Peak skin and eye lens radiation dose from brain perfusion CT: CTDIvol and Monte Carlo based estimations.

PURPOSE: To quantify the eye lens, peak skin and brain doses associated with head CT perfusion exam by means of thermoluminescent dosimeters (TLDs) measurements in a cadaver and compare them to Monte Carlo (MC) dose estimations as well as to the CTDIvol. METHOD: 18 TLDs were inserted in the brain, skin, and eye lenses of a female cadaver head, who underwent a CT brain perfusion scan using a Siemens Definition Flash. The table-toggling protocol used 80 kVp, 200 mAs, 32 × 1.2 mm collimation and 30 sequences. From the CT images, a voxel model was created. Doses were calculated with a MC framework (EGSnrc) and compared to TLD measurements. TLD measurements were also compared to the displayed CTDIvol. RESULTS: The average measured doses were: 185 mGy for the eyes lenses, 107 mGy for the skin, 172 mGy for the brain and 273 mGy for the peak skin. The reported CTDIvol of 259 mGy overestimated the averaged organ doses but not the peak skin dose. MC estimated organ doses were 147 mGy for the eyes (average), 104 mGy for the skin and 178 mGy for the brain (-20 %, -3% and 4% difference respect to the TLDs measurements, respectively). CONCLUSIONS: CTDIvol remains a conservative metric for average brain, skin and eyes lenses doses. For accurate eye lens and skin dose estimates MC simulations can be used. CTDIvol should be used with caution as it was of the same order of magnitude as the peak skin dose for this protocol and this particular CT scanner.

Rotating and translating anthropomorphic head voxel models to establish an horizontal Frankfort plane for dental CBCT Monte Carlo simulations: a dose comparison study.

In order to carry out Monte Carlo (MC) dosimetry studies, voxel phantoms, modeling human anatomy, and organ-based segmentation of CT image data sets are applied to simulation frameworks. The resulting voxel phantoms preserve patient CT acquisition geometry; in the case of head voxel models built upon head CT images, the head support with which CT scanners are equipped introduces an inclination to the head, and hence to the head voxel model. In dental cone beam CT (CBCT) imaging, patients are always positioned in such a way that the Frankfort line is horizontal, implying that there is no head inclination. The orientation of the head is important, as it influences the distance of critical radiosensitive organs like the thyroid and the esophagus from the x-ray tube. This work aims to propose a procedure to adjust head voxel phantom orientation, and to investigate the impact of head inclination on organ doses in dental CBCT MC dosimetry studies. The female adult ICRP, and three in-house-built paediatric voxel phantoms were in this study. An EGSnrc MC framework was employed to simulate two commonly used protocols; a Morita Accuitomo 170 dental CBCT scanner (FOVs: 60 × 60 mm2 and 80 × 80 mm2, standard resolution), and a 3D Teeth protocol (FOV: 100 × 90 mm2) in a Planmeca Promax 3D MAX scanner. Result analysis revealed large absorbed organ dose differences in radiosensitive organs between the original and the geometrically corrected voxel models of this study, ranging from -45.6% to 39.3%. Therefore, accurate dental CBCT MC dose calculations require geometrical adjustments to be applied to head voxel models.

CUSTOMISATION OF A MONTE CARLO DOSIMETRY TOOL FOR DENTAL CONE-BEAM CT SYSTEMS.

A versatile EGSnrc Monte Carlo (MC) framework, initially designed to explicitly simulate X-ray tubes and record the output data into phase space data files, was modified towards dental cone-beam computed tomography (CBCT) dosimetric applications by introducing equivalent sources. Half value layer (HVL) measurements were conducted to specify protocol-specific energy spectra. Air kerma measurements were carried out with an ionisation chamber positioned against the X-ray tube to obtain the total filtration attenuation characteristics. The framework is applicable to bowtie and non-bowtie inherent filtrations, and it accounts for the anode heel effect and the total filtration of the tube housing. The code was adjusted to the Promax 3D Max (Planmeca, Helsinki, Finland) dental CBCT scanner. For each clinical protocol, calibration factors were produced to allow absolute MC dose calculations. The framework was validated by comparing MC calculated doses and measured doses in a cylindrical water phantom. Validation results demonstrate the reliability of the framework for dental CBCT dosimetry purposes.

