X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging

X-ray fluoroscopy is widely used for image guidance during cardiac intervention. However, radiation dose in these procedures can be high, and this is a significant concern, particularly in pediatric applications. Pediatrics procedures are in general much more complex than those performed on adults and thus are on average four to eight times longer¹. Furthermore, children can undergo up to 10 fluoroscopic procedures by the age of 10, and have been shown to have a three-fold higher risk of developing fatal cancer throughout their life than the general population^2,3.We have shown that radiation dose can be significantly reduced in adult cardiac procedures by using our scanning beam digital x-ray (SBDX) system⁴-- a fluoroscopic imaging system that employs an inverse imaging geometry^5,6 (Figure 1, Movie 1 and Figure 2). Instead of a single focal spot and an extended detector as used in conventional systems, our approach utilizes an extended X-ray source with multiple focal spots focused on a small detector. Our X-ray source consists of a scanning electron beam sequentially illuminating up to 9,000 focal spot positions. Each focal spot projects a small portion of the imaging volume onto the detector. In contrast to a conventional system where the final image is directly projected onto the detector, the SBDX uses a dedicated algorithm to reconstruct the final image from the 9,000 detector images.For pediatric applications, dose savings with the SBDX system are expected to be smaller than in adult procedures. However, the SBDX system allows for additional dose savings by implementing an electronic adaptive exposure technique. Key to this method is the multi-beam scanning technique of the SBDX system: rather than exposing every part of the image with the same radiation dose, we can dynamically vary the exposure depending on the opacity of the region exposed. Therefore, we can significantly reduce exposure in radiolucent areas and maintain exposure in more opaque regions. In our current implementation, the adaptive exposure requires user interaction (Figure 3). However, in the future, the adaptive exposure will be real time and fully automatic.We have performed experiments with an anthropomorphic phantom and compared measured radiation dose with and without adaptive exposure using a dose area product (DAP) meter. In the experiment presented here, we find a dose reduction of 30%.     

Assessment of dose error due to nylon mesh of treatment couch

PurposeThis study aims at the assessment of dose error in patients undergoing radiotherapy due to treatment couch of Co-60 teletherapy unit.Materials and methodsIn this study beam attenuation due to treatment couch of Co-60 unit was measured in air for different gantry angles and field sizes. Polymethylmethacrylate (PMMA) phantom was used to estimate the effect of depth on attenuation. Impact of couch on surface dose was also evaluated.ResultsBeam attenuation due to couch was in the range of 0.5–28% for different gantry angles with standard field size of 10 × 10 cm² with optimum position of metallic cranks. Maximum attenuation (29%) was observed with smallest field size i.e. 5 × 5 cm². Beam attenuation has been found higher in phantom as compared to that in air However, no particular trend of attenuation has been noted with varying depth of phantom. A 6% increase in surface dose has also been observed due to couch insertion for normal beam incidence. Maximum error of 80% is also note-worthy for most unfavorable situation of irradiation at 180 degree through the metallic cranks.ConclusionIt has been determined that ignoring the treatment couch and its accessories can result in dose error of 0.5–80%, depending on gantry angle, field size and position of couch accessories. Therefore, consideration of dose error due to couch during treatment planning is recommended.     

Incident air kerma to absorbed organ dose conversion factors for breast and lung in PA thorax radiography: The effect of patient thickness and radiation quality

PurposeConverting the measurable quantities to patient organ doses in projection radiography is usually based on a standard-sized patient model and a specific radiation quality, which are likely to differ from the real situation. Large inaccuracies can therefore be obtained in organ doses, because organ doses are dependent on the exposure parameters, exposure geometry and patient anatomy. In this study, the effect of radiation quality and patient thickness on the organ dose conversion factors were determined.MethodsIn this study, the posterior–anterior projection radiograph of the thorax was selected in order to determine the effect of radiation quality (tube voltages of 70–130 kV and total filtrations of 3 mmAl to 4 mmAl + 0.2 mmCu) and patient thickness (anterior–posterior thicknesses of 19.4–30.8 cm) on the breast and lung dose conversion factors. For this purpose, Monte Carlo simulation programs ImpactMC and PCXMC were used with computed tomography examination data of adult male and female patients and mathematical hermaphrodite phantoms, respectively.ResultsCompared to the reference beam quality and patient thickness, the relative variation range in organ dose conversion factors was up to 74% for different radiation qualities and 122% for different patient thicknesses.ConclusionsConversion factors should only be used with comprehensive understanding of the exposure conditions, considering the exposure parameters, exposure geometry and patient anatomy they are valid for. This study demonstrates that patient thickness-specific and radiation quality-specific conversion factors are needed in projection radiography.     

