Establishing measurement traceability for national laboratories: Results of an IAEA comparison of (131)I.

A radioactivity measurement comparison for solutions of (131)I was conducted by the International Atomic Energy Agency for participants in one of its Cooperative Research Projects aimed at enhancing quality assurance practices in nuclear medicine. The comparison solutions were prepared from a single master stock solution and distributed to the participating laboratories, who measured the activity concentration of the solution using either the laboratory's radionuclide activity calibrator or primary standardization methods. From the 7 results received, a Comparison Reference Value was calculated to be 37.35(78)MBqg(-1) at the reference time. Degrees of equivalence, as defined by the Mutual Recognition Agreement (MRA) of the Comité International des Poids et Mesures (CIPM), were calculated for each laboratory, demonstrating that equivalence to within +/-4% could be achieved. The comparison has been registered as a supplementary comparison with the CIPM, Consultative Committee for Ionizing Radiation, Section II-measurement of radionuclides (CCRI(II)) for the purposes of allowing the participants to establish traceability to international standards for this radionuclide.

A comparison of Australian and Canadian calibration coefficients for air kerma and absorbed dose to water for 60Co gamma radiation.

Australian and Canadian calibration coefficients for air kerma and absorbed dose to water for 60Co gamma radiation have been compared using transfer standard ionization chambers of types NE 2561 and NE 2611A. Whilst the primary standards of air kerma are similar, both being thick-walled graphite cavity chambers but employing different methods to evaluate the Awall correction, the primary standards of absorbed dose to water are quite different. The Australian standard is based on measurements made with a graphite calorimeter, whereas the Canadian standard uses a sealed water calorimeter. The comparison result, expressed as a ratio of calibration coefficients R=N(ARPANSA)/N(NRC), is 1.0006 with a combined standard uncertainty of 0.35% for the air kerma standards and 1.0052 with a combined standard uncertainty of 0.47% for the absorbed dose to water standards. This demonstrates the agreement of the Australian and Canadian radiation dosimetry standards. The results are also consistent with independent comparisons of each laboratory with the BIPM reference standards. A 'trilateral' analysis confirms the present determination of the relationship between the standards, within the 0.09% random component of the combined standard uncertainty for the three comparisons.

Evidence for using Monte Carlo calculated wall attenuation and scatter correction factors for three styles of graphite-walled ion chamber.

The basic equation for establishing a 60Co air-kerma standard based on a cavity ionization chamber includes a wall correction term that corrects for the attenuation and scatter of photons in the chamber wall. For over a decade, the validity of the wall correction terms determined by extrapolation methods (K(w)K(cep)) has been strongly challenged by Monte Carlo (MC) calculation methods (K(wall)). Using the linear extrapolation method with experimental data, K(w)K(cep) was determined in this study for three different styles of primary-standard-grade graphite ionization chamber: cylindrical, spherical and plane-parallel. For measurements taken with the same 60Co source, the air-kerma rates for these three chambers, determined using extrapolated K(w)K(cep) values, differed by up to 2%. The MC code 'EGSnrc' was used to calculate the values of K(wall) for these three chambers. Use of the calculated K(wall) values gave air-kerma rates that agreed within 0.3%. The accuracy of this code was affirmed by its reliability in modelling the complex structure of the response curve obtained by rotation of the non-rotationally symmetric plane-parallel chamber. These results demonstrate that the linear extrapolation technique leads to errors in the determination of air-kerma.

IAEA/WHO postal dose audits for radiotherapy hospitals in Eastern and South-Eastern Europe.

The IAEA/WHO TLD programme has been in operation for 34 years. In this period the calibration of approximately 5200 high-energy photon beams in over 1300 radiotherapy hospitals in 115 countries worldwide was checked. Of these, 18% of the audits were performed in Eastern and South-Eastern Europe. There are large contrasts in the region; while the results are very good for most countries, a few countries struggle with basic problems in dosimetry. The hospitals operating radiotherapy services without qualified medical physicists or dosimetry equipment have poorer results than those properly equipped and staffed. Only about 2/3 of TLD audit participants in Eastern Europe have the appropriate dosimetry equipment. To achieve consistency of the audit results within Eastern and South-Eastern Europe, strengthening of radiotherapy infrastructure in a few countries would be necessary.