Optimization of dental CBCT exposures through mAs reduction.

OBJECTIVES: To investigate the effect of tube current-exposure time (mAs) reduction on clinical and technical image quality for different CBCT scanners, and to determine preliminary minimally acceptable values for the mAs and contrast-to-noise ratio (CNR) in CBCT. METHODS: A polymethyl methacrylate (PMMA) phantom and an anthropomorphic skull phantom, containing a human skeleton embedded in polyurethane, were scanned using four CBCT devices, including seven exposure protocols. For all protocols, the mAs was varied within the selectable range. Using the PMMA phantom, the CNRAIR was measured and corrected for voxel size. Eight axial slices and one coronal slice showing various anatomical landmarks were selected for each CBCT scan of the skull phantom. The slices were presented to six dentomaxillofacial radiologists, providing scores for various anatomical and diagnostic parameters. RESULTS: A hyperbolic relationship was seen between CNRAIR and mAs. Similarly, a gradual reduction in clinical image quality was seen at lower mAs values; however, for several protocols, image quality remained acceptable for a moderate or large mAs reduction compared with the standard exposure setting, depending on the clinical application. The relationship between mAs, CNRAIR and observer scores was different for each CBCT device. Minimally acceptable values for mAs were between 9 and 70, depending on the criterion and clinical application. CONCLUSIONS: Although noise increased at a lower mAs, clinical image quality often remained acceptable at exposure levels below the manufacturer's recommended setting, for certain patient groups. Currently, it is not possible to determine minimally acceptable values for image quality that are applicable to multiple CBCT models.

A methodology to develop computational phantoms with adjustable posture for WBC calibration.

A Whole Body Counter (WBC) is a facility to routinely assess the internal contamination of exposed workers, especially in the case of radiation release accidents. The calibration of the counting device is usually done by using anthropomorphic physical phantoms representing the human body. Due to such a challenge of constructing representative physical phantoms a virtual calibration has been introduced. The use of computational phantoms and the Monte Carlo method to simulate radiation transport have been demonstrated to be a worthy alternative. In this study we introduce a methodology developed for the creation of realistic computational voxel phantoms with adjustable posture for WBC calibration. The methodology makes use of different software packages to enable the creation and modification of computational voxel phantoms. This allows voxel phantoms to be developed on demand for the calibration of different WBC configurations. This in turn helps to study the major source of uncertainty associated with the in vivo measurement routine which is the difference between the calibration phantoms and the real persons being counted. The use of realistic computational phantoms also helps the optimization of the counting measurement. Open source codes such as MakeHuman and Blender software packages have been used for the creation and modelling of 3D humanoid characters based on polygonal mesh surfaces. Also, a home-made software was developed whose goal is to convert the binary 3D voxel grid into a MCNPX input file. This paper summarizes the development of a library of phantoms of the human body that uses two basic phantoms called MaMP and FeMP (Male and Female Mesh Phantoms) to create a set of male and female phantoms that vary both in height and in weight. Two sets of MaMP and FeMP phantoms were developed and used for efficiency calibration of two different WBC set-ups: the Doel NPP WBC laboratory and AGM laboratory of SCK-CEN in Mol, Belgium.

Effective radiation dose and eye lens dose in dental cone beam CT: effect of field of view and angle of rotation.