A Deep Learning-based correction to EPID dosimetry for attenuation and scatter in the Unity MR-Linac system

PurposeEPID dosimetry in the Unity MR-Linac system allows for reconstruction of absolute dose distributions within the patient geometry. Dose reconstruction is accurate for the parts of the beam arriving at the EPID through the MRI central unattenuated region, free of gradient coils, resulting in a maximum field size of ~10 × 22 cm² at isocentre. The purpose of this study is to develop a Deep Learning-based method to improve the accuracy of 2D EPID reconstructed dose distributions outside this central region, accounting for the effects of the extra attenuation and scatter.MethodsA U-Net was trained to correct EPID dose images calculated at the isocenter inside a cylindrical phantom using the corresponding TPS dose images as ground truth for training. The model was evaluated using a 5-fold cross validation procedure. The clinical validity of the U-Net corrected dose images (the so-called DEEPID dose images) was assessed with in vivo verification data of 45 large rectum IMRT fields. The sensitivity of DEEPID to leaf bank position errors (±1.5 mm) and ±5% MU delivery errors was also tested.ResultsCompared to the TPS, in vivo 2D DEEPID dose images showed an average γ-pass rate of 90.2% (72.6%–99.4%) outside the central unattenuated region. Without DEEPID correction, this number was 44.5% (4.0%–78.4%). DEEPID correctly detected the introduced delivery errors.ConclusionsDEEPID allows for accurate dose reconstruction using the entire EPID image, thus enabling dosimetric verification for field sizes up to ~19 × 22 cm² at isocentre. The method can be used to detect clinically relevant errors.     

Monte carlo model and output factors of elekta infinity™ 6 and 10 MV photon beam

AimThis study aimed to commission the Elekta Infinity™ working in 6 and 10 MV photon beam installed in Concord International Hospital, Singapore, and compare the OFs between MC simulation and measurement using PTW semiflex and microDiamond detector for small field sizes.Material and MethodsThere are two main steps in this study: modelling of Linac 6 and 10 MV photon beam and analysis of the output factors for field size 2 × 2–10 × 10 cm². The EGSnrc/BEAMnrc-DOSXYZnrc code was used to model and characterize the Linac and to calculate the dose distributions in a water phantom. The dose distribution and OFs were compared to the measurement data in the same condition.ResultsThe commissioning process was only conducted for a 10 × 10 cm² field size. The PDD obtained from MC simulation showed a good agreement with the measurement. The local dose difference of PDDs was less than 2% for 6 and 10 MV. The initial electron energy was 5.2 and 9.4 MeV for 6 and 10 MV photon beam, respectively. This Linac model can be used for dose calculation in other situations and different field sizes because this Linac has been commissioned and validated using Monte Carlo simulation. The 10 MV Linac produces higher electron contamination than that of 6 MV.ConclusionsThe Linac model in this study was acceptable. The most important result in this work comes from OFs resulted from MC calculation. This value was more significant than the OFs from measurement using semiflex and microDiamond for all beam energy and field sizes because of the CPE phenomenon.     

Delta4 Discover transmission detector: A comprehensive characterization for in-vivo VMAT monitoring

ObjectiveTo investigate the dosimetric behaviour, influence on photon beam fluence and error detection capability of Delta⁴ Discover transmission detector.MethodsThe transmission detector (TRD) was characterized on a TrueBeam linear accelerator with 6 MV beams. Linearity, reproducibility and dose rate dependence were investigated. The effect on photon beam fluence was evaluated in terms of beam profiles, percentage depth dose, transmission factor and surface dose for different open field sizes. The transmission factor of the 10x10 cm² field was entered in the TPS’s configuration and its correct use in the dose calculation was verified recalculating 17 clinical IMRT/VMAT plans. Surface dose was measured for 20 IMRT fields. The capability to detect different delivery errors was investigated evaluating dose gamma index, MLC gamma index and leaf position of 15 manually modified VMAT plans.ResultsTRD showed a linear dependence on MU. No dose rate dependence was observed. Short-term and long-term reproducibility were within 0.1% and 0.5%. The presence of the TRD did not significantly affect PDDs and profiles. The transmission factor of the 10x10 cm² field size was 0.985 and 0.983, for FF and FFF beams respectively. The 17 recalculated plans met our clinical gamma-index passing rate, confirming the correct use of the transmission factor by the TPS. The surface dose differences for the open fields increase for shorter SSDs and greater field size. Differences in surface dose for the IMRT beams were less than 2%. Output variation ≥2%, collimator angle variations within 0.3°, gantry angle errors of 1°, jaw tracking and leaf position errors were detected.ConclusionsDelta⁴ Discover shows good linearity and reproducibility, is not dependent on dose rate and does not affect beam quality and dose profiles. It is also capable to detect dosimetric and geometric errors and therefore it is suitable for monitoring VMAT delivery.     

