doses, the standard data are not an appropriate substitute for patient-specific data. Particularly, when accurate patient-specific dose estimation is a serious concern in RAI treatment (RAIT) for nuclear medicine practitioners. However, acquiring computed tomography (CT) images for patient-specific modeling will impose additional radiation dose to patients. It was concluded that CT imaging limited to the region from skull base to mid thorax (i.e., for organs with RAIT doses of >~50 mGy with a dose of 150 Gy prescribed to the thyroid) may be suggested and is clinically relevant because the normal organ dose increments are not greater than 10%.

The effect of contrast material on radiation dose during computed tomography pulmonary angiography.

This study evaluated the impact of contrast material (CM) on radiation dose for adults undergoing computed tomography pulmonary angiography (CTPA). A previously developed physiologically based pharmacokinetic (PBPK) model and phantoms representing the average (reference) adult male and female individual were used to evaluate the iodine concentration in tissues as a function of time elapsed since the initiation of iodinated contrast medium administration. In order to estimate the radiation dose more accurately, a detailed model of pulmonary vessels was added to the phantoms. Then, the material composition of phantoms was modified to include the iodine concentration in different organs and tissues at different acquisition times after CM injection. The calculations were performed using Monte Carlo N-Particle extended code (MCNPX) version 2.6.0. The radiation dose estimates during CTPA were provided as a function of scan acquisition time after injection considering the distribution of iodinated CM within ICRP reference phantoms. It was shown that the estimated radiation dose to the lungs could be 31-40% (27-34%) larger when considering the effect of iodinated contrast administration with injection rate of 5 (3)mL/s. Moreover, the effective dose for contrast-enhanced CT (CECT) would be utmost 10-13% larger than that for non-enhanced CT (NECT). The radiation doses to the other organs in-/outside the scanned region would be decreased if the scan performed on time. In case of late scanning, absorbed dose decreases slightly for lungs (∼15-20%) whereas becomes (∼10% or more) higher than its NECT value for some organs such as heart muscle, kidneys, and spleen. To sum up, the late scanning (Δt>5s after the end of injection) is not recommended because of higher dose delivered to other organs than the lungs (particularly heart muscle).

A revised dosimetric characterization of 60Co BEBIG source: From single-source data to clinical dose distribution.

PURPOSE: Although the dosimetric characterization of 60Co BEBIG source can be found in several literature studies, the data sets show major discrepancies and the lack of uncertainty analyses. This study tried to determine an accurate dosimetric data set for this source using Monte Carlo (MC) simulations along with detailed uncertainty analysis. To explore how different dosimetric data sets can make changes in practical situations, clinical dose distributions based on our results were compared with the dose distributions derived from Granero et al. and consensus data sets. METHODS AND MATERIALS: The MC simulations were performed with Monte Carlo N-Particle eXtended code (MCNPX) version 2.6.0 and the TG-43 parameters were estimated adhering to the American Association of Physicists in Medicine (AAPM) and European SocieTy for Radiotherapy and Oncology (ESTRO) 229 report. The dose rate distributions for single-source and two typical clinical cases, including one intracavitary and one interstitial, were calculated using an in-house code on the basis of the TG-43 formalism. RESULTS: The total uncertainties for water dose rate on source transverse axis at 1 cm and 5 cm, air kerma strength, and dose rate constant were evaluated to be 0.10%, 0.09%, 0.04%, and 0.11%, respectively. Meaningful differences were found for the interstitial case in which 22% of clinical target volume (CTV) showed differences from ±1% to ±10% or even larger. CONCLUSIONS: The MC uncertainty was derived about 16 times smaller than the typical MC component stated in TG-138, partly because of large number of histories and partly because the spectra of 60Co and also its photons' attenuation coefficients are adequately accurate. The results showed that in the clinical situations, the applicator geometry and the superposition of single-source dose distributions can reduce the differences observed between several data sets.

Dosimetric factors for diagnostic nuclear medicine procedures in a non-reference pregnant phantom.