The response of lif thermoluminescence dosemeters to photon beams in the energy range from 30 kV x rays to 60Co gamma rays.

The energy response of standard (TLD-100) and high-sensitivity (TLD-100H) LiF thermoluminescence dosemeters (TLDs) has been studied for photon beams with mean energies from about 25 keV to 1100 keV. Canadian primary standards for air kerma were used to establish the air kerma rates for each of the photon beams. TLDs were mounted in a PMMA holder and the air kerma response was measured as a function of energy. The EGSnrc Monte Carlo code was used to model the TLD holder and calculate the absorbed dose to the TLD chip per unit air kerma for each beam. The measured and calculated results were combined to obtain the intrinsic dose response of the TLD chip. Broadly, our results are consistent with existing data, which show a marked difference in the energy dependence of the two materials. However, the precision of our measurements (standard uncertainty of about 0.6%) has permitted the identification of features that have not been noted before. In particular, the energy dependence of the two materials is quite different in the important energy region delimited by 137Cs and 60Co gamma rays.

The effect of wall thickness on the response of a spherical ionization chamber.

Air-filled ionization chambers are used widely for radiation dosimetry. For some applications it is important to know the effect on the chamber response of photon attenuation and scattering in the chamber walls. Traditionally, the wall effect is determined by measuring the chamber response as a function of wall thickness and extrapolating linearly to zero thickness. We have constructed a spherical graphite chamber with variable wall thickness. The change in the chamber response with wall thickness has been measured in a 137Cs gamma-ray beam. Our data show that the change in response is not linear with wall thickness, in agreement with the theoretical prediction of Bielajew (1990 Med. Phys. 17 583-7). A linear versus non-linear extrapolation of the measured data to zero wall thickness leads to a difference of almost 1% in the estimate of the wall correction factor, Kw. The value of Kw obtained using the non-linear extrapolation is in good agreement with the result obtained using Monte Carlo techniques.

Comparison of dosimetric standards of Canada and France for photons at 60Co and higher energies.

We report the results of a comparison of the dosimetric standards of Canada and France for photon beams at 60Co and a few higher energies. The present primary standard of absorbed dose to water for NRC, Canada is based on measurements made with a sealed water calorimeter. The corresponding standard of the LNHB, France is based on measurements made with a graphite calorimeter at 60Co energy and transferred to absorbed dose to water for 60Co and higher-energy photon beams using both ion chambers and Fricke dosemeters as transfer instruments. To make this comparison, we used three graphite-walled NE2571 Farmer chambers. The absorbed dose to water determined by the LNHB was greater than that determined by NRC by 0.20% at 60Co energy. This difference is not significant given the uncertainties on the standards. In order to do the comparison for higher-energy photons, we interpolated the NRC data set at the beam qualities used at the LNHB. When %dd(10)x is used as the method of specifying beam quality, the determination of absorbed dose to water by the LNHB is about 0.2% greater than that determined by NRC and consistent with the results at 60Co. However, when using TPR20,10 as the beam quality specifier, the LNHB determination is greater than the NRC's determination by 0.8% and 1.2% at 12 and 20 MV respectively. This discrepancy, which systematically increases with increasing energy, eventually exceeds the uncertainties in the ratio of the standards, estimated to be 0.7%. This underscores the importance of selecting the method of specifying beam quality, either %dd(10)x or TPR20,10, at least for the 'soft' beams used by NRC in this comparison. In the case of the air kerma standards, which were also compared at 60Co energy, the LNHB determination was greater than NRC's by 0.14%, which is not significant given the uncertainties on the standards.

Comparison of dosimetry calibration factors at the NRCC and the NIST. National Research Council of Canada. National Institute of Standards and Technology.