Enhancement of soft-tissue contrast in cone-beam CT using an anti-scatter grid with a sparse sampling approach

PurposeAnti-scatter grids suppress the scatter substantially thus improving image contrast in radiography. However, its active use in cone-beam CT for the purpose of improving contrast-to-noise ratio (CNR) has not been successful mainly due to the increased noise related to Poisson statistics of photons. This paper proposes a sparse-view scanning approach to address the above issue.MethodCompared to the conventional cone-beam CT imaging framework, the proposed method reduces the number of projections and increases exposure in each projection to enhance image quality without an additional cost of radiation dose to patients. For image reconstruction from sparse-view data, an adaptive-steepest-descent projection-onto-convex-sets (ASD POCS) algorithm regularized by total-variation (TV) minimization was adopted. Contrast and CNR with various scattering conditions were evaluated in projection domain by a simulation study using GATE. Then we evaluated contrast, resolution, and image uniformity in CT image domain with Catphan phantom. A head phantom with soft-tissue structures was also employed for demonstrating a realistic application. A virtual grid-based estimation and reduction of scatter has also been implemented for comparison with the real anti-scatter grid.ResultsIn the projection domain evaluation, contrast and CNR enhancement was observed when using an anti-scatter grid compared to the virtual grid. In the CT image domain, the proposed method produced substantially higher contrast and CNR of the low-contrast structures with much improved image uniformity.ConclusionWe have shown that the proposed method can provide high-quality CBCT images particularly with an increased contrast of soft-tissue at a neutral dose for image-guidance.     

A constrained linear regression optimization algorithm for diaphragm motion tracking with cone beam CT projections

PurposeWe presented a feasibility study to extract the diaphragm motion from the inferior contrast cone beam computed tomography (CBCT) projection images using a constrained linear regression optimization algorithm.MethodsThe shape of the diaphragm was fitted by a parabolic function which was initialized by five manually placed points on the diaphragm contour of a pre-selected projection. A constrained linear regression model by exploiting the spatial, algebraic, and temporal constraints of the diaphragm, approximated by a parabola, was employed to estimate the parameters. The algorithm was assessed by a fluoroscopic movie acquired at anterior-posterior (AP) fixed direction and kilovoltage CBCT projection image sets from four lung and two liver patients using the Varian 21iX Clinac. The automatic tracing by the proposed algorithm and manual tracking were compared in both space and frequency domains for the algorithm evaluations.ResultsThe error between the results estimated by the proposed algorithm and those by manual tracking for the AP fluoroscopic movie was 0.54 mm with standard deviation (SD) of 0.45 mm. For the detected projections the average error was 0.79 mm with SD of 0.64 mm for all six enrolled patients and the maximum deviation was 2.5 mm. The mean sub-millimeter accuracy outcome exhibits the feasibility of the proposed constrained linear regression approach to track the diaphragm motion on rotational fluoroscopic images.ConclusionThe new algorithm will provide a potential solution to rendering diaphragm motion and possibly aiding the tumor target tracking in radiation therapy of thoracic/abdominal cancer patients.     

Photon-beam radiotherapy in pregnant patients: Can the fetal dose be limited to 10 cGy or less?