OBJECTIVE: To quantify the effect of field of view (FOV) and angle of rotation on radiation dose in dental cone beam CT (CBCT) and to define a preliminary volume-dose model. METHODS: Organ and effective doses were estimated using 148 thermoluminescent dosemeters placed in an anthropomorphic phantom. Dose measurements were undertaken on a 3D Accuitomo 170 dental CBCT unit (J. Morita, Kyoto, Japan) using six FOVs as well as full-rotation (360°) and half-rotation (180°) protocols. RESULTS: For the 360° rotation protocols, effective dose ranged between 54 µSv (4 × 4 cm, upper canine) and 303 µSv (17 × 12 cm, maxillofacial). An empirical relationship between FOV dimension and effective dose was derived. The use of a 180° rotation resulted in an average dose reduction of 45% compared with a 360° rotation. Eye lens doses ranged between 95 and 6861 µGy. CONCLUSION: Significant dose reduction can be achieved by reducing the FOV size, particularly the FOV height, of CBCT examinations to the actual region of interest. In some cases, a 180° rotation can be preferred, as it has the added value of reducing the scan time. Eye lens doses should be reduced by decreasing the height of the FOV rather than using inferior FOV positioning, as the latter would increase the effective dose considerably. ADVANCES IN KNOWLEDGE: The effect of the FOV and rotation angle on the effective dose in dental CBCT was quantified. The dominant effect of FOV height was demonstrated. A preliminary model has been proposed, which could be used to predict effective dose as a function of FOV size and position.

MaMP and FeMP: computational mesh phantoms applied for studying the variation of WBC efficiency using a NaI(Tl) detector.

In a previous study, the counting efficiency calibration was calculated for 36 computational mesh phantoms called MaMP and FeMP-Male and Female Mesh Phantoms, which span variations in height, weight and gender. They were created to be used in a sitting configuration WBC set-up using an HPGe detector. Now this work is extended to investigate the influence of body sizes and the position of the detector on the counting efficiency (CE) for a different counting geometry. This was done by creating a new set of MaMP and FeMP mesh phantoms lying on a reclining chair and by studying the variation of the counting efficiency using a NaI(Tl) detector for the WBC set-up of SCK-CEN. The deviation of the CE due to the detector's position with respect to the phantom was investigated. Correlations were also studied for CE as a function of trunk volume, waist-hips ratio (WHR) and waist-chest ratio (WCR) for different mesh phantoms.

A pragmatic approach to determine the optimal kVp in cone beam CT: balancing contrast-to-noise ratio and radiation dose.

OBJECTIVES: To determine the optimal kVp setting for a particular cone beam CT (CBCT) device by maximizing technical image quality at a fixed radiation dose. METHODS: The 3D Accuitomo 170 (J. Morita Mfg. Corp., Kyoto, Japan) CBCT was used. The radiation dose as a function of kVp was measured in a cylindrical polymethyl methacrylate (PMMA) phantom using a small-volume ion chamber. Contrast-to-noise ratio (CNR) was measured using a PMMA phantom containing four materials (air, aluminium, polytetrafluoroethylene and low-density polyethylene), which was scanned using 180 combinations of kVp/mA, ranging from 60/1 to 90/8. The CNR was measured for each material using PMMA as background material. The pure effect of kVp and mAs on the CNR values was analysed. Using a polynomial fit for CNR as a function of mA for each kVp value, the optimal kVp was determined at five dose levels. RESULTS: Absorbed doses ranged between 0.034 mGy mAs(-1) (14 × 10 cm, 60 kVp) and 0.108 mGy mAs(-1) (14 × 10 cm, 90 kVp). The relation between kVp and dose was quasilinear (R(2) > 0.99). The effect of mA and kVp on CNR could be modelled using a second-degree polynomial. At a fixed dose, there was a tendency for higher CNR values at increasing kVp values, especially at low dose levels. A dose reduction through mA was more efficient than an equivalent reduction through kVp in terms of image quality deterioration. CONCLUSIONS: For the investigated CBCT model, the most optimal contrast at a fixed dose was found at the highest available kVp setting. There is great potential for dose reduction through mA with a minimal loss in image quality.

Study of the counting efficiency of a WBC setup by using a computational 3D human body library in sitting position based on polygonal mesh surfaces.