In early 1998, three transfer ionization chambers were used to compare the air-kerma and absorbed-dose-to-water calibration factors measured by the National Research Council of Canada (NRCC) and the National Institute of Standards and Technology (NIST). The ratios between the NRCC and NIST calibration factors are 0.9950 and 1.0061 in the case of the absorbed-dose-to-water and air-kerma standards, respectively. In the case of the standard of absorbed dose to water, the combined uncertainty of the ratio between the standards of the two laboratories is about 0.6% and consequently, the observed difference of 0.5% is not significant at the one sigma level. In the case of the standard of air kerma, the combined uncertainty of the ratio between the standards of the two laboratories is about 0.4%, and so the observed difference of 0.61% is significant at the one sigma level. However, this discrepancy is due to the known differences in the methods of assessing the wall correction factor at the two laboratories. Taking into account changes implemented in the standards that form the basis of the calibrations, the present results are consistent with those of the previous comparison done in 1990/91. As a direct result of these differences in the calibration factors, changing from an air-kerma based protocol following TG-21 to an absorbed-dose-to-water based protocol following TG-51, would alter the relationship between clinical dosimetry in Canada and the United States by about 1%. For clinical reference dosimetry, the change from TG-21 to TG-51 could result in an increase of up to 2% depending upon the ion chamber used, the details of the protocol followed and the source of traceability, either NRCC or NIST.

Absorbed-dose beam quality conversion factors for cylindrical chambers in high energy photon beams.

Recent working groups of the AAPM [Almond et al., Med. Phys. 26, 1847 (1999)] and the IAEA (Andreo et al., Draft V.7 of "An International Code of Practice for Dosimetry based on Standards of Absorbed Dose to Water," IAEA, 2000) have described guidelines to base reference dosimetry of high energy photon beams on absorbed dose to water standards. In these protocols use is made of the absorbed-dose beam quality conversion factor, kQ which scales an absorbed-dose calibration factor at the reference quality 60Co to a quality Q, and which is calculated based on state-of-the-art ion chamber theory and data. In this paper we present the measurement and analysis of beam quality conversion factors kQ for cylindrical chambers in high-energy photon beams. At least three chambers of six different types were calibrated against the Canadian primary standard for absorbed dose based on a sealed water calorimeter at 60Co [TPR10(20)=0.572, %dd(10)x=58.4], 10 MV [TPR10(20)=0.682, %dd(10)x=69.6), 20 MV (TPR10(20)=0.758, %dd(10)x= 80.5] and 30 MV [TPR10(20) = 0.794, %dd(10)x= 88.4]. The uncertainty on the calorimetric determination of kQ for a single chamber is typically 0.36% and the overall 1sigma uncertainty on a set of chambers of the same type is typically 0.45%. The maximum deviation between a measured kQ and the TG-51 protocol value is 0.8%. The overall rms deviation between measurement and the TG-51 values, based on 20 chambers at the three energies, is 0.41%. When the effect of a 1 mm PMMA waterproofing sleeve is taken into account in the calculations, the maximum deviation is 1.1% and the overall rms deviation between measurement and calculation 0.48%. When the beam is specified using TPR10(20), and measurements are compared with kQ values calculated using the version of TG-21 with corrected formalism and data, differences are up to 1.6% when no sleeve corrections are taken into account. For the NE2571 and the NE2611A chamber types, for which the most literature data are available, using %dd(10)x, all published data show a spread of 0.4% and 0.6%, respectively, over the entire measurement range, compared to spreads of up to 1.1% for both chambers when the kQ values are expressed as a function of TPR10(20). For the PR06-C chamber no clear preference of beam quality specifier could be identified. When comparing the differences of our kQ measurements and calculations with an analysis in terms of air-kerma protocols with the same underlying calculations but expressed in terms of a compound conversion factor CQ, we observe that a system making use of absorbed-dose calibrations and calculated kQ values, is more accurate than a system based on air-kerma calibrations in combination with calculated CQ (rms deviation of 0.48% versus 0.67%, respectively).