PurposeTo estimate fetal dose and its components from three-dimensional conformal radiotherapy for several malignancies presented during pregnancy.Materials and methodsFetal dose was measured from radiotherapy for Hodgkin's lymphoma and for tumors in the region of nasopharynx, breast and lung. Anthropomorphic phantoms were used to simulate an average pregnant patient at the first, second and third trimesters of gestation. Thermoluminescent dosemeters (TLD) were employed for fetal dose measurements. Phantom exposures were also performed to estimate fetal dose due to head leakage, scatter from collimators and beam modifiers and scatter generated inside the phantom (D_in). All treatments were delivered for 6 MV photon beams.ResultsRadiotherapy of Hodgkin's lymphoma resulted in a fetal dose of 5.6–57.9 cGy depending upon the gestational age and the distance between the fetal level and the field edge. The corresponding dose ranges for treatment of nasopharyngeal, breast and lung cancer was 4.0–17.1 cGy, 3.9–24.8 cGy and 5.7–74.3 cGy, respectively. The D_in at the first trimester of gestation was always smaller than 10 cGy for all examined malignancies. Pregnancy progression resulted in D_in values above or below 10 cGy depending upon the treatment site and gestational age.ConclusionThis study provides data about the fetal exposure and the contribution of D_in to the total fetal dose from conformal radiation therapy. The D_in knowledge prior to patient's irradiation enables radiation oncologists and medical physicists to decide whether fetal dose may be limited to 10 cGy or less with or without the introduction of special shielding materials.     

A novel position-sensitive mega-size dosimeter for photoneutrons in high-energy X-ray medical accelerators

PurposeA novel position-sensitive mega-size polycarbonate (MSPC) dosimeter is introduced. It provides photoneutron (PN) dose equivalent matrix of positions in and out of a beam of a high energy X-ray medical accelerator under a single exposure.MethodsA novel position-sensitive MSPC dosimeter was developed and applied. It has an effective etched area of 50 × 50 cm², as used in this study, processed in a mega-size electrochemical etching chamber to amplify PN-induced-recoil tracks to a point viewed by the unaided eyes. Using such dosimeters, PN dose equivalents, dose equivalent profiles and isodose equivalent distribution of positions in and out of beams for different X-ray doses and field sizes were determined in a Siemens ONCOR Linac.ResultsThe PN dose equivalent at each position versus X-ray dose was linear up to 20 Gy studied. As the field size increased, the PN dose equivalent in the beam was also increased but it remained constant at positions out of the beam up to 20 cm away from the beam edge. The jaws and MLCs due to material differences and locations relative to the target produce different PN contributions.ConclusionsThe MSPC dosimeter introduced in this study is a perfect candidate for PN dosimetry with unique characteristics such as simplicity, efficiency, dose equivalent response, large size, flexibility to be bent, resembling the patient’s skin, highly position-sensitive with high spatial resolution, highly insensitive to X-rays, continuity in measurements and need to a single dosimeter to obtain PN dose equivalent matrix data under a single X-ray exposure.     

Dual-energy CT imaging of orbits during episcleral brachytherapy with Ru-106 plaques: A phantom study on its potential for plaque position verification

PurposeTo investigate the potential of dual energy CT (DECT) to suppress metal artifacts and accurately depict episcleral brachytherapy Ru-106 plaques after surgical placement.MethodsAn anthropomorphic phantom simulating the adult head after surgical placement of a Ru-106 plaque was employed. Nine DECT acquisition protocols for orbital imaging were applied. Monochromatic 140 keV images were generated using iterative reconstruction and an available metal artifact reduction algorithm. Generated image datasets were graded by four observers regarding the ability to accurate demarcate the Ru-106 plaque. Objective image quality and visual grading analysis (VGA) was performed to compare different acquisition protocols. The DECT imaging protocol which allowed accurate plaque demarcation at minimum exposure was identified. The eye-lens dose from orbital DECT, with and without the use of radioprotective bismuth eye-shields, was determined using Monte Carlo methods.ResultsAll DECT acquisition protocols were judged to allow clear demarcation of the plaque borders despite some moderate streaking/shading artifacts. The differences between mean observers’ VGA scores for the 9 DECT imaging protocols were not statistically significant (p > 0.05). The eye-lens dose from the proposed low-exposure DECT protocol was found to be 20.1 and 22.8 mGy for the treated and the healthy eye, respectively. Bismuth shielding was found to accomplish >40% reduction in eye-lens dose without inducing shielding-related artifacts that obscure plaque delineation.ConclusionsDECT imaging of orbits after Ru-106 plaque positioning for ocular brachytherapy was found to allow artifact-free delineation of plaque margins at relatively low patient exposure, providing the potential for post-surgery plaque position verification.     

