Impact of the measurement conditions and compression paddle on mammography dosimeter response.

The effect of mammography measurement conditions was investigated to evaluate their impact on measurement uncertainties in clinical practice. The most prominent physical X-ray beam quantities i.e., - air kerma, half-value layer, and X-ray tube voltage - were examined by measuring the response of two ionization chambers and six X-ray multimeters (XMMs) of different models. Measurements were performed using several anode/filter combinations and both with and without the compression paddle in the X-ray beam. Maximum differences of higher than 6 % were found for all quantities when the dosimeter displayed value was compared with the reference value or the variation within the clinical anode/filter combinations Mo/Mo and Mo/Rh were considered. The study showed that the calibration procedure with the W/Al anode/filter combination was reliable only for ionization chambers, and the response of XMMs varies in such a way that the calibration coefficient cannot be predicted between various measurement conditions used in calibration and clinical practices. XMM calibrations are typically performed without a compression paddle in the beam, and the response of the XMM changes when radiation quality is slightly altered. If XMM specific data is not available, based on this study, an additional uncertainty of 2 % (k = 1) could be used as a typical estimate, at least for air kerma measurements. XMMs should be used for clinical measurements in mammography only with correct settings. If the correct settings are not available, the XMMs should not be used or used only with extreme caution.

Intraoperative CBCT imaging in endovascular abdomen aneurysm repair - Optimization of exposure parameters using a stent phantom.

Cone beam computed tomography (CBCT) may provide essential additional image guidance to endovascular abdominal aneurysm repair (EVAR) operations but also significant radiation exposure to patients if scans are not carefully optimized. The purpose of our study was to define the image quality requirements for intraoperative EVAR CBCT imaging and to optimize the CBCT exposure parameters accordingly. A Multi-Energy CT phantom simulating a large patient was used by replacing the central phantom cylinder with a custom water-filled insert including an EVAR stent. Different exposure parameters covering a range of radiation qualities and dose levels were used to define the optimal image quality level regarding stent graft evaluation (compressed, bent, or collapsed). The radiation dose was measured with a calibrated air kerma-area product (KAP) meter and organ doses were calculated based on Monte Carlo simulations and a mathematical patient model. Based on the results, updated exposure parameters with the highest mean energy and lowest dose level available were recommended. With the updated protocol, the radiation exposure could be significantly decreased. The KAP value decreased from 9720 µGy·m2 to 440 µGy·m2 and reference point air kerma from 351 mGy to 16 mGy (a reduction of 96%) and organ doses of the organs in the irradiated region decreased on an average 91%. The new protocol resulted in acceptable clinical image quality based on testing with clinical cases.

EFFECT OF PELVIC LEAD SHIELD ON ORGAN DOSES IN POSTERO-ANTERIOR CHEST RADIOGRAPHY.

Lead shields are commonly used in X-ray imaging to protect radiosensitive organs and to minimise patient's radiation dose. However, they might also complicate or interfere with the examination, and even decrease the diagnostic value if they are positioned incorrectly. In this study, the radiation dose effect of waist half-apron lead shield was examined via Monte Carlo simulations of postero-anterior (PA) chest radiography examinations using a female anthropomorphic phantom. Relevant organs for dose determination were lungs, breasts, liver, kidneys and uterus. The organ dose reductions varied depending on shield position and organ but were negligible for properly positioned shields. The shield that had the largest effective dose reduction (9%) was partly positioned inside the field of view, which should not be done in practice. Dose reduction was practically 0% for properly positioned shields. Therefore, the use of lead shield in the pelvic region during chest PA examinations should be discontinued.

Performance of semiconductor dosimeters with a range of radiation qualities used for mammography: A calibration laboratory study.