Fricke dosimetry: the difference between G(Fe3+) for 60Co gamma-rays and high-energy x-rays.

A calibration of the Fricke dosimeter is a measurement of epsilon G(Fe3+). Although G(Fe3+) is expected to be approximately energy independent for all low-LET radiation, existing data are not adequate to rule out the possibility of changes of a few per cent with beam quality. When a high-precision Fricke dosimeter, which has been calibrated for one particular low-LET beam quality, is used to measure the absorbed dose for another low-LET beam quality, the accuracy of the absorbed dose measurement is limited by the uncertainty in the value of G(Fe3+). The ratio of G(Fe3+) for high-energy x-rays (20 and 30 MV) to G(Fe3+) for 60Co gamma-rays, G(Fe3+)MV(Co), was measured to be 1.007(+/-0.003) (confidence level of 68%) using two different types of water calorimeter, a stirred-water calorimeter (20 MV) and a sealed-water calorimeter (20, 30 MV). This value is consistent with our calculations based on the LET dependence of G(primary products) and, as well, with published measurements and theoretical treatments of G(Fe3+).

Diminished myocardial function precedes tissue acidosis during coronary hypoperfusion.

The current study sought to elucidate the relationship between myocardial pH and function during a significant but not absolute reduction in coronary flow. In a canine model, a partial coronary arterial stenosis was created, with the left anterior descending coronary artery (LAD) flow reduced by 50% compared to prestenosis levels, and maintained at that level for the duration of the study. During the experiment, interstitial myocardial pH and regional myocardial function, as assessed by the regional preload recruitable work area (PRWA), were measured. PRWA was depressed to 60% of baseline values, on average, for the entire period of reduced LAD flow. In contrast to the pattern observed with myocardial blood flow and systolic function, metabolic evidence of myocardial ischemia, that is, reduced myocardial pH did not become significantly different from baseline levels until after LAD flow had been reduced for 15 min. Thus, measurable changes in myocardial pH appeared slowly over time despite the fact that regional myocardial blood flow was decreased immediately. Therefore, myocardial pH cannot be used to anticipate alterations in myocardial contractile function.

Hypothermic cardioplegic arrest is associated with increased myocardial adenosine.

The current study examined the effects of temperature on myocardial pH, contractile function and adenosine triphosphate metabolism, particularly the production of adenosine. We matched intermittent delivery of blood cardioplegia in two groups (hypothermia 15 degrees C; normothermia 37 degrees C), for 2 h of cardioplegic arrest. Hypothermic perfusion resulted in a markedly alkalotic pH, and nearly a threefold increase in adenosine and adenosine monophosphate levels compared to normothermic hearts. Tissue levels of adenosine triphosphate were preserved to the same extent in each group, despite the increased energy requirements of normothermia. Myocardial contractile function was not statistically different between the two groups at 30 min and 2 h after the cross clamp was removed. These data suggest that both methods, hypothermia via its reduced energy demands, and normothermia through continued glycolytic metabolic activity, allow the myocardium to maintain energy stores and resume adequate function. However, hypothermic perfusion results in an accumulation of adenosine, demonstrating that temperature should be considered when attempting to manipulate the generation and accumulation of the compound.

Retrograde abdominal visceral perfusion: is it beneficial?

BACKGROUND: It is proposed that retrograde abdominal perfusion be used in combination with retrograde cerebral perfusion to provide total body visceral protection during aortic reconstruction; however, its physiologic effects remain unknown. METHODS: We compared the effect of superior vena caval perfusion alone with that of combined superior and inferior vena caval perfusion on the liver and kidney in 6 mongrel dogs. Organ blood flow was measured using ultrasonic flow probes on the hepatic artery, the portal vein, and the renal artery. Regional tissue blood flow to the liver and the kidney was assessed using colored microspheres and pH probes. Anesthetized dogs were placed on total cardiopulmonary bypass. After cooling to 20 degrees C, retrograde perfusion was begun with 30 minutes of superior vena caval perfusion followed by another 30 minutes of bicaval perfusion, or vice versa. RESULTS: Very little renal blood flow was measured with either method of retrograde perfusion. Although the liver received more blood flow in comparison to the kidney, there was no significant difference between superior vena caval perfusion alone and bicaval perfusion. The addition of inferior vena caval perfusion results in portal hypertension, hepatic congestion, ascites, and bowel edema. CONCLUSIONS: In the canine model, bicaval perfusion does not provide superior protection to the liver and kidneys when compared with superior vena caval perfusion alone.