Immunological and cytotoxicological responses of the Asian clam,Corbicula fluminea (M.), experimentally exposed to cadmium

Abstract

Bivalve molluscs, as filter-feeding organisms, are known to accumulate metals that can produce deleterious effects on organisms. The phagocytic activity of haemocytes and lysosomal alterations in the digestive gland cells were measured in the freshwater Asian clam exposed to cadmium, in order to assess the possible use of immunocompetence and lysosomal responses as biomarkers of freshwater quality. Clams were exposed in the laboratory to nominal concentrations of 3, 10, 21.4, 46.5 and 100 µg l^?1 of cadmium and sampled after 7, 15 and 30 days of exposure. The results show a decrease of phagocytic activity after only 7 days of exposure to 10 µg l^?1 of cadmium. This response was also observed as the exposure time was increased. Lysosomes in the digestive cells increased in size and number after 7 days of exposure as cadmium concentration increased. After 30 days of exposure, a decrease in size and number indicated a change in the response to the metal from concentrations of 46.5 µg l^?1 of cadmium. A dose and time response both in phagocytic activity of haemocytes and lysosomal structure demonstrated a possible use of these biomarkers in freshwater biomonitoring.     

Feasibility study on the use of 230 MeV proton cyclotron in proton therapy centers as a spallation neutron source for BNCT

AimThe feasibility of using 230 MeV proton cyclotrons in proton therapy centers as a spallation neutron source for Boron Neutron Capture Therapy (BNCT) was investigated.BackgroundBNCT is based on the neutron irradiation of a ¹⁰B-containing compound located selectively in tumor cells. Among various types of neutron generators, the spallation neutron source is a unique way to generate high-energy and high-flux neutrons.Materials and MethodsNeutron beam was generated by a proton accelerator via spallation reactions and then the produced neutron beam was shaped to be appropriate for BNCT. The proposed Beam Shaping Assembly (BSA) consists of different moderators, a reflector, a collimator, as well as thermal and gamma filters. In addition, the simulated Snyder head phantom was utilized to evaluate the dose distribution in tumor and normal tissue due to the irradiation by the designed beam. MCNPX2.6 Monte Carlo code was used to optimize BSA as well as evaluate dose evaluation.ResultsA BSA was designed. With the BSA configuration and a beam current of 104 nA, epithermal neutron flux of 3.94 × 10⁶ [n/cm²] can be achieved, which is very low. Provided that we use the beam current of 5.75 μA, epithermal neutron flux of 2.18 × 10⁸ [n/cm²] can be obtained and the maximum dose of 38.2 Gy-eq can be delivered to tumor tissue at 1.4 cm from the phantom surface.ConclusionsResults for 230 MeV protons show that with proposed BSA, proton beam current about 5.75 μA is required for this purpose.     

Simultaneous production of mixed electron–photon beam in a medical LINAC: A feasibility study

PurposeThe electron or photon beams might be used for treatment of tumors. Each beam has its own advantage and disadvantages. Combo beam can increase the advantages. No investigation has been performed for producing simultaneous mixed electron and photon beam. In current study a device has been added to the Medical Linac to produce a mixed photon–electron beam.MethodsFirstly a Varian 2300CD head was simulated by MCNP Monte Carlo Code. Two sets of perforated lead sheets with 1 and 2 mm thickness and 0.2, 0.3, and 0.5 cm punches then placed at the top of the applicator holder tray. This layer produces bremsstrahlung x-ray upon impinging fraction electrons on it. The remaining fraction of electrons passes through the holes. The simulation was performed for 10 × 10, 6 × 6, and 4 × 4 cm² field size.ResultsFor 10 × 10 cm² field size, among the punched targets, the largest penumbra difference between the depth of 1 and 7 cm was 72%. This difference for photon and electron beams were 31% and 325% respectively. A maximum of 39% photon percentage was produced by 2 mm target with 0.2 cm holes diameter layer. The minimum surface dose value was 4% lesser than pure electron beam. For small fields, unlike the pure electron beam, the PDD, penumbra, and flatness variations were negligible.ConclusionsThe advantages of mixing the electron and photon beam is reduction of pure electron's penumbra dependency with the depth, especially for small fields, also decreasing of dramatic changes of PDD curve with irradiation field size.     