This study evaluates the impact of using non-reference fetal models on the fetal radiation dose from diagnostic radionuclide administration. The six-month pregnant phantoms including fetal models at the 10th and 90th growth percentiles were constructed at either end of the normal range around the 50th percentile and implemented in the Monte Carlo N-Particle code version MCNPX 2.6. This code has then been used to evaluate the 99mTc S factors of the target organs of interest, as this is the most commonly used radionuclide in nuclear medicine procedures. Substantial variations were observed in the S factors between the 10th/90th percentile phantoms from the 50th percentile phantom, with the greatest difference being 38.6%. When the source organs were in close proximity to, or inside the fetal body, the 99mTc S factors presented strong statistical correlations with fetal body habitus. The trends observed in the S factors and the differences between various percentiles were justified by the source organs' masses, and chord length distributions. The results of this study showed that fetal body habitus had a considerable effect on fetal dose (on average up to 8.4%) if constant fetal biokinetic data were considered for all fetal weight percentiles. However, a smaller variation on fetal dose (up to 5.3%) was obtained if the available biokinetic data for the reference fetus were scaled by fetal mass.

Internal dosimetry of inhaled iodine-131.

In this paper, the dose assessment for the iodine inhalation exposure in 19 aerosol sizes and three gas/vapor forms at three levels of thyroid uptake, was performed. Two different modes of work (light vs. heavy) and breathing (nose vs. mouth) for aerosol inhalation were investigated. In order to calculate the cumulated activities per unit of inhaled activity, a combined model which included the latest models of both human respiratory and alimentary tract was developed. The S values for 131I were computed based on the ICRP adult male and female reference voxel phantoms by the Monte Carlo method. Then, the committed equivalent and committed effective dose coefficients were obtained (The data are available at http://www.um.ac.ir/∼mirihakim). In general, for the nonzero thyroid uptakes, the maximum cumulated activity was found in the thyroid. When the thyroid is blocked, however, the maximum depends on the work and breathing mode and radioisotope form. Overall, the maximum CED coefficient was evaluated for the inhalation of elemental iodine at thyroid uptake of ∼27% (2.8 × 10-8 Sv/Bq). As for the particle inhalation per se, mouth breathing of 0.6 nm and 0.2 µm AMTD particles showed to have the maximum (2.8 × 10-8 Sv/Bq) and minimum (6.4 × 10-9 Sv/Bq) CED coefficients, respectively. Compared to the reference CED coefficients, the authors found an increase of about 58% for inhalation of the aerosols with AMAD of 1 µm and 70% for 5 µm.

Pulmonary embolism in pregnant patients: Assessing organ dose to pregnant phantom and its fetus during lung imaging.

PURPOSE: The purpose of this study was to provide updated radiation dose from diagnostic exams performed for pregnant patients suspected of pulmonary embolism (PE) using the recently developed BREP phantoms of pregnant woman and the fetus. Also to challenge the validity of current recommendations suggest that ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) vs. computed tomography pulmonary angiography (CTPA) should be considered for diagnosis of PE in radiosensitive groups such as pregnant women. METHODS: The Monte Carlo calculations involving detailed geometrical simulation of pregnant women and the fetus were performed. RESULTS: The results showed that when radiation dose to the fetus is of concern, CTPA is more appropriate at early stages causes 50%-97% lower fetal doses for the first two trimesters of pregnancy. While for gestational periods more than 6 months, V/Q SPECT leads to a 15% lower fetal dose and thus, is less hazardous. The fetal dose from CTPA increases with gestational age, while that from V/Q SPECT decreases. Furthermore, the maximum amount of fetal dose is received by fetal skeleton (i.e., on average about 1.8 and 3.9 times larger dose from SPECT and CT, respectively). CONCLUSIONS: V/Q SPECT should not always be preferred for pregnant patients suspected of PE. This finding is in contrast with the guidance to choose the preferred modality based on the maternal effective dose. The reason of this issue was discussed in this paper based on chord length distributions (CLDs). The importance of considering fetal organs separately in MC calculations was also highlighted.