Wall-correction and absorbed-dose conversion factors for Fricke dosimetry: Monte Carlo calculations and measurements.

For megavoltage radiotherapy photon beams, EGS4 Monte Carlo calculations show, and experimental measurements confirm with an accuracy of 0.2%, that glass or quartz-walled vials used in Fricke dosimetry increase the dose in the Fricke solution. This is mainly caused by increased electron scattering from the glass which increases the dose to the Fricke solution. The dose perturbation is shown to vary from nothing in a 60Co beam up to 2% in a 24-MV beam. For plastic vials of similar shapes, calculations demonstrate that the effect is in the opposite direction and even at high energies it is much less (0.2% to 0.5%).

A direct comparison of water calorimetry and Fricke dosimetry.

Considerable effort has been devoted to measuring the absorbed dose to water using water calorimetry. Most of these efforts have been hampered by a lack of adequate knowledge of the heat defect of water. We argue that there is now sufficient information to establish with considerable confidence the heat defect of high-purity water containing various dissolved gases. For the present work we used water saturated with a 50/50 mixture of H2 and O2 gases, for which the heat defect is calculated to be -2.1%. As a test of this assignment, we have compared the absorbed dose to water as measured using water calorimetry with that obtained from Fricke dosimetry. The water calorimeter consisted of a small sealed vessel containing 100 ml of stirred water saturated with a 50/50 mixture of H2 and O2 gases. It was irradiated with 20 MV x-rays at a dose rate of about 0.4 Gy s-1. The same vessel was then filled with Fricke dosemeter solution, and irradiated under identical conditions. Our Fricke dosimetry is based on the Svensson and Brahme value of epsilon G (3.515 x 10(-3) 1 cm-1 J-1) and agrees to within 0.2% with the dose to water for 60Co gamma-rays obtained via graphite calorimetry. We find that for 20 MV x-rays, the dose to water determined by water calorimetry is 1.006 +/- 0.004 times the dose determined by Fricke dosimetry. Within 0.6(+/- 0.4)%, this result supports the calculated heat defect of -2.1% for water saturated with a 50/50 mixture of H2 and O2 gases.

The PIOTRON: initial performance, preparation and experience with pion therapy.

The PIOTRON is a large solid angle superconducting channel built for the use of negative pi-mesons in radiotherapy. The pions are produced by protons of 590 MeV striking a target of molybdenum or beryllium. The pions are divided into 60 channels and deflected twice to enter the treatment volume radially. The momentum and the momentum band for all 60 channels can be chosen and the beam spot of Bragg peak pions at the isocenter of the applicator is a few centimeters in each direction. Dynamic scanning can thus achieve 3-dimensionally shaped treatment volumes. Two different methods are available: the ring scan, using changes of pion range; and the spot scan, involving translation of the patient through the fixed beam spot. Dose distributions of individual and multiple beams were plotted in a cylindrical water phantom. Radiobiological experiments with mammalian cells in gel and with mouse feet were performed. A special beam geometry using a sector of 15 beams was selected for the first treatments of patients with metastatic skin nodules. Six patients were treated. Acute skin reactions were scored and compared with those from orthovoltage therapy with comparable beam geometry. The RBE for 10 fractions is between 1.4 and 1.5. The next step involved treatment of patients inside water-bolus rings in preparation for dynamic therapy. Patients were then treated with the spot scan dynamic mode in the water bolus. The initial responses and reactions are favorable and confirm the feasibility and accuracy of dynamic pion therapy.