Inter-comparison of population models for the calculation of radiation dose effects on wildlife

An inter-comparison of five models designed to predict the effect of ionizing radiation on populations of non-human wildlife, performed under the IAEA EMRAS II programme, is presented and discussed. A benchmark scenario ‘Population response to chronic irradiation’ was developed in which stable generic populations of mice, hare/rabbit, wolf/wild dog and deer were modelled as subjected to chronic low-LET radiation with dose rates of 0–5?×?10^?2 Gy?day^?1 in increments of 10^?2 Gy?day^?1. The duration of exposure simulations was 5?years. Results are given for the size of each surviving population for each of the applied dose rates at the end of the 1st to 5th years of exposure. Despite the theoretical differences in the modelling approaches, the inter-comparison allowed the identification of a series of common findings. At dose rates of about 10^?2 Gy?day^?1 for 5?years, the survival of populations of short-lived species was better than that of long-lived species: significant reduction in large mammals was predicted whilst small mammals survive at 80–100?% of the control. Dose rates in excess of 2?×?10^?2 Gy?day^?1 for 5?years produced considerable reduction in all populations. From this study, a potential relationship between higher reproduction rates and lower radiation effects at population level can be hypothesized. The work signals the direction for future investigations to validate and improve the predictive ability of different population dose effects models.     

Influence of beam incidence and irradiation parameters on stray neutron doses to healthy organs of pediatric patients treated for an intracranial tumor with passive scattering proton therapy

PurposeIn scattering proton therapy, the beam incidence, i.e. the patient’s orientation with respect to the beam axis, can significantly influence stray neutron doses although it is almost not documented in the literature.MethodsMCNPX calculations were carried out to estimate stray neutron doses to 25 healthy organs of a 10-year-old female phantom treated for an intracranial tumor. Two beam incidences were considered in this article, namely a superior (SUP) field and a right lateral (RLAT) field. For both fields, a parametric study was performed varying proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and air gap size.ResultsUsing a standard beam line configuration for a craniopharyngioma treatment, neutron absorbed doses per therapeutic dose of 63 μGy Gy⁻¹ and 149 μGy Gy⁻¹ were found at the heart for the SUP and the RLAT fields, respectively. This dose discrepancy was explained by the different patient’s orientations leading to changes in the distance between organs and the final collimator where external neutrons are mainly produced. Moreover, investigations on neutron spectral fluence at the heart showed that the number of neutrons was 2.5 times higher for the RLAT field compared against the SUP field. Finally, the influence of some irradiation parameters on neutron doses was found to be different according to the beam incidence.ConclusionBeam incidence was thus found to induce large variations in stray neutron doses, proving that this parameter could be optimized to enhance the radiation protection of the patient.     

Monte Carlo study on the secondary cancer risk estimations for patients undergoing prostate radiotherapy: A humanoid phantom study

AimThe aim of this study was to estimate the secondary malignancy risk from the radiation in FFB prostate linac-based radiotherapy for different organs of the patient.BackgroundRadiation therapy is one of the main procedures of cancer treatment. However, the application the radiation may impose dose to organs of the patient which can be the cause of some malignancies.Materials and methodsMonte Carlo (MC) simulation was used to calculate radiation doses to patient organs in 18 MV linear accelerator (linac) based radiotherapy. A humanoid MC phantom was used to calculate the equivalent dose s for different organs and probability of secondary cancer, fatal and nonfatal risk, and other risks and parameters related to megavoltage radiation therapy. In out-of-field radiation calculation, it could be seen that neutrons imparted a higher dose to distant organs, and the dose to surrounding organs was mainly due to absorbed scattered photons and electron contamination.ResultsOur results showed that the bladder and skin with 54.89 × 10⁻³ mSv/Gy and 46.09 × 10⁻³ mSv/Gy, respectively, absorbed the highest equivalent dose s from photoneutrons, while a lower dose was absorbed by the lung at 3.42 × 10⁻³ mSv/Gy. The large intestine and bladder absorbed 55.00 × 10⁻³ mSv/Gy and 49.08 × 10⁻³, respectively, which were the highest equivalent dose s due to photons. The brain absorbed the lowest out-of-field dose, at 1.87 × 10⁻³ mSv/Gy.ConclusionsWe concluded that secondary neutron portion was higher than other radiation. Then, we recommended more attention to neutrons in the radiation protection in linac based high energy radiotherapy.     