PURPOSE: To investigate the radiation quality dependence of the response of commercial semiconductor-based dosimeters, and to estimate potential errors and uncertainties related to different measurement and calibration scenarios. METHODS: All measurement results were compared to reference values measured at the IAEA dosimetry laboratory which is traceable to the international system of units (SI). Energy dependence of the response of eight semiconductor dosimeters were determined for five different anode-filter combinations and tube voltages from 25 to 35 kV. For systems capable of deriving half value layer (HVL) and tube voltage from measurements, calibration coefficients for these measurements were calculated. RESULTS: For six dosimeters, the maximum deviations from the reference value of the air kerma measurement were within ±5% as required by IEC 61674. Calibration coefficients for radiation qualities (anode-filter and tube voltage combinations) relative to reference radiation quality Mo-Mo 28 kV deviate up to 12%. HVL and tube voltage measurements exhibited deviations up to 11% and 10%, respectively. CONCLUSIONS: The air kerma responses of modern semiconductor dosimeters have a small energy dependence. However, no dosimeter tested complied with the accuracy limits stated by the manufacturer for tube voltage measurements, and only two dosimeters complied with the limits for HVL measurements. Absolute measurement of HVL and tube voltage with semiconductor dosimeters have to be verified for actual clinical radiation conditions on clinical mammography systems. Semiconductor dosimeters can be used for quality control measurements if individual calibration coefficients are available for the radiation condition applied. If other conditions are applied, additional uncertainty needs to be considered, particularly in the case of HVL and tube voltage measurements.

IAEA-SSDL bilateral comparisons for diagnostic level air kerma measurement standards.

Comparisons of national standard of air kerma for conventional and mammographic diagnostic X-ray radiation qualities were conducted by the IAEA. Eleven secondary standards dosimetry laboratories provided calibration data for Exradin A3 and Radcal RC6M transfer ionization chambers circulated. Each comparison result expressed as the ratio of the participant and IAEA calibration coefficient were within the acceptance limit of ±2.5%. From the 67 results of 11 participants and 10 available beam qualities, the comparison result was within its standard uncertainty in 63 cases, and within the expanded (k = 2) uncertainty in four cases. Detailed calibration uncertainty budgets from participant laboratories are presented. The relative standard calibration uncertainty of each participant was in the range of 0.5-1.3%. These results indicate that the calibration related uncertainty component is reasonable low for a clinical measurement. In addition to the calibration coefficient, other corrections should be applied for clinical measurement to achieve the recommended accuracy.

Comparison of pencil-type ionization chamber calibration results and methods between dosimetry laboratories.

A comparison of calibration results and procedures in terms of air kerma length product, PKL, and air kerma, K, was conducted between eight dosimetry laboratories. A pencil-type ionization chamber (IC), generally used for computed tomography dose measurements, was calibrated according to three calibration methods, while its residual signal and other characteristics (sensitivity profile, active length) were assessed. The results showed that the "partial irradiation method" is the preferred method for the pencil-type IC calibration in terms of PKL and it could be applied by the calibration laboratories successfully. Most of the participating laboratories achieved high level of agreement (>99%) for both dosimetry quantities (PKL and K). Estimated relative standard uncertainties of comparison results vary among laboratories from 0.34% to 2.32% depending on the quantity, beam quality and calibration method applied. Detailed analysis of the assigned uncertainties have been presented and discussed.

Radiation exposure to foetus and breasts from dental X-ray examinations: effect of lead shields.