A Monte Carlo study on quantifying the amount of dose reduction by shielding the superficial organs of an Iranian 11-year-old boy.

A method for minimizing organ dose during computed tomography examinations is the use of shielding to protect superficial organs. There are some scientific reports that usage of shielding technique reduces the surface dose to patients with no appreciable loss in diagnostic quality. Therefore, in this Monte Carlo study based on the phantom of a 11-year-old Iranian boy, the effect of using an optimized shield on dose reduction to body organs was quantified. Based on the impact of shield on image quality, lead shields with thicknesses of 0.2 and 0.4 mm were considered for organs exposed directly and indirectly in the scan range, respectively. The results showed that there is 50%-62% reduction in amounts of dose for organs located fully or partly in the scan range at different tube voltages and modeling the true location of all organs in human anatomy, especially the ones located at the border of the scan, range affects the results up to 49%.

Dose estimations for Iranian 11-year-old pediatric phantoms undergoing computed tomography examinations.

In order to establish an organ and effective dose database for Iranian children undergoing computed tomography (CT) examinations, in the first step, two Iranian 11-year-old phantoms were constructed from image series obtained from CT and magnetic resonance imaging (MRI). Organ and effective doses for these phantoms were calculated for head, chest, abdomen-pelvis and chest-abdomen-pelvis (CAP) scans at tube voltages of 80, 100 and 120 kVp, and then they were compared with those of the University of Florida (UF) 11-year-old male phantom. Depth distributions of the organs and the mass of the surrounding tissues located in the beam path, which shield the internal organs, were determined for all phantoms. From the results, it was determined that the main organs of the UF phantom receive smaller doses than the two Iranian phantoms, except for the urinary bladder of the Iranian girl phantom. In addition, the relationship between the anatomical differences and the size of the dose delivered was also investigated and the discrepancies between the results were examined and justified.

Effects of shielding the radiosensitive superficial organs of ORNL pediatric phantoms on dose reduction in computed tomography.

In computed tomography (CT), some superficial organs which have increased sensitivity to radiation, receive doses that are significant enough to be matter of concern. Therefore, in this study, the effects of using shields on the amount of dose reduction and image quality was investigated for pediatric imaging. Absorbed doses of breasts, eyes, thyroid and testes of a series of pediatric phantoms without and with different thickness of bismuth and lead were calculated by Monte Carlo simulation. Appropriate thicknesses of shields were chosen based on their weights, X-ray spectrum, and the amount of dose reduction. In addition, the effect of lead shield on image quality of a simple phantom was assessed quantitatively using region of interest (ROI) measurements. Considering the maximum reduction in absorbed doses and X-ray spectrum, using a lead shield with a maximum thickness of 0.4 mm would be appropriate for testes and thyroid and two other organs (which are exposed directly) should be protected with thinner shields. Moreover, the image quality assessment showed that lead was associated with significant increases in both noise and CT attenuation values, especially in the anterior of the phantom. Overall, the results suggested that shielding is a useful optimization tool in CT.

Facility optimization to improve activation rate distributions during IVNAA.

Currently, determination of body composition is the most useful method for distinguishing between certain diseases. The prompt-gamma in vivo neutron activation analysis (IVNAA) facility for non-destructive elemental analysis of the human body is the gold standard method for this type of analysis. In order to obtain accurate measurements using the IVNAA system, the activation probability in the body must be uniform. This can be difficult to achieve, as body shape and body composition affect the rate of activation. The aim of this study was to determine the optimum pre-moderator, in terms of material for attaining uniform activation probability with a CV value of about 10% and changing the collimator role to increase activation rate within the body. Such uniformity was obtained with a high thickness of paraffin pre-moderator, however, because of increasing secondary photon flux received by the detectors it was not an appropriate choice. Our final calculations indicated that using two paraffin slabs with a thickness of 3 cm as a pre-moderator, in the presence of 2 cm Bi on the collimator, achieves a satisfactory distribution of activation rate in the body.