Radiation exposure to infants undergoing voiding cystourethrography: The importance of the digital imaging technology

PurposeTo determine the radiation burden to infants undergoing voiding cystourethrography (VCUG) in a single institution and investigate the effect of shifting from analogue to digital imaging that allowed the use of a radiography-free examination protocol.MethodsAnthropometric and exposure data were prospectively collected for 35 consecutive infants undergoing VCUG on a digital system with a standardized examination protocol not including radiographs. Thermoluminescent dosimeters were used to determine entrance-skin dose. Monte Carlo simulations and patient-specific anthropomorphic phantoms were employed to determine organ/tissue doses and effective dose (ED). The associated theoretical risk of radiation-induced cancer was determined and compared to the nominal risk of cancer induction. The radiation burden from VCUG on a modern digital system with a contemporary examination protocol was compared to corresponding data reported previously for an analogue system in the same institution.ResultsThe median ED from VCUG was found 47 μSv. The associated total life attributable risk of radiation-induced cancer was found 10x10^-6 and 13x10^-6 for boys and girls, respectively. VCUG was found to increase the nominal risk of cancer by a factor of 1.000025 in boys and 1.000034 in girls. Shifting from analogue to digital imaging system resulted in 89% reduction of the radiation burden from VCUG.ConclusionThe theoretical radiation risks for infants undergoing VCUG using a modern digital imaging system and a radiography-free protocol were found to be minor. The transition from analogue to digital equipment resulted in considerable reduction of the radiation burden from VCUG.     

Kilovoltage beam model for flat panel imaging system with bow-tie filter for scatter prediction and correction

PurposeKilovoltage flat-panel imaging systems are used for cone-beam Computed Tomography (CBCT) and digital Tomosynthesis (DTS). Hereby, the presence of scatter and relatively large dose from imaging are challenging factors. In this study a phenomenological beam model was developed to characterize imager response to imaging beams with a bow-tie filter (Varian OBI system).Materials and methodThe kilovoltage beam model was based on dose ratio formalism and thus was using standard concepts of megavoltage dose calculation such as scatter factors, tissue maximum ratio and off-axis ratio. Primary and scatter (head and phantom scatter) were modeled with three Gaussian kernels. Parameters were based on measured transmission images for slabs of solid water of different total thickness and various jaw settings.ResultsThe beam model was used to evaluate contributions from primary, secondary and tertiary contributions for different geometrical objects such as cylinders and step-like phantoms. Theoretical predictions of radiographs using the model for known objects are consistent with the measurements.ConclusionSecondary and tertiary contributions were interpreted as scatter and can be subtracted from CBCT projections based on the analytical model. Therefore our model can provide a basis for improvement of image quality (less artifacts due to scatter, better contrast and resolution) in CBCT reconstruction.     

Occupational exposure in a PET/CT facility using two different automatic infusion systems

PurposeThe aim of this study was to measure the occupational exposure using active personal dosimeters (APD) in the PET/CT department at different stages of the operation chain i.e. radiopharmaceutical arrival, activity preparation, dispensing, injection, patient positioning, discharge and compare the radiation exposure doses received using two automatic injection/infusion systems. This paper also reflects optimization processes that were performed to reduce occupational exposure.MethodsMeasured APD data were analysed for medical physicists, radiology technologists and administrative staff from 2014 till 2018. For dispensing and injecting ¹⁸F-FDG, the automatic infusion/injection system IRIDE (Comecer, Italy) or the automatic fractionator ALTHEA (Comecer, Italy) with wireless injection system WIS (Comecer, Italy) were used. Radiation exposure optimization methods were applied during the data collection period (installation of the transport port, patient management, APD alarm threshold and etc.).ResultsRadiology technologists who perform injection procedures, regardless of the automatic infusion system, received the highest radiation exposure dose. The average doses to the radiology technologists per one study were 1.72 ± 0.33 μSv and 1.16 ± 0.11 μSv with ALTHEA/WIS and IRIDE system, respectively. The average dose for accompanying the patient to the PET/CT scanner and scan procedure was 0.52 ± 0.07 μSv. For the medical physicists, the average dose was 0.29 ± 0.09 µSv. The measured dose for administrative staff was 0.30 ± 0.15 μSv.ConclusionsOccupational exposure can be effectively optimized by different means including staff monitoring with APD, implementation of radiation safety culture and the usage of automatic infusion systems.