A realistic computational 3D human body library, called MaMP and FeMP (Male and Female Mesh Phantoms), based on polygonal mesh surface geometry, has been created to be used for numerical calibration of the whole body counter (WBC) system of the nuclear power plant (NPP) in Doel, Belgium. The main objective was to create flexible computational models varying in gender, body height, and mass for studying the morphology-induced variation of the detector counting efficiency (CE) and reducing the measurement uncertainties. First, the counting room and an HPGe detector were modeled using MCNPX (Monte Carlo radiation transport code). The validation of the model was carried out for different sample-detector geometries with point sources and a physical phantom. Second, CE values were calculated for a total of 36 different mesh phantoms in a seated position using the validated Monte Carlo model. This paper reports on the validation process of the in vivo whole body system and the CE calculated for different body heights and weights. The results reveal that the CE is strongly dependent on the individual body shape, size, and gender and may vary by a factor of 1.5 to 3 depending on the morphology aspects of the individual to be measured.

Monte Carlo modeling for dose assessment in cone beam CT for oral and maxillofacial applications.

PURPOSE: To adjust Monte Carlo modeling for dose assessment in dedicated cone beam computed tomography (CBCT) of the oral and maxillofacial region. METHODS: Two different CBCT systems with different fields of view (FOVs), beam qualities, and scan geometries were modeled using Monte Carlo simulation. Dose calculations for typical CBCT examinations were performed with the head and neck part of four computational anatomical phantoms. RESULTS: Simulation results compared favorably to values acquired experimentally using physical phantoms (in the literature). For a given phantom scanned with 90 kV and 60 × 60 mm FOV, effective dose per mAs was on average the same for the two different systems. Exposing the four phantoms under identical settings for the same CBCT system resulted in variations in organ doses of greater than 100%, leading to differences in effective dose of 30%. For one system, the dose dependence on the operating tube potential can be described with a quadratic polynomial function. Dose distributions over the axial plane were presented as contour plots. CONCLUSIONS: Monte Carlo modeling is an efficient and accurate means of evaluating dose distributions for dedicated cone beam oral and maxillofacial CT. Results suggest large dose differences among patients undergoing the same examination on a given system, supporting approaches toward patient specific dosimetry. A dedicated and standardized computational phantom for head and neck dosimetry should be established.

Variability of dental cone beam CT grey values for density estimations.

OBJECTIVE: The aim of this study was to investigate the use of dental cone beam CT (CBCT) grey values for density estimations by calculating the correlation with multislice CT (MSCT) values and the grey value error after recalibration. METHODS: A polymethyl methacrylate (PMMA) phantom was developed containing inserts of different density: air, PMMA, hydroxyapatite (HA) 50 mg cm(-3), HA 100, HA 200 and aluminium. The phantom was scanned on 13 CBCT devices and 1 MSCT device. Correlation between CBCT grey values and CT numbers was calculated, and the average error of the CBCT values was estimated in the medium-density range after recalibration. RESULTS: Pearson correlation coefficients ranged between 0.7014 and 0.9996 in the full-density range and between 0.5620 and 0.9991 in the medium-density range. The average error of CBCT voxel values in the medium-density range was between 35 and 1562. CONCLUSION: Even though most CBCT devices showed a good overall correlation with CT numbers, large errors can be seen when using the grey values in a quantitative way. Although it could be possible to obtain pseudo-Hounsfield units from certain CBCTs, alternative methods of assessing bone tissue should be further investigated. ADVANCES IN KNOWLEDGE: The suitability of dental CBCT for density estimations was assessed, involving a large number of devices and protocols. The possibility for grey value calibration was thoroughly investigated.

Dose distribution for dental cone beam CT and its implication for defining a dose index.