Increasing the Personnel Safety of a Landmine Detection System using Proper Shielding Materials.

It has been proven that landmine detection systems based on prompt gamma neutron activation analysis method can be used effectively in detecting low metal content mines. Unfortunately, neutron and gamma radiations of these systems are inevitable. Therefore, the personnel safety of these devices is one of the major limitations in using these systems. In this work, a system composed of a moderated americium-beryllium neutron source was considered. We have investigated different thicknesses of proper neutron shielding materials such as polyethylene and boric acid around the system to shield neutrons and increase the safety conditions for the operators. The effect of using different thicknesses of a cylindrical lead shield (around the source) for shielding the gamma radiation of the source was also studied. Several experiments were done to measure neutron and gamma dose equivalent rate at different distances from the source. Most of the results were compared with the results obtained by Monte Carlo N-particle transport 4C code. Finally, we found a system that is safe for the operators who work at about a 1 m distance from the landmine detection system.

Improving the moderator geometry of an anti-personnel landmine detection system.

The optimum moderating geometry using an (241)Am-Be neutron source for detecting landmines has been investigated. The experimental setup composed of a Pb cylindrical shell enclosing the neutron source, embedded in a fixed-size high-density polyethylene cylinder with a variable thickness of the upper and lower moderator/reflector. According to the fact that the increased flux of thermal neutrons in the mine position yields increased prompt gamma rays, some groups of experiment have been done to measure several moderator configurations' responses, replacing a thermal neutron detector with the landmine and counting the neutron capture events.

Evaluation the nonlinear response function of a 3 x 3 in NaI scintillation detector for PGNAA applications.

Response functions of the 3 x 3 in NaI detector, which is mainly used in PGNAA applications, have been calculated by using MCNP-4C code. Calculated results are compared with measured data by using standard gamma-ray sources and prompt gamma-rays from pure element samples to check their accuracy. Prompt gamma-rays from pure element samples were used for this determination in the range from 1.942 to 10.829 MeV by use of (241)Am-Be neutron source and gamma-rays from radioisotope sources were used in the range from 0.081 to 4.438 MeV. Through the precise modeling of the detector structure, the agreement between both results has been improved. A surprising result is that in the PGNAA method the agreement between the MCNP simulation and experiment will be better by using a suitable neutron shield for NaI detector in order to prevent the activation of NaI (Tl) and a proper gamma-shield to attenuate the high-rate 4.438 MeV gamma-ray, (241)Am-Be gamma-ray component.

Improving the safety of a body composition analyser based on the PGNAA method.

The 252Cf radioisotope and 241Am-Be are intense neutron emitters that are readily encapsulated in compact, portable and sealed sources. Some features such as high flux of neutron emission and reliable neutron spectrum of these sources make them suitable for the prompt gamma neutron activation analysis (PGNAA) method. The PGNAA method can be used in medicine for neutron radiography and body chemical composition analysis. 252Cf and 241Am-Be sources generate not only neutrons but also are intense gamma emitters. Furthermore, the sample in medical treatments is a human body, so it may be exposed to the bombardments of these gamma-rays. Moreover, accumulations of these high-rate gamma-rays in the detector volume cause simultaneous pulses that can be piled up and distort the spectra in the region of interest (ROI). In order to remove these disadvantages in a practical way without being concerned about losing the thermal neutron flux, a gamma-ray filter made of Pb must be employed. The paper suggests a relatively safe body chemical composition analyser (BCCA) machine that uses a spherical Pb shield, enclosing the neutron source. Gamma-ray shielding effects and the optimum radius of the spherical Pb shield have been investigated, using the MCNP-4C code, and compared with the unfiltered case, the bare source. Finally, experimental results demonstrate that an optimised gamma-ray shield for the neutron source in a BCCA can reduce effectively the risk of exposure to the 252Cf and 241Am-Be sources.