OBJECTIVES: Dental radiography may involve situations where the patient is known to be pregnant or the pregnancy is noticed after the X-ray procedure. In such cases, the radiation dose to the foetus, though low, needs to be estimated. Uniform and widely used guidance on dental X-ray procedures during pregnancy are presently lacking, the usefulness of lead shields is unclear and practices vary. METHODS: Upper estimates of radiation doses to the foetus and breasts of the pregnant patient were estimated with an anthropomorphic female phantom in intraoral, panoramic, cephalometric and CBCT dental modalities with and without lead shields. RESULTS: The upper estimates of foetal doses varied from 0.009 to 6.9 µGy, and doses at the breast level varied from 0.602 to 75.4 µGy. With lead shields, the foetal doses varied from 0.005 to 2.1 µGy, and breast doses varied from 0.002 to 10.4 µGy. CONCLUSIONS: The foetal dose levels without lead shielding were <1% of the annual dose limit of 1 mSv for a member of the public. Albeit the relative shielding effect, the exposure-induced increase in the risk of breast cancer death for the pregnant patient (based on the breast dose only) and the exposure-induced increase in the risk of childhood cancer death for the unborn child are minimal, and therefore, need for foetal and breast lead shielding was considered irrelevant. Most important is that pregnancy is never a reason to avoid or to postpone a clinically justified dental radiographic examination.

Fetal radiation dose in computed tomography.

The connection between recorded volumetric CT dose index (CTDI vol) and determined mean fetal dose (Df) was examined from metal-oxide-semiconductor field-effect transistor dose measurements on an anthropomorphic female phantom in four stages of pregnancy in a 64-slice CT scanner. Automated tube current modulation kept the mean Df fairly constant through all pregnancy stages in trauma (4.4-4.9 mGy) and abdomino-pelvic (2.1-2.4 mGy) protocols. In pulmonary angiography protocol, the mean Df increased exponentially as the distance from the end of the scan range decreased (0.01-0.09 mGy). For trauma protocol, the relative mean Df as a function of gestational age were in the range 0.80-0.97 compared with the mean CTDI vol. For abdomino-pelvic protocol, the relative mean Df was 0.57-0.79 and for pulmonary angiography protocol, 0.01-0.05 compared with the mean CTDI vol, respectively. In conclusion, if the fetus is in the primary beam, the CTDI vol can be used as an upper estimate of the fetal dose. If the fetus is not in the primary beam, the fetal dose can be estimated by considering also the distance of the fetus from the scan range.

Aspects of forward scattering from the compression paddle in the dosimetry of mammography.

The best compression paddle position during air kerma measurement in mammography dosimetry was studied. The amount of forward scattering as a function of the compression paddle distance was measured with different X-ray spectra and different types of paddles and dose meters. The contribution of forward scattering to the air kerma did not present significant dependency on the beam quality or of the compression paddle type. The tested dose meter types detected different amounts of forward scattering due to different internal collimation. When the paddle was adjusted to its maximum clinical distance, the proportion of the detected forward scattering was only 1 % for all dose meter types. The most consistent way of performing air kerma measurements is to position the compression paddle at the maximum distance from the dose meter and use a constant forward scattering factor for all dose meters. Thus, the dosimetric uncertainty due to the forward scatter can be minimised.

Experimental investigation on the choice of the tungsten/rhodium anode/filter combination for an amorphous selenium-based digital mammography system.

The signal difference-to-noise ratio (SDNR) between aluminium sheets and a homogeneous background was measured for various radiation qualities and breast thicknesses to determine the optimal radiation quality when using a Novation DR mammography system. Breast simulating phantoms, with a thickness from 2 cm to 7 cm, and aluminium sheet, with a thickness of 0.2 mm, were used. Three different combinations of anode/filter material and a wide range of tube voltages were employed for each phantom thickness. Each radiation quality was studied using three different dose levels. The tungsten (W) anode and rhodium (Rh) filter combination achieved the specified SDNR at the lowest mean glandular dose for all the phantom thicknesses and X-ray tube voltages. The difference between the doses for different anode/filter combinations increased with the phantom thickness. For a 5-cm phantom, with a peak tube voltage of 27 kV and a SDNR of 5, the mean glandular dose associated with the use of W/Rh was reduced by 49% when compared to the molybdenum/molybdenum (Mo/Mo) anode/filter combination and by 33% when compared to Mo/Rh. Based on these measurements, the use of the W/Rh anode/filter can be recommended. It remains important, however, to select the appropriate dose level.