OBJECTIVES: To characterize the dose distribution for a range of cone beam CT (CBCT) units, investigating different field of view sizes, central and off-axis geometries, full or partial rotations of the X-ray tube and different clinically applied beam qualities. The implications of the dose distributions on the definition and practicality of a CBCT dose index were assessed. METHODS: Dose measurements on CBCT devices were performed by scanning cylindrical head-size water and polymethyl methacrylate phantoms, using thermoluminescent dosemeters, a small-volume ion chamber and radiochromic films. RESULTS: It was found that the dose distribution can be asymmetrical for dental CBCT exposures throughout a homogeneous phantom, owing to an asymmetrical positioning of the isocentre and/or partial rotation of the X-ray source. Furthermore, the scatter tail along the z-axis was found to have a distinct shape, generally resulting in a strong drop (90%) in absorbed dose outside the primary beam. CONCLUSIONS: There is no optimal dose index available owing to the complicated exposure geometry of CBCT and the practical aspects of quality control measurements. Practical validation of different possible dose indices is needed, as well as the definition of conversion factors to patient dose.

Estimation of paediatric organ and effective doses from dental cone beam CT using anthropomorphic phantoms.

OBJECTIVES: Cone beam CT (CBCT) is an emerging X-ray technology applied in dentomaxillofacial imaging. Previous published studies have estimated the effective dose and radiation risks using adult anthropomorphic phantoms for a wide range of CBCT units and imaging protocols. METHODS: Measurements were made five dental CBCT units for a range of imaging protocols, using 10-year-old and adolescent phantoms and thermoluminescent dosimeters. The purpose of the study was to estimate paediatric organ and effective doses from dental CBCT. RESULTS: The average effective doses to the 10-year-old and adolescent phantoms were 116 µSv and 79 µSv, respectively, which are similar to adult doses. The salivary glands received the highest organ dose and there was a fourfold increase in the thyroid dose of the 10-year-old relative to that of the adolescent because of its smaller size. The remainder tissues and salivary and thyroid glands contributed most significantly to the effective dose for a 10-year-old, whereas for an adolescent the remainder tissues and the salivary glands contributed the most significantly. It was found that the percentage attributable lifetime mortality risks were 0.002% and 0.001% for a 10-year-old and an adolescent patient, respectively, which are considerably higher than the risk to an adult having received the same doses. CONCLUSION: It is therefore imperative that dental CBCT examinations on children should be fully justified over conventional X-ray imaging and that dose optimisation by field of view collimation is particularly important in young children.

Development of micro-CT protocols for in vivo follow-up of mouse bone architecture without major radiation side effects.

In vivo micro-computed tomography (micro-CT) will offer unique information on the time-related changes in bone mass and structure of living mice, provided that radiation-induced side effects are prevented. Lowering the radiation dose, however, inevitably decreases the image quality. In this study we developed and validated a protocol for in vivo micro-CT imaging of mouse bone architecture that retains high quality images but avoids radiation-induced side effects on bone structure and hematological parameters. The left hindlimb of male C57Bl/6 mice was scanned in vivo at 3 consecutive time points, separated each time by a 2-week interval. Two protocols for in vivo micro-CT imaging were evaluated, with pixel sizes of 9 and 18 µm and administered radiation doses of 434 mGy and 166 mGy per scan, respectively. These radiation doses were found not to influence trabecular or cortical bone architecture in pre-pubertal or adult mice. In addition, there was no evidence for hematological side effects as peripheral blood cell counts and the colony-forming capacity of hematopoietic progenitor cells from bone marrow and spleen were not altered. Although the images obtained with these in vivo micro-CT protocols were more blurred than those obtained with high resolution (5 µm) ex vivo CT imaging, longitudinal follow-up of trabecular bone architecture in an orchidectomy model proved to be feasible using the 9 µm pixel size protocol in combination with a suitable bone segmentation technique (i.e. local thresholding). The image quality of the 18 µm pixel size protocol was too degraded for accurate bone segmentation and the use of this protocol is therefore restricted to monitor marked changes in bone structure such as bone metastatic lesions or fracture healing. In conclusion, we developed two micro-CT protocols which are appropriate for detailed as well as global longitudinal studies of mouse bone architecture and lack noticeable radiation-induced side effects.

Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications.

OBJECTIVES: To compare the effective dose levels of cone beam computed tomography (CBCT) for maxillofacial applications with those of multi-slice computed tomography (MSCT). STUDY DESIGN: The effective doses of 3 CBCT scanners were estimated (Accuitomo 3D, i-CAT, and NewTom 3G) and compared to the dose levels for corresponding image acquisition protocols for 3 MSCT scanners (Somatom VolumeZoom 4, Somatom Sensation 16 and Mx8000 IDT). The effective dose was calculated using thermoluminescent dosimeters (TLDs), placed in a Rando Alderson phantom, and expressed according to the ICRP 103 (2007) guidelines (including a separate tissue weighting factor for the salivary glands, as opposed to former ICRP guidelines). RESULTS: Effective dose values ranged from 13 to 82 microSv for CBCT and from 474 to 1160 microSv for MSCT. CBCT dose levels were the lowest for the Accuitomo 3D, and highest for the i-CAT. CONCLUSIONS: Dose levels for CBCT imaging remained far below those of clinical MSCT protocols, even when a mandibular protocol was applied for the latter, resulting in a smaller field of view compared to various CBCT protocols. Considering this wide dose span, it is of outmost importance to justify the selection of each of the aforementioned techniques, and to optimise the radiation dose while achieving a sufficient image quality. When comparing these results to previous dosimetric studies, a conversion needs to be made using the latest ICRP recommendations.

Dosimetry of digital panoramic imaging. Part I: Patient exposure.

OBJECTIVES: To measure patient radiation dose during panoramic exposure with various panoramic units for digital panoramic imaging. METHODS: An anthropomorphic phantom was filled with thermoluminescent dosemeters (TLD 100) and exposed with five different digital panoramic units during ten consecutive exposures. Four machines were equipped with a direct digital CCD (charge coupled device) system, whereas one of the units used storage phosphor plates (indirect digital technique). The exposure settings recommended by the different manufacturers for the particular image and patient size were used: tube potential settings ranged between 64 kV and 74 kV, exposure times between 8.2 s and 19.0 s, at fuse current values between 4 mA and 7 mA. The effective radiation dose was calculated with inclusion of the salivary glands. RESULTS: Effective radiation doses ranged between 4.7 microSv and 14.9 microSv for one exposure. Salivary glands absorbed the most radiation for all panoramic units. When indirect and direct digital panoramic systems were compared, the effective dose of the indirect digital unit (8.1 microSv) could be found within the range of the effective doses for the direct digital units (4.7-14.9 microSv). CONCLUSIONS: A rather wide range of patient radiation doses can be found for digital panoramic units. There is a tendency for lower effective doses for digital compared with analogue panoramic units, reported in previous studies.

Dosimetry of digital panoramic imaging. Part II: Occupational exposure.

OBJECTIVES: To measure occupational radiation dose during panoramic exposure from five digital panoramic X-ray units. METHODS: Exposures were made with five different digital panoramic units, of which four were equipped with a direct digital CCD (charge coupled device, "direct digital" technique), and one used storage phosphor plates ("indirect digital" technique). An anthropomorphic phantom served as the patient. An ionization chamber recorded the scattered radiation at 1 m from the phantom at five different locations around the panoramic units, both at the level of the thyroid gland and the level of the gonads, and effective organ doses were calculated. Exposure parameters were set as recommended by the manufacturers for the particular image and patient size: tube potential settings ranged between 64 kV and 74 kV, exposure times between 8.2 s and 19.0 s, tube current values between 4 mA and 7 mA. RESULTS: The maximum organ equivalent dose at 1 m from the panoramic unit was 0.60 microGy, the maximum organ effective dose was 0.10 microSv. Organ equivalent doses varied between 0.18 microGy and 0.30 microGy and organ effective doses between 0.01 microSv and 0.05 microSv for the different positions around the units (average for the different panoramic units). The variations in organ doses for the various machines were 0.04-0.53 microGy organ equivalent dose and 0.01-0.08 microSv organ effective dose. CONCLUSIONS: Assuming that 500 panoramic radiographs per year are taken by a dental practitioner at 1 m distance from the panoramic unit, he or she will receive an annual additional organ effective dose between 5 microSv and 15 microSv for the thyroid gland and between 5 microSv and 40 microSv for the gonads, depending on the type of digital panoramic unit.

Radiation dose vs. image quality for low-dose CT protocols of the head for maxillofacial surgery and oral implant planning.

The goal of this study was to determine the acquisition parameters for a low-dose multi-slice CT protocol and to compare the effective dose and the image quality of this low-dose protocol with the image quality of a clinical multi-slice CT protocol, routinely used for visualisation of the head. The low-dose protocol was derived from a clinical multi-slice CT protocol by lowering mA s and kV and increasing the pitch. The low-dose protocol yielded a dose reduction from 1.5 to 0.18 mSv for a multi-slice CT scan of the whole head, whereas noise in the low-dose CT images was increased. For bone segmentation, noise could be reduced by use of a non-linear edge preserving smoothing filter. Tests on ESP and skull phantom indicated that the accuracy of the measurements on low-dose CT is acceptable for image-based planning of maxillofacial and oral implant surgery, reducing the dose by a factor of 8.

Attitude of the Belgian dentist population towards radiation protection.

OBJECTIVES: To perform a survey of private dental offices in Belgium and gain insight in the knowledge and attitude of Belgian dentists towards quality care in radiography and radiation protection. METHODS: A questionnaire was distributed among 700 Belgian dental offices, which were included based on demographic data and the use of intraoral radiographic equipment. RESULTS: The response rate was 71%. Implementation of standards for quality care and radiation protection was suboptimal. In most offices, exposure settings of the intraoral radiation tube were 65 kV/kVp to 70 kV/kVp and 10 mA to 12 mA, with an average exposure time of 0.45 s. No reduction of exposure time was noticed when using faster film types. About one-third of the responders worked with digital image receptors. Aiming devices and rectangular collimation were used in a minority of practices (40% and 6%, respectively). The distance of the dentist to the radiation tube during exposure was on average 2.2 m, although 8% of the dentists assisted in holding the image receptor inside the patient's mouth. One quarter of the dentists were standing behind a wall when taking radiographs. Lead aprons were worn more often by female dentists. Dose estimation revealed that male dentists received a significantly larger effective dose per year than female dentists (8.3 mSv vs 3.2 mSv). CONCLUSIONS: The implementation of standards of quality care for radiography and radiation protection could be improved among Belgian dentists. An elaborate educational programme in dental radiography is a prerequisite. Furthermore, recommendations could help to attain a change in attitude towards the use of ionizing radiation in order to meet European guidelines.

Quality assurance in radiotherapy by identifying standards and monitoring treatment preparation.

BACKGROUND AND PURPOSE: Due to the complexity of the treatment preparation in radiotherapy, a number of errors go undetected until after the first treatment session. Some of these errors could easily have been noticed before treatment if an objective filter existed in addition to human supervision. With this in mind, a conceptually novel extension to conventional quality assurance procedures was explored to create a global platform monitoring treatment preparation by comparison with the existing local standards. MATERIALS AND METHODS: The feasibility of developing such a platform was evaluated for a test case on a cohort of 202 patients having received breast irradiation. By statistical analysis of the treatment parameters, mean values and tolerance levels could be defined for most parameters based on the observed standard deviations. Useful correlations were traced providing us with a means to automatically track errors, the detection of which would otherwise solely depend upon the alertness of the supervisor. RESULTS AND CONCLUSIONS: Apart from its possibilities as a mere quality control tool, the platform, developed in the framework of EQUART (European Quality Assurance Program in Radiotherapy by Monitoring Treatment Preparation), can be incorporated in the treatment preparation chain, providing standard setup values for the simulation. A crucial achievement of EQUART lies in the fact that filtering out of errors occurs prior to treatment